A new survey of patients’ medical records finds that nearly a quarter of adults who seek treatment for attention deficit hyperactivity disorder may be exaggerating or faking their symptoms. Why would someone fake a psychological disorder? In a word, Adderall.
The authors of the study, published in The Clinical Neuropsychologist, said there were actually a variety of reasons people exaggerated their symptoms: some legitimately had ADHD, but just wanted to make sure their doctor gave them the diagnosis; others really thought they had ADHD, but didn’t (rather they were stressed or depressed). But in many cases, the reason for claiming symptoms of ADHD was to obtain the drugs — like Adderall and Ritalin — that are used to treat it.
(More on TIME.com: “Kids With ADHD May Use Drugs and Alcohol More Often”)
These drugs are stimulants, which work by boosting levels of the neurotransmitters dopamine and norepinephrine in the brain. In people who have ADHD, the drugs calm behavior and help maintain focus. In healthy people, the drugs serve as performance enhancers. College students, journalists, scientists and baseball players, among others, have been known to use the drugs to increase their ability to concentrate, improve attention, memory and learning, and get ahead.
“There are big cultural pressures to get these drugs,” Dr. Anjan Chatterjee, a professor of neurology at the University of Pennsylvania, told MSNBC. “That’s because everyone is in an arms race of accomplishment.”
(More on TIME.com: “Preterm Birth Raises the Risk of Childhood ADHD”)
For the new study, lead researcher Paul Marshall, a clinical neuropsychologist at Hennepin Faculty Associates in Minneapolis, and colleagues analyzed patients’ responses in in-person interviews and questionnaires. Within the questionnaires were inserted certain red-flag-raising tests specifically designed to pinpoint fakers and exaggerators. Reported MSNBC:
Ultimately, Marshall and his colleagues found patients who not only exaggerated their symptoms but also scored much more poorly on the embedded tests than people with actual ADHD symptoms would have.
A doctor in [an MSNBC-commissioned] Truth On Call poll summarized the fakers like this: “Patients try to describe typical symptoms with a request for specific ADHD drugs. With standard symptom questionnaires, they will push the responses to the extreme and try to request specific medications when prescribed alternatives.”
The problem is that there is no single guaranteed test for ADHD. Diagnoses depend on individual physicians’ assessments. So how reliable are doctors — and the measures they use — generally?
A study by University of Kentucky psychologists, published in June 2010 in Psychological Assessment, sought an answer by asking college kids to try to fake ADHD symptoms on a series of tests. There were actually three groups of students who took the tests: some who legitimately had ADHD and were temporarily off their medication, others who didn’t have ADHD and weren’t asked to fake it, and those who didn’t have ADHD but were told they’d get $45 if they could convince the assessor they did. To prepare, they were given five minutes to look over ADHD information obtained from Google.
(More on TIME.com: “A Better Way to Diagnose ADHD”)
Regarding the assessment measures, Psychology Today reported:
Tests for detecting ADHD fall into two broad categories. Firstly, and most simply, there is self-report, where the patient describes their symptoms in response to structured questioning. Second there are neuropsychological tests, where the patient is asked to perform a particular task. These often appear much like a simple computer game and are structured such that persons with ADHD will make certain types of mistakes on the game due to impulsivity, inattention or other ADHD symptoms.
The self-reports couldn’t tell the real ADHD sufferers from the fakers, and the computer tests weren’t much more effective either, the study found.
ADHD diagnoses in adults may be trickier than in kids. For children, there are at least multiple sources of information and observation — parents, teachers, doctors. With adults, physicians can rely only on self-reporting. The Centers for Disease Control and Prevention estimates that 2% to 4% of adults actually have ADHD, many of whom were initially diagnosed as children.
If healthy adults continue to exaggerate symptoms for personal gain, the fallout could affect those who really need help, should doctors become increasingly wary of handing out diagnoses. Worse, legitimate patients are having a hard enough time getting their medication as it is, without fakers filching pills for performance enhancement. Finally, as the MSNBC story points out, if misused the medications could become habit forming — and a surefire way to ruin performance is misusing prescription drugs.