Utility of the Test of Memory Malingering (TOMM) in Children Ages 4-7 Years with and without ADHD

There is growing consensus that assessment for non-credible performance is a necessary component of pediatric neuropsychological examination. The current study examined the utility and validity of the Test of Memory Malingering (TOMM) in children ages 4-7 years with and without Attention-deficit/Hyperactivity Disorder (ADHD); 66 children (30 controls, 36 ADHD) completed all three TOMM trials. There were no significant group differences in total score on any trial, or passing rate for Trial 2 or Retention. Four-year-olds with ADHD achieved "passing" score on Trial 1 less often than controls. Across groups, performance on Trial 2 and Retention improved with age, such that 85% of the sample achieved a passing score. Four-year-olds had greater difficulty and achieved a passing score significantly less often than children 5-7 years. Moreover, half of the 4-year-olds performed worse on Retention than Trial 2, calling into question the utility of the Retention trial at this age. Performance was associated with IQ only within the ADHD group on the Retention trial. Results suggest that the TOMM can be used with confidence in clinical groups as young as 5 years. Among 4-year-olds, performance appears dependent on severity of ADHD or disruptive behaviors, and may be associated with factors other than effort.