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The Quest to Find True ADHD: Navigating the Diagnostic Challenge of Malingering – A Systematic Review
Published online by Cambridge University Press: 26 August 2025
Abstract
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Introduction
Attention-Deficit/Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder and accurate diagnosis is essential but remains challenging due to the potential for malingering. Additionally, the increasing demands of a fast-paced society place, prompting quick solutions, may lead to simulated presentations or feigning. This paper examines the complexities of distinguishing genuine ADHD cases from malingering, emphasizing the need for refined diagnostic protocols. Malingering, in fact, involves deliberately fabricating symptoms to achieve a desired result, such as:
- Academic Advantages
- Access to Medications
- Avoiding Responsibilities
Objectives
Given all these challenges, we explored how current scientific literature addresses this issue. Inspired by the work of many colleagues, we aimed to summarize their efforts in this systematic review to propose a possible solution for collaborative improvement.
Methods
We analyzed over 296 papers from major scientific databases focusing on “malingering and ADHD” to create a comprehensive overview of this increasingly widespread problem.
Results
The main results, after a thorough analysis of all parameters, emphasize the need for:
1. Advanced Assessment and Objective Measures: dynamic assessment techniques, combined with psychophysiological measures and parental input.
2. Enhanced Diagnostic Protocols and Tools Integration: ADHD rating scales and Symptom Validity Tests (SVTs) like TOMM (Test of Memory Malingering) and WMT (Word Memory Test) to minimize diagnostic errors, make the criteria more robust.
The following table summarizes the criteria analyzed in the 37 articles selected after a thorough review.
| Study Reference | Participants | Age | ADHD Assessment Tools | Malingering Assessment Tools | Comorbidities | Main Findings |
|---|---|---|---|---|---|---|
| Selected studies (37) | Diverse populations such as college students and ADHD patients. | Mean ages ranging from early 20s to late 20s; gender distribution varies. | Various scales including CAARS, BAARS-IV, ImPACT. | Several scales, including NV-MSVT, PAI, b Test, WMCD. | Commonly reported: anxiety and depression. | Challenges in differentiation, high prevalence of comorbidities, issues with malingering detection. |
Conclusions
Traditional ADHD assessments, based heavily on self-reported symptoms, are becoming less reliable, especially with the growing trend of self-diagnosis and malingering. To address this, adding performance-based tests like TOMM and WMT is key for spotting malingering and improving diagnosis accuracy. Our study aims to elucidate this issue, which has subtle but profound implications for the quality of life of thousands of patients, who may receive a superficial diagnosis that could affect them for a lifetime, even pharmacologically.
Disclosure of Interest
None Declared
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- Information
- European Psychiatry , Volume 68 , Special Issue S1: Abstracts of the 33rd European Congress of Psychiatry , April 2025 , pp. S285
- Creative Commons
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.- Copyright
- © The Author(s), 2025. Published by Cambridge University Press on behalf of European Psychiatric Association
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