Positive Illusory Bias in Adolescents with ADHD

51 Pages·2016·0.39 MB·English

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2016
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Elizaveta Bourchtein
Virginia Commonwealth University
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Positive Illusory Bias in Adolescents with ADHD: Prevalence, Stability, and Accuracy of
Reporters

A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science
at Virginia Commonwealth University.

By

Elizaveta Bourchtein,
Bachelor of Arts
Wesleyan University, May 2010

Director: Joshua M. Langberg, Ph.D.,
Associate Professor, Department of Psychology

Virginia Commonwealth University
Richmond, VA
April, 2016
Acknowledgement

This research was funded by grant number R01 MH082865 awarded to Drs. Joshua Langberg
and Steven W. Evans by the National Institute of Mental Health. I am grateful to my advisor, Dr.
Joshua Langberg, for his constant encouragement, gentle guidance, and frequent reassurance
throughout my thesis in particular and in my graduate career overall. His incredibly supportive
mentorship style made this process enjoyable and rewarding, and I am thankful to have the
opportunity to learn from his expertise. I also greatly appreciate the thoughtful feedback and
assistance I received from Drs. Terri Sullivan and Kevin Sutherland, who were very helpful in
allowing me to consider this project from multiple viewpoints. I would also like to acknowledge
the guidance I received from Dr. Robert Perera, whose knowledge of the statistical techniques
used in this thesis proved invaluable. Lastly, I am grateful to my labmates, friends, and family
members – particularly my grandfather – for the ongoing support, helpful advice, and endless
encouragement.

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Table of Contents

Acknowledgement ...........................................................................................................................ii
List of Tables ...................................................................................................................................v
List of Figures .................................................................................................................................vi
Abstract ..........................................................................................................................................vii
Overview ..........................................................................................................................................1
Introduction ......................................................................................................................................3
Impairment Across Development ........................................................................................3
Self-Perceptions of Functioning and Impairment ................................................................4
Outcomes Associated with a PIB in Youth with ADHD .....................................................5
Social functioning and aggression behaviors ...........................................................5
Risky behavior as an outcome of the PIB ................................................................6
Poorer treatment outcomes in children with a PIB ..................................................6
Theories Explaining Presence of the PIB ............................................................................7
Defining the PIB ..................................................................................................................8
Subtracting raw scores .............................................................................................8
Subtracting standardized scores ...............................................................................9
Additional Issues in Measurement of the PIB ...................................................................10
Assumption of third party raters’ accuracy ............................................................10
Potential for ceiling effect ......................................................................................12
Present Study and Aims .....................................................................................................13
Aim 1: Using latent profile analysis to define the PIB...................................................... 13
Hypothesis 1a .........................................................................................................14
Hypothesis 1b .........................................................................................................15
Aim 2: Assessing the stability of the PIB over time using latent transition
analysis (LTA) approach compared to a traditional subtraction approach ........................15
Hypothesis 2 ...........................................................................................................16
Aim 3: Examine whether parent or adolescent reports are driving the PIB ......................16
Hypothesis 3 ...........................................................................................................16
Methods ..........................................................................................................................................16
Participants .........................................................................................................................16
Procedure ...........................................................................................................................18
Measures of Competence ...................................................................................................19
Self-Perception Profile for Children (SPPC) .........................................................19
Parent Rating Scale of Child’s Actual Behavior (PRS) .........................................19
Grades ....................................................................................................................20
Analytic Plan ..................................................................................................................................20
Aim 1 .................................................................................................................................20

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Aim 2 .................................................................................................................................21
Aim 3 .................................................................................................................................21
Results ............................................................................................................................................23
Missing Data ......................................................................................................................23
Aim 1 .................................................................................................................................23
Optimal number of profiles ....................................................................................23
Theoretical conceptualization of profiles ...............................................................24
Proportion of sample in each profile ......................................................................25
Aim 2 .................................................................................................................................25
Optimal number of statuses ...................................................................................25
Theoretical conceptualization of statuses ..............................................................26
Proportion of sample in each status .......................................................................27
Stability of statuses over time ................................................................................27
Aim 3 .................................................................................................................................27
Discussion ......................................................................................................................................29
Prevalence of PIB ..............................................................................................................30
Associations with More Objective Indicators ....................................................................30
Measurement of PIB ..........................................................................................................31
Stability Across Time ........................................................................................................32
Limitations .........................................................................................................................33
Future Directions ...............................................................................................................33
Conclusions ........................................................................................................................34
References ......................................................................................................................................36
Vita .................................................................................................................................................42

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List of Tables

1. Indices of Fit for Two- to Five-Profile Solutions at Baseline Using LPA .................................23
2. Means of Discrepancies of Each Domain of the SPPC/PRS Within Profiles Defined
Using LPA at Baseline .......................................................................................................25
3. Indices of Fit for Two- to Five-Profile Solutions Using LTA ...................................................26
4. Scholastic Indicators and Comparison with GPA Across LPA-Defined
Profiles at Baseline ............................................................................................................28

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List of Figures

1. Optimal Profile Solution at Baseline Using LPA ......................................................................24
2. Optimal Status Solution at Baseline Using LTA .......................................................................26

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Abstract

POSITIVE ILLUSORY BIAS IN ADOLESCENTS WITH ADHD: PREVALENCE,
STABILITY, AND ACCURACY OF REPORTERS

By Elizaveta Bourchtein, B.A.
A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science
at Virginia Commonwealth University.

Virginia Commonwealth University, 2016

Major Director: Joshua Langberg, Ph.D., Associate Professor, Department of Psychology

The positive illusory bias (PIB) – over-reporting levels of self-competence compared to other
raters – has been demonstrated in youth with attention-deficit/hyperactivity disorder (ADHD),
despite increased impairment rates. However, due to inconsistent definitions of the PIB,
conflicting findings have emerged regarding prevalence of the PIB in youth with ADHD and
whether parent or child report is actually “biased” and driving the PIB. Additionally, stability of
the PIB across time is unknown. The present study used person-centered methodology cross-
sectionally and longitudinally to evaluate the prevalence of the PIB in adolescents with ADHD.
Results revealed a cross-domain global PIB group at baseline (18.4% of sample) but only a small
social PIB group was present and stable across time. Parents in the PIB group were better
reporters of scholastic competence relative to an objective measure than were youth. These
findings suggest that the PIB may be significantly less prevalent in this population than
previously thought.
Overview

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that
affects approximately 7% of school-aged children (Visser, Blumberg, Danielson, Bitsko, &
Kogan, 2013) and is characterized by developmentally inappropriate levels of inattention and/or
hyperactivity and impulsivity (American Psychiatric Association, 2013). Although children with
ADHD typically experience clinically significant impairment across a variety of domains
(Hinshaw, 2002), some exhibit inflated, positive self-perceptions of their behavior, a
phenomenon referred to as a positive illusory bias (PIB). Specifically, despite experiencing
repeated failures and underachievement, a subset of youth with ADHD rate themselves as
significantly more competent in comparison to other raters (e.g., parents and teachers). In non-
ADHD samples, the presence of a PIB may be adaptive, as it is linked to higher self-esteem
(Gresham, Lane, MacMillan, Bocian, & Ward, 2000). In ADHD samples, however, a PIB may
have potentially deleterious effects, including associations with poorer social skills, higher levels
of aggression, and increased risky behavior in adolescence (e.g., Hoza, Murray-Close, Arnold,
Hinshaw, Hechtman, & MTA Cooperative Group, 2010; Hoza et al., 2013). Given the negative
outcomes associated with the PIB, intervention development has been proposed. Specifically, if
youth with ADHD do not recognize their difficulties, it may be important to help them gain a
more realistic appraisal of their functioning before they will be motivated to learn new skills or
to change patterns of behavior (Owens, Goldfine, Evangelista, Hoza, & Kaiser, 2007). However,

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