Cognitive deficits and positively biased self-perceptions in children with ADHD

The Processes Underlying Positive Illusory Bias in ADHD: The Role of Executive Functions and Pragmatic Language Skills

OBJECTIVE

Children with ADHD often show a positive illusory bias (PIB), reporting an extremely positive idea of their own competence, despite their difficulties. The mechanisms underlying this phenomenon are still poorly understood. In the present study, we examined social PIB and investigated the role of executive functions (EFs) and pragmatic language (PL).

METHOD

Forty-one children with ADHD and 42 typically-developing children matched on age, IQ, and receptive language were administered measures of social competence, EFs and PL. The parents were also asked to estimate their child's social competence.

RESULTS

There was evidence of social difficulties and PIB in children with ADHD. Only PL, not EFs, seemed to mediate the association between ADHD and PIB.

CONCLUSION

Our findings suggest that PL abilities should be considered in efforts to improve self-perception in children with ADHD.

Memory and metamemory for actions in children with autism: Exploring global metacognitive judgements

BACKGROUND

Standards in education emphasize the role of metacognition in successful academic outcomes for those with and without learning challenges. Research into metamemory in Autism Spectrum Disorder (ASD) has produced mixed outcomes, with some studies finding children with ASD to have spared metacognitive accuracy and others finding it impaired. While most research has used item-by-item metamemory judgements, the novelty of the current study was to use global judgments-of-learning (global JOLs).

METHOD

Twenty-three children with and twenty without ASD were presented with two lists of action words during a learning phase and were asked to either act out the words in a self-performed task or just listen to them being read aloud in a verbal task (control condition). Typically, self-performance produces memory benefits called the enactment effect. For both tasks, children also made pre-learning and post-learning global JOLs, stating how many words they thought they would recall.

RESULTS

Both groups demonstrated the enactment effect, but neither predicted its beneficial effect. Compared to controls, participants with ASD were found to be less accurate in predicting their future memory performance, specifically in the self-performed task. Both groups were comparable in terms of metacognitive monitoring.

CONCLUSIONS

Overall, the findings suggest that success or failure in metacognitive tasks in ASD might depend on task difficulty, and the type of metacognitive judgement used.

Impact of executive functioning on health-related quality of life of pediatric brain tumor survivors

BACKGROUND

Brain tumor survivors are at risk for significant late effects following treatment completion that may adversely impact health-related quality of life (HRQOL). The current study examines the relationship between executive functioning (EF) and HRQOL in pediatric brain tumor survivors within a longitudinal framework. We hypothesized that early deficits in EF would be related to less optimal HRQOL in this population.

PROCEDURE

The current study utilized retrospective medical chart review to identify neurocognitive correlates of HRQOL in 137 youth previously treated for a pediatric brain tumor. Participants completed the Pediatric Quality of Life Inventory (PedsQL) and neuropsychological assessment, including a well-validated measure of executive functioning (Behavior Rating Inventory of Executive Function; BRIEF). General linear regression and multivariate models were utilized to examine the relationship between child executive functioning and HRQOL.

RESULTS

Multiple domains of child executive functioning, as reported by parents on the BRIEF, significantly predicted parent-proxy reported HRQOL after controlling for demographic and medical covariates, including child intellectual functioning (IF). Similarly, after controlling for covariates, the BRIEF Cognitive Regulation Index was a significant predictor of self-reported physical and school functioning domains of HRQOL.

CONCLUSION

Current data demonstrate EF is a significant predictor of HRQOL during survivorship for youth previously diagnosed with a pediatric brain tumor. Results suggest that opportunities may exist to intervene and improve HRQOL of pediatric brain tumor survivors by targeting EF.

Intervention response among preschoolers with ADHD: The role of emotion understanding

Emotion recognition/understanding (ERU), which is the ability to correctly identify emotional states in others as well as one's self, plays a key role in children's social-emotional development and is often targeted in early intervention programs. Yet the extent to which young children's ERU predicts their intervention response remains unclear. The current study examined the extent to which initial levels of ERU and changes in ERU predicted intervention response to a multimodal early intervention program (Summer Treatment Program for Pre-Kindergarteners; STP-PreK). Participants included 230 young children (Mage = 4.90, 80.0% male) with attention-deficit/hyperactivity disorder (ADHD) who participated in the 8-week STP-PreK. Children's ERU was measured via a standardized behavioral task. Similarly, standardized measures of academic achievement (Woodcock-Johnson-IV), executive functioning (Head-Toes-Knees-Shoulders-Task), and social-emotional functioning (Challenging Situation Task) were obtained pre- and post-intervention. Parents and teachers also reported on children's behavioral functioning pre- and post-intervention. Children with better initial ERU made greater improvements in academic, executive functioning (EF), and social-emotional domains, along with decreases in inattention symptom severity. However, pre-intervention levels of ERU were not associated with improvements in parent/teacher report of hyperactivity, oppositional defiant disorder, and overall behavioral impairment. Lastly, changes in ERU only predicted improvement in EF, but not any other school readiness outcomes. We provide preliminary evidence that initial levels of ERU predict intervention response across school readiness domains in a sample of preschoolers with ADHD.

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.

Association of ADHD and Executive Functioning With Childhood Depression

Objective: Despite its association with increased severity and treatment resistance, relatively little is known about the correlates of early-onset childhood depression. ADHD and executive functioning (EF) are each related to depression. Given their covariation, we tested the independent association of ADHD dimensions (i.e., inattention, hyperactivity) and EF with childhood depression using structural equation modeling to identify potential targets for intervention. Method: Participants were 225 five- to 10-year-old children (68% male) with (n = 117) and without (n = 108) ADHD. Youth completed laboratory assessments of EF, and parent, teacher, and youth reports of depression were gathered. Results: With control of EF and anxiety, across informants, inattention, but not hyperactivity, was positively related to child depression. EF was positively associated with depression according to parent ratings only. Conclusion: We consider the association of inattention and EF with childhood depression, including implications for intervention and prevention from a developmental psychopathology framework.

Positive Illusory Bias Still Illusory? Investigating Discrepant Self-Perceptions in Girls with ADHD

OBJECTIVE

To examine whether girls with attention deficit/hyperactivity disorder (ADHD) demonstrate positive illusory self-perceptions during adolescence and young adulthood.

METHODS

We tested, across a 5-year longitudinal span, whether self-perceptions versus external-source ratings were more strongly predictive of young adulthood impairment and depressive symptoms. Participants included an ethnically diverse sample of 140 girls with ADHD and 88 comparison girls, aged 11-18 years (M = 14.2) at adolescent and 19-24 years (M = 19.6) at young adult assessment.

RESULTS

Although girls with ADHD rated themselves more positively than indicated by external ratings, their self-reports still did not differ significantly from external ratings in both scholastic competence and social adjustment domains. Comparison girls, on the other hand, rated themselves significantly less positively than indicated by external ratings in social adjustment. Positive discrepancy scores in adolescence did not significantly predict depressive symptoms in young adulthood and vice versa. Crucially, measures of actual competence in adolescence were more strongly associated with young adulthood impairments than were inaccurate self-perceptions for girls with ADHD.

CONCLUSIONS

Our findings continue to challenge the existence of a positive illusory bias among girls with ADHD, including any association of such bias with key indicators of impairment.

Social Functioning in Youth with Attention-Deficit/Hyperactivity Disorder and Sluggish Cognitive Tempo

The current review summarizes the research to date on social functioning for youth with attention-deficit/hyperactivity disorder (ADHD) with a focus on three key domains: peer rejection, friendship, and social information processing. The review extends past reviews by examining the research to date on how the presence of sluggish cognitive tempo (SCT) symptoms, a common correlate of ADHD, affects the social presentation of youth with ADHD. Overall, youth with ADHD show significant difficulty with peer rejection, forming and maintaining friendships, and abnormalities in how they process and respond to social information. Further, the presence of SCT symptoms results in great social withdrawal and isolation. Future studies are needed to better understand the social difficulties of youth with ADHD, particularly using experimental approaches that can manipulate and isolate mechanisms within the social information processing model. In addition, novel intervention approaches are needed to more effectively ameliorate the social difficulties of youth with ADHD and those with co-occurring SCT symptoms.

How Good Am I? Implicit and Explicit Self-Esteem as a Function of Perceived Parenting Styles Among Children With ADHD

OBJECTIVE

To investigate implicit and explicit self-esteem and academic self-evaluation among children with ADHD as a function of parenting styles, namely, authoritarian, authoritative and permissive parenting.

METHOD

Participants included 43 children with ADHD and 35 non-ADHD controls who filled out self-concept and perceived parenting style questionnaires. They also took an Implicit Association Test (IAT) that measured unacknowledged self-esteem.

RESULTS

Lower self-esteem was found among children with ADHD than among controls, with stronger effect on the implicit level. Perceived authoritarian parenting was related to lower implicit self-esteem among children with ADHD. Higher self-esteem was found in the authoritative than in the permissive parenting groups in the non-ADHD control group but not among children with ADHD.

CONCLUSION

The role of parental support versus authoritarian parenting in terms of implicit self-esteem points to the importance of promoting responsiveness strategies among parents in the treatment of children with ADHD.

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.

Is the Positive Illusory Bias Common in Young Adolescents with ADHD? A Fresh Look at Prevalence and Stability Using Latent Profile and Transition Analyses

The goal of this study was to use novel approaches that do not require the use of arbitrary cut-points (i.e., latent profile/transition analysis) to evaluate the prevalence and stability of the positive illusory bias (PIB) in young adolescents with attention-deficit/hyperactivity disorder (ADHD). Participants were 326 middle-school students diagnosed with ADHD (Mage = 12.26 years, 71% male, 77% Caucasian). The Self-Perception Profile for Children (SPPC) was completed by participants and their parents at baseline and again 12 and 18 months later. Cross-sectional results revealed four subgroups based on SPPC responses. Only a small subset (18.4%) of youth with ADHD exhibited a global PIB, across the behavioral, scholastic, and social domains, with an additional 29% displaying a PIB in the scholastic domain only. Additionally, average parent/adolescent-rated competence within each subgroup was in line with an objective measure of scholastic competence (i.e., grades). When examined longitudinally, only a PIB in the social domain was stable across the 18-month study period and only for half of the sample. These findings suggest that the PIB is not ubiquitous in youth with ADHD, with many young adolescents rating themselves accurately relative to their parents and their grades. Further, when stability across time is considered, the PIB may be specific to social functioning, as opposed to a global, cross-domain phenomenon. Implications for the future measurement of the PIB are discussed.

Clinician-delivered cognitive training for children with attention problems: effects on cognition and behavior from the ThinkRx randomized controlled trial

PURPOSE

The impact of attention problems on academic and social functioning coupled with the large number of children failing to respond to stimulant medication or behavioral therapy makes adjunctive therapies such as cognitive training appealing for families and clinicians of children with attention difficulties or childhood attention deficit hyperactivity disorder. However, the results of cognitive training studies have failed to find far transfer effects with this population. This study examined the quantitative cognitive effects and parent-reported behavioral effects of a clinician-delivered cognitive training program with children who have attention problems.

PATIENTS AND METHODS

Using a randomized controlled study design, we examined the impact of a clinician-delivered cognitive training program on processing speed, fluid reasoning, memory, visual processing, auditory processing, attention, overall intelligence quotient score, and behavior of students (n=13) aged 8-14 years with attention problems. Participants were randomly assigned to either a waitlist control group or a treatment group for 60 hours of cognitive training with ThinkRx, a clinician-delivered intervention that targets multiple cognitive skills with game-like, but rigorous mental tasks in 60-90-minute training sessions at least 3 days per week.

RESULTS

Results included greater mean pretest to posttest change scores on all variables for the treatment group versus the control group with statistically significant differences noted in working memory, long-term memory, logic and reasoning, auditory processing, and intelligence quotient score. Qualitative outcomes included parent-reported changes in confidence, cooperation, and self-discipline.

CONCLUSION

Children with attention problems who completed 60 hours of clinician-delivered ThinkRx cognitive training realized both cognitive and behavioral improvements.

The Role of Animal Assisted Intervention on Improving Self-Esteem in Children With Attention Deficit/Hyperactivity Disorder

Attention Deficit/Hyperactivity Disorder (ADHD), the most ubiquitous mental health problem in children, has been associated with poor self-esteem. Psychosocial interventions have aimed to improve self-esteem among this group, with the aim of reducing the development of comorbid depression and anxiety. The present study implemented a randomized control design to examine the possibility of Animal Assisted Interventions (AAI) as a viable approach to improving self-esteem among children with ADHD. Children's self-esteem across multiple domains as measured by the Self-Perception Profile for Children was evaluated (n = 80, ages 7-9, 71% male). To test the hypothesis that AAI improves self-esteem, stratified Wilcoxon Signed-Rank Tests (SAS NPAR1WAY procedure) were used to compare pre- to post-treatment ratings. Analyses indicated that scores of children's self-perceptions in the domains of behavioral conduct, social, and scholastic competence, were significantly increased from baseline to post-treatment in the AAI group (z = 2.320, p = .021, z = 2.631, p = .008, and z = 2.541, p = .011, respectively), whereas pre-post-treatment differences in self-perceptions were not found for the children in the control group without AAI. Findings suggest that AAI is a viable strategy for improving ratings of self-perceived self-esteem in children with ADHD.

Discrepancies between self- and adult-perceptions of social competence in children with neuropsychiatric disorders

BACKGROUND

The present study examines discrepancies between self- and adult-perceptions of social competence in children with attention deficit-hyperactivity disorder (ADHD), autism spectrum disorders (ASD) and possible co-morbid disruptive behaviour disorders (DBD).

METHOD

Self-reported questionnaires were collected from multiple informants at the baseline of a multi-systemic family intervention programme for children (aged 5-12) with ADHD, ASD and possible co-morbid DBD. In total, out of the 154 families eligible for the study, information was received concerning children from 124 families (children n = 121; mothers n = 117; fathers n = 86; teachers n = 97). In addition to this, a comparison community sample of 318 school-aged children (approximately 10 years old) was utilized to examine the perceptions of children's social competence across intervention and population groups in more detail.

RESULTS

Children's self-perceptions in the prosocial dimension of social competence (i.e. cooperating skills, empathy) did not differ between the intervention and comparison groups. Interestingly, the children in the intervention sample expressed more impulsivity and disruptiveness - the antisocial dimension of social competence - when compared with the children in the comparison sample. Adult ratings demonstrated that mothers, fathers and teachers reported decreased prosocial behaviour and increased antisocial behaviour across overall dimensions and sub-dimensions when compared with adults' ratings of elementary school children. Informant discrepancies between self-ratings and adult ratings across intervention groups yielded significant effect sizes (eta-squared) across all domains of social competence ranging from .09 to .25.

CONCLUSION

Children's positive self-ratings of social competence relative to adult ratings increased within intervention sample when compared with population sample. The intervention sample children appeared to acknowledge their social competence deficits, yet self-perceptions were inflated relative to adult ratings when focusing on peer relationship difficulties, particularly, aggression to peers.

Concordance of parent-, teacher- and self-report ratings on the Conners 3 in adolescent survivors of cancer

Survivors of childhood cancer are at risk for attention problems. The objectives of this study were to assess concordance between parent-, teacher-, and self-report ratings on a measure of attention (Conners Rating Scales, 3rd ed.; Conners, 2008) in adolescent survivors of childhood cancer and to examine associations with a performance-based task. The Conners 3 was completed by 80 survivors of pediatric cancer (39 brain tumor, 41 acute lymphoblastic leukemia; ages 12–17; at least 1 year posttreatment; 51.3% male) as well as their parents and 1 teacher. In addition, survivors completed a continuous performance test. Parents and teachers demonstrated moderate agreement on most subscales; however, agreement was weaker than would be expected based on the normative sample. Agreement between self- and proxy ratings was more variable. The strongest associations for all raters were observed on the Learning Problems subscale. There were significant mean differences between parent and teacher ratings, with parents reporting more problems across subscales. Only self-ratings of Inattention were significantly associated with the continuous performance test (omission errors). Agreement across raters in assessment of attentional functioning in adolescent survivors of childhood cancer is modest. Findings support the need to obtain multiple ratings of behavior, including both proxy- and self-report, when assessing youth with cancer, particularly adolescents.

Clinical and functional correlates of processing speed in pediatric Attention-Deficit/Hyperactivity Disorder: a systematic review and meta-analysis

It is well established that processing speed is negatively impacted in children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD). Unfortunately, exactly how processing speed vulnerabilities manifest in daily functioning has not been well established. To support clinical care of youth with ADHD, it is important to better understand the functional consequences and relevant outcomes associated with processing speed deficits. This systematic review and meta-analysis sought to identify the association between processing speed and clinical or functional correlates among children or adolescents diagnosed with ADHD. A total of 409 abstracts were screened, of which, 60 full-text articles were identified as potentially relevant, and 8 of these studies met inclusion criteria. Domains evaluated across these studies included reading skills, mathematics skills, written expression, anxiety, self-appraisals of competence, and adaptive functioning. Six studies reported an association between processing speed and reading skills, allowing for meta-analysis. Processing speed difficulties among youth with ADHD appear strongly associated with several clinical and functional correlates including weaker academic skills, poorer adaptive skills, increased self-reported anxiety, and overestimates of social competence. Meta-analytic results for studies reporting the association between processing speed and reading skills indicate a medium overall weighted mean effect size (r = 0.33, 95% CI = 0.28 -0.39) with minimal heterogeneity (I² = 0.17). Clinical implications of these findings, limitations in the current knowledge base, and suggestions for future research are discussed.

Self-Awareness of Executive Functioning Deficits in Adolescents With ADHD

OBJECTIVE

Children with ADHD lack self-awareness of their social and academic deficits, frequently rating themselves more favorably than external sources. The purpose of the current study was to assess whether adolescents with ADHD also hold a positive bias toward their executive functioning (EF).

METHOD

Participants include 22 control and 35 ADHD subjects, aged 11 to 16. Participants and their parents completed the Behavior Rating Inventory of Executive Functioning (BRIEF) Self and Parent forms, respectively. Discrepancy scores were calculated for each domain by subtracting the adolescents' T-score from the parents' T-score.

RESULTS

Discrepancy scores were significantly higher in the ADHD group than controls within the Inhibit, Shift, Monitor, Emotional Control, Working Memory, and Plan/Organization domains (all p < .05).

CONCLUSION

As compared with controls, adolescents with ADHD tend to endorse fewer EF difficulties than what parents report. This is the first study to demonstrate that those with ADHD may overestimate their EF ability.

Social Functioning in Children With or At Risk for Attention Deficit/Hyperactivity Disorder: A Meta-Analytic Review

Considerable work has demonstrated significant impairment in social functioning for children with attention deficit/hyperactivity disorder (ADHD). The social functioning profiles of children with ADHD are marked by impairments across diverse domains as they tend to experience greater rates of peer rejection, have lower levels of social skills, and have impaired social cognitions. The purpose of this study was to (a) quantitatively examine the association between ADHD and deficits across several domains of social functioning (peer functioning, social skills, social information processing), (b) examine differences in the magnitude of such associations, and (c) examine the effect of potential moderators. A meta-analysis of 109 studies (n = 104,813) revealed that children with ADHD have the most impairment within the peer functioning domain (weighted effect size [ES] r = .33) followed by significantly smaller effects within the social skills (weighted ES r = .27) and social information-processing domains (weighted ES r = .27). When examining potential moderators, results revealed that the association between ADHD and deficits within the social skills domain was weaker among studies that controlled for co-occurring conduct problems (CP). Studies that utilized sociometric and teacher reports of peer status reported the largest effects within the peer functioning domain. In addition, studies that utilized the "gold standard" approach to diagnosing ADHD documented the largest effects within both the social skills and peer functioning domains. Last, studies utilizing younger samples revealed the largest effects for deficits within the peer functioning domain. Theoretical and clinical implications are discussed.

School Experiences of Adolescents With Attention-Deficit/Hyperactivity Disorder

This article reports on a qualitative study of the school experiences of adolescents with attention-deficit/hyperactivity disorder (ADHD) in the context of quantitative research on teacher attitudes and practices, adolescent self-appraisals, and social and family relationships. Twelve adolescents with ADHD participated in in-depth, semistructured interviews addressing major aspects of school life. Using a modified grounded theory framework, researchers coded these interviews. Three themes emerged: (a) support for a performance deficit, (b) academic and social engagement, and (c) moving from dependence to independence. What is most striking is the low level of agency students demonstrated; that is, rather than acting with purpose on their environments, they seemed to react to things that happened to them. These findings suggest that teachers of adolescents with ADHD know about the nature of the disorder, understand that students' difficulties with organization and academic performance are not typically intentional, use evidence-based interventions to support students, and provide the monitoring and scaffolding needed for academic achievement. The students also provide specific suggestions for parents and peers regarding the supports they need to be successful.

Biased self-perceived social competence and engagement in subtypes of aggression: Examination of peer rejection, social dominance goals, and sex of the child as moderators

This study expands on prior research suggesting that children who either over- or under-estimate their social competence relative to others' reports are more likely to be aggressive. Linear and curvilinear associations between biased social self-perceptions and forms (physical vs. relational) and functions (proactive vs. reactive) of aggression were tested along with three moderators (peer rejection, social dominance goals, and child sex). Children in the fifth through eight grade (N = 167) completed self-reports of perceived social competence and social dominance goals. Teachers completed ratings of children's social competence, peer rejection, and reactive and proactive physical and relational aggression. Bias in self-perceived social competence was quantified as the residual difference between child and teacher ratings of the child's social competence. There was a significant interaction between quadratic bias and peer rejection predicting reactive physical aggression; rejected children with a positive bias or a negative bias were highest in reactive physical aggression. The interaction between linear bias, social dominance goals, and the sex of the child was also significant when predicting proactive physical aggression. Among girls who highly valued social dominance, a positive bias predicted greater proactive physical aggression. Results are discussed in terms of implications for aggression theory and intervention. Aggr. Behav. 42:498-509, 2016. © 2016 Wiley Periodicals, Inc.

Overestimation of Physical Abilities Among Boys With and Without ADHD

OBJECTIVE

Children with ADHD have been widely reported to overestimate their abilities in social and academic domains, but a similar overestimation of physical abilities has not been examined.

METHOD

Twenty-four elementary school-age boys with ADHD and fifteen boys without ADHD were compared on their ability to accurately estimate their ability to complete four lab-based physical tasks, varying on three levels of difficulty: (a) within their ability, (b) 8% beyond their ability, and (c) 13% beyond their ability.

RESULTS

Children with ADHD were significantly more likely than controls to overestimate their physical ability at difficult levels of the task.

CONCLUSION

Implications of these results for preventing risky behaviors in children with ADHD are discussed.

Positive Illusions? The Accuracy of Academic Self-Appraisals in Adolescents With ADHD

OBJECTIVE

Children with attention deficit/hyperactivity disorder (ADHD) overestimate their academic competencies (AC) relative to performance and informant indicators (i.e., positive illusory bias; PIB). Do adolescents with ADHD exhibit this PIB and does it render self-views inaccurate? We examined the magnitude of the AC-PIB in adolescents with and without ADHD, the predictive accuracy of parent and adolescent AC ratings, and whether executive functions (EF) predict the AC-PIB.

METHOD

Adolescents (49 ADHD; 47 typically developing) completed math and EF tests, and self-rated their AC. Parents rated their adolescents' AC and EF.

RESULTS

Adolescents with ADHD performed more poorly on the math task (vs. comparison group) but had a larger AC-PIB relative to parents' ratings. EFs predicted the PIB within the full sample. Adolescents' AC ratings, regardless of ADHD status, were more predictive of math performance than their parents' AC ratings.

CONCLUSION

Adolescents with ADHD appear self-aware in their AC despite a modest PIB; nuanced self-appraisals may depend on EFs.

Self-perception of competencies in adolescents with autism spectrum disorders

Research has demonstrated that, despite difficulties in multiple domains, children with autism spectrum disorders (ASD) show a lack of awareness of these difficulties. A misunderstanding of poor competencies may make it difficult for individuals to adjust their behaviour in accordance with feedback and may lead to greater impairments over time. This study examined self-perceptions of adolescents with ASD (n = 19) and typically developing (TD) mental-age-matched controls (n = 22) using actual performance on objective academic tasks as the basis for ratings. Before completing the tasks, participants were asked how well they thought they would do (pre-task prediction). After completing each task, they were asked how well they thought they did (immediate post-performance) and how well they would do in the future (hypothetical future post-performance). Adolescents with ASD had more positively biased self-perceptions of competence than TD controls. The ASD group tended to overestimate their performance on all ratings of self-perceptions (pre-task prediction, immediate, and hypothetical future post-performance). In contrast, while the TD group was quite accurate at estimating their performance immediately before and after performing the task, they showed some tendency to overestimate their future performance. Future investigation is needed to systematically examine possible mechanisms that may be contributing to these biased self-perceptions.

Perceived social acceptance and peer status differentially predict adjustment in youth with and without ADHD

OBJECTIVE

This study extends previous research and examined if the longitudinal relation between self-perceived social acceptance and changes in adjustment was moderated by peer status and ADHD diagnosis.

METHOD

A sample of children with ADHD and a normative comparison group (age 8-13 years) were assessed at baseline and one-year follow-up. Self-perceived social acceptance, peer status, and three areas of adjustment (depression symptoms, aggression/conduct problems, and social skills) were measured.

RESULTS

Moderation was found when predicting depression symptoms and aggression/conduct problems. Specifically, in children with ADHD only, higher perceived social acceptance protected against increases in depression symptoms for those with lower peer preference, but predicted greater aggression/conduct problems for those with higher peer preference. There was not evidence of significant moderation for predicting social skills; instead non-ADHD status, greater peer preference, and greater self-perceived social acceptance were each predictive of greater social skills.

CONCLUSION

Results highlight the complex association between positive social self-perceptions and adjustment for children with ADHD and caution against a universal assumption that high self-perceptions are adaptive.

Co-occurring aggressive and depressive symptoms as related to overestimations of competence in children with attention-deficit/hyperactivity disorder

Research indicates that on average, children with attention-deficit/hyperactivity disorder (ADHD) overestimate their competence in various domains. ADHD also frequently co-occurs with disorders involving aggressive and depressive symptoms, which themselves seem to influence estimations of self-competence in social, academic, and behavioral domains. In particular, high levels of aggressive behavior are generally associated with overestimations of competence, and high levels of depressive symptoms are related to underestimations of competence. This paper reviews studies of overestimations of competence among children with ADHD and examines the extent to which comorbid aggressive or depressive symptoms may be influencing these estimates. Although significant challenges arise due to limited information regarding comorbidities and problematic methods used to assess overestimations of competence, existing evidence suggests that ADHD may be associated with overestimations of competence over and above co-occurring aggression. As well, studies suggest that comorbid depression may reduce the appearance of overestimations of competence in children with ADHD. Underlying mechanisms (e.g., neuropsychological deficits or self-protection) of overestimations in children with ADHD are discussed, each with particular clinical implications for the assessment and treatment of ADHD. Future research would do well to carefully consider and explicitly describe the comorbid aggressive and depressive characteristics among individuals with ADHD when overestimations of competence are examined.

Does childhood positive self-perceptual bias mediate adolescent risky behavior in youth from the MTA study?

OBJECTIVE

This study's primary aim was to examine whether the positive self-perceptual bias present in many youth with attention-deficit/hyperactivity disorder (ADHD; Hoza et al., 2004; Hoza, Pelham, Dobbs, Owens, & Pillow, 2002) mediates the relation of childhood ADHD status to later risky behaviors.

METHOD

Using a subset of children with ADHD and comparison children (n = 645) from the Multimodal Treatment Study of Children With ADHD, we predicted that a positive bias in childhood would partially or fully mediate the relation between having ADHD and risky driving and sexual behaviors 8 years later.

RESULTS

Results strongly supported this hypothesis for risky driving behavior but only provided limited support for risky sexual behavior.

CONCLUSIONS

Taken together, findings suggest that future research should explore whether self-perceptual bias may be a useful target of intervention for children with ADHD.

Effects of symptoms of ADHD, ODD, and cognitive functioning on social acceptance and the positive illusory bias in children

OBJECTIVE

To examine the effects of symptoms of ADHD and ODD and cognitive functioning on social acceptance and positive bias in children.

METHOD

The sample consisted of 86 children (49 girls) between 7 and 13 years old, recruited to reflect a wide range of ADHD symptoms. Parents and teachers reported on ADHD and ODD symptoms and social acceptance. Children reported on social acceptance and were given tasks measuring working memory, inhibition and reaction-time variability. A discrepancy score between child and adult reports of social acceptance was used as a measure of positive bias.

RESULTS

Inattention independently explained variance in social acceptance. The cognitive factors were related to social acceptance and the positive bias, but not beyond the ADHD and ODD symptoms.

CONCLUSION

It is primarily disruptive behavior that contributes to external reports of children's social acceptance.

ADHD and autism: differential diagnosis or overlapping traits? A selective review

According to DSM-IV TR and ICD-10, a diagnosis of autism or Asperger Syndrome precludes a diagnosis of attention-deficit/hyperactivity disorder (ADHD). However, despite the different conceptualization, population-based twin studies reported symptom overlap, and a recent epidemiologically based study reported a high rate of ADHD in autism and autism spectrum disorders (ASD). In the planned revision of the DSM-IV TR, dsm5 (www.dsm5.org), the diagnoses of autistic disorder and ADHD will not be mutually exclusive any longer. This provides the basis of more differentiated studies on overlap and distinction between both disorders. This review presents data on comorbidity rates and symptom overlap and discusses common and disorder-specific risk factors, including recent proteomic studies. Neuropsychological findings in the areas of attention, reward processing, and social cognition are then compared between both disorders, as these cognitive abilities show overlapping as well as specific impairment for one of both disorders. In addition, selective brain imaging findings are reported. Therapeutic options are summarized, and new approaches are discussed. The review concludes with a prospectus on open questions for research and clinical practice.

Neuroeconomics of attention-deficit/hyperactivity disorder: differential influences of medial, dorsal, and ventral prefrontal brain networks on suboptimal decision making?

Psychiatric neuroeconomics offers an alternative approach to understanding mental disorders by studying the way disorder-related neurobiological alterations constrain economic agency, as revealed through decisions about choices between future goods. In this article, we apply this perspective to understand suboptimal decision making in attention-deficit/hyperactivity disorder (ADHD) by integrating recent advances in the neuroscience of decision making and studies of the pathophysiology of ADHD. We identify three brain networks as candidates for further study and develop specific hypotheses about how these could be implicated in ADHD. First, we postulate that altered patterns of connectivity within a network linking medial prefrontal cortex and posterior cingulate cortex (i.e., the default mode network) disrupts ordering of utilities, prospection about desired future states, setting of future goals, and implementation of aims. Second, we hypothesize that deficits in dorsal frontostriatal networks, including the dorsolateral prefrontal cortex and dorsal striatum, produce executive dysfunction-mediated impairments in the ability to compare outcome options and make choices. Third, we propose that dopaminergic dysregulation in a ventral frontostriatal network encompassing the orbitofrontal cortex, ventral striatum, and amygdala disrupts processing of cues of future utility, evaluation of experienced outcomes (feedback), and learning of associations between cues and outcomes. Finally, we extend this perspective to consider three contemporary themes in ADHD research.

Can children with ADHD be motivated to reduce bias in self-reports of competence?

OBJECTIVE

Our purpose in the current study was to examine whether children with attention-deficit/hyperactivity disorder (ADHD) and comparison children, if adequately motivated, are able to purposefully match their teachers' ratings of competence in multiple domains and whether any reductions in self-perceptual bias normalize self-views in relation to comparison children's self-perceptions.

METHOD

Participants included children with ADHD (n = 178) and comparison children (n = 86), between 7 and 12 years of age. The majority of participants were Caucasian (81.4%) and male (77.3%). Primary measures included the Self-Perception Profile for Children (SPPC; Harter, 1985), which was administered during a baseline assessment. In a subsequent session, children completed the SPPC twice more following instructions to first attempt to match their teachers' ratings of competence and then following the offer of an incentive for matching their teachers' ratings. Repeated measures analyses of covariance were conducted with between- and within-subjects factors.

RESULTS

Significant reductions in 2 of 3 domains (scholastic, behavioral conduct) were found for children with ADHD. No reductions were found across domains for comparison children or in the social domain for children with ADHD. Across conditions, the amount of bias exhibited by children with ADHD was never normalized in relation to comparison children's ratings.

CONCLUSIONS

Explicit instructions to match teacher ratings of competence and implementation of incentives were only partially effective in reducing the biased self-perceptions of children with ADHD. Results suggest that children with ADHD, on average, cannot view themselves in a completely unbiased fashion, rather than that they will not do so, although self-protection clearly plays a partial role.

Changes in self-perceptions in children with ADHD: a longitudinal study of depressive symptoms and attributional style

This study examined positive self-perceptions in relation to depressive symptoms and attributional style in a sample of 88 boys with attention-deficit/hyperactivity disorder (ADHD) assessed at baseline and at a 2- to 3-year follow-up. Change in boys' self-perceptions of competency in the scholastic, social, and behavioral domains was examined as a predictor of changes in depressive symptoms and depressive attributional style. Additionally, teacher-rated perceptions of competency at baseline and follow-up were considered as unique predictors. Results indicated that across all three domains, a reduction in children's self-perceptions of competency over time predicted greater depressive symptoms at follow-up, even when controlling for teacher-rated competency. Analyses also suggested that a reduction in self-perceptions in the social domain was the strongest relative predictor of later depressive symptoms and also predicted greater depressive attributional style at follow-up. In contrast, teacher-rated competency was not a significant predictor of depressive symptoms or attributional style at follow-up. Results support a protective function of positive self-perceptions in regards to depressive cognitions over a 2- to 3-year period for children with ADHD. However, literature suggesting risks for other negative outcomes also is discussed.