Symptom Overreporting Research Articles

Examining the utility of the BAARS-IV scales as embedded symptom validity indicators for adult attention-deficit/hyperactivity disorder evaluations

Objective: This study investigated whether extreme cut-scores on the Barkley Adult Attention-Deficit/Hyperactivity Disorder (ADHD) Rating Scale-Fourth Edition (BAARS-IV) self-report scales could serve as symptom overreporting indicators in adult ADHD evaluations. Method: The sample consisted of 162 adults who underwent a neuropsychological evaluation for ADHD. Patients were classified into valid (n = 115) and invalid (n = 47) groups based on multiple criterion symptom validity tests. Results: Overreporting cut-scores identified for each of the BAARS-IV scales demonstrated acceptable classification accuracy or better. The Current Total scale yielded the highest classification accuracy (area under the curve of .83). An optimal raw cut-score of ≥56 for this scale yielded 47% sensitivity when upholding ≥90% specificity. A cut-score of ≥31 for the Current Inattention scale (90% specificity; 47% sensitivity) and ≥29 for the Current Sluggish Cognitive Tempo scale (88% specificity; 46% sensitivity) were also relatively strong indicators of overreporting. The Current Total and Current Sluggish Cognitive Tempo scales captured nonredundant aspects of symptom validity, and using them together increased sensitivity to 57% while maintaining ≥90% specificity. Conclusions: Findings provide preliminary support for the criterion and construct validity of extreme cut-scores on the BAARS-IV Current Sluggish Cognitive Tempo, Current Inattention, and Current Total scales as indicators of ADHD symptom overreporting. However, employing the cut-scores from the Current Sluggish Cognitive Tempo (≥29) and Current Total (≥56) together may be the most promising way to detect overreporting. Scores above both of these cut-points should, at a minimum, prompt further investigation into the validity of a patient’s reported symptoms.

Internalizing and somatic symptoms influence the discrepancy between subjective and objective cognitive difficulties in adults with ADHD who have valid and invalid test scores.

This study investigated the relationship between various intrapersonal factors and the discrepancy between subjective and objective cognitive difficulties in adults with attention-deficit hyperactivity disorder (ADHD). The first aim was to examine these associations in patients with valid cognitive symptom reporting. The next aim was to investigate the same associations in patients with invalid scores on tests of cognitive symptom overreporting. The sample comprised 154 adults who underwent a neuropsychological evaluation for ADHD. Patients were divided into groups based on whether they had valid cognitive symptom reporting and valid test performance (n = 117) or invalid cognitive symptom overreporting but valid test performance (n = 37). Scores from multiple symptom and performance validity tests were used to group patients. Using patients' scores from a cognitive concerns self-report measure and composite index of objective performance tests, we created a subjective-objective discrepancy index to quantify the extent of cognitive concerns that exceeded difficulties on objective testing. Various measures were used to assess intrapersonal factors thought to influence the subjective-objective cognitive discrepancy, including demographics, estimated premorbid intellectual ability, internalizing symptoms, somatic symptoms, and perceived social support. Patients reported greater cognitive difficulties on subjective measures than observed on objective testing. The discrepancy between subjective and objective scores was most strongly associated with internalizing and somatic symptoms. These associations were observed in both validity groups. Subjective cognitive concerns may be more indicative of the extent of internalizing and somatic symptoms than actual cognitive impairment in adults with ADHD, regardless if they have valid scores on cognitive symptom overreporting tests.

B - 126 Posttraumatic Stress Disorder Symptoms as a Predictor of Invalid Attention-Deficit/Hyperactivity Disorder and General Psychiatric Symptom Reporting among Adult Neuropsychology Referrals

Abstract Objective Diagnosing Attention-Deficit/Hyperactivity Disorder (ADHD) in adulthood is complicated by the nonspecific nature of attention complaints, which overlap with most forms of internalizing psychopathology as well as elevated rates of invalid symptom overreporting. This study assessed the relationship between posttraumatic stress disorder (PTSD) symptoms and overreporting of both ADHD and general psychological symptoms. Method Data from 308 consecutive adults (mean age = 29.0; mean education = 16.09; 57.5% female, 42.5% male; 35% White, 27% Hispanic, 18% Black, 13% Asian, 7% Other) referred for neuropsychological evaluation of possible ADHD were administered the PTSD Checklist for DSM-5 (PCL-5) and embedded symptom validity tests (SVTs) on the Clinical Assessment of Attention Deficit-Adult (CAT-A) and the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF). Patients were classified as overreporting/no overreporting ADHD and general psychiatric symptoms based on elevations on the CAT-A and MMPI-2-RF overreporting SVTs, respectively. Results Logistic regressions showed that higher PCL-5 scores significantly predicted overreporting of both ADHD symptoms on CAT-A (X2 = 7.47, p = 0.006; Classification Accuracy = 85.1%; Nagelkerke R2 = 0.04; B.025; p = 0.007) and psychiatric symptoms on MMPI-2-RF (X2 = 58.76, p < 0.001; Classification Accuracy = 71.4%; Nagelkerke R2 = 0.35; B = -1.92; p < 0.001), with significantly greater variance predicted for overreporting of psychiatric symptoms. Conclusions Higher PTSD symptoms predicted overreporting of ADHD symptoms (CAT-A) and, more significantly, broad psychopathology (MMPI-2-RF). Findings reinforce the necessity of SVTs when evaluating ADHD among adults, particularly in the context of elevated PTSD symptoms, and also indicate that neuropsychologists should consider routinely assessing patients’ trauma history/symptomatology during ADHD evaluations to improve diagnostic accuracy.

Psychometric validation of the Italian Self-Report Symptoms inventory (SRSI): Factor structure, construct validity, and diagnostic accuracy

The Self-Report Symptom Inventory (SRSI) is a novel tool designed to detect symptom overreporting and other forms of noncredible responding. Unlike existing scales, the SRSI includes genuine and pseudosymptoms scales covering cognitive, affective, motor, pain, and post-traumatic stress disorder domains. The present study aims to investigate the psychometric properties of the Italian Version of the SRSI (SRSI-It), in particular, its factor structure, reliability, convergent and discriminant validity, and diagnostic accuracy. Data from 1180 healthy participants showed a hierarchical structure with higher-order constructs for genuine symptoms and pseudosymptoms, each comprising five subscales. The SRSI-It showed a strong convergent validity with the Structured Inventory of Malingered Symptomatology and discriminant validity through low correlations with the Psychopathic Personality Inventory-Revised. Receiver operating characteristic analysis determined cut scores of 6 (95% specificity) and 9 (98% specificity) for pseudosymptoms, with a Ratio Index score of 0.289 (82% specificity). In summary, the SRSI-It appears to be a promising tool for identifying symptom exaggeration in clinical and forensic contexts, ultimately enhancing the quality and reliability of evaluations in these contexts.

The Impact of Adverse Childhood Experiences on Symptom and Performance Validity Tests Among a Multiracial Sample Presenting for ADHD Evaluation.

Adverse childhood experiences (ACEs) are commonly reported in individuals presenting for attention-deficit hyperactivity disorder (ADHD) evaluation. Performance validity tests (PVTs) and symptom validity tests (SVTs) are essential to ADHD evaluations in young adults, but extant research suggests that those who report ACEs may be inaccurately classified as invalid on these measures. The current study aimed to assess the degree to which ACE exposure differentiated PVT and SVT performance and ADHD symptom reporting in a multi-racial sample of adults presenting for ADHD evaluation. This study included 170 adults referred for outpatient neuropsychological ADHD evaluation who completed the ACE Checklist and a neurocognitive battery that included multiple PVTs and SVTs. Analysis of variance was used to examine differences in PVT and SVT performance among those with high (≥4) and low (≤3) reported ACEs. Main effects of the ACE group were observed, such that high ACE group reporting demonstrated higher scores on SVTs assessing ADHD symptom over-reporting and infrequent psychiatric and somatic symptoms on the Minnesota Multiphasic Personality Inventory-2-Restructured Form. Conversely, no significant differences emerged in total PVT failures across ACE groups. Those with high ACE exposure were more likely to have higher scores on SVTs assessing over-reporting and infrequent responses. In contrast, ACE exposure did not affect PVT performance. Thus, ACE exposure should be considered specifically when evaluating SVT performance in the context of ADHD evaluations, and more work is needed to understand factors that contribute to different patterns of symptom reporting as a function of ACE exposure.

Cross-validating the Clinical Assessment of Attention Deficit–Adult symptom validity scales for assessment of attention deficit/hyperactivity disorder in adults

ABSTRACT Introduction The Clinical Assessment of Attention Deficit-Adult is among the few questionnaires that offer validity indicators (i.e., Negative Impression [NI], Infrequency [IF], and Positive Impression [PI]) for classifying underreporting and overreporting of attention-deficit/hyperactivity disorder (ADHD) symptoms. This is the first study to cross-validate the NI, IF, and PI scales in a sample of adults with suspected or known ADHD. Method Univariate and multivariate analyses were conducted to examine the independent and combined value of the NI, IF, and PI scores in predicting invalid symptom reporting and neurocognitive performance in a sample of 543 adults undergoing ADHD evaluation. Results The NI scale demonstrated better classification accuracy than the IF scale in discriminating patients with and without valid scores on measures of overreporting. Only NI scores significantly predicted validity status when used in combination with IF scores. Optimal cut-scores for the NI (≤51; 30% sensitivity / 90% specificity) and IF (≥4; 18% sensitivity / 90% specificity) scales were consistent with those reported in the original manual; however, these indicators poorly discriminated patients with invalid and valid neurocognitive performance. The PI scale demonstrated acceptable classification accuracy in discriminating patients with invalid and valid scores on measures of underreporting, albeit with an optimal cut-score (≥27; 36% sensitivity / 90% specificity) lower than that described in the manual. Conclusion Findings provide preliminary evidence of construct validity for these scales as embedded validity indicators of symptom overreporting and underreporting. However, these scales should not be used to guide clinical judgment regarding the validity of neurocognitive test performance.

Cognitive Underperformance in a Mixed Neuropsychiatric Sample at Diagnostic Evaluation of Adult ADHD.

(1) Background: The clinical assessment of attention-deficit/hyperactivity disorder (ADHD) in adulthood is known to show non-trivial base rates of noncredible performance and requires thorough validity assessment. (2) Objectives: The present study estimated base rates of noncredible performance in clinical evaluations of adult ADHD on one or more of 17 embedded validity indicators (EVIs). This study further examines the effect of the order of test administration on EVI failure rates, the association between cognitive underperformance and symptom overreporting, and the prediction of cognitive underperformance by clinical information. (3) Methods: A mixed neuropsychiatric sample (N = 464, ADHD = 227) completed a comprehensive neuropsychological assessment battery on the Vienna Test System (VTS; CFADHD). Test performance allows the computation of 17 embedded performance validity indicators (PVTs) derived from eight different neuropsychological tests. Further, all participants completed several self- and other-report symptom rating scales assessing depressive symptoms and cognitive functioning. The Conners' Adult ADHD Rating Scale and the Beck Depression Inventory-II were administered to derive embedded symptom validity measures (SVTs). (4) Results and conclusion: Noncredible performance occurs in a sizeable proportion of about 10% up to 30% of individuals throughout the entire battery. Tests for attention and concentration appear to be the most adequate and sensitive for detecting underperformance. Cognitive underperformance represents a coherent construct and seems dissociable from symptom overreporting. These results emphasize the importance of performing multiple PVTs, at different time points, and promote more accurate calculation of the positive and negative predictive values of a given validity measure for noncredible performance during clinical assessments. Future studies should further examine whether and how the present results stand in other clinical populations, by implementing rigorous reference standards of noncredible performance, characterizing those failing PVT assessments, and differentiating between underlying motivations.

Comorbidity and polypharmacy impact neurobehavioral symptoms and symptom validity failure among post-9/11 veterans with mild traumatic brain injury.

The study aimed to examine the association between post-concussive comorbidity burdens [post-traumatic stress disorder (PTSD), depression, and/or headache] and central nervous system (CNS) polypharmacy (five or more concurrent medications) with reported neurobehavioral symptoms and symptom validity screening among post-9/11 veterans with a history of mild traumatic brain injury (mTBI). Administrative medical record data from the Department of Veterans Affairs (VA) were used in the study. Post-9/11 veterans with mTBI and at least 2 years of VA care between 2001 and 2019 who had completed the comprehensive traumatic brain injury evaluation (CTBIE) were included in the study. Retrospective cross-sectional design was used in the study. Neurobehavioral Symptom Inventory (NSI), International Classification of Diseases, Ninth Revision, and Clinical Modification diagnosis codes were included in the study. Of the 92,495 veterans with a history of TBI, 90% had diagnoses of at least one identified comorbidity (PTSD, depression, and/or headache) and 28% had evidence of CNS polypharmacy. Neurobehavioral symptom reporting and symptom validity failure was associated with comorbidity burden and polypharmacy after adjusting for sociodemographic characteristics. Veterans with concurrent diagnoses of PTSD, depression, and headache were more than six times more likely [Adjusted odds ratio = 6.55 (99% CI: 5.41, 7.92)]. to fail the embedded symptom validity measure (Validity-10) in the NSI. TBI-related multimorbidity and CNS polypharmacy had the strongest association with neurobehavioral symptom distress, even after accounting for injury and sociodemographic characteristics. Given the regular use of the NSI in clinical and research settings, these findings emphasize the need for comprehensive neuropsychological evaluation for individuals who screen positively for potential symptom overreporting, the importance of multidisciplinary rehabilitation to restore functioning following mTBI, and the conscientious utilization of symptom validity measures in research efforts.

MMPI-2-RF Profiles of Treatment-Seeking Veterans in a VA Pain Clinic and Associations with Markers of Physical Performance.

Chronic pain is a debilitating condition for many military Veterans and is associated with posttraumatic stress disorder (PTSD). This study examined the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) in 144 Veterans (88.2% male, mean age = 57.95years) recruited from a VA outpatient pain clinic and associations with self-reported pain severity, pain-related interference in daily activities, prescription opioid use, and objective metrics of physical performance on tasks impacted by pain (walking, stair climbing, grip strength, indexed by a single latent variable). Among the cohort with valid responses on the MMPI-2-RF (n = 117) and probable PTSD, mean Somatic Complaints (RC1) and Ideas of Persecution (RC6) scores were clinically elevated. All MMPI-2-RF scales were more strongly correlated with self-reported pain interference than severity. Regressions revealed associations between self-rated pain interference (but not pain or PTSD severity) and physical performance scores (β = .36, p = .001). MMPI-2-RF overreporting Validity and Higher-Order scales contributed incremental variance in predicting physical performance, including Infrequent Psychopathology Responses (β = .33, p = .002). PTSD severity was associated with prescription opioid use when accounting for the effects of over-reported somatic and cognitive symptoms (odds ratio 1.05, p ≤ .025). Results highlight the role of symptom overreporting and perceptions of functional impairment to observable behaviors among individuals with chronic pain.

Detecting Symptom Overreporting – Equivalence of the Dutch and German Self-Report Symptom Inventory

Abstract. The Self-Report Symptom Inventory (SRSI) intends to measure symptom overreporting. To assess the Dutch and German SRSI equivalence, both versions were split into two half-forms. Forty bilingual participants were randomly allocated to two groups that completed the first half in German and the second half in Dutch or vice versa. Each group completed the SRSI honestly and then under feigning instructions. For both conditions, the Dutch and German SRSI did not statistically significantly differ within and across the two groups. For most comparisons, the Bayes factor was ≥ 3, indicating moderate evidence favoring the equivalence of language versions and half-forms. Genuine and pseudosymptoms endorsement was significantly higher in the feigning than in the honest condition (both Zs = 5.44, r rb = 1.00). The SRSI standard cut score correctly identified honest responding and detected 80% of feigned responses. Our results align with Giger and Merten’s (2019) German and French SRSI equivalence study.

Insular Connectivity Is Associated With Self-Appraisal of Cognitive Function After a Concussion.

Concussion is associated with acute cognitive impairments, with declines in processing speed and reaction time being common. In the clinical setting, these issues are identified via symptom assessments and neurocognitive test (NCT) batteries. Practice guidelines recommend integrating both symptoms and NCTs into clinical decision-making, but correlations between these measures are often poor. This suggests that many patients experience difficulties in the self-appraisal of cognitive issues. It is presently unclear what neural mechanisms give rise to appraisal mismatch after a concussion. One promising target is the insula, which regulates aspects of cognition, particularly interoception and self-monitoring. The present study tested the hypothesis that appraisal mismatch is due to altered functional connectivity of the insula to frontal and midline structures, with hypo-connectivity leading to under-reporting of cognitive issues and hyper-connectivity leading to over-reporting. Data were collected from 59 acutely concussed individuals and 136 normative controls, including symptom assessments, NCTs and magnetic resonance imaging (MRI) data. Analysis of resting-state functional MRI supported the hypothesis, identifying insular networks that were associated with appraisal mismatch in concussed athletes that included frontal, sensorimotor, and cingulate connections. Subsequent analysis of diffusion tensor imaging also determined that symptom over-reporting was associated with reduced fractional anisotropy and increased mean diffusivity of posterior white matter. These findings provide new insights into the mechanisms of cognitive appraisal mismatch after a concussion. They are of particular interest given the central role of symptom assessments in the diagnosis and clinical management of concussion.

A-220 Screening for Cognitive Over-Reporting with the Neurobehavioral Symptom Inventory

Abstract Objective Considerable research in veteran and military populations has focused on the development of embedded symptom validity indicators on the Neurobehavioral Symptom Inventory (NSI) including the low frequency (LOW6), negative impression management (NIM5), and validity (VAL10) scales. These measures have been less studied in other clinical settings. This study examined embedded NSI validity scales in a rehabilitation setting. Method Participants (N = 94) underwent outpatient neuropsychological evaluation using the NSI, MMPI-2-RF, and Memory Complaints Inventory (MCI), among other measures. Cognitive symptom over-reporting was psychometrically determined if the MCI (average score > 39) and MMPI-2-RF (RBS > 79 T or FBS > 79 T) were elevated. Results Thirty-four participants (36%) met over-reporting criteria. NSI total scores were significantly different between over-reporting (M = 48.7, SD = 12.2) and non-over-reporting (M = 28.1, SD = 14.3) groups (p < .0001, d = 1.5). Receiver operating characteristic analysis using embedded NSI scales to classify cases showed area under the curve (AUC) values of .82 for LOW6 and NIM5, and .83 for VAL10. A VAL10 cutoff (>18) showed sensitivity of 56% and 90% specificity. VAL10 scores of 4 or below demonstrated 100% sensitivity and may be considered evidence that additional assessment of cognitive over-reporting is not needed. Conclusion Findings support the utility of NSI validity indicators to screen for cognitive over-reporting in a rehabilitation setting.

Psychometric Performance of the Miller Forensic Assessment of Symptoms Test (M-FAST) in Veteran PTSD Assessment.

This study examined the psychometric properties of a widely used measure of symptom exaggeration, the Miller Forensic Assessment of Symptoms Test (M-FAST, Miller, 2001), in a sample of 209 (83.7% male) trauma-exposed veterans (57.9% probable current posttraumatic stress disorder; PTSD). M-FAST total scores evidenced acceptable internal consistency, but several subscales showed poor internal consistency. Factor analytic and item-response theory analyses identified seven poorly performing items. Comparisons with other measures of psychopathology and response validity (including subscales from the Minnesota Multiphasic Personality Inventory-2 Restructured Form) revealed that M-FAST scores were highly correlated with indices of psychopathology while less strongly associated with measures of symptom over-reporting. Empirically and clinically-derived (using a follow-up testing-the-limits procedure) revised M-FAST scores failed to improve the measure's psychometric performance. Results raise concerns about the validity of the M-FAST for identifying malingering in veterans with PTSD and carry implications for access to care and forensic evaluations in this population.

Validating the usefulness of the NSI validity-10 with the MMPI-2-RF

Purpose/Aim of the Study: The Neurobehavioral Symptom Inventory (NSI) is a 22-item self-report measure created to quantify the somatosensory, cognitive, and affective symptoms of Post-concussive Syndrome. Developers of the NSI used a subset of 10 items, the Validty-10, to measure symptom overreporting. We compared the Validity-10 versus the remaining NSI items (i.e., the Remaining-12) for how accurately they detect symptom exaggeration on the Minnesota Multiphasic Personality Inventory Second Edition - Restructured Form (MMPI-2-RF).Materials and Methods: We used a sample of 45 veterans evaluated in a Polytrauma/TBI Clinic of a Midwest VA Healthcare System who completed the NSI and MMPI-2-RF.Results: The Vaidity-10, Remaining-12, and Total Score all strongly correlated with mean of the MMPI-2-RF validity scales (r = .65, .67, and .70, respectively), illustrating equivalency among the various NSI scores. Groups were created based on significant T score elevation on any MMPI-2-RF validity scale (i.e. F-r > 119, or Fp-r, F-s, FBS, or RBS > 99). ROC analyses demonstrated that areas under the curve were equivalent for NSI Total Score (.84), Validity-10 (.81), and Remaining-12 (.81) in detecting overreporting.Conclusions: These findings do not support the notion that the Validity-10 has unique utility as an embedded symptom validity scale and highlights the likelihood that NSI Total Score can also serve this function.

Prevalence of overreporting on symptom validity tests in a large sample of psychosomatic rehabilitation inpatients

Objective: Noncredible symptom claims, regularly expected in forensic contexts, may also occur in clinical and rehabilitation referral contexts. Hidden motives and secondary gain expectations may play a significant role in clinical patients. We studied the prevalence of noncredible symptom report in patients treated for minor mental disorders in an inpatient setting.Method: Five hundred and thirty seven clinical inpatients of a psychosomatic rehabilitation center were studied (mean age: 50.2 years; native speakers of German). They were referred for treatment of depression, anxiety, somatoform disorder, adjustment disorder, and neurasthenia. Results of two symptom validity tests (Structured Inventory of Malingered Symptomatology, SIMS; Self-Report Symptom Inventory, SRSI) and the Beck Depression Inventory–II (BDI–II) were analyzed.Results: At screening level, 34.5% and 29.8% of the patients were found to presumably overreport symptoms on the SIMS and SRSI, respectively. At the standard cut score of the SRSI (maximum false positive rate: 5%), the proportion of diagnosed overreporting was 18.8%. SIMS and SRSI pseudosymptom endorsement correlated at .73. Highly elevated depressive symptom claims with BDI–II scores above 40, found in 9.3% of the patients, were associated with elevated pseudosymptom endorsement. Moreover, extended times of sick leave and higher expectations of disability pension were associated with elevated pseudosymptom endorsement.Conclusions: The prevalence of symptom overreporting in some clinical patient groups is a serious, yet underinvestigated problem. The current estimates yielded a high prevalence of distorted, noncredible symptom claims in psychosomatic rehabilitation patients. The challenges arising to health professionals working in such settings are immense and need more consideration.

The Self-Report Symptom Inventory as an Instrument for Detecting Symptom Over-Reporting

Abstract. The recently developed Self-Report Symptom Inventory (SRSI) intends to provide an alternative approach to the detection of symptom over-reporting. Unlike other measures, the SRSI includes both non-existent symptoms (i.e., pseudosymptoms) and genuine symptoms. Previous research using the German SRSI showed that people who exaggerate their complaints over-endorse both types of symptoms. In the current simulation experiment, we tested whether the Dutch and English SRSI are effective in identifying over-reporting by comparing SRSI scores of an honest group ( n = 51) with those of two experimental simulator groups (pain, n = 54; anxiety, n = 53). The pain and anxiety simulators endorsed significantly more genuine symptoms and pseudosymptoms than honest participants (ηp2 = .50 and ηp2 = .30, respectively). Furthermore, pain and anxiety over-reporters specifically over-endorsed symptoms corresponding to their simulation instructions (Cohen’s ds > 0.77). Using the recommended cut-off score, the SRSI detected 48% of pain over-reporters and 73% of anxiety over-reporters, with areas under the curve (AUC) ranging from .88 to .91. These results indicate that the SRSI is a promising tool for identifying over-reporting, but further research with clinical samples is needed.

The Cry for Help in Psychological Injury and Law: Concepts and Review

The cry for help is one of the explanations of results indicating negative impression management on symptom validity tests (SVTs) and respondent validity scales of personality and related inventories used in the area of psychological/psychiatric injury and law. One common interpretation of scale/test findings like these is that respondents are exaggerating, and their symptoms are due to feigning or even malingering. However, research shows that patients with scale/test results on these measures and inventories that indicate symptom over-reporting might be expressing genuine extreme psychopathology or emotional distress. A related possibility is that the respondents are catastrophizing, thinking the worst, desperate and pleading for understanding and help. That is, they might be “crying out for help.” The cry for help motivation in the context of psychiatric forensic disability and related psychiatric/psychological evaluations is poorly defined in the literature, leading to contradictory research results and interpretations. Also, certain conditions and disorders that are relevant to forensic disability evaluations and related contexts might, in and of themselves, include a cry for help, complicating the forensic conclusion (e.g., dissociation, somatic symptom disorder). The present paper addresses definitional issues related to the cry for help, including its conscious/unconscious status, reviews the literature on it, suggests ways of measuring it (and the prevalence of malingering), indicates the ethical scope of when it should be used, and offers research strategies to improve the reliability and validity of its use in the forensic disability and related evaluation context.

Distress Tolerance and Symptom Severity as Mediators of Symptom Validity Failure in Veterans With PTSD.

Performance validity tests (PVTs) and symptom validity tests (SVTs) are necessary in clinical and research contexts. The extent to which psychiatric distress contributes to failure on these tests is unclear. The authors hypothesized that the relation between posttraumatic stress disorder (PTSD) and validity would be serially mediated by distress tolerance and symptom severity. Participants included 306 veterans, 110 of whom met full criteria for current PTSD. PVTs included the Medical Symptom Validity Test (MSVT) and b Test. The Structured Inventory of Malingered Symptomatology (SIMS) was used to measure symptom validity. MSVT failure was significantly and directly associated with PTSD severity (B=0.05, CI=0.01, 0.08) but not distress tolerance or PTSD diagnosis. b Test performance was not significantly related to any variable. SIMS failure was significantly associated with PTSD diagnosis (B=0.71, CI=0.05, 1.37), distress tolerance (B=-0.04, CI=-0.07, -0.01), and symptom severity (B=0.07, CI=0.04, 0.09). The serial mediation model significantly predicted all SIMS subscales. PTSD severity was associated with failing a memory-based PVT but not an attention-based PVT. Neither PVT was associated with distress tolerance or PTSD diagnosis. SVT failure was associated with PTSD diagnosis, poor distress tolerance, and high symptomatology. For veterans with PTSD, difficulty managing negative emotional states may contribute to symptom overreporting. This may reflect exaggeration or an inability to tolerate stronger negative affect, rather than a "cry for help."

Assessing ADHD in college students: Integrating multiple evidence sources with symptom and performance validity data.

Prior research supports the use of multiple types of evidence from multiple sources when assessing ADHD in adults. However, limited research has examined how to best integrate the resulting set of data into a well-supported diagnostic conclusion. Moreover, clients sometimes overreport symptoms or display low effort on performance tasks, further complicating the interpretation of assessment data. The present study examined self-ratings and observer (e.g., parent) ratings of symptoms as well as performance task data from 514 postsecondary students assessed for ADHD at a university-affiliated clinic. Observer ratings were more reliable than self-ratings and were more likely to be corroborated by other data. The 2 types of ratings showed moderate to large relationships with each other as continuous variables (.32 < r < .52) while agreement around categorical symptom cutoffs was slight or fair (.12 < κ < .32). Both types of ratings showed only small relationships with a performance test designed to assess ADHD symptoms. Approximately half of the cases in the sample had at least 1 piece of potentially noncredible data (suggesting potential symptom overreporting, inconsistent responding, or inadequate effort). Requiring ratings from multiple informants (as opposed to a single informant) of clinically significant symptoms for a diagnosis substantially reduced the effect of noncredible data, while also reducing the number of diagnoses by approximately half. Implications of these and other findings for practice and future research are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

When Patients Overreport Symptoms: More Than Just Malingering

Mental-health patients may report more symptoms than they actually experience. Experts and laypeople often view this overreporting as a sign of malingering. We show that there are multiple pathways to symptom overreporting: carryover effects from previous tests that lower the threshold for answering affirmatively to symptom items, suggestive misinformation that escalates symptom reports, inattentive responding that promotes indiscriminate endorsement of symptoms, and personality traits that bias symptom reports in an upward direction. A one-sided focus on malingering may distract from a research agenda that may contribute to knowledge accumulation in this domain.