Detecting Attention Deficit Hyperactivity Disorder and its feigning using the Personality Assessment Inventory

Abstract

Attention Deficit Hyperactivity Disorder is a relatively common and often disabling disorder in adults. However, feigning ADHD symptomatology is both easy and potentially common. We explored the most effective strategies for A) identifying individuals who had been diagnosed with ADHD based on existing PAI symptom indicators, and B), discriminating between feigned and genuine ADHD symptoms using PAI negative distortion indicators. Our sample consisted of 463 college aged participants who had been diagnosed with ADHD (n = 60), were asked to feign ADHD (n = 71), and a control group (n = 333). Self-reported diagnosis and successful feigning were corroborated by the CAARS-S: E scale. We first compared two PAI-derived ADHD indicators to determine which best differentiated between our ADHD and Control groups. Next, we compared seven negative distortion indicators to determine which could best distinguish between real and feigned ADHD symptoms. Our results revealed that the PAI-ADHD scale was the most effective symptom indicator. Further, the Negative Distortion Scale (NDS) and the Item-FAA scale were the most effective for identifying feigners. When assessing ADHD based on the PAI, the PAI-ADHD scale appears promising as an indicator of symptomatology, while the NDS and Item-FAA appear useful to rule-out feigning.

Keywords:

• Attention deficit hyperactivity disorder
• feigning
• negative distortion indicators
• personality assessment inventory

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Authors’ contributions

Joseph Maffly-Kipp: Conceptualization, Data curation, Formal Analysis, Investigation, Methodology, Writing—original draft, Writing—review and editing. Leslie Morey: Conceptualization, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Writing—review and editing.

Disclosure statement

Leslie Morey authored the Personality Assessment Inventory. We have no other conflicts of interest to declare.

Notes

1 As noted by Harrison et al. (2022), it is important to be clear that the Item-FAA scale is based on PAI item scores (0–3, as scored in the parent scale), not item responses (i.e., 1–4, no reverse-scoring).

2 We corroborated self-reported diagnoses with the CAARS due to the documented unreliability of clinician diagnosis of ADHD (Weis et al., 2019), and the recommendation to use multiple sources of evidence in making judgments about ADHD (Nelson & Lovett, 2019). This strategy has been used in previous work (see Rios & Morey, 2013).

3 Scoring instructions for all scales used in our analyses can be found in supplementary materials.

4 We used the CAARS-E raw score that corresponds to 65T for women aged 18–29, the demographic which captures the majority of our sample. Using the cut score for men, or a score corresponding to 70T or 75T, our sensitivity would have been lower than what we report.

5 In order to rule out the possibility that this scale was simply capturing general distress, we partialled out the PAI Mean Clinical Elevation from the PAI-ADHD scale. The resulting residual was still able to significantly differentiate between the two groups (AUC = .746), suggesting that the scale is capturing elevations specific to ADHD symptomatology.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.