martes, 10 de mayo de 2011

Aalgunas últimas novedades sobre TDAH

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** New findings on how girls with ADHD evaluate their social competence **

As discussed in a recent issue of Attention Research Update - - children with ADHD often struggle in their peer relationships and are frequently disliked and rejected. Furthermore, the friendships they establish tend to be of poorer quality than those of other children.

Because peer relationships are so important to children's healthy development, many researchers have focused on helping children with ADHD in this area. Unfortunately, these efforts have not yielded consistently positive findings. For example, in the MTA Study - the largest treatment study of ADHD ever conducted (see for a review) neither state-of-the-art medication treatment nor intensive behavior therapy yielded meaningful improvements in children's peer relations, even though significant reductions in core ADHD symptoms were obtained.

Although children with ADHD often have significant social difficulties, it is noteworthy that they actually tend to overestimate their social competence. Thus, in studies where the social competence ratings of children with and without ADHD are compared to ratings made by parents and teachers, the discrepancy between child and adult ratings is significantly higher for children with ADHD than for other children. In other words, they view their social competence more positively relative to how adults view them then do other children.

Some have argued that this 'positive illusory bias' (PIB) is a good thing in that it enables children with ADHD to maintain positive feelings about themselves despite their frequent social struggles. Others, however, suggest that a lack of awareness about their social problems, i.e., seeing themselves as more competent than they really are, may reduce their motivation to change their social behavior and thus contributes to perpetuating their social difficulties.

Although the existence of a positive illusory bias in children with ADHD is an interesting finding, several important questions remain. First, the research has largely been restricted to boys with ADHD, as relatively few girls have been included in prior research on this issue. Carefully examining whether the PIB found to characterize boys with ADHD is also clearly present in girls is thus an important question to address, especially since the link between social difficulties and psychological maladjustment may be stronger in girls than in boys.

Second, important questions remain about the relationship between overestimating one's social competence and actual social functioning in children with ADHD. As noted above, there is currently no consensus as to whether a PIB is harmful for children with ADHD, and some have argued that it serves an important self-protective role. One way to address this question is to examine the magnitude of the PIB in relation to children's actual social competence. If children with larger PIBs are actually regarded as less socially competent, it would suggest that overestimating one's competence may undermine a child's likelihood of experiencing social success.

These questions were addressed in a study recently published online in the Journal of Abnormal Child Psychology [Ohan & Johnswton (2011). Positive illusions of social competence in girls with and without ADHD. Journal of Abnormal Child Psychology, published online 25 January 2011.] Participants were 42 9-12 year old girls with ADHD and 40 girls without. Measures of social competence were collected from the girls themselves, their mothers, and their teachers. In addition, all girls participated in a laboratory social task so that their social competence could be directly observed by the researchers. Additional measures of girls psychosocial functioning, i.e., their number of friends, impairment in various domains, and aggressive behavior were also collected.

To compute PIB scores, each girls rating of her social competence was subtracted from the score provided by their parent, teacher, and the researcher who observed them during the laboratory social interaction task. Thus, 3 different PIB scores were computed for each child with positive scores reflecting the child's rating herself higher than she was rated by the other source, i.e., a positive illusory bias.

- Results -

Question 1 - "Do girls with ADHD show a stronger tendency to overestimate their social competence than other girls?"

The answer to this question was clearly yes as all 3 PIB scores were significantly higher for girls with ADHD relative to comparison girls. The magnitude of the difference was large for scores based on mother and teacher ratings, and smaller - but still statistically significant - for scores computed based on the lab-based social interaction measure.

When examining factors within the group of girls with ADHD that were associated with higher PIB scores, the researchers found that scores were higher among girls who also had high levels of oppositional-defiant behavior and hyperactive-impulsive symptoms and lower in girls with higher levels of depressive and inattentive symptoms.

Question 2 - "Is there evidence that overestimating social competence is associated with poorer social functioning?" To address this question, the researchers examined the correlation between children's PIB scores and various indices of social adjustment, e.g., number of friends reported by the mother, functional impairment reported by mothers and teachers, aggressive behavior reported by mothers and teachers.

The results were quite interesting. For girls without ADHD, higher PIB scores tended to be associated with more positive social functioning. That is, for these girls, seeing oneself as more socially competent than may actually be the case was linked to better overall social adjustment. This reflects the potential benefits of a 'positive illusory bias' that some researchers have described.

For girls with ADHD, however, the results were decidedly different. For these girls, higher PIB scores were negatively and significantly associated with virtually every aspect of social functioning the researchers examined. Thus, the more girls with ADHD overestimated their social competence, the fewer friends they had, the more aggressively they behaved, and the more impaired they were judged to be. This is exactly the opposite of what was found for the comparison girls.

- Summary and implications -

Results from this study extend earlier work with boys by documenting that girls with ADHD also tend to overestimate their social competence relative to other girls. The fact that this was found regardless of whether overestimation was in relation to parent ratings, teacher ratings, or observations of girls' social behavior allows for greater confidence in the results.

In addition to this primary finding, the results also offer strong initial evidence that overestimating one's social competence operates differently in girls with and without ADHD, and that for girls with ADHD, over-estimates are consistently associated with poorer adjustment.

In discussing the clinical implications of their findings, the authors suggest that "...the PIB may be an obstacle to instigating independent self-improvement in areas that are needed most..." and reference related work in the PIB is associated with poorer treatment outcomes. They note that this may be especially true for girls with ADHD and Oppositional Defiant Disorder, " their negative and hostile attitude towards others may be worsened or maintained by an overly positive self-view."

What remains unclear from the current study is the degree to which girls with ADHD are actually self-aware of their social difficulties and provide overly positive reports to portray a more positive self-presentation, i.e., they are being defensive, versus being truly unaware of their limitations. The authors suggest that if children are deliberately presenting themselves in an unrealistically positive light, treatment will need to address this defensive coping style. If, however, they are truly unaware of how they are perceived by others, than helping them develop more accurate self-evaluation skills may be necessary and appropriate. Of course, this is unlikely to be an 'either-or' phenomenon and both processes may be occurring.

Either way, this line of research contributes to a fuller understanding of the social difficulties experienced by girls with ADHD and will hopefully contribute to the development of interventions that effectively promote their social success.

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