Assessing performance validity during attention-deficit/hyperactivity disorder evaluations: Cross-validation of...

Area of Science:

• Neuropsychology
• Clinical Psychology
• Psychometrics

Background:

• Performance validity tests (PVTs) are crucial in neuropsychological evaluations.
• Existing memory-based PVTs may be less effective for attention-deficit/hyperactivity disorder (ADHD) assessment.
• Non-memory-based PVTs derived from processing speed and executive functions are needed.

Purpose of the Study:

• To cross-validate non-memory-based PVTs (Verbal Fluency, Trail Making Test) against memory-based measures (Rey 15-Item Test) in adult ADHD evaluations.
• To determine the utility of Verbal Fluency (VF) and Trail Making Test (TMT) as embedded PVTs for adult ADHD.
• To compare the efficacy of Rey 15-Item Test (RFIT) Recall versus Recall/Recognition for adult ADHD evaluations.

Main Methods:

• A consecutive case series of 416 adults undergoing outpatient neuropsychological evaluation for ADHD.
• Four non-memory-based validity indices from VF and TMT were analyzed.
• Cross-validation was performed using Rey 15-Item Test (RFIT) Recall and Recall/Recognition as criterion measures.
• Validity classifications were based on failure rates across five independent criterion PVTs.

Main Results:

• TMT-A and TMT-B T-scores demonstrated acceptable classification accuracy (AUCs = .707-.723) with 29%-36% sensitivity and ≥89% specificity.
• RFIT Recall/Recognition showed similar sensitivity (42%) and specificity (90%) to TMT-B but with lower classification accuracy.
• VF and TMT embedded PVTs showed comparable sensitivity and specificity to other clinical populations, but required adjusted cut-scores.

Conclusions:

• Non-memory-based PVTs, specifically TMT measures, are valuable for assessing performance validity in adult ADHD.
• RFIT Recall/Recognition is a more effective PVT than standard RFIT Recall for adult ADHD evaluations.
• Adjusted cut-scores are necessary for optimal use of VF and TMT embedded PVTs in adult ADHD assessments.