Feigning Adult ADHD on a Comprehensive Neuropsychological Test Battery: An Analogue Study.

The evaluation of performance validity is an essential part of any neuropsychological evaluation. Validity indicators embedded in routine neuropsychological tests offer a time-efficient option for sampling performance validity throughout the assessment while reducing vulnerability to coaching. By administering a comprehensive neuropsychological test battery to 57 adults with ADHD, 60 neurotypical controls, and 151 instructed simulators, we examined each test's utility in detecting noncredible performance. Cut-off scores were derived for all available outcome variables. Although all ensured at least 90% specificity in the ADHD Group, sensitivity differed significantly between tests, ranging from 0% to 64.9%. Tests of selective attention, vigilance, and inhibition were most useful in detecting the instructed simulation of adult ADHD, whereas figural fluency and task switching lacked sensitivity. Five or more test variables demonstrating results in the second to fourth percentile were rare among cases of genuine adult ADHD but identified approximately 58% of instructed simulators.

Associating Flexible Regulation of Emotional Expression With Psychopathological Symptoms.

Background: Stressful situations and psychopathology symptoms (e.g., depression and anxiety) shape how individuals regulate and respond to others' emotions. However, how emotional expressions influence mental health and impact intrapersonal and interpersonal experiences is still unclear. Objective: Here, we used the Flexible Regulation of Emotional Expression (FREE) scale to explore the relationship between emotional expression abilities with affective symptoms and mental health markers. Methods: From a sample of 351 participants, we firstly validate a German version of the FREE scale on a final sample of 222 participants located in Germany, recruited through an online platform. Following this, we performed confirmatory factor analyses to assess the model structure of the FREE-scale. We then utilize a LASSO regression to determine which indicators of psychopathology symptoms and mental health are related to emotional expressive regulation and determine their particular interactions through the general linear model. Results: We replicated the FREE scale's four latent factors (i.e., ability to enhance and suppress positive as well as negative emotional expressions). After the selection of relevant instruments through LASSO regression, the suppress ability showed specific negative associations with depression (r = 0.2) and stress symptoms (r = 0.16) and positive associations with readiness to confront distressing situations (r = 0.25), self-support (r = 0.2), and tolerance of emotions (r = 0.2). Both, emotional expressions enhance and suppress abilities positively associated with coping markers (resilience) and emotion regulation skills. Finally, the interaction effects between emotional flexibility abilities and stress, depression, and anxiety symptoms evidenced that consistent with the flexibility theory, enhancing and suppressing abilities may predict psychopathological symptoms. Conclusions: These findings emphasize the importance of considering the flexibility to express emotions as a relevant factor for preserved mental health or the development of psychopathological symptoms and indicate that online surveys may serve as a reliable indicator of mental health.

Non-credible symptom report in the clinical evaluation of adult ADHD: development and initial validation of a new validity index embedded in the Conners' adult ADHD rating scales.

As attention-deficit/hyperactivity disorder (ADHD) is a feasible target for individuals aiming to procure stimulant medication or accommodations, there is a high clinical need for accurate assessment of adult ADHD. Proven falsifiability of commonly used diagnostic instruments is therefore of concern. The present study aimed to develop a new, ADHD-specific infrequency index to aid the detection of non-credible self-report. Disorder-specific adaptations of four detection strategies were embedded into the Conners' Adult ADHD Rating Scales (CAARS) and tested for infrequency among credible neurotypical controls (n = 1001) and credible adults with ADHD (n = 100). The new index' ability to detect instructed simulators (n = 242) and non-credible adults with ADHD (n = 22) was subsequently examined using ROC analyses. Applying a conservative cut-off score, the new index identified 30% of participants instructed to simulate ADHD while retaining a specificity of 98%. Items assessing supposed symptoms of ADHD proved most useful in distinguishing genuine patients with ADHD from simulators, whereas inquiries into unusual symptom combinations produced a small effect. The CAARS Infrequency Index (CII) outperformed the new infrequency index in terms of sensitivity (46%), but not overall classification accuracy as determined in ROC analyses. Neither the new infrequency index nor the CII detected non-credible adults diagnosed with ADHD with adequate accuracy. In contrast, both infrequency indices showed high classification accuracy when used to detect symptom over-report. Findings support the new indices' utility as an adjunct measure in uncovering feigned ADHD, while underscoring the need to differentiate general over-reporting from specific forms of feigning.

Utility of the Structured Interview of Reported Symptoms (SIRS-2) in detecting feigned adult attention-deficit/hyperactivity disorder.

Introduction: The Structured Interview of Reported Symptoms (SIRS-2) utilizes various strategies in the detection of simulated psychiatric disorders. The present study aimed to examine which of these strategies proves most useful in uncovering feigned attention deficit hyperactivity disorder (ADHD) in adulthood. Method: One-hundred seventy-one individuals instructed to feign ADHD were compared to 46 genuine patients with ADHD as well as 99 neurotypical controls in their reports provided on the SIRS-2. Results: Responses provided by simulators resembled those of genuine patients with ADHD on all SIRS-2 subscales with the exception of a supplementary scale tapping Overly Specified symptom reports, where a moderate effect emerged (d = 0.88). Classification accuracy remained low, with particularly poor sensitivity (sensitivity = 19.30%). Sensitivity was higher when the decision rules postulated in the first edition SIRS were applied instead of its successor's decision model, yet this increase in sensitivity came at the price of unacceptably low specificity. Conclusion: The present results call for a disorder-specific instrument for the detection of simulated ADHD and offer starting points for the development of such a tool.

Self-Reported Empathy in Adult Women with Autism Spectrum Disorders - A Systematic Mini Review.

INTRODUCTION: There is limited research on Autism Spectrum Disorders (ASD) in females. Although the empathy construct has been examined thoroughly in autism, little attention has been paid to empathy in adult women with this condition or to gender differences within the disorder. OBJECTIVE: Self-reported empathy in adult women with ASD was examined and compared to that of typically developed men and women as well as to men with this condition. METHODS: Online databases were searched for articles investigating self-reported empathy among adult women with ASD. Only six studies comparing women to men were identified. RESULTS: All studies found women with an ASD to report lower levels of empathy than typically developed women, and typically developed men, but similar levels to men with this condition. CONCLUSION: The self-reported empathic ability of women diagnosed with ASD resembles that of their male counterparts most closely; they show a hypermasculinisation in empathy. This is particularly surprising considering the large gender difference in empathy in the general population. DISCUSSION: One of the limitations of this review is that the current diagnostic criteria for ASD are oriented towards male-specific behaviour and fail to integrate gender specific characteristics. Hence, women diagnosed with ASD are likely to be at the male end of the continuum. The suggested hypermasculinisation of women on the spectrum, as evident from this review, may therefore be exaggerated due to a selection bias.