Faking ADHD Symptoms

A very real problem

They come to their doctors with stories of inattention. They say that they’re unfocused, edgy, disorganized, depressed. Some hint about requiring medication; others boldly ask for a specific brand. All are certain of their diagnosis: ADHD.

Yet experts reveal that many of these patients do not suffer from the disorder—they’re faking it. Or, at the very least, they’re exaggerating ADHD-like symptoms. Either way, the phenomenon adds another layer to what is already a sometimes controversial diagnosis.

The motives
The reasons behind this strange trend are surprisingly complicated. Access to ADHD medications, whether for studying purposes or recreational use, is certainly one motivation. Another is the desire for special accommodations, such as extra time for tests or free tutoring services. In these cases, the faker sets out to consciously manipulate the system.

However, there are others who are not deliberately tricking their doctors, says Allyson G. Harrison, PhD, clinical director of the Regional Assessment and Resource Center at Queen’s University in Kingston, Ontario, and a researcher on the topic. “These patients may not know how to deal with some of the symptoms they’re experiencing, so they exaggerate them in order to be taken seriously,” she explains.

In both scenarios, the scope of the problem isn’t fully known. One study found that up to 50 percent of students who visited a university clinic were feigning or amplifying their symptoms. In general, experts believe that the behavior is more common among teens and adults than in children.

What parents can do
The best way to rule out the possibility of faking (and to get the most accurate diagnosis, period) is to undergo ADHD testing with a cognitive specialist. To find one, ask your doctor or local hospital or consult organizations such as the Attention Deficit Disorder Association (www.add.org) and Children and Adults with Attention Deficit Disorder (www.chadd.org). “A family doctor can certainly diagnosis you as having certain symptoms,” explains Harrison. “But a psychologist or a neuropsychologist can assess whether they’re caused by another condition that can mimic ADHD.” Anxiety, depression, and post-traumatic stress disorder are among the possibilities. Harrison also emphasizes that many people experience ADHD-like symptoms at some time in their lives without actually qualifying for the diagnosis. Still, there are scenarios that might raise suspicions:

• Request for specific drugs—Patients who ask for a drug by name, in particular stimulant medications, may be interested in crushing and snorting the drugs to get high or in selling them to others.
• Sudden onset of symptoms—Most people with ADHD exhibit signs of the disorder as kids. Consequently, it’s unlikely that a college student who has never had problems with inattention or impulsivity will develop ADHD out of the blue.
• Specific timing—A request for diagnosis that coincides with a big test or exam period may spell trouble. Demand for the drugs is especially high at these times among students who wish to study longer or sell the pills for profit.

Effect on the ADHD community
For those diagnosed with ADHD, this phenomenon may seem exasperating. Already, there are lingering misunderstandings about ADHD, in particular that it isn’t a “real” disorder. Yet Harrison believes that the fakers may, in fact, drive researchers to find better screening methods.

“My hope is that this will lead to tests that are very sensitive and specific to AD/HD,” she says. “The result will be improved services and support for the individuals who really do have it.”

References
1. Harrison, A.G. (2006). Adults faking AD/HD: You must be kidding! (August 2006) The ADHD Report. 14(4), 1-7.
2. Harrison, A.G. (Interview, July 22, 2008).
3. Harrison, A.G., Edwards, M.J, & Parker, K.C. (2007). Identifying students faking ADHD: Preliminary findings and strategies for detection. Archives of Clinical Neuropsychology, 22(5), 577-88.
4. Quinn, C.A. (2003). Detection of malingering in assessment of adult ADHD. Archives of Clinical Neuropsychology, 18(4), 379-95.
5. Sullivan, B.K., May, K., & Galbally, L. (2007). Symptom exaggeration by college adults in attention-deficit hyperactivity disorder and learning disorder assessments. Applied Neuropsychology, 14(3), 189-207.