INS NYC 2024 Program

Poster	Poster Session 10 Program Schedule 02/17/2024 09:00 am - 10:15 am Room: Majestic Complex (Posters 61-120) Poster Session 10: Neurodevelopmental \| Congenital Conditions Final Abstract #94 Performance Validity Testing in Neuropsychological Evaluations of ADHD: Differential Impacts of Final Diagnostic Classification? Logan Tufty, University of Illinois at Chicago, Chicago, United States Benjamin Wenzel, University of Illinois at Chicago, Chicago, United States Nevin Orleans, University of Illinois at Chicago, Chicago, United States Gabriel Ovsiew, University of Illinois at Chicago, Chicago, United States Brian Cerny, University of Illinois at Chicago, Chicago, United States Devin Ulrich, University of Illinois at Chicago, Chicago, United States Matthew Phillips, University of Illinois at Chicago, Chicago, United States Kyle Jennette, University of Illinois at Chicago, Chicago, United States Neil Pliskin, University of Illinois at Chicago, Chicago, United States Woojin Song, University of Illinois at Chicago, Chicago, United States Jason Soble, University of Illinois at Chicago, Chicago, United States Category: ADHD/Attentional Functions Keyword 1: attention deficit hyperactivity disorder Keyword 2: performance validity Keyword 3: neuropsychological assessment Objective: There has been a significant rise in adults seeking neuropsychological evaluations for attention-deficit/hyperactivity disorder (ADHD). Considering the possible secondary gain from an ADHD diagnosis, particularly in educational settings (e.g., stimulant medication access; academic/testing accommodations), practice standards require administration of performance validity tests (PVTs) to assess the credibility of neurocognitive test performance. Although research has consistently supported the need for PVTs among patients being evaluated for ADHD, researchers have yet to explicitly examine differences in PVT failure rates across patients with differing final diagnoses following an ADHD evaluation. Most notably, given the high comorbidity of psychopathology with ADHD as well as overlapping inattention symptoms between many disorders, it is imperative to examine whether active, non-ADHD psychiatric symptomatology affects PVT failure rates in this population. Our study aimed to investigate whether base rates of invalid test performance differed significantly across patients diagnosed with ADHD, ADHD and a comorbid internalizing disorder, or an internalizing disorder only. Participants and Methods: Consecutive patients (N = 646) were extracted from an archival clinical database of neuropsychological referrals for ADHD conducted at an urban academic medical center. Patients had a mean age of 28.2 years (SD = 7.0), mean education of 15.9 years (SD = 2.14), and 61.0% identified as female. Racially, the sample was 43.0% White, 23.8% Hispanic, 16.1% Black, 10.8% Asian, and 6.2% Other. Patients were grouped by final diagnosis (ADHD, ADHD + internalizing disorder, internalizing disorder only), with internalizing disorders including depression, anxiety, or posttraumatic stress disorder (PTSD). All patients were administered a uniform neurocognitive battery including 6 PVTs (2 freestanding and 4 embedded), which have previously been cross-validated in adult ADHD samples as part of their evaluation. Invalid test performance was defined as failing ≥ 2 PVTs, and valid performance as ≤1 PVT failure. Results: Failure rates across the 6 individual PVTs ranged from 4%-19%. Among the entire sample, 16.4% of participants failed ≥ 2 PVTs, indicating invalid performance. Among study groups, base rates of invalid performance were 17% for the ADHD-only group, 18% for the ADHD + internalizing disorder group, and 14% for the internalizing disorder only group. A chi-square test of independence indicated no significant group differences in rates of invalid test performance among the 3 study groups, 𝜒²(2, N = 646) = .887, p = .642. Conclusions: The overall invalidity base rate highlights that a significant subset of adults undergoing evaluation for ADHD will produce invalid neuropsychological test results. However, no significant differences in PVT failure rates were found between patients based on final diagnosis of ADHD, ADHD and a comorbid internalizing psychological disorder, or an internalizing psychological disorder alone. Thus, the presence/absence of comorbid internalizing/affective psychopathology does not meaningfully influence PVT performance or yield a higher base rate or invalidity for adults presenting clinically for ADHD evaluation.

Poster

02/17/2024
09:00 am - 10:15 am
Room: Majestic Complex (Posters 61-120)

Poster Session 10: Neurodevelopmental | Congenital Conditions

Final Abstract #94

Performance Validity Testing in Neuropsychological Evaluations of ADHD: Differential Impacts of Final Diagnostic Classification?

Logan Tufty, University of Illinois at Chicago, Chicago, United States
Benjamin Wenzel, University of Illinois at Chicago, Chicago, United States
Nevin Orleans, University of Illinois at Chicago, Chicago, United States
Gabriel Ovsiew, University of Illinois at Chicago, Chicago, United States
Brian Cerny, University of Illinois at Chicago, Chicago, United States
Devin Ulrich, University of Illinois at Chicago, Chicago, United States
Matthew Phillips, University of Illinois at Chicago, Chicago, United States
Kyle Jennette, University of Illinois at Chicago, Chicago, United States
Neil Pliskin, University of Illinois at Chicago, Chicago, United States
Woojin Song, University of Illinois at Chicago, Chicago, United States
Jason Soble, University of Illinois at Chicago, Chicago, United States

Category: ADHD/Attentional Functions

Keyword 1: attention deficit hyperactivity disorder
Keyword 2: performance validity
Keyword 3: neuropsychological assessment

Objective:

There has been a significant rise in adults seeking neuropsychological evaluations for attention-deficit/hyperactivity disorder (ADHD). Considering the possible secondary gain from an ADHD diagnosis, particularly in educational settings (e.g., stimulant medication access; academic/testing accommodations), practice standards require administration of performance validity tests (PVTs) to assess the credibility of neurocognitive test performance. Although research has consistently supported the need for PVTs among patients being evaluated for ADHD, researchers have yet to explicitly examine differences in PVT failure rates across patients with differing final diagnoses following an ADHD evaluation. Most notably, given the high comorbidity of psychopathology with ADHD as well as overlapping inattention symptoms between many disorders, it is imperative to examine whether active, non-ADHD psychiatric symptomatology affects PVT failure rates in this population. Our study aimed to investigate whether base rates of invalid test performance differed significantly across patients diagnosed with ADHD, ADHD and a comorbid internalizing disorder, or an internalizing disorder only.

Participants and Methods:

Consecutive patients (N = 646) were extracted from an archival clinical database of neuropsychological referrals for ADHD conducted at an urban academic medical center. Patients had a mean age of 28.2 years (SD = 7.0), mean education of 15.9 years (SD = 2.14), and 61.0% identified as female. Racially, the sample was 43.0% White, 23.8% Hispanic, 16.1% Black, 10.8% Asian, and 6.2% Other. Patients were grouped by final diagnosis (ADHD, ADHD + internalizing disorder, internalizing disorder only), with internalizing disorders including depression, anxiety, or posttraumatic stress disorder (PTSD). All patients were administered a uniform neurocognitive battery including 6 PVTs (2 freestanding and 4 embedded), which have previously been cross-validated in adult ADHD samples as part of their evaluation. Invalid test performance was defined as failing ≥ 2 PVTs, and valid performance as ≤1 PVT failure.

Results:

Failure rates across the 6 individual PVTs ranged from 4%-19%. Among the entire sample, 16.4% of participants failed ≥ 2 PVTs, indicating invalid performance. Among study groups, base rates of invalid performance were 17% for the ADHD-only group, 18% for the ADHD + internalizing disorder group, and 14% for the internalizing disorder only group. A chi-square test of independence indicated no significant group differences in rates of invalid test performance among the 3 study groups, 𝜒²(2, N = 646) = .887, p = .642.

Conclusions:

The overall invalidity base rate highlights that a significant subset of adults undergoing evaluation for ADHD will produce invalid neuropsychological test results. However, no significant differences in PVT failure rates were found between patients based on final diagnosis of ADHD, ADHD and a comorbid internalizing psychological disorder, or an internalizing psychological disorder alone. Thus, the presence/absence of comorbid internalizing/affective psychopathology does not meaningfully influence PVT performance or yield a higher base rate or invalidity for adults presenting clinically for ADHD evaluation.