Falsification ADHD
When doing psychological evaluations for ADHD, a clinician usually assumes that the person being evaluated is putting forth minimal effort and is not exaggerating or magnifying the symptoms (Mapou, 2019). Research in neuropsychology has established that factors like effort and motivation can significantly impact the correct interpretation of self-reported symptoms and test scores. In the last few years, there has been a significant increase in the number of adults and young persons coming to specialists complaining that they have ADHD symptoms and wonder if they have the disorder. Many of these people have no prior diagnosis of ADHD and may not be able to offer information about childhood behavior to corroborate their symptoms. This is the kind of situation that the clinician in Scenario II is examining. The clinician is tasked with having to differentiate between the symptoms of ADHD and those of other disorders when making a differential diagnosis (Mapou, 2019). But the psychologist has to be aware of the possibility that the person may be exaggerating or feigning the symptoms.
In general, it is challenging to diagnose ADHD in adults since unlike other diagnoses that can be confirmed using the lab or radiological evidence, ADHD is a clinical diagnosis that is determined based on self-reported symptoms and establishing that the patent has met the diagnostic criteria for ADHD in childhood (Mapou, 2019). The difficulty is enhanced further by adults being frequently poor historians and not being effective at retrospectively determining if their childhood behaviors were consistent with the DSM-5 criteria. Additionally, research has reliably determined that it is usually impossible for adults to get information about their childhood behaviors. Further, self-reports of any childhood symptoms without any external corroboration are problematic since people have no objective of determining if their childhood behaviors were extreme or impairing relative to that of their peers. Despite the difficulties, psychologists are instructed to diagnose ADHD based on clinical interviews and self-reported data alone (Mapou, 2019). There is still exists no consistent pattern of impairment of specific tests that have been identified despite studies showing that some of the neuropsychological testing done on adults with ADHD perform more poorly than in clinical controls such as processing speed or memory, sustained attention, and executive functioning.
The methods used to evaluate symptom exaggeration or the level of effort and motivate a significant part of any neuropsychological tests primarily because psychologists have little ability to recognize dishonest clients unless the test of effort and motivation are included in their assessment battery (Sadek, 2017). In this case, the patient can exaggerate symptoms, and symptom exaggeration is the continuum of behaviors that range from a subconscious exaggeration of the real symptoms to outright fabrication of symptoms otherwise known as malingering. The American Psychiatric Association describes malingering as someone exaggerating symptoms despite having genuine symptoms, and the motivation of this behavior is for secondary gains, such as economic benefits. However, symptom exaggeration occurs because of various reasons. There are various reasons why individuals consciously or unconsciously choose to feign or exaggerate the symptoms of ADHD. An example is that a student can be motivated to feign ADHD to get access to disability status so that they can get more academic support or concessions, including the extra time during tests (Sadek, 2017). Moreover, people who have disabilities are at times eligible to tax benefits, are granted access to government-funded programs and services, and can even have their student loans waived. Other reasons for faking ADHD symptoms are decreased workload and more favorable marking schemes for students.
A survey was done in the laboratory of Professor David Berry at the University of Kentucky and is intended to examine the capability of college students feigning ADHD. The students were put in three groups whereby the first group had students with ADHD who were temporarily off medication, those without ADHD, and those without ADHD, but they had been told to pretend they have it (Druedahl & Sporrong, 2019). The last group of fakers was told that their prize would be 45 dollars if they would convince the assessor that they have ADHD. The students were given five minutes to prepare, and they were allowed to obtain information from Google. All the groups were evaluated using standard ADHD tests by researchers unaware of the group of students they had been assigned. Generally, testing for ADHD is categorized into two broad categories, and that first is self-report. Self-report is whereby patients define the symptoms in reaction to a structured questioning.
The second category is neuropsychological tests, and it is about a patient being asked to perform a specific task. The tests are usually likened to a simple computer game. They are structured such that people who have ADHD will make certain kinds of mistakes on the game because of ADHD symptoms such as impulsivity and inattention. All the groups were tested using multiple approaches (Druedahl & Sporrong, 2019). For self-reported tests, two of them were administered, and they include the ADHA Rating Scale or ARS, which was created by Murphy and Barkley and the Conners Adult ADHD Rating Scale or CAARS. Neither of the tests administered distinguished between those students faking ADHD or those having it. For the multifaceted neuropsychological tests, some of them were successfully faked. Still, others singled out the fakers since they overdid some things, which resulted in severe symptoms that can be witnessed in ADHD patients. What was more troubling for the researchers was that the neuropsychological tests were unable to differentiate between ADHD individuals and those who had no symptoms and were not faking (Druedahl & Sporrong, 2019). The tests couldn’t establish differences between the individuals in the control group and those who had ADHD and yet they are considered to be accurate tests among the psychologists.
Furthermore, in the psychiatry field, there has been a long history of patients feigning symptoms because of legal, financial, and academic motives (Dawson, Wymbs, Evans, & DuPaul, 2019). To deal with the problem, various tests have been developed to detect those faking. There is still no specific test that I used to determine those who are faking ADHD symptoms. Sollman and some of his colleagues tried to develop various malingering tests to see if they could detect those faking ADHD, but no tests were able to pick out those with fake ADHD correctly. In public health, the misdiagnosis of ADHD is a big issue, and the blame is being placed on unreliable tests. Some psychologists argue that the ease with which ADHD tests can be faked plays a significant role in the misdiagnosis of ADHD.
Furthermore, the internet is blamed for some of the misdiagnosis (Dawson, Wymbs, Evans, & DuPaul, 2019). Currently, it is natural for a patient who has an appointment to do some research beforehand, and only five minutes of Google can show a patient what the clinicians are looking for. Therefore, it is easy for the patient to fool themselves that ADHD is why they are experiencing problems like having bad grades. Finally, ADHD researchers need to look more into how patients fake ADHD symptoms and how the neuropsychological tests’ weaknesses can be addressed conclusively.
Fortunately, the psychologist can detect ADHD in several ways. For instance, if a person is self-referred for ADHD disorder and asks precisely for stimulant medication, there is a high probability that the patient is only seeking drugs and is faking ADHD. It is because the issue of stimulant misuse has been a great concern on the college campus (Dawson, Wymbs, Evans, & DuPaul, 2019). Thus, for a doctor who is treating a self-referred patient, there has been independent verification from wither a parent or a guardian who has known them since childhood. The utilization of the ADHD rating scales will not detect fake ADHD since it is accessible to fake poor performance on tests of reading or math ability. The neuropsychological tests provided can sometimes detect malingering, but they need a referral to a specialist.
Furthermore, the doctors who are presently concerned about fake ADHD need to look for objective indicators of impairment like academic performance below expectations ad documented traffic accidents. Also, a verification must be sought from the patient’s parents to determine if the impairing symptoms of the disorders were present before the age of twelve (Dawson, Wymbs, Evans, & DuPaul, 2019). Additionally, since the issue of fake ADHD is of particular concern among the college campus s, it is helpful for a psychologist to speak to a teacher who has had frequent contact with the patient. But in this era of technology, virtual lectures, and substantial lecture halls, it is challenging for a teacher to have significant and frequent interaction with a student. The best way for a psychologist to determine if someone has ADHD or is faking it is by performing a complete diagnosis.
In conclusion, according to available researches, ADHD can be realistically portrayed through the falsification of the symptoms. The fakers are most likely to be successful on the symptom checklist of the condition. One primary reason why people fake the diagnosis of ADHD is because of academic benefits. There are also other secondary benefits since some people want access to the types of drugs that treat ADHD patients, and various reports show the illegal use of the prescriptions. ADHD prescriptions are illicitly used since they enhance alertness, give a person more energy, augment attention, and improve academic and athletic performance. Some of the drugs likewise help alleviate psychological distress and help individuals to deal with weight concerns and restlessness.
Further, the prescriptions can be utilized for recreational purposes and, in some instances, sources of income. Thus, it doesn’t matter if a patient is being examined in a psychiatric or primary care setting. What matters is that the diagnosis of ADHD needs to be done comprehensively and ensure several sources of information are utilized so that the medication that is being offered is not misused.
References
Dawson, A. E., Wymbs, B. T., Evans, S. W., & DuPaul, G. J. (2019). Exploring how adolescents with ADHD use and interact with technology. Journal of Adolescence, 71, 119-137.
Druedahl, L. C., & Sporrong, S. K. (2019). More than meets the eye: A Foucauldian perspective on treating ADHD with medicine. Research in Social and Administrative Pharmacy.
Mapou, R. L. (2019). Counterpoint: Neuropsychological testing is not useful in the diagnosis of ADHD, but…. The ADHD Report, 27(2), 8-12.
Sadek, J. (2017). ADHD and Malingering. In Clinician’s Guide to Adult ADHD Comorbidities (pp. 11-20). Springer, Cham.