Twenty years ago, Berry, a University of Kentucky psychology professor, designed specific testing for patients who feigned injury in order to collect settlement money in head trauma cases. Ranseen, a psychologist in the Department of Psychiatry at UK, performs specialized testing included in evaluations of adults referred for ADHD. Some of these individuals attempt to invent ADHD symptoms, presumably to obtain a prescription for medication or to gain academic accommodations such as more time and other advantages during exams.
"Many clinicians think that they can tell if someone is faking it without using any specialized test measures," Ranseen said. "Sadly, the research says that's not true."
Berry and Ranseen combined neuropsychological forces with UK graduate student Myriam Sollman at the helm, employing head trauma methodologies to examine the ability of college students to feign ADHD. For the study, Sollman, Ranseen and Berry divided students into three groups: students who were diagnosed with ADHD, students without the disorder and those who were told to fake it.
"For each 'faker,' we promised $45 if they could be convincing and 'avoid being detected as a faker,'" Sollman said. Fakers were given five minutes of prep time with Google prior to their evaluations.
Sollman's research confirmed that standard, self-reporting ADHD tests failed to distinguish between students with ADHD and those pretending. It was only after pooling all of the test results that the ADHD imposters were rooted out.
"Our study basically told us that the self-reporting aspect of psychological evaluation testing for ADHD was worth almost nothing," Ranseen said. "The motivations of the person being examined for a disorder are a part of the diagnosis, which is a known variant in the case of many psychological evaluations."
The motives behind acquiring stimulant medication for disorders like ADHD vary, but Berry provides a characteristic example: "A student begins college work in the fall, and it's harder than high school," he said. "They view themselves through the ADHD lens, but then they overdo it a bit."
These patients aren’t trying to intentionally deceive their doctors, although that does happen, Ranseen said.
"A lot of times, you've got a stressed out kid with a small problem, and they make it bigger," he said.
Many students aim to gain access to stimulant medication, with the hope that they will boost academic performance.
"There's a real incentive for normal people to get this medicine," Berry said. "It works — they can focus more. While the incentives aren't as strong as those present in head trauma cases, they are still present."
Students with learning disorders like ADHD are frequently given the opportunity to use additional resources, as well as extra time for coursework and exams.
"This is a function of the information age," Ranseen said. "Kids know that it's about believability, so they'll do what they have to in order to get what they want. There are websites out there that show students and adults how to feign an evaluation to get the drugs. The kids are on top of this; they know the buzz words. It's unbelievable."
Despite anti-malingering tests and their effectiveness with ADHD, many clinicians stand by their old ways.
"This is not a trivial problem," Berry said. "And most clinicians don't use all of these tests."
Sollman hopes that her research results further express the importance of a full cognitive/psychological assessment when physicians, psychiatrists and psychologists evaluate for ADHD.
"We've got the tools," Berry said. "Folks out there just need to be convinced to use them."