Many of you will be thinking "why would anyone want to fake ADHD!?" Well a common reason is apparently to gain access to stimulant medications with the hope that they will boost academic performance, or for more simple abuse purposes.
Additionally, students with learning disorders (inc. ADHD) are usually given access to additional resources, both educational and financial. These resources are genuinely needed by students with learning disabilities and include things like extra time for exams and coursework, more favorable marking schemes, reduced workload, additional teaching. However, for a student that does NOT have a learning disorder, these resources would present a significant advantage.
A new study, from the laboratory of Professor David Berry at the University of Kentucky examined the ability of college students to feign ADHD. The authors (Sollman, Ranseen and Berry) took three groups of students; those with ADHD (but temporarily off their medication), those without ADHD and those without ADHD but told to pretend they had it.
This last group of "fakers" was told that if they could convince the assessor that they did have ADHD, they would be given 45 dollars. They were given just 5 minutes of preparation time, which they spent with information obtained from Google.
All groups were then assessed using standard ADHD tests by researchers who were unaware which group the students had been assigned to.
Tests for detecting ADHD fall into two broad categories. Firstly, and most simply, there is self-report, where the patient describes their symptoms in response to structured questioning. Second there are neuropsychological tests, where the patient is asked to perform a particular task. These often appear much like a simple computer game and are structured such that persons with ADHD will make certain types of mistakes on the game due to impulsivity, inattention or other ADHD symptoms.
Sollman and co tested both categories of test using multiple approaches.
Two self-report tests were administered, the ADHA Rating Scale ("ARS") developed by Barkley and Murphy and another known as the "Conners Adult ADHD Rating Scale (CAARS)
Neither of these tests could distinguish between students with ADHD and those faking it.
The more complex neuropsychological tests did not fare much better, some were successfully faked, while others showed a tendency for fakers to overdo it resulting in more severe symptoms than might be seen in ADHD. Perhaps more troubling, these neuropsychological tests were not able to differentiate between true ADHD and control individuals (who had no symptoms and were not faking).
There is a long history of symptom-feigning in psychiatry, driven by legal, financial and academic motives. To counter this, a battery of tests has been developed to detect feigners. As yet there is not a specific test to catch feigned ADHD. Sollman and co used a range of general "malingering" tests to see if they could detect the fakers. No test by itself was able to pick out the students with fake ADHD. A glimmer of hope was offered by pooling the results of all these tests together, which did detect students who were faking their ADHD. However, this approach also identified two students with genuine ADHD as fake. Clearly an undesirable outcome.
In the wider context of public health, the over/misdiagnosis of ADHD is a big issue. The tests themselves are unreliable, misdiagnosing ADHD even in persons not willfully faking.The ease with which ADHD tests can be faked must surely also play a role, especially since the ease with which ADHD tests can be feigned has been known for a while eg 1, 2. Obviously those willfully faking ADHD will contribute to the problem, but it's easy to see how a misdiagnosis could be arrived at without such malicious intent; test scores are bad? having difficulty concentrating? Someone suggests ADHD and you make an appointment to see someone about it. It's natural that you would do some reading beforehand and this study shows that 5 minutes with Google will tell you what the clinician is looking for. It would be just as easy to fool yourself that ADHD is the reason why your grades have been bad.
Another interesting wrinkle is the problem this poses for ADHD research. Take the study in question; how are the researchers to know that the participants with "true" ADHD group haven't themselves faked their way to an ADHD diagnosis, willfully or otherwise? This could even potentially explain why some of the neuropsychological tests used did not pick up "true" ADHD.
Oh dear, what a mess! What is to be done?