Russell D. Pella

Ability of college students to simulate ADHD on objective measures of attention.

Objective: The authors examined the ability of college students to simulate ADHD symptoms on objective and self-report measures and the relationship between knowledge of ADHD and ability to simulate ADHD. Method: Undergraduate students were assigned to a control or a simulated ADHD malingering condition and compared with a clinical AD/HD group. The authors used several clinical attentional measures and symptom validity tests to differentiate experimental groups via a series of multivariate procedures. Results: Simulators successfully feigned ADHD symptoms on a retrospective self-report measure. Moreover, knowledge of ADHD was unrelated to objective attentional measure performance. Overall, participants who simulated ADHD on some objective measures (i.e., specific Wechsler Adult Intelligence Scale—III [WAIS-III] subtests) showed similar performance to the clinical ADHD comparison sample. Conclusion: The implications of these findings highlight the importance of relying on multiple vectors of information, be it objective, observational, self-report, or reports by others, when diagnosing ADHD and assessing factors related to potential secondary gain. (J. of Att. Dis. 2010; 13(4) 325-338)

Can we improve the clinical assessment of working memory? An evaluation of the Wechsler Adult Intelligence Scale–Third Edition using a working memory criterion construct

Working memory is the cognitive ability to hold a discrete amount of information in mind in an accessible state for utilization in mental tasks. This cognitive ability is impaired in many clinical populations typically assessed by clinical neuropsychologists. Recently, there have been a number of theoretical shifts in the way that working memory is conceptualized and assessed in the experimental literature. This study sought to determine to what extent the Wechsler Adult Intelligence Scale–Third Edition (WAIS–III) Working Memory Index (WMI) measures the construct studied in the cognitive working memory literature, whether an improved WMI could be derived from the subtests that comprise the WAIS–III, and what percentage of variance in individual WAIS–III subtests is explained by working memory. It was hypothesized that subtests beyond those currently used to form the WAIS–III WMI would be able to account for a greater percentage of variance in a working memory criterion construct than the current WMI. Multiple regression analyses (n = 180) revealed that the best predictor model of subtests for assessing working memory was composed of the Digit Span, Letter–Number Sequencing, Matrix Reasoning, and Vocabulary. The Arithmetic subtest was not a significant contributor to the model. These results are discussed in the context of how they relate to Unsworth and Engles (2006, 2007) new conceptualization of working memory mechanisms.

A Critical Item Analysis of the QABF: Development of a Short Form Assessment Instrument.

Due to the relative inability of individuals with intellectual disabilities (ID) to provide an accurate and reliable self-report, assessment in this population is more difficult than with individuals in the general population. As a result, assessment procedures must be adjusted to compensate for the relative lack of information that the individual may be able to provide and rely more on the behavioral expression of communication. One method commonly used is the indirect functional assessment that utilizes behavior rating scales developed to gather behavioral data in a short time. One of the few empirically derived and psychometrically sound scales is the Questions About Behavioral Function (QABF), a 25-item questionnaire designed to rate specific behavioral functions and maintaining variables. The purpose of this study was to use both exploratory and confirmatory factor analytic procedures to examine the psychometric properties of the QABF, conduct an item analysis, and determine if a short form version could be developed that is both psychometrically valid and reliable, and clinically useful. Results of the item selection procedure indicated that the original 25 items could be reduced to 15. Evaluation of the 15-item short form showed that the QABF-SF maintained the original five-factor structure of the original form, while maintaining an equivalent degree of reliability and validity. The QABF-SF appears to be a useful tool to aid clinicians in the brief functional assessment of behavior in individuals with ID.

Evaluation of embedded malingering indices in a non-litigating clinical sample using control, clinical, and derived groups

Although recent findings have indicated that a portion of college students presenting for psychoeducational evaluations fail validity measures, methods for determining the validity of cognitive test results in psychoeducational evaluations remain under-studied. In light of this, data are needed to evaluate utility of validity indices in this population and to provide base rates for students meeting research criteria for malingering and to report the relationship between testing performance and the level of external incentive. The authors utilized archival data from: (i) a university psychological clinic (n = 986) and (ii) a university control sample (n = 182). Empirically supported embedded validity indices were utilized to identify retrospectively suspected malingering patients. Group performance, according to invalidity and the level of incentive seeking, was evaluated through a series of multivariate mean comparisons. The current study supports classifying patients according to the level of incentive seeking when evaluating neurocognitive performance and feigned/exaggerated deficits.

Assessment and rehabilitation of acquired visuospatial and proprioceptive deficits associated with visuospatial neglect

Visuoperceptual disruptions are among the most common, and most debilitating, of the aftereffects following stroke or head injury. Visuospatial neglect in particular, which frequently occurs as a result of insult to the right cerebral hemisphere, has a variety of implications for patient welfare and outcome. And while there exists a great deal of useful information in the area of visual neglect, it is spread out amongst near-countless journal articles, book chapters, and workshop summaries. Thus, it is the purpose of this paper to provide an overview of various topics relating to visuospatial disturbances. Areas covered include theories on sequelae and neuropathology, common direct and indirect complications, rates and types of recovery, past and current trends in assessment and rehabilitation techniques, and thoughts on directions for future research.

The use of clozapine among individuals with intellectual disability: A review

Clozapine has been approved in the United States since 1990 for refractory or treatment resistant schizophrenia in the general population. However, as with many other antipsychotic medications, it is being prescribed for reasons other than those indicated. Among individuals with intellectual disabilities, clozapine is increasingly being prescribed to treat behavioral problems, although the empirical evidence for such a practice is lacking. This review was undertaken as an attempt to summarize the available studies regarding the use of clozapine for behavioral purposes among individuals with intellectual disabilities. Findings of our review suggest that the effectiveness of clozapine in targeting challenging behaviors among individuals with intellectual disabilities is relatively inconclusive at present. We discuss reasons why these limitations exist and offer some solutions to help alleviate these limitations.

The Vulnerability to Coaching across Measures of Effort

Neuropsychologists are increasingly called upon to conduct evaluations with individuals involved in personal injury litigation. While the inclusion of measures of effort within a test battery may help clinicians determine whether a client has put forth full effort, attorney coaching may allow dishonest clients to circumvent these efforts. The purpose of this study was to determine the degree to which frequently used measures of effort are susceptible to coaching, as well as to explore and classify strategies undertaken by coached malingering simulators. Overall, coached simulators performed significantly better on 7 of 14 measured variables. Potential improvements in the external validity of the simulation design were also explored.

Utility of the Personality Assessment Inventory for Detecting Malingered ADHD in College Students

Objective: The purpose of the current study is to examine the utility of the Personality Assessment Inventory (PAI) for detecting feigned ADHD in college students. Method: A sample of 238 undergraduate students was recruited and asked to simulate ADHD (ADHD simulators) or respond honestly (controls) on the PAI. Archival data (n = 541) from individuals diagnosed with clinical ADHD, no diagnosis, learning disorder, mood/anxiety, comorbid ADHD-mood/anxiety, or suspect effort were used. Results: Few individuals scored above the cutoffs on PAI validity scales. When alternative cutoff scores were examined, cutoffs of ≥77 on the Negative Impression Management (NIM) scale, ≥3 on the Malingering Index (MAL), and ≥1 on the Rogers Discriminant Function (RDF) yielded excellent specificity in all groups and sensitivities of .33, .30, and .20, respectively. Conclusion: Individuals who were asked to simulate ADHD easily manipulate the PAI; however, alternative cutoff scores proposed for PAI validity indices may improve the detection of feigned ADHD symptoms.

Noncredible performance in mild traumatic brain injury

According to the Centers for Disease Control and Prevention approximately 1.4 million Americans suffer some form of Traumatic Brain Injury (TBI) each year (Centers for Disease Control & Prevention, 1999; Langlois, Rutland-Brown, & Thomas, 2004). Such injuries occur by falling (28%), involvement in motor vehicle accidents (MVA) (20%), being struck by or against objects (including vehicles) (19%), and physical assault (11%) (Langlois et al.). As of the millennium’s closing in the USA, TBI resulted in approximately 50,000 deaths, 235,000 hospitalizations, and 1.1 million emergency room visits per annum. As a result of TBI, at least 5.3 million Americans currently need long-term assistance performing activities of daily living (Thurman, Alverson, Dunn, Guerrero, & Sniezek, 1999), often requiring substantial community, financial, and governmental resources. For instance, estimates of direct medical costs and other indirect costs (e.g., loss of work productivity, etc.) total well over

A Psychometric Evaluation of the STAI-Y, BDI-II, and PAI Using Single and Multifactorial Models in Young Adults Seeking Psychoeducational Evaluation

60 billion in the United States annually (Finkelstein, Corso, & Miller, 2006). Mild TBI (MTBI) accounts for 80% of all TBI cases (Sohlberg & Mateer, 2001) and has also been dubbed the “signature wound of the war on terrorism” in military personnel (Association of the United States Army, 2008). There is a reported high rate of MTBI in Operation Enduring Freedom/Operation Iraqi Freedom veterans, ranging from 12 to 15% (Hoge et al., 2008; Schneiderman, Braver, & Kang, 2008). However, the number of individuals who suffer a MTBI and fail to present to an emergency medical department or do not identify themselves on the battlefield remains unknown and understudied.