Metacognitive Deficits in Attention Deficit Hyperactivity Disorder: Insights From Adolescents and Their Parents

Metacognition refers to the awareness and regulation of one's cognitive processes, including self-monitoring, planning, and controlling thoughts. In individuals with attention deficit hyperactivity disorder (ADHD), although research is limited, deficits in metacognitive skills are commonly observed, which contribute to difficulties in attention, task completion, and self-regulation. The aim of this study is to identify metacognitive characteristics in adolescents diagnosed with ADHD and to explore the relationship between these characteristics and the metacognitions of their parents.

The study included 107 adolescents, aged 12-18 years, who were newly diagnosed with ADHD, as well as 100 healthy control participants. A sociodemographic form, The Schedule for Affective Disorders and Schizophrenia for School Aged Children-Present and Lifetime version for DSM-5 (K-SADS-PL DSM-5), Metacognitions Questionnaire for Children (MCQ-C) were applied, while their parents completed the Metacognitions Questionnaire-30 (MCQ-30), Turgay DSM-IV Disruptive Behavior Disorders Rating Scale Form (T-DSM-IV-S) and the Adult ADHD Self-Report Scale for DSM-5 (ASRS-5). Based on ASRS-5 scores, parents were categorized into two groups: those at increased risk of ADHD (ASRS ≥ 14) and those at low risk of ADHD (ASRS < 14). Group differences were examined using multivariate analyses (MANCOVA/MANOVA), while associations between adolescent and parental variables were assessed using correlation analyses.

In adolescents with ADHD, scores on the negative meta-worry, superstitious, punishment and responsibility beliefs and cognitive monitoring subscales -as well as the MCQ-C total score- were significantly higher compared to the control group, while no difference was found for positive meta-worry, regardless of subtype. On the parental MCQ-30, all subscale and total scores were significantly higher in the ADHD group. Parents categorized as being at increased risk of ADHD had significantly higher MCQ-30 total scores compared to those at low risk. Furthermore, the severity of ADHD symptoms in adolescents, particularly inattention and hyperactivity-impulsivity, was positively and weakly correlated with the MCQ-C total score. In addition, a weak negative correlation was observed between adolescents' positive meta-worry and parents' cognitive confidence.

Our study suggests that metacognitive impairment is prevalent among adolescents with ADHD and their parents. Enhancing metacognitive awareness in individuals with ADHD may facilitate their adaptation to treatment and preparedness for alternative forms of therapeutic intervention.