Objective: The use of continuous performance tests (CPTs) for assessing ADHD related cognitive impairment is ubiquitous. Novel psychophysiological measures may enhance the data that is derived from CPTs and thereby improve clinical decision-making regarding diagnosis and treatment. As part of the current study, we integrated an eye tracker with the MOXO-dCPT and assessed the utility of eye movement measures to differentiate ADHD patients and healthy controls. Method: Adult ADHD patients and gender/age-matched healthy controls performed the MOXO-dCPT while their eye movements were monitored ( n = 33 per group). Results: ADHD patients spent significantly more time gazing at irrelevant regions, both on the screen and outside of it, than healthy controls. The eye movement measures showed adequate ability to classify ADHD patients. Moreover, a scale that combined eye movement measures enhanced group prediction, compared to the sole use of conventional MOXO-dCPT indices. Conclusions: Integrating an eye tracker with CPTs is a feasible way of enhancing diagnostic precision and shows initial promise for clarifying the cognitive profile of ADHD patients. Pending replication, these findings point toward a promising path for the evolution of existing CPTs.

Objective: The objective of this study was to assess the MOXO-d-CPT utility in detecting feigned ADHD and establish cutoffs with adequate specificity and sensitivity. Method: The study had two phases. First, using a prospective design, healthy adults who simulated ADHD were compared with healthy controls and ADHD patients who performed the tasks to the best of their ability ( n = 47 per group). Participants performed the MOXO-d-CPT and an established performance validity test (PVT). Second, the MOXO-d-CPT classification accuracy, employed in Phase 1, was retrospectively compared with archival data of 47 ADHD patients and age-matched healthy controls. Results: Simulators performed significantly worse on all MOXO-d-CPT indices than healthy controls and ADHD patients. Three MOXO-d-CPT indices (attention, hyperactivity, impulsivity) and a scale combining these indices showed adequate discriminative capacity. Conclusion: The MOXO-d-CPT showed promise for the detection of feigned ADHD and, pending replication, can be employed for this aim in clinical practice and ADHD research.

Response time (RT) is a less obvious outcome measure than conventional accuracy measures used in performance validity tests (PVTs). It is also under less conscious control and is affected by cognitive processes associated with deception. Studies that assessed the utility of RT for the detection of feigned cognitive impairment are however numbered. Moreover, RT variability was not assessed in a clinically used PVT. In the current study, we assessed the utility of RT measures for the detection of feigned cognitive impairment in the Word Memory Test (WMT). Healthy participants (N = 90) were randomly assigned to a simulation or control condition and their per-item RTs were recorded while they performed the WMT's immediate recognition (IR) subtest. Simulators had longer mean RTs and larger RT variance than controls. Combining RT measures and the IR-subtest's accuracy score enabled a highly accurate detection of simulators. Moreover, the combined scale demonstrated incremental value (though slight) in predicting group membership beyond the use of the accuracy score as the sole PVT measure. The findings tentatively point toward the usefulness of RT measures to enhance the detection of feigned cognitive impairment. Further studies are needed, however, in order to explore the utility of these measures in clinical settings.

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Eye movements showed initial promise for the detection of deception and may be harder to consciously manipulate than conventional accuracy measures. Therefore, we integrated an eye-tracker with the Word Memory Test (WMT) and tested its usefulness for the detection of feigned cognitive impairment. As part of the study, simulators (n = 44) and honest controls (n = 41) performed WMT's immediate-recognition (IR) subtest while their eye movements were recorded. In comparison to the control group, simulators spent less time gazing at relevant stimuli, spent more time gazing at irrelevant stimuli, and had a lower saccade rate. Group classification using a scale that combined the eye movement measures and the WMT's accuracy measure showed tentative promise (i.e., it enhanced classification compared to the use of the accuracy measure as the sole predictor of group membership). Overall, integration of an eye-tracker with the WMT was found to be feasible and the eye movement measures showed initial promise for the detection of feigned cognitive impairment. Moreover, eye movement measures proved useful in enhancing our understanding of strategies utilized by the simulators and the cognitive processes that affect their behavior. While the findings are clearly preliminary, we hope that they will encourage further research of these promising psychophysiological measures.