Factor structure and clinical correlates of the 61-item Wender Utah Rating Scale (WURS).

The objective of this study was to assess the factor structure and clinical correlates of a 61-item version of the Wender Utah Rating Scale (WURS), a self-report retrospective measure of childhood problems, experiences, and behavior used in ADHD assessment. Given the currently mostly widely used form of the WURS was derived via a criterion-keyed approach, the study aimed to use latent variable modeling of the 61-item WURS to potentially identify more and more homogeneous set of items reflecting current conceptualizations of ADHD symptoms. Exploratory structural equation modeling was used to generate factor scores which were then correlated with neuropsychological measures of intelligence and executive attention as well as a broad measure of personality and emotional functioning. Support for a modified five-factor model was found: ADHD, disruptive mood and behavior, negative affectivity, social confidence, and academic problems. The ADHD factor differed somewhat from the traditional 25-item WURS short form largely through weaker associations with several measures of personality and psychopathology. This study identified a factor more aligned with DSM-5 conceptualization of ADHD as well as measures of other types of childhood characteristics and symptoms which may prove useful for both research and clinical practice.

Utility of the Personality Assessment Inventory for Detecting Malingered ADHD in College Students.

OBJECTIVE: The purpose of the current study is to examine the utility of the Personality Assessment Inventory (PAI) for detecting feigned ADHD in college students. METHOD: A sample of 238 undergraduate students was recruited and asked to simulate ADHD (ADHD simulators) or respond honestly (controls) on the PAI. Archival data (n = 541) from individuals diagnosed with clinical ADHD, no diagnosis, learning disorder, mood/anxiety, comorbid ADHD-mood/anxiety, or suspect effort were used. RESULTS: Few individuals scored above the cutoffs on PAI validity scales. When alternative cutoff scores were examined, cutoffs of ≥77 on the Negative Impression Management (NIM) scale, ≥3 on the Malingering Index (MAL), and ≥1 on the Rogers Discriminant Function (RDF) yielded excellent specificity in all groups and sensitivities of .33, .30, and .20, respectively. CONCLUSION: Individuals who were asked to simulate ADHD easily manipulate the PAI; however, alternative cutoff scores proposed for PAI validity indices may improve the detection of feigned ADHD symptoms.

"Why is this so hard?" A review of detection of malingered ADHD in college students.

OBJECTIVE: The purpose of this article is to review studies that have investigated malingered ADHD in college students and offer recommendations for assessing effort in clinical evaluations of ADHD in college students. METHOD: This article identified and summarized nineteen peer-reviewed, empirical studies published between 2002 and 2011 that investigated malingered ADHD in college students. RESULTS: Few of the measures examined proved useful for detecting malingered ADHD. Most self-report questionnaires were not sensitive to malingering. While there is some variability in the usefulness of neuropsychological test failure, profiles between malingerers and individuals with ADHD are too similar to confidently detect malingered ADHD. Failure of three or more symptom validity tests proved most useful at detecting malingered ADHD. CONCLUSION: This review suggests that there is substantial need for measures designed specifically for detecting malingered ADHD. Simulators are able to produce plausible profiles on most tools used to diagnose ADHD.

College students' conceptualizations of deficits involved in mild intellectual disability.

Precedential rulings in recent capital murder trials may, in some cases, leave it up to a jury to determine whether or not an individual meets criteria for an intellectual disability (ID) and should be spared from the death penalty. Despite the potential for misconceptions about ID to bias decisions, few empirical studies have examined the public's conceptualizations of individuals with ID. This study sought to examine 890 college students' conceptualizations of the deficits involved in mild ID. Students were asked to respond to two online surveys about the cognitive and adaptive behavior deficits that people with mild ID may experience. While most students were correct about basic facts, such as ID is not contagious and not curable, there was no clear consensus regarding beliefs about individuals with ID getting married, having children, or engaging in other mainstream activities of adult living. Students' responses are examined in light of results of studies that identify and examine bona fide deficits and areas of successful mainstreaming among persons with ID. Implications of misconceptions are discussed.

Evaluation of embedded malingering indices in a non-litigating clinical sample using control, clinical, and derived groups.

Although recent findings have indicated that a portion of college students presenting for psychoeducational evaluations fail validity measures, methods for determining the validity of cognitive test results in psychoeducational evaluations remain under-studied. In light of this, data are needed to evaluate utility of validity indices in this population and to provide base rates for students meeting research criteria for malingering and to report the relationship between testing performance and the level of external incentive. The authors utilized archival data from: (i) a university psychological clinic (n = 986) and (ii) a university control sample (n = 182). Empirically supported embedded validity indices were utilized to identify retrospectively suspected malingering patients. Group performance, according to invalidity and the level of incentive seeking, was evaluated through a series of multivariate mean comparisons. The current study supports classifying patients according to the level of incentive seeking when evaluating neurocognitive performance and feigned/exaggerated deficits.

Development and validation of the stanford binet-5 rarely missed items-nonverbal index for the detection of malingered mental retardation.

Current research suggests that effort indices designed for the detection of malingered neurocognitive functioning do not have adequate sensitivity or specificity for use in cases where malingered mental retardation (MR) is the issue. Therefore, development and validation of reliable, objective measures for the detection of malingered MR have become imperative for both forensic and disability cases in recent years. The purpose of this study was to develop and validate an embedded malingering index for the Stanford Binet Intelligence Scales, Fifth Edition. Data from individuals in the SB5 standardization sample, who had intellectual deficits in the MR range, were used. Items that were rarely missed by the MR sample were pooled and validated using a sample of 54 college students asked to feign MR. Nonverbal items that were missed significantly more frequently by the malingering "analog MR sample" were retained and composed the Stanford Binet Rarely Missed Items-Nonverbal (SBRMI-NV) index. When only individuals who successfully malingered MR (FSIQ < 71) were included, sensitivity of 0.88 and specificity of 1.00 were obtained. Results indicate that although the SBRMI-NV needs further validation, it shows great promise in the detection of malingered MR.

The relationships of working memory, secondary memory, and general fluid intelligence: working memory is special.

Recent efforts have been made to elucidate the commonly observed link between working memory and reasoning ability. The results have been inconsistent, with some work suggesting that the emphasis placed on retrieval from secondary memory by working memory tests is the driving force behind this association (Mogle, Lovett, Stawski, & Sliwinski, 2008), whereas other research suggests retrieval from secondary memory is only partly responsible for the observed link between working memory and reasoning (Unsworth & Engle, 2006, 2007). In the present study, we investigated the relationship between processing speed, working memory, secondary memory, primary memory, and fluid intelligence. Although our findings show that all constructs are significantly correlated with fluid intelligence, working memory-but not secondary memory-accounts for significant unique variance in fluid intelligence. Our data support predictions made by Unsworth and Engle (2006, 2007) and suggest that the combined need for maintenance and retrieval processes present in working memory tests makes them special in their prediction of higher order cognition.

Assessment and rehabilitation of acquired visuospatial and proprioceptive deficits associated with visuospatial neglect.

Visuoperceptual disruptions are among the most common, and most debilitating, of the aftereffects following stroke or head injury. Visuospatial neglect in particular, which frequently occurs as a result of insult to the right cerebral hemisphere, has a variety of implications for patient welfare and outcome. And while there exists a great deal of useful information in the area of visual neglect, it is spread out amongst near-countless journal articles, book chapters, and workshop summaries. Thus, it is the purpose of this paper to provide an overview of various topics relating to visuospatial disturbances. Areas covered include theories on sequelae and neuropathology, common direct and indirect complications, rates and types of recovery, past and current trends in assessment and rehabilitation techniques, and thoughts on directions for future research.

The vulnerability to coaching across measures of effort.

Neuropsychologists are increasingly called upon to conduct evaluations with individuals involved in personal injury litigation. While the inclusion of measures of effort within a test battery may help clinicians determine whether a client has put forth full effort, attorney coaching may allow dishonest clients to circumvent these efforts. The purpose of this study was to determine the degree to which frequently used measures of effort are susceptible to coaching, as well as to explore and classify strategies undertaken by coached malingering simulators. Overall, coached simulators performed significantly better on 7 of 14 measured variables. Potential improvements in the external validity of the simulation design were also explored.

A Comparison of Laboratory and Clinical Working Memory Tests and Their Prediction of Fluid Intelligence.

The working memory (WM) construct is conceptualized similarly across domains of psychology, yet the methods used to measure WM function vary widely. The present study examined the relationship between WM measures used in the laboratory and those used in applied settings. A large sample of undergraduates completed three laboratory-based WM measures (operation span, listening span, and n-back), as well as the WM subtests from the Wechsler Adult Intelligence Scale-III and the Wechsler Memory Scale-III. Performance on all of the WM subtests of the clinical batteries shared positive correlations with the lab measures; however, the Arithmetic and Spatial Span subtests shared lower correlations than the other WM tests. Factor analyses revealed that a factor comprising scores from the three lab WM measures and the clinical subtest, Letter-Number Sequencing (LNS), provided the best measurement of WM. Additionally, a latent variable approach was taken using fluid intelligence as a criterion construct to further discriminate between the WM tests. The results revealed that the lab measures, along with the LNS task, were the best predictors of fluid abilities.

The Wender Utah Rating Scale: Adult ADHD diagnostic tool or personality index?

OBJECTIVE: The Wender Utah Rating Scale (WURS) is used to retroactively assess ADHD symptoms. This study sought to determine whether the WURS actually functions as an index of dysfunctional personality traits. METHOD: Five hundred twenty-two adult participants completed the WURS and at least one of the following measures: Wechsler Adult Intelligence Scale-III (WAIS-III), Trails Making Test (Forms A and B), Conners' Continuous Performance Test, d2 Test of Attention, and the Personality Assessment Inventory (PAI). RESULTS: The WURS correlated significantly with all PAI clinical and treatment scales; however, of the neuropsychological measures, only the CPT significantly correlated with the WURS score. Multiple regression analyses revealed a significant model that included clinical and treatment scales from the PAI as well as working memory and processing speed indexes from the WAIS-III that accounted for 39% of the variance in WURS scores. CONCLUSION: Performance on the WURS was more related to dysfunctional personality traits than to actual attentional performance in this young adult sample. (J. of Att. Dis. 2009; 13(1) 87-94).

The relation of depression and anxiety to measures of attention in young adults seeking psychoeducational evaluation.

The relation between mood and attentional functioning in young adults seeking psychoeducational evaluation has not been previously reported. This study examined the relation of self-reported depression and anxiety on attentional abilities among 161 young adults referred for psychoeducational evaluation. Depression and anxiety were measured with the Beck Depression Inventory-II and the State-Trait Anxiety Inventory, respectively. Attentional functioning was assessed using the Trail Making Test, the d2 Test of Attention, the Conners' Continuous Performance Test, and the WAIS-III Working Memory and Processing Speed Indices. The unique variance accounted for by depression or anxiety was minimal (typically <1.5%); these null results were confirmed by diagnostic subgroup analyses and also after examining the interaction between depression and anxiety. These results suggest that performance on measures of attention within samples of young adults seeking psychoeducational evaluation is minimally related to self-reported depression and anxiety.

The conviction of delusional beliefs scale: reliability and validity.

This study reports on the development of a new measure of delusional belief conviction, the Conviction of Delusional Beliefs Scale (CDBS). Most of the current scales in use assess belief conviction with a single item and primarily reflect the cognitive aspects of conviction. The CDBS represents an improvement over existing scales in that it contains a larger number of test items that can be subjected to psychometric examination. In addition, the CDBS also broadens the concept of belief conviction by incorporating cognitive, emotional, and behavioral items. In the present study, fifty participants with delusions completed the CDBS along with measures of delusional ideation, psychiatric symptomatology, insight, and reading ability. The CDBS showed very good levels of internal consistency and test-retest stability over a six-week period. All of the CDBS items loaded highly on a unitary factor of belief conviction. The CDBS positively correlated with four measures of belief conviction thereby reflecting the convergent validity of the scale. The CDBS was unrelated to other dimensions of delusional ideation, psychiatric symptomatology, insight, and reading ability, which supported the discriminant validity of the scale. The CDBS appears to be a reliable and valid measure of delusional belief conviction that could be used in clinical and research settings.

Information processing following mild head injury.

Research has shown that individuals who have sustained mild head injury demonstrate a slowed speed of processing that is exacerbated by fatigue/stress. We administered the Paced Auditory Serial Addition Test (PASAT) at the beginning and at the end of a 4-h experimental protocol to determine whether fatigue or a stressor would result in poorer scores for individuals who had previously sustained mild head injury. A significant improvement was found between the first and second administration for both head-injured and control subjects, but difference scores revealed a significant between-groups difference for the first of the four trials, with the head-injured participants performing worse than controls. Apparently, head-injured participants were slower to develop, as well as slower to regain, a means of efficiently processing rapidly presented information.

Complex partial seizure symptom endorsement in individuals with a history of head injury.

Research has shown that subjects at risk for cerebral dysfunction endorse more complex partial seizure symptoms than low risk controls. It has been suggested that seizure activity be regarded as occurring on a continuum of neurobehavioral dysfunction, rather than as a discrete syndrome. The present study assessed seizure symptom endorsement in individuals reporting a positive history of head injury. There were three groups of college student participants: head injury with loss of consciousness (LOC; n=31); head injury followed by a dazed period or alteration of consciousness (AOC; n=36); non-injured controls (NHI; n=60). In general, the LOC group reported greater frequency of symptomatology and a greater number of clinically significant symptoms (above the 90th percentile) than the NHI group, and a greater number of clinically significant symptoms than the AOC group. The AOC group did not differ from the NHI group on either variable. These results lend credence to the concept of a continuum representing an epilepsy spectrum disorder.

Are we honestly studying malingering? A profile and comparison of simulated and suspected malingerers.

Malingering research typically uses analog simulation design or differential prevalence design among "real" patients. Both have been criticized for methodological limitations in external and internal validity, respectively. Samples of simulated malingerers were compared to suspected malingerers to examine generalizability of analog findings. Overall results support the use of simulation designs. Furthermore, it was demonstrated that stringent selection of suspected malingerers maintains internal validity of the differential prevalence design. A second focus, to determine if demographic matching of simulated malingerers is necessary, showed that matching on age and race is not necessary.

Utility of the UFOV test with mild traumatic brain injury.

Driving skills are socially important, easily disrupted by brain injury, and potentially risky and difficult to evaluate afterward. The Useful Field of View test has seen successful use with severe traumatic brain injury (TBI), but its use with mild TBI victims has not been examined. This study shows its ecological insensitivity among persons with mild TBI or no impairment and suggests its use be limited to more severely impaired persons.

Detecting simulated memory impairment: further validation of the Word Completion Memory Test (WCMT).

The Word Completion Memory Test (WCMT) was developed to detect sophisticated attempts at simulating memory impairment. The primary purpose of the present study was to provide additional validity and reliability information about the WCMT. Seventy-one participants were recruited for this study: 30 normal volunteers and 11 memory-disordered patients instructed to perform their best, and 30 normal volunteers instructed to fake memory impairment. Normal volunteers were administered five tests of neuropsychological functioning and five tests of simulation to explore the convergent and divergent validity of the WCMT. Two weeks later, these participants completed all 10 measures a second time. Memory-disordered patients were administered the WCMT and two additional simulation measures as part of a comprehensive neuropsychological evaluation. The WCMT successfully discriminated simulators from nonsimulators with an overall classification accuracy of 97% and demonstrated good psychometric properties. In conclusion, the WCMT continues to show promise as a measure of simulated memory impairment.

Informed consent in schizophrenia: the use of cues in the assessment of understanding.

The purpose of this study was to determine if providing cues could facilitate participant understanding for consent form information. Understanding scores were measured in a group of participants diagnosed with schizophrenia and a control group using cued recognition and uncued recall methods. When understanding was measured with uncued methods, persons with schizophrenia showed lower scores compared to the control group. However, when cues were provided, there was no difference between the two groups on understanding scores, and persons with schizophrenia showed normal levels of understanding. The results suggest that cued methods may be a better alternative to measure participant understanding.

Sensation seeking and risk behaviors in young adults with and without a history of head injury.

Research has demonstrated a relation between sensation seeking and risky behavior as well as an association between risky behavior and the occurrence of head injury. This study assessed sensation seeking in young adults with and without a history of head injury by administration of the Sensation Seeking Scale (SSS), the Driver Risk Index (DRI), and the MacAndrews Scale of the Minnesota Multiphasic Personality Inventory (MMPI). There was a significant difference between the groups for the Thrill and Adventure Seeking Subscale of the SSS and the MacAndrews Scale of the MMPI, with head-injured participants scoring higher. Gender differences were seen in both groups for subscales of the SSS, with men scoring higher. Significant correlations were found for head-injured participants between the DRI and the Boredom Susceptiblity Subscale of the SSS, suggesting that as knowledge of risk increased for these participants, so did their preferences for risky behaviors. However, non-head-injured participants indicated a lower interest in risky behaviors as their knowledge of risk increased.