Metacognitive Deficits Research Articles

Contrasting metacognitive profiles and their association with negative symptoms in groups with schizophrenia, early psychosis and depression in a Russian sample.

Research has suggested that negative symptoms in psychotic disorders may be in part fueled by deficits in metacognition or the ability to form integrated ideas about oneself and others. One limitation of this work is that it has largely come from North America and Western Europe. To further the literature, we assessed symptoms using the Positive and Negative Syndrome Scale and Metacognition using the Metacognitive Assessment Scale - Abbreviated in a sample of outpatients with prolonged schizophrenia (n = 41), early episode psychosis (n = 37) and major depression (n = 30) gathered in Moscow, Russia. Verbal memory was assessed for use as a potential covariate. ANOVA revealed the two groups with psychosis had significantly poorer metacognitive function in terms of self-reflectivity and awareness of the other, than the group with depression. In both psychosis groups negative symptoms were more robustly related to metacognition than other forms of symptoms after controlling for neurocognition. Results support the possibility that metacognitive deficits are a psychological factor which cross culturally contributes to negative symptoms and point to metacognition as a potentially important target for intervention.

S75. PERFORMANCE IN WORKING MEMORY AND EXECUTIVE FUNCTIONS AS IT RELATES TO THEORY OF MIND ABILITIES IN A NONCLINICAL SAMPLE OF INDIVIDUALS WITH SCHIZOTYPAL TRAITS

BackgroundIn recent decades, research in the treatment of schizophrenia has shifted to early detection and intervention. Unfortunately, the development of psychosis is still poorly understood, making such an endeavour more challenging. Cognitive models of psychosis suggest that neurocognitive deficits place an individual at greater risk of developing metacognitive deficits. Such deficits in metacognition have been shown to contribute to the development of positive symptomatology. A large body of literature supports that patients with schizophrenia exhibit impairments across nearly all domains of neurocognition, as well as metacognition. Theory of mind (ToM) is one of the most widely studied components of metacognition, which includes both cognitive (i.e., understanding what another person is thinking) and affective (i.e., understanding what another person is feeling) processes. Research indicates patients with schizophrenia demonstrate deficits in cognitive and affective ToM, and these deficits are associated with delusional symptomatology. If ToM is involved in the development of positive symptoms, it is expected that this deficit would be present prior to the onset of a first episode psychosis. It is unclear from current research findings if this is the case, however. Additionally, research examining the role of neurocognition as it relates to ToM is lacking. While some research has examined these variables in clinically-high-risk (CHR) groups, little research has examined nonclinical samples at risk for psychosis. Thus, this study sought to examine the relationship between ToM and neurocognition in a nonclinical sample with schizotypal traits, as research suggests these individuals may be at risk of developing a psychotic illness. It was hypothesized that lower performance in working memory and executive functioning would be related to poorer performance in cognitive and affective ToM, which would subsequently be associated with subsyndromal delusions. It was further predicted that schizotypal traits would moderate the relationship between neurocognitive performance and ToM abilities.MethodsUndergraduate students (N = 99) completed self-report measures of personality and psychosocial functioning, including the Schizotypal Personality Questionnaire, Beck Depression Inventory-II, Launay-Slade Hallucination Scale-Revised, and 21-Item Peters Delusions Inventory. Participants also completed the Neuropsychological Assessment Battery Screening Module, which is a screening measure for neurocognitive dysfunction. Finally, they completed the Recognition of Faux Pas Test, a task-based measure that evaluates cognitive and affective ToM.ResultsData collection is complete, and the data will be analysed using partial least squares structural equation modeling. This is a regression-based path analysis designed for exploratory models. This statistical method is better able to handle non-normally distributed data and smaller sample sizes when compared to covariance-based structural equation modeling.DiscussionStudy findings will be discussed in the context of cognitive models for the development of psychosis. The ways in which these findings, and cognitive models more broadly, can facilitate early detection of schizophrenia will be discussed, along with how such models can be used to inform psychosocial interventions for the illness.

T52. COGNITION, METACOGNITION AND SOCIAL COGNITION AFTER A FIRST EPISODE PSYCHOSIS. PRELIMINARY RESULTS FROM A 5-YEAR-FOLLOW-UP STUDY

BackgroundCognitive impairment is considered a core feature of psychotic disorders. Deficits in cognition, metacognition and social cognition have been reported to be correlated, and indeed predictors, of functional outcome or level of disability. Psychotic patients tend to present lower IQ and show impairment in specific cognitive domains, and in social cognition, than controls. Several studies have found deficits in facial emotion recognition (FER) and a higher prevalence of the jumping to conclusions (JTC) reasoning and data gathering biases among psychotic patients, even at time of illness onset, compared to controls. However, the trajectory of this impairment remains unclear. Only a few studies have jointly investigated longitudinally the course of neurocognitive and social cognitive deficits, emotional processing, and JTC. Therefore, this study aimed to explore long-term trajectories of IQ, JTC, and FER using 5-year follow up (FU) data.Methods36 patients with First Episode Psychosis (FEP) and 70 controls from the London subsample of the EUGEI study were followed up after 5 years. Sociodemographic, clinical and neuropsychological assessments were performed at baseline and 5-year-follow-up. Current IQ was measured using WAIS III short form, JTC bias through the 60:40 beads task, and FER using Degraded Facial Affect Recognition (DFAR) task. In STATA 15, repeated measures ANOVA was used to analyse changes between baseline and follow up scores.ResultsMean IQ scores for patients were 88.4 (20) at baseline and 92.6 (SD 17.9) at FU. For controls, IQ scores were 104.5 (SD 18.4) at baseline and 108.9 (SD 19.5) at FU. For patients, mean number of beads was 3.9 (SD 4) at baseline and 3.2 (SD 3.4) at FU, while controls decided after 6.3 (SD 4.6) beads on average at baseline and 6.5 (SD 3.2) at FU. For patients, mean DFAR scores were overall [baseline: 72.5 (SD 16); FU: 72.4 (SD 18.1)], neutral [baseline: 79 (SD 19.1); FU: 76.5 (SD 24.3)], happy [baseline: 86.9 (SD 16.9); FU: 88.4 (SD 18.9)], fearful [baseline: 51.3 (25.6); FU: 54.2 (SD 20.9)], angry [baseline: 72.8 (24.3); FU: 70.4 (26.9)]. For controls, mean DFAR scores were overall [baseline: 76.3 (SD 8.6); FU: 75.4 (SD 8.7)], neutral [baseline: 82.2 (SD 12.8); FU: 84.9 (SD 13.1)], happy [baseline: 93 (SD 7.9); FU: 90.7 (SD 8.5)], fearful [baseline: 60.5 (18.1); FU: 58.1 (SD 20.3)], angry [baseline: 69.5 (19.5); FU: 58.1 (20.3)]. Repeated-measures ANOVA showed that patients scored significantly lower than controls on: IQ [F(1,103) = 22.6, p < 0.001], beads task [F(1,104) = 12.5, p = 0.0006], DFAR overall [F(1,101) = 6.94, p = 0.0096], DFAR neutral [F(1,101) = 10.36, p = 0.0017], DFAR happy [F(1,101) = 7.88, p = 0.0059] and DFAR fearful [F(1,101) = 5.45, p = 0.0213]. There was a significant effect of time for IQ scores [F(1,103) = 19.4, p > 0.001], but no time*group interaction. There was no significant main effect of time or time*group interaction for beads task and all DFAR scores.DiscussionIn line with previous literature, lower IQ was found in the patients group, both at baseline and 5-year-follow-up. Likewise, jumping to conclusion bias and facial emotion recognition impairments were prominent in patients compared to controls. Preliminary Results: pointed out small yet significant improvement in current IQ for both groups. Nonetheless, JTC bias and deficits in recognising emotional facial expressions were found to be steady along the course of the illness. Further research is warranted to examine the association between those impairments and functional outcome.

Metacognition deficits and impulsivity in Parkinson’s Disease patients with and without gambling behavior: A pilot study

IntroductionImpaired metacognition and impulsivity are critical factors in pathological gambling behavior subsistence. This study aims at jointly exploring metacognitive skills and impulsivity levels in subgroups of Parkinson’s Disease (PD) patients with different gambling status. Method48 PD participants were divided into three subgroups: PD Gamblers (PDG), PD patients with a previous history of gambling and PD controls. Impulsivity was assessed by the Barratt Impulsiveness Scale. After performing the Iowa Gambling Task (IGT), patients filled in a self-report measure to assess their metacognitive strategies. ResultsFindings highlighted that PDG showed higher levels of impulsivity than PD controls as reflected by clinical scales and behavioral measure. Also, PDG displayed a worse performance at IGT although they stated to use an efficacious strategy, suggesting then an erroneous metacognitive representation. ConclusionsOverall findings proposed that high levels of impulsivity combined with an explicit metacognitive bias on self-efficacy could intervene in the persistence of pathological gambling behavior in PD patients.

Metacognitive myopia in change detection: A collective approach to overcome a persistent anomaly.

Going beyond the origins of cognitive biases, which have been the focus of continued research, the notion of metacognitive myopia refers to the failure to monitor, control, and correct for biased inferences at the metacognitive level. Judgments often follow the given information uncritically, even when it is easy to find out or explicitly explained that information samples are misleading or invalid. The present research is concerned with metacognitive myopia in judgments of change. Participants had to decide whether pairs of binomial samples were drawn from populations with decreasing, equal, or increasing proportions p of a critical feature. Judgments of p changes were strongly affected by changes in absolute sample size n, such that only increases (decreases) in p that came along with increasing (decreasing) n were readily detected. Across 4 experiments these anomalies persisted even though the distinction of p and n was strongly emphasized through outcome feedback and full debriefing (Experiment 1-4), simultaneous presentation (Experiments 2-4), and recoding of experienced samples into descriptive percentages (Experiment 3-4). In Experiment 4, a joint attempt was made by 10 scientists working in 7 different institutions to develop an effective debiasing training, suggesting how multilab-collaboration might improve the quality of science in the early stage of operational research designing. Despite significant improvements in change judgments, debiasing treatments did not eliminate the anomalies. Possible ways of dealing with the metacognitive deficit are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Metacognitive Reflection and Insight Therapy: A Recovery-Oriented Treatment Approach for Psychosis.

Recent research has suggested that recovery from psychosis is a complex process that involves recapturing a coherent sense of self and personal agency. This poses important challenges to existing treatment models. While current evidence-based practices are designed to ameliorate symptoms and skill deficits, they are less able to address issues of subjectivity and self-experience. In this paper, we present Metacognitive Insight and Reflection Therapy (MERIT), a treatment approach that is explicitly concerned with self-experience in psychosis. This approach uses the term metacognition to describe those cognitive processes that underpin self-experience and posits that addressing metacognitive deficits will aid persons diagnosed with psychosis in making sense of the challenges they face and deciding how to effectively manage them. This review will first explore the conceptualization of psychosis as the interruption of a life and how persons experience themselves, and then discuss in more depth the construct of metacognition. We will next examine the background, practices and evidence supporting MERIT. This will be followed by a discussion of how MERIT overlaps with other emerging treatments as well as how it differs. MERIT’s capacity to engage patients who reject the idea that they have mental illness as well as cope with entrenched illness identities is highlighted. Finally, limitations and directions for future research are discussed.

Evolution of social networks in early psychosis

ABSTRACT Individuals diagnosed with schizophrenia are consistently found to have smaller social networks, as well as deficits in metacognition; the results for those with comorbid substance misuse are contradictory. The role of metacognition in the development of social relationships in individuals with early psychosis and comorbid substance misuse is poorly understood and few studies have investigated its impact longitudinally. Method: A mixed method approach was used to analyze data from 10 verbatims from semi-structured, retrospective longitudinal interviews, and metacognition ratings. Results: Distinct profiles were identified and appeared stable over time in their reactions to life transition. Profile 1 presented with overall better metacognitive abilities, and varied on the onset, conclusion and diversity of relationships. Profile 2 showed poorer abilities, and completely changed social networks at transitions. The presence of mutually supportive relationships and of personal interest contributing to friendship formation differentiated profiles. Conclusion: Two profiles emerged: distinct in their stability and quality of friendships, as well as in their metacognitive abilities and substance use friendships. Interests, and intensity of the interpersonal connection also distinguished both profiles.

Explications cognitives des hallucinations acoustico-verbales dans la schizophrénie : un article de synthèse de la littérature scientifique

AimsOur article consists in both analysis and synthesis of contemporary cognitive models of auditory verbal hallucinations (AVHs) in schizophrenia. Our work is based on the analysis of the scientific literature including original articles, literature reviews as well as meta-analysis. MethodologyIn order to identify the most pertinent studies in the electronic search, the three following databases were systematically searched: PubMed, PsycINFO and MEDLINE. For both the analysis and synthesis we selected original articles, literature reviews as well as meta-analysis referring to any cognitive explanation of the auditory hallucinatory experience in schizophrenia. A cognitive model of auditory hallucinations refers to any incorporation of cognitive frameworks and explanations in one's conceptualization of the hallucinatory phenomenon in schizophrenia. We also focused our work on past conceptualization of auditory hallucinations in order to explain the development and the contribution of current cognitive models in the understanding of the onset and the maintaining of AVHs. After a brief review of clinical characteristics and historical conceptualization of auditory verbal hallucinations, contemporary explanations were presented in the area of schizophrenia. These explanations referred to researches into cognitive psychopathology including metacognitive as well as neuroimaging studies. ResultsThe examination of scientific literature highlighted the complexity of AVHs through multifactorial explanations here mostly explained by cognitive and metacognitive deficits. We synthesized former conceptualizations of AVHs, which were sustained on mechanistic or sensory explanations. Esquirol, Baillarger and Briere de Boismont were the first as conceiving AVHs as a perception disorder and introduced the idea that auditory hallucinations resulted from a failure to control one's memories/fantasies. Later, Broca and Wernicke discovered auditory areas in the human brain implicated in language comprehension and production. AVHs began to be conceptualized by the scientific world as being mechanistically brain-related. Sigmund Freud was among the first to study the meaning of AVHs, a domain still being investigated by todays cognitive sciences. More recently, neuroimaging studies allowed the validation of these sensory explanations in considering the onset of AVHs through the deficit of cortical and subcortical areas implicated in the process of languages (e.g. Broca and Wernicke areas) and emotions (e.g. limbic system, amygdala, hippocampus). At a more mechanistic level, contemporary cognitive models of AVHs explained AVHs as an intrusive verbal representation into the awareness which is non-inhibited (i.e. deficit in intentional inhibition) and also non-recognized as one's own experience (i.e. deficit in source monitoring, planning and metacognition), or even attributed to an external source (attribution bias). In terms of inhibitory control, inhibition is a basic cognitive mechanism defined as a collection of processes that allows the suppression of previously activated cognitive contents and the clearing of irrelevant actions or attention from consciousness. Intentional inhibition is effortful and occurs when an individual deliberately suppresses the activation of an item after deciding it is irrelevant. Theoretical support for the suggestion that an inhibitory failure is involved in AVHs in schizophrenia arises from studies that have shown that a failure in inhibition results in intrusive thoughts from long-term memory. Recent findings also found that individuals with AVHs in schizophrenia demonstrated an impaired source monitoring. In episodic memory research, a distinction was made between content (an event) and context (e.g. source or temporal characteristics of an event) information. The context of memories provides cues that allow an individual to differentiate one memory from other memories. AVHs are conceptualized as a failure to access the contextual cues that would allow voice-hearer to form an intact representation of events in memories. Regarding planning, AVHs refer to the intrusion of unwanted memories into the inner speech that are not recognized from one's own representation. Previous cognitive theories highlighted the important role played by metacognitive skills and belief (i.e. thinking about one's thinking) in the explanation of AVHs. Finally, the external attribution bias was extensively studied over the last three decades and refers to the tendency to attribute negative events (situational or cognitive) to an external source. In this framework, AVHs refer to intrusive thoughts externally attributed to a voice. ConclusionFor more than one century, scientific discoveries in (bio)medical science have allowed the validation of former sensory and mechanistic explanations of AVHs. Nevertheless, many explanatory models account for the way AVHs are maintained (source monitoring, deficit in planning, externalizing bias), while they scarcely expose how they are triggered (intrusive thoughts, deficit in inhibition). The relation between AVHs and intrusive thoughts still remain unclear, and further studies are needed for the understanding of a potential causal relationship.

Transdiagnostic Phenotyping Reveals a Host of Metacognitive Deficits Implicated in Compulsivity

Recent work suggests that obsessive-compulsive disorder (OCD) patients have a breakdown in the relationship between explicit beliefs (i.e. confidence about states) and updates to behaviour. The precise computations underlying this disconnection are unclear because case-control and transdiagnostic studies yield conflicting results. Here, a large online population sample (N = 437) completed a predictive inference task previously studied in the context of OCD. We tested if confidence, and its relationship to action and environmental evidence, were specifically associated with self-reported OCD symptoms or common to an array of psychiatric phenomena. We then investigated if a transdiagnostic approach would reveal a stronger and more specific match between metacognitive deficits and clinical phenotypes. Consistent with prior case-control work, we found that decreases in action-confidence coupling were associated with OCD symptoms, but also 5/8 of the other clinical phenotypes tested (8/8 with no correction applied). This non-specific pattern was explained by a single transdiagnostic symptom dimension characterized by compulsivity that was linked to inflated confidence and several deficits in utilizing evidence to update confidence. These data highlight the importance of metacognitive deficits for our understanding of compulsivity and underscore how transdiagnostic methods may prove a more powerful alternative over studies examining single disorders.

The Psychotherapeutic Treatment of Schizophrenia: Psychoanalytical Explorations of the Metacognitive Movement

Metacognition refers to the set of activities which allow persons to have a sense of oneself and of others available to them within the flow of daily experience. These activities range from awareness of discrete aspects of experience to their synthesis into larger, more complex ideas. Following research documenting the existence and influence of metacognitive deficits in schizophrenia, psychotherapeutic frameworks have emerged aiming to improve metacognition in this group. Metacognitive Reflection and Insight Therapy (MERIT) is one such integrative psychotherapy framework. Therapeutic targets and principles of MERIT are intended to be integrative but share common characteristics with psychoanalytical tradition in the treatment of schizophrenia. This paper accordingly explores how psychoanalytic theory can help explain how the effects of MERIT upon metacognition and self-experience in schizophrenia may reflect its effects on repairing the collapse of the boundary/connection between self and the world, mental fragmentation, and the lack of symbolization.

Psychosis: Between Dreams and Perceptual Reality

From the beginning of time, the layman always described and understood psychosis as a dream-like state. Researchers have characterized both psychosis and dreaming with common denominators, both displaying visuomotor hallucinations, loose associations, metacognitive deficit, impaired reality discrimination, strong emotional component, resulting in a general lack of insight. The association of psychosis with dreaming was present in literature centuries ago, in the works of great thinkers such as Kant and Schopenhauer, which prompted many modern specialists to delve deeper into studying this connection for a better understanding of psychosis and possible applications in the clinical practice. During REM sleep, which is the most associated with dreaming, visual and motor areas in the brain show increased activation, which is congruent with the presence of hallucinations, the hallmark of the dreaming state. Also, the amygdala, involved in emotion regulation, has a prominent role in the sleeping brain. The deactivation of parts of the prefrontal cortex translate in altered capacity for making decisions and critical thinking. Several neuroimaging studies have shown similar neural patterns in the wakeful state of psychotic patients, especially those associated with the presence or absence of insight. As insight is thought to play a major role in treatment compliance and quality of life in psychotic patients, it is the most studied element linking psychosis and REM sleep. Lucid dreaming is a state of awareness of dreaming, while the individual is still asleep. The dreamer has a degree of control of the narrative and capacity for self-reflection, aspects deemed as insight. Lucid dreaming is a rare occurrence, but has the potential to be trained, concept with great relevance in researching modalities for insight gain in psychotic patients. In conclusion, the research of insight present in lucid dreaming shows great prospect for developing better interventions that target the lack of it in psychotic patients, thus contributing to significant improvement in their prognosis, quality of life and treatment compliance.

Disruptions of frontoparietal control network and default mode network linking the metacognitive deficits with clinical symptoms in schizophrenia.

The metacognitive deficit in awareness of one's own mental states is a core feature of schizophrenia (SZ). The previous studies suggested that the metacognitive deficit associates with clinical symptoms. However, the neural mechanisms underlying the relationship remain largely unknown. We here investigated the neural activities associated with the metacognitive deficit and the neural signatures associated with clinical symptoms in 38 patients with SZ using functional magnetic resonance imaging with a perceptual decision‐making task accompanied with metacognition, in comparison to 38 age, gender, and education matched healthy control subjects. The metacognitive deficit in patients with SZ was associated with reduced regional activity in both the frontoparietal control network (FPCN) and the default mode network. Critically, the anticorrelational balance between the two disrupted networks was substantially altered during metacognition, and the extent of alteration positively scaled with negative symptoms. Conversely, decoupling between the two networks was impaired when metacognitive monitoring was not required, and the strength of excessive neural activity positively scaled with positive symptoms. Thus, disruptions of the FPCN and the default mode network underlie the metacognitive deficit, and alternations of network balance between the two networks correlate with clinical symptoms in SZ. These findings implicate that rebalancing these networks holds important clinical potential in developing more efficacious therapeutic treatments.

Perceptual biases and metacognition and their association with anomalous self experiences in first episode psychosis.

Anomalous self-experiences have been described as a prerequisite for anomalous perceptual experiences. Later, these anomalous perceptual experiences may then be metacognitively appraised as distressing, maintaining these experiences and later leading to anomalous (delusional) beliefs. This model of anomalous events may potentially be driven by perceptual biases and metacognitive deficits. This cross-sectional study explored the association between perceptual biases, metacognition and anomalous self- and perceptual experiences and delusional beliefs in First Episode Psychosis (FEP) and a matched healthy control sample. Fifty-eight individuals with FEP and seventy-two healthy controls were included in the main analysis. Increased auditory perceptual biases were significantly associated with increased state and trait anomalous self-experiences, in particular alienation from surroundings and emotional numbing. No significant associations were found between metacognitive efficiency and anomalous experiences. These findings may be consistent with the minimal self-disturbance model of schizophrenia spectrum vulnerability, particularly with the hyperreflexivity concept.

The Efficacy, Feasibility And Acceptability Of A Remotely Accessible Use Of CIRCuiTS, A Computerized Cognitive Remediation Therapy Program For Schizophrenia: A Pilot Study.

IntroductionThe Computerized Interactive Remediation of Cognition – Training for Schizophrenia (CIRCuiTS) is a form of cognitive remediation therapy developed to target neurocognitive and metacognitive deficits of people with schizophrenia, which have a detrimental impact on real-life functioning. The English version of CIRCuiTS demonstrated good acceptability and feasibility. A recent randomized controlled trial provided evidence that the program improves memory and functioning, and that the impact on functional outcome is mediated by metacognition. The next steps in the development of CIRCuiTS include both: 1) the translation and adaptation of the program in different cultural settings; and 2) the demonstration of feasibility, acceptability and effectiveness of a standardized method to administer CIRCuiTS remotely.PurposeTo implement the CIRCuiTS Italian version and to assess acceptability, feasibility and efficacy of a standardized method to administer CIRCuiTS remotely.MethodsParticipants were assessed at baseline and received up to 40 CIRCuiTS therapy sessions, three times a week, for about 1 hr over a three-month period. Participants were reassessed post-treatment.ResultsThe program demonstrated good feasibility and high acceptability when assessed by the number of dropouts and evaluation of patients’ satisfaction. Participants improved in learning, speed of processing, working memory and executive control. They showed a reduction in disorganization and improvement in self-esteem, functional capacity, and real-life functioning.ConclusionIn this study, a standardized protocol for using CIRCuiTS from home was implemented. The first set of data showed in the paper is encouraging. The proposed procedure could lead to a dropout reduction while maintaining the efficacy of the program.

Tracing Metacognition in Psychotherapy: Associations With Symptoms of General Distress and Depression.

Deficits in metacognition have often been identified as a central feature in various forms of psychopathology. The current study explores changes in metacognition and symptoms during the process of psychodynamic-oriented psychotherapy conducted in a community setting among people with diverse psychological challenges. We examined the associations between metacognition and symptoms at both the within-client and the between-clients level. Nine good-outcome and nine poor-outcome cases of psychodynamic treatment were analyzed. In terms of metacognitive abilities, results showed that clients who were part of the good-outcome group had higher levels of decentration than did clients who were part of the poor-outcome group. In addition, clients' ability to understand the other's mind improved significantly only for clients in the good-outcome group. Furthermore, sessions in which clients' self-reflectivity was higher were followed by increased symptom levels (in the next session) beyond group (poor or good outcome group). Clinical implications regarding the improvement of metacognitive abilities and their associations with outcome measures are discussed.

Metacognitive and motivation deficits, exposure to trauma, and high parental demands characterize adolescents with late-onset ADHD.

The objective of this study is to evaluate support for three hypotheses about the etiology of adolescent-onset ADHD symptoms: (1) a "cool" cognitive load hypothesis, (2) a "hot" rewards processing hypothesis, and (3) a trauma exposure hypothesis. Participants (N = 50) were drawn from two public high schools in a culturally diverse metropolitan area. A detailed procedure for identifying and confirming late-onset ADHD cases is described. Adolescents with late-onset ADHD (n = 15) were identified and compared to childhood-onset (n = 17) and non-ADHD classmates (n = 18). Adolescents and parents completed measures of neurocognition, rewards' processing, clinical profile, and environmental demands. Late-onset cases were clinically and neurocognitively indistinguishable from childhood-onset cases; however, they experienced higher demands from parents (d = 1.09). Compared to the non-ADHD group, late-onset cases showed significant deficits in metacognition (d = 1.25) and academic motivation (d = 0.80), as well as a pronounced history of multiple trauma exposure (OR 11.82). At 1-year follow-up, ADHD persisted in 67.7% of late-onset cases. Late-onset cases (26.7%) were more likely than childhood-onset cases (0.0%) to transfer to alternative schools by 1-year follow-up. Multiple factors may contribute to adolescent-onset ADHD. Adolescents with metacognition and motivation deficits may be at greatest risk for the late-onset ADHD phenotype, particularly in highly demanding environments. Exposure to traumatic stress may play a key role in the exacerbation of existing deficits or onset of new symptoms. Late-onset ADHD was persistent in most cases and associated with higher risk for school disengagement than childhood-onset ADHD. Further work is needed to better understand the etiologies of late-onset ADHD symptoms.

A-24 Metacognition and behavioral regulation associated with distinct connectivity patterns in autism spectrum disorder

Abstract Objective Executive function (EF) deficits are well documented in children with autism spectrum disorder (ASD)1-2 and are commonly measured clinically using parent ratings3. No studies have investigated whether parent ratings of EF predict brain connectivity in ASD. Aim Examine whether the Behavior Rating Inventory of Executive Function (BRIEF) predicts functional brain connectivity in ASD. Method Resting-state fMRI and behavioral data were obtained from the Autism Brain Imaging Data Exchange (ABIDE-II) database6 (n = 106 ASD, ages 5-13). ROI-to-ROI (Region of Interest) connectivity was computed for 132 ROIs spanning the whole brain, defined using Conn Toolbox. Multiple regression analyses examined the effect of BRIEF metacognition on connectivity while controlling for BRIEF behavioral regulation, and vice versa. Age, sex, and full-scale IQ were included as covariates. FDR correction was used (p &lt; 0.05). Results More severe deficits in metacognition were associated with stronger connectivity between the left hippocampus and several ROIs, including the cerebellum and planum temporale. More severe deficits in metacognition were associated with weaker right hippocampus – right frontal pole connectivity. More severe deficits in behavioral regulation were associated with stronger connectivity between subcortical regions (i.e., thalamus, putamen, and caudate) and regions involved in motor (superior frontal gyrus) and limbic systems (cingulate gyrus). More severe behavioral regulation deficits were associated with weaker cerebellar-cerebellar connectivity. Conclusions Findings suggest that parent-ratings of metacognitive abilities in children with ASD are associated with hippocampal connectivity, while behavioral regulation abilities are associated with thalamic and striatum connections. These results build upon previous studies of metacognition and behavioral regulation 5,6.

Judging own and peer performance when using feedback in elementary school

Children find it challenging to self-monitor the quality of their own test responses, and are typically overconfident. Inaccurate self-monitoring may not only be due to a metacognitive deficit, but also to self-protective biases. Therefore, monitoring peer performance and detecting others' errors may be easier than monitoring oneself. This study investigated 97 children's (52 fourth and 45 sixth grade) feedback use when scoring their own and their peers' concept learning. Children completed a concept-learning task, took a test, and then scored their own responses and the responses of one of their peers with use of feedback standards. Error detection was better for peer- than for self-score judgments. Further, monitoring was more accurate for older than younger children, and inaccurate prior knowledge led to less accurate peer and self-judgments. Findings imply that, when implementing co-scoring activities, it is important to be aware that its accuracy is affected by children's age and prior knowledge.

Evaluating Cognitive-Linguistic Deficits Postconcussion in Adults

Purpose: We sought to document the cognitive-linguistic challenges experienced by 3 adults with concussion at varying lengths postinjury. Method: A multiple case study design utilized motivational interviewing techniques, 4 self-report measurement tools, and 5 standardized neurocognitive tests. The 1 female and 2 male participants were 1, 21, and 37 months postconcussion. Results: All participants self-reported cognitive and linguistic challenges significantly impacting daily functioning and quality of life. Cognitively, participants demonstrated deficits in independence, metacognition, and cognitive flexibility. Linguistically, participants demonstrated deficits in verbal memory, verbal fluency, and reading. The participant 1-month postconcussion demonstrated deficits on multiple standardized measures; however, participants in the chronic phase of recovery demonstrated substantially more self-reported deficits than were noted on standardized testing. Discussion: Evaluation of cognitive-linguistic deficits postconcussion requires both self-report and standardized measurement; however, limitations of both tools exist. We discuss clinical implications for professionals selecting testing measures for use in this population.

Neurobiological and clinical effect of metacognitive interpersonal therapy vs structured clinical model: study protocol for a randomized controlled trial

BackgroundBorderline Personality Disorder (BPD) is a complex and debilitating disorder, characterized by deficits in metacognition and emotion dysregulation. The “gold standard” treatment for this disorder is psychotherapy with pharmacotherapy as an adjunctive treatment to target state symptoms.The present randomized clinical trial aims to assess the clinical and neurobiological changes following Metacognitive Interpersonal Therapy (MIT) compared with Structured Clinical Management (SCM) derived from specific recommendations in APA (American Psychiatric Association) guidelines for BPD.MethodsThe study design is a randomized parallel controlled clinical trial and will include 80 BPD outpatients, aged 18–45 enrolled at 2 recruitment centers. Primary outcome will be the clinical change in emotion regulation capacities assessed with the Difficulties in Emotion Regulation Scale (DERS). We will also investigated the effect of psychotherapy on metacognitive abilities and several clinical features such as BPD symptomatology, general psychopathology, depression, personal functioning, and trait dimensions (anger, impulsivity, alexithymia). We will evaluate changes in brain connectivity patterns and during the view of emotional pictures. A multidimensional assessment will be performed at the baseline, at 6, 12, 18 months. We will obtain structural and functional Magnetic Resonance Images (MRIs) in MIT-Treated BPD (N = 30) and SCM-treated BPD (N = 30) at baseline and after treatment, as well as in a group of 30 healthy and unrelated volunteers that will be scanned once for comparison.DiscussionThe present study could contribute to elucidate the neurobiological mechanisms underlying psychotherapy efficacy. The inclusion of a multidisciplinary study protocol will allow to study BPD considering different features that can affect the treatment response and their reciprocal relationships.Trial registrationNCT02370316. Registered 02/24/2015.