Some Fake ADHD to Get Meds, Special Treatment
FRIDAY Aug. 27, 2010 -- While attention-deficit hyperactivity disorder (ADHD) is a real and pervasive condition, new research suggests there is a cluster of kids and adults who successfully fake the condition either to get drugs or gain special privileges in school.
"People who want to fake ADHD could be able to do a good job of faking on a number of standard clinical instruments that are used to diagnose ADHD," said David Berry, senior author of the report appearing in the current issue of Psychological Assessment. Obviously, health-care professionals need to be concerned, he said, adding that "our evidence suggests [fakers] are pretty good at it if they want to be."
"This goes on around the country," confirmed Dr. Ana Campo, an associate professor of clinical psychiatry at the University of Miami Miller School of Medicine. "There's an overuse of stimulants around the country [among students] to get any competitive edge. There's blatant misuse. We need to be really careful when we're prescribing medications."
Berry used the same test methodology that he had designed two decades ago to determine whether patients were claiming head trauma to collect money after accidents.
"We were interested in whether people who were normal college students could fake ADHD," said Berry, a professor of psychology at the University of Kentucky, Lexington, who conducted the research with UK psychologist John Ranseen and graduate student Myriam Sollman.
Seventy-three University of Kentucky students were split into two groups, one of which was instructed to respond honestly to questions on standard assessments of ADHD. The others were given five minutes to review easily accessible information from the Internet on the condition and told to do their best to fake it. Their incentive: $45 if they succeeded (in reality, all participants were given $45 at the end of the study).
A third "control" group consisted of students legitimately diagnosed with ADHD who took the same test.
"Almost nobody [in the fakers' group] failed the test," said Berry.
"Drugs is the obvious [motivation], but there are others," he continued. "Most universities provide people who have a diagnosis of ADHD with a variety of things that vary from one institution to another -- extra time on tests, copies of teachers' notes that they're lecturing from. They may get special accommodations in terms of where they're staying at the university, a single room versus a double room."
They can also get prescriptions for stimulants that can help them focus, the researchers said.
It's unclear how widespread the practice is, although Campo said her review of the literature had turned up prevalence rates of 8 percent to 35 percent.
The problem, she said, "is that there's always the risk of side effects when taking these medications: increasing blood pressure, tachycardia [abnormal heartbeat], anxiety symptoms. If you use them illegally and are vulnerable, you could become dependent."
Berry advocates using additional anti-fraud screening -- also called "malingering" tests -- to sort out the ADHD frauds from the legitimate cases. (In medical terms, "malingering" means fabricating or exaggerating symptoms of physical or mental disorders for a variety of "secondary gains" motives, such as drugs, money, or even sympathy and attention.)
"These should accompany the standard ADHD test," he said. "I think you can't use one without the other. You can't diagnose ADHD with the malingering test but you can't diagnose malingering with the ADHD test."
The U.S. National Institute of Mental Health has more on ADHD.
Posted: August 2010
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