ABSTRACT

Objective

Previous research indicated that adults with ADHD may have deficits in metacognition, yet the evidence base is scarce. This study aims to explore the existence and nature of metacognitive deficits in adults with ADHD, how psychopathology (such as inattention and depression) may affect metacognition and whether metacognition may impact daily functioning in adults with ADHD.

Method

Forty-six adult patients with ADHD and 46 controls completed questionnaires for metacognition, psychopathology and daily functioning (subjective assessment; self- and informant report). Participants performed two attention tests in a neuropsychological assessment. After test completion, participants were asked to evaluate their performance with the help of a visual aid and this self-evaluation of test performance was compared with their actual test performance (objective assessment).

Results

Patients with ADHD reported large deficits in knowledge of cognition and medium deficits in regulation of cognition compared to controls. Self-evaluation of cognitive test performance revealed no significant deficits. Regression analyses revealed that psychopathology may explain a part of the variation in metacognition. Further regressions indicated that metacognition may account for a significant and meaningful proportion of variance in daily functioning, both self-rated and informant-rated.

Conclusions

Current findings of compromised metacognitive functioning of adults with ADHD suggest that clinicians may not want to rely on patients’ self-reports in the clinical assessment. Inattention predicted impairments in metacognition, pointing toward the importance of attention for awareness and metacognition. Finally, we recommend that metacognition is addressed in the treatment trajectory of patients with ADHD, given that aspects of metacognition were directly linked to impairments in daily functioning as rated by participants and their relatives.

中文翻译：

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成人多动症的元认知、精神病理学和日常功能

摘要

客观的

先前的研究表明，患有多动症的成年人可能存在元认知缺陷，但证据基础很少。本研究旨在探讨 ADHD 成人元认知缺陷的存在和性质，精神病理学（如注意力不集中和抑郁）如何影响元认知，以及元认知是否会影响 ADHD 成人的日常功能。

方法

46 名 ADHD 成年患者和 46 名对照完成了元认知、精神病理学和日常功能的问卷调查（主观评估；自我和知情者报告）。参与者在神经心理学评估中进行了两次注意力测试。测试完成后，参与者被要求在视觉辅助工具的帮助下评估他们的表现，并将这种测试表现的自我评估与他们的实际测试表现（客观评估）进行比较。

结果

与对照组相比，ADHD 患者在认知知识方面存在严重缺陷，在认知调节方面存在中等缺陷。认知测试表现的自我评估显示没有显着缺陷。回归分析表明，精神病理学可能解释了元认知变异的一部分。进一步的回归表明，元认知可能在日常功能（包括自评和线人评分）中占显着且有意义的变异比例。

结论

目前关于 ADHD 成人元认知功能受损的发现表明，临床医生可能不希望在临床评估中依赖患者的自我报告。注意力不集中预测元认知障碍，指出注意力对意识和元认知的重要性。最后，我们建议在 ADHD 患者的治疗轨迹中解决元认知问题，因为元认知的各个方面与参与者及其亲属所评定的日常功能受损直接相关。