Scores in Self-Report Questionnaires Assessing Adult ADHD Can Be Influenced by Negative Response Bias but Are Unrelated to Performance on Executive Function and Attention Tests

Abstract

Self-report questionnaires are in widespread use in the assessment of adults with suspected attention-deficit and hyperactivity disorder (ADHD). Notwithstanding the high degree of validity, these questionnaires are considered to possess, their stand-alone use in assessment for adult ADHD may result in false-positive diagnoses due to the risk of negative response bias. Most of the self-report questionnaires in typical use are based on the diagnostic systems DSM-5 or ICD-10. From a neuropsychological point of view, however, testing of various executive function abilities and attentional performance is important in the assessment of adult ADHD. The present study (N = 211) found no evidence linking executive function (working memory and inhibitory processes) and attentional performance (processing speed) to the results of a self-report questionnaire, the ADHS-LE. The number of failures on the three symptom or performance validity tests (SVT/PVT) used provided the sole, and significant, explanation for the response behavior reported on the ADHS-LE. Of these three SVT/PVTs (the German version of the Structured Inventory of Malingered Symptomatology, SIMS, the reliable digit span, and the standard deviation of simple reaction time), only the SIMS was found to be a significant predictor variable. In the clinical context of this study, 32.6% of subjects produced at least one invalid SVT/PVT result. The use of a more conservative criterion—failure on at least two of the three SVT/PVTs deemed to be feigning ADHD—reduced the proportion of participants generating invalid values to 5%.

Detecting symptom exaggeration in compensation-seeking individuals, psychotherapy clients, and individuals referred for job assessments: Psychometric features of the French and Dutch versions of the Self-Report Symptom Inventory.

“…Moreover, the SRSI failure rate of 10%–18.2% in psychotherapy clients is consistent with the estimated base rate of 15% for symptom overreporting across all clinical neuropsychological evaluations (Martin & Schroeder, 2020). Using the SIMS, Dandachi-FitzGerald et al (2016) and Bodenburg et al (2022) observed similar rates of symptom validity test failure in clinical patients: 14.1% and 17.6%, respectively. These findings indicate that symptom overreporting occurs in clinical (nonforensic) assessments.…”

Genotype-Environment Interaction in ADHD: Genetic Predisposition Determines the Extent to Which Environmental Influences Explain Variability in the Symptom Dimensions Hyperactivity and Inattention

“…Furthermore, the degree of hyperactivity and inattention was assessed using the two subscales of the SWAN which were part of the test booklet sent to twins and answered by themselves (not their parents or teachers). Although the items were derived from the DSM-IV-TR (American Psychiatric Association 2008 ), research suggests that one needs a more robust assessment (for example a clinical interview and/or neuropsychological assessment) for a more reliable distinction between subjects with and without ADHD (see e.g., Bodenburg et al 2022 ).…”

Assessing the credibility of clinical presentations using performance and symptom validity tests: Current trends and future directions—Part II.

“…In stark contrast to this outdated practice, experts now seem to agree that patient groups cannot be unequivocally considered “bona fide comparison groups” for experimental simulation studies because invalid test results can and do occur outside of the medicolegal/forensic context. For example, in one of the studies included in this special issue, the percentage of SVT failure was as high as 18.1% in a group of individuals assessed prior to psychotherapeutic treatment (Dandachi-FitzGerald et al, 2023), and previous studies have observed similar failure rates in other clinical samples with different SVTs (Bodenburg et al, 2022; Dandachi-FitzGerald et al, 2016; Schroeder & Martin, 2022). Of note, certain SVTs sometimes seem to yield a relatively high number of positive results even in nonclinical contexts (Boskovic et al, 2022; Zahid et al, 2023).…”