August 19, 2014

The Positive Illusory Bias in Children with Adolescents with ADHD: Further Evidence

The Article Can Be Found Here

·         Many individuals with ADHD display a positive illusory bias (viewing themselves as more competent that they actually are)  for their academic, behavioral, and social competencies (see Hoza et al., 2012)
·         Evidence that children and adolescents with ADHD display higher levels of positive illusory bias than children with moderate to severe behavioral, emotional, and social disturbances but without ADHD (Whitley et al., 2008)
·         Positive illusory bias varies across domains (more likely to overestimate competence in areas with greatest deficits; Hoza et a., 2004) – Possibility of domain-specific positive illusory bias in individuals with ADHD has been proposed and is being investigated
·         Comorbid problems may moderate the presence of positive illusory bias (e.g., Treuting & Hinshaw, 2001; Hoza et al., 2004) – children with comorbid internalizing problems appear to more accurately rate their abilities
Present Study
·         Goal of Present: compare parent reports to  child reports of competence on different activities of daily life in children and adolescents with and without ADHD
·         Participants: 183 children and adolescents (89 with ADHD, 94 control); predominantly male (88%); average age of 11.5 years (ranges from 6 to 15; SD = 2.3)
·         Illusory Bias calculated by subtracting the parent ratings from the child/adolescent ratings for each area of daily living (measured using the Competence Scale for Children and Adolescents) à Positive value = overestimation of ability (positive illusory bias); Negative value = underestimation of ability (negative illusory bias)
·         Results:
o   Using the summary score (composite score of all 34 activities of daily life), children and adolescents with ADHD displayed a positive illusory bias
o   Activities of daily life that best predicted group membership were:
§  Dealing with difficult situations
§  Playing by the rules
§  Concentrating
§  Being able to wait
§  Asking for help
o   Children and adolescents with ADHD displayed positive illusory bias on activities involving cognition (i.e. memorizing school material); graphomotor skills (i.e. writing); executive tasks (i.e. tidying up); and activities related to ADHD symptomatology (i.e. able to wait; concentrating).  They did not display such a bias in personal care activities (i.e. washing hands, putting on pants)
o   Several predictors of positive illusory bias were found:
§  Age – positive illusory bias tends to decrease with age (this depending on group membership however) à age was significant for control children but not for children with ADHD
§  High total CBCL and subscale scores on the CBCL were positively related to illusory bias à greater behavioral disturbances related to greater illusory bias
·         Externalizing symptoms in particular predicted the degree of illusory bias
§  Length of treatment, intelligence, medication, marital status and ADHD subtype were all not related to illusory bias
Discussion Questions
1.       The reason for this positive illusory bias is still unknown.   I am curious what people’s thoughts are on why it is present.
o   One proposed explanation is that children with ADHD may have a “self-serving bias” in which they deny their deficits in order to prevent distress and to protect their self- image.  Do you agree with this?
o   There is some evidence that there may be positive illusory bias may serve as a protective factor for depressive cognitions for children with ADHD (McQuade, Hoza, Murray-Close, Waschbusch, & Owens, 2011)
2.       Given the suggested domain-specific positive illusory bias, what domains would you think children and adolescents would display such biases in?
3.       This study found no effect of ADHD subtype on positive illusory bias.  However, other studies have found that children with ADHD – Primarily Inattentive type do not seem to display the positive illusory bias that children with ADHD – Primarily Hyperactive/Impulsive type and Combined type display (e.g., Owens & Hoza, 2003).  Would you expect there to be differences in positive illusory bias based on if children display hyperactive/impulsive symptoms compared to inattention?  Why might this be the case? 
4.       What implications do you think having a positive illusory bias could have as these children and adolescents with ADHD move to adulthood?

5.       What suggestions do you have for interventions for children with ADHD who display a positive illusory bias?

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