Abstract
Adults with ADHD may engage in two distinct but related social-cognitive processes: positive illusory bias (PIB) and self-handicapping (SH). A theoretical basis for these mechanisms in ADHD is provided through the self-worth theory of achievement motivation. These mechanisms may initially serve a self-protective function, but ultimately lead to negative outcomes. However, research in this area is limited, and most of what is known about PIB and SH is not specific to adults with ADHD. We conducted a scoping review of the extant literature of PIB and SH among adults with ADHD. Eight studies were reviewed (six PIB and two SH). Results suggest that adults with ADHD may be more likely to engage in PIB and SH than their non-ADHD peers, and that engaging in these patterns may lead to worsened outcomes over time. The findings are limited by a small number of studies with varying sampling, operational definitions, and measures. Recommendations for research and clinical work are provided, including considering various ways to operationalize PIB and SH, investigating the impact of PIB and SH on assessment reporting style (i.e., under- versus over-reporting), and considering the role of PIB and SH in the treatment of ADHD in adults.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
Throughout the paper, we refer to sex/gender because the included studies were often unclear about how they defined these variables.
References
Ajzen, I. (1985). From intentions to actions: A theory of planned behavior. In Action control (pp. 11–39). Springer. https://doi.org/10.1007/978-3-642-69746-3_2
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787
Arksey, H., & O’Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19–32. https://doi.org/10.1080/1364557032000119616
Barkley, R. A. (1997). Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD. Psychological Bulletin, 121(1), 65. https://doi.org/10.4324/9781315054315-11
Barkley, R. A. (2007). Self-Handicapping Comments in ADHD Children. The ADHD Report, 15(4), A1.
Barkley, R. A. (Ed.). (2015). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment, 4th ed. (pp. xiii, 898). The Guilford Press. https://doi.org/10.1177/019874299401900205
Barkley, R. A., Murphy, K. R., & Fischer, M. (2010). ADHD in adults: What the science says. Guilford press.
Barkley, R. A., Knouse, L. E., & Murphy, K. R. (2011). Correspondence and disparity in the self-and other ratings of current and childhood ADHD symptoms and impairment in adults with ADHD. Psychological Assessment, 23(2), 437. https://doi.org/10.1037/a0022172
Bourchtein, E., Langberg, J. M., Owens, J. S., Evans, S. W., & Perera, R. A. (2017). Is the positive illusory bias common in young adolescents with ADHD? A fresh look at prevalence and stability using latent profile and transition analyses. Journal of Abnormal Child Psychology, 45(6), 1063–1075. https://doi.org/10.1007/s10802-016-0248-3
Breda, V., Rohde, L. A., Menezes, A. M. B., Anselmi, L., Caye, A., Rovaris, D. L., & Grevet, E. H. (2020). Revisiting ADHD age-of-onset in adults: To what extent should we rely on the recall of childhood symptoms? Psychological Medicine, 50(5), 857–866. https://doi.org/10.1017/S003329171900076X
Butzbach, M., Fuermaier, A. B., Aschenbrenner, S., Weisbrod, M., Tucha, L., & Tucha, O. (2021). Metacognition in adult ADHD: Subjective and objective perspectives on self-awareness of cognitive functioning. Journal of Neural Transmission, 1–17.
Carlson, C. L., Pelham, W. E., Milich, R., & Hoza, B. (1993). ADHD boys’ performance and attributions following success and failure: Drug effects and individual differences. Cognitive Therapy and Research, 17(3), 269–287. https://doi.org/10.1007/BF01172950
Covington, M. V., & Beery, R. G. (1976). Self-worth and school learning. Holt, Rinehart & Winston.
Curtis, R. C. (2017). Self-Defeating Behaviors. In Reference Module in Neuroscience and Biobehavioral Psychology (p. B9780128093245065000). Elsevier. https://doi.org/10.1016/B978-0-12-809324-5.06551-2
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(3), 256–265. https://doi.org/10.1207/s15374424jccp2603_4
Dykstra, J. B. (2015). Self-Handicapping Strategies in Emerging Adults Concerned about Attention-Deficit/Hyperactivity Disorder. Ohio University.
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(5), 779–791. https://doi.org/10.1007/s10802-007-9210-8
Faries, M. D. (2016). Why we don’t “just do it” understanding the intention-behavior gap in lifestyle medicine. American Journal of Lifestyle Medicine, 10(5), 322–329. https://doi.org/10.1177/1559827616638017
Frank, A. W. (1993). The Rhetoric of Self-Change: Illness Experience as Narrative. The Sociological Quarterly, 34(1), 39–52. https://doi.org/10.1111/j.1533-8525.1993.tb00129.x
Golden, C. M. (2007). The positive illusory bias: An examination of self-perceptions in adults with ADHD symptomatology (Doctoral dissertation, Ohio University).
Hartung, C. M., & Lefler, E. K. (2019). Sex and gender in psychopathology: DSM–5 and beyond. Psychological Bulletin, 145(4), 390–409. https://doi.org/10.1037/bul0000183
Higgins, R. L. (1990). Self-handicapping. In Self-Handicapping (pp. 1–35). Springer. https://doi.org/10.1007/978-1-4899-0861-2_1
Hirt, E. R., Deppe, R. K., & Gordon, L. J. (1991). Self-reported versus behavioral self-handicapping: Empirical evidence for a theoretical distinction. Journal of Personality and Social Psychology, 61(6), 981. https://doi.org/10.1037/0022-3514.61.6.981
Hoza, B., Waschbusch, D. A., Owens, J. S., Pelham, W. E., & Kipp, H. (2001). Academic task persistence of normally achieving ADHD and control boys: Self-evaluations, and attributions. Journal of Consulting and Clinical Psychology, 69(2), 271. https://doi.org/10.1037/0022-006X.69.2.271
Hoza, B., Gerdes, A. C., Hinshaw, S. P., Arnold, L. E., Pelham, W. E., Molina, B. S. G., Abikoff, H. B., Epstein, J. N., Greenhill, L. L., Hechtman, L., Odbert, C., Swanson, J. M., & Wigal, T. (2004). Self-Perceptions of Competence in Children With ADHD and Comparison Children. Journal of Consulting and Clinical Psychology, 72(3), 382–391. https://doi.org/10.1037/0022-006X.72.3.382
Hoza, B., Pelham, W. E., 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(2), 268–278. https://doi.org/10.1037/0021-843X.111.2.268
Hoza, B., Murray-Close, D., Arnold, L. E., Hinshaw, S. P., Hechtman, L., & MTA Cooperative Group. (2010). Time-dependent changes in positively biased self-perceptions of children with attention-deficit/hyperactivity disorder: A developmental psychopathology perspective. Development and Psychopathology, 22(2), 375–390. https://doi.org/10.1017/S095457941000012X
Jaconis, M., Boyd, S. J., Hartung, C. M., McCrea, S. M., Lefler, E. K., & Canu, W. H. (2016). Sex differences in claimed and behavioral self-handicapping and ADHD symptomatology in emerging adults. ADHD Attention Deficit and Hyperactivity Disorders, 8(4), 205–214. https://doi.org/10.1007/s12402-016-0200-y
Jiang, Y., & Johnston, C. (2012). The Relationship Between ADHD Symptoms and Competence as Reported by Both Self and Others. Journal of Attention Disorders, 16(5), 418–426. https://doi.org/10.1177/1087054710392541
Jones, E. E., & Berglas, S. (1978). Control of attributions about the self through self-handicapping strategies: The appeal of alcohol and the role of underachievement. Personality and Social Psychology Bulletin, 4(2), 200–206. https://doi.org/10.1177/014616727800400205
Kessler, R. C., Adler, L., Barkley, R., Biederman, J., Conners, C. K., Demler, O., & Zaslavsky, A. M. (2006). The prevalence and correlates of adult ADHD in the United States: Results from the National Comorbidity Survey Replication. American Journal of Psychiatry, 163(4), 716–723. https://doi.org/10.1176/ajp.2006.163.4.716
Knouse, L. E., Bagwell, C. L., Barkley, R. A., & Murphy, K. R. (2005). Accuracy of Self-Evaluation in Adults with ADHD: Evidence from a Driving Study. Journal of Attention Disorders, 8(4), 221–234. https://doi.org/10.1177/1087054705280159
Knouse, L. E., & Mitchell, J. T. (2015). Incautiously Optimistic: Positively Valenced Cognitive Avoidance in Adult ADHD. Cognitive and Behavioral Practice, 22(2), 192–202. https://doi.org/10.1016/j.cbpra.2014.06.003
Knouse, L. E., Mitchell, J. T., Kimbrel, N. A., & Anastopoulos, A. D. (2019). Development and evaluation of the ADHD cognitions scale for adults. Journal of Attention Disorders, 23(10), 1090–1100. https://doi.org/10.1177/1087054717707580
Laird, R. D., & De Los Reyes, A. (2013). Testing Informant Discrepancies as Predictors of Early Adolescent Psychopathology: Why Difference Scores Cannot Tell You What You Want to Know and How Polynomial Regression May. Journal of Abnormal Child Psychology, 41(1), 1–14. https://doi.org/10.1007/s10802-012-9659-y
Lefler, E. K., Flory, K., Canu, W. H., Willcutt, E. G., & Hartung, C. M. (2021). Unique considerations in the assessment of ADHD in college students. Journal of Clinical and Experimental Neuropsychology, 43(4), 352–369. https://doi.org/10.1080/13803395.2021.1936462
Leventhal, H., Meyer, D., & Nerenz, D. R. (1980). The Common Sense Representation of Illness Danger. In S. Rachman (Ed.), Contributions to Medical Psychology (pp. 17–30). Pergamon Press.
Martel, M. M., Nigg, J. T., & Schimmack, U. (2017). Psychometrically informed approach to integration of multiple informant ratings in adult ADHD in a community-recruited sample. Assessment, 24(3), 279–289. https://doi.org/10.1177/1073191116646443
Martin, A. J. (2012). Attention-Deficit/Hyperactivity Disorder (ADHD), Perceived Competence, and Self-Worth: Evidence and Implications for Students and Practitioners. In D. Hollar (Ed.), Handbook of Children with Special Health Care Needs (pp. 47–72). Springer New York. https://doi.org/10.1007/978-1-4614-2335-5_3
Martin, A. J. (2020). Self-Worth Theory and Students with Attention-Deficit/Hyperactivity Disorder. In A. J. Martin, R. A. Sperling, & K. J. Newton (Eds.), Handbook of Educational Psychology and Students with Special Needs (1st ed., pp. 363–387). Routledge. https://doi.org/10.4324/9781315100654-18
Martin, A. J., & Marsh, H. W. (2003). Fear of failure: Friend or foe? Australian Psychologist, 38(1), 31–38. https://doi.org/10.1080/00050060310001706997
McClelland, D. C., & Mac Clelland, D. C. (1961). Achieving society (Vol. 92051). Simon and Schuster. https://doi.org/10.1037/14359-000
McCrea, S. M. (2008). Self-handicapping, excuse making, and counterfactual thinking: Consequences for self-esteem and future motivation. Journal of Personality and Social Psychology, 95(2), 274–292. https://doi.org/10.1037/0022-3514.95.2.274
McCrea, S. M., & Hirt, E. R. (2001). The Role of Ability Judgments in Self-Handicapping. Personality and Social Psychology Bulletin, 27(10), 1378–1389. https://doi.org/10.1177/01461672012710013
McQuade, J. D., Hoza, B., Murray-Close, D., Waschbusch, D. A., & Owens, J. S. (2011). Changes in self-perceptions in children with ADHD: A longitudinal study of depressive symptoms and attributional style. Behavior Therapy, 42(2), 170–182. https://doi.org/10.1016/j.beth.2010.05.003
Milich, R. (1994). The response of children with ADHD to failure: If at first you don’t succeed, do you try, try, again? School Psychology Review, 23(1), 11–28. https://doi.org/10.1080/02796015.1994.12085692
Mitchell, J. T., Benson, J. W., Knouse, L. E., Kimbrel, N. A., & Anastopoulos, A. D. (2013). Are Negative Automatic Thoughts Associated with ADHD in Adulthood? Cognitive Therapy and Research, 37(4), 851–859. https://doi.org/10.1007/s10608-013-9525-4
Newark, P. E., Elsässer, M., & Stieglitz, R.-D. (2016). Self-Esteem, Self-Efficacy, and Resources in Adults With ADHD. Journal of Attention Disorders, 20(3), 279–290. https://doi.org/10.1177/1087054712459561
Ohan, J. L., & Johnston, C. (2002). Are the Performance Overestimates Given by Boys With ADHD Self-Protective? Journal of Clinical Child & Adolescent Psychology, 31(2), 230–241. https://doi.org/10.1207/S15374424JCCP3102_08
Ohan, J. L., & Johnston, C. (2007). What is the Social Impact of ADHD in Girls? A Multi-Method Assessment. Journal of Abnormal Child Psychology, 35(2), 239–250. https://doi.org/10.1007/s10802-006-9076-1
Owens, J., & Hoza, B. (2003). Diagnostic utility of DSM-IV-TR symptoms in the prediction of DSM-IV-TR ADHD subtypes and ODD. Journal of Attention Disorders, 7(1), 11–27. https://doi.org/10.1177/108705470300700102
Owens, J. S., Goldfine, M. E., Evangelista, N. M., Hoza, B., & 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(4), 335–351. https://doi.org/10.1007/s10567-007-0027-3
Prevatt, F., Proctor, B., Baker, L., Garrett, L., & Yelland, S. (2011). Time Estimation Abilities of College Students With ADHD. Journal of Attention Disorders, 15(7), 531–538. https://doi.org/10.1177/1087054710370673
Prevatt, F., Proctor, B., Best, L., Baker, L., Van Walker, J., & Taylor, N. W. (2012). The Positive Illusory Bias: Does It Explain Self-Evaluations in College Students With ADHD? Journal of Attention Disorders, 16(3), 235–243. https://doi.org/10.1177/1087054710392538
Ramsay, J. R. (2020). Rethinking adult ADHD: Helping clients turn intentions into actions. American Psychological Association. https://doi.org/10.1037/0000158-000
Rhodewalt, F. (1990). Self-Handicappers. In R. L. Higgins, C. R. Snyder, & S. Berglas, Self-Handicapping (pp. 69–106). Springer US. https://doi.org/10.1007/978-1-4899-0861-2_3
Rhodewalt, F., Saltzman, A. T., & Wittmer, J. (1984). Self-handicapping among competitive athletes: The role of practice in self-esteem protection. Basic and Applied Social Psychology, 5(3), 197–209.
Sheeran, P., & Webb, T. L. (2016). The intention–behavior gap. Social and Personality Psychology Compass, 10(9), 503–518. https://doi.org/10.1111/spc3.12265
Sibley, M. H., Pelham, W. E., Jr., Molina, B. S., Gnagy, E. M., Waxmonsky, J. G., Waschbusch, D. A., & Kuriyan, A. B. (2012). When diagnosing ADHD in young adults emphasize informant reports, DSM items, and impairment. Journal of Consulting and Clinical Psychology, 80(6), 1052. https://doi.org/10.1037/a0029098
Sibley, M. H., Mitchell, J. T., & Becker, S. P. (2016). Method of adult diagnosis influences estimated persistence of childhood ADHD: A systematic review of longitudinal studies. The Lancet Psychiatry, 3(12), 1157–1165. https://doi.org/10.1016/S2215-0366(16)30190-0
Snyder, C. R., & Smith, T. W. (1982). Symptoms as self-handicapping strategies: The virtues of old wine in a new bottle. Integrations of Clinical and Social Psychology, 104, 104–127.
Sodano, S. M., Tamulonis, J. P., Fabiano, G. A., Caserta, A. M., Hulme, K. F., Hulme, K. L., Stephan, G. R., & Tronci, F. (2021). Interpersonal Problems of Young Adults With and Without Attention-Deficit/Hyperactivity Disorder. Journal of Attention Disorders, 25(4), 562–571. https://doi.org/10.1177/1087054718821728
Suhr, J., & Wei, C. (2013). Symptoms as an excuse: Attention deficit/hyperactivity disorder symptom reporting as an excuse for cognitive test performance in the context of evaluative threat. Journal of Social and Clinical Psychology, 32(7), 753. https://doi.org/10.1521/jscp.2013.32.7.753
Suhr, J., & Wei, C. (2017). Attention deficit/hyperactivity disorder as an illness identity. Neuropsychological evaluation of somatoform and other functional somatic conditions. New York, NY: Routledge.
Suyemoto, K. L., Erisman, S. M., Holowka, D. W., Fuchs, C., Barrett-Model, H., Ng, F., & Roemer, L. (2016). UMass Boston comprehensive demographic questionnaire, revised. Appendix in Wadsworth, LP, Morgan, LP, Hayes-Skelton, SA, Roemer, L., & Suyemoto, KL Ways to boost your research rigor through increasing your cultural competence. The Behavior Therapist, 39, 83–89.
Swanson, E. N., Owens, E. B., & Hinshaw, S. P. (2012). Is the positive illusory bias illusory? Examining discrepant self-perceptions of competence in girls with ADHD. Journal of Abnormal Child Psychology, 40(6), 987–998. https://doi.org/10.1007/s10802-012-9615-x
Thompson, T., & Richardson, A. (2001). Self-handicapping status, claimed self-handicaps and reduced practice effort following success and failure feedback. British Journal of Educational Psychology, 71(1), 151–170. https://doi.org/10.1348/000709901158442
Torrente, F., López, P., Alvarez Prado, D., Kichic, R., Cetkovich-Bakmas, M., Lischinsky, A., & Manes, F. (2014). Dysfunctional Cognitions and their Emotional, Behavioral, and Functional Correlates in Adults with Attention Deficit Hyperactivity Disorder (ADHD): Is the Cognitive-Behavioral Model Valid? Journal of Attention Disorders, 18(5), 412–424. https://doi.org/10.1177/1087054712443153
Tricco, A. C., Lillie, E., Zarin, W., O'Brien, K. K., Colquhoun, H., Levac, D., ... & Straus, S. E. (2018). PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Annals of Internal Medicine, 169(7), 467–473.
Urdan, T. (2004). Predictors of Academic Self-Handicapping and Achievement: Examining Achievement Goals, Classroom Goal Structures, and Culture. Journal of Educational Psychology, 96(2), 251–264. https://doi.org/10.1037/0022-0663.96.2.251
Volz-Sidiropoulou, E., Boecker, M., & Gauggel, S. (2016). The positive illusory bias in children and adolescents with ADHD: Further evidence. Journal of Attention Disorders, 20(2), 178–186. https://doi.org/10.1177/1087054713489849
Waschbusch, D. A., Craig, R., Pelham, W. E., & King, S. (2007). Self-Handicapping Prior to Academic-Oriented Tasks in Children with Attention Deficit/Hyperactivity Disorder (ADHD): Medication Effects and Comparisons with Controls. Journal of Abnormal Child Psychology, 35(2), 275–286. https://doi.org/10.1007/s10802-006-9085-0
Weiner, B. (1985). An attributional theory of achievement motivation and emotion. Psychological Review, 92(4), 548. https://doi.org/10.1007/978-1-4612-4948-1_6
Zuckerman, M., Kieffer, S. C., & Knee, C. R. (1998). Consequences of self-handicapping: Effects on coping, academic performance, and adjustment. Journal of Personality and Social Psychology, 74(6), 1619–1628. https://doi.org/10.1037/0022-3514.74.6.1619
Author information
Authors and Affiliations
Contributions
All authors contributed to the study conception and design. Material preparation, data collection (e.g., literature search), and data analyses were performed by Tamara M. Abu-Ramadan. Tamara M. Abu-Ramadan had the idea for this literature review. The first draft of the manuscript was written by Tamara M. Abu-Ramadan and all authors contributed to the writing, development, and critical revision of consecutive drafts. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of Interest
Tamara M. Abu-Ramadan, Elizabeth K. Lefler, Laura E. Knouse and Cynthia M. Hartung declare that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Abu-Ramadan, T.M., Lefler, E.K., Knouse, L.E. et al. Positive Illusory Bias and Self-Handicapping in Adults with ADHD: A Scoping Review of the Literature and Recommendations for Research and Clinical Practice. J Psychopathol Behav Assess 45, 917–936 (2023). https://doi.org/10.1007/s10862-023-10084-2
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10862-023-10084-2