Abstract
Although attention deficit hyperactivity disorder (ADHD) in adulthood is associated with marked cognitive impairment, research on metacognition in adult ADHD is scarce. Deficits in metacognition may have a negative impact on treatment adherence, functional outcomes, and everyday life. This study explores metacognition, specifically self-awareness of cognitive performance, in adults with ADHD by combining objective and subjective assessments. Forty-seven patients with ADHD and 47 control individuals completed a neuropsychological assessment battery including tests for attention, executive functions and memory (objective assessment), as well as questionnaires for cognitive functioning and symptom severity (subjective assessment; self- and informant-report). Participants evaluated their test performance of the objective assessment after test completion by selecting a percentile rank which was subtracted from their normed test result, yielding a discrepancy score. Compared to controls, adults with ADHD showed impairments in attention (medium effects) and memory (small and medium effects), but not in executive functions. The discrepancy scores between self-evaluation and cognitive performance revealed deficits in self-awareness of attentional functions (small effects), but not in executive functions and memory in patients with ADHD compared to controls. Discrepancy scores between self- and informant-reports of cognitive functioning revealed no significant differences. Adults with ADHD show impairments in metacognition in attentional functions, but may have intact metacognitive abilities in other domains. Patients with ADHD tend to overestimate their abilities, especially in attentional functions. Subjective and objective measures of metacognition may not correspond, highlighting the need for clinicians to not solely rely on patients’ self-report in their assessment.
Highlights
attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder which affects about 2.5% of adults (Simon et al 2009)
As almost all research on metacognitive skills in adults with ADHD so far has relied on self- and informant accounts, we aim to explore whether any difference in metacognition between patients and controls as measured by the postdiction discrepancy method can be found by subjective accounts of cognitive functioning
The discrepancy scores (DS) of cognitive performance showed that patients with ADHD significantly overestimate their attentional functions (Attention DS: p = 0.014; r = 0.255) as compared to controls
Summary
ADHD is a neurodevelopmental disorder which affects about 2.5% of adults (Simon et al 2009). Adult ADHD is characterized by impairments in several cognitive domains, such as attention, memory, and executive functions (Schoechlin and Engel 2005). An aspect related to executive functioning that has hardly been investigated in adult ADHD is metacognition. Metacognition encompasses various cognitive processes, such as self-awareness, self-monitoring, and self-regulation (Knouse et al 2005), which impact adaptive behavior in various environments (Eslinger et al 2005). Metacognition was found to influence coping, functional outcomes, and treatment adherence in patients with dementia (Williamson et al 2010) and self-awareness of executive functioning could even predict functional decline in patients with mild cognitive impairment (Scherling 2016). Deficits in self-awareness of cognitive ability were shown to have a negative impact on everyday life (Rothlind et al 2017; Torres et al 2016), suggesting that metacognition may be relevant in the clinical context
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