Accuracy of self-perceptions in children and adults with ADHD

Abstract

ADHD is associated with a wide range of social, emotional and cognitive sequelae. This
accumulation of negative experiences has an impact on various factors, such as the individual’s selfperceptions
of competence and self-esteem, which in turn may advocate maladaptive coping
strategies and interfere with treatment. Therefore, early assessment and intervention promoting
accurate self-perception and meta-cognitive skills are crucial. Since ADHD is a disorder that persists
in up to two thirds of the children into adulthood, it remains unclear whether eventual inaccurate
self-perceptions are something that children with ADHD eventually outgrow, or whether they persist
into adolescence and adulthood. Existing studies of self-perceptions and self-concept in patients with
ADHD have yielded mixed results.
Thus, the goal of the present thesis was to investigate whether children and adults with
ADHD are able to make accurate judgments of their self-regulatory skills. To that aim, we first
developed and evaluated a new age-appropriate instrument of metacognitive knowledge of selfregulatory
skills in young children – the SelfReg –, which demonstrated to be a valid and sensitive
instrument. In a next step, the accuracy of self-perceptions of children with ADHD on this new ageappropriate
instrument was analyzed. Accuracy of self-perceptions in adults with ADHD was
examined by means of existing self-report inventories assessing cognitive and executive deficits in
everyday situations, and compared them to those of adults without ADHD.
Consistent with the hypothesis, results indicated that children and adults with ADHD are able
to provide accurate self-perceptions when tested with an ecologically valid and appropriate
instrument. In accordance with previous findings assessing the self-concept of patients with ADHD,
adults with ADHD presented with significantly lower self-concepts compared to controls. Of note,
findings persisted even when controlling for possible confounding depressive symptoms. However,
effect sizes in study 2, investigating children with ADHD, indicated a tendency toward a positive
bias after all, when children with ADHD were compared to controls.
Therefore, an additional exploratory cluster analysis was performed. Results offered
evidence for characteristic overestimation as well as for underestimation or accurate estimation of
skills in different subgroups of children with ADHD. Children belonging to the “positive bias” group
were slightly younger and tended to have lower IQ scores than other children with ADHD. This
finding was in accordance with the “meta-cognitive deficit” explanation of inflated self-perceptions
(e.g. Poissant, 2005), but in contrast to recent studies claiming that inflated self-perceptions persist in
ADHD over the years (Hoza et al. 2010). Finally, the study provided further support for the findings
of previous studies postulating greater predictive power of behavioural questionnaires over executive
function test in the assessment of executive impairments in daily life of patients with ADHD.
However, the results should also be considered in the context of some limitations. The
findings suggest that over- and underestimation of self-regulatory skills is not universal to ADHD,
but may be restricted to a distinct subgroup of ADHD patients whose special characteristics and
developmental risks remain to be fully described. Therefore, further research with larger samples is
warranted to determine whether this association exists in different populations with different levels of
executive function and self-awareness. In the majority of cases, however, self-reports from patients
with ADHD, assessed with ecologically valid and age-appropriate instruments such as the SelfReg,
seem to constitute reliable and important source of information for clinical intervention.