Using Depression and Anxiety Self-report Inventory Cutoffs to Screen for Invalid Psychiatric Symptom Overreporting During Diagnostic Evaluations for Attention-deficit/Hyperactivity Disorder.

OBJECTIVE

This study validated embedded symptom validity tests (SVT) in the Beck Depression (BDI-II) and Beck Anxiety (BAI) Inventories that are sensitive to psychiatric symptom overreporting in an outpatient clinical population referred for attention-deficit/hyperactivity disorder diagnostic evaluation.

METHODS

Cross-sectional data from 623 consecutive neuropsychological referrals were analyzed. The sample comprised young-to-middle-aged community-dwelling adults, was predominantly female (61%), and 44% non-Hispanic white, 25% Hispanic, 16% non-Hispanic black, 10% Asian, and 5% other race/ethnicity.

RESULTS

BDI-II ≥ 26 (33% to 86% sensitivity/90% specificity) and BAI ≥ 16 (38% to 82% sensitivity/90% specificity) were optimal cut-scores for detecting potential symptom overreporting. Scores exceeding the cutoffs on both the BDI-II and BAI SVTs should be counted as a single elevation, because these tests captured redundant aspects of overreporting. However, the BDI-II SVT was the stronger symptom overreporting indicator and should be prioritized as the more accurate test when BDI-II/BAI SVT discrepancies occur.

CONCLUSIONS

BDI-II and BAI embedded SVTs can detect possible symptom overreporting among diagnostically diverse outpatients undergoing attention-deficit/hyperactivity disorder evaluations. These SVTs are not intended to replace well-validated SVTs, but screen for symptom overreporting and identify patients who may require further assessment without incurring additional time, costs, or burden, as they are embedded in brief, routinely administered self-report measures.