ADHD and Anxiety Symptoms: Does Construct or Assessment Type Matter More?

OBJECTIVE: This study examined the relationships between self-reported ADHD symptoms, self-reported anxiety, and continuous performance test (CPT) performance. METHOD: 128 postsecondary students referred for clinical evaluation for possible ADHD and related conditions completed the Conners Adult ADHD Rating Scale, the Behavior Assessment Scale for Children, Third Edition, and either of two CPTs. RESULTS: Multiple regression models found that when self-reported anxiety and CPT performance were used to simultaneously predict self-reported ADHD symptoms, CPT performance was not a significant predictor, whereas self-reported anxiety was. This finding was replicated across two different subsamples that took different CPTs. CONCLUSION: Self-reported anxiety and ADHD symptoms are strongly related, but neither of these variables is significantly related to CPT performance. Implications for clinical practice and future research are discussed.

Under Pressure: Emotional Reactions to Stress of Neurosurgeons and Neurosurgical Trainees.

OBJECTIVE: Neurosurgeons demonstrate some of the highest levels of burnout among surgeons, yet little research has been done to understand the underlying stressors that neurosurgeons and trainees experience and the emotional responses to them. Our goal was to conduct a feasibility study identifying job stressors and emotional responses among neurosurgeons rather than generalize findings across the profession. METHODS: Emphasizing a qualitative approach in this feasibility and descriptive study, we strategically selected a small sample of neurosurgical attendings, residents, and fellows at 2 United States academic neurosurgical departments to ensure an in-depth analysis laying the groundwork for future extensive research. Participants were asked to complete a questionnaire regarding work-related stressors and high- and low-arousal emotional responses to these stressors, as well as a standardized Depression, Anxiety, and Stress Scale. Both quantitative and qualitative analyses evaluating types of stressors and emotional responses reported were assessed based on participant training level. RESULTS: Participants identified 3 main stressors: 1) administrative deficiencies; 2) delivering bad news/saving lives; and 3) work-life balance. A low frequency of negative emotional responses was reported, but those reported were mainly high-arousal emotions. Limited prior training in coping strategies was also reported. We also found that residents, fellows, and faculty surgeons reported about work stressors and coping strategies differently. CONCLUSIONS: The results of our study provide an understanding of neurosurgical professionals' unique emotional landscape, emphasizing the need for reforms in administrative practices, enhanced, healthy coping strategies, and career stage-specific mental health support.

Sluggish Cognitive Tempo (SCT), Comorbid Psychopathology, and Functional Impairment in College Students: The Clinical Utility of SCT Subfactors.

BACKGROUND: Sluggish cognitive tempo (SCT) has been proposed to be either its own distinct disorder or a transdiagnostic process. OBJECTIVE: To examine SCT within ADHD (and its specific presentations) and internalizing disorders and its relationship with functional impairment, particularly when considered from a multidimensional perspective. METHOD: Undergraduate students (N = 2,806) completed self-report scales measuring SCT, ADHD, anxiety, depression, and functional impairment. The SCT scale consisted of three subfactors identified in prior research. RESULTS: Students with internalizing disorders were equally as likely as those with ADHD to report clinically significant SCT, and having multiple other disorders predicted especially high levels of SCT symptoms. Only sleepy/sluggish symptoms incrementally predicted impairment. CONCLUSIONS: These findings provide more support for SCT as a transdiagnostic process than as a distinct disorder. All areas of SCT symptoms are associated with ADHD, anxiety, and depression, but the sleepy/sluggish symptoms may be uniquely associated with problems in everyday living.

What experiences constitute failures? High school students' reflections on their struggles in STEM classes.

Inculcating the capacity to adapt successfully to failures is essential for talent development in science, technology, engineering, and mathematics (STEM) fields. Despite its importance, this capacity to learn from failure is among the least understood processes in the field of talent development. This study aims to investigate how students conceptualize and react to failures and whether there is a correlation between students' conceptualizations of failure, emotional reactions to it, and academic performance. We invited 150 high-achieving high school students to share, interpret, and label their most memorable struggles in their STEM classes. Most of their struggles focused on the learning process itself, such as poor understanding of the subject matter, insufficient motivation or effort, or adopting ineffective learning strategies. Poor performance outcomes, such as poor test scores and bad grades, were not mentioned as frequently as the learning process. Students who labeled their struggle experiences as failures tended to focus more on performance outcomes, whereas students who labeled their struggle experiences as neither failures nor successes focused more on the learning process. Higher-achieving students were also less likely to label their struggles as failures than less-high achievers. Implications for classroom instruction are discussed with a particular focus on talent development in STEM fields.

Objectivity or Advocacy? The Ethics of the Scout Mindset in Psychoeducational Assessment.

Psychologists often act as advocates when conducting diagnostic evaluations, using their reports as a way to assist clients in achieving their goals. At times, this comes at the expense of objectivity. The "soldier" and "scout" mindsets are useful metaphors for biased and unbiased reasoning, respectively, and they apply well to the practice of conducting psychological evaluations. Psychologists face several strong incentives for adopting a soldier mindset, but these can lead to unethical practices. Cultivating a scout mindset of actively open-minded thinking, in which a wide variety of assessment data are obtained, considered fairly and in an evenhanded manner, and presented with appropriate degrees of confidence, is critical for ethical psychological evaluations. There are certain types of advocacy that can coexist with such practices, but any attempts at advocacy must respect objectivity as a higher goal.

Identifying Feigned ADHD in College Students: Comparing the Multidimensional ADHD Rating Scale to Established Validity Measures.

OBJECTIVE: There is increased concern for malingering in ADHD evaluations due to presence of incentives such as accommodations and medications. Although several validity tests are available to classify malingering in non-ADHD populations, there is no test with proven effectiveness to detect feigned ADHD. This study investigated the ability of the MARS Symptom Validity Index 4 (MARS SV-index 4) and two published validity tests (the Word Memory Test [WMT] and Clinical Assessment of Attention Deficit-Adult [CAT-A] Infrequency scale) to detect malingered ADHD. METHOD: The participants consisted of 68 young adults, 34 with ADHD. Participants completed the MARS, CAT-A, and WMT validity measures. RESULTS: The MARS SV index-4 demonstrated higher sensitivity rates for simulated malingering (61.8%) at close to optimal specificity (88.2%) compared to two published tests (which had sensitivity <42% at specificity >90%). CONCLUSION: The MARS shows good ability to detect feigned ADHD and appears to be useful for adult ADHD assessments.

Processing speed and timed academic skills in children with learning problems.

Information processing speed is commonly measured in intelligence and neuropsychological testing, and the scores from speed measures are considered in diagnostic and management recommendations for students with academic learning problems. However, this score usage often depends on assumptions about strong relationships between cognitive speed and the ability to perform actual academic tasks under time pressure. The primary purpose of the present study was to test the strength of these relationships empirically. In the present study, children with prior learning disability diagnoses (146 girls and 301 boys, ages 10-14 years old) completed diagnostic batteries that included measures of cognitive speed as well as timed academic skills. The relationships between the two types of measures were often modest (median r = 0.25), and the gap between processing speed and timed academic scores was typically approximately 1 standard deviation. The pattern of relationships suggested that superficial similarity in stimuli and task demands affected the strength of associations. These results suggest that timed academic skills cannot be reliably estimated based on processing speed scores, and there will often be significant gaps between the two. Therefore, making diagnostic judgments (e.g., learning disability diagnoses) or management recommendations (e.g., for extended time testing accommodations) should be based on more direct measures of relevant academic skills.

Using the Woodcock-Johnson IV tests of cognitive abilities to detect feigned ADHD.

Research has suggested that many young adults can successfully feign ADHD, reporting clinically significant symptom levels and displaying deficits on cognitive tasks when asked to do so. Standalone performance validity tests (PVTs) have shown some success in identifying feigned ADHD, but these tests are rarely used in typical ADHD evaluation batteries. The present study attempted to develop embedded PVT indices from the Woodcock-Johnson IV Tests of Cognitive Abilities (WJ-IV). College students (N = 150) completed a battery including tasks from the WJ-IV, as well as an established standalone PVT and a rating scale measuring ADHD and related symptoms. Thirty of the students had been professionally diagnosed with ADHD; of the remaining 120 students, half were asked to perform honestly and to the best of their ability on the battery, whereas the other half were asked to try to simulate ADHD. Several processing speed and working memory scores from the WJ-IV effectively identified students feigning ADHD, detecting at least 50% of those students at score cutoffs that also maintained specificity of 90% or more, close to the efficiency of the standalone PVT. In addition, students with ADHD diagnoses generally did not show deficits on the WJ-IV. Implications for practice and future research are discussed.

Improving Gifted Talent Development Can Help Solve Multiple Consequential Real-World Problems.

Fully developing the talents of all students is a fundamental goal for personal well-being and development and ultimately for global societal innovation and flourishing. However, in this paper we focus on what we believe is an often neglected and underdeveloped population, that of the gifted. We draw from the cognitive aptitude and gifted education research literatures to make the case that solutions to consequential real-world problems can be greatly enhanced by more fully developing the talents of the intellectually gifted population, which we operationalize in this paper as roughly the top 5% of cognitive talent. Should well-supported high achievers choose to solve them, these problems span health, science, economic growth, and areas unforeseen. We draw from longitudinal research on intellectually precocious students and retrospective research on leaders and innovators in society, showing that mathematical, verbal, and spatial aptitudes are linked to societal innovation. We then discuss two remaining fundamental challenges: the identification of disadvantaged and marginalized groups of students who have traditionally been neglected in selection for gifted programming suited to their current developmental needs, and the building of skills beyond academic ones, specifically in the related areas of open-minded thinking and intellectual humility.

Systematic Review: Educational Accommodations for Children and Adolescents With Attention-Deficit/Hyperactivity Disorder.

OBJECTIVE: Children and adolescents with attention-deficit/hyperactivity disorder (ADHD) often receive instruction and take tests using educational accommodations. This review aims to summarize and integrate the research literature on accommodations for this specific population. METHOD: Electronic databases in medicine (MEDLINE), psychology (PsycINFO), and education (ERIC) were systematically searched (last update January 13, 2020), with inclusion criteria selecting any document with a focus on accommodations in educational settings or on academic tasks for children or adolescents with ADHD. The search yielded 497 unique documents. Additional searches yielded 13 more documents. Of the 510 total potentially useful documents, 68 met criteria for topical relevance and age range, to be discussed in the narrative review. The wide range of document types led to a qualitative synthesis. RESULTS: Accommodations are by far the most common response to ADHD in educational settings, with testing accommodations such as extended time being particularly prevalent. However, most accommodations fail to show evidence of benefits that are specific to students with ADHD, and many of the more common accommodations have few or no experimental studies supporting them. An exception is read-aloud accommodations, which have two randomized experiments finding specific benefits for younger students with ADHD. Students and those who work with them often express ambivalence and dissatisfaction over the accommodations process. CONCLUSION: More empirical research is needed to examine the effects of these extremely common supports. In the absence of supportive evidence, health professionals should be hesitant to recommend accommodations immediately after a diagnosis. Even when such evidence exists, educational accommodations should only be provided along with evidence-based interventions, or after interventions have failed, as suggested by the "life course" model of managing ADHD.

Differential Diagnosis of Sluggish Cognitive Tempo Symptoms in College Students.

Objective: Sluggish cognitive tempo (SCT) refers to a set of symptoms that prior research has found to be related to several different psychological disorders, especially the predominantly inattentive presentation of ADHD. This study collected evidence relevant to the question of whether SCT is a distinct disorder. Method: College students (N = 910) completed measures of SCT, ADHD, depression, anxiety, sleep quality, and substance misuse. Results: Students reporting clinically high SCT (reporting at least five symptoms often or very often) had significantly higher levels and rates of other types of psychopathology. Moreover, when students reporting clinically significant levels of ADHD, depression, and anxiety symptoms, poor sleep quality, or hazardous levels of alcohol or cannabis use were removed, very few students reporting high SCT remained (only 4.8% of the original high-SCT group). Conclusion: SCT may be best thought of as a symptom set common to many types of psychopathology, and it may be caused by sleep problems or substance misuse as well.

Profiles of Diagnosed and Undiagnosed College Students Meeting ADHD Symptom Criteria.

Objective: This study compared the psychological profiles of college students who self-reported an ADHD diagnosis in contrast to students without a diagnosis who reported above-threshold ADHD symptoms. Method: A large sample of college students yielded four subgroups: students with a self-reported diagnosis who met symptom criteria (Diagnosed, n = 40), students with a self-reported diagnosis who did not meet symptom criteria (Low Symptoms, n = 47), students who had no diagnosis and did not meet symptom criteria (Controls, n = 87), and students who had no diagnosis yet met symptom criteria (Undiagnosed, n = 38). All participants completed a battery of self-report rating scales assessing a variety of symptom and impairment domains. Results: The Diagnosed and Undiagnosed groups differed significantly from Controls on all domains, while the Low Symptom group did not differ significantly from Controls in any domain. Conclusion: Implications for engaging with reported diagnosis of ADHD in the college population are discussed.

Learning disability documentation submitted by osteopathic medical students.

An increasing number of individuals are requesting disability accommodations on high-stakes licensing examinations, and neuropsychological evaluation reports are a frequent component of disability documentation. This study reviewed 103 requests for accommodations based on a learning disability (LD), submitted to the National Board of Osteopathic Medical Examiners between 2013 and 2016 for accommodation on the licensure exams for osteopathic physicians. Depending on criteria employed, anywhere from 84 to 97% of applicants failed to meet recognized criteria for a LD diagnosis, with the vast majority demonstrating academic functioning that was average or better relative to most other individuals in the general population. Thus, although given a disability diagnosis, the majority lacked evidence of substantial impairment that would require accommodations under the Americans with Disabilities Act. Additionally, no significant differences were found between the academic achievement or fluency scores of those requesting 50% as compared to 100% extra time. Finally, many evaluators employed grade-based assessment measures to demonstrate academic impairment, even when candidates' functioning using age-based comparisons was unimpaired. Recommendations for future research and practice based on these and other findings are discussed.

The Multidimensional ADHD Rating Scale: A measure of symptoms, impairment, and symptom validity.

Objective: Two studies examined the psychometric properties of the Multidimensional ADHD Rating Scale (MARS), which assesses ADHD symptoms, related functional impairment, and symptom validity (SV). Method: Study 1 used MARS item responses from college students with and without ADHD (with some of the latter group assigned to feign ADHD) to create an SV-index, and to identify optimal cut scores for the clinical (symptom and impairment) indexes. Study 2 cross-validated the findings on a new sample. Results: In both studies, malingerers reported more symptoms and impairment than participants with ADHD, who reported more symptoms and impairment than controls. Receiver operating characteristic analyses found very good discrimination of genuine ADHD from control cases by the clinical MARS indexes, and very good discrimination of genuine ADHD from malingered ADHD by the SV-index. Conclusion: This research provides initial support for the effectiveness of the MARS to detect simulated cases of malingering, and to differentiate ADHD from non-ADHD cases in college students.

Network models of psychopathology and comorbidity: philosophical and pragmatic considerations.

Cramer et al.'s account of comorbidity comes with a substantive philosophical view concerning the nature of psychological disorders. Although the network account is responsive to problems with extant approaches, it faces several practical and conceptual challenges of its own, especially in cases where the individual differences in network structures require the analysis of intra-individual time-series data.

Objective criteria for classification of postsecondary students as learning disabled: effects on prevalence rates and group characteristics.

This study examined the consequences of classifying postsecondary students as learning disabled (LD) using five objective sets of criteria: IQ-achievement discrepancies (1.0 to 1.49 SD, 1.5 to 1.99 SD, and >or= 2.0 SD), DSM-IV criteria, and chronic educational impairment beginning in childhood. The participants were 378 postsecondary students from two universities who had been previously classified as LD and were receiving instructional and/or testing accommodations. The agreement between diagnostic models was often low, both in terms of the proportion of students identified as well as which students were identified by the models. The discrepancy models identified the largest proportions of students as LD (10% to 42%), whereas fewer than 10% of participants met either of the other sets of criteria, and 55% of the participants were not classified as LD by any of the models. Implications for further research and practices in postsecondary settings are discussed.

Are ADHD Screeners Safe to Use?

Objective: To investigate whether administration of a common ADHD screener followed by generic feedback would affect college students' subsequent symptom reports and cognitive performance. Method: Participants were 157 college students randomly assigned to an experimental group-which completed the World Health Organization Adult ADHD Self-Report Scale screener and received standard generic feedback-or a control group. All participants then completed a battery of cognitive tasks and a long-form symptom rating scale. Results: The experimental and control groups did not differ significantly in terms of their subsequent symptom reports or their performance on any cognitive tasks. These null results remained after considering possibilities such as unequal group variances and interactions between screening effects and gender. Conclusion: When administered judiciously alongside generic feedback in a group setting, this common ADHD screener does not appear to affect college students' self-perceptions or cognitive abilities.

Assessing ADHD in college students: Integrating multiple evidence sources with symptom and performance validity data.

Prior research supports the use of multiple types of evidence from multiple sources when assessing ADHD in adults. However, limited research has examined how to best integrate the resulting set of data into a well-supported diagnostic conclusion. Moreover, clients sometimes overreport symptoms or display low effort on performance tasks, further complicating the interpretation of assessment data. The present study examined self-ratings and observer (e.g., parent) ratings of symptoms as well as performance task data from 514 postsecondary students assessed for ADHD at a university-affiliated clinic. Observer ratings were more reliable than self-ratings and were more likely to be corroborated by other data. The 2 types of ratings showed moderate to large relationships with each other as continuous variables (.32 < r < .52) while agreement around categorical symptom cutoffs was slight or fair (.12 < κ < .32). Both types of ratings showed only small relationships with a performance test designed to assess ADHD symptoms. Approximately half of the cases in the sample had at least 1 piece of potentially noncredible data (suggesting potential symptom overreporting, inconsistent responding, or inadequate effort). Requiring ratings from multiple informants (as opposed to a single informant) of clinically significant symptoms for a diagnosis substantially reduced the effect of noncredible data, while also reducing the number of diagnoses by approximately half. Implications of these and other findings for practice and future research are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

What's so special about working memory? An examination of the relationships among working memory, secondary memory, and fluid intelligence.

Working memory capacity (WMC) has received attention across many areas of psychology, in part because of its relationship with intelligence. The mechanism underlying the relationship is unknown, but the nature of typical WMC tasks has led to two hypothesized mechanisms: secondary-memory processes (e.g., search and retrieval) and the maintenance of information in the face of distraction. In the present study, participants (N= 383) completed a battery of cognitive tasks assessing processing speed, primary memory, working memory, secondary memory, and fluid intelligence. Secondary memory was the strongest predictor of fluid intelligence and added unique predictive value in models that accounted for working memory. In contrast, after accounting for the variance in fluid intelligence associated with the secondary-memory construct, the working memory construct did not significantly predict variability in fluid intelligence. Therefore, the secondary-memory requirements shared by many memory tasks may be responsible for the relationship between WMC and fluid intelligence, making the relationship less unique than is often supposed.

Symptoms of ADHD and academic concerns in college students with and without ADHD diagnoses.

OBJECTIVE: Previous research has found ADHD symptoms to be common in the general population but has not compared endorsement of symptoms between ADHD and non-ADHD groups. This study examines self-reported ADHD symptoms and academic complaints in college students. METHOD: Students without (n = 496) and with ADHD (n = 38) completed a questionnaire covering the 18 ADHD symptoms in the Diagnostic and Statistical Manual of Mental Disorders and academic and test-taking concerns. RESULTS AND CONCLUSION: Students with ADHD diagnoses reported significantly more ADHD symptoms and academic concerns, but none of the 18 symptoms or 6 concerns proved to be both sensitive and specific to ADHD. Poor specificity of symptoms and academic complaints casts doubt on the utility of this self-reported information in diagnosis, particularly if used alone and without regard to severity or extent of impairment.