The Utility of One Versus Multiple Symptom Validity Test Failures on the MMPI-2-RF in Adult ADHD Evaluations

Minimal research has investigated the impact of elevating one versus multiple symptom validity tests (SVTs) on the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) during a neuropsychological evaluation. This study investigated the implications of elevating one versus ≥ 2 overreporting SVTs on the MMPI-2-RF among adults undergoing a neuropsychological evaluation for attention-deficit/hyperactivity disorder (ADHD). Specifically, this study examined the extent to which the number of MMPI-2-RF SVT elevations is associated with meaningful differences in self-reported symptoms of ADHD and co-occurring internalizing psychopathology. Participants were 606 adults referred for outpatient neuropsychological ADHD evaluations at an academic medical center. The Clinical Assessment of Attention Deficit-Adult Total Index, Beck Depression Inventory-Second Edition, and Beck Anxiety Inventory were used to assess self-reported symptoms of ADHD and co-occurring internalizing psychopathology. It was first confirmed that the MMPI-2-RF SVTs assess largely disparate aspects of symptom overreporting and could be used in aggregation without increasing the risk of false positives. For each additional MMPI-2-RF SVT elevation, there was an increase in self-reported ADHD and internalizing symptoms. The most statistically and clinically meaningful differences in self-reported symptoms were observed when comparing ≥ 2 elevations to no elevations. Conversely, there were no meaningful changes in symptom reporting when comparing one SVT elevation to no elevations. Clinicians should scrutinize the credibility of self-reported symptoms that are core and ancillary to ADHD when patients have ≥ 2 elevations on the MMPI-2-RF SVTs. These findings may generalize to the MMPI-3. However, additional research is needed to determine whether these findings apply to other types of SVTs and evaluation settings.