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. 2021 Jul;128(7):939-955.
doi: 10.1007/s00702-020-02293-w. Epub 2021 Jan 19.

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

Marah Butzbach  1 , Anselm B M Fuermaier  2 , Steffen Aschenbrenner  3   4 , Matthias Weisbrod  3   5 , Lara Tucha  6 , Oliver Tucha  2   6
Affiliations

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

Marah Butzbach et al. J Neural Transm (Vienna). 2021 Jul.

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.

Keywords: Adult ADHD; Metacognition; Neuropsychological performance; Self-awareness.

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Conflict of interest statement

The authors have no conflict of interest to disclose

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