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Related Concept Videos

Attention-Deficit/Hyperactivity Disorder01:30

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Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by persistent inattention, hyperactivity, and impulsivity. It affects approximately 5-8% of children globally, with around 60-70% of cases persisting into adulthood. ADHD has significant implications for educational attainment, social interactions, and occupational success.
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Identifying Factors that Increase False-Positive Rates on Embedded Performance Validity Testing in ADHD Evaluations.

John-Christopher A Finley1, Logan M Tufty2,3, Steven A Abalos3

  • 1Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA.

Archives of Clinical Neuropsychology : the Official Journal of the National Academy of Neuropsychologists
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Embedded performance validity indicators (EVIs) can have high false-positive rates (FPRs) in attention-deficit/hyperactivity disorder (ADHD) evaluations. Aggregating EVIs and avoiding those without demographic adjustments, especially for race, can reduce ADHD assessment inaccuracies.

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ADHDAssessmentAttentionForensic neuropsychologyMalingering/symptom validity testing

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Area of Science:

  • Neuropsychology
  • Clinical Psychology
  • Psychometrics

Background:

  • Embedded performance validity indicators (EVIs) are crucial for accurate attention-deficit/hyperactivity disorder (ADHD) assessments.
  • Certain EVIs exhibit higher false-positive rates (FPRs) in ADHD evaluations, potentially leading to misdiagnosis.
  • Understanding the factors contributing to high FPRs is essential for refining assessment protocols.

Purpose of the Study:

  • To investigate the relationship between FPRs and 15 EVIs from six cognitive tests in adults with ADHD.
  • To identify specific EVIs that contribute to elevated FPRs in this population.
  • To determine the impact of aggregating EVIs on overall FPRs.

Main Methods:

  • Analysis of data from 517 adult ADHD referrals with valid neurocognitive test performance.
  • Calculation of FPRs based on established EVI cutoffs with ≥0.90 specificity.
  • Comparison of FPRs for individual and aggregated EVIs, considering various test characteristics.

Main Results:

  • Two cognitive tests yielded EVIs with >10% FPRs independently; aggregation reduced the total FPR to 8.1%.
  • Sustained attention test EVIs showed FPRs around 11%.
  • EVIs lacking demographic adjustments (e.g., for race) had higher FPRs (~14%).

Conclusions:

  • Practitioners should select EVIs carefully, considering the source test and the number of indicators used.
  • Aggregating EVIs can help minimize FPRs in ADHD evaluations.
  • Development of more nuanced validity testing approaches is necessary for improved ADHD assessments.