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.

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.

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.

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.

Effects of Concussion in Adolescent Students: Perceptions and Performance.

OBJECTIVE: The purpose of this study was to compare adolescent students with and without concussion on a battery of academic, neurocognitive, and socioemotional measures and assess the aftereffects of concussion across domains of functioning. METHODS: Twenty-four adolescents (ages 13-17) reporting postconcussion symptoms were compared to 24 controls matched for age and gender across a battery of tests and surveys. RESULTS: After correcting for multiple comparisons, there were no significant differences on any neuropsychological measures. Similarly, there were no significant group differences on academic measures of vocabulary, word recognition, or reading comprehension. Self-reported concussion symptoms were much greater for students with concussion, as were self-reports of anxiety, depression, and somatization symptoms. Parents also rated those with concussion as having greater depression and somatization symptoms, but not to a degree that survived Bonferroni correction. Lastly, those with concussion reported a significantly greater number of school problems and academic concerns. CONCLUSIONS: Results indicated that adolescents who reported postconcussion symptoms do not perform differently from peers on most neurocognitive and academic tasks, yet they showed considerably more worry, somatization, academic concerns, and feelings of inadequacy than matched controls. The findings suggest that interventions to address psychological and academic stress may be indicated for adolescents symptomatic from concussion.

Parent Knowledge and Perceptions of Concussion Related to Youth Football.

Introduction There is increased concern about concussion in youth athletes, yet there is little research on parent knowledge of concussion. Purpose  The purpose of the current study was to investigate attitudes to and knowledge of concussion among parents of youth football players. Methods We surveyed 180 parents/guardians of youth football players, ages 5-12, regarding their knowledge and beliefs concerning concussion. Results We found that the vast majority of respondents (86%) had confidence in their ability to recognize concussions. Yet, a significant number also held misconceptions about concussions, such as 'too much sleep' (48%) or 'eating certain foods' (26%) make concussion symptoms worse. Most (82%) had not heard of the Zurich guidelines, and less than half (44%) were aware that sustained mental activity could worsen symptoms. Parents were concerned about their child sustaining a concussion, but a substantial minority also reported 'serious concern' about their children losing playing time or their position.  Discussion Results are somewhat positive in terms of parents' general knowledge of concussions; yet, response variability and misconceptions point to a continued need for concussion education for parents. Medical professionals can play an important role in informing families about concussion symptoms, management, and recovery.

Executive Dysfunction and Functional Impairment Associated With Sluggish Cognitive Tempo in Emerging Adulthood.

OBJECTIVE: Research has identified a relationship between sluggish cognitive tempo (SCT) symptoms and symptoms of ADHD, anxiety, and depression; however, no study has controlled for symptoms of ADHD, anxiety, and depression when examining impairment related to SCT symptoms. This study aimed to examine (a) the extent to which functional impairment and executive function (EF) problems were accounted for by SCT symptoms when controlling for ADHD, anxiety, and depression symptoms, and (b) which type of symptoms were associated with the greatest amount of impairment. METHOD: College students ( N = 458) completed self-report scales of ADHD, SCT, anxiety, and depression symptoms, as well as functional impairment and EF problems. RESULTS: Thirteen percent of the sample was found to have high levels of SCT symptoms. SCT symptoms showed a moderate to strong correlation with the other symptom sets; however, high levels of SCT symptoms often occurred separate from high levels of ADHD, anxiety, or depression symptoms. SCT symptoms accounted for the most unique variance for both EF problems and functional impairment. Students with high levels of SCT symptoms, with or without high levels of ADHD symptoms, exhibited more impairment and EF problems than the controls. CONCLUSION: SCT is a clinical construct worthy of additional study, particularly among college students.

Sluggish Cognitive Tempo and Speed of Performance.

OBJECTIVE: This study examined whether college students who reported higher levels of sluggish cognitive tempo (SCT) symptoms were actually more "sluggish" in their performance while completing speeded cognitive and academic measures. METHOD: College students ( N = 253) completed self-reports of SCT and their reading and test-taking abilities as well as tests of processing speed, reading fluency, and reading comprehension. RESULTS: Across all variables, SCT symptoms were most significantly associated with self-reported difficulty on timed reading tasks. However, students with high SCT scores were not significantly slower than controls on any of the timed tasks. CONCLUSION: In college students, self-reports of high SCT levels do not suggest actual slow performance on cognitive and academic tasks.

Test-taking performance of high school students with ADHD.

OBJECTIVE: The authors examined the test-taking performance of high school students with (n = 38) and without (n = 746) ADHD. METHOD: Students were assessed via an online battery of tests (TestTracker) including reading speed, decoding, vocabulary, comprehension, effort, test anxiety, and time and strategy usage. RESULTS: Students with ADHD had poorer decoding scores, and lower comprehension and vocabulary accuracy. Groups performed similarly on reading speed, number of items attempted, perceived test anxiety, self-perception of testing skills, and strategy use. CONCLUSION: Students with ADHD (all of whom were receiving test accommodations in school) made more errors on some reading tasks, yet performed similarly to typical students on indices of speed and amount of test items accessed. The finding of more errors but no time differences might argue for a different intervention beside extended time, unless the extra time is used to review and correct work.

Effects of Extended Time for College Students With and Without ADHD.

OBJECTIVE: The number of students with a disability requesting test accommodations has been steadily increasing in higher education settings. The present study examined the effects of extra time on the reading comprehension performance of college students with and without ADHD. METHOD: A modified version of The Nelson-Denny Reading Test was completed by 38 college students with ADHD and 38 matched controls under three conditions: standard time, time and one half, and double time. RESULTS: Groups did not differ in the number of items attempted or correctly answered at standard time, time and one half, or double time. Comparing the ADHD group at extended time to non-ADHD peers at standard time, the ADHD group attempted and answered significantly more test items. CONCLUSION: Extra time conferred an advantage to the ADHD group, suggesting that extended time accommodations are not specific and perhaps not necessary for all college students with an ADHD diagnosis.

A prospective study of symptoms and neurocognitive outcomes in youth with concussion vs orthopaedic injuries.

BACKGROUND: This study examined symptom reports and neurocognitive outcomes in children (8-17 years) with mild traumatic brain injury (mTBI) or orthopaedic injury (OI). METHOD: Children and parents were initially assessed upon presentation in the Emergency Department of a local hospital and again at 3 months. Children completed the Immediate Post-Concussion Assessment and Cognitive Testing battery (ImPACT) and parents completed the Behavior Rating Inventory of Executive Function (BRIEF). The Peabody Picture Vocabulary Test, 3rd edition (PPVT-III) was completed by the children at the 3-month assessment. RESULTS: Children with mTBI reported more symptoms than the OI group initially, but did not differ from the OI group at 3 months. Both groups reported a higher than expected number of symptoms at 3 months. On the ImPACT, children with mTBI performed significantly worse than the OI on a visual memory test at both assessments. The OI group had higher levels of parent-reported executive dysfunction on the BRIEF at initial and 3-month assessments. DISCUSSION: As expected, more post-concussion symptoms were initially reported by children and adolescents with mTBI vs orthopaedic injury, but there was no difference at 3 months. The BRIEF and ImPACT cognitive measures did not differentiate concussed subjects from controls, with the exception of concussed subjects' lower performance on a visual memory test at both initial assessment and at 3 months.

Economic grand rounds: Predictors of missed appointments over the course of child mental health treatment.

Although missed appointments in service delivery systems reduce effective case management, clinical efficiency, staff morale, and resource utilization, researchers have paid little attention to the impact of missed appointments on patient care. This column presents findings from a study that examined predictors of missed appointments during the course of therapy among 2,903 psychiatric patients between the ages of three and 17. Self-reported history of maternal depression proved to be the most powerful predictor. Living more than 30 miles from the clinic and having a parent who was single or never married also predicted missed appointments.

Economic grand rounds: the cost of collaboration: predictors of hours spent in collateral contacts.

Collateral contacts, while at the heart of wraparound care, are time consuming and often nonreimbursable. This column presents data from a study of 1,639 child patients. It examined whether the amount of time that clinicians spent in collateral activities could be predicted by demographic variables, child diagnosis, parental psychopathology or family history of mental disorders, or staff variables. For every 60 minutes of direct patient contact, approximately 20 minutes of collateral activities were performed by the clinician. The best predictors of spending time in collateral activities were having parents who were not married, a mother with depression or anxiety, a child patient with a history of substance misuse or abuse, and a child patient with a history of maltreatment.

Measuring post-concussion symptoms in adolescents: feasibility of ecological momentary assessment.

Although there is a large literature examining head trauma in general, several areas remain understudied. Notably, little is known about symptom expression over the course of a day for adolescents recovering from concussion. Furthermore, intra-individual symptom variability has not been well characterized. This pilot study examined the feasibility of a momentary data-gathering method, as well as the sensitivity of the assessment to the subtle and dynamic changes in symptoms of concussion. Six adolescents, three of whom suffered a concussion and three non-injured controls, provided symptom ratings five times per day for 5 days. This ecological momentary assessment (EMA) was conducted on a personal digital assistant to capture variability in symptom reports while in the natural environment. Preliminary results indicated that the EMA method showed great promise as a research tool in natural settings (e.g., school and home). Adolescents were able to comply with all tasks with little interference in their daily activities. Students with concussion showed generally higher symptom ratings across physical, cognitive, and affective domains, and temporal and diurnal patterns for symptoms emerged. Implications for future research and patient care are discussed.

The role of impairment in the diagnosis of ADHD.

OBJECTIVE: Current diagnostic criteria for ADHD require the consideration of impairment in making a diagnosis, although clinical and research definitions of ADHD rely more heavily on reported symptoms. This study explored the relationship between impairment and symptoms, variables predictive of impairment, and variation in ADHD identification when impairment criteria are added to symptom criteria. METHOD: ADHD symptoms and impairment were assessed using archival parent and teacher rating scale data. RESULTS: The results indicated that (a) single impairment measures alone and a global impairment index were, at best, only moderately correlated with symptom reports; (b) predictor variables accounted for a small percentage of the variance in impairment; and (c) the number of children meeting criteria for ADHD diagnosis varied dramatically when impairment measures were considered. CONCLUSION: Symptoms and impairment are related yet distinct constructs that should be measured independently to determine the presence of ADHD.

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.

Gifted students with learning disabilities: who are they?

More than 20 years ago, psychologists first described gifted students with learning disabilities (LD). In the past decade, several sets of identification criteria have been proposed for this population. Many of the suggested assessment practices are unsupported by research in psychoeducational assessment, and some have been directly contradicted by recent research. We argue that an uncritical acceptance of the concept of concomitant giftedness and LD has led to unsound identification procedures and to interventions that are not targeted properly. Specific recommendations for future research and implications for current clinical practice are discussed.

Teaching teachers about childhood cancer: the effects of a web-based training program.

The purpose of this study was to examine the utility and acceptability of a modular computer-based training program on childhood cancer (eg, acute and late effects of treatment, intervention strategies) for teachers. A within-subjects design was implemented with 41 teachers and teachers in training. Participants completed tests of childhood cancer knowledge and application skills both before and after completing the web-based training. An acceptability questionnaire was completed after the training. Results indicated significant gains in knowledge and in case application, as well as high levels of acceptability of the training. It seems that a web-based training program can be accessed by teachers and in 2 to 4 hours can significantly increase cancer knowledge in an acceptable manner.

ADA-based accommodations in higher education: a survey of clinicians about documentation requirements and diagnostic standards.

The expansion of the number of students requesting accommodations in postsecondary settings compels clinicians to become knowledgeable about the legal definitions and documentation requirements of the Americans with Disabilities Act (ADA). Because the law is relatively new, courts and regulatory agencies have only recently begun to clarify what constitutes a disability. In this study, 147 clinicians completed a questionnaire developed to assess their understanding of the law and the diagnostic approaches they used to justify claims of learning disability (LD), attention-deficit/hyperactivity disorder (ADHD), and psychiatric disability. Whereas the clinicians agreed on certain points (e.g., the right of institutions to formulate specific policies regarding documentation), they substantially disagreed on several fundamental issues. Clinician consensus was lowest on items that asked about the basic intent of the law, the metrics for assessing impairment, and the criteria for assessing ADHD in adulthood. Judged against the legislative history of the ADA and the body of regulatory rulings and legal decisions, many clinicians' responses showed a need for clarification regarding the distinction between special education law and the antidiscrimination intent of the ADA. The respondents also expressed a nearly uniform wish for more training in this fast-growing area of clinical practice.