Positively Biased Self-Perceptions in Children with ADHD: Unique Predictor of Future Maladjustment

Perceptions of Academic Performance, Impairment, and Mental Health in University Students With and Without ADHD

OBJECTIVE

This study aims to investigate the impact of positive illusory bias (PIB) on the relationship between ADHD symptoms and functioning in college students, with a focus on gender differences.

METHOD

The sample consisted of 195 college students, including 148 with ADHD and 47 without ADHD. Measures of ADHD symptomatology, life satisfaction, affect, gender identity, and impairment were collected, along with cumulative grade point average.

RESULTS

ADHD symptomatology was inversely linked to subjective well-being, with PIB acting as a significant moderator. Functional impairment was predicted by ADHD symptoms and subjective well-being, while social impairment and academic functioning were predicted by PIB and well-being. Significant gender differences were found, particularly in the interaction between PIB and ADHD symptoms for non-binary individuals.

CONCLUSION

This study suggests that PIB is relevant for emerging adults with ADHD enrolled in higher education. Subjective well-being and PIB act as buffers against the detrimental functional and social effects of ADHD symptoms in emerging adult college students. The study highlights the importance of considering gender-specific approaches in understanding and supporting the mental health of this population.

The Pictorial Interview of Children's Metacognition and Executive Functions (PIC-ME): Cultural Adaptation for Ultra-Orthodox Jewish Populations

Introduction

Executive functions (EFs) are strongly linked to attention deficit hyperactivity disorder (ADHD). The pictorial interview of children's metacognition and executive functions (PIC-ME) assesses children's self-perceptions regarding their EF. This study is aimed at describing the cultural adaptation of the PIC-ME to the ultra-Orthodox (UO) Jewish population in Israel.

Method

In the first of three stages, 30 occupational therapists, who were experienced in working with children with ADHD from the UO population, completed a questionnaire about the suitability of PIC-ME for the UO community. In the second stage, six therapists participated in a focus group to discuss the recommendations and the adaptations made following the first stage. In the third stage, 20 UO children aged 5-10 participated in the tool validation process.

Results

First stage: most of the items of the original tool were found to be appropriate in representing the EFs of UO children and did not need to be adapted. No significant differences were found between the boys' and girls' versions regarding the tool's adaptability. However, most of the therapists suggested that the pictures in both versions needed adaptations. Second stage: additional recommendations led to the development of a final adapted version. Third stage: over 70 percent agreement was found among UO children regarding the clarity of the adapted pictures. No significant differences were found between boys and girls or between age groups.

Conclusions

This study presented wide agreement on the necessity for cultural adaptation of the PIC-ME to the UO population and described the adaptation process. Based on its face validity, the UO version may be a useful tool to assess the self-perception of EF among UO children. Further studies are needed to assess its psychometric properties and its usefulness as an outcome measure. The study findings may contribute to the cultural adaptation of other tools for culturally distinct populations.

Perceived parenting attitudes in relation to ADHD symptoms and aggressive behaviors in a sample of Egyptian children with ADHD

Background

Externalizing behaviors are common in children with attention-deficit hyperactivity disorder (ADHD). This study was aiming to investigate the perceived parenting attitudes in children with ADHD and their correlates to the severity of symptoms and associated aggressive behaviors in those children. Accordingly, 140 children with ADHD were assessed using Mini International Neuropsychiatric Interview for Children; Conners’ Parent Rating Scale-Revised, Long Version; the problem scale of the Child Behavior Checklist for ages 4–18; and the Perceived Parenting Attitude Scale.

Results

Assessment of associated behavioral problems in the participants revealed the presence of significant aggressive and externalizing problems. The participants perceived a similar attitude between their mothers and fathers. No significant association is found between severity of ADHD symptoms and perceived parenting attitudes, while consistency in parenting in both mothers and fathers was positively correlated to the aggressive behaviors of the participants.

Conclusions

Aggression is a common symptom associated with ADHD that should be identified and addressed. Although the current study has revealed that consistency in parenting is positively correlated to the aggression in ADHD children, yet children with ADHD might have a positive illusory bias in their social self-perceptions making it difficult to account for the reliability of their perceived parenting attitudes; hence, it remains to be clarified whether perceived parents’ attitudes are attributed to children’s aggression or to children’s perception caused by the previously mentioned illusory bias. For future research, it is highly recommended to assess parenting from the parents’ and their children’s points of view.

Using Metacognitive Methods to Examine Emotion Recognition in Children With ADHD

Objective: This study investigated confidence accuracy associations for emotion recognition (ER) in children with ADHD and typically developing children (TD). Method: Thirty-nine children with ADHD and 42 TD (M = 9 years, 11 months, SD = 14.92 months, 26 females) completed an ER task. Intelligence and executive function task performance were also measured. Results: The ADHD group was more confident on ER compared with TD, but no group differences were found on their overall accuracy. Specifically, the ADHD group was more confident in its recognition of sad and angry faces compared with the TD group. On a metacognitive index, the ADHD group displayed lower resolution, suggesting that the TD group was better at discriminating correct from incorrect responses. Higher resolution was associated with lower ADHD symptoms. Conclusion: Confidence ratings with reference to performance on a specific task can provide an index of social-cognition in children with ADHD.

Self-Concept and Inattention or Hyperactivity-Impulsivity Symptomatology: The Role of Anxiety

Attention-deficit/hyperactivity disorder (ADHD) has been associated with low levels of self-concept (academic, emotional, social or physical), although this association can differ in the function of the inattention or hyperactivity-impulsivity symptomatology. Furthermore, the relation between ADHD and self-concept can be mediated or moderated by the levels of anxiety. This work is aimed to examine the differential effect of inattention symptomatology and hyperactivity-impulsivity symptomatology on academic, emotional, social and physical self-concept and the mediating or moderating role of anxiety in this relationship. A total of 167 students (70.7% boys and 29.3% girls) aged between 11 and 16 participated in this study. Students' ADHD symptomatology, self-concept in four areas (academic, emotional, social and physical self-concept) and trait anxiety were measured with the State-Trait Anxiety Inventory for Children. The results indicate that trait anxiety mediates the relationship between inattention and emotional, social and physical self-concept but does not moderate this relationship. Trait anxiety does not mediate or moderate the relationship between hyperactivity-impulsivity symptoms and self-concept. When inattention symptomatology increases, academic self-concept decreases directly, but students' emotional, social and physical self-concept decreases indirectly through trait anxiety.

Factors Relating to the Presence and Modifiability of Self-Perceptual Bias Among Children with ADHD

Past research raises concerns about whether the presence of self-perceptual biases among children with attention-deficit/hyperactivity disorder (ADHD) interferes with accurate assessment and/or diminishes treatment response. Yet, it remains unclear whether self-perceptual bias is a construct that can be modified. The current study examines individual differences in how children with ADHD (n = 178) display and modify their self-perceptions of competence in the presence of an external motivator for self-perceptual accuracy. Participants were grouped based on the presence and modifiability of their self-perceptual biases across three experimental conditions. Results demonstrate that the presence and modifiability of participants' self-perceptual biases across conditions was associated with adjustment (i.e., externalizing and internalizing problems) and cognitive functioning. Findings suggest multiple factors may be associated with self-perceptual bias (e.g., self-protection and cognitive impairment), and that these factors may differ across children. Implications for intervention, including whether assessment and treatment can be improved, are discussed.

Does Positive Illusory Bias Affect Self-Concept and Loneliness in Children With Symptoms of ADHD?

Objective: Positive illusory bias (PIB) has been amply studied in children with ADHD, but its function is still limited understanding. Method: In a sample of 21 children with symptoms of ADHD, this study investigated whether they were more likely to be rejected by peers and examined PIB, and its influence on self-concept and loneliness, comparing the children with symptoms of ADHD with children who had weak social skills, but no ADHD. The children's and teachers' perception of social difficulties were compared, and self-concept and loneliness were analyzed in the two groups, which were also compared with typically developing (TD) children. Results: The results showed the presence of PIB on social skills in children with symptoms of ADHD, but this phenomenon did not give them a higher self-concept, which was similar to that of children with weak social skills and lower than in TD children. Conclusion: The implications of these findings are discussed.

Explicit and Implicit Positive Illusory Bias in Children With ADHD

OBJECTIVE

Children with ADHD overestimate their own social and behavioral competence when using explicit self-report measures, a phenomenon known as Positive Illusory Bias (PIB). This study examined whether children with ADHD show PIB when self-perceptions are measured implicitly, reflecting associations that are relatively difficult to consciously control.

METHOD

Participants were 23 children (ages 6.8-9.8) with ADHD and 55 typically developing (TD) children. Children's explicit self-perceptions of competence were measured via self-report on the Self-Perception Profile for Children; their implicit associations were assessed using an Implicit Association Test. Parent and teacher ratings formed an adult-reported composite indicator of children's competence, to which children's self-perceptions were compared.

RESULTS

Children with ADHD overestimated their competence as compared with adult-informant reports on both explicit and implicit measures, whereas TD children tended to be accurate.

CONCLUSION

Inflated self-perceptions in children with ADHD may exist on an implicit level outside of conscious awareness.

Comparison of Children With and Without ADHD on a New Pictorial Self-Assessment of Executive Functions

OBJECTIVE

We examined the Pictorial Interview of Children's Metacognition and Executive Functions' (PIC-ME's) reliability and validity, targeting children's appraisal of their executive function (EF) in daily life.

METHOD

One hundred children with attention deficit hyperactivity disorder (ADHD) and 44 typically developing children (ages 5-10 yr) completed the PIC-ME. Parents completed the PIC-ME and Behavior Rating Inventory of Executive Function (BRIEF).

RESULTS

Cronbach's α for the child PIC-ME was .914. A high correlation was found between the parent PIC-ME total and the BRIEF (r = .724). Comparisons between groups revealed significant differences on the parent PIC-ME (p < .0001) but none on the child PIC-ME. Children with ADHD identified a median of eight EF challenges they wanted to set as treatment goals.

CONCLUSION

Results support the PIC-ME's initial reliability and validity among children with ADHD. Children were able to identify several EF challenges and engage in goal setting.

Controlled Social Interaction Tasks to Measure Self-Perceptions: No Evidence of Positive Illusions in Boys with ADHD

Studies have suggested that children with Attention-Deficit/Hyperactivity Disorder (ADHD) possess a Positive Illusory Bias (PIB) where they have higher self-perceptions of competence than more objective measures of their competence. However, recent research calls into question the primary methodology of these studies, that is, difference scores. This study investigated the PIB in boys with ADHD within the social domain using a novel methodology that refrains from using difference scores. Eighty-one 8- to 12-year-old boys with and without ADHD completed social interaction tasks where their actual social performance was made comparable, allowing for tests of between-group differences in self-perceptions that do not rely on difference scores. In addition, to examine whether clarity of social feedback moderates the presence of the PIB, the social tasks presented unclear, clear positive, or clear negative feedback. Boys rated how well they performed in each social interaction task, and these ratings were compared between ADHD and non-ADHD groups. Compared to the non-ADHD group, boys with ADHD did not show a PIB in their ratings of performance on the social tasks. There also was no moderation of boys' ratings by type of feedback received. In contrast, when the PIB was calculated using difference scores based on child and parent ratings of child competence, boys with ADHD showed a PIB compared to boys without ADHD. These findings call attention to the need to re-examine the phenomenon of the PIB using methodologies outside of difference scores.

Social Skills Training and ADHD-What Works?

PURPOSE OF REVIEW

Many children and adolescents with attention-deficit/hyperactivity disorder (ADHD) have difficulties in their social skills and peer relationships. Because social problems exacerbate later maladjustment in ADHD populations, it is important to address this serious impairment. Although social skills training (SST) is a common intervention approach, evidence to date suggests that SST has limited efficacy, at least when provided in traditional, clinic-based settings. The current review summarizes recent advances to traditional SST approaches that may potentially enhance their efficacy.

RECENT FINDINGS

We identify two promising directions in which SST may be modified to make it more efficacious for ADHD populations. The first direction involves providing increased reinforcement and reminders of appropriate social behavior at the point of performance to youth with ADHD (e.g., in vivo, in real life peer situations as opposed to in the clinic). We note the importance of ensuring that youth with ADHD are receptive to such reminders. The second direction involves encouraging peers to be more socially accepting and inclusive of youth with ADHD. This avenue has been understudied in the literature to date. SST for children and adolescents with ADHD may be enhanced by providing more in vivo reminders and feedback at the point of performance and by making efforts to alter peers' impressions about youth with ADHD.