Clin Child Fam Psychol Rev (2007) 10:335351
DOI 10.1007/s10567-007-0027-3
A Critical Review of Self-perceptions and the Positive Illusory
Bias in Children with ADHD
Julie Sarno Owens Matthew E. Goldfine
Nicole M. Evangelista Betsy Hoza
Nina M. Kaiser
Published online: 28 September 2007

Springer Science+Business Media, LLC 2007
Abstract Despite significant functional problems in
multiple domains, children with Attention-Deficit/Hyper-
activity Disorder (ADHD) unexpectedly provide extremely
positive reports of their own competence in comparison to
other criteria reflecting actual competence. This counter-
intuitive phenomenon is known as the positive illusory bias
(PIB). This article provides a comprehensive and critical
review of the literature examining the self-perceptions of
children with ADHD and the PIB. Specifically, we analyze
methodological and statistical challenges associated with
the investigation of the phenomenon, the theoretical basis
for the PIB, and the effects of sample heterogeneity on self-
perception patterns. We conclude by discussing the
implications of this work and providing recommendations
for advancing research in this area.
J. S. Owens (&)
N. M. Evangelista
Ohio University, Porter Hall 200, Athens, OH 45701, USA
e-mail: owensj@ohio.edu
N. M. Evangelista
e-mail: ne298698@ohio.edu
M. E. Goldfine
West Virginia University, 2210 Life Sciences Bldg,
Morgantown, WV 26506-604, USA
e-mail: Matthew.Goldfine@mail.wvu.edu
B. Hoza
University of Vermont, Dewey Hall Rm 226, Burlington,
VT 05405, USA
e-mail: Betsy.Hoza@uvm.edu
N. M. Kaiser
University of California, Box 0984, LPPI, CPT, San Francisco,
CA 94143-0984, USA
e-mail: nina.kaiser@ucsf.edu
Keywords ADHD
Self-perceptions
Positive illusions

Positive illusory bias
Children
As one of the most prevalent childhood mental health
disorders, Attention-Deficit/Hyperactivity Disorder
(ADHD) affects an estimated 37% of all school-aged
children (American Psychiatric Association 2000). Diag-
nosed considerably more often in males, ADHD is
characterized by developmentally inappropriate hyperac-
tive/impulsive and/or inattentive symptoms that result in
impairment in multiple settings (American Psychiatric
Association 2000). Children with ADHD consistently have
been found to display academic difficulties (LeFever et al.
2002), social deficits (Pelham and Bender 1982), and
behavior problems (Barkley 1990). Within the academic
domain, children with ADHD typically have poorer aca-
demic achievement scores (Hinshaw 1992), lower grades
(Cantwell and Satterfield 1978) and less persistence on
school-related tasks than their non-impaired peers (Hoza
et al. 2001). Within the social domain, children with
ADHD have fewer close friendships (Bagwell et al. 2001),
are more rejected in the classroom (Hodgens et al. 2000;
Hoza et al. 2005), and have more negative interactions
with their mothers as compared to their peers without
ADHD (Cunningham and Barkley 1979). Within the
behavioral domain, the most noticeable deficits include
aggression (Loney and Milich 1982) and noncompliance
with adult commands (Danforth et al. 1991). Given the
above-described deficits, this population is at increased risk
for school dropout, drug abuse, and juvenile delinquency
(Shaffer 1994).
Despite these findings of chronic functional problems in
academic, social, and behavioral domains, many children
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with ADHD tend to underreport the presence of these
problems. Indeed, a growing body of literature suggests
that many children with ADHD actually overestimate their
own competence in comparison to other criteria reflecting
actual competence (e.g., Hoza et al. 2004; Hoza et al.
2002). In other words, within this population, childrens
self-perceptions frequently do not correspond with objec-
tive measures of performance or with parent and teacher
ratings of competence. This phenomenon has been termed
the positive illusory bias (PIB) and is operationally defined
as a disparity between self-report of competence and actual
competence such that self-reported competence is sub-
stantially higher than actual competence (Hoza et al.
2002).
Interestingly, social psychology research has docu-
mented the existence of similar positive illusions in the
general population. For example, multiple studies have
produced consistent evidence of the better than average with ADHD. Specifically, past results imply that children
effect (e.g., Alicke and Govorun 2005). When adults are
asked to compare themselves to a hypothetical average and competencies, despite histories marked with failure in
target, self-evaluations are typically more positive than
mathematically possible. In addition, a review by Taylor
and Brown (1988) suggested that mentally healthy indi-
viduals hold unrealistically positive self-evaluations,
inflated beliefs of power over the environment, and exag-
gerated optimism about the future.
Thus, moderately positive illusory beliefs appear to be
somewhat normative. However, the PIB found in children
with ADHD differs from the overly positive cognitions
found in the general population in three ways. First, the
discrepancy between perceived and actual competence
typically is of greater magnitude in samples of children
with ADHD as compared to children without ADHD (Hoza
et al. 2002; Owens and Hoza 2003), and thus deviates from
normative positive cognitions. That is, children with
ADHD report positive illusory levels of self-competence
that exceed those of similarly aged, non-diagnosed peers.
Indeed, past researchers have suggested that excessively
inflated self-perceptions may differ qualitatively from the
moderately enhanced self-evaluations exhibited in the
general population (e.g., Baumeister 1989; Taylor and
Armor 1996). Second, Taylor and Brown (1988) suggested
that moderate positive illusions are adaptive in that they
enhance motivation, performance, and task persistence.
This does not seem to be true for the positive illusions held
by children with ADHD. Despite demonstrating positive
illusory self-perceptions, children with ADHD tend to give
up more frequently on tasks and perform worse than their
non-ADHD peers (Hoza et al. 2001; ONeill and Douglas
1991).
Third, within the context of other theoretical models, the
PIB in children with ADHD seems to be a unique and
counterintuitive phenomenon. For example, Harters model
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Clin Child Fam Psychol Rev (2007) 10:335351
of motivation (1981) purports that childrens self-percep-
tions of competence and control contribute to their
motivational orientation. More specifically, children who
experience success following task engagement develop an
enhanced sense of self-efficacy. As a result, these children
are motivated to engage in future challenging tasks and are
subsequently reinforced by additional success. Conversely,
children who experience failure on a given task develop a
lower sense of self-competence and thus are less likely to
participate in future challenging tasks. Since most children
with ADHD have been found to experience failure in
multiple domains, Harters (1981) model would suggest
that these children are at risk for developing a low sense of
self-competence. However, most studies that have exam-
ined self-perceptions in children with ADHD have found
evidence inconsistent with Harters model, suggesting that
there is something unique about the self-system of children
with ADHD have unrealistically high self-views of skills
numerous domains (e.g., Hoza et al. 2002). On one hand,
such positive illusory self-views may render children with
ADHD more susceptible to failure, as these views likely
prevent children from recognizing the need for improve-
ment, acknowledging negative feedback, and altering their
approach to task completion (Milich and Okazaki 1991).
On the other hand, if children with ADHD do not perceive
their academic and social failures, this lack of awareness
may spare their self-confidence, protect their self-esteem,
and ward off negative affect. As this review article high-
lights, additional research examining the relative adaptive
or maladaptive consequences of positive illusory self-
perceptions upon social-emotional functioning and task
performance and persistence is needed before firm con-
clusions can be drawn in this area.
We acknowledge that overly positive self-evaluations
are not exclusive to children with ADHD and have been
found in other non-clinic samples (e.g., Gresham et al.
1998; Heath and Glen 2005; Hymel et al. 1993). None-
theless, for several reasons, the current article will
primarily focus on the positive illusory self-perceptions of
children with ADHD. First, the pattern of differences
between children with ADHD and asymptomatic control
children has been replicated across multiple studies and
laboratories. These studies represent a rich and coherent
literature that warrants synthesis and critical analysis. Since
this literature is focused on a well-defined sample, rec-
ommendations produced by such an analysis can be
focused and directive. Second, a closer examination of the
studies that have found a similar pattern of positive illusory
self-concepts in non-clinic samples of children reveals a
common behavioral characteristic. Although the focus of
these studies may have been children with poor social
Clin Child Fam Psychol Rev (2007) 10:335351
status, learning disabilities, or aggressive behavior (Gre-
sham et al. 1998; Heath and Glen 2005; Hymel et al.
1993), disruptive behavior problems are a common factor
linking all of these samples. Thus, to date extant research
does not specify the degree to which positive illusions are
specific to any one population. However, most research
suggests that the PIB is linked to characteristics associated
with ADHD. Given the coherence of the literature focused
on this disorder, we will contain this review to samples of
children with ADHD or clearly defined ADHD symptoms.
Finally, ADHD is a disorder for which evidence-based
behavioral treatments have been identified. There is sug-
gestive evidence that awareness of ones own deficits may
serve a motivating function in behavioral treatment (Hoza
and Pelham 1995), whereas inaccurate estimations of self-
competence may interfere with treatment progress. Thus, a
better understanding of the self-system of children with
ADHD may have implications for future enhancements to
evidence-based treatment for this population.
The goal of this article is to provide a comprehensive
and critical review of the literature examining the self-
perceptions of children with ADHD. Our synthesis and
analysis of the literature was guided by three overarching
questions: Is the PIB present in the self-perceptions of
children with ADHD? What is the function (or explana-
tion) of the PIB in children with ADHD? And, is the PIB
adaptive or maladaptive in children with ADHD? Our
understanding of the latter two questions will guide our
interpretation of the data associated with the first question.
That is, simply identifying the existence of the PIB is not
enough. Research in this area must strive to understand the
underlying mechanism or function of the bias, as well as
the short- and long-term consequences of this pattern of
self-perceptions; both of these issues might have important
implications for treatment modifications.
Thus, first we review the extant literature that provides
substantial empirical support for the presence of the PIB in
children with ADHD. In doing so, we highlight critical
methodological and statistical challenges associated with
the investigation of the phenomenon. Next, to create a
conceptual context for stimulating new ideas and advanc-
ing research regarding the underlying mechanisms of the
PIB, we review the data that explore the possible functions
of the phenomenon, as well as the effects of sample het-
erogeneity on patterns of self-perceptions. To date, the
adaptiveness of the PIB is unclear. Thus, in the absence of
longitudinal studies examining the implications of the
short- and long-term effects of this perceptual style, we can
only speculate with regard to possible consequences of the
PIB and suggest how future studies can explore this issue.
Thus, we conclude by discussing the implications of this
work and offering recommendations for future studies. We
hope that this review will ignite interest and provide
337
guidance in research that attempts to obtain a better con-
ceptualization of self-perceptual patterns in children with
ADHD.
Self-perceptions and Children with ADHD
The methodology used to examine the self-perceptions of
children with ADHD has evolved over the last decade.
Early research compared ratings of competence on self-
perception measures (i.e., absolute rating scale scores),
predictions of performance on various tasks, and post-
performance self-evaluation ratings among children with
and without ADHD. These early studies highlighted unique
patterns in childrens self-perceptions and provided pre-
liminary evidence to suggest that the self-perceptions of
children with ADHD were less congruent with actual
performance than were those of control children. In order
examine the self-perceptions within this population, more
recent studies have investigated discrepancies between
childrens self-perceived competence and competence as
indexed by standardized achievement measures or parent
and teacher ratings. These studies provide additional sup-
port for the existence of a PIB in children with ADHD.
More recently, researchers have begun to examine the role
of ADHD subtype, comorbidity, and gender in the self-
perception patterns of children with ADHD. Below, we
synthesize the findings of these methodological approaches
in order of methodological strength (i.e., studies with
weaker methodology are reviewed first), including studies
that make use of (a) absolute self-perception scores (mean
scores) in the absence of a criterion for comparison,
(b) pre-task prediction and/or post-task performance eval-
uation ratings, and (c) discrepancy analyses utilizing a
criterion to calculate the discrepancy between child-
reported competence and actual competence. See Table 1
for a summary of all studies examining the PIB in children
with ADHD. Following this analysis, we further discuss
methodological and statistical challenges associated with
examining the PIB in children with ADHD.
Absolute Self-perceptions
In one of the first studies to compare the self-perceptions of
boys with and without ADHD, Hoza et al. (1993) utilized
the Self-Perception Profile for Children (SPPC; Harter
1985) to assess childrens self-perceptions of scholastic
competence, social acceptance, behavioral conduct, ath-
letic competence, physical appearance, and global self-
worth. After controlling for comorbid internalizing symp-
toms, Hoza et al. found that the self-perceptions of boys
with ADHD were not significantly different from those of
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Table 1 Summary of studies examining the positive illusory bias in children with ADHD
Citation Age Sample size % Male Comorbidity Type of analyses

Diener and Milich (1997) 811 years ADHD = 30; CTL = 90 100 None SPH
Evangelista et al. (2007) 35 grades ADHD = 67; CTL = 40 56 None DIS (T)
Horn et al. (1989) 79 years ADHD = 54; CTL = 19 64 None ABS
Hoza et al. (2004) 710 years ADHD = 487; CTL = 287 80 CP, DEP, LOW ACH DIS (P, T)
Hoza et al. (2002) 713 years ADHD = 195; CTL = 73 100 AGG, DEP, LOW ACH ABS, DIS (T)
Hoza et al. (1993) 813 years ADHD = 27; CTL = 25 100 None ABS
Hoza et al. (2001) 713 years ADHD = 83; CTL = 66 100 None PP
Hoza et al. (2000) 713 years ADHD = 120; CTL = 65 100 None PP
Ialongo et al. (1994) 711 years ADHD = 48; CTL = 21 73 None ABS
Milich and Okazaki (1991) 911 years ADHD = 23; CTL = 22 100 None PP
Ohan and Johnston (2002) 712 years ADHD = 45; CTL = 43 100 None SPH
ONeill and Douglas (1991) 37 grades ADHD = 20; CTL = 20; LD = 20 100 None PP
Owens and Hoza (2003) 912 years IA = 38; HICB = 59; CTL = 83 76 None ABS, DIS (T, A)
Treuting and Hinshaw (2001) 712 years ADHD = 114; CTL = 87 100 AGG ABS
Whalen et al. (1991) 713 years ADHD = 15; CTL = 25 100 None PP
Note. Comorbidity column indicates if analyses included subgroupings within the ADHD group. CTL = control; CP = conduct problems;
DEP = depression; LOW ACH = low achievement; AGG = aggression; LD = learning disability; IA = ADHD, Inattentive Type; HICB =
ADHD, Hyperactive/Impulsive or Combined Type; ABS = absolute analyses; DIS (P) = discrepancy analyses with parent as criterion; DIS
(T) = discrepancy analyses with teacher as criterion; DIS (A) = discrepancy analyses with actual achievement scores as criterion; SPH = test of
the self-protective hypothesis; PP = pre-task prediction and/or post-performance ratings

boys without ADHD across all domains, with the exception
of athletic competence in which boys with ADHD provided
more positive self-evaluations than boys without ADHD.
Notably, the boys with ADHD in this sample were enrolled
in intensive day treatment and thus presumably demon-
strating significant functional problems. Consequently, the
authors interpreted these findings as evidence of self-
enhancement on the part of the boys with ADHD. Data
from more recent studies with larger sample sizes have
replicated this pattern (e.g., Hoza et al. 2002).
Conversely, two studies (Horn et al. 1989; Ialongo et al.
1994) found that children with ADHD reported signifi-
cantly lower self-concepts than did control children.
However, there are several possible explanations for the
inconsistency between these findings and those of Hoza
et al. (2002, 1993). First, Horn et al. (1989) and Ialongo
and colleagues (1994) utilized the Piers-Harris Self-Con-
cept Scale (Piers 1969), whereas most other studies (e.g.,
Hoza et al. 2002, 1993) utilized the SPPC (Harter 1985). It
may be that between-group differences in self-perceptions
are better detected when a more sensitive dimensional
assessment method (e.g., SPPC) is used compared to a
dichotomous assessment method (e.g., Piers-Harris Self-
Concept Scale). Second, Horn and colleagues (1989) only
administered the anxiety, happiness, and popularity sub-
scales of the Piers-Harris Self-Concept Scale, excluding
more salient domains such as behavior and academics.
Finally, Horn et al. (1989) did not control for internalizing
symptoms, whereas Hoza et al. (1993) did control for
internalizing symptoms. Importantly, there is some evi-
dence to support the idea that comorbid mood problems
(and authors decisions about how to assess these symp-
toms) are quite relevant to findings about self-perceptions;
we discuss this issue in detail later in the article.1
In sum, studies examining the absolute self-perceptions
of children with ADHD have generated mixed results.
However, these studies provide the weakest support for the
PIB because without a basis for comparison, the congru-
ence between childrens perceptions and actual
competence is unknown. In an attempt to advance the lit-
erature, other studies have utilized childrens predictions of
their future task performance and post-task performance
evaluations in order to determine the presence of a PIB.
Pre-task Prediction and Post-performance Ratings
Many of the early studies examining pre-task predictions
and post-task performance evaluations made by children
with ADHD revealed a glaring optimism in both arenas.
For example, Whalen et al. (1991) found that 80% of boys
1
Treuting and Hinshaw (2001) also failed to find evidence of higher
self-reported self-perceptions in children with ADHD as compared to
controls. However, the pattern of findings in this study may be better
explained through sample characteristics other than ADHD (i.e.,
depressive symptoms). Thus, Treuting and Hinshaws study is
discussed in more detail later in the article (see Effects of Sample
Heterogeneity section).

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with ADHD predicted perfect performance on a word-
search task compared to 43% of boys without ADHD.
Another study demonstrated that despite similar perfor-
mance (i.e., no significant group difference) on a story
recall task, children with ADHD reported higher pre-task
predictions than control children (ONeill and Douglas
1991). Additionally, boys with ADHD studied for less
time, appeared to exert less effort, and utilized less effec-
tive strategies relative to control boys. Milich and Okazaki
(1991) obtained similar results when evaluating the pre-
dictions of boys with and without ADHD prior to solving a
set of find-a-word puzzles. Boys with ADHD predicted
better self-performance, yet completed considerably fewer
puzzles than controls. Boys with ADHD also reported more
frustration and gave up more frequently than boys without
ADHD.
Similarly, findings from several other studies employing
success-failure manipulation tasks imply that children with
ADHD are overly optimistic in their post-task performance
evaluations. Hoza et al. (2000) examined childrens self-
evaluations of performance in a success-failure manipula-
tion task within the social domain using a get-acquainted
task. Boys with and without ADHD were instructed to get a
child confederate to like them and to convince the con-
federate to come to a camp (or school). Performance was
manipulated with the help of the confederate, such that
each child participated in a successful and unsuccessful
social interaction. Coders who were unaware of group
status evaluated boys with ADHD as less socially compe-
tent than boys without ADHD across both success and
failure conditions. Importantly, despite these objective
indices of relative incompetence at the task, boys with
ADHD evaluated their own task performance as signifi-
cantly better than did control boys. This overestimation
was most evident after experiencing a failed social
interaction.
Hoza et al. (2001) expanded upon the previous study
(Hoza et al. 2000) by examining childrens self-evaluations
of performance in the context of success and failure
experiences in the academic domain (i.e., find-a-word
puzzles). Despite the fact that boys with ADHD solved
fewer test puzzles, gave up more often, and were rated by
objective evaluators to be less effortful, their post-task
evaluations were not significantly different from those of
control children. These findings suggest that the self-
evaluation ratings of children with ADHD were not com-
mensurate with their actual performance. More
specifically, boys with ADHD provided overly optimistic
reports of their own performance.
Clearly, the studies described in this section represent a
methodological improvement over using absolute self-
perceptions scores in the absence of a criterion. As such,
future research should continue to explore critical
339
questions related to the PIB in the context of such meth-
odology (i.e., using performance on a specific task as the
basis for childrens ratings of competence and the com-
petence criterion). In the next section, we discuss another
methodological improvement over the use of absolute self-
perceptions; the use of discrepancy scores that index the
congruence between the childs perceptions of competence
and other estimates of actual competence across multiple
domains.
Discrepancy and Criterion Analysis
Recent studies have utilized discrepancy analyses in which
difference scores are calculated by subtracting a criterion
score (e.g., teacher report) from the childs self-report of
competence. Difference scores are then compared between
children with and without ADHD. Across studies, mother,
father, and teacher reports of competence across multiple
domains have been used as comparison criteria, and scores
on standardized academic achievement tests.
Hoza et al. (2002) examined the self-perceptions of boys
with and without ADHD by comparing the boys self-
report on the SPPC (Harter 1985) against teacher report on
the parallel teacher version (Teacher Report of Childs
Actual Behavior; Harter 1985). Relative to teacher report,
boys with ADHD overestimated their academic, behav-
ioral, and social abilities to a greater degree than did
control boys. In a more recent study, Hoza et al. (2004),
further advanced the literature by demonstrating that the
PIB was present in both boys and girls with ADHD and that
the bias was observed regardless of the informant ratings
used as the criterion (i.e., mothers, fathers, and teachers),
ruling out potential rater bias on the part of teachers as an
explanation for the phenomenon. Interestingly, two studies
(Hoza et al. 2004, 2002) have provided evidence that
children with ADHD demonstrate the greatest overesti-
mation of competence in their domain of greatest deficit.
To date, Owens and Hozas (2003) study is the only
investigation of the role of ADHD subtype (Predominantly
Inattentive Type [IA] versus Hyperactive/Impulsive and/or
Combined Types [HICB]) in self-perceptions of compe-
tence in the academic domain. The effect of ADHD
subtype will be discussed in more detail in the Effects of
Sample Heterogeneity section; however, it is noteworthy
that Owens and Hoza employed a discrepancy analysis
with teacher report and standardized achievement tests
used as the criterion. Boys and girls in the HICB group
overestimated their scholastic competence more than con-
trol boys when math and reading achievement scores were
used as the criterion. Boys and girls in the IA group,
however, provided estimates of their own academic com-
petence that were more congruent with the criterion.
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Moreover, regression analyses indicated that greater over-
estimation of scholastic competence was associated with
more severe hyperactive/impulsive symptoms, but not
more severe inattentive symptoms, suggesting that children
in the IA group were not simply overlooking (e.g., failing
to perceive due to attentional difficulties) their
underperformance.
Measurement, Methodological, and Statistical Issues
Related to the PIB
Over time, studies investigating the PIB in children with
ADHD have made methodological improvements. None-
theless, methodological and statistical limitations remain.
In this section, we discuss challenges in assessing the PIB
in children with ADHD, delineate current methodological
and statistical approaches, and highlight the strengths and
weaknesses of each approach. We conclude by making
suggestions that may guide future inquiry in this area.
Rater Bias in Competence Measurement
As previously discussed, due to the methodological limi-
tations of analyzing absolute self-perception scores (e.g.,
Gresham et al. 1998; Hoza et al. 2002) and as an attempt to
better evaluate the accuracy of self-perceptions, researchers
have examined self-perceptions in comparison to criteria
that presumably provide more objective indices of chil-
drens actual competencies (Hoza et al. 2002). Many
studies examining the PIB have relied on teacher report as
a criterion against which to compare childrens self-per-
ceptions. One might argue that the overly inflated self-
perceptions of children with ADHD are a result of rater
bias on the part of the teacher providing the criterion rating.
That is, teachers may provide overly negative evaluations
given the difficulties that teachers experience with children
with ADHD; consequently, the self-perceptions of children
with ADHD would appear inflated. However, a recent
study addressed this concern by obtaining ratings of com-
petence from teachers, mothers, and fathers (Hoza et al.
2004). The PIB was found in children with ADHD across
all raters, but was not evident for control children. Hoza
et al. (2004) findings provide greater confirmation that the
self-perceptions of children with ADHD are positive illu-
sory and suggest that the PIB is not simply an artifact of
rater bias on the part of the teacher. It is also possible that
both parents and teachers perceptions could be negatively
biased, leading to overestimation on the part of the child
with ADHD. However, additional studies comparing chil-
drens self-perceptions to more objective criteria such as
achievement scores or lab task performance also report
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Clin Child Fam Psychol Rev (2007) 10:335351
positive illusions in ADHD samples (e.g., Ohan and
Johnston 2002; Owens and Hoza 2003). These findings
confirm that rater bias alone (whether on the part of a
teacher or parent) is not an adequate explanation for these
findings. Nonetheless, future research that incorporates
objective criteria, including standardized tests, actual task
performance, and competency estimates made by more
objective raters (i.e., observers who are unaware of diag-
nostic status) would be helpful in confirming this point.
Challenges to Difference Score Approaches
To date, the majority of research investigating the PIB in
children with ADHD employs statistical difference scores
that index the discrepancy between childrens perceptions
of competence and actual competence. Studies investigat-
ing the PIB have utilized both unstandardized and
standardized difference scores (e.g., Owens and Hoza
2003). We acknowledge that difference scores are not
without limitations. Criticisms of the use of difference
scores center around two primary themes. First, the reli-
ability of a difference score typically is substantially lower
than are the reliabilities of the variables employed to
construct the discrepancy as a result of combined mea-
surement error (Edwards 2001). The low reliability of
difference scores then results in an increased likelihood of
making a Type II error, or failure to detect in the sample
the presence of a meaningful relationship between the
discrepancy score and relevant outcome variables that exist
in the population (Edwards 2001).
Second, difference scores have a tendency to be strongly
and systematically correlated with their components (e.g.,
Cronbach 1958; Zuckerman and Knee 1996). These cor-
relations, then, may result in the detection of significant
relations between difference scores and dependent vari-
ables that actually are reflective of a relation between one
of the difference scores component variables and the
dependent variables, rather than being indicative of any
predictive ability of the discrepancy score itself (Cronbach
1958). For this reason, the use of difference scores may
make it difficult to piece apart the meaning of statistically
significant relationships. For example, Griffin et al. (1999)
argue that correlations between difference scores and other
variables may reflect any number of underlying patterns
among component and outcome variables. Many
researchers have further contended that difference scores
are linearly related to their components, such that any
difference score is no more than the sum of its constituent
parts (Zuckerman and Knee 1996). Based on this argument,
critics of the discrepancy construct have maintained that
utilizing component variables is more parsimonious than
using difference scores (Cronbach 1958).
Clin Child Fam Psychol Rev (2007) 10:335351
A more simplistic limitation of the difference score is
that children with ADHD are mathematically more likely
to overestimate their competence than are control children
simply as a function of their lower levels of actual com-
petence. In other words, due to the true impairments on the
part of children with ADHD, the criterion scores (e.g.,
actual achievement scores) almost certainly will be much
lower for children with ADHD than for control children.
As a result, it is much easier for children with ADHD to
overestimate their competence compared to control chil-
dren (i.e., the potential gap is much larger for children
with ADHD). Similarly, there may be a ceiling effect for
control children such that they may not be able to mathe-
matically overestimate their competence if their score on
the competence criterion is already high.
Despite these limitations of difference scores, there are
several marked advantages to their use. Difference score
advocates have addressed concerns about the validity of the
discrepancy score construct by arguing for the importance
of conceptual validity over that of statistical validity.
Researchers endorsing this viewpoint contend that dis-
crepancy scores represent constructs that are theoretically
distinct from the constructs represented by the component
variables (Tisak and Smith 1994a, b). Colvin et al. (1996)
asserted that for this reason, construction of difference
scores facilitates a different type of parsimony than that
advocated by opponents of the difference score construct.
They noted that difference scores provide researchers with
the opportunity to investigate the concepts that might
otherwise be awkward to assess, comprehend, and eval-
uate (Colvin et al. 1996, p. 1253). This certainly seems to
be the case when examining the relative accuracy of chil-
drens self-perceptions.
In addition, Tisak and Smith (1994a) contended that
although difference scores as a category may be prone to
low reliability, reliability should be evaluated on a case-by-
case basis. Rogosa et al. (1984) noted that even difference
scores with low reliability might still have utility. In fact, it
has been argued that if difference scores do indeed possess
low reliability, the effect of this reduced reliability will be
to attenuate statistical correlations with other variables.
Statistically significant results therefore would serve as
conservative estimates of relations between difference
scores and other variables (Colvin et al. 1996).
Alternative Statistical Methodologies
Given the challenges and limitations associated with the
use of difference scores, alternative statistical methodolo-
gies warrant discussion and exploration. Other researchers
have employed residual difference scores to investigate
similar constructs. These scores are generated through
341
regression analyses that employ one informant (i.e., the
child) as a predictor of the other informant (i.e., teacher,
parent, or objective criterion assessing actual competence).
A residual difference score indexing the difference
between the score predicted by the independent variable
(child) and that provided by the dependent variable (cri-
terion) is generated by the regression analysis, and this
score typically is converted into a z-score (see Chi and
Hinshaw 2002; De Los Reyes and Kazdin 2004). However,
we note that the drawback of this statistical approach is that
the best-fitting regression line divides the sample roughly
in half, with approximately 50% of cases lying above the
line and 50% lying below it. Hence, this approach will
always result in a distribution of scores composed of
approximately 50% underestimators and 50% overestima-
tors. However, in samples for which this assumed equal
distribution of overestimators and underestimators does not
hold (for example, children with ADHD), residual differ-
ence scores consequently may misrepresent the data.
A recent review (De Los Reyes and Kazdin 2004)
examined the most commonly used methods for comparing
informant ratings in child psychopathology; these authors
recommended the use of standardized difference scores.
More specifically, the authors evaluated three informant
discrepancy methods, including unstandardized difference
scores among two informants ratings, standardized dif-
ference scores among two informants ratings, and the
residual difference between two informants ratings. The
standardized difference score measure was the only method
that was uniformly correlated with the ratings from which
it was computed. More specifically, standardization of the
component scores prior to computing the discrepancy
associates the discrepancy score with both component
parts, which alleviates concerns about construct validity.
Future studies should investigate other analyses that may
best evaluate the accuracy of self-perceptions while mini-
mizing methodological limitations. Although there are
limitations to using discrepancy analyses, the alternatives
also have significant limitations. Thus, we concur with De
Los Reyes and Kazdin (2004) in recommending that
researchers employ standardized discrepancy scores when
conducting evaluations of childrens self-perceptions.
Theoretical Explanations for the Positive Illusory Bias
The PIB in the self-perceptions of children with ADHD has
been well documented; however, the function and causes of
this phenomenon are unclear. Hypothesized explanations
for the PIB include cognitive immaturity (Milich 1994),
neuropsychological deficits (Owens and Hoza 2003),
ignorance of incompetence (Hoza et al. 2002), and self-
protection (Ohan and Johnston 2002). We acknowledge
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that these hypotheses may not be mutually exclusive.
Indeed, because the mechanisms underlying the PIB are not
yet well understood, and thus not yet well-articulated, there
is overlap in the various constructs that past researchers
have proposed to explain the function of the PIB. Given the
existing data (or lack thereof), the goal of this section is not
to provide definitive answers, but rather to provide a con-
ceptual context for stimulating new ideas and advancing
research regarding the underlying mechanisms of the PIB.
The following discussion presents current empirical evi-
dence supporting or disconfirming each of the possible
explanations presented in the literature till date.
Cognitive Immaturity
Compared to older children, younger children tend to
overestimate their skills in various academic tasks, and
overestimate their future performance, and purportedly this
overestimation serves as an adaptive purpose (Bjorklund
and Green 1992). For example, by definition, young chil-
dren experience frequent failure as they continuously
encounter novel tasks. Young childrens optimistic beliefs
about their ability to succeed allow them to try new
activities and persist on challenging tasks. Since children
with ADHD often are characterized as being behaviorally
and cognitively immature (Whalen 1989), it has been
suggested that cognitive immaturity may explain their
positive illusory self-perceptions (Milich 1994). That is,
the PIB found in children with ADHD may be analogous to
the overestimation of self-competence evident in young
children because both types of children have immature
cognitive functions. This hypothesis, thus, implies that
children with ADHD, like the general population of young
children, will outgrow this bias in cognitions.
Direct empirical support for this hypothesis is quite
limited (Milich 1994). Upto date, no study has directly
examined the cognitive immaturity hypothesis in the
positive illusory self-perceptions of children with ADHD.
Moreover, no study has examined the presence of the PIB
in a longitudinal sample or in a cross-sectional sample with
ages that span early childhood to young adulthood. As
such, the role of development in the expression of the PIB
is largely unknown. In order to sufficiently examine the
cognitive immaturity hypothesis, both longitudinal and
cross-sectional studies are needed. Thus, conclusions about
the cognitive immaturity hypothesis can only be drawn
indirectly from extant data.
For example, if the PIB in children with ADHD was
analogous to the optimism of young children, such opti-
mism would result in continued persistence during
challenging tasks. In contrast, several studies suggest that
optimistic self-perceptions in children with ADHD do not
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Clin Child Fam Psychol Rev (2007) 10:335351
result in continued persistence (Hoza et al. 2001; Milich
1994). Instead, Milich (1994) characterized the perfor-
mance behavior of children with ADHD as being consistent
with learned helplessness, despite the presence of opti-
mistic assessments of self-competence. This indirect
evidence challenges the viability of cognitive immaturity
as the best explanation for the PIB.
Neuropsychological Deficits
Neuroimaging studies suggest that there are four main
neural regions associated with ADHD. These regions
include the (a) prefrontal cortices, (b) basal ganglia, (c)
cerebellum, and (d) corpus callosum (Nigg 2006). There is
preliminary evidence that children with ADHD have
abnormal patterns of brain activation during challenging
tasks that require the use of these four structures. The four
neural regions listed above all also are related to executive
functioning, and not surprisingly, neuropsychological
research suggests that children with ADHD demonstrate
executive functioning deficits (e.g., Murphy et al. 2001;
Swanson et al. 1998; Tannock 1998).
Anosognosia is a neurologically based lack of awareness
of personal errors (Stuss and Benson 1987) and impair-
ments in self-awareness (Ownsworth et al. 2002; Starkstein
et al. 2006) that is linked to frontal lobe damage and
executive dysfunction. Patients who have frontal lobe
damage and executive dysfunction are unable to self-
monitor and regulate their behavior (Stuss and Benson
1987) and often overestimate their abilities, despite main-
taining the ability to evaluate the competence of their
spouses (e.g., Duke et al. 2002; Kaszniak and Christensen
1995). Taken together, it is possible that the unique pattern
of self-perceptions, self-monitoring, and self-awareness
found in children with ADHD may be the result of some
form of an anosognosia-like condition, stemming from
executive dysfunction. If this were the case, consistent with
research on anosognosia in adult patients (e.g., Duke et al.
2002), children with ADHD would have difficulty accu-
rately evaluating their own competence, but would be
capable of accurately evaluating the competence of others.
Further, this pattern of competence evaluation would be
more extreme in children with ADHD who demonstrate
greater executive functioning deficits (as assessed by
standardized tests of executive functioning) than those with
less impairment in these areas. Unfortunately, no study has
examined the relation between executive dysfunction and
the PIB. Given the current state of knowledge, we cannot
determine the relation among executive dysfunction, the
PIB, and ADHD. However, the prominent role of executive
dysfunction in the manifestation of ADHD makes this an
area worthy of future research.
Clin Child Fam Psychol Rev (2007) 10:335351
Ignorance of Incompetence Hypothesis
According to Kruger and Dunning (1999), individuals who
are incompetent in a given domain suffer a dual burden:
not only do they reach erroneous conclusions and make
unfortunate choices, but their incompetence robs them of
their ability to realize it (p. 1121). This phenomenon has
been labeled ignorance of incompetence (Dunning et al.
2003; Kruger and Dunning 1999). Since children with
ADHD demonstrate chronic and significant deficits (e.g.,
Barkley 1990; Pelham and Bender 1982; LeFever et al.
2002), it might be argued that these children are incom-
petent across multiple domains. As such, ignorance of
incompetence may be a plausible explanation for the overly
optimistic self-assessments of children with ADHD. If
applied to children with ADHD, this hypothesis would
suggest that overly inflated self-perceptions of children
with ADHD might be a result of their inability to recognize
their deficits precisely because they are incompetent and
lack skills. For instance, a child with ADHD who lacks
social skills will not be able to accurately evaluate why he
or she could not maintain a friendship. However, in con-
trast to the executive function hypothesis (anosognosia) in
which the child with ADHD would have difficulty accu-
rately evaluating their own competence, but would be
capable of accurately evaluating the competence of others,
the ignorance of incompetence hypothesis implies that the
child would be a poor evaluator of both self-competence
and the competence of others. Upto date, no studies have
directly tested the ignorance of incompetence hypothesis
(i.e., replicated the methodology of Kruger and Dunning
1999) in children with ADHD. Nonetheless, we present
some preliminary confirming and disconfirming evidence
for this hypothesis as an explanation for the PIB in children
with ADHD.
In support of the ignorance of incompetence hypothesis,
Hoza et al. (2004, 2002) have found that children with
ADHD overestimate their competence the most in their
domain(s) of greatest deficit. For example, children with
ADHD and comorbid aggression tended to overestimate
their competence the most in the social acceptance and
behavioral conduct domains; whereas children with ADHD
and comorbid low achievement tended to overestimate
their competence the most in the scholastic competence
domain. As such, Hoza et al. (2002) speculated that chil-
dren with ADHD may not have the knowledge to evaluate
competence if they are significantly impaired in a given
domain (i.e., if these children do not have the skills nec-
essary to succeed in the specified domain, they also do not
possess the skills necessary to evaluate their competence in
that domain).
Conversely, in Owens and Hozas (2003) study, HICB
children were no more impaired in the academic domain
343
(i.e., as assessed by standardized achievement tests) than
were IA children; yet HICB children overestimated their
academic self-competence significantly more than IA
children. If the ignorance of incompetence hypothesis was
applicable to the PIB in ADHD, it would be expected that
IA children would also demonstrate inflated perceptions of
scholastic competence because IA children were as equally
impaired academically as HICB children. Further, perfor-
mance estimates of children with ADHD have been shown
to decrease following positive feedback in the social
domain (Diener and Milich 1997; Ohan and Johnston
2002). The ignorance of incompetence hypothesis cannot
explain why the performance estimates of children with
ADHD become more aligned with actual performance after
receiving positive feedback.
Lastly, Evangelista et al. (2007) found that children with
ADHD were accurate (i.e., not significantly different from
control children) in evaluating other childrens competence
in success and failure situations in both academic and
social domains; yet, children with ADHD overestimated
their own competence relative to teachers perceptions
across multiple domains significantly more than the control
children did. These findings suggest that children with
ADHD likely have the skills to evaluate the competence of
others across multiple domains, even in domains in which
they experience significant deficits. According to the
ignorance of incompetence hypothesis, individuals who are
incompetent in a given domain and lack the skills to
evaluate competency in this domain that should not be able
to evaluate the competency of themselves or others (Dun-
ning et al. 2003). As such, Evangelista and colleagues
(2007) study provides the most convincing evidence that
disconfirms the ignorance of incompetence hypothesis as
the most viable explanation for the PIB in children with
ADHD. Future studies should replicate the methodology
used by Kruger and Dunning (1999) to further explore this
hypothesis.
Self-protective Hypothesis
The self-protective hypothesis posits that, when children
with ADHD are threatened by a challenging task, they
attempt to hide their incompetence and prevent feelings of
failure or inadequacy by inflating reports of self-compe-
tence (Diener and Milich 1997). In other words, this
hypothesis suggests that children with ADHD overestimate
their competence as a coping mechanism that presents a
confident front to others and allows children to protect their
self-esteem. This explanation is consistent with Hoza et al.
(2004, 2002) findings that children with ADHD overesti-
mated their competence the most in the domain of greatest
deficit. Evangelista et al. (2007) findings also provide
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support for the self-protective hypothesis. Namely, children
with ADHD inflated reports of their own competence, but
not the competence of others (i.e., consistent with the idea
that there is no need for self-protection when rating another
persons competence). Taken together, these findings
(Evangelista et al. 2007; Hoza et al. 2004, 2002) lend
preliminary support to the self-protective hypothesis.
Additional research that has directly tested the self-
protective hypothesis offers more substantive confirming
evidence. For example, Diener and Milich (1997) tested the
self-protective hypothesis in boys with ADHD within the
social domain. Diener and Milich reasoned that boys with
ADHD who receive positive feedback about their social
performance would lower their performance estimates, as
they would no longer feel the need to bolster their self-
perceptions (i.e., self-protect) once positive feedback was
received. Boys with ADHD and non-impaired control boys
engaged in a social interaction task with an unfamiliar peer.
Boys were randomly assigned to either a positive feedback
or no feedback condition. Results supported the hypothesis
such that boys with ADHD who received positive feedback
lowered their self-perceptions of social performance,
whereas boys with ADHD who received no feedback
increased their self-perceptions of social performance. The
opposite pattern was observed in non-impaired control
boys. More specifically, after positive feedback, non-
impaired control boys increased their self-perceptions of
social performance, whereas after no feedback, non-
impaired control boys decreased their self-perceptions of
social performance. These results suggested that boys with
ADHD do not feel the need to enhance their reports of self-
competence once positive feedback is given (i.e., they have
proven their competence and/or warded off feelings of
inadequacy), lending support to the self-protective
hypothesis.
Ohan and Johnston (2002) expanded on the previous
studys methodology by testing the self-protective
hypothesis in boys with ADHD in both academic and
social domains. Similar to Diener and Milich (1997), Ohan
and Johnston hypothesized that boys with ADHD would
lower their reports of self-competence after receiving
positive feedback about their performance on a maze task
with a confederate (i.e., teacher). Performance on the maze
task represented the academic domain and the interaction
with the confederate teacher represented performance in
the social domain. Participants were assigned to positive
feedback, no feedback, or average feedback conditions.
Consistent with Diener and Milich (1997), results revealed
that boys with ADHD lowered their self-perceptions of
social performance following positive feedback; whereas
boys without ADHD did not (Ohan and Johnston 2002).
Conversely, there were no differences in self-perceptions
of social performance between boys with and without
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Clin Child Fam Psychol Rev (2007) 10:335351
ADHD who received average or no feedback. Unexpect-
edly, there was a different pattern of results for the
academic domain. More specifically, both groups of boys
increased their self-perceptions after receiving positive
feedback. Thus, results provide additional support for the
self-protective hypothesis in the social domain; however,
such support was not replicated in the academic domain.
It is possible that the mechanism behind the PIB in
children with ADHD varies depending on the domain. In
other words, children with ADHD may believe that social
competence is more important than academic competence;
as a result, they may feel the need to self-protect to a
greater extent in the social domain. However, it is also
possible that methodological limitations in the Ohan and
Johnston (2002) study contributed to the inconsistency of
findings across domains. For example, it is arguable that
the academic task utilized in the study (i.e., the maze task)
was not viewed by the children as an ecologically valid
academic task. In addition, performance representing the
academic and social domains was drawn from one situation
(i.e., the studentteacher interaction occurred in the context
of maze completion), rather than from independent situa-
tions (i.e., an academic task that does not include a social
interaction and vice-versa). This overlap may have created
confounding effects, making it difficult to adequately
assess the self-protective hypothesis in the academic
domain.
Despite the limitations of these studies (Diener and
Milich 1997; Ohan and Johnston 2002), they offer insight
into the mechanism that may be responsible for the PIB in
children with ADHD. Upto date, the self-protective
hypothesis has garnered more empirical support than any
other explanation for the PIB in children with ADHD.
Nonetheless, because inconsistencies (e.g., support is found
in the social but not academic domain) and methodological
limitations remain, additional investigation and extension
to other domains of competence are warranted.
In sum, the function of the PIB in children with ADHD
is unclear. Cognitive immaturity, neuropsychological def-
icits, ignorance of incompetence, and self-protection are
possible explanations; however, as discussed, most of these
hypotheses have not been directly tested. Further, these
hypotheses may not be mutually exclusive. For example,
cognitive immaturity and ignorance of incompetence may
be difficult to distinguish; in fact, these two hypotheses
may compliment each other. That is, because children with
ADHD may be cognitively immature, they may also be
deemed incompetent in a given domain. At this time, the
self-protective hypothesis has accrued the most empirical
support and appears to provide the most viable explanation
for the PIB. Additional research is needed to confirm or
disconfirm the other hypotheses and elucidate the function
of the PIB in children with ADHD.
Clin Child Fam Psychol Rev (2007) 10:335351
Effects of Sample Heterogeneity
Given the high rates of comorbid mental health diagnoses
experienced by children with ADHD (Barkley 1990; Jen-
sen et al. 1997), as well as the multiple subtype
classifications (American Psychiatric Association 2000), it
is widely accepted that this population is highly heteroge-
neous. A recent review of comorbidity in ADHD estimates
that between 43% and 93% of children with ADHD have
comorbid disruptive behavior disorders and 1351% have
comorbid internalizing diagnoses (Jensen et al. 1997).
These maladaptive, co-occurring symptoms may alter the
expression of the PIB. Next, we discuss the effects of
comorbid depressive symptoms, aggression, and low aca-
demic achievement, as well as ADHD subtype and gender
on the PIB.
Comorbid Depressive Symptoms
Previous research indicates that symptoms of depression
uniquely affect positive illusory self-perceptions in
children with ADHD (Hoza et al. 2004, 2002). In gen-
eral, the pattern of findings is consistent with the overall
effects of depression within child and adolescent popu-
lations (e.g., Gladstone and Kaslow 1995). Namely, two
studies have examined the role of comorbid depression
by comparing the self-perception patterns among three
groups of children: (a) children with ADHD and
comorbid depressive symptoms (ADHD + Dep), (b)
children with ADHD without depressive symptoms
(ADHD Dep) and (c) non-impaired control children.
Interestingly, children with ADHD Dep overestimated
their competence relative to all criteria (i.e., parent and
teacher ratings) significantly more than children with
ADHD + Dep and non-impaired children (Hoza et al.
2004, 2002). Furthermore, children with ADHD + Dep
did not significantly differ from similarly aged, non-
diagnosed peers (i.e., children without ADHD or
depressive symptoms) in estimations of self-competence
relative to criterion (Hoza et al. 2004). In other words,
comorbid depressive symptoms, as determined by ele-
vated scores on the Childrens Depression Inventory
(Kovocas 1992), appear to mitigate the PIB in children
with ADHD. Thus, symptoms of depression, even among
children with ADHD, continue to be associated with
more modest self-evaluations. Given that children with
ADHD and comorbid depressive symptoms seem to
exhibit a different self-perception pattern than other
groups of children with ADHD, future studies should
compare children with ADHD and comorbid depression
to other populations, such as children with depressive
symptoms but not ADHD.
345
Comorbid Aggression
Treuting and Hinshaw (2001) were among the first
researchers to examine the effects of comorbid aggression
on the absolute self-perception scores of children with
ADHD (i.e., using an updated version of the Piers-Harris
Childrens Self-Concept Scale [Piers, 1984]); however,
their results have not been replicated. In this study, boys
with ADHD and comorbid aggression demonstrated lower
self-perceptions on four out of the seven subscales
(behavioral, academic, happiness, and global self-concept)
than did non-aggressive boys with ADHD. On the
remaining three subscales, the two groups were statistically
similar. However, these results must be interpreted with
caution as there were high rates of depression in the sample
of boys with ADHD and comorbid aggression. Conse-
quently, depressive symptomatology, rather than
aggression, may have been responsible for lower self-per-
ception ratings among the aggressive subgroup of children
with ADHD. Further, we note that this study examined
absolute self-perceptions, rather than self-perceptions rel-
ative to a criterion. As such, it is possible that different
pattern of results may have emerged if childrens self-
perceptions were compared to a criterion.
Hoza et al. (2002) advanced our underststanding of the
role of comorbid aggression by examining childrens self-
perceptions relative to teacher ratings in boys with ADHD
and comorbid aggression (ADHD + Agg), boys with
ADHD without comorbid aggression (ADHD Agg), and
non-impaired boys. In contrast to Treuting and Hinshaw
(2001), Hoza et al. (2002) results revealed that both ADHD
subgroups overestimated their competence relative to tea-
cher ratings in the scholastic, social, and behavioral
domains significantly more than did control boys (Hoza
et al. 2002). However, boys with ADHD + Agg overesti-
mated their competence within the social and behavioral
domains significantly more than did boys with ADHD
Agg. Social and behavioral competence are two areas that
would likely be most affected by aggressive behavior.
Interestingly, estimations of competence in other domains
where aggression likely has little or no effect, such as
physical appearance, were not affected by the presence of
comorbid aggression. A similar pattern was found in a
sample that included both boys and girls with ADHD,
lending additional support to the findings (Hoza et al.
2004).
Comorbid Academic Difficulties
Interestingly, the role of comorbid academic difficulties is
similar to that of comorbid aggression in that children with
ADHD and academic difficulties tend to overestimate their
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competence the most in the domain in which they experi-
ence the greatest deficits (Hoza et al. 2004). Results from
two studies suggest that children with ADHD and low
academic achievement overestimated their academic
competence as compared to a criterion significantly more
than did children with ADHD who demonstrated average
or above-average academic achievement (Hoza et al. 2004,
2002). However, children with ADHD and low academic
achievement did not demonstrate such overestimation in
domains in which they experienced less difficulty (e.g.,
athletic competence). Since this pattern has been found in
other domains (i.e., aggression) and because low academic
achievement is commonly found in children with ADHD
(Hinshaw 1992), future research should continue to explore
the role of low academic achievement on the presentation
of the PIB.
ADHD Subtype
Not surprisingly, the three subtypes of ADHD (American
Psychiatric Association 2000) are unique with regard to
their clinical manifestations (Gaub and Carlson 1997). As
such, Owens and Hoza (2003) explored the relation
between ADHD subtype and the manifestation of the PIB.
Owens and Hoza examined self-perceptions of scholastic
competence in boys and girls with a combination of
hyperactive/impulsive and inattentive (HICB) symptoms
and boys and girls with inattentive (IA) symptoms using
both teacher report and standardized achievement tests as
criterion measures. Subtype differences emerged when
examining both absolute self-perception scores from the
SPPC (Harter 1985) and self-perceptions relative to a cri-
terion score (e.g., teacher ratings, achievement scores).
Children with HICB were more likely than children with
IA to overestimate scholastic competence when using math
and reading achievement scores as the comparison crite-
rion. Moreover, in some cases, children with IA actually
underestimated their scholastic competence relative to the
criterion and did not display a PIB.
The findings of Owens and Hoza (2003) warrant repli-
cation as there have been no other studies examining the
role of ADHD subtype differences in the PIB. Nonetheless,
the preliminary results suggest that future studies examin-
ing the PIB should consider role of ADHD subtype before
drawing conclusions about the ADHD sample as a whole.
Furthermore, it is possible that the lower self-perceptions
of competence in IA children occurred as a function of
sluggish cognitive tempo, a characteristic that is present in
some children with IA. Since children with IA who dem-
onstrate a sluggish cognitive tempo tend to be more
depressed and have poorer social skills than children with
IA who have a more active cognitive tempo (Carlson and
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Mann 2002), the unique and combined contributions of
sluggish cognitive tempo and depression in explaining
ADHD subtype differences in the PIB warrant further
exploration.
Gender
Given that ADHD is predominantly diagnosed in boys
(American Psychiatric Association 2000), many of the
initial studies investigating the PIB included only boys in
their sample. To date, only three studies (Evangelista et al.
2007; Hoza et al. 2004; Owens and Hoza 2003) have
investigated the PIB with a discrepancy analysis in both
boys and girls with ADHD; and in general, the pattern
suggests that the PIB is present in both sexes.
The only gender differences that were found in Hoza
et als (2004) study were main effects of gender, and thus,
not specific to children with ADHD. Namely, when teacher
report was used as the criterion, boys (with and without
ADHD) overestimated their behavioral competencies as
compared to the criterion more than girls (with and without
ADHD), whereas girls (with and without ADHD) under-
estimated their physical appearance as compared to the
criterion more than boys (with and without ADHD; Hoza
et al. 2004). Similarly, in Owens and Hozas (2003) study,
significant main effects of gender were found, but signifi-
cant gender ADHD status interactions were not found.
The gender effects indicated that girls overestimated their
academic competence more than boys when judged against
teacher report and math achievement scores (Owens and
Hoza 2003). Given that far fewer girls than boys partici-
pated in these three studiesonly 20% of the ADHD
sample, combined across studiesthe conclusions that can
be drawn are limited. The best summary of extant data is
that gender differences have not been found in the mani-
festation of the PIB in children with ADHD.
Limitations and Conclusions
To date, no studies have examined the moderating effect of
ethnicity on the PIB within an ADHD sample. However,
there are some indications that socio-cultural differences
may exist. David and Kistner (2000) found that African-
American children were more likely to report dispropor-
tionally higher self-ratings of peer likeability when
compared to a criterion were than Caucasian children.
However, ADHD symptoms were not assessed and com-
parisons were made based upon peer reports of aggressive
behavior. Nevertheless, such indications of ethnic differ-
ences in self-perceptions warrant further investigations of
race, culture, and socioeconomic status, and their relation
Clin Child Fam Psychol Rev (2007) 10:335351
to the PIB in children with ADHD. Similarly, little atten-
tion has been paid to the expression and manifestation of
the PIB across the developmental spectrum. Indeed, most
studies have restricted their samples to children between
the ages of 8 and 12. Clearly, the role of development in
the PIB warrants additional investigation through broad
cross-sectional and longitudinal studies.
In summary, it is indisputable that the ADHD population
includes significant heterogeneity. Collectively, past
research indicates that childrens patterns of self-percep-
tions are associated with co-occurring symptoms and
functional impairment. Comorbid difficulties may diminish
(i.e., depressive symptoms) or exacerbate (i.e., aggression,
low achievement) the degree to which the PIB is present. In
addition, there is some evidence that hyperactive/impulsive
symptoms may be more strongly correlated with the PIB
than inattentive symptoms (Owens and Hoza 2003).
However, replication of this finding is warranted. Future
studies could advance the literature by comparing children
with ADHD and comorbid symptoms to impaired, non-
ADHD samples (e.g., children with learning disabilities,
children with depression, children with aggression).
Finally, while gender differences have not been found in
the manifestation of the PIB in children with ADHD,
continued investigation of gender is warranted until this
null finding has been replicated across multiple studies.
In general, we cannot provide authoritative conclusions
regarding the effect of sample heterogeneity on the PIB, as
no one study has parceled out all potential comorbidities,
ADHD subtypes, and genders to definitively quantify the
effects of these characteristics on the PIB. Yet, as the
respective studies indicate, comorbidity, ADHD subtype,
and gender must all be considered in future studies in order
to better elucidate the manifestation and function of the
PIB. In addition, researchers investigating the impact of
ethnicity or development will be breaking new ground in
this area of research.
Implications and Future Directions
Taken together, past research supports the existence of
inflated perceptions of self-competence in children with
ADHD. However, the critical question is whether the PIB
is adaptive or maladaptive in children with ADHD. There
are conflicting views as to whether accurate self-percep-
tions are necessary to ones healthy well being. Taylor and
Brown (1988) suggested that moderate, but not excessive,
positive illusions are advantageous in that they lead indi-
viduals to approach and persist when faced with a
challenging task. Extant data do not provide an answer to
this question for children with ADHD. Given the functional
deficits associated with ADHD, a contextual factor that
347
warrants consideration when investigating this question is
the childs actual competence. That is, children with
ADHD who overestimate their competence, but perform
within the average range, may indeed experience the
advantages of positive illusions on task persistence. In
contrast, it is possible that children with ADHD who
overestimate their abilities and perform below average may
experience these advantages in the short-term, but may
actually experience negative consequences from the PIB
over the long-term.
Interestingly, there is some preliminary evidence that
excessively inflated positive illusions in children with
ADHD may have a short-term buffering effect against
depression (Vaughn 2007). It seems likely, however, that
the short-term benefits of positive illusions may be out-
weighed by the negative long-term consequences of being
unable to recognize and remediate functional deficits (for
discussion, see Owens and Hoza 2003). For example, it
has been suggested that awareness of ones own deficits
may serve a motivating function in behavioral treatment
(Hoza and Pelham 1995), whereas inaccurate estimations
of self may interfere with treatment progress. Further,
some studies suggest that boys with externalizing behav-
iors who respond best to treatment are those with low
self-esteem (Lochman et al. 1985) or low self-confidence
(Hoza and Pelham 1995). This suggestive evidence
implies that children with ADHD who demonstrate posi-
tive illusory self-perceptions of competence may not
respond well to treatment, possibly resulting in more
negative consequences in adolescence and adulthood.
Nonetheless, to date, a longitudinal study examining the
long-term benefits and consequences of the PIB in indi-
viduals with ADHD has yet to be conducted. Thus, such
studies are warranted.
Some researchers have contemplated the extent to which
excessive positive illusions could be reduced through
humility training (Gresham et al. 1998, p. 405) in order
to facilitate awareness and motivation for improvement.
Gresham and colleagues (1998) suggested that children
with ADHD who display a PIB might benefit from
instruction with the goal of increasing awareness of their
respective deficits. Although this conclusion is intuitively
appealing, we note that this suggestion is both in direct
contrast with conventional clinical wisdom (e.g., Bloom-
quist 1996) and also based on speculation rather than on
empirical evidence. With the exception of Vaughn (2007),
research examining the short-term or long-term benefits or
consequences of the PIB on adjustment is lacking at this
time. We strongly recommend additional research exam-
ining the relative adaptive or maladaptive consequences of
positive illusory self-perceptions upon social-emotional
functioning and task performance and persistence prior to
altering current treatment approaches.
123
348
The current review also highlights the impact of sample
characteristics on self-perception patterns in children with
ADHD; this is of particular importance, given the hetero-
geneity of the ADHD population. Future studies should
at a minimuminclude documentation of sample charac-
teristics such as gender, age, ethnicity, ADHD subtype,
depressive symptoms, academic achievement, and aggres-
sion. Additional research further investigating the influence
of each of these characteristics alone and in combination
would offer additional contributions to extant literature.
For example, until recently (e.g., Evangelista et al. 2007;
Owens and Hoza 2003), studies investigating the PIB only
included boys in their samples and those including girls
still have a larger proportion of boys (e.g., Hoza et al.
2004; Owens and Hoza 2003). Similarly, to date, only one
study has examined the role of ADHD subtypes in self-
perceptions of academic competence (Owens and Hoza
2003).
As previously discussed, the self-protective hypothesis
appears to be the explanation for the PIB with the most
empirical support to date. Nonetheless, there are several
limitations that can be improved upon. First, the self-pro-
tective hypothesis has not been examined in girls with
ADHD. It is possible that boys and girls will respond dif-
ferently in situations design to elicit possible self-
protection. Second, the relation between ADHD subtype
and the self-protective hypothesis has not been fully
examined. Ohan and Johnston (2002) conducted some
supplementary analyses to address this gap in the literature.
For example they compared non-impaired boys to the
subset of ADHD boys who met criteria for ADHD, Com-
bined Type or ADHD, Hyperactive/Impulsive Type and the
pattern of results did not change. However, the study
lacked a sufficient number of ADHD, Inattentive Type
children (and thus sufficient power) to adequately examine
the relation between ADHD subtype and the self-protective
hypothesis. Third, it seems necessary to further examine
self-protection within the context of a more ecologically-
valid academic task. It is possible that evidence for the self-
protective hypothesis was not evident in Ohan and John-
stons (2002) study, because child participants did not
perceive the mazes to be representative of a typical aca-
demic task. On the other hand, it is possible that there are
different explanations for positive illusions within different
domains of competence. Future research examining these
questions would be useful.
Treatment implications with regard to the PIB will differ
markedly depending on the explanation that ultimately
produces the most compelling support. Thus, it is crucial to
further elucidate the function of the PIB, and to study the
phenomenon longitudinally in order to adequately deter-
mine its possible short- and long-term benefits and
consequences. Until such work is completed, it will be
123
Clin Child Fam Psychol Rev (2007) 10:335351
difficult to arrive at the most appropriate and effective
treatment recommendations. Further, studies that directly
compare two or more theoretical explanations within a
given study would significantly advance our understanding
of the relative merits of each theory in explaining the
function of the PIB. Lastly, longitudinal and cross-sec-
tional studies that span the developmental trajectory are
warranted in order to definitively confirm or disconfirm the
cognitive immaturity hypothesis as a valid explanation of
the PIB in children with ADHD.
Given the methodological and statistical limitations of
discrepancy analyses, future researchers are strongly
encouraged to consider alternative strategies for evaluating
the accuracy of childrens self-perceptions. Although we,
like De Los Reyes and Kazdin (2004), suggest that future
researchers be consistent in employing standardized dis-
crepancy scores in examinations of self-perceptions
relative to more objective criteria, we acknowledge that
even this approach carries some limitations. We encourage
future researchers to interpret findings in the context of the
approach that they choose to employ, while acknowledging
the limitations of that particular approach. Furthermore,
given that different analytic strategies provide different
types of information (e.g., absolute self-perception scores
versus discrepancy scores), providing the results of both
analyses may enhance our ability to draw conclusions
across multiple studies. Finally, we hope that the devel-
opment of new methodological approaches will remain a
goal of future research in this area.
As noted earlier in this article, the PIB is not a phe-
nomenon that is exclusive to children with ADHD. Indeed,
past research has found positive illusions to be present in
children who are peer-rejected and/or aggressive (Gresham
et al. 1998; Hymel et al. 1993), and in children with
learning disabilities (Heath and Glen 2005). Although these
conditions often are comorbid with ADHD, the possibility
arises that the PIB may occur as a function of general
impairmentADHD-related or otherwise. Consequently,
we reiterate the need for future research to examine self-
perceptions in similarly-aged and impaired non-ADHD
populations in order to determine if the PIB is best
accounted for by ADHD symptoms relative to other types
of social, emotional, or behavioral deficits. For example,
dimensional research examining associations between
positive illusions and different types of dysfunction (e.g.,
ADHD symptoms, academic difficulties, peer relationship
challenges) may be useful. Alternatively, studies that
include other impaired comparison groups, such as children
with other mental health disorders (e.g., depression) also
may assist in determining whether the PIB is specific to
ADHD or if it is a phenomenon related to more general
difficulties or dysfunction. To conclusively assert that the
PIB is truly a function of ADHD, future studies should
Clin Child Fam Psychol Rev (2007) 10:335351
include samples that better account for the heterogeneities
that we have outlined and other disorders.
Despite significant functional problems in multiple
domains, children with ADHD unexpectedly provide
overly positive reports of their own competence in com-
parison to multiple different types of objective criteria.
Furthermore, the degree to which these children overesti-
mate their competence seems to differ from that found in
the general population. This counterintuitive phenomenon
has been the source of considerable controversy and dis-
cussion. This critical review has highlighted the important
facets of extant research with the intent of providing
guideposts for future studies that attempt to further eluci-
date the nature and function of the PIB in children with
ADHD.
References
Alicke, M. D., & Govorun, O. (2005). The better-than-average effect.
In M. D. Alicke, D. A. Dunning, &J. I. Krueger (Eds.), The self
in social judgment (pp. 85106). New York: Psychology Press.
American Psychiatric Association (2000). Diagnostic and statistical
manual of mental disorders (4th ed., text rev.). Washington, DC:
American Psychiatric Association.
Bagwell, C. L., Molina, B. S. G., Pelham, W. E. Jr., & Hoza, B.
(2001). Attention-deficit hyperactivity disorder and problems in
peer relations: Predictions from childhood to adolescence.
Journal of the American Academy of Child and Adolescent
Psychiatry, 40, 12851292.
Barkley, R. A. (1990). Attention-deficit hyperactivity disorder: A
handbook for diagnosis and treatment. New York: Guilford Press.
Baumeister, R. F. (1989). The optimal margin of illusion. Journal of
Social & Clinical Psychology, 8, 176189.
Bjorklund, D. F., & Green, B. L. (1992). The adaptive nature of
cognitive immaturity. American Psychologist, 47, 4654.
Bloomquist, M. L. (1996). Skills training for children with behavior
disorders: A parent and therapist guidebook. New York:
Guilford Press.
Cantwell, D. P., & Satterfield, J. H. (1978). The prevalence of
academic underachievement in hyperactive children. Journal of
Pediatric Psychology, 3, 168171.
Carlson, C. L., & Mann, M. (2002). Sluggish cognitive tempo predicts
a different patter of impairment in the attention deficit hyper-
activity disorder, predominantly inattentive type. Journal of
Clinical Child and Adolescent Psychology, 31, 123129.
Chi, T. C., & Hinshaw, S. P. (2002). Mother-child relationships of
children with ADHD: The role of maternal depressive symptoms
and depression-related distortions. Journal of Abnormal Child
Psychology, 30, 387400.
Colvin, C. R., Block, J., & Funder, D. C. (1996). Psychometric truths
in the absence of psychological meaning: A reply to Zuckerman
& Knee. Journal of Personality and Social Psychology, 70,
12521255.
Cronbach, L. J. (1958). Proposals leading to analytic treatment of
social perception scores. In R. Tagiuri &L. Petrullo (Eds.),
Person perception and interpersonal behavior (pp. 353379).
Stanford, CA: Stanford University Press.
Cunningham, C. E., & Barkley, R. A. (1979). The interactions of
normal and hyperactive children with their mothers in free play
and structured tasks. Child Development, 50, 217224.
349
Danforth, J. S., Barkley, R. A., & Stokes, T. F. (1991). Observation of
parent-child interactions with hyperactive children: Research
and clinical implications. Clinical Psychology Review, 11,
703727.
David, C. F., & Kistner, J. A. (2000). Do positive self-perceptions
have a dark side? Examination of the link between perceptual
bias and aggression. Journal of Abnormal Child Psychology, 28,
327337.
De Los Reyes, A., & Kazdin, A. E. (2004). Measuring informant
discrepancies in clinical child research. Psychological Assess-
ment, 16, 330334.
Diener, M. B., & Milich, R. (1997). Effects of positive feedback on
the social interactions of boys with attention deficit hyperactivity
disorder: A test of the self-protective hypothesis. Journal of
Clinical Child Psychology, 26, 256265.
Duke, L. M., Seltzer, B., Seltzer, J. E., & Vasterling, J. J. (2002).
Cognitive components of deficit awareness in alzheimers
disease. Neuropsychology, 16, 359369.
Dunning, D., Johnson, K., Ehrlinger, J., & Kruger, J. (2003). Why
people fail to recognize their own incompetence. Current
Directions in Psychological Science, 12, 8387.
Edwards, J. R. (2001). Ten difference score myths. Organizational
Research Methods, 4, 265287.
Evangelista, N. M., Owens, J. S., Golden, C. M., & Pelham, W. E.
(2007). The positive illusory bias: Do inflated self-perceptions in
children with ADHD generalize to perceptions of others?
Manuscript under review.
Gaub, M., & Carlson, C. L. (1997). Behavioral characteristics of
DSM-IV ADHD subtypes in a school-based population. Journal
of Abnormal Child Psychology, 25, 103111.
Gladstone, T. R., & Kaslow, N. J. (1995). Depression and attributions
in children and adolescents: A meta-analytic review. Journal of
Abnormal Child Psychology, 23, 597606.
Gresham, F. M., MacMillan, D. L., Bocian, K. M., Ward, S. L., &
Forness, S. R. (1998). Comorbidity of hyperactivity-impulsivity-
inattention and conduct problems: Risk factors in social,
affective, and academic domains. Journal of Abnormal Child
Psychology, 26, 393406.
Griffin, D., Murray, S., & Gonzalez, R. (1999). Difference score
correlations in relationship research: A conceptual primer.
Personal Relationships, 6, 505518.
Harter, S. (1981). A model of mastery motivation in children:
Individual differences, developmental change. In W. A. Collins
(Ed.), Aspects of the development of competence (pp. 215255).
Hillsdale, NJ: Erlbaum.
Harter, S. (1985). Manual for the self-perception profile for children.
Denver: University of Denver Department of Developmental
Psychology.
Heath, N., & Glen, T. (2005). Positive illusory bias and the self-
protective hypothesis in children with learning disabilities.
Journal of Clinical Child and Adolescent Psychology, 34,
272281.
Hinshaw, S. P. (1992). Academic underachievement, attention
deficits, and aggression: Comorbidity and implications for
intervention. Journal of Consulting and Clinical Psychology,
60, 893903.
Hodgens, J. B., Cole, J., & Boldizar, J. (2000). Peer-based differences
among boys with ADHD. Journal of Clinical Child Psychology,
29, 443452.
Horn, W. F., Wagner, A. E., & Ialongo, N. (1989). Sex differences in
school-aged children with pervasive attention deficit hyperac-
tivity disorder. Journal of Abnormal Child Psychology, 17,
109125.
Hoza, B., Gerdes, A. C., Hinshaw, S. P., Arnold, E. L., Pelham, W. E.,
Molina, B. S. G. et al. (2004). Self-perceptions of competence in
123
350
children with ADHD and comparison children. Journal of
Consulting and Clinical Psychology, 72, 382391.
Hoza, B., Mrug, S., Gerdes, A. C., Hinshaw, S. P., Bukowski, W. M.,
Gold, J. A. et al. (2005). What aspects of peer relationships are
impaired in children with ADHD? Journal of Consulting and
Clinical Psychology, 73, 411423.
Hoza, B., & Pelham, W. E. (1995). Social-cognitive predictors of
treatment response in children with ADHD. Journal of Social
and Clinical Psychology, 14, 2335.
Hoza, B., Pelham, W. E. Jr., Dobbs, J., Owens, J. S., & Pillow, D. R.
(2002). Do boys with attention deficit/hyperactivity disorder
have positive illusory self-concepts? Journal of Abnormal
Psychology, 111, 268278.
Hoza, B., Pelham, W. E., Milich, R., Pillow, D., & McBride, K.
(1993). The self-perceptions and attributions of attention deficit
hyperactivity disordered and nonreferred boys. Journal of
Abnormal Child Psychology, 21, 271286.
Hoza, B., Pelham, W. E., Waschbusch, D. A., Kipp, H., & Owens, J.
S. (2001). Academic task persistence of normally achieving
ADHD and control boys: Performance, self-evaluations, and
attributions. Journal of Consulting and Clinical Psychology, 69,
271283.
Hoza, B., Waschbusch, D. A., Pelham, W. E., Molina, B. S. G., &
Milich, R. (2000). Attention-deficit/hyperactivity disordered and
control boys responses to social success and failure. Child
Development, 71, 432446.
Hymel, S., Bowker, A., & Woody, E. (1993). Aggressive versus
withdrawn unpopular children: Variations in peer and self-
perceptions in multiple domains. Child Development, 64,
879896.
Ialongo, N. S., Lopez, M., Horn, W. F., Pascoe, J. M., & Greenberg,
G. (1994). Effects of psychostimulant medication on self-
perceptions of competence, control, and mood in children with
attention deficit hyperactivity disorder. Journal of Clinical Child
Psychology, 23, 161173.
Jensen, P. S., Martin, D., & Cantwell, D. P. (1997). Comorbidity in
ADHD: Implications for research, practice, and DSM-V. Journal
of the American Academy of Child & Adolescent Psychiatry, 36,
10651079.
Kaszniak, A. W., & Christensen, G. D. (1995). One-year longitudinal
changes in the metamemory impairment of Alzheimers disease
[abstract]. Journal of the International Neuropsychological
Society, 1, 145.
Kovocas, M. (1992). Childrens depression inventory. North
Tonowanda, NY: Multi-Health Systems, Inc.
Kruger, J., & Dunning, D. (1999). Unskilled and unaware of it: How
difficulties in recognizing ones own incompetence lead to
inflated self-assessments. Journal of Personality and Social
Psychology, 77, 11211134.
LeFever, G. B., Villers, M. S., & Morrow, A. L. (2002). Parental
perceptions of adverse educational outcomes among children
diagnosed and treated for ADHD: A call for improved school/
provider collaboration. Psychology in the Schools, 39, 6371.
Lochman, J. E., Lampron, L. B., Burch, P. R., & Curry, J. F. (1985).
Client characteristics associated with behavior change for treated
and untreated aggressive boys. Journal of Abnormal Child
Psychology, 13, 527538.
Loney, J., & Milich, R. (1982). Hyperactivity, inattention, and
aggression in clinical practice. In M. Wolraich &D. Routh
(Eds.), Advances in developmental and behavioral pediatrics
(Vol. 3, pp. 113147). Greenwich, CT: JAI Press.
Milich, R. (1994). The response of children with ADHD to failure: If
at first you dont succeed, do you try, try again? School
Psychology Review, 23, 1128.
123
Clin Child Fam Psychol Rev (2007) 10:335351
Milich, R., & Okazaki, M. (1991). An examination of learned
helplessness among attention-deficit hyperactivity disordered
boys. Journal of Abnormal Child Psychology, 19, 607623.
Murphy, K. R., Barkley, R. A., & Bush, T. (2001). Executive
functioning and olfactory identification in young adults with
attention deficit-hyperactivity disorder. Neuropsychology, 15,
211220.
Nigg, J. T. (2006). What causes ADHD? Understanding what goes
wrong and why. New York: Guilford.
ONeill, M. E., & Douglas, V. I. (1991). Study strategies and story
recall in attention-deficit disorder and reading disability. Journal
of Abnormal Child Psychology, 19, 671692.
Ohan, J. L., & Johnston, C. (2002). Are the performance overesti-
mates given by boys with ADHD self-protective?. Journal of
Clinical Child Psychology, 31, 230241.
Owens, J. S., & Hoza, B. (2003). The role of inattention and
hyperactivity/impulsivity in the positive illusory bias. Journal of
Consulting and Clinical Psychology, 71, 680691.
Ownsworth, T. L., McFarland, K. M., & Young, R. (2002). The
investigation of factors underlying deficits in self-awareness and
self-regulation. Brain Injury, 16, 291309.
Pelham, W. E., & Bender, M. E. (1982). Peer relationships in
hyperactive children: Description, treatment. In K. D. Gadow &
I. Bialer (Eds.), Advances in learning and behavioral disabilities
(pp. 366436). Greenwich, CT: JAI Press.
Piers, E. V. (1969). Manual for the Piers-Harris childrens
self-concept scale. Nashville, TN: Counselor Recordings and
Tests.
Piers, E. V. (1984). Manual for the piers-harris childrens self-
concept scale (the way i feel about myself). Los Angeles:
Western Psychological Services.
Rogosa, D., Brandt, D., & Zimowski, M. (1984). A growth curve
approach to the measurement of change. Psychological Bulletin,
92, 726748.
Shaffer, D. (1994). Attention deficit hyperactivity disorder in adults.
American Journal of Psychiatry, 151, 633638.
Starkstein, S. E., Jorge, R., Mizrahi, R., & Robinson, R. G. (2006). A
diagnostic formulation for anosognosia in Alzheimers disease.
Journal of Neurology, Neurosurgery, and Psychiatry, 77,
719725.
Stuss, D. T., & Benson, D. F. (1987). The frontal lobes and control of
cognition and memory. In E. Perecman (Ed.), The frontal lobes
revisited. Hillsdale, NJ: Lawrence Erlbaum Associates.
Swanson, J., Castellanos, F. X., Murias, M., LaHoste, G., & Kennedy,
J. (1998). Cognitive neuroscience of attention deficit hyperac-
tivity disorder and hyperkinetic disorder. Current Opinion in
Neurobiology, 8, 263271.
Tannock, R. (1998). Attention deficit hyperactivity disorder:
Advances in cognitive, neurobiological, and genetic research.
Journal of Child Psychology and Psychiatry, 39, 6599.
Taylor, S. E., & Armor, D. A. (1996). Positive illusions and coping
with adversity. Journal of Personality, 64, 873898.
Taylor, S. E., & Brown, J. D. (1988). Illusions and well-being: A
social psychological perspective on mental health. Psychological
Bulletin, 103, 193210.
Tisak, J., & Smith, C. S. (1994a). Defending and extending difference
score methods. Journal of Management, 20, 675682.
Tisak, J., & Smith, C. S. (1994b). Rejoinder to Edwardss comments.
Journal of Management, 20, 691694.
Treuting, J. J., & Hinshaw, S. P. (2001). Depression and self-esteem
in boys with attention-deficit/hyperactivity disorder: Associa-
tions with comorbid aggression and explanatory attributional
mechanisms. Journal of Abnormal Child Psychology, 29,
2339.
Clin Child Fam Psychol Rev (2007) 10:335351
Vaughn, A. (2007). Peer rejection and positive illusions as predictors
of later childhood adjustment in children with and without
ADHD. Unpublished masters thesis, Purdue University.
Whalen, C. K. (1989). Attention deficit and hyperactivity disorders. In T.
H. Ollendick & M. Hersen (Eds.), Handbook of child psychopa-
thology (2nd ed., pp. 131169). New York: Plenum Press.
Whalen, C. K., Henker, B., Hinshaw, S. P., Heller, T., & Huber-
Dressler, A. (1991). Messages of medication: Effects of actual
351
versus informed medication status on hyperactive boys expec-
tancies and self-evaluations. Journal of Consulting and Clinical
Psychology, 59, 602606.
Zuckerman, M., & Knee, C. R. (1996). The relation between overly-
positive self-evaluation and adjustment: A comment on Colvin,
Block, & Funder (1995). Journal of Personality and Social
Psychology, 70, 12501251.
123