B-05: Psychological Distress and Neuropsychological Performance in Adults With Attention-Deficit/Hyperactivity Disorder: An Alternative Personality Assessment Inventory Factor Structure

Abstract

Objective: Examine the relationship between psychological distress and neuropsychological performance in adults with ADHD using an alternative approach to PAI interpretation. Method/Data Selection: Participants were 109 adult outpatients [58.2% female; mean (SD): age = 29.98 (10.80); education = 14.06 (2.27)] who completed neuropsychological evaluation at a university doctoral clinical psychology training and research clinic between 2010-2025 and were diagnosed with ADHD. Eleven standard linear regression analyses were conducted, with dependent variables consisting of memory, attention, visuospatial, language, processing speed, and executive functioning index scores. Likelihood-ratio chi-square analyses were conducted across three clinical ranges (below average, low average, average and above). Independent variables across analyses were: Hoelzle and Meyer (2009) (HM) Personality Assessment Inventory Factors: 1) general psychological distress; 2) elevated mood and dominance; and 3) substance use and psychopathy. Results/Data Synthesis: No HM Factor accounted for more than 5% of the variance in neuropsychological test scores. Likelihood-ratio analyses revealed a single statistically significant finding: 16.1% of patients with elevated HM Factor 1 scores (general distress) had processing speed index scores in the low-average range compared to 2.6% for non-elevated patients. Conclusions: Findings suggest little relationship between psychological distress as reflected in PAI scores and neuropsychological test performance. Clinically, adults with elevated scores on a general distress PAI factor are about 6 times more likely to have low-average processing speed than those without elevation, suggesting emotional distress exacerbates inefficient processing speed in about 16% of adults with ADHD. Otherwise, below-average neuropsychological scores in adults with ADHD should not be attributed to psychological factors reflected in elevated PAI scores.