Effects of Symptoms of ADHD,ODD,and Cognitive Functioning on Social Acceptance and the Positive Illusory Bias in Children

Abstract

Objective: To examine the effects of symptoms of ADHD and ODD and cognitive functioning on social acceptance and positive bias in children. Method: The sample consisted of 86 children (49 girls) between 7 and 13 years old, recruited to reflect a wide range of ADHD symptoms. Parents and teachers reported on ADHD and ODD symptoms and social acceptance. Children reported on social acceptance and were given tasks measuring working memory, inhibition and reaction-time variability. A discrepancy score between child and adult reports of social acceptance was used as a measure of positive bias. Results: Inattention independently explained variance in social acceptance. The cognitive factors were related to social acceptance and the positive bias, but not beyond the ADHD and ODD symptoms. Conclusion: It is primarily disruptive behavior that contributes to external reports of children’s social acceptance.

Keywords

ADHD ODD cognitive functioning social acceptance positive bias

Poor social acceptance is often associated with unhappiness and puts children at increased risk for adverse outcomes, thus it is important to investigate the potential factors involved (Gifford-Smith & Brownell, 2003). It is well known that disruptive behaviors, such as overly active, norm breaking, and negativistic behaviors, are associated with poor social acceptance; however, several issues concerning these associations need to be further elucidated. In the present study, we investigated the independent and joint effects of symptoms of ADHD and oppositional defiant disorder (ODD) and cognitive functioning, with regard to social acceptance and child overestimation of social acceptance. Cognitive functioning was reflected by children’s performance on tasks measuring the following three cognitive factors: working memory, inhibition, and reaction-time variability.

ADHD and ODD are the two most common disruptive behavior disorders in childhood (Harden & Zoccolillo, 1997). Children with ADHD persistently display levels of activity that are in far excess of their age group; they are unable to sustain attention and persistence to tasks and their self-regulation lags behind their developmental level (American Psychiatric Association, 2000). They also display behaviors such as initiating conversations at inappropriate times, not listening to others, and frequently interrupting or intruding on others (Barkley, 1998). The diagnostic criteria for ADHD consist of symptoms of inattention and hyperactivity/impulsivity, two separate, although highly correlated symptom domains (American Psychiatric Association, 2000). The importance of separating these symptom domains in studies has repeatedly been stressed in the ADHD literature as they may be differently related to social and cognitive functioning (e.g., Diamantopoulou, Rydell, Thorell, & Bohlin, 2007; Wåhlstedt, Thorell, & Bohlin, 2008).

ODD is a behavior disorder characterized by a pattern of negativistic, hostile, defiant, and disobedient behavior toward authority figures (Loeber, Burke, Lahey, Winters, & Zera, 2000). Interpersonal sensitivity and high emotional reactivity are core features of ODD, and several of the diagnostic criteria pertain specifically to social interactions, for example, “easily annoyed by others,” “spiteful and vindictive,” and “blames others for mistakes or misbehavior” (American Psychiatric Association, 2000). Moreover, ADHD and ODD symptoms are highly comorbid and overlap 30% to 90% in clinical and community-based samples (August, Realmuto, MacDonald, Nugent, & Crosby, 1996; Biederman, 2005; Cunningham & Boyle, 2002; Drabick, Gadow, Carlson, & Bromet, 2004).

Much of the research on disruptive behavior has thus far been carried out using a categorical approach to disruptive behavior disorders, using cutoff points for symptom levels reflecting diagnosis criteria. It is increasingly being recognized that the clinical features of ADHD represent the extreme end of normal traits, rather than a distinct category (e.g., Bauermeister et al., 2007; Sonuga-Barke, Dalen, Daley, & Remington, 2002; Sonuga-Barke, Dalen, & Remington, 2003). In other words, relationships between these behaviors and other aspects of child functioning also need to be investigated dimensionally, taking into consideration a range of symptoms (Kraemer, Noda, & O’Hara, 2004). It is of theoretical and practical interest to establish whether, for example, peer dislike is evident only at the highest levels of disruptive behaviors or whether the relationships between disruptive behaviors and peer problems apply across a continuum. Moreover, possible consequences for children with subclinical levels of disruptive behavior should be of interest for mental health workers (Angold, Costello, Farmer, Burns, & Erkanli, 1999). A dimensional approach to the study of disruptive behavior also allows for the identification of differential relationships from specific symptom domains to outcomes.

Social Acceptance and Disruptive Behavior

The behavioral symptoms associated with ADHD and ODD can be expected to interfere with social functioning and negatively affect social acceptance. It is indeed well established, in clinical and community samples, that it is likely for children with high levels of ADHD symptoms to be estimated by others, such as parents, teachers, and peers, as having less social acceptance (e.g., Diamantopoulou et al., 2007; Diamantopoulou, Henricsson, & Rydell, 2005; Hoza et al., 2005). Even so, little is still known of how the different symptom domains of ADHD, inattention, and hyperactivity/impulsivity are related to children’s social acceptance. As of yet one study, using peer estimations of social acceptance in a population sample, demonstrated that both dimensions of ADHD compromise peer relationships in 8- to 9-year-olds (Diamantopoulou et al., 2007). However, this study did not take into consideration possible overlap with ODD symptoms.

Although the relationships between ODD and peer problems are less investigated, children fulfilling the criteria for an ODD diagnosis are reported to have strained interpersonal relationships and receive negative peer nominations, and are rejected by peers (Burke, Loeber, & Birmaher, 2002). Studies on the specific contributions of symptoms of ADHD and ODD in relation to social outcomes are scarce and the relative importance of lower levels of the different disruptive behaviors for social acceptance is unknown.

In addition to using an external observer of the child and his or her social standing, such as using measures of social acceptance based on adult and/or peer reports, another important aspect of social functioning is how socially accepted the individual perceives himself or herself to be. A child’s own perceptions influence the degree of discomfort or comfort experienced in peer relationships (Ladd, 1999). Relatively, few studies have investigated the self-perceptions of children with disruptive behavior with regard to social acceptance. Some researchers have found an association between ADHD and negative self-perceptions (e.g., Horn, Wagner, & Lalongo, 1989; Ialongo, Lopez, Horn, Pascoe, & Greenberg, 1994). At the same time, others argue that children with ADHD hold unwarranted positive self-perceptions as compared with controls (e.g., Gresham, MacMillan, Bocian, Ward, & Forness, 1998; Hoza, Pelham, Dobbs, Owens, & Pillow, 2002; Hoza, Pelham, Milich, Pillow, & McBride, 1993). It is not known how ODD is independently related to self-perceptions of social standing.

Positive Illusory Bias (PIB) and Disruptive Behavior

Investigations of the phenomenon of overly positive self-evaluations have provided a more nuanced picture of the relationships between disruptive behavior and social acceptance. It is normative to hold moderately positive self-evaluations (Alicke & Govorun, 2005); such illusions are thought to enhance motivation and task persistence (Taylor & Brown, 1994). Deviating from these normative positive evaluations, an overly positive bias has been identified. This bias is known in a growing literature as the PIB, that is, an overestimation of one’s own competence or performance as compared with an external source, such as reports from teachers, parents, peers, or performance measures (for a review see Owens, Goldfine, Evangelista, Hoza, & Kaiser, 2007).

A PIB has been demonstrated in children diagnosed with ADHD within the social domain (e.g., Hoza et al., 1993, 2002, 2004; Hoza, Waschbusch, Pelham, Molina, & Milich, 2000). This positive perception of the self has been linked to negative outcomes and has for example been suggested to contribute to and maintain problems with social acceptance (Hoza & Pelham, 1995). Furthermore, overestimation in children with ADHD has been linked to negative adjustment such as conduct problems (Kaiser, Hoza, Pelham, Gnagy, & Greiner, 2008) and increased aggression over time (Hoza, Murray-Close, Arnold, Hinshaw, & Hechtman, 2010).

It is important to keep in mind that the PIB represents an individual variation in bias and that not all children with ADHD evidence overestimations (McQuade et al., 2011). Knowledge about the possible background to and functional correlates of the PIB could have theoretical as well as practical implications, such as guiding interventions aimed at ameliorating the social behavior of children with disruptive behavioral problems. A PIB within the social domain has not been studied in population samples; thus, we do not know whether an overestimation of social acceptance is specific to high levels of behavioral problems or whether it is related to ADHD symptoms dimensionally.

The possible role of ODD symptoms in the relationships between ADHD and the PIB has not been considered with regard to social outcomes. This is somewhat surprising in view of the large overlap between the two types of disruptive behaviors. Overestimation has been linked to aggression and peer rejection (de Castro, Brendgen, Van Boxtel, Vitaro, & Schaepers, 2007; Hymel, Bowker, & Woody, 1993; Patterson, Kupersmidt, & Griesler, 1990), and as ODD is characterized by negative emotionality, bad temper, and aggression (Burke, Loeber, & Birmaher, 2004), there may be associations to ODD. Relationships between ADHD and a PIB with regard to social acceptance could possibly be due to comorbidity with ODD.

Cognitive Functioning, Disruptive Behavior, and the PIB

It is generally acknowledged that cognitive dysfunction is a component of the multifactorial etiology of ADHD symptoms. Especially so-called executive dysfunctions, such as deficient working memory (the temporary manipulation and storing of information) and inhibition (the ability to suppress a prepotent response or to resist distraction), have been suggested to play a role in the development of ADHD (Martinussen, Jill Hayden, Hogg-Johnson, & Tannock, 2005; Willcutt, Doyle, Nigg, Faraone, & Pennington, 2005). Studies on cognitive functioning have also consistently shown a more variable response speed on reaction tasks in children with ADHD (Castellanos, Sonuga-Barke, Milham, & Tannock, 2006; Castellanos & Tannock, 2002; Pennington, 2006).

Links between cognitive dysfunction and ODD symptoms are more uncertain. Although there is indirect support of cognitive problems also among children with ODD (Moffitt, 1993; Séguin, Boulerice, Harden, Tremblay, & Pihl, 1999), evidence is mounting that these problems are mainly related to co-occurring ADHD symptoms, as links to ODD symptoms tend to disappear when controlling for ADHD behaviors, in children from preschool age to adolescence (Brocki, Nyberg, Thorell, & Bohlin, 2007; Forssman, Eninger, Tillman, Rodriguez, & Bohlin, 2010; Thorell & Wåhlstedt, 2006). However, firm conclusions on this matter are still premature.

It is also worth noting that even with regard to ADHD, which is more closely linked to cognitive deficits than ODD, not all individuals with ADHD have been found to have such deficits (Willcutt et al., 2005). In other words, the behavioral symptoms and cognitive problems do not necessarily overlap and could have specific additive or interactive effects on outcomes. One could hypothesize that children burdened with poorer cognitive functioning as well as behavioral symptoms could have an increased risk for peer problems and/or that different behavioral symptoms in combination with cognitive problems have different effects on social acceptance.

Two studies have investigated the interplay of cognitive functioning and ADHD behaviors with regard to social acceptance. Both studies failed to find that executive-function deficits added to peer problems beyond the effect of ADHD symptoms (Biederman et al., 2004; Diamantopoulou et al., 2007). In one of the studies, the interaction of ADHD symptoms and executive-function deficits impacted unfavorably on children’s prosocial behavior but not on peer acceptance (Diamantopoulou et al., 2007). Thus, the evidence indicates that the effects of cognitive functioning on social acceptance are negligible relative to the effect of disruptive behaviors. However, this issue cannot be considered settled.

First, very few studies have looked into the matter, and those who have addressed ADHD behaviors, whereas nothing is known about the interplay of ODD behaviors and cognitive functioning. Moreover, both studies cited above have investigated cognitive functions in terms of the sum of cognitive function measures with poor performance, which clouds the possible impact of specific cognitive skills on social acceptance, such as working memory or disinhibition. Finally, the detrimental effect of cognitive deficits in combination with high levels of ADHD behaviors on prosocial behavior (Diamantopoulou et al., 2007) suggests that social acceptance also could be compromised and should be worthy of further exploration, given the generally strong relationships between prosociality and peer acceptance (e.g., Rydell, Hagekull, & Bohlin, 1997).

Hitherto, cognitive functioning in relation to ADHD and the PIB has been investigated in one clinical study that demonstrated relationships between deficits in various aspects of cognitive functioning and the existence of the PIB in the academic, behavioral conduct, and social acceptance domains (McQuade et al., 2011). For social acceptance, all cognitive factors studied (working memory, fluency, attention, planning, set shifting, and concept formation) differentiated between ADHD children with and without a PIB. However, this study did not control for ODD symptoms, and interaction effects were not investigated.

The Present Study

The aim of this study was to examine the interplay of ADHD and ODD symptoms and cognitive functioning on social acceptance and the PIB. Cognitive functioning was studied in terms of the following cognitive factors: working memory, inhibition, and reaction-time variability (RTV). Specifically, we investigated the independent and additive effects of the disruptive behaviors on social acceptance and the PIB, given the cognitive factors, as well as the independent and additive effects of the cognitive factors, given the disruptive behaviors. We also investigated interactive effects of the disruptive behaviors and the cognitive factors. We expected that high levels of the disruptive behaviors would be negatively related to adult-reported social acceptance, but with regard to the other relationships, we studied that current knowledge did not allow for specific hypotheses.

Method

Participants and Procedure

Participants were aged between 7 and 13 years (M = 10 years, SD = 1.5 years) and came from a mid-Sweden university town and its surrounding area. We recruited children with clinically identified ADHD and children from schools with a varying range of ADHD symptoms, to secure a sample with a wide variation of ADHD symptoms. This was deemed important for identifying associations with social acceptance and the PIB across the spectrum of ADHD symptoms. A total of 22 children (11 girls; we strove to recruit girls as well as boys with ADHD problems) who had an ADHD diagnosis or were currently being evaluated by ADHD specialists were recruited through the local child psychiatric clinic and from a special education unit catering to the needs of children with neuropsychiatric disorders. Two boys with clinically identified ADHD were excluded due to a comorbid diagnosis of Asperger syndrome. A total of 66 children not diagnosed or currently being assessed for ADHD, balanced for sex and age with the diagnosed group, were recruited from local schools (38 girls). Among the recruited children, 12 were on ADHD medication, and for 5 of them, parents did not consent to the child being off medication on the day of the testing. However, there were no differences in any cognitive measure between children who were and children who were not on medication, p > .50.

Plots indicated that the group of children with clinical levels of ADHD symptoms and the group recruited from schools overlapped; that is, the complete sample did not have a bimodal distribution in ADHD symptoms, which could have been an effect of the recruitment strategy. The inattention-, hyperactivity-/impulsivity-, and ODD-symptom scales all had values of kurtosis <1.10 and values of skewness <1.35, which indicates adequate normality (Kline, 1998). Maternal education was high, as 48% had a college or a university degree, 72% of the children lived with both biological parents, 80% had one or two siblings, and for 82%, both parents were born in Sweden.

Data were collected from children, parents, and teachers. Parents were required to sign a consent form addressing permission for the child to participate and for their child’s teacher to fill in a questionnaire. Research assistants performed individual sessions lasting 1 to 1.5 hr with each child at his or her school. Before commencing the session, the child was informed that participation was voluntary and that he or she could terminate participation at any time. As part of the procedure, the child was administered a test battery consisting of tests of working memory, response inhibition, and RTV, and the child responded to a questionnaire that included items on his or her perception of being socially accepted by peers. The tasks were given in a fixed order composed of two test blocks with a short recess in between. The first block was composed of the cognitive measures and the second block of the questionnaire. The research assistant gave standardized verbal instructions for all tasks, read the questionnaire items out loud to the child, and encouraged them to make inquiries if something was unclear. The children received a toy worth 3 euros as an appreciation of his or her participation. Questionnaires were distributed to teachers at the school visit and mailed to parents. Nonresponders received up to two reminders. Teachers received one movie ticket for each questionnaire. The study was approved by the local Ethics Committee, No. 2004-Ö-450.

Measures

Self-reports

The social scale from the Harter Self-Perception Profile for Adolescents (Harter, 1988) was used for child self-reports of social acceptance. The adolescent version has previously been used successfully on 9-year-olds (Diamantopoulou et al., 2007). This scale consists of five items with a four-step response format (0 = does not apply at all to 3 = applies very well). The mean of the child items was used as the child score, α = .74. The internal consistency was satisfactory among both younger (7- to 9-year-olds, n = 44, α = .76) and older children (10- to 12-year-olds, n = 42, α = .71).

Teacher and parent ratings

Teachers and parents rated ADHD and ODD symptoms. ADHD symptoms were measured using the ADHD Rating Scale–IV, an 18-item measure reflecting Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) criteria, which is well validated and extensively used within ADHD research (DuPaul, Thomas, & Anastopoulos, 1998). Nine items measure inattention and 9 items measure hyperactivity/impulsivity. A four-step response format was used ranging from 0 (never or rarely) to 3 (very often), α = .91 to .96 for parent and teacher ratings. ODD symptoms were studied using the eight DSM-IV criteria (Bussing et al., 2008) in the same format as described for ADHD symptoms, α = .93, in both parent and teacher ratings. Because of the slightly higher number of items in each of the two ADHD-symptom domain measures than in the ODD symptom measure, we chose to compile aggregate scores at the scale level rather than at the item level, α = .70 to .88 for the aggregated scale scores. Ascending numbers indicate higher levels of each phenomenon. Parent and teacher ratings of disruptive behaviors were correlated, r = .55, .79, and .61, p < .01, for ODD, inattention, and hyperactivity/impulsivity behaviors, respectively.

Adult reports of children’s social acceptance were collected using the two-item teacher scale that corresponds to the Harter Self-Perception Profile for Adolescents (Harter, 1988), teachers, α = .82, and parents, α = .77. Agreement between parents and teachers was r = .49, p < .01, and teachers and parents did not differ in their ratings of the level of social acceptance in the sample, t = 1.93, ns. There was a discrepancy of more than one response step on the parent and teacher scales for seven children. With these children excluded, none of the correlation coefficients between the adult social acceptance score and the other variables was different compared with correlations computed on the whole sample, p > .05. Thus, we used the mean of parent and teacher reports as the adult measure, α = .79. Ascending numbers indicate higher levels of each phenomenon. Child reports of social acceptance were related to the aggregated measure of adult ratings, r = .44, p < .01, as well as to the parent ratings, r = .31, and the teacher ratings, r = .42, p < .01.

As recommended, the PIB construct was estimated by using a discrepancy score between the standardized child and adult scores of the social acceptance measure (Owens et al., 2007). High values indicate a large positive bias. This results in a range of scores that varies from underestimation to overestimation. As underestimation and overestimation could empirically be associated with different cognitive factors and/or behaviors, we created a measure that focused strictly on overestimation by restricting the range of the discrepancy scores to include only those that reflected an overestimation. This was done by giving scores indicating a negative bias, that is, a discrepancy score ≤0 and a score of 0. The correlations between the parent and teacher scores of social acceptance, respectively, and the PIB were of similar magnitude, r = –.56 and r = –.51, ns. Correlations between the parent and teacher ratings of ADHD and ODD symptoms, respectively, and the PIB were between r = .42 and .49.

Counting span task

Children’s performance on a counting span task (Towse, Hitch, & Hutton, 1998) was used as a measure of working memory. The counting span task is a widely used and reliable test of verbal working memory, which has been deemed valid insofar as it is highly correlated with other working memory tasks and higher order cognitive abilities (for review see Conway et al., 2005). Participants were presented with displays on a computer consisting of arrays of blue squares and red circles on a white background. They were instructed to count red circles out loud, while pointing at each, and to remember the total number of red circles counted for each array in correct order for later recall. A number of arrays were presented in a sequence, and at the end of a sequence, the participants recalled the numbers. On the first level of the test, there were two arrays in a sequence. The number of arrays displayed increased with one array for each level, with seven arrays at the highest level. On each level there were three trials, and the test ended when the participant failed to correctly recall all numbers on at least two trials on a level. A correct response was the answer produced by the participant when counting, not necessarily the actual number of red circles. The maximum score on this test is 119, which is one score for each correct number on each trial. This measure was reversed so that high values signify poorer working memory performance.

Continuous performance test (CPT)

Children were also given a CPT. This extensively used test paradigm is thought to assess attention abilities such as inhibitory control and vigilance (Losier, McGrath, & Klein, 1996). The CPT used in the present study was developed by QbTech AB in Gothenburg, Sweden and involved the rapid presentation (a pace of one per 2 s [0.5 Hz]) of two kinds of alternating visual stimuli: a gray circle (the target) and a gray circle with a cross (nontarget) on a computer screen (Bergfalk, 2003). Participants were instructed to respond to the target stimulus by pressing the button once and to refrain from responding to nontarget stimuli. Responses were given by means of a thumb press on a handheld button, the button held in the participant’s dominant hand. Each stimulus was visible for 100 ms. The total number of stimuli presented was 450. An equal number of target and nontarget stimuli were presented in a random order. Response time was recorded in milliseconds. The test duration was 15 min. This version of the CPT has successfully been administered to children between the ages of 6 and 12 years (Brocki, Tillman, & Bohlin, 2010).

The mean of the standardized commission-error rate, that is when a response was registered when the stimulus was a nontarget, and the standardized multiresponse rate, that is when more than one button response was detected per stimulus presentation, were combined into the inhibition measure, α = .74. Higher numbers indicate poorer inhibition performance. The standard deviation of the response time during the CPT was used as the measure for RTV. Analysis of test–retest data collected for 24 children (age: M = 10.8, SD = 1.7; retest interval: M = 9.5 days, SD = 10.7 days) showed r = .85 for commissions, .72 for multiresponse rate, and .78 for RTV (F. Ulberstad, personal communication, May 10, 2011).

Statistical Analyses

In the preliminary analyses, we examined gender differences by conducting t tests and computed Pearson product–moment correlations between all variables, with control for age, to ascertain their relationships. In the main analyses, to examine potential main and interactive effects of symptoms of ADHD and ODD and cognitive factors on child- and adult-reported social acceptance and the PIB, we examined two different models by conducting a series of hierarchical regression analyses, entering variables into the models in a predetermined order as specified below.

In both models, we entered age in the first step. In Model 1, to investigate whether the separate symptoms of the disruptive behaviors contributed beyond the three separate cognitive factors to the dependent variables, we entered working memory, inhibition, and RTV in a second step and the ADHD-symptom domains of inattention and hyperactivity/impulsivity and ODD symptoms in a third step. In Model 2, to investigate whether any of the cognitive factors contributed beyond the disruptive behaviors to the dependent variables, we entered the behavioral symptoms in a second step and the three cognitive factors in a third step. To assess possible interaction effects of ADHD and ODD symptoms with each of the cognitive factors, we entered the interaction terms between the behavioral symptoms and the separate cognitive factors in a fourth step, each interaction studied in separate analyses. We centered all independent variables before entering them into the interaction analyses. Interaction effects were interpreted using simple slopes (Cohen, Cohen, West, & Aiken, 2003).

Results

Preliminary Results

The t tests showed that there were no gender differences in any variable (p > .05). Descriptive statistics of all variables can be found in Table 1. Pearson product–moment correlations between all variables with control for age can be found in Table 2. ADHD and ODD symptoms were positively correlated with each other. Both ADHD-symptom domains were positively correlated with all of the cognitive factors. ODD symptoms were positively correlated with working memory and RTV. Adult-reported social acceptance was negatively related to the disruptive behaviors and all of the cognitive factors. Child-reported social acceptance was negatively related to symptoms of inattention. The PIB was positively related to the disruptive behaviors and to poorer performance on the cognitive measures.

Table 1.

Descriptive Statistics (N = 86)

	M (SD)	Minimum	Maximum
Age in years	9.96 (1.5)	7.00	12.58
Independent variables
Inattention	0.73 (0.77)	0	2.83
Hyperactivity/impulsivity	0.59 (0.68)	0	2.83
ODD	0.56 (0.61)	0	2.44
Working memory	3.39 (0.86)	1.00	5.50
Inhibition	0 (0.89)	−0.89	3.21
RTV	163.7 (75.81)	73	539
Dependent variables
Adult-reported social acceptance	2.28 (0.64)	0.25	3.00
Self-reported social acceptance	2.26 (0.63)	0.20	3.00
PIB	0.41 (0.69)	0	3.18

Note: ODD = Oppositional Defiant Disorder; RTV = reaction-time variability; PIB = positive illusory bias.

Table 2.

Pearson’s Correlations Partialized by Age (N = 86)

	2	3	4	5	6	7	8	9
1. Inattention	.84***	.68***	.26*	.34**	.38***	−.67***	−.25*	.46***
2. Hyperactivity/impulsivity		.78***	.28*	.31**	.50***	−.61***	−.18	.49***
3. ODD			.34**	.21	.37***	−.56***	−.08	.50***
4. Working memory				.35**	.27*	−.30**	−.10	.25*
5. Inhibition					.64***	−.29**	−.05	.33*
6. RTV						−.27*	.05	.42***
7. Adult-reported social acceptance							.43***	−.62***
8. Child-reported social acceptance								.32**
9. PIB

Note: ODD = Oppositional Defiant Disorder; RTV = reaction-time variability; PIB = positive illusory bias.

p < .05. **p < .01. ***p < .001.

Main Results

Child-reported social acceptance was not explained by any of the independent variables in the regression analyses, p > .05. As seen in Table 3, in Model 1, with the cognitive factors in the second step and the disruptive behaviors in the third step, inattention contributed independently to adult-reported social acceptance. With regard to the PIB, in Model 1, RTV and ODD symptoms contributed independently. Applying a Bonferroni correction, the contribution of ODD symptoms to the PIB was marginally significant, p < .10.

Table 3.

Hierarchical Regression Analyses of Dependent and Independent Variables (N = 86)

	Dependent variables
	Adult-reported social acceptance		PIB
Independent variables	ΔR²	β	ΔR²	β
Step 1	.00		.01
Age		−.05		−.11
Step 2	.14**		.20***
Working memory		−.24		.15
Inhibition		−.13		.06
RTV		−.15		.38**
Step 3	.35***		.13**
Inattention		−.50**		.13
Hyperactivity/impulsivity		−.05		.00
ODD		−.16		.31*
Step 1	.00		.01
Age		−.05		−.11
Step 2	.47***		.28***
Inattention		−.55**		.13
Hyperactivity/impulsivity		−.01		.14
ODD		−.18		.31*
Step 3	.02		.05
Working memory		−.10		.03
Inhibition		−.10		.09
RTV		.10		.21

Note: PIB = positive illusory bias; RTV = reaction-time variability; ODD = Oppositional Defiant Disorder.

p < .05. **p < .01. ***p < .001.

Model 2 (see Table 3) showed that none of the cognitive factors contributed significantly beyond the disruptive behaviors to any of the outcomes. After Bonferroni correction, the contribution of ODD symptoms to the PIB was again marginally significant, p < .10. No interaction effects were found for social acceptance, p > .05. An interaction effect between ODD and RTV was found for the PIB, ΔR² = .04, β = .24, p < .05, p < .10, after Bonferroni correction. Although the interaction effect was marginally significant, its interpretation was clear: At high RTV levels, ODD behaviors were positively related to the PIB, β = .47, p < .01, but not at low RTV levels, β = .10, ns.

To explore the utility of combining parent and teacher ratings of disruptive behaviors, the analyses on the social acceptance variables were rerun using the nonaggregated parent and teacher scale scores. The correlations between parent ratings of ADHD and ODD symptoms and of social acceptance and the PIB were not different in size than the correlations between teacher ratings of ADHD and ODD symptoms and social acceptance and the PIB, all p > .05. The importance of inattention for explaining adult-rated social acceptance was replicated using parent and teacher ratings of disruptive behaviors in separate regressions, whereas the contribution of ODD symptoms for explaining the PIB was reduced to insignificance (p > .05) in half of these analyses. Thus, the combined parent and teacher ratings strengthened the associations we studied compared with separate ratings.

To allow for comparison with research using the full range of discrepancy scores as the construct of the PIB, analyses were rerun using an unrestricted PIB estimate, that is, including both overestimation and underestimation of social acceptance. Results were similar to those presented above except that in Model 1, the RTV variable did not contribute significantly to the full range PIB, p > .05.

Discussion

How the children evaluated their social acceptance was negatively associated with inattention in the bivariate analyses but was not explained by any of the cognitive factors or disruptive behaviors in the regression analyses. The behavioral symptoms and cognitive factors were negatively related to social acceptance as viewed by adults; however, only symptoms of inattention contributed independently of hyperactivity/impulsivity and ODD in the regression analyses. Cognitive factors did not contribute beyond the behavioral symptoms to adult-reported social acceptance or the PIB. When the cognitive factors were placed in the second step of the hierarchical regression (Model 1), RTV contributed independently to the PIB, and ODD contributed independently to the PIB beyond cognitive factors. The investigation of the marginally significant interaction effect showed that at high levels of RTV, ODD was positively related to the PIB.

Disruptive Behavior and Social Acceptance

Previous research has found links between external estimations of social acceptance and both inattention and hyperactivity/impulsivity; however, this was without control for ODD symptoms and using peer reports (Diamantopoulou et al., 2007). Here, we found that when considering symptoms of inattention, hyperactivity/impulsivity, and ODD, adult reports of social acceptance were primarily related to symptoms of inattention. The importance of this symptom domain was underscored by the fact that inattention was the only aspect of disruptive behavior that was correlated to child reports of social acceptance in the bivariate analysis. Perhaps, the predominance of inattention could partly be an effect of the children’s age (almost 10 years old). The hyperactivity/impulsivity levels were significantly lower than inattention levels, t = 3.15, p < .01; inattention was a more prominent feature of behavior in this sample than was hyperactivity/impulsivity. This is in agreement with findings showing that in middle childhood, the hyperactive/impulsive aspect of ADHD problems tend to have abated, whereas inattentive problems remain (Brocki & Bohlin, 2006; Hart, Lahey, Loeber, Applegate, & Frick, 1995). Also, at this age, inattention could perhaps interfere more with being able to attend to communication, which could be more unattractive to peers than occasional bursts of impulsivity and high activity.

It is somewhat surprising that ODD behaviors did not come out as particularly important for social acceptance considering the negativistic nature of these problems. However, levels of ODD symptoms were also low compared with inattention, t = 2.05, p < .05, perhaps not surprising as the sample was recruited to secure a wide variation in ADHD symptoms. Furthermore, ODD symptoms covaried more with the hyperactive/impulsive than with the inattentive symptom domain. When regressing ODD symptoms on the ADHD-symptom domains, only the hyperactive/impulsive domain came out as significant, β = .70 versus β = .09. Thus, the impact of ODD symptoms may have been lost in the high common variance. Also, ODD behaviors may mostly be directed toward adults, and hence more disturbing to parents and teachers than to other children. This study indicates that the ODD behaviors per se do not play a role in children’s social acceptance. Studies using peer evaluations of social acceptance would enhance knowledge regarding this issue.

Disruptive Behavior and the PIB

Previous research has been inconsistent regarding disruptive behavior and self-reports of social acceptance (Gresham et al., 1998; Horn et al., 1989; Hoza et al., 1993, 2002; Ialongo et al., 1994). Our findings indicate that the child’s perception of how well he or she is socially accepted is not related to disruptive behavior or cognitive problems. The PIB has been linked to ADHD symptoms (Owens et al., 2007) and, as we have demonstrated, to ODD symptoms, although the independent contribution of ODD symptoms was only marginally significant when controlling for multiple testing. We found an individual variation in the PIB (see Table 1), and as previously shown, not all children with ADHD evidence overestimations (McQuade et al., 2011). Heterogeneity between samples with regard to an overly positive view of social standing could be one possible explanation to the inconsistencies in the literature regarding associations between disruptive behaviors and self-perceptions of social acceptance. Overestimation has been linked to aggression (de Castro et al., 2007; Hymel et al., 1993; Patterson et al., 1990), and possibly, aggression in peer interactions may have been associated with the ODD behaviors in our study and carried the relationship to the PIB. There are of course also other variables that may moderate the relationships between disruptive behaviors and self-perceptions of social acceptance, such as gender. The sample size did not allow interaction analyses, including gender, thus this issue was left outside the scope of this study.

Cognitive Factors, Disruptive Behavior, Social Acceptance, and the PIB

This study supports previous results indicating that compared with the underlying cognitive problems of ADHD symptoms, it is mainly the overt behaviors that are related to social acceptance (Biederman et al., 2004; Diamantopoulou et al., 2007). We found bivariate relationships between all cognitive measures and the PIB, but as demonstrated in the regressions, their eventual impact seemed to go via their behavioral expressions. It could be that the cognitive problems related to disruptive behavior in this mainly nonreferred sample were not severe enough to have an independent effect on social acceptance.

Previous research has linked the PIB in ADHD children to self-protective psychological mechanisms (Evangelista, Owens, Golden, & Pelham, 2008; Hoza et al., 2010), but there is recent evidence of associations with cognitive problems among ADHD children with overestimations (McQuade et al., 2011); however, the relative importance of cognitive and behavioral factors for the PIB were not assessed. Our findings support that cognitive factors are related to child overestimation of social acceptance, but as mentioned above, they were mostly overshadowed by the influence of disruptive behaviors.

Why RTV came out as important in our study with regard to the PIB can only be speculated on, but perhaps a more variable reaction time reflects an inattentive state and that children with increased RTV are not taking in social-cue information. Furthermore, variable reaction time is one of the most consistent cognitive manifestations of ADHD (Castellanos et al., 2006), so perhaps this effect is simply more highly detectable.

In contrast to this study, McQuade et al. (2011) found that several cognitive abilities were important for the PIB when comparing groups of children with and without an ADHD diagnosis and when comparing the ADHD children with and without a PIB. Again, this study did not control for ODD. It could be that the cognitive problems in the clinical sample were higher as compared with the sample used in our study. McQuade et al’s. study (2011) also only used teachers as reporters when calculating the PIB, whereas we used both parents and teachers.

As to the importance of the PIB relative to behaviors and cognitive factors, our strategy to test a restricted range representing only overestimation rendered only marginal differences from results using the whole range of overestimation and underestimation of social acceptance. However, by focusing on overestimation, the association with RTV was more apparent. Further research investigating the differences between overestimation and underestimation is needed as the full range construct of the PIB could dilute results when investigating these phenomena dimensionally.

Limitations

Before coming to conclusion, a few aspects of this study should be mentioned. First, external evaluations of child social acceptance were provided by adults around the child and not by peers. Peer nominations are a major source of information when it comes to children’s social standing, and especially when mainly uncharted territory is investigated, such as the role of cognitive problems in conjunction with disruptive behavior, findings based on other informants should be replicated using peer evaluations of social acceptance. However, we had secured a broad picture of the child’s functioning in school and home, which usually is not the case with peer reports, and the significant relationships between teacher, parent, and child ratings attest to reliability. This was the case even though we used the two-item version of the Harter Scale for teachers for the adult ratings. Second, the use of indicators of three cognitive factors and three domains of disruptive behavior put strains on the sample that was somewhat restricted in size, a drawback in terms of statistical power. When the regression results were subjected to Bonferroni corrections, three coefficients declined from significant to trend status. However, it should be pointed out that the Bonferroni procedure is very conservative and may be applied at the cost of Type II errors (Rothman, 1990). We included a small group of children in the clinical range for ADHD in the sample, thus securing a wide range of ADHD behaviors, which should improve the possibilities to detect relationships between the phenomena of interest. Still, our results, some of them not demonstrated before, need to be replicated in larger samples. Third, we used a limited number of measures for each cognitive factor, and the measure for inhibition and RTV were derived from the same test. Future studies should use multiple measures of each construct.

Conclusion

With the above considerations in mind, this study demonstrated that using multiple aspects of cognitive functioning and studying symptoms of disruptive behavior dimensionally, it is primarily disruptive behavior that contributes to external reports of children’s social acceptance. As to which disruptive aspect seems most important for social acceptance, this study adds to the diversity of results by showing that inattention contributes to explained variance independent of hyperactivity/impulsivity and ODD symptoms. To paint a complete picture, these issues must be studied in samples of various ages and with various problem levels, perhaps also with regard to gender. We have added to the knowledge of the PIB by showing that it is at least marginally related to ODD, independent of ADHD symptoms. Moreover, as many researchers have stressed, our findings underscore the fruitfulness of considering the two ADHD-symptom domains and ODD together in investigations of disruptive behavior. Furthermore, cognitive factors play a role in children’s overestimation of social acceptance. There were relationships between cognitive factors and the PIB, without control for behavior. A suggestion for further research would be to investigate how the PIB mediates cognitive problems longitudinally and how it affects social standing over time.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article:

This research was supported by a grant from the Swedish Council for Working Life and Social Research.

Bios

Sara Scholtens is a PhD student at the Department of Psychology, Uppsala University.

Sofia Diamantopoulou is a researcher at the Department of Basic Psychology and Methodology, University of Murcia.

Carin M. Tillman is a researcher at the Department of Psychology, Uppsala University. She has conducted research on executive functions and ADHD.

Ann-Margret Rydell is a professor of psychology at the Department of Psychology, Uppsala University.

References

Alicke

M. D.

Govorun

(2005). The better-than-average effect. In Alicke

M. D.

Dunning

Krueger

(Eds.), The self in social judgment (pp. 85-106). New York, NY: Psychology Press.

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

Angold

Costello

E. J.

Farmer

E. M.

Burns

B. J.

Erkanli

(1999). Impaired but undiagnosed. Journal of the American Academy of Child & Adolescent Psychiatry, 38, 129-137.

August

G. J.

Realmuto

G. M.

MacDonald

A. W.

Nugent

S. M.

Crosby

(1996). Prevalence of ADHD and comorbid disorders among elementary school children screened for disruptive behavior. Journal of Abnormal Child Psychology, 24, 571-595.

Barkley

R. A.

(1998). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment. New York, NY: Guilford.

Bauermeister

J. J.

Shrout

P. E.

Ramírez

Bravo

Alegría

Martínez-Taboas

Canino

(2007). ADHD correlates, comorbidity, and impairment in community and treated samples of children and adolescents. Journal of Abnormal Child Psychology, 35, 883-898.

Bergfalk

(2003). QbTest user manual. Gothenburg, Sweden: QbTech AB.

Biederman

(2005). Attention-deficit/hyperactivity disorder: A selective overview. Biological Psychiatry, 57, 1215-1220.

10.

Biederman

Monuteaux

M. C.

Doyle

A. E.

Seidman

L. J.

Wilens

T. E.

Ferrero

Faraone

S. V.

(2004). Impact of executive function deficits and attention-deficit/hyperactivity disorder (ADHD) on academic outcomes in children. Journal of Consulting and Clinical Psychology, 72, 757-766.

11.

Brocki

K. C.

Bohlin

(2006). Developmental change in the relation between executive functions and symptoms of ADHD and co-occurring behaviour problems. Infant and Child Development, 15, 19-40.

12.

Brocki

K. C.

Nyberg

Thorell

L. B.

Bohlin

(2007). Early concurrent and longitudinal symptoms of ADHD and ODD: Relations to different types of inhibitory control and working memory. Journal of Child Psychology and Psychiatry, 48, 1033-1041.

13.

Brocki

K. C.

Tillman

C. M.

Bohlin

(2010). CPT performance, motor activity, and continuous relations to ADHD symptom domains: A developmental study. European Journal of Developmental Psychology, 7, 178-197.

14.

Burke

J. D.

Loeber

Birmaher

(2002). Oppositional defiant disorder and conduct disorder: A review of the past 10 years, part II. Journal of the American Academy of Child & Adolescent Psychiatry, 41, 1275-1293.

15.

Burke

J. D.

Loeber

Birmaher

(2004). Oppositional defiant disorder and conduct disorder: A review of the past 10 years, part II. Journal of the American Academy of Child & Adolescent Psychiatry, 2, 1275-1293.

16.

Bussing

Fernandez

Harwood

Wei

Garvan

Eyberg

Swanson

(2008). Parent and teacher SNAP-IV ratings of attention deficit hyperactivity disorder symptoms: Psychometric properties and normative ratings from a school district sample. Assessment, 15, 317-328.

17.

Castellanos

F. X.

Sonuga-Barke

E. J. S.

Milham

M. P.

Tannock

(2006). Characterizing cognition in ADHD: Beyond executive dysfunction. Trends in Cognitive Sciences, 10, 117-123.

18.

Castellanos

F. X.

Tannock

(2002). Neuroscience of attention-deficit/hyperactivity disorder: The search for endophenotypes. Nature Reviews Neuroscience, 3, 617-628.

19.

Cohen

West

Aiken

(2003). Applied multiple regression/correlation analysis for the behavioral sciences (3rd ed.). Mahwah, NJ: Lawrence Erlbaum Associates.

20.

Conway

A. R.

Kane

M. J.

Bunting

M. F.

Hambrick

Wilhelm

Engle

R. W.

(2005). Working memory span tasks: A methodological review and user’s guide. Psychonomic Bulletin & Review, 12, 769-786.

21.

Cunningham

C. E.

Boyle

M. H.

(2002). Preschoolers at risk for attention-deficit hyperactivity disorder and oppositional defiant disorder: Family, parenting, and behavioral correlates. Journal of Abnormal Child Psychology, 30, 555-569.

22.

de Castro

B. O.

Brendgen

Van Boxtel

Vitaro

Schaepers

(2007). “Accept me, or else . . .”: Disputed overestimation of social competence predicts increases in proactive aggression. Journal of Abnormal Child Psychology, 35, 165-178.

23.

Diamantopoulou

Henricsson

Rydell

A. M.

(2005). ADHD symptoms and peer relations of children in a community sample: Examining associated problems, self-perceptions, and gender differences. International Journal of Behavioral Development, 29, 388-398.

24.

Diamantopoulou

Rydell

A. M.

Thorell

L. B.

Bohlin

(2007). Impact of executive functioning and symptoms of attention deficit hyperactivity disorder on children’s peer relations and school performance. Developmental Neuropsychology, 32, 521-542.

25.

Drabick

D. A.

Gadow

K. D.

Carlson

G. A.

Bromet

E. J.

(2004). ODD and ADHD symptoms in Ukrainian children: External validators and comorbidity. Journal of the American Academy of Child & Adolescent Psychiatry, 43, 735-743.

26.

DuPaul

G. J.

Thomas

Anastopoulos

A. D.

(1998). ADHD Rating Scale–IV: Checklists, norms, and clinical interpretation. New York, NY: Guilford.

27.

Evangelista

N. M.

Owens

J. S.

Golden

C. M.

Pelham

W. E.

(2008). The positive illusory bias: Do inflated self-perceptions in children with ADHD generalize to perceptions of others? Journal of Abnormal Child Psychology, 36, 779-791.

28.

Forssman

Eninger

Tillman

C. M.

Rodriguez

Bohlin

(2010). Cognitive functioning and family risk factors in relation to symptom behaviors of ADHD and ODD in adolescents. Journal of Attention Disorders, Advance online publication. doi:10.1177/1087054710385065

29.

Gifford-Smith

M. E.

Brownell

C. A.

(2003). Childhood peer relationships: Social acceptance, friendships, and peer networks. Journal of School Psychology, 41, 235-284.

30.

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, 393-406.

31.

Harden

P. W.

Zoccolillo

(1997). Disruptive behavior disorders. Current Opinion in Pediatrics, 9, 339.

32.

Hart

E. L.

Lahey

B. B.

Loeber

Applegate

Frick

P. J.

(1995). Developmental change in attention-deficit hyperactivity disorder in boys: A four-year longitudinal study. Journal of Abnormal Child Psychology, 23, 729-749.

33.

Harter

(1988). Manual for the self-perception profile for adolescents. Denver, CO: University of Denver.

34.

Horn

W. F.

Wagner

A. E.

Lalongo

(1989). Sex differences in school-aged children with pervasive attention deficit hyperactivity disorder. Journal of Abnormal Child Psychology, 17, 109-125.

35.

Hoza

Gerdes

A. C.

Hinshaw

S. P.

Arnold

L. E.

Pelham

W. E.

Molina

B. S. G.

Wigal

(2004). Self-perceptions of competence in children with ADHD and comparison children. Journal of Consulting and Clinical Psychology, 72, 382-391.

36.

Hoza

Mrug

Gerdes

A. C.

Hinshaw

S. P.

Bukowski

W. M.

Gold

J. A.

Arnold

L. E.

(2005). What aspects of peer relationships are impaired in children with attention-deficit/hyperactivity disorder? Journal of Consulting and Clinical Psychology, 73, 411-423.

37.

Hoza

Murray-Close

Arnold

L. E.

Hinshaw

S. P.

Hechtman

(2010). Time-dependent changes in positively biased self-perceptions of children with attention-deficit/hyperactivity disorder: A developmental psychopathology perspective. Development and Psychopathology, 22, 375-390.

38.

Hoza

Pelham

W. E.

(1995). Social-cognitive predictors of treatment response in children with ADHD. Journal of Social & Clinical Psychology, 14, 23-35.

39.

Hoza

Pelham

W. E.

Dobbs

Owens

J. S.

Pillow

D. R.

(2002). Do boys with attention-deficit/hyperactivity disorder have positive illusory self-concepts? Journal of Abnormal Psychology, 111, 268-278.

40.

Hoza

Pelham

W. E.

Milich

Pillow

McBride

(1993). The self-perceptions and attributions of attention deficit hyperactivity disordered and nonreferred boys. Journal of Abnormal Child Psychology, 21, 271-286.

41.

Hoza

Waschbusch

D. A.

Pelham

W. E.

Molina

B. S.

Milich

(2000). Attention-deficit/hyperactivity disordered and control boys’ responses to social success and failure. Child Development, 71, 432-446.

42.

Hymel

Bowker

Woody

(1993). Aggressive versus withdrawn unpopular children: Variations in peer and self-perceptions in multiple domains. Child Development, 64, 879-896. doi:10.1111/j.1467-8624.1993.tb02949.x

43.

Ialongo

N. S.

Lopez

Horn

W. F.

Pascoe

J. M.

Greenberg

(1994). Effects of psychostimulant medication on self-perceptions of competence, control, and mood in children with attention deficit hyperactivity disorder. Journal of Clinical Child & Adolescent Psychology, 23, 161-173.

44.

Kaiser

N. M.

Hoza

Pelham

W. E.

Gnagy

Greiner

A. R.

(2008). ADHD status and degree of positive illusions: Moderational and mediational relations with actual behavior. Journal of Attention Disorders, 12, 227-238.

45.

Kline

R. B.

(1998). Principles and practice of structural equation modeling. New York, NY: Guilford.

46.

Kraemer

Noda

O’Hara

(2004). Categorical versus dimensional approaches to diagnosis: Methodological challenges. Journal of Psychiatric Research, 38, 17-25.

47.

Ladd

G. W.

(1999). Peer relationships and social competence during early and middle childhood. Annual Review of Psychology, 50, 333-359.

48.

Loeber

Burke

J. D.

Lahey

B. B.

Winters

Zera

(2000). Oppositional defiant and conduct disorder: A review of the past 10 years, part I. Journal of American Academy of Child & Adolescent Psychiatry, 39, 1468-1484.

49.

Losier

B. J.

McGrath

P. J.

Klein

R. M.

(1996). Error patterns on the continuous performance test in non-medicated and medicated samples of children with and without ADHD: A meta-analytic review. Journal of Child Psychology and Psychiatry, 37, 971-987.

50.

Martinussen

Jill Hayden

D.C.

Hogg-Johnson

Tannock

(2005). A meta-analysis of working memory impairments in children with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 44, 377-384.

51.

McQuade

J. D.

Tomb

Hoza

Waschbusch

D. A.

Hurt

E. A.

Vaughn

A. J.

(2010). Cognitive deficits and positively biased self-perceptions in children with ADHD. Journal of Abnormal Child Psychology, 39, 307-319.

52.

Moffitt

T. E.

(1993). The neuropsychology of conduct disorder. Development and Psychopathology, 5, 135-151.

53.

Owens

J. S.

Goldfine

M. E.

Evangelista

N. M.

Hoza

Kaiser

N. M.

(2007). A critical review of self-perceptions and the positive illusory bias in children with ADHD. Clinical Child and Family Psychology Review, 10, 335-351.

54.

Patterson

C. J.

Kupersmidt

J. B.

Griesler

P. C.

(1990). Children’s perceptions of self and of relationships with others as a function of sociometric status. Child Development, 61, 1335-1349. doi:10.1111/j.1467-8624.1990.tb02865.x

55.

Pennington

B. F.

(2006). From single to multiple deficit models of developmental disorders. Cognition, 101, 385-413.

56.

Rothman

K. J.

(1990). No adjustments are needed for multiple comparisons. Epidemiology, 1, 43-46.

57.

Rydell

A. M.

Hagekull

Bohlin

(1997). Measurement of two social competence aspects in middle childhood. Developmental Psychology, 33, 824-833.

58.

Séguin

J. R.

Boulerice

Harden

P. W.

Tremblay

R. E.

Pihl

R. O.

(1999). Executive functions and physical aggression after controlling for attention deficit hyperactivity disorder, general memory, and IQ. Journal of Child Psychology and Psychiatry, 40, 1197-1208.

59.

Sonuga-Barke

E. J.

Dalen

Daley

Remington

(2002). Are planning, working memory, and inhibition associated with individual differences in preschool ADHD symptoms? Developmental Neuropsychology, 21, 255-272.

60.

Sonuga-Barke

E. J.

Dalen

Remington

(2003). Do executive deficits and delay aversion make independent contributions to preschool attention-deficit/hyperactivity disorder symptoms? Journal of the American Academy of Child & Adolescent Psychiatry, 42, 1335-1342.

61.

Taylor

S. E.

Brown

J. D.

(1994). Positive illusions and well-being revisited: Separating fact from fiction. Psychological Bulletin, 116, 21-27.

62.

Thorell

L. B.

Wåhlstedt

(2006). Executive functioning deficits in relation to symptoms of ADHD and/or ODD in preschool children. Infant and Child Development, 15, 503-518.

63.

Towse

J. N.

Hitch

G. J.

Hutton

(1998). A reevaluation of working memory capacity in children. Journal of Memory and Language, 39, 195-217.

64.

Wåhlstedt

Thorell

L. B.

Bohlin

(2008). Heterogeneity in ADHD: Neuropsychological pathways, comorbidity and symptom domains. Journal of Abnormal Child Psychology, 37, 551-564.

65.

Willcutt

E. G.

Doyle

A. E.

Nigg

J. T.

Faraone

S. V.

Pennington

B. F.

(2005). Validity of the executive function theory of attention-deficit/hyperactivity disorder: A meta-analytic review. Biological Psychiatry, 57,1336-1346.