Metacognition in adult ADHD: subjective and objective perspectives on self-awareness of cognitive functioning

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.

Neurocognition and Metacognition in Anxiety Disorders

“…In contrast, research on nonclinical populations has indicated the metacognitive impact of anxiety, stereotype threat, and ruminations on task performance. 22,24,71 In line with the above findings, [12][13][14][15]69 this study also provides evidence for poorer metacognitive awareness and regulation in ADs and a new quantitative measure, the MARS. The development of the MARS represents an important step in the empirical investigation of metacognition in relation to cognitive abilities.…”

“…For instance, poorer metacognitive awareness of attentional abilities has been demonstrated in individuals with Attention Deficit Hyperactivity Disorder (ADHD), in the form of a discrepancy between objective neurocognitive assessments and self-evaluation of performance. 69 Other research has shown that individuals with depression, OCD, and schizophrenia report greater negative momentary influences and fear about test outcomes during neurocognitive test performance [12][13][14][15] -it has been emphasized that such factors must not be merely considered "noise" but may provide important insights into neurocognitive impairments. 70 Such influences may be reported to a greater extent by individuals with psychiatric disorders, as they may be unable to metacognitively regulate the impact of these factors on task performance; nevertheless, the "metacognitive" aspect of such factors has not received much attention.…”

Weight Management for Students with Attention-Deficit Hyperactivity Disorder (ADHD): A Qualitative Study

“…This non-judgmental approach replaced their former perspectives, which led to feelings of self-criticism and self-blaming. Difficulties in implementing these functions are typical of people with ADHD and may impact their daily functioning [ 31 ].…”

Primary School Children’s Self-Reports of Attention Deficit Hyperactivity Disorder-Related Symptoms and Their Associations With Subjective and Objective Measures of Attention Deficit Hyperactivity Disorder

“…The literature offers several theoretical and methodological explanations for PIB. First, PIB may reflect ADHD-related deficits in metacognitive functions, such as self-reflection, self-awareness, and self-regulation ( Zucker et al, 2002 ; Butzbach et al, 2021 ). Related to the deficits in meta-cognition is the ability to detect and correct errors.…”