The objective of this study was to develop a subtle self-report scale—the Subtle ADHD Malingering Screener (SAMS)—to screen for malingering among individuals reporting symptoms of attention deficit/hyperactivity disorder (ADHD). This study employed a cross-sectional experimental design with an ADHD group, a control group—comprising individuals without ADHD—and a malingering group—comprising individuals without ADHD who were instructed to feign ADHD in their responses. Factor analysis and psychometric testing were conducted to develop a final scale that could distinguish the malingering from the other groups. A 10-item, two-factor solution was obtained for the SAMS, with a sensitivity of 90.3% and specificity of 80.1%. The SAMS presents an innovative approach to help reduce overdiagnosis of ADHD and misuse of prescription stimulants. The efficient, straightforward form of the measure particularly enhances its potential application in both medical and psychosocial clinical settings.
AndersonJ. C.GerbingD. W. (1988). Structural equation modeling in practice: A review and recommended two-step approach. Psychological Bulletin, 103, 411-423.
2.
AngoldA.ErkanliA.EggerH. L.CostelloJ. (2000). Stimulant treatment for children: A community perspective. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 975-984.
3.
BookshR. L.PellaR. D.SinghA. N.GouvierW. D. (2009). Ability of college students to simulate ADHD on objective measures of attention. Journal of Attention Disorders, 31, 325-338.
4.
BooneD. (1998). Internal consistency reliability of the Personality Assessment Inventory with psychiatric inpatients. Journal of Clinical Psychology, 54, 839-843.
5.
BrodM.TeslerL. E.ChristensenT. L. (2009). Qualitative research and content validity: Developing best practices based on science and experience. Quality of Life Research, 18, 1263-1278.
6.
BrownT. A. (2014). Confirmatory factor analysis for applied research (2nd ed.). New York, NY: Guilford Press.
7.
BurkhartB. R.GyntherM. D.ChristianW. L. (1978). Psychological mindedness, intelligence, and item subtlety endorsement patterns on the MMPI. Journal of Clinical Psychology, 34, 76-79.
8.
CattellR. B. (1966). The scree test for the number of factors. Multivariate Behavioral Research, 1, 245-276.
9.
CheethamA. H.HazelJ. E. (1969). Binary (presence-absence) similarity coefficients. Journal of Paleontology, 43, 1130-1136.
10.
ChenL. Y.CrumR. M.StrainE. C.AlexanderG. C.KaufmannC.MojtabaiR. (2016). Prescriptions, nonmedical use, and emergency department visits involving prescription stimulants. Journal of Clinical Psychiatry, 77, 297-304.
11.
CohenJ. (1960). A coefficient of agreement for nominal scales. Educational and Psychological Measurement, 20, 37-46.
12.
CoferC. N.ChanceJ.JudsonA. J. (1949). A study of malingering on the Minnesota Multiphasic Personality Inventory. Journal of Psychology, 27, 491-499.
13.
ComreyA. L. (1988). Factor-analytic methods of scale development in personality and clinical psychology. Journal of Consulting and Clinical Psychology, 56, 754-761.
14.
DeVellisR. F. (2017). Scale development: Theory and applications (Vol. 26, 4th ed.). Thousand Oaks, CA: Sage.
15.
DrennanJ. (2003). Cognitive interviewing: Verbal data in the design and pretesting of questionnaires. Journal of Advanced Nursing, 42, 57-63.
16.
FisherA. B.WatkinsM. W. (2008). ADHD rating scales’ susceptibility to faking in a college student sample. Journal of Postsecondary Education and Disability, 20, 81-92.
17.
FloraD. B.CurranP. J. (2004). An empirical evaluation of alternative methods of estimation for confirmatory factor analysis with ordinal data. Psychological Methods, 9, 466-491.
18.
FranklinS. B.GibsonD. J.RobertsonP. A.PohlmannJ. T.FralishJ. S. (1995). Parallel analysis: A method for determining significant principal components. Journal of Vegetation Science, 6, 99-106.
19.
Garnier-DykstraL. M.CaldeiraK. M.VincentK. B.O’GradyK. E.ArriaA. M. (2012). Nonmedical use of prescription stimulants during college: Four-year trends in exposure opportunity, use, motives, and sources. Journal of American College Health, 60, 226-234.
20.
HairJ. F.BlackW.C.BabinB. J.AndersonR. E.TathamR. L. (2010). Multivariate data analysis (7th ed.). Upper Saddle River, NJ: Pearson.
21.
HarpJ. P.JasinskiL. J.Shandera-OchsnerA. L.MasonL. H.BerryD. T. (2011). Detection of malingered ADHD using the MMPI-2-RF. Psychological Injury and Law, 4, 32-43.
22.
HarrisonA. G. (2006). Adults faking ADHD: You must be kidding!The ADHD Report, 14(4), 1-7.
23.
HathawayS. R.McKinleyJ. C. (1940). A multiphasic personality schedule (Minnesota): I. Construction of the schedule. Journal of Psychology, 10, 249-254.
24.
HaynesS. N.RichardD.KubanyE. S. (1995). Content validity in psychological assessment: A functional approach to concepts and methods. Psychological Assessment, 7, 238-247.
25.
JachimowiczG.GeiselmanR. E. (2004). Comparison of ease of falsification of attention deficit hyperactivity disorder diagnosis using standard behavioral rating scales. Cognitive Science Online, 2(1), 6-20.
26.
JasinskiL. J.RanseenJ. D. (2011). Malingered ADHD evaluations: A further complication for accommodations reviews. The Bar Examiner, 79, 6-16.
27.
JensenP. S.HinshawS. P.SwansonJ. M.GreenhillL. L.ConnersC. K.ArnoldL. E.. . . MarchJ. S. (2001). Findings from the NIMH Multimodal Treatment Study of ADHD (MTA): Implications and applications for primary care providers. Journal of Developmental & Behavioral Pediatrics, 22, 60-73.
28.
KuhnG. M. (1973). The phi coefficient as an index of ear differences in dichotic listening. Cortex, 9, 450-457.
29.
LanyonR. I. (1970). Development and validation of a psychological screening inventory. Journal of Consulting and Clinical Psychology, 35, 1-24.
30.
LanyonR. I. (1997). Detecting deception: Current models and directions. Clinical Psychology: Science and Practice, 4, 377-387.
31.
Lees-HaleyP. R.EnglishL. T.GlennW. J. (1991). A fake bad scale on the MMPI-2 for personal injury claimants. Psychological Reports, 68, 203-210.
32.
MillerG. A. (1985). The substance abuse subtle screening inventory (SASSI) manual. Springville, IN: SASSI Institute.
33.
MoreyL. C. (1991). Personality Assessment Inventory professional manual. Lutz, FL: Psychological Assessment Resources.
34.
MussoM. W.GouvierW. D. (2012). Why is this so hard? A review of detection of malingered ADHD in college students. Journal of Attention Disorders, 18, 186-201. doi:10.1177/1087054712441970
35.
MuthénL. K.MuthénB. O. (1998-2017). Mplus user’s guide (8th ed.). Los Angeles, CA: Muthén & Muthén.
36.
MyerholtzL. E.RosenbergH. (1997). Screening DUI offenders for alcohol problems: Psychometric assessment of the substance abuse subtle screening inventory. Psychology of Addictive Behaviors, 11, 155-165.
37.
MyerholtzL.RosenbergH. (1998). Screening college students for alcohol problems: Psychometric assessment of the SASSI-2. Journal of Studies on Alcohol and Drugs, 59, 439-446.
NunnallyJ. (1978). Psychometric methods (2nd ed.). New York, NY: McGraw-Hill.
40.
O’ConnorB. P. (2000). SPSS and SAS programs for determining the number of components using parallel analysis and Velicer’s MAP test. Behavior Research Methods, Instruments, & Computers, 32, 396-402.
41.
PerroneJ.NelsonL. S. (2012). Medication reconciliation for controlled substances: An “ideal” prescription-drug monitoring program. New England Journal of Medicine, 366, 2341-2343.
42.
QuinnC. A. (2003). Detection of malingering in assessment of adult ADHD. Archives of Clinical Neuropsychology, 18, 379-395.
43.
RhemtullaM.Brosseau-LiardP. E.SavaleiV. (2012). When can categorical variables be treated as continuous? A comparison of robust continuous and categorical SEM estimation methods under suboptimal conditions. Psychological Methods, 17, 354-373.
44.
RiosJ.MoreyL. C. (2013). Detecting feigned ADHD in later adolescence: An examination of three PAI-A negative distortion indicators. Journal of Personality Assessment, 95, 594-599.
45.
RogersR.UstadK. L.SalekinR. T. (1998). Convergent validity of the Personality Assessment Inventory: A study of emergency referrals in a correctional setting. Assessment, 5, 3-12.
46.
SuhrJ.HammersD.Dobbins-BucklandK.ZimakE.HughesC. (2008). The relationship of malingering test failure to self-reported symptoms and neuropsychological findings in adults referred for ADHD evaluations. Archives of Clinical Neuropsychology, 23, 521-530.
47.
SullivanB. K.MayK.GalballyL. (2007). Symptom exaggeration by college adults in attention-deficit hyperactivity disorder and learning disorder assessments. Applied Neuropsychology, 14, 189-207.
48.
TuchaL.SontagT. A.WalitzaS.LangeK. W. (2009). Detection of malingered attention deficit hyperactivity disorder. ADHD Attention Deficit and Hyperactivity Disorders, 1, 47-53.
WeigelM.MestonC.RosenR. (2005). The Female Sexual Function Index (FSFI): Cross-validation and development of clinical cutoff scores. Journal of Sex & Marital Therapy, 31, 1-20.
51.
WillisG. B. (2005). Cognitive interviewing: A tool for improving questionnaire design. Thousand Oaks, CA: Sage.
52.
WooleyC. N.RogersR.FiducciaC. E.KelseyK. (2012). The effectiveness of substance use measures in the detection of full and partial denial of drug use. Assessment, 20, 670-680. doi:10.1177/1073191112447098
53.
YoungJ. C.GrossA. M. (2011). Detection of response bias and noncredible performance in adult attention-deficit/hyperactivity disorder. Archives of Clinical Neuropsychology, 26, 165-175.
54.
YuC. Y. (2002). Evaluating cutoff criteria of model fit indices for latent variable models with binary and continuous outcomes (Unpublished doctoral dissertation). University of California, Los Angeles, CA. Retrieved from https://www.statmodel.com/download/Yudissertation.pdf
55.
ZgierskaA.MillerM.RabagoD. (2012). Patient satisfaction, prescription drug abuse, and potential unintended consequences. Journal of the American Medical Association, 307, 1377-1378.
56.
ZitoJ. M.SaferD. J.MagderL. S.GardnerJ. F.ZarinD. A. (1999). Psychotherapeutic medication patterns for youths with attention-deficit/hyperactivity disorder. Archives of Pediatrics & Adolescent Medicine, 153, 1257-1263.
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