VViirrggiinniiaa CCoommmmoonnwweeaalltthh UUnniivveerrssiittyy VVCCUU SScchhoollaarrss CCoommppaassss Theses and Dissertations Graduate School 2016 PPoossiittiivvee IIlllluussoorryy BBiiaass iinn AAddoolleesscceennttss wwiitthh AADDHHDD:: PPrreevvaalleennccee,, SSttaabbiilliittyy,, aanndd AAccccuurraaccyy ooff RReeppoorrtteerrss Elizaveta Bourchtein Virginia Commonwealth University Follow this and additional works at: https://scholarscompass.vcu.edu/etd Part of the Clinical Psychology Commons © The Author DDoowwnnllooaaddeedd ffrroomm https://scholarscompass.vcu.edu/etd/4122 This Thesis is brought to you for free and open access by the Graduate School at VCU Scholars Compass. It has been accepted for inclusion in Theses and Dissertations by an authorized administrator of VCU Scholars Compass. For more information, please contact [email protected]. © Elizaveta Bourchtein 2016 All Rights Reserved Positive Illusory Bias in Adolescents with ADHD: Prevalence, Stability, and Accuracy of Reporters A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science at Virginia Commonwealth University. By Elizaveta Bourchtein, Bachelor of Arts Wesleyan University, May 2010 Director: Joshua M. Langberg, Ph.D., Associate Professor, Department of Psychology Virginia Commonwealth University Richmond, VA April, 2016 Acknowledgement This research was funded by grant number R01 MH082865 awarded to Drs. Joshua Langberg and Steven W. Evans by the National Institute of Mental Health. I am grateful to my advisor, Dr. Joshua Langberg, for his constant encouragement, gentle guidance, and frequent reassurance throughout my thesis in particular and in my graduate career overall. His incredibly supportive mentorship style made this process enjoyable and rewarding, and I am thankful to have the opportunity to learn from his expertise. I also greatly appreciate the thoughtful feedback and assistance I received from Drs. Terri Sullivan and Kevin Sutherland, who were very helpful in allowing me to consider this project from multiple viewpoints. I would also like to acknowledge the guidance I received from Dr. Robert Perera, whose knowledge of the statistical techniques used in this thesis proved invaluable. Lastly, I am grateful to my labmates, friends, and family members – particularly my grandfather – for the ongoing support, helpful advice, and endless encouragement.   ii Table of Contents Acknowledgement ...........................................................................................................................ii List of Tables ...................................................................................................................................v List of Figures .................................................................................................................................vi Abstract ..........................................................................................................................................vii Overview ..........................................................................................................................................1 Introduction ......................................................................................................................................3 Impairment Across Development ........................................................................................3 Self-Perceptions of Functioning and Impairment ................................................................4 Outcomes Associated with a PIB in Youth with ADHD .....................................................5 Social functioning and aggression behaviors ...........................................................5 Risky behavior as an outcome of the PIB ................................................................6 Poorer treatment outcomes in children with a PIB ..................................................6 Theories Explaining Presence of the PIB ............................................................................7 Defining the PIB ..................................................................................................................8 Subtracting raw scores .............................................................................................8 Subtracting standardized scores ...............................................................................9 Additional Issues in Measurement of the PIB ...................................................................10 Assumption of third party raters’ accuracy ............................................................10 Potential for ceiling effect ......................................................................................12 Present Study and Aims .....................................................................................................13 Aim 1: Using latent profile analysis to define the PIB...................................................... 13 Hypothesis 1a .........................................................................................................14 Hypothesis 1b .........................................................................................................15 Aim 2: Assessing the stability of the PIB over time using latent transition analysis (LTA) approach compared to a traditional subtraction approach ........................15 Hypothesis 2 ...........................................................................................................16 Aim 3: Examine whether parent or adolescent reports are driving the PIB ......................16 Hypothesis 3 ...........................................................................................................16 Methods ..........................................................................................................................................16 Participants .........................................................................................................................16 Procedure ...........................................................................................................................18 Measures of Competence ...................................................................................................19 Self-Perception Profile for Children (SPPC) .........................................................19 Parent Rating Scale of Child’s Actual Behavior (PRS) .........................................19 Grades ....................................................................................................................20 Analytic Plan ..................................................................................................................................20 Aim 1 .................................................................................................................................20   iii Aim 2 .................................................................................................................................21 Aim 3 .................................................................................................................................21 Results ............................................................................................................................................23 Missing Data ......................................................................................................................23 Aim 1 .................................................................................................................................23 Optimal number of profiles ....................................................................................23 Theoretical conceptualization of profiles ...............................................................24 Proportion of sample in each profile ......................................................................25 Aim 2 .................................................................................................................................25 Optimal number of statuses ...................................................................................25 Theoretical conceptualization of statuses ..............................................................26 Proportion of sample in each status .......................................................................27 Stability of statuses over time ................................................................................27 Aim 3 .................................................................................................................................27 Discussion ......................................................................................................................................29 Prevalence of PIB ..............................................................................................................30 Associations with More Objective Indicators ....................................................................30 Measurement of PIB ..........................................................................................................31 Stability Across Time ........................................................................................................32 Limitations .........................................................................................................................33 Future Directions ...............................................................................................................33 Conclusions ........................................................................................................................34 References ......................................................................................................................................36 Vita .................................................................................................................................................42   iv List of Tables 1. Indices of Fit for Two- to Five-Profile Solutions at Baseline Using LPA .................................23 2. Means of Discrepancies of Each Domain of the SPPC/PRS Within Profiles Defined Using LPA at Baseline .......................................................................................................25 3. Indices of Fit for Two- to Five-Profile Solutions Using LTA ...................................................26 4. Scholastic Indicators and Comparison with GPA Across LPA-Defined Profiles at Baseline ............................................................................................................28   v List of Figures 1. Optimal Profile Solution at Baseline Using LPA ......................................................................24 2. Optimal Status Solution at Baseline Using LTA .......................................................................26   vi Abstract POSITIVE ILLUSORY BIAS IN ADOLESCENTS WITH ADHD: PREVALENCE, STABILITY, AND ACCURACY OF REPORTERS By Elizaveta Bourchtein, B.A. A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science at Virginia Commonwealth University. Virginia Commonwealth University, 2016 Major Director: Joshua Langberg, Ph.D., Associate Professor, Department of Psychology The positive illusory bias (PIB) – over-reporting levels of self-competence compared to other raters – has been demonstrated in youth with attention-deficit/hyperactivity disorder (ADHD), despite increased impairment rates. However, due to inconsistent definitions of the PIB, conflicting findings have emerged regarding prevalence of the PIB in youth with ADHD and whether parent or child report is actually “biased” and driving the PIB. Additionally, stability of the PIB across time is unknown. The present study used person-centered methodology cross- sectionally and longitudinally to evaluate the prevalence of the PIB in adolescents with ADHD. Results revealed a cross-domain global PIB group at baseline (18.4% of sample) but only a small social PIB group was present and stable across time. Parents in the PIB group were better reporters of scholastic competence relative to an objective measure than were youth. These findings suggest that the PIB may be significantly less prevalent in this population than previously thought. Overview Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects approximately 7% of school-aged children (Visser, Blumberg, Danielson, Bitsko, & Kogan, 2013) and is characterized by developmentally inappropriate levels of inattention and/or hyperactivity and impulsivity (American Psychiatric Association, 2013). Although children with ADHD typically experience clinically significant impairment across a variety of domains (Hinshaw, 2002), some exhibit inflated, positive self-perceptions of their behavior, a phenomenon referred to as a positive illusory bias (PIB). Specifically, despite experiencing repeated failures and underachievement, a subset of youth with ADHD rate themselves as significantly more competent in comparison to other raters (e.g., parents and teachers). In non- ADHD samples, the presence of a PIB may be adaptive, as it is linked to higher self-esteem (Gresham, Lane, MacMillan, Bocian, & Ward, 2000). In ADHD samples, however, a PIB may have potentially deleterious effects, including associations with poorer social skills, higher levels of aggression, and increased risky behavior in adolescence (e.g., Hoza, Murray-Close, Arnold, Hinshaw, Hechtman, & MTA Cooperative Group, 2010; Hoza et al., 2013). Given the negative outcomes associated with the PIB, intervention development has been proposed. Specifically, if youth with ADHD do not recognize their difficulties, it may be important to help them gain a more realistic appraisal of their functioning before they will be motivated to learn new skills or to change patterns of behavior (Owens, Goldfine, Evangelista, Hoza, & Kaiser, 2007). However,   1