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

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.

Theory of Mind and Social Informant Discrepancy in Autism

When autistic youth are asked to assess their own social skills, they frequently rate themselves more favorably than their parents rate them. The magnitude of this informant discrepancy has been shown to relate to key clinical outcomes such as treatment response. It has been proposed that this discrepancy arises from difficulties with Theory of Mind. Participants were 167 youth 11 to 17 years old; 72% male, and their parents. Youth completed self-report measures of social skills and social cognitive tasks, while their parents completed questionnaires regarding social skills. A repeated-measures ANOVA indicated both non-autistic and autistic youth rated themselves more favorably than their parents rated them across all measures. Zero-order correlations revealed that raw differences between parent- and participant-report were negatively correlated with scores on parent-reported Theory of Mind measures. However, polynomial analysis did not indicate interaction effects between parent- and participant-report on any of the measures used. Polynomial regression revealed that increases in parent-reported social skill predicted larger increases in parent-report Theory of Mind at low levels of parent-reported social skill compared to high levels of parent-reported social skill. Participant-report social skills predicted performance on a behavioral Theory of Mind test in a curvilinear fashion, such that the relationship was positive at low levels of participant-reported social skills, but negative at high levels. This study replicates the finding that raw difference score analyses may result in illusory effects that are not supported when using more contemporary analysis methods, and that more complex and subtle relationships between social insight and perspective-taking exist within autistic youth.

Self-esteem in children and adolescents with and without attention-deficit/hyperactivity disorder: A meta-analytic review

Meta-analytic methods were used to examine global and domain-specific (i.e., academic, social, behavioral) self-esteem in children and adolescents with and without ADHD. Potential moderators of effect size heterogeneity were also examined via meta-regressions within a three-level approach. Findings from 49 aggregated global self-esteem effect sizes (ADHDN = 2500, TDN = 9448), 12 academic self-esteem effect sizes (ADHDN = 386, TDN = 315), 11 social self-esteem effect sizes (ADHDN = 258, TDN = 254), and 8 behavioral self-esteem effect sizes (ADHDN = 231, TDN = 211) suggest that children and adolescents with ADHD experience moderate global (ES = 0.46, p < .001), academic (ES = 0.60, p = .009), and social (ES = 0.67, p = .001) self-esteem impairments compared to children and adolescents without the disorder. The aggregated behavioral self-esteem effect size (ES = 0.20, p = .54), however, was not significant, and the global self-esteem effect size was markedly smaller compared to effect sizes for the academic and social domains. Further, examination of potential moderators of effect size heterogeneity indicated null effects for medication status, diagnostic complexity, informant, age, sex, comorbid psychopathology, and self-esteem dimension. Collectively, findings suggest that children and adolescents with ADHD do not hold a ubiquitous negative self-perception of difficulties across academic, social, and behavioral domains of functioning, and unexamined domains that are distal to ADHD may serve to bolster global self-esteem.

Illuminating the daily life experiences of adolescents with and without ADHD: protocol for an ecological momentary assessment study

INTRODUCTION

Adolescents with attention-deficit/hyperactivity disorder (ADHD) are at elevated risk of a range of difficulties, among which emotion regulation, peer and co-occurring mental health problems are prominent challenges. To better support adolescents with ADHD, ecologically valid interventions that can be embedded in daily life to target the most proximal antecedents of these challenges are needed. Ecological momentary assessment (EMA) designs are ideally suited to meeting this need.

METHODS AND ANALYSES

In the mental health in the moment ADHD study, we will use an EMA design to capture the daily life experiences of approximately 120 adolescents aged 11-14 years with a clinical diagnosis of ADHD and the same number of age-matched and gender-matched peers without a diagnosis of ADHD. We will combine this with comprehensive information gathered from online surveys. Analysing the data using techniques such as dynamic structural equation modelling, we will examine, among other research questions, the role of emotion regulation and peer problems in mediating the links between characteristics of ADHD and commonly co-occurring outcomes such as anxiety, depression and conduct problems. The results can help inform interventions to support improved peer functioning and emotion regulation for adolescents with ADHD.

ETHICS AND DISSEMINATION

This study received a favourable ethical opinion through the National Health Service ethical review board and the University of Edinburgh PPLS Research Ethics panel. The results will be disseminated through journal publications, conferences and seminar presentations and to relevant stakeholders, such as those with ADHD, their families and clinicians.

A latent profile transition analysis and influencing factors of internet addiction for adolescents: A short-term longitudinal study

Internet addiction for adolescent, which is widely concerned by the whole society, has become a public health problem. Internet addiction not only had a negative impact on physical and mental development of adolescents, but also was harmful to their study, life, interpersonal communication and personality formation, and so on. In recent years, the data analysis methods of longitudinal research have developed rapidly. It not only focused on the overall average growth trend, but also considered the differences in the individual trends. Latent profile transition analysis (LPTA) is an extension of latent profile analysis (LPA) and latent transition analysis (LTA), and is a longitudinal data analysis method. LPTA can simultaneously estimate group membership in multiple time points and their latent transition tendency among these subgroups between each two time points. This study used LPTA to explore the development trend of adolescent internet addiction over time and its influencing factors. 1033 adolescents participated in a short-term 6-month longitudinal study with a total of three tests. Participants completed internet addiction test, self-rating anxiety scale and self-rating depression scale. The results showed that: (1) There are three categories of adolescent internet addiction, namely non-internet addiction group, low-internet addiction group and high-internet addiction group. (2) Non-internet addiction group has a strong stability. Low-internet addiction group has a high probability to become non-internet addiction group or high-internet addiction group. (3) Boys are more likely than girls to develop into high-internet addiction group. Anxiety and depression both affect the development of adolescent internet addiction.

Changes in Depression Among Adolescents: A Multiple-Group Latent Profile Transition Analysis

Background

Depression of adolescents is an important public health problem. Persistent depression will become a huge hidden danger of individual mental health development. It is important to study the change mechanism of adolescents' depression.

Methods

A total of 563 males and 739 females aged 11-19 years reported their depression. 1302 adolescents participated in a short-term 6-month longitudinal study. They were contacted every three months for two follow-up tests (T2 and T3). Participants completed internet addiction test, self-rating anxiety scale and self-rating depression scale. Multiple-group latent profile transition analysis (MLPTA) was used to identify meaningful subgroups and transitions between groups across time. Covariates (anxiety and internet addiction) were used to analyze the influencing factors.

Results

The results showed that: (1) There are three categories of adolescents' depression, namely no-depression group, low-depression-mountain group and low-depression-hill group. (2) The depression of the subjects showed a trend of improvement, but the proportion of low-depression-mountain group is relatively high at three time points (0.44, 0.59, and 0.30). (3) The transition probability between the low-depression-mountain group and the no-depression group is large, which suggests the low-depression-mountain group can easily convert into the no-depression group, but the transition probability from low-depression-hill group to other groups is relatively low and stable, which suggests the low-depression-hill group is not easily converted into the no-depression group. (4) Both anxiety and internet addiction affect the development of adolescents' depression across three time points. Anxiety played a significant role in affecting female adolescents' depression, while internet addiction played a significant role in affecting male adolescents' depression.

Conclusion

This study demonstrated a transition pattern in adolescents' depression. We should pay more attention to the low-depression-mountain group and try to do their mental health well. Adolescents' Depression changes rapidly with anxiety and internet addiction for different genders, which suggests that some interventions are needed.

Clinical Change Mechanisms in the Treatment of College Students with ADHD: Trajectories and Associations with Outcomes

The purpose of this study was to evaluate trajectories of response for the three theorized mechanisms of clinical change (knowledge, behavioral strategies, and adaptive thinking) associated with the Accessing Campus Connections and Empowering Student Success (ACCESS) intervention for college students with attention-deficit/hyperactivity disorder (ADHD) and their association with treatment outcomes. Participants included 250 college students comprehensively diagnosed with ADHD randomly assigned to ACCESS or to a delayed-treatment control who completed ratings at baseline, end of active treatment, and end of the maintenance phase of treatment (after two semesters). Growth mixture models (GMMs) were used to evaluate trajectories. Participants in ACCESS made significant gains in the use of behavioral strategies and trajectories were associated with large effect size improvements in measures of symptoms and functioning. Participants also made improvements in ADHD knowledge. However, only the knowledge trajectory with rapid improvement displayed significantly better outcomes. Only one trajectory group showed improvement in adaptive thinking with most ACCESS participants remaining stable across time. However, adaptive thinking trajectories were strongly related to both symptom and functional outcomes. ACCESS is associated with large gains in two of the three theorized clinical mechanisms of change, behavioral strategies and ADHD knowledge. Rapid improvement in behavioral strategies was associated with robust improvement in symptoms and functioning. Although improvements in the third mechanism, adaptive thinking, were small, they were strongly associated with outcomes demonstrating the importance of a cognitive-behavioral approach in treating college students 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.

Online and Intellectual Awareness of Executive Functioning in Daily Life among Adolescents with and without ADHD

OBJECTIVE

Executive function deficits (EFD) are a central mechanism underlying negative outcomes in ADHD. This study examined awareness of EFD manifested in "real-time" task performance (Online Awareness) and in general self-knowledge of daily activities, outside the context of a specific task (Intellectual Awareness) among adolescents with and without ADHD.

METHODS

102 adolescents with (n = 52) and without (n = 50) ADHD were administered Weekly Calendar Planning Activity (WCPA) and Behavior Rating Inventory of Executive Function (BRIEF). Parents completed the BRIEF parent version. Awareness was defined using the discrepancy paradigm: performance versus estimation on WCPA for online awareness; self versus parent report on the BRIEF for intellectual awareness.

RESULTS

Adolescents with ADHD overestimated their performance on the WCPA and underestimated their EFD on the BRIEF compared to parent's ratings. The discrepancy scores in both types of awareness were significantly larger among ADHD than controls (p < .005).

CONCLUSIONS

Adolescents with ADHD demonstrate significantly lower rates of online and intellectual awareness of EFD compared to controls.

Childhood ADHD Symptoms, Parent Emotion Socialization, and Adolescent Peer Problems: Indirect Effects Through Emotion Dysregulation

Although parent reactions to children's negative emotions are important to the development of adolescent social and emotional functioning, there is a lack of research examining this aspect of parenting in samples that include youth with attention-deficit/hyperactivity disorder (ADHD). This study addresses this gap in the research by examining the independent effects of childhood ADHD symptoms and parent reactions to negative emotions in the longitudinal prediction of adolescent emotion dysregulation and peer problems. A sample of 124 youth (52% female) with and without clinical elevations in ADHD symptoms were assessed in childhood (8-12 years; M = 10.50) and followed up 5-6 years later in adolescence (13-18 years; M = 16.15). Path models tested the direct effects of childhood ADHD symptoms, supportive parent reactions, and non-supportive parent reactions on adolescent peer problems (friendship quality, deviant peer affiliation, peer aggression) and the indirect effects via adolescent emotion dysregulation. Emotion dysregulation mediated the effects of greater ADHD symptoms and of less parent supportive reactions on adolescent peer problems; parent reactions also independently predicted specific adolescent peer problems. Even for youth with clinical elevations in ADHD symptoms, parent reactions to children's negative emotions may be important in understanding adolescent emotion dysregulation and peer problems.

Challenges Faced by Primary Caretakers of Adolescent Girls with Intellectual Disability during their Menstrual Cycle in Puducherry: A Mixed Method Study

Background:

Adolescents with Intellectually Disability (ID) compared to their normal peers face greater challenges at menarche due to their caregiver dependence for their day-to-day personal care activities.

Objective:

The objective of the study was to know the sociodemographic characteristics of adolescent girls with ID and to explore the challenges faced by their primary caretakers during their menstrual cycle in Puducherry.

Subjects and Methods:

The study was conducted among primary caretaker of adolescent girls with ID from December 2018 to May 2019. The study adopted quantitative method to capture sociodemographic details among 73 primary caretakers of adolescent with ID who attained menarche and In-Depth Interview (IDI) was conducted to explore the challenges faced by primary caretakers. The caretakers of adolescents were selected using purposive sampling and conventional content analysis was followed for data analysis.

Results:

We discovered that 80.9% of adolescent with ID were not able to manage their menstruation of their own. Primary caretakers who were interviewed were mostly mother's 67.1%. Due to caretaker's dependency, 94.5% of the adolescent with ID were not going to school during their menstrual cycle.

Conclusions:

Majority of the caretakers faced problems such as rejection of sanitary napkins and inability to recognize about the start of period by their adolescents with ID.

Screen time and early adolescent mental health, academic, and social outcomes in 9- and 10- year old children: Utilizing the Adolescent Brain Cognitive Development ℠ (ABCD) Study

In a technology-driven society, screens are being used more than ever. The high rate of electronic media use among children and adolescents begs the question: is screen time harming our youth? The current study draws from a nationwide sample of 11,875 participants in the United States, aged 9 to 10 years, from the Adolescent Brain Cognitive Development Study (ABCD Study®). We investigate relationships between screen time and mental health, behavioral problems, academic performance, sleep habits, and peer relationships by conducting a series of correlation and regression analyses, controlling for SES and race/ethnicity. We find that more screen time is moderately associated with worse mental health, increased behavioral problems, decreased academic performance, and poorer sleep, but heightened quality of peer relationships. However, effect sizes associated with screen time and the various outcomes were modest; SES was more strongly associated with each outcome measure. Our analyses do not establish causality and the small effect sizes observed suggest that increased screen time is unlikely to be directly harmful to 9-and-10-year-old children.

Interpersonal Problems of Young Adults With and Without Attention-Deficit/Hyperactivity Disorder

Objective:Interpersonal functioning is a core area of impairment for young adults with Attention-Deficit/Hyperactivity Disorder (ADHD), yet the assessment of their interpersonal problems has not been approached using a comprehensive model of interpersonal behaviors. Method: Interpersonal problems of young adults with ADHD (n = 24) were compared to non-ADHD peers (n = 26) by self- and collateral-report using the Inventory of Interpersonal Problems-Circumplex-Item Response Theory (IIP-C-IRT). Results: Both self- and collateral-reports yielded significantly higher scores across interpersonal problem domains, except for self-reported Hostile-Dominant (HD) interpersonal problems. Discrepancy scores between self- and collateral-report supported larger differences in the ADHD versus non-ADHD groups for HD problems. Large correlations between collateral-reported family relationship impairments and HD problems were found only for the ADHD group. Conclusion: Young adults with ADHD have higher levels of interpersonal problems relative to their non-ADHD peers, but also appear to underreport HD interpersonal problems relative to non-ADHD peers, suggesting the presence of a bias. (J. of Att. Dis. XXXX; XX[X] XX-XX).

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.

ADHD in Adolescents: Commentary on the Special Issue of Ripple Effects in Self-Perceptions and Social Relationships

Adolescence is a developmental period that affords both risk as well as enormous opportunity. Ripple effects can extend far and wide and speak to the nuance and complexity in understanding and treating ADHD during the adolescent period. The studies in this special issue provide novel and important insights into the lives of adolescents with ADHD, and they collectively point to important areas for both research and clinical attention. Further, each of the studies underscore the importance of soliciting the perspective of adolescents with ADHD. In this commentary, I consider the value of self-report when working with adolescents with ADHD, the possibility of a self-perception bias in youth with ADHD, challenges in assessing social functioning in adolescence, and implications for school-based assessments and interventions. For treatment specifically, I raise the possibility of a modular intervention approach for adolescents with ADHD and shared decision making that solicits and incorporates the adolescent perspective. The voices of adolescents with ADHD may be crucial for understanding how to lower risk, promote resilience, reduce stigma, and improve our assessments and interventions.

Transition to Employment Program (SUPER) for Youth at Risk: A Conceptual and Practical Model

This article describes the development, implementation, and evaluation of the transdisciplinary “Successful Pathways to Employment for youth at Risk” (SUPER) program to raise the transition readiness of youth at risk (YAR) from school into participation in adults’ responsibilities and employment. More than 10% of adolescents are at risk of dropping out of school following poor academic attainments. Schools appraise academic merit but do not develop relevant educational programs to prepare youth to transition into adult working life. The SUPER program addresses a range of knowledge and skills required for this transition. Sixty YAR from three high schools participated in the 18-week SUPER program. Comparing the pre- and postintervention results revealed that the students’ engagement with responsibilities, objective knowledge about the work world, and self-rated self-advocacy skills improved as did their supervisor-rated work performance capacity. This study confirms the contribution of the SUPER model. Its concepts, tools, principles, and community labor-market involvement through workplace internships were effective and could apply in other contexts. The SUPER model provides evidence-based knowledge translation that can bring conceptual and practical changes towards successful transition and participation of YAR in adult working roles.

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.

Adolescents' experiences of being diagnosed with attention deficit hyperactivity disorder: a phenomenological study conducted in Sweden

OBJECTIVES

To explore adolescents' experiences of being diagnosed with Attention deficit hyperactivity disorder (ADHD).

DESIGN

Qualitative interview study, using a phenomenological framework and analysis.

SETTING

The children's clinic of a specialised out-care hospital located in a multicultural area of a Swedish city.

PARTICIPANTS

13 adolescents, 7 boys and 6 girls between 14 and 19 years old, who had been diagnosed with ADHD.

RESULTS

The participants' experience of being diagnosed with ADHD was interpreted as a process of understanding oneself as being different, for better or worse, like many others. The participants sought acceptance and a sense of normality, while developing an understanding of both the positive and the negative sides of their ADHD traits. These two sides of a coin were inter-related parts of themselves and were shared by many others, which increased their acceptance. Three themes described phases of the process: struggling with vulnerability, responding to a label and manoeuvring social life.

CONCLUSION

The results add to previous research, illuminating that the adolescents tried to make sense of both the uniqueness and the vulnerability of the ADHD diagnosis. The findings can be useful for healthcare professionals, in reflecting on the complexity of ADHD and on the adolescents' expectations.

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.

Attention deficit/hyperactivity disorder and future expectations in Russian adolescents

In recent years, there has been an increasing focus on the role of future expectations-the extent to which a future outcome is deemed likely-in the health and well-being of adolescents, with research linking future expectations to outcomes such as an increased likelihood of engaging in risky health behaviors. As yet, however, there has been no research on future expectations and attention deficit/hyperactivity disorder (ADHD) in adolescence. To address this research gap, the current study examined the association between ADHD symptoms/possible ADHD status and future expectations in a school-based sample of adolescents. Data were analyzed from 537 Russian adolescents (aged 12-17) with teacher-reported ADHD symptoms and self-reported future expectations. Logistic regression analysis was used to examine associations. In fully adjusted analyses, inattention symptoms/possible ADHD inattentive status was associated with lower future educational expectations, while a possible ADHD hyperactivity status was associated with increased odds for negative future expectations relating to work, family and succeeding in what is most important. The findings of this study suggest that greater ADHD symptoms/possible ADHD status in adolescence may be linked to an increased risk for negative future expectations across a variety of different life domains.

The Revised Child Anxiety and Depression Scales (RCADS): Psychometric Evaluation in Children Evaluated for ADHD

Co-occurring internalizing symptoms are common and important to assess in children with attention-deficit/hyperactivity disorder (ADHD). One frequently used child self-report measure of internalizing symptoms is the Revised Child Anxiety and Depression Scales (RCADS), yet the psychometric properties of the RCADS remain unexamined in children referred for ADHD specifically. The present study evaluated the RCADS in 117 children (ages 8-12; 66% male) evaluated for suspected ADHD at an ADHD specialty clinic (83% met criteria for ADHD). In addition to the RCADS, children completed measures of social anxiety and depression. Parents completed the RCADS-Parent Version (RCADS-P) in addition to other measures of internalizing and externalizing symptoms. Children and parents both completed a measure of aggression. Factor structure, reliability, and convergent/discriminant validity of the RCADS were examined. Results supported the six-factor structure of the child-report RCADS (Separation Anxiety, Social Phobia, Generalized Anxiety Disorder, Panic Disorder, and Obsessive Compulsive Disorder, Major Depressive Disorder). The RCADS demonstrated adequate reliability as well as convergent and discriminant validity with other child ratings. The total anxiety score on the RCADS also demonstrated convergent and discriminant validity with parent measures, though the depression score on the RCADS did not. Findings provide preliminary psychometric support for the RCADS in children referred for ADHD.

Comparing Alliance in Two Cognitive-Behavioural Therapies for Adolescents With ADHD Using a Randomized Controlled Trial

Alliance is defined as the client-therapist bond and their ability to collaborate on therapeutic activities. Treatment for adolescents with ADHD is rarely studied in terms of alliance. In this study, two cognitive-behavioral treatments (CBT; one structured treatment aimed at planning skills and one less-structured solution-focused treatment, both delivered in the style of Motivational Interviewing) were compared with regard to alliance and alliance-outcome association. The influence of therapist competence on this alliance-outcome association was also evaluated. The alliance between 69 adolescents diagnosed with ADHD and their therapists was measured early in treatment, using the Therapy Process Observational Coding System for Child Psychotherapy-Alliance scale. Observer-rated therapist competence was measured using the Motivational Interviewing Treatment Integrity scale (version 3.1.1.). Outcome variables were the adolescents' reduction in planning problems and ADHD symptoms. The alliance, and, more specifically, collaboration on therapeutic activities, was significantly higher for the more structured CBT (p = .04; moderate effect size). Alliance was not related to outcome in the more structured CBT, while the alliance was positively related to the reduction in planning problems in the less structured CBT. Finally, alliance was a significant mediator between therapist competence and treatment outcome for the less-structured CBT. The clarity and structure of CBT may help facilitate alliance formation for adolescents with ADHD who often have difficulty implementing structure themselves. Therapists may need to invest more in alliance formation in less structured CBT as the alliance affects outcome. Moreover, enhancing therapist competence in less structured CBT may help improve outcomes in less structured CBT, as therapist competence may impact outcome through alliance.

Trajectories of Global Self-Worth in Adolescents with ADHD: Associations with Academic, Emotional, and Social Outcomes

Resilience models suggest that there are likely to be multiple trajectories of self-worth and that despite experiencing impairment, some youth with attention deficit/hyperactivity disorder (ADHD) may maintain a positive self-worth, which could buffer them against negative outcomes. The present study used a cohort-sequential longitudinal design to evaluate developmental trajectories of global self-worth in a sample of 324 middle-school-age adolescents (71% male) diagnosed with ADHD between ages 11 and 14 in predicting outcomes at age 15. Sex, medication status, and ADHD/oppositional defiant disorder symptom severity were included as covariates in the models. Using growth mixture modeling, 3 distinct self-worth trajectory groups were identified: (a) high and increasing (44.4% of participants), (b) moderate and decreasing (48.8%), and (c) low and decreasing (6.8%). Participants with high and increasing global self-worth were less likely to exhibit co-occurring depressive symptoms and had better social functioning and higher grades at age 15 relative to those in either decreasing trajectory. Implications of these findings for monitoring and supporting positive global self-worth for adolescents with ADHD are discussed.

Is the Positive Bias an ADHD Phenomenon? Reexamining the Positive Bias and its Correlates in a Heterogeneous Sample of Children

The goals of this study were to (a) evaluate the presence of the positive bias (PB) in elementary-school-aged children with and without ADHD when PB is defined at the individual level through latent profile analysis and (b) examine the extent to which several correlates (i.e., social functioning, aggression, depression, and anxiety) are associated with the PB. Participants were 233 youth (30% female; 8 to 10 years of age), 51% of whom met criteria for ADHD. During an individual evaluation, children and parents completed a battery of questionnaires to assess child competence, depression, anxiety, and aggression. Children also participated in a novel group session with same-sex unfamiliar peers (half of the group was comprised of children with ADHD) to engage in group problem-solving tasks and free play activities. After the group session, peers and staff completed ratings of each child's behavior (e.g., likeability, rule following). The best fitting LPA model for parent and self-ratings of competence revealed four profiles: High Competence/Self-Aware; Variable Competence/Self-Aware; Low Competence/Self-Aware; and Low Competence/PB, in which the PB was present across domains. Only 10% of youth showed a PB and youth with ADHD were no more likely to display the PB than their non-ADHD peers with similar levels of low competence. Lastly, the Low Competence/Self-Aware profile demonstrated higher levels of anxiety and depression than the Low Competence/PB profile; the profiles did not differ on aggression or peer or staff ratings of social/behavioral functioning. Implications for understanding the PB in children with and without ADHD are discussed.