February 18, 2021
Many college students truly have ADHD and deserve to be treated but some attempt to fake ADHD symptoms with the goal of getting stimulant medications for non-medical uses such as studying and getting high. Some students who fake ADHD also seek to gain accommodations that would give them additional time to complete exams. To address this issue, two psychologists examined data from 514 university students being assessed for ADHD to evaluate the ability of assessment tools to detect students who fake ADHD symptoms.
All participants had asked to be assessed to determine whether they could qualify for disability services. This was therefore by no means a random sample of university students, and could be expected to include some non-ADHD individuals seeking the benefits of an ADHD diagnosis.; however, this offered a good opportunity to explore which combination of tools would yield the best accuracy, and be best at excluding malingerers.
That was achieved by using both multiple informants and multiple assessment tools, and comparing results. Self-assessment was supplemented by assessment by other informants (e.g. parent, partner, friend, or other relative). These were supplemented with symptom validity tests to check for telltale highly inconsistent symptom reporting, or symptom exaggeration, which could signal false positives.
On the other hand, some individuals with ADHD have executive functioning problems that may make it difficult for them to reliably appraise their own symptoms on self-assessment tests, which can lead to false negatives. Performance validity tests were therefore also administered, in order to detect poor effort during evaluation, which could lead to false negatives.
Observer reporting was found to be more reliable than self-reporting, with significantly lower inconsistency scores (p< .001), and significantly higher exaggeration scores (p < .001). More than twice as many self-reports showed evidence of symptom exaggeration as did observer reports. This probably understates the problem when one considers that the observer reports were performed not by clinicians but by parents and partners who may themselves have had reasons to game the tests in favor of an ADHD diagnosis.
Even so, the authors noted, “External incentives such as procurement of a desired controlled substance or eligibility for a desired disability accommodation are likely to be of more perceived value to those who directly obtain them.” They suggested compensating for this by making ADHD diagnoses only on the basis of positive observer tests in addition to self-reports: “Applying an ‘and’ rule—one where both self- and observer reports were required to meet the diagnostic threshold— generally cut the proportions meeting various thresholds at least in half and washed out the differences between the adequate and inadequate symptom validity groups.”
They also recommended including formal tests of response validity, using both symptom validity tests and performance validity tests. Overall, they found that just over half the subsample of 410 students administered performance validity tests demonstrated either inadequate symptom or performance validity.
Finally, they recommended “that clinicians give considerable weight to direct, objective evidence of functional impairment when making decisions about the presence of ADHD in adults. The degree to which symptoms cause significant difficulty functioning in day-to-day life is a core element of the ADHD diagnostic criteria (American Psychiatric Association,2013), and it cannot be assumed that significant symptoms cause such difficulty, as symptoms are only moderately associated with functional impairment. we urge clinicians to procure objective records (e.g., grade transcripts, work performance evaluations, disciplinary and legal records) to aid in determining functional impairment in adults assessed for ADHD.”
Jason M. Nelson and Benjamin J. Lovett, “Assessing ADHD in College Students: Integrating Multiple Evidence Sources With Symptom and Performance Validity Data,” Psychological Assessment, published online January 31, 2019 http://dx.doi.org/10.1037/pas0000702.
Attention-Deficit/Hyperactivity Disorder (ADHD) remains a prevalent condition among children and adolescents in the United States. A recent analysis based on the National Health Interview Survey (NHIS), conducted by the National Center for Health Statistics at the CDC, provides an updated look at ADHD prevalence from 2018 to 2021. Here’s a closer look at what the data reveals.
The NHIS is an annual survey primarily conducted through face-to-face interviews in respondents’ homes. Telephone interviews are used as a substitute in cases where travel is impractical. For each family interviewed, one child aged 3-17 is randomly selected for the survey through a computer program. Over the four years studied (2018-2021), a total of 26,422 households with children or adolescents participated.
The analysis found that 9.5% of children and adolescents in the United States had been diagnosed with ADHD, based on reports from family members. However, the prevalence varied significantly with age:
The increase in ADHD diagnosis with age underscores the importance of monitoring children’s developmental needs as they progress through school and adolescence.
The survey revealed a notable difference in ADHD prevalence between genders, with 12.4% of males diagnosed compared to 6.6% of females—nearly a two-to-one gap. This aligns with previous research indicating that ADHD is more frequently diagnosed in boys than girls, though awareness of how ADHD presents differently across genders is growing.
Family income played a significant role in ADHD prevalence, particularly among lower-income groups:
This pattern suggests that socioeconomic factors might influence the diagnosis and management of ADHD, with lower-income families possibly experiencing greater barriers to early diagnosis or consistent treatment.
Geographic location also impacted ADHD rates. Prevalence was highest in the South (11.3%), followed by the Midwest (10%), the Northeast (9.1%), and significantly lower in the West (6.9%). These variations could reflect regional differences in healthcare access, diagnostic practices, or cultural attitudes towards ADHD.
Despite these variations in demographics, the overall prevalence of ADHD remained relatively stable across the study period from 2018 to 2021, showing no significant changes by year.
The findings from this updated analysis provide a clearer picture of ADHD’s prevalence across different demographic groups in the United States. They highlight the need for tailored approaches to diagnosis and care, taking into account factors like age, gender, income, and geographic location. With ADHD being a common condition affecting nearly 1 in 10 children, ongoing research and support for families are crucial to ensure that those with ADHD receive the care and resources they need.
This study reinforces the importance of awareness and early intervention, especially for families in underserved regions or those facing economic challenges. As clinicians and educators continue to support children with ADHD, understanding these demographic trends can help in creating more equitable access to diagnosis and treatment.
Stimulant medications like methylphenidate and amphetamines are well-established treatments for reducing ADHD symptoms, making a notable difference in focus and behavior. Given that caffeine is also a stimulant, researchers have wondered whether it might offer similar benefits for managing ADHD symptoms. A recent meta-analysis conducted by a Brazilian research team sought to explore this question.
The researchers faced an immediate challenge: there is surprisingly little research directly investigating caffeine's effects on ADHD symptoms. After a thorough review of peer-reviewed literature, they identified only four randomized controlled trials (RCTs) suitable for their analysis, encompassing a combined total of just 152 participants.
The limited number of studies—and participants—meant that the meta-analysis was not as robust as the research team might have hoped. However, they proceeded to examine the available data to determine whether caffeine showed any measurable benefit over a placebo.
The results of the meta-analysis showed a slight decrease in ADHD symptoms among those who consumed caffeine compared to those given a placebo. However, this reduction was not statistically significant. The small sample size likely played a role in this outcome, making the study underpowered. Even if future studies with larger groups of participants were to show statistical significance, the observed effect size would likely remain too small to be clinically meaningful.
Interestingly, the four trials included in the meta-analysis showed very little variation in their findings. Each study slightly favored caffeine over placebo, but none came close to achieving statistical significance.
Ultimately, the researchers concluded that “overall, the totality of the evidence suggests no significant benefit of caffeine over placebo in the treatment of children with ADHD.” The findings indicate that while caffeine might produce a slight reduction in symptoms, it is not an effective alternative to established ADHD treatments like methylphenidate or amphetamines.
This study highlights the importance of relying on proven medications for ADHD management rather than seeking alternatives that lack substantial evidence. While caffeine might offer a slight stimulant effect, it falls short of delivering the therapeutic benefits needed for those with ADHD to manage their symptoms effectively. For clinicians, parents, and individuals with ADHD, these results underscore the value of evidence-based treatments in improving quality of life and daily functioning.
ADHD has long been associated with higher rates of criminal behavior, but most studies have relied heavily on self-reported data and small, non-representative samples. A new Swedish study addresses these limitations, providing a more comprehensive and reliable picture using data from nationwide registers. It sheds light on the role of ADHD medication in reducing the risk of criminal convictions, offering insights for clinicians, policymakers, and families.
Earlier research, such as a 2019 Danish study, found that ADHD diagnosed in children and adolescents ages 4 to 15 was associated with a 1.6-fold increased risk of future criminal conviction. However, these findings were limited by a smaller sample size and a focus on just one nation’s context. Like Denmark, Sweden’s single-payer universal healthcare system allows for the collection of extensive data on health and crime records, providing an ideal environment for large-scale, population-based research.
To investigate ADHD’s connection to criminal behavior, the Swedish research team analyzed records from a cohort of 1,646,645 individuals born between 1986 and 1997. They excluded those who died or emigrated before age 15 (the age of criminal responsibility in Sweden) and those who immigrated to Sweden, resulting in a final study group of 1,235,939 individuals. Slightly more than half of the cohort was male.
ADHD diagnoses were based on clinical records and prescriptions for approved ADHD medications, while criminal convictions—both violent and nonviolent—were identified using Sweden’s National Crime Register, covering the years 2001 to 2013. The study adjusted for various potential confounding factors, including sex, birth year, parental education, and other psychiatric conditions. They also used the Swedish Multi-Generation Register to control for unmeasured familial factors to compare outcomes among full siblings.
The study found that ADHD is strongly associated with increased rates of criminal convictions. Compared to individuals without ADHD, those with an ADHD diagnosis were roughly:
Interestingly, when comparing conviction rates among males and females with ADHD, the rates of nonviolent convictions were similar, but females with ADHD were about 25% more likely to be convicted of a violent crime than males with ADHD.
The research also highlighted the importance of ADHD medication in reducing criminal behavior. When individuals with ADHD who were taking medication were excluded from the analysis, the data showed significantly higher rates of criminal convictions:
These findings suggest that ADHD medications can significantly reduce the risk of both violent and nonviolent criminal behavior in individuals with ADHD, emphasizing the value of pharmacological treatment for those with the condition.
The researchers concluded that “ADHD is a strong risk factor for both violent and non‐violent criminal convictions in males and females even after adjustments for psychiatric comorbidities and unmeasured familial factors.” The study also found that untreated ADHD poses a particularly high risk for criminal behavior, highlighting the protective role of medication.
These findings are clinically relevant for several reasons. First, they reinforce the importance of ensuring that individuals with ADHD have access to effective treatment options, especially during the transition from adolescence into adulthood, which is statistically a period of higher risk for criminal behavior. Additionally, the study provides critical data for shaping public policy and interventions aimed at supporting individuals with ADHD, with a focus on reducing criminality through proper management of the disorder.
This study offers new insights into the complex relationship between ADHD, medication, and criminal behavior, emphasizing the crucial role of treatment in mitigating risks. It provides a compelling case for prioritizing access to ADHD medication as part of a broader strategy for supporting those with ADHD.
_logo%201.svg)
