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

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 Development and Content Validation of a Clinical Screening Scale to Identify Attention-Deficit Hyperactivity Disorder Cases Based on the Gender Perspective: An e-Delphi Study

BACKGROUND

Although many studies analyse gender differences in the clinical expression of Attention-Deficit Hyperactivity Disorder (ADHD) and prevalence studies show that girls with ADHD are underdiagnosed, there are no instruments that are sensitive to the detection of girls with ADHD.

OBJECTIVE

The objective of this study is to develop a self-report early detection instrument for boys and girls with ADHD aged 7 to 16, which includes the gender perspective and is sensitive to the detection of girls with ADHD.

METHODS

The scale was developed and the items that comprised it were created from the thematic analysis of ADHD and its evaluation in children based on the diagnostic criteria of the DSM-5-TR. A modified e-Delphi method involving a three-round web survey was used to establish a consensus on the content of the scale. Ten experts were recruited to form a professional panel. The panel members were asked to assess the differential symptomatology of ADHD in boys and girls, the dimensions to be evaluated, and the importance of scale items to evaluate the content.

RESULTS

A consensus was reached regarding 13 total items distributed in three dimensions: inattention; hyperactivity/impulsivity; and, a third dimension, internalisation, which includes symptoms most present in the expression of ADHD in girls.

CONCLUSIONS

To the best of our knowledge, the development of this scale using the Delphi method is the first specific scale used for identifying ADHD that also addresses the gender perspective and the differential symptomatology between boys and girls. However, we must proceed to the analysis of psychometric properties, as the scale requires an exhaustive study of its reliability and validity. We can anticipate that this scale will provide relevant and reliable information that can be used for the identification of ADHD in both boys and girls.

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.

A measure of functioning in adults With ADHD: Psychometric properties of the general life functioning scale-parent version

OBJECTIVE

The General Life Functioning Scale (GLF) was developed to provide a complementary alternative to existing measures of impairment. We examined the psychometric properties of the GLF-Parent version (GLF-P), given the known value of informant ratings.

METHODS

The GLF-P was administered to parents of adults with attention-deficit/hyperactivity disorder (ADHD) diagnosed in childhood and a nonADHD comparison group in the Pittsburgh ADHD Longitudinal Study. GLF-P ratings described 334 participants (ADHD = 186; comparison = 148) rated at age 25 (Mage  = 24.80 years, SDage  = 0.46, range = 24-26) and 401 participants (ADHD = 237; comparison = 164) rated at age 30 (Mage  = 29.30, SDage  = 0.64, range = 28-33). Exploratory (EFA) and confirmatory (CFA) factor analyses were used.

RESULTS

EFAs suggested and CFAs confirmed a five-factor solution. We found measurement invariance across diagnostic and age groups, satisfactory internal consistency, construct validity, and known-group validity.

CONCLUSION

Psychometric results suggest the GLF-P as a helpful adjunctive measure of functioning. Further research is needed to determine the utility of the GLF across diverse settings.

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.

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.

Revisiting ADHD age-of-onset in adults: to what extent should we rely on the recall of childhood symptoms?

BACKGROUND

ADHD diagnosis requires the presence of symptoms before the age of twelve. In clinical assessment of adults, the most frequent strategy to check this criterion is investigating self-report recall of symptoms, despite little evidence on the validity of this approach. We aim to evaluate the recall accuracy and factors associated with its reliability in a large population-based sample of adults.

METHODS

Individuals from the 1993 Pelotas Birth Cohort were followed-up from childhood to adulthood. At the age of 22, 3810 individuals were assessed through structured interviews by trained psychologists regarding mental health outcomes, including ADHD diagnosis and ADHD symptoms in childhood. The retrospective recall was compared with available information on ADHD childhood symptoms at the age of eleven. We also assessed factors related to recall accuracy through multiple regression analyses.

RESULTS

Self-reported recall of childhood symptoms at 22 years of age had an accuracy of only 55.4%, with sensitivity of 32.8% and positive predictive value of 40.7%. Current inattention symptoms were associated with lower risk and social phobia with higher risk for false-positive endorsement, while higher levels of schooling correlated with lower risk and male gender with higher risk for false-negative endorsement.

CONCLUSIONS

Clinicians treating male patients with social phobia and ADHD symptoms should assess even more carefully retrospective recall of ADHD childhood symptoms. Moreover, characteristics associated with recall improvement do not impact accuracy robustly. In this context, the recall of childhood ADHD symptoms seems an unreliable method to characterize the neurodevelopmental trajectory in adults with currently-impairing ADHD symptomatology.