Regional Assessment and Resource Centre, Queens University, Kingston, Canada.
Appl Neuropsychol Child. 2020 Oct-Dec;9(4):314-322. doi: 10.1080/21622965.2020.1750115. Epub 2020 Apr 17.
Measuring performance validity in Attention Deficit Hyperactivity Disorder (ADHD) assessments is essential, with multiple studies identifying how easily young adults can feign symptoms on self-report measures. Few methods, however, exist to identify such feigning when it occurs. While some clinicians include computerized tests of attention (e.g., Test of Variables of Attention [TOVA]) when assessing for possible ADHD, it is unclear how symptom exaggerators perform, and whether the TOVA Symptom Exaggeration Index (SEI) adequately identifies performance-based exaggeration when it occurs. Using archival data from a university-based ADHD screening clinic we investigated the performance of 245 late adolescents/emerging adults. Three groups were created: (1) Good effort but not ADHD ( = 183); (2) Good effort and diagnosed ADHD ( = 13); and (3) suspect effort ( = 49), based on final diagnosis and performance on an existing validity measure. Results showed clearly that those with suspect effort performed more poorly than the other two groups on all but second-half commission errors on the TOVA. Similar to Nicholls et al., the suspect effort group showed significantly subaverage (i.e., greater than two standard deviations below the mean) scores in Omission errors; in this replication, however, this was true for both the first and second half of the test. Response time variability was similarly exaggerated, with the suspect effort group again returning extreme scores in both halves of the test. Suspect effort students were indistinguishable from those with genuine ADHD when looking solely at self-reported symptoms; however, embedded symptom validity measures on an ADHD rating scale discriminated well between groups. Overall, results support the use of the TOVA as an embedded performance validity measure in the assessment of late adolescents/emerging adults and support previous findings that symptom report alone cannot distinguish credible from noncredible ADHD presentation.
在注意力缺陷多动障碍（ADHD）评估中，测量表现效度至关重要，多项研究已经证实，年轻人很容易在自我报告的测量中表现出症状。然而，当这种情况发生时，很少有方法可以识别这种伪装。虽然一些临床医生在评估可能的 ADHD 时会包括计算机化的注意力测试（例如，注意力变量测试[TOVA]），但尚不清楚症状夸大者的表现如何，以及 TOVA 症状夸大指数（SEI）是否能够在出现时充分识别基于表现的夸大。我们使用来自大学 ADHD 筛查诊所的档案数据，调查了 245 名青少年/成年早期患者的表现。根据最终诊断和现有有效性测量的表现，创建了三个组：（1）有良好的努力但没有 ADHD（ = 183）；（2）有良好的努力和被诊断为 ADHD（ = 13）；（3）可疑的努力（ = 49）。结果表明，在 TOVA 上，除了第二半的错误反应外，所有其他方面，可疑努力组的表现明显劣于其他两组。与 Nicholls 等人的研究结果相似，可疑努力组在遗漏错误上的得分明显低于平均水平（即，比平均值低两个标准差以上）；然而，在这次复制中，这是真实的，无论是在测试的前半部分还是后半部分。反应时间的可变性也被夸大了，可疑努力组在测试的前半部分和后半部分都返回了极端分数。仅从自我报告的症状来看，可疑努力的学生与真正的 ADHD 患者无法区分；然而，ADHD 评定量表中的嵌入式症状有效性测量可以很好地区分两组。总体而言，结果支持将 TOVA 用作评估青少年/成年早期患者的嵌入式表现有效性测量，并且支持之前的研究结果，即仅凭症状报告无法区分可信和不可信的 ADHD 表现。
