ChatGPT Helps Students Feign ADHD: An Analogue Study on AI-Assisted Coaching

Source | HN Comments

该研究探讨了使用 ChatGPT 辅助指导学生伪装 ADHD 的可能性。研究者通过 ChatGPT 生成指导信息，帮助学生在临床评估中伪装 ADHD 症状。实验结果表明，接受 AI 指导的学生在症状报告和认知表现方面进行了调整，降低了检测的灵敏度。研究认为，公众可访问的 AI 工具可能对 ADHD 评估的有效性构成威胁，并建议临床医生在使用评估材料时保持谨慎。

ChatGPT 如何帮助学生伪装多动症：一项关于 AI 辅助指导的类比研究

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ChatGPT 如何帮助学生伪装 ADHD：一项关于 AI 辅助指导的类比研究

原始研究
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发布时间：2025年3月24日
第18卷，第97-107页，（2025）
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Anselm B. M. Fuermaier ORCID: orcid.org/0000-0002-2331-0840 1 &
Isabella J. M. Niesten 2
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摘要

这项预先注册的研究旨在评估，在成年期，AI 生成的指导是否有助于学生成功地伪装注意力缺陷/多动障碍 (ADHD)。首先，基于 22 名学生提出的问题，我们进行了广泛的 ChatGPT 查询，以开发一份简明的 AI 生成的信息表，旨在指导学生在临床评估期间伪装 ADHD。其次，我们在一项实验性的类比研究中评估了这种指导的效果，其中 110 名大学生被随机分配到三个组之一：(1) 对照组 (n = 42)，(2) ADHD 症状指导模拟组 (n = 35)，以及 (3) AI 指导模拟组 (n = 33)。所有参与者都接受了临床神经心理学评估，其中包括 ADHD 症状、功能障碍、选择性注意力和工作记忆的测量。我们预先注册的数据分析显示，与症状指导组相比，AI 指导模拟组持续地调整了他们的症状过度报告和认知表现不佳程度，幅度为小到中等，从而降低了检测灵敏度。我们得出结论，公众可访问的 AI 工具（例如当前版本的聊天机器人）可以为在临床神经心理学评估期间伪装 ADHD 提供清晰有效的策略，从而对评估的有效性构成重大威胁。我们建议研究人员和临床医生在共享评估材料、示例项目和评分方法时谨慎行事。

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注意力缺陷/多动障碍 (ADHD) 是一种神经发育障碍，其特征是发展不适当的注意力不集中、多动和冲动水平。据估计，大约一半的 ADHD 儿童继续符合成人 ADHD 的诊断标准，导致成人持续性 ADHD 的全球患病率为 2.58%（Song et al., [2021](https://link.springer.com/article/10.1007/</article/10.1007/s12207-025-09538-7#ref-CR46> "Song, Q., Zhang, Y., Li, X., & Rudan, I. (2021). The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis. Journal of Global Health, 11, 04009. https://doi.org/10.7189/jogh.11.04009

    ")）。成人 ADHD 的诊断评估主要基于与主要诊断分类系统（如 DSM-5 和 ICD-11）相符的综合诊断访谈（例如，American Psychiatric Association, [2013](https://link.springer.com/article/10.1007/</article/10.1007/s12207-025-09538-7#ref-CR1> "American Psychiatric Association. \(2013\). Diagnostic and statistical manual of mental disorders \(DSM-5; 5th ed.\). American Psychiatric Publishing."); World Health Organization, [2019](https://link.springer.com/article/10.1007/</article/10.1007/s12207-025-09538-7#ref-CR55> "World Health Organization \(2019\). International statistical classification of diseases and related health problems \(11th ed.\).
     https://icd.who.int/browse11
     
    . Accessed Mar 2025")）。许多临床医生在做出诊断时，很大程度上依赖于症状的自我报告和感知到的障碍（Fuermaier et al., [2024a](https://link.springer.com/article/10.1007/</article/10.1007/s12207-025-09538-7#ref-CR23> "Fuermaier, A. B. M., Gontijo-Santos Lima, C., & Tucha, O. \(2024a\). Impairment assessment in adult ADHD and related disorders: Current opinions from clinic and research. Journal of Attention Disorders, 28\(12\), 1529–1541.
     https://doi.org/10.1177/10870547241261598
     
    "), [b](https://link.springer.com/article/10.1007/</article/10.1007/s12207-025-09538-7#ref-CR24> "Fuermaier, A. B. M., Tucha, L., Merten, T., Fathollah, Gol, M., & Tucha, O. \(2024b\). Symptom validity testing in adults with clinically diagnosed ADHD: Comparison of the Conner’s Adult ADHD Rating Scale \(CAARS\) and the Self-Report Symptom Inventory \(SRSI\). Journal of Clinical and Experimental Neuropsychology, 46\(8\), 693–706.
     https://doi.org/10.1080/13803395.2024.2411365
     
    "); Nelson et al., [2014](https://link.springer.com/article/10.1007/</article/10.1007/s12207-025-09538-7#ref-CR35> "Nelson, J. M., Whipple, B., Lindstrom, W., & Foels, P. A. \(2014\). How is ADHD assessed and documented? Examination of psychological reports submitted to determine eligibility for postsecondary disability. Journal of Attention Disorders, 23\(14\), 1780–1791.
     https://doi.org/10.1177/1087054714561860
     
    "); Weis et al., [2019](https://link.springer.com/article/10.1007/</article/10.1007/s12207-025-09538-7#ref-CR52> "Weis, R., Till, C. H., & Erickson, C. P. \(2019\). ADHD assessment in college students: Psychologists’ adherence to DSM- 5 criteria and multi-method/multi-informant assessment. Journal of Psychoeducational Assessment, 37\(2\), 209–225.
     https://doi.org/10.1177/0734282917735152
     
    ");)。然而，诊断指南建议使用各种工具补充访谈，包括症状和障碍的自我报告和信息者报告的问卷，以及神经心理学表现测试（如果认为有用）（参见 Fuermaier et al., [2024a](https://link.springer.com/article/10.1007/</article/10.1007/s12207-025-09538-7#ref-CR23> "Fuermaier, A. B. M., Gontijo-Santos Lima, C., & Tucha, O. \(2024a\). Impairment assessment in adult ADHD and related disorders: Current opinions from clinic and research. Journal of Attention Disorders, 28\(12\), 1529–1541.
     https://doi.org/10.1177/10870547241261598
     
    "), [b](https://link.springer.com/article/10.1007/</article/10.1007/s12207-025-09538-7#ref-CR24> "Fuermaier, A. B. M., Tucha, L., Merten, T., Fathollah, Gol, M., & Tucha, O. \(2024b\). Symptom validity testing in adults with clinically diagnosed ADHD: Comparison of the Conner’s Adult ADHD Rating Scale \(CAARS\) and the Self-Report Symptom Inventory \(SRSI\). Journal of Clinical and Experimental Neuropsychology, 46\(8\), 693–706.
     https://doi.org/10.1080/13803395.2024.2411365
     
    ")），以客观评估认知功能（Sibley, [2021](https://link.springer.com/article/10.1007/</article/10.1007/s12207-025-09538-7#ref-CR45> "Sibley, M. H. \(2021\). Empirically-informed guidelines for first-time adult ADHD diagnosis. Journal of Clinical and Experimental Neuropsychology, 43\(4\), 340–351.
     https://doi.org/10.1080/13803395.2021.1923665
     
    ")）。

鉴于 ADHD 容易出现扭曲的症状表现和症状捏造，彻底的多方法评估至关重要（有关症状有效性差的解释框架，请参见 Dandachi-FitzGerald et al., [2024](https://link.springer.com/article/10.1007/</article/10.1007/s12207-025-09538-7#ref-CR16> "Dandachi-FitzGerald, B., Merckelbach, H., & Merten, T. (2024). Cry for help as a root cause of poor symptom validity: A critical note. Applied Neuropsychology: Adult, 31(4), 527–532. https://doi.org/10.1080/23279095.2022.2040025

    ")）。在这方面，症状有效性测试 (SVT) 指的是症状性主诉的准确性，而表现有效性测试 (PVT) 指的是实际能力任务表现的有效性（Larrabee, [2012](https://link.springer.com/article/10.1007/</article/10.1007/s12207-025-09538-7#ref-CR32> "Larrabee, G. J. \(2012\). Performance validity and symptom validity in neuropsychological assessment. Journal of the International Neuropsychological Society, 18\(4\), 625–30630.
     https://doi.org/10.1017/s1355617712000240
     
    ")）。表现有效性通过独立测试（专门为评估有效性而开发）或嵌入式测量（来自标准认知测量）进行评估。过去二十年来，关于成人 ADHD 临床评估的大量研究证据表明，SVT 和 PVT 指示的症状过度报告和认知表现不佳的基线率显着（范围从 9% 到高达 27%）（例如，参见 Dong et al., [2023](https://link.springer.com/article/10.1007/</article/10.1007/s12207-025-09538-7#ref-CR17> "Dong, H., Koerts, J., Pijnenborg, G. H. M., Scherbaum, N., Müller, B. W., & Fuermaier, A. B. M. \(2023\). Cognitive underperformance in a mixed neuropsychiatric sample at diagnostic evaluation of adult ADHD. Journal of Clinical Medicine, 12, 6926.
     https://doi.org/10.3390/jcm12216926
     
    "); Fuermaier et al., [2024a](https://link.springer.com/article/10.1007/</article/10.1007/s12207-025-09538-7#ref-CR23> "Fuermaier, A. B. M., Gontijo-Santos Lima, C., & Tucha, O. \(2024a\). Impairment assessment in adult ADHD and related disorders: Current opinions from clinic and research. Journal of Attention Disorders, 28\(12\), 1529–1541.
     https://doi.org/10.1177/10870547241261598
     
    "), [b](https://link.springer.com/article/10.1007/</article/10.1007/s12207-025-09538-7#ref-CR24> "Fuermaier, A. B. M., Tucha, L., Merten, T., Fathollah, Gol, M., & Tucha, O. \(2024b\). Symptom validity testing in adults with clinically diagnosed ADHD: Comparison of the Conner’s Adult ADHD Rating Scale \(CAARS\) and the Self-Report Symptom Inventory \(SRSI\). Journal of Clinical and Experimental Neuropsychology, 46\(8\), 693–706.
     https://doi.org/10.1080/13803395.2024.2411365
     
    "); Hirsch et al., [2022](https://link.springer.com/article/10.1007/</article/10.1007/s12207-025-09538-7#ref-CR31> "Hirsch, O., Fuermaier, A. B. M., Tucha, O., Albrecht, B., Chavanon, M. L., & Christiansen, H. \(2022\). Symptom and performance validity in samples of adults at clinical evaluation of ADHD: A replication study using machine learning algorithms. Journal of Clinical and Experimental Neuropsychology, 44\(3\), 171–184.
     https://doi.org/10.1080/13803395.2022.2105821
     
    "); Mascarenhas et al., [2023](https://link.springer.com/article/10.1007/</article/10.1007/s12207-025-09538-7#ref-CR34> "Mascarenhas, M. A., Cocunato, J. L., Armstrong, I. T., Harrison, A. G., & Zakzanis, K. K. \(2023\). Base rates of non-credible performance in a post-secondary student sample seeking accessibility accommodations. The Clinical Neuropsychologist, 37\(8\), 1608–1628.
     https://doi.org/10.1080/13854046.2023.2167737
     
    "); Ovsiew et al., [2023](https://link.springer.com/article/10.1007/</article/10.1007/s12207-025-09538-7#ref-CR37> "Ovsiew, G. P., Cerny, B. M., Boer, A. B., Petry, L. G., Resch, Z. J., Durkin, N. M., & Soble, J. R. \(2023\). Performance and symptom validity assessment in attention deficit/hyperactivity disorder: Base rates of invalidity, concordance, and relative impact on cognitive performance. The Clinical Neuropsychologist, 37\(7\), 1498–1515.
     https://doi.org/10.1080/13854046.2022.2162440
     
    "); Phillips et al., [2023](https://link.springer.com/article/10.1007/</article/10.1007/s12207-025-09538-7#ref-CR38> "Phillips, M. S., Wisinger, A. M., Lapitan-Moore, F. T., Ausloos-Lozano, J. E., Bing-Canar, H., Durkin, N. M., Ovsiew, G. P., Resch, Z. J., Jennette, K. J., & Soble, J. R. \(2023\). Cross-validation of multiple embedded performance validity indices in the Rey Auditory Verbal Learning test and Brief Visuospatial Memory test-revised in an adult attention deficit/hyperactivity disorder clinical sample. Psychological Injury and Law, 16\(1\), 27–35.
     https://doi.org/10.1007/s12207-022-09443-3
     
    ")）。各种因素都可能导致 ADHD 评估中这些形式的扭曲的症状表现和测试表现（Dandachi-FitzGerald et al., [2024](https://link.springer.com/article/10.1007/</article/10.1007/s12207-025-09538-7#ref-CR16> "Dandachi-FitzGerald, B., Merckelbach, H., & Merten, T. \(2024\). Cry for help as a root cause of poor symptom validity: A critical note. Applied Neuropsychology: Adult, 31\(4\), 527–532.
     https://doi.org/10.1080/23279095.2022.2040025
     
    ")），其中夸大或伪造症状的次要动机在年轻人中尤为重要，尤其是在大学生中（Booksh et al., [2010](https://link.springer.com/article/10.1007/</article/10.1007/s12207-025-09538-7#ref-CR6> "Booksh, R. L., Pella, R. D., Singh, A. N., & Gouvier, W. D. \(2010\). Ability of college students to simulate ADHD on objective measures of attention. Journal of Attention Disorders, 13\(4\), 325–338.
     https://doi.org/10.1177/1087054708329927
     
    "); Harrison & Edwards, [2010](https://link.springer.com/article/10.1007/</article/10.1007/s12207-025-09538-7#ref-CR29> "Harrison, A. G., & Edwards, M. J. \(2010\). Symptom exaggeration in postsecondary students: Preliminary base rates in a Canadian sample. Applied Neuropsychology, 17\(2\), 135–143.
     https://doi.org/10.1080/09084281003715642
     
    ")）。这些好处可能包括延长考试或作业时间、特殊住宿或助学金、获得兴奋剂药物、为学术表现不佳或社交场合中不可靠的行为提供借口，以及增加同伴的关注（Dandachi-Fitzgerald et al., [2020](https://link.springer.com/article/10.1007/</article/10.1007/s12207-025-09538-7#ref-CR15> "Dandachi-FitzGerald, B., Merckelbach, H., Bošković, I., & Jelicic, M. \(2020\). Do you know people who feign? Proxy respondents about feigned symptoms. Psychological Injury and Law, 13, 225–234.
     https://doi.org/10.1007/s12207-020-09387-6
     
    "); Fuermaier et al., [2021](https://link.springer.com/article/10.1007/</article/10.1007/s12207-025-09538-7#ref-CR22> "Fuermaier, A. B. M., Tucha, O., Koerts, J., Tucha, L., Thome, J., & Faltraco, F. \(2021\). Feigning ADHD and stimulant misuse among Dutch university students. Journal of Neural Transmission, 128, 1079–1084.
     https://doi.org/10.1007/s00702-020-02296-7
     
    "); Harrison, [2017](https://link.springer.com/article/10.1007/</article/10.1007/s12207-025-09538-7#ref-CR28> "Harrison, A. G. \(2017\). Clinical, ethical, and forensic implications of a flexible threshold for LD and ADHD in postsecondary settings. Psychological Injury and Law, 10, 138–150.
     https://doi.org/10.1177/108705472210920
     
    "); Rabiner, [2013](https://link.springer.com/article/10.1007/</article/10.1007/s12207-025-09538-7#ref-CR39> "Rabiner, D. L. \(2013\). Stimulant prescription cautions: Addressing misuse, diversion and malingering. Current Psychiatry Reports, 15, 375.
     https://doi.org/10.1007/s11920-013-0375-2
     
    ")）。

一个需要考虑的重要问题是，试图伪装认知障碍和/或精神疾病的个人，至少在许多情况下，会做好准备，以避免被有效性测量所抓住（有关概述，请参见 Garcia-Willingham et al., 2018）。在大多数情况下，这包括准备有关检测程序和/或该疾病的典型症状的信息。在法医背景下，研究发现律师（或法学院学生）在道德上有义务指导他们的客户了解心理评估中的有效性指标（Wetter & Corrigan, 1995; Youngjohn, 1995）。同样，在成人 ADHD 评估的背景下，研究发现，受测者会寻找在线信息，以帮助他们产生模仿真正诊断出 ADHD 的个体的测试结果，