Objective To determine if individuals referred for Attention Deficit/ Hyperactivity Disorder (ADHD) differential diagnosis, who do and do not fail performance validity tests (PVTs) present themselves differently on self-report measures of executive functioning (Behavioral Rating Inventory of Executive Function; BRIEF) and ADHD (Conner’s Adult ADHD Rating Scales; CAARS). Method A convenience sample of 83 adults referred to an outpatient neuropsychology private practice for neuropsychological assessment for ADHD was collected. MANOVA was performed comparing individuals who passed PVTs (Word Memory Test or WAIS-IV Reliable Digit Span) to individuals who failed PVTs on the Behavioral Regulation Index and Metacognitive Index of the BREIF and Inattention/Memory Problems, Hyperactivity/Restlessness, Impulsivity/Emotional Lability, Problems with Self-Concept, DSM-IV Inattentive Symptoms, DSM-IV Hyperactive-Impulsive Symptoms of the CAARS. Results All statistical comparisons were non-significant at the p = < .05. Conclusions Individuals who fail PVTs are indistinguishable from individuals who pass PVTs on the BRIEF and the CAARS. This is consistent with past research suggesting that validity of self-report cannot be inferred from performance validity testing (Van Dyke, Millis, Axelrod, & Hanks, 2013; Bush, et al., 2005). Also, this data highlights the importance of self-report measures containing their own validated measures of symptom validity.

Objective Multiple sclerosis (MS) is an autoimmune demyelinating disease more common in women than men, usually diagnosed between 20-30 years of age. Approximately 50% of individuals with MS develop cognitive dysfunction, with men and progressive MS subtype cases at higher risk (Beatty & Aupperle, 2002). Mr. Doe’s case is unique because he was diagnosed with primary progressive MS at age 56 and demonstrated only mild cognitive dysfunction. Method Mr. Doe presented to his neurologist with complaints of extreme fatigue, slowed processing, and sensory and motor disturbances. He was seen for neuropsychological evaluation one year after diagnosis and was reassessed one year later. He reported worsening mood including passive suicidal ideation since diagnosis. He reported difficulties with work duties (attorney) and household demands due to gradual motor and sensory disturbances, slowed processing speed, fatigue, and mood disturbance. Results Mr. Doe’s initial neuropsychological assessment revealed variability in auditory working memory, weakness in sustained visual attention, and mild deficits in upper extremity fine motor dexterity. Memory, executive functioning, language, and processing speed were all intact unless a motor component was involved (mild decline after one year). His cognitive performances remained generally stable after one year, but depression, anxiety, and hopelessness levels were all significantly worse. Conclusions Although Mr. Doe’s impairments are extremely mild and somewhat unexpected given the primary progressive MS diagnosis, his gender, and age, the affected domains are consistent with the diagnosis. This case demonstrates the importance of understanding base rates for conditions we assess, but also not ruling out lower base rate conditions.