Utility of the Structured Interview of Reported Symptoms (SIRS-2) in detecting feigned adult attention-deficit/hyperactivity disorder

Abstract

Introduction: The Structured Interview of Reported Symptoms (SIRS-2) utilizes various strategies in the detection of simulated psychiatric disorders. The present study aimed to examine which of these strategies proves most useful in uncovering feigned attention deficit hyperactivity disorder (ADHD) in adulthood. Method: One-hundred seventy-one individuals instructed to feign ADHD were compared to 46 genuine patients with ADHD as well as 99 neurotypical controls in their reports provided on the SIRS-2. Results: Responses provided by simulators resembled those of genuine patients with ADHD on all SIRS-2 subscales with the exception of a supplementary scale tapping Overly Specified symptom reports, where a moderate effect emerged (d = 0.88). Classification accuracy remained low, with particularly poor sensitivity (sensitivity = 19.30%). Sensitivity was higher when the decision rules postulated in the first edition SIRS were applied instead of its successor's decision model, yet this increase in sensitivity came at the price of unacceptably low specificity. Conclusion: The present results call for a disorder-specific instrument for the detection of simulated ADHD and offer starting points for the development of such a tool.

Non-credible symptom report in the clinical evaluation of adult ADHD: development and initial validation of a new validity index embedded in the Conners’ adult ADHD rating scales

“…Adaptation of detection strategies previously described by Rogers (2018) may be useful additions or alternatives to the reliance on erroneous stereotypes, according to the authors. They suggest that inquiries into symptom combinations, which are rarely reported jointly by genuine patients, may present another basis on which to formulate ADHD-specific items for validity tests; a recommendation supported by findings published recently (Becke et al 2019).…”

“…Diagnoses of ADHD were secured through a comprehensive clinical work-up and confirmed by at least two experienced clinicians. The diagnostic process included a psychiatric interview, which enquired both past and present symptoms of ADHD in accordance with the DSM criteria (American Psychiatric Association 2013; Barkley and Murphy 1998). Additionally, participants scored above the recommended cut-offs on two standardized self-report rating scales, which tapped symptoms of ADHD across the same time span (WURS-K and ASR) (Adler et al 2006;Kessler et al 2005a, b;Ward et al 1993).…”

Joint Consideration of Validity Indicators Embedded in Conners’ Adult ADHD Rating Scales (CAARS)

“…While the CII, EI, and Ds-ADHD utilize items drawn from existing instruments, the INF and the ACI each contain disorder-specific items written specifically for the purpose of detecting noncredible self-report in the clinical assessment of ADHD. The ACI's items were developed as ADHD-specific adaptations of detection strategies described by Rogers (Becke et al, 2019;Rogers, 2018). Initial validation studies showed comparable classification accuracy for the Ds-ADHD and INF, whereas the performance of the ACI was comparable to the CII's classification accuracy.…”