A survey to assess adhd symptoms and detect feigning in adult adh

Antioch University AURA - Antioch University Repository and Archive Student & Alumni Scholarship, including Dissertations & Theses Dissertations & Theses 2021 A survey to assess ADHD symptoms and detect feigning in adult ADHD: Initial scale development Michelle Babcock Antioch University Seattle Follow this and additional works at: https://aura.edu/etds Part of the Psychology Commons Recommended Citation Babcock, M. A survey to assess ADHD symptoms and detect feigning in adult ADHD: Initial scale development.edu/etds/743 This Dissertation is brought to you for free and open access by the Student & Alumni Scholarship, including Dissertations & Theses at AURA - Antioch University Repository and Archive. It has been accepted for inclusion in Dissertations & Theses by an authorized administrator of AURA - Antioch University Repository and Archive. For more information, please contact hhale@antioch.edu, wmcgrath@antioch.

A SURVEY TO ASSESS ADHD SYMPTOMS AND DETECT FEIGNING IN ADULT ADHD: INITIAL SCALE DEVELOPMENT A Dissertation Presented to the Faculty of Antioch University Seattle In partial fulfillment for the degree of DOCTOR OF PSYCHOLOGY by Michelle Babcock ORCID Scholar No. 0000-0002-8284-1131 September 2021 A SURVEY TO ASSESS ADHD SYMPTOMS AND DETECT FEIGNING IN ADULT ADHD: INITIAL SCALE DEVELOPMENT This dissertation, by Michelle Babcock, has been approved by the committee members signed below who recommend that it be accepted by the faculty of Antioch University Seattle in partial fulfillment for the degree of DOCTOR OF PSYCHOLOGY Dissertation Committee: Christopher Heffner, PhD, PsyD Michael J. Toohey, PhD Brad Tyson, PhD i Copyright © 2021 by Michelle Babcock All Rights Reserved ii ABSTRACT A SURVEY TO ASSESS ADHD SYMPTOMS AND DETECT FEIGNING IN ADULT ADHD: INITIAL SCALE DEVELOPMENT Michelle Babcock Antioch University Seattle Seattle, WA Adult attention-deficit / hyperactivity disorder (ADHD) diagnoses have significantly increased over the last 20 years, and in some cases, adults seek an ADHD diagnosis to procure stimulant medication and academic accommodations. With the ease of access to the internet, adults can acquire the knowledge to misrepresent symptoms for secondary gain.

The falsification of symptoms or feigning is problematic for the individual seeking the diagnosis, the psychological profession, and society at large. This study aimed to develop a multipurpose self-report scale comprised of the DSM-5 ADHD criteria, executive functioning, and embedded symptom validity indexes to assess ADHD and detect feigned responses. Along with researcher expertise and four subject matter experts, a content validity ratio was calculated to determine whether the scale items measured the content area. Analyses resulted in a preliminary survey tool consisting of 28 ADHD items and 20 validity items that can aid adult ADHD diagnostic clarification while differentiating between genuine and feigned responses.

Future studies are necessary to expand and further validate this new survey tool. This dissertation is available in open access at AURA (https://aura.edu) and OhioLINK ETD Center (https://etd. Keywords: ADHD, assessment, feigning, symptom validity iii Dedication This dissertation is dedicated to all the courageous people who work tirelessly to help others. Specifically, I dedicate this dissertation to my peers who have dedicated years in the service of others, sitting for long hours listening to their patient’s problems, and finding ways to help others grow.

Moreover, I want to acknowledge the perilous journey that each peer has taken to work towards a doctorate. Principally, I want this dissertation to recognize and honor the challenges, losses, tears, discouragements, long hours, living an unbalanced life, incessant struggles, and the sacrifices that each person relinquished to accomplish their goal. iv Acknowledgements Thank you to the entire Antioch University Seattle staff and professors who have supported me throughout the whole program. Thank you to Dr.

Christopher Heffner for his time helping me with the dissertation process, positive presence, and supporting me in the program as my dissertation chair and academic advisor. I am forever thankful that you encouraged me to remain in the program after expressing a desire to quit my second quarter. Thank you to my other dissertation committee members. Michael Toohey provided me with candid feedback that helped me grow professionally and personally, and I want to personally thank him for believing in my assessment skills.

Finally, to Dr. Brad Tyson for introducing me to neuropsychology, making me laugh, and encouraging me to complete my dissertation. I also want to thank the subject matter experts who dedicated their time and provided valuable feedback. Thank you to my peers who supported me through all these years.

Specifically, I would like to thank Lori Woehler for keeping me on track with my dissertation and telling me, “You got this, you can do this.” Wendy Efred for our time in the San Juan Islands and processing personal and professional challenges. To Abi Martin for providing a safe space to process my intrapsychic and interpersonal difficulties. I am more confident in myself because of our interactions. Thank you to my family, who have consistently supported me throughout this process.

Especially, thank you to my mom, who has sacrificed so much for her family and helped me achieve my goals. Lastly, thanks to my sister, Kim, who has continually been there for me while working toward my goal. I am forever thankful to all of you. v TABLE OF CONTENTS ABSTRACT.

1 CHAPTER II: LITERATURE REVIEW. 4 Attention Deficit / Hyperactivity Disorder. 4 DSM-5 Diagnostic Criteria. 6 Functional Impact of an ADHD Diagnosis.

8 Challenges Diagnosing Adult ADHD. 9 Concerns for Misdiagnosing and Underdiagnosing ADHD. 15 Why Feigning is a Problem. 15 Limitations of Current Assessments to Detect Feigned ADHD Symptoms.

16 Purpose of Study. 23 CHAPTER III: METHODOLOGY. 26 Overall Test Development. 26 Planned Overall Project.

26 IRB Approval Process. 26 Defined the Constructs. 27 Generated Item Pool. 31 Searched for Subject Matter Experts (SMEs).

32 Elicited Item Feedback. 35 CHAPTER IV: RESULTS. 35 ADHD Item Analysis. 36 Hyperactivity and/or Impulsivity Items.

37 vi Executive Function Items. 38 Validity Item Analysis. 38 Inconsistent Responding Items. 39 Infrequent Symptoms Items.

39 Negative Impression Scale. 42 Assessing for ADHD. 42 Detecting Feigned Responses. 52 Appendix A: Informed Consent.

64 Appendix B: First Pool Items. 66 Appendix C: Inter-Rater Agreement. 70 Appendix D: Final Pool Items. 75 vii 1 CHAPTER I: INTRODUCTION This study seeks to develop a tool that can help diagnose adult attention- deficit/hyperactivity disorder (ADHD) and discriminate between those with ADHD and those who attempt to feign ADHD.

According to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association [APA], 2013), ADHD is a neurodevelopmental disorder that can persist into adulthood in 60%–70% of cases (McGough & Barkley, 2004). Some research has shown an increase in adult ADHD diagnoses (Oehrlein et al., 2016; Robison et al., Sclar, & Skaer, 2005), while other research found that mental health office visits for adult ADHD diagnoses and medication between 1994 and 2009 increased by a factor of six (Olfson, Blanco, Wang, & Greenhill, 2013). Moreover, there is a growing trend in the number of adults, including post-secondary students, seeking an ADHD diagnosis for secondary gain (Tucha, Fuermaier, Koerts, Groen, & Thome, 2015). Adult individuals, whether in a college or community setting, might intentionally feign or exaggerate ADHD symptoms for academic accommodations (Aita, Sofko, Hill, Musso, & Boettcher, 2018; Sollman, Ranseen, & Berry, 2010) and stimulant medications (Castle, Aubert, Verbrugge, Khalid, & Epstein, 2007; McCabe, West, Teter, & Boyd, 2014; Robison, Sclar, & Skaer, 2005).

Pharmacological intervention, including both stimulant and non-stimulant medication, is recognized as the primary treatment for ADHD (Wilens et al. This line of treatment improves various symptoms and aspects of ADHD (Tucha et al., 2015); however, individuals without ADHD seek the nonmedical use of stimulants to help enhance cognitive functioning, improve academic performance, lose weight, alleviate psychological distress, and for euphoric effects (Tucha et al., 2015; Wilens et al. 2 Failing to diagnose or misdiagnosing individuals with ADHD is problematic for the cpsychological profession and society at large. For example, medical providers might provide unnecessary time and nonessential medication to those who do not actually need the resources (Doshi et al.

Moreover, Medicaid and Medicare costs have doubled over the past two decades, and the projected national health care expenditures are expected to further increase in the coming years (Center for Medicare and Medicaid Services, 2017). In the absence of accurate diagnoses, treatment is delayed, resulting in downstream financial burdens (Khullar, Jha, & Jena, 2015), and accurate ADHD diagnosis is essential as it frequently co-occurs with other mental health disorders (Faraone, Bierderman, Spencer, & Wilens, 2000). Furthermore, the expenses of diagnostic errors can stretch beyond the patients whose conditions are either missed or misdiagnosed. For example, individuals diagnosed with ADHD are twice as likely to die than people without ADHD.

Dalsgaard and colleagues (2015) followed 1.92 million people, of whom 32,061 had ADHD, over a 32-year period. Those with ADHD had higher mortality rates than those without ADHD, with higher death rates among girls and women. The excess in mortality rates was mainly caused by unnatural deaths associated with increased substance use and risky behaviors, poor health habits, and increased risk for accidents. Indeed, a recent meta-analysis suggested that adults with ADHD are at higher risk for adverse outcomes such as driving accidents (Vaa, 2014).

Psychologists’ scientific and professional judgments affect individual lives and others, and the profession must safeguard individuals and society, do no harm (APA, 2010), and attempt to provide more accurate diagnoses. Considering the significant consequences of feigning ADHD, gaining a deeper understanding of how ADHD is successfully feigned and developing assessment methods to uncover feigned efforts should be high priority. While a myriad of guidelines exists to help 3 diagnose adult ADHD, identifying ADHD is challenging (Cumyn, Kolar, Keller, & Hechtman, 2007) as the diagnosis is primarily based on an individual’s subjective self-report and a clinical interview (Bordoff, 2017; Bryant et al. A standalone measure was recently developed to identify individuals feigning ADHD symptomology (Courrege, Skeel, Feder, & Boress, 2019), and published guidelines exist to help determine those who may not have ADHD (Heilbronner et al.

However, no multipurpose tool exists to help support the diagnosis while simultaneously detecting feigned responses in adult ADHD (Sagar, Miller, & Erdodi, 2017; Tucha et al. Therefore, the current dissertation centers on the psychometric development of a survey tool that can aid in the diagnosis of adult ADHD and discriminate between genuine and feigned ADHD. The paper mainly consists of five chapters: introduction, literature review, methodology, results, and discussion. The first chapter provides a brief overview and justification for the project.

The second chapter, the literature review, is divided into two main sections. The first part of the literature review provides an overview of ADHD, the criteria, and the complexities of diagnosing ADHD. The second section introduces and defines feigning and addresses how individuals might be motivated to falsify their symptoms. This section also discusses the limitations of the current assessments to detect feigned responses.

The third chapter addresses the methodology used to develop the survey tool, while the fourth and fifth chapters concentrate on the results and discussion, respectively. 4 CHAPTER II: LITERATURE REVIEW Attention Deficit / Hyperactivity Disorder DSM-5 Diagnostic Criteria ADHD is recognized as a neurodevelopmental disorder with onset in childhood (APA, 2013; Van Ewijk & Oosterlaan, 2015), though symptoms often persist into adulthood (Mannuzza, Klein, & Moulton III, 2003), with some research suggesting that ADHD is one of the most prevalent psychiatric disorders in adults (Cumyn, Kolar, Keller, & Hechtman, 2007). The prevalence rates for ADHD in adults is less established (Matte, Rohde, & Grevet, 2012); however, current estimates range from approximately 2.4% in the general United States population (Adler, Shaw, Sitt, Maya, & Morrill, 2009; APA, 2013; Kessler et al., 2006; Simon, Czobor, Balint, Meszaros, & Bitter, 2009). Applying this prevalence rate to the 2010 U.

Consensus for ages 18 years and older suggests that almost 6 million adults endure symptoms associated with ADHD (U.