differences and similarities in self-perceived competence,
depression, and anxiety symptoms
Imke Visser 1064550
In completion of the masterthesis ‘Forensische Orthopedagogiek’ Department of Child Development and Education (CDE)
Faculty of Social and Behavioural Sciences University of Amsterdam Supervisor: Drs. E. Kornelis
Internship at Onderzoeksgroep Forensische Geestelijke Gezondheidszorg, Eindhoven Supervisor: Dr. I.L. Bongers & Drs. E. Hofstra
1 Contents Abstract ... 2 Introduction ... 3 Methods... 8 Participants ... 8 Procedure ... 11 Measures ... 12
Anxiety and depression ... 12
Self-perceived competence ... 12
Analysis... 13
Results ... 15
Attrition analysis ... 15
Descriptive statistical analysis ... Error! Bookmark not defined. Anxiety and depression ... 17
Self-perceived competence ... 17
Anxiety and depression controlled by self-esteem ... 19
Discussion ... 19
Implications... Error! Bookmark not defined. Further research ... Error! Bookmark not defined. Limitations ... 24
Conclusion ... 25
Acknowledgement ... 26
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Abstract
The current study explores the differences and similarities in adolescents with ASD and adolescents with ADHD with regards to self-perceived competence and anxiety and depression symptoms. Data was gathered on patients admitted to De Catamaran, a hospital for youth forensic psychiatry and orthopsychiatry. A total of 99 young males are included in the dataset; 69 were classified with ASD and 30 were classified with ADHD. Anxiety and depression related symptoms were measured using the Dutch version of the Youth Self Report. perceived competence was measured using the Dutch version of the Self-Perception Profile for Adolescents, the ‘Competentie Belevingsschaal voor Adolescenten’. No difference was found in anxiety and depression symptoms between adolescents with ASD and adolescents with ADHD. An effect in self-perceived competence was found, wherein adolescents with ASD perceive themselves being less athletic than adolescents with ADHD. Bar this result, no differences among other domains of self-perceived competence were found between adolescents with ASD and adolescents with ADHD. In the self-perception of both groups there seem to be more similarities than differences. The results contribute to a better understanding of adolescents diagnosed with these mental disorders in both forensic as well as in orthopsychiatric settings.
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Introduction
Adolescents with either an Autism Spectrum Disorder (ASD) or an Attention Deficit Hyperactivity Disorder (ADHD) have a higher probability of long term health related risks, including high levels of anxiety (Rommelse et al., 2009; Sobanski, 2006; White, Oswald, Ollendick, & Scahill, 2009) and increased occurrence of depression (Biederman et al., 2006; Sobanski, 2006; Sterling, Dawson, Estes, & Greenson, 2008). Self-perceived competence plays an important role in the degree of experienced anxiety or depression (Sowislo & Orth, 2013; Trzesniewski et al., 2006). Whereas adolescents with ASD perceive themselves less competent compared to their neurotypical peers (Bauminger, Schulman, & Agam, 2004, Capps et al., 1995; Vickerstaff, Heriot, Wong, Lopes, & Dossetor, 2007), research on self-perception among adolescents with and without ADHD are less conclusive (Bagwell, Molina, Pelham, & Hoza, 2001; Bussing, Zima, & Perwien, 2000; Mikami & Hinshaw, 2006). Clinical treatment, therapy, or related interventions would benefit from a more nuanced understanding of how specifically ASD or ADHD may influence one’s self-perceived competence, and in turn how this is associated with the extent of experienced anxiety and depression.
Autism Spectrum Disorder1 is a neurodevelopmental disorder characterized by core deficits in three domains: social interaction, communication, and repetitive or stereotypical behavior (American Psychiatric Association, 2000). Adolescents with ASD have difficulties which manifest in both describing their own feelings and understanding others’ mental states (Fitzgerald & Molyneux, 2004; Moran et al., 2011). Furthermore, children with ASD have difficulties in shifting perspectives in order to judge what others might think (Baron-Cohen, Leslie, & Frith, 1985). The worldwide prevalence of ASD is consistently estimated to range between 0.6 and 0.7% of the general populace (Fombonne, 2009). The prevalence of ADHD
1 Autism Spectrum Disorder is an all-encompassing term, meaning Autism, Asperger Disorder and Pervasive
Developmental Disorder-Not Otherwise Specified (PDD-NOS) from here on will be referred with the generalizing term ‘ASD’
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is considerably higher, being estimated at 7.2% of the worldwide population (Thomas, Sanders, Doust, Beller, & Glasziou, 2015). Individuals with ADHD display high levels of activity, impulsivity, and inattention (American Psychiatric Association, 2000; Greenfield Spira & Fichel, 2005), through which they generally have poorer academic results than their neurotypical peers (Loe & Feldman, 2007), while also experiencing more difficulties on a social level (Huang-Pollock, Mikami, Pfiffner, & McBurnett, 2009; Van der Oord et al., 2005).
Higher rates of anxiety and depression are associated with both ASD and ADHD when being contrasted to their neurotypical peers (Gadow, Guttmann-Steinmetz, Rieffe, & De Vincent, 2012; Larson, Russ, Kahn, & Halfon, 2011; Mayes, Calhoun, Murray, Ahuja, & Smith, 2011). Individuals with ASD show symptoms related to general anxiety (Russell & Sofronoff, 2005; Sterling et al., 2008), social phobia (Kuusikko et al., 2008; Russell & Sofronoff, 2005), obsessions and compulsions (Cath, Ran, Smit, Van Balkom, & Comijs, 2008; Russell & Sofronoff, 2005; Sterling et al., 2008; Zandt, Prior, and Kyrios, 2007). High levels of anxiety related symptoms are more likely to occur in depressed individuals with ASD than in non-depressed individuals with ASD (Sterling et al., 2008). It is difficult to observe depression in adolescents with ASD; common symptoms of depression, such as lack of affection through emotional expression and a monotone manner of speech, are already masked because these very same symptoms are already pre-existing symptoms of autism (Stewart, Barnard, Pearson, Hasan, & O’Brien, 2006). Turning to ADHD, this developmental disorder is frequently associated with one or more comorbid disorders (Rommelse et al., 2009). Ranging from 13% to 51%, patients with ADHD suffer from internalizing disorders, such as anxiety and depression (Rommelse et al., 2009). When ADHD and depression act in accordance, more significant impairments are observed than either disorder individually could engender (Daviss, 2008). Despite this outcome, Lawson and colleagues (2015) found
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no different levels of parent-rates anxiety and depression symptoms in adolescents with ASD and adolescents with ADHD. Van Steensel, Bӧgels and De Bruin (2012) came to a different conclusion, in which they state that more comorbid internalizing disorders in children with ASD were found compared to children with ADHD. However, while children with ASD had higher rates of anxiety disorders, no higher rates in comorbid mood disorders were found (Mayes et al., 2011; Van Steensel et al., 2012). Gadow and colleagues (2012) found that mothers reported their children with ASD as more depressed and less confident than the mothers with children with ADHD. Additionally, teachers reported children with ASD being lower in (physical) energy and showing less interest than children with ADHD. In light of the above described literature, it is clear adolescents with ASD and adolescents with ADHD are more prone to experience symptoms regarding anxiety and depression. Though results from studies so far remain a long shot from being conclusive, adolescents with ASD do seem to experience these anxiety and depression related symptoms in a slightly higher frequency than their ADHD counterparts.
Remarkably, when accounting for these observed (high) rates of anxiety and depression in individuals with either ASD or ADHD, very little is actually known regarding possible cognitive mechanisms underlying long-term health related risks. Perhaps low-self-esteem is to be considered as a viable explanation; low self-low-self-esteem and depression are well known related phenomena that frequently appear in conjunction within individuals (Burwell & Shirk, 2006; Orth, Robins, Trzesniewski, Maes & Schmitt, 2009). Besides a relationship between low self-esteem and depression, Sowislo and Orth’s (2013) findings indicate a small but nonetheless significant relation between low self-esteem and anxiety. Thus, while anxiety and depression are in general frequently observed for both people with ASD and people with ADHD, differences in intensity of both depression and anxiety between both groups should be remarked upon as well. Which anxiety and depression related symptoms present
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themselves in individuals with ASD largely depends on the individual possessing a low- or high functioning2 form of autism (Sterling et al., 2008; Vickerstaff et al., 2007). With high functioning ASD adolescents having a higher risk of depressive symptoms than adolescents with ADHD, it can be argued that low self-esteem plays a different, if not bigger part for these specific individuals.
Adolescents with ASD perceive themselves to be overall less competent than their neurotypical peers (Bauminger et al., 2004, Capps et al., 1995). Perceived social competence is at its lowest among high functioning adolescents with ASD (Capps et al., 1995; Vickerstaff et al., 2007). This would suggest high functioning children with ASD are more accurately aware of their own shortcomings, if not downright capable of being more accurate in their self-awareness overall. It is likely their high intelligence enables them to have greater access to their own and other’s emotional experiences by way of reasoning (Losh & Capps, 2006). During high school interaction with peers becomes more complex and demanding on a person with ASD (Tantam, 2003). Although some people with ASD prefer isolation or at least very limited social contact, many young people with autism are conscious of their troubles/shortcomings in social situations (Attwood, 2000). Adolescents with ASD report more feelings of loneliness in contrast to their neurotypical peers (Bauminger & Kasari, 2000; White & Roberson-Nay, 2009). Loneliness is associated with low self-esteem, higher levels of anxiety and eventually depression (Heinrich & Gullone, 2006). A greater social- and self-awareness combined with a heightened interest in social relationships makes high functioning adolescents with ASD especially vulnerable to depression rather than the lower functioning adolescents with ASD (Lopata et al., 2010; Solomon, Goodlin-Jones, Anders, 2004).
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In this context high functioning means the absence of any intellectual disorder and a linguistic competence similar to their peers (Van Elst, Pick, Biscaldi, Fangmeier and Riedel, 2013).
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Whereas adolescents with ASD seem to perceive themselves overall as less competent than their neurotypical peers, this same relation is not found as clear cut among adolescents diagnosed with ADHD. Much still remains unclear about self-perception(s) and related processes in adolescents with ADHD, which very well might be (partially) due to the nature of this cognitive disorder. ADHD itself can be seen as an impairment spanning and affecting multiple domains of everyday life, due the higher levels of (physical) activity, impulsivity, and inattentiveness in those afflicted by ADHD. This impairment in multiple domains generally result in poorer academic outcomes and difficulties when engaging other people on a social level (e.g. Sjöwall, Roth, Lindqvist, & Thorell, 2013; Willcutt et al., 2012). At first glance, it could then be anticipated for adolescents with ADHD to perceive themselves as overall less competent as their neurotypical peers (Mikami & Hinshaw, 2006; Shaw-Zirt, Popali-Lehane, & Bergman, 2005). However, research thus far centering on self-perception(s) among adolescents with externalizing disorders like ADHD are far from conclusive (Locke, 2009; Sandstrom & Jordan, 2008). Multiple researchers have reported on observing no significant difference in the self-perception(s) of those with ADHD compared to their neurotypical peers (see for example Bagwell, Molina, Pelham, & Hoza; 2001; Bussing, Zima, & Perwien, 2000; Van Damme & Vanderplasschen, 2014). Moreover, when self-perception(s) of adolescents with and without ADHD are matched and measured to actual performance, results have shown adolescents with ADHD tend to overestimate their own performance and competence more frequently than those without ADHD. This is also referred to as the ‘positive illusory bias’ (Hoza et al., 2004; Mikami, Calhoun, & Abikoff, 2010). An overly positive self-perception in children with ADHD may very well function in not only protecting their self-esteem, but also assisting them in coping with (prior) experienced failures across the aforementioned multiple domains of everyday life, which consequently results in lower levels of anxiety and depression (Owens, Goldfine, Evangelista,
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Hoza, & Kaiser, 2007). If anything, the ‘positive illusory bias’ illustrates the need for a higher awareness in contemporary clinical practice of adolescents with ADHD overestimating their performances, and as such take this process into account when engaging with them in a forensic or clinical setting. This need becomes all the more pressing when we stop and consider how this ‘positive illusory bias’ is at one hand associated with a decrease of depression related symptoms, but on the other hand also responsible for the engendering and increase of overall aggression (Hoza, Murray-Close, Arnold, & Hinshaw, 2010). An interesting inverted parallel may be found in the adolescents with ASD, who – at least when high functioning – generally possess a more ‘accurate’, if not downright negative self-perception (Lopata et al., 2010; Solomon, Goodlin-Jones, Anders, 2004).
The aim of this current study is to investigate whether adolescents with ASD perceive themselves differently than adolescents with ADHD do in a forensic psychiatry and orthopsychiatric sample. Consecutively, it seems that self-perceived competence in adolescents with ASD is related in a different way to anxiety or depression than adolescent diagnosed with ADHD. The first hypothesis of this study is the assumption adolescents with ASD have higher levels of self-reported anxiety and depression than adolescents with ADHD. The second hypothesis is that in general adolescents with ASD perceive themselves as less competent than adolescents with ADHD. The third is that differences in anxiety and depression symptoms between adolescents with ASD and adolescents with ADHD are related to differences in self-esteem.
Methods
Participants
Data was gathered on patients admitted to ‘De Catamaran’, a hospital for youth forensic psychiatry and orthopsychiatry. ‘De Catamaran’ is part of the GGZ Eindhoven, located in the Netherlands. This hospital offers both psychological and psychiatric assessments and
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treatment to adolescents between the ages of 14 to 23 years. These adolescents have been into contact with the criminal justice system and/or pose a risk to themselves or others throughout their behavior. Adolescents admitted in the period from January 2005 to December 2014, with a minimal stay of three months, were included in the sample. The hospital has admitted mainly male adolescents; therefore only male patients were included in the sample.
Of the in total 205 eligible patients 106 patients were excluded. Exclusion criteria were based on the psychiatric background of the persons in question. The psychiatric background was retrieved from the most recent assessment available, as described in the first treatment plan. Excluded patients from this study either had comorbid ASD and ADHD (i.e. a classification with both ASD and ADHD), or a complete absence of an ASD or ADHD classification and were thus excluded.
After exclusion the sample was comprised of 99 young males: 69 were classified with ASD (including: Autism, Asperger Disorder and PDD-NOS), with the remaining 30 being classified with ADHD; presence of comorbid disorders other than ASD or ADHD were allowed. Most common comorbid disorders, according to the Axis-I classification of the DSM-IV, were disruptive behavior disorders (41.4%), substance disorders (23.2%) and reactive attachment disorders (11.1%). The age at admission ranged between 14 to 22 years (M = 16.91, SD = 1.89). Fifty-one patients were sentenced under Dutch juvenile criminal law (51.5%), forty-one patients were sentenced under the Dutch juvenile civil law (41.4%) and seven patients were admitted on voluntary basis (7.1%). The three most common convicted offences were moderate violent offences (52.5%), property offences without violence (39.4%), and vandalism (28.3%). Only sixteen patients had no prior conviction whatsoever (18.1%). The most recent IQ scores ranged from 73 to 127 (M = 94.89; SD = 12.96). For sixteen patients IQ scores could not be retrieved or found. A more detailed summary of patients’ characteristics are displayed in Table 1 and Table 2.
10 Table 1 Patients’ descriptive Selected sample (n = 99) Excluded sample (n = 106) M SD Range M SD Range
Age at admission in years 16.91 1.89 14-22 16.90 1.90 14-23
Intelligence (IQ)a 94.89 12.96 73-127 94.40 10.96 66-126
Note: a In the selected sample IQ scores could not be traced for sixteen patients; three patients were never tested and for thirteen patients IQ
scores were unknown. In the excluded sample seventeen patients could not been traced; nine patients never had an IQ test and from eight patients the IQ scores were unknown.
Table 2
Detailed patients’ characteristics
Selected sample (n = 99) Excluded sample (n = 106) n % n % Judicial measure Criminal law 51 51.5 46 43.4 Civil law 41 41.4 50 47.2 Voluntary 7 7.1 10 9.4
Previous delinquent behaviora
No conviction 18 18.1 26 24.5
Misdemeanor 24 24.2 26 24.5
Drug offence 7 7.1 3 2.8
Vandalism (property) 28 28.3 34 32.1
Property offence without violence
39 39.4 51 48.1
Moderate violent offence 52 52.5 53 50.0
Violent property offence 19 19.2 20 18.9
Serious violent offence 10 10.1 9 8.5
Sex offence 13 13.1 14 13.2
Manslaughter 4 4.0 4 3.8
Murder 2 2.0 3 2.8
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Procedure
Research data were obtained from a Routine Outcome Monitoring (ROM) database containing YSR (Youth Self Report) questionnaires and the Dutch version of the SPPA (Self-Perception Profile for Adolescents), the latter more specifically being the CBSA (Competentie Belevingsschaal voor Adolescenten) questionnaires. The ROM-procedure started from January 2005. While the procedure itself is continuous, obtained data for this study consists of data recorded from January 2005 until December 2014. These questionnaires were used in monitoring patients and the overall progress of their treatment during their admittance at ‘De Catamaran’, with both questionnaires being re-taken at intervals of six months subsequently.
Prior to December 2012 verbal and written explanation of the ROM was given to patients and they had to provide written informed consent. The signed informed consent gave permission to use specific data for research purposes under the condition that anonymity was ensured by way of coded data. Patients were at all times free to stop or withdraw from the study. After granting permission, subsequent data was acquired via paper and pencil questionnaires which themselves had been conducted in person by research assistants. Duration of each questionnaire was approximately 15 to 20 minutes. Starting from December 2012 and onward, the ROM-measurement became an integral part of the treatment and informed consent was acquired passively: consent to the use of data for research ends was included with the signing of the agreement of treatment. The YSR questionnaires were filled out digitally, with the CBSA still consisting of a paper and pencil version.
For the purpose of this study, only data from the first measurement within six months after admittance have been selected from the ROM database. However, since the adolescents were free to refuse cooperation at any time, some missing values on either the YSR or the CBSA could not be avoided. Two adolescents refused to complete the CBSA questionnaire,
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but did complete the YSR questionnaire; three adolescents refused to complete the YSR questionnaire but did complete the CBSA. There were 25 adolescents who completed the ASR (Adult Self Report) instead of the YSR. Because some variety in questioned items is observed between the ASR and YSR, the ASR questionnaires have not been included in this study.
Measures
Anxiety and depression
Anxiety and depression related symptoms were measured using the Dutch version of the Youth Self Report (YSR; Verhulst, Van der Ende, & Koot, 1997). The YSR is a self-report questionnaire intended to be filled in by adolescents ranging from 11 to 18 years. At ‘De Catamaran’ the YSR was also filled in by adolescents above 18 years old as well, because ‘De Catamaran’ treats youth and adolescents up to 23 years old in a youth setting. The YSR contains 112 items about behavioral or emotional problems that have occurred during the past six months. The used scoring format is based on a three-point Likert scale: 0 = not true, 1 = somewhat or sometimes true, and 2 = very true or often true. The YSR consists of the following eight narrow-band scales: withdrawn, somatic complaints, anxious/depressed, social problems, thought problems, attention problems, delinquent behavior, and aggressive behavior. Only the scales withdrawn and anxious/depressed were used for this study. The reliability and validity of the YSR have both been proven for the Dutch versions (Verhulst et al., 1997). The internal consistency of the scale anxious/depressed (α = .85) and withdrawn (α = .75) for this specific sample is considered as being good.
Self-perceived competence
Self-perceived competence was measured using the Dutch version of the Self-Perception Profile for Adolescents (SPPA; Harter, 1988), ‘Competentie Belevingsschaal voor Adolescenten’(CBSA; Treffers et al., 2002). The CBSA is a self-report questionnaire
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intended to be filled in by adolescents ranging from 11 to 18 years. At ‘De Catamaran’ the CBSA was also filled in by adolescents above 18 years old. The 35 CBSA items are divided in seven subscales (including six domain-specific sense of competence and global self-worth), with each subscale then consisting of five items. Although these six specific domains all affect the global self-worth, it is important here to distinguish between the self-evaluations which represent the overall evaluations of one’s considered worth as a person (global self-worth) and those which reflect the individual’s sense of adequacy across specific domains (Harter, 2003). This multidimensional perspective is particularly important in assessing adolescents, where various domains related to global self-worth increase on a different basis (Harter, 2003). Questions are phrased as following: ‘Some adolescents do / are / feel [X] ‘and ‘Other adolescents do / are / do not feel [X]”. To complete the questionnaire, participants responding to each item engage in a two-step process. First, the adolescent indicate which chosen statement they associate themselves as being most like/they can relate to the most. Secondly, they decide whether the chosen statement is ‘really like me’ or ‘sort of like me’. Items are scored on four-point rating scale, through which high scores reflect greater self-perceived competence. The seven subscales are scholastic competence (α = .58); social acceptance (α = .77); athletic competence (α = .82); physical appearance (α = .83); close friendships (α = .77); behavioral conduct (α = .84); and global self-worth (α = .81). The reliability and validity of the CBSA as noted has been proven for the Dutch versions (Treffers et al., 2002). The internal consistency of the subscales overall in this sample is good, with the subscale scholastic competence forming an exception. Due to the low internal consistency scholastic competence has been excluded from further analyses.
Analysis
All analyses were performed using Statistical Package for the Social Sciences (SPSS) 19.0. The attrition analysis is computed with a t-test (for continuous variables) and Chi-square-tests
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(for categorical variables) to map the differences in background characteristics, subscales from the CBSA and the subscales anxious/depressed and withdrawn from the YSR. This was performed over the selected sample and the excluded sample. For this analysis any known previous delinquent behavior was corrected with the Yates Continuity correction because of the overestimation of the Chi-square value when a two-by-two table is used. Factors which have violated the Chi-square assumption concerning the minimum expected cell frequency, which in general should be five or bigger, were computed with the Fisher’s Exact Test.
Descriptive statistical analyses were computed separately for adolescents with ASD and adolescents with ADHD. This analysis will include the means, standard deviations, frequency counts and percentages of the variables in the sample. To examine to what extent adolescents with ASD differ from adolescents with ADHD, Chi-square analyses for the categorical outcome variables (Judicial measure; previous delinquent behavior; Psychiatric comorbidity) and t-tests for the continuous variables (age at admission, IQ score) were applied. Factors which violated the Chi-square assumption concerning the minimum expected cell frequency were therefore computed with the Fisher’s Exact Test. The Yates Continuity correction is used for a two-by-two table (previous delinquent behavior; Psychiatric comorbidity).
Using one-way ANOVAs the mean differences between adolescents with ASD and adolescents with ADHD on the subscale scores withdrawn and anxious/depressed from the YSR and the six subscale scores from the CBSA were tested. The ANOVAs are controlled by the Welch’s F, due to the unequal sample size. Distributions will be reviewed to evaluate underlying statistical assumption of normality and checking for outliers. When distributions appear to be non-normal, the non-parametric Mann-Whitney U test will be conducted as well.
Computing an ANCOVA mean differences in scores between adolescents with ASD and adolescents with ADHD on the subscales withdrawn and anxious/depressed will be
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controlled by the covariate global self-worth. The assumption of homogeneity of regression was checked by first looking for an interaction effect between the group variable and the covariate global self-worth. When there is no significant interaction, the assumption of homogeneity of regression has not been violated. The assumption of a linear relationship between the covariate global self-worth and the dependent variable withdrawn and anxious/depressed was checked by inspecting a scatterplot. The slopes of the regression should be roughly parallel.
Results Attrition analysis
To test whether the selected sample (i.e. adolescents with ASD or ADHD) deviates from the excluded sample, independent-samples t-tests and chi-square tests for independence were conducted. No significant differences were found between the selected sample and excluded sample on age at admission, IQ, judicial measure, and previous delinquent behavior. Additionally, the samples were the same on the anxious / depressed scale, (t(203) = .211, p = .883), and also on the scale of withdrawn, (t(203) = .200, p = .842). Results showcased only one significant difference, being on ‘social acceptance’ between the selected sample and the excluded sample, (t(200) = -2.508, p < .05). The magnitude of differences in the mean (mean difference = -.15, 95% CI: -2.06 to -.25) was small (eta squared = .031).
Characteristics of patients
To test whether adolescents with ASD and adolescents with ADHD were different in patients’ characteristics, independent-samples t-tests and chi-square tests for independence were conducted. Patients with either ASD or ADHD did not differ significantly in age at admission, IQ, and judicial measure. Results did show a significant difference in previous delinquent behavior. A chi-square test for independence indicated adolescents with ASD being significant less frequently convicted for a drug offence than adolescents with ADHD
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(X2(1) = 6.032, p < .05 ). Furthermore, adolescents with ASD did differ from adolescents with ADHD in psychiatric comorbidity. Adolescents with ASD were significantly less classified with a disruptive behavior disorder (X2(1) = 7.277, p <.01) and reactive attachment disorder (X2(1) = 6.510, p < .05) than adolescents with ADHD. Patients’ characteristics are displayed in Table 3 and Table 4.
Table 3
Descriptives of patients with ASD and patients with ADHD
ASD (n = 69)
ADHD (n = 30)
M SD Range M SD Range
Age at admission in years 17.04 1.85 14-22 16.60 1.98 14-22
Intelligence (IQ)a 96.26 13.50 73-123 91.88 11.36 78-127
Note: a In patients with ASD IQ scores could not be traced for twelve patients; three patients were never tested and for nine patients IQ
scores were unknown. In patients with ADHD four patients could not been traced; IQ scores for these four patients were unknown.
Table 4
Characteristics from patients with ASD and patients with ADHD
ASD (n = 69) ADHD (n = 30) n % n % Judicial measure Criminal law 37 53.6 14 46.7 Civil law 27 39.1 14 46.7 Voluntary 5 7.3 2 6.7
Previous delinquent behaviora
No conviction 12 17.4 6 20.0
Misdemeanor 15 21.7 9 30.0
Drug offence 2 2.9* 5 16.7*
Vandalism (property) 19 27.5 9 30.0
Property offence 26 37.7 13 43.3
Moderate violent offence 37 53.6 15 50.0
Violent property offence 11 15.9 8 26.7
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Sex offence 9 13.0 4 13.3
Manslaughter 2 2.9 2 6.7
Murder 2 2.9 0 0
Psychiatric comorbidityb
Axis-I classification of DSM-IVc
Disruptive behavior disorder 22 31.9** 19 63.3**
Substance disorder 12 17.4 11 36.7
Reactive attachment disorder 4 5.9* 7 23.3*
Other disordersd 16 23.2 10 33.3
Note: aClassification of Van Kordelaar (2002) as used in Mulder ea (2012) bOnly DSM-IV classifications with a prevalence of >10% are
displayed. cDue to comorbidity, percentages of DSM-IV Axis-1 classifications do not sum up to 100. dOther disorders are schizophrenia or
other psychotic disorders, other disorders usually first diagnosed in infancy, childhood, of adolescence, mood disorders, anxiety disorders, sexual and gender identity disorders, cognitive disorders, impulse-control disorders not elsewhere classified and adjustment disorders. * significant level p <.05 ** significant level p <.01
Anxiety and depression
No outliers were found, but after a visual inspection both subscale scores were positively skewed. The scale scores anxious/depressed, D(83) = ,189, p < .001, and withdrawn, D(83) = ,137, p = .001, were both significantly non-normal. Therefore the non-parametric Mann-Whitney U test was conducted instead of a one-way ANOVA between groups. There was no difference in levels of anxiety/depression between adolescents with ASD (Mdn = 43.70) or adolescents with ADHD (Mdn = 41.50) found, U = 742.50, z = -.385, p = .700. In addition no differences in levels of withdrawn between adolescents with ASD (Mdn = 44.65) or adolescents with ADHD (Mdn = 39.46) were found, U = 687.50, z = -.907, p = .364.
Table 5
Mann-Whitney U test subscale scores anxious/depressed and withdrawn
YSR scale ASD ADHD U z p
Mdn Mdn
Anxiety/Depression 43.70 41.50 742.50 -.385 .700
Withdrawn 44.65 39.46 687.50 -.907 .364
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A one-way ANOVA between groups was conducted to explore differences in subscale scores, which consisted of social acceptance, athletic competence, physical appearance, behavioral conduct, close friendships, and global self-worth between adolescents with ASD and adolescents with ADHD. Despite adolescents with ASD (M = 13.89, SD = 3.45) perceiving themselves less socially accepted compared to adolescents with ADHD (M = 15.10, SD = 2.95), this difference was not significant (F (1, 64.638) = 2.75, p = .083). There was a significant difference in scores for adolescents with ASD (M = 13.45, SD = 3.93) and adolescents with ADHD (M = 15.23, SD = 3.51) on the subscale ‘athletic competence’ (F (1¸ 62.067) = 4.56, p < .05). However, the actual difference between groups was quite small (r2 = .22). Results are displayed in detail in Table 6. Before the one-way cross group analysis of variance was conducted, distributions were reviewed to evaluate underlying statistical assumption of normality and checking for outliers. No outliers were found, but in follow-up from a visual inspection all six subscale scores from the CBSA were non-normal. Adding to this, the Kolmogorov-Smirnov score for self-perceived athletic competence was significantally different from a normal distribution. Consequently, the non-parametric Mann-Whitney test was conducted. This Mann-Mann-Whitney test confirmed a significant difference in self-perceived athletic competence between adolescents with ASD (Mdn = 45.02) and adolescents with ADHD (Mdn = 57.88), U = 738.50, z = -2.089, p < .05, r = .21.
Table 6
ANOVA subscale scores CSBA
CBSA scale ASD ADHD F p
M (SD) M (SD) Social acceptance 13.89 (3.45) 15.10 (2.95) 2.75 .083 Athletic competence 13.45 (3.93) 15.23 (3.51) 4.56 .029* Physical appearance 14.79 (4.13) 15.57 (3.36) .81 .332 Behavioral conduct 12.70 (3.76) 11.67 (3.81) 1.56 .220 Close friendships 16.11 (3.53) 15. 83 (2.87) .15 .674 Global self-worth 14.08 (4.09) 14.63 (3.62) .39 .514
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Anxiety and depression controlled by self-esteem
Initially the mean differences in scores between adolescents with ASD and adolescents with ADHD on the subscales withdrawn and anxious/depressed were to be controlled by the covariate global self-worth by computing an ANCOVA. However, results from the preceding analysis made using global self-worth in this manner contribute nothing of any value to the findings, as depression and anxiety were observed to show no significant difference for the adolescents with ASD, and for the adolescents with ADHD as well.
Discussion
The aim of this study was to examine whether adolescents with ASD and adolescents with ADHD perceived themselves differently in a forensic psychiatry and orthopsychiatry sample. An effect in self-perceived competence was found, wherein adolescents with ASD perceived themselves as less athletic than adolescents with ADHD. Barring this result, no differences in other domains of self-perceived competence were found between adolescents with ASD and adolescents with ADHD. Subsequently, no differences in anxiety/depression and in withdrawn between adolescents with ASD and adolescents with ADHD were found. There was thus no need to examine if differences in anxiety and depression symptoms between adolescents with ASD and adolescents with ADHD were related to differences in self-esteem, because there were no significant differences to speak of.
In contrast to prior research (e.g. Gadow et al., 2012; Mayes et al., 2011; Van Steensel et al., 2012), results of this current study mirror those of Lawson and colleagues (2015), who found no different levels of parent-rated anxiety and depression symptoms in adolescents with ASD and adolescents with ADHD. The lack of differences in anxiety and depression symptoms in adolescents with ASD and adolescents with ADHD in this current study, alongside the study of Lawson and colleagues (2015), may perhaps be partially indebted to
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the fact that these symptoms were measured together as single construct, rather than two separate and individual phenomena. Despite there being a high overlap among anxiety and depression symptoms (Brozina and Abela 2006; Kazdin 2005; Laurent and Ettelson 2001; Stark & Laurent, 2001), evidence is found for a two-factor model (Anderson & Hope, 2008; De Bolle & De Fruyt, 2010). Whereas depression and anxiety are characterized by negative affect, only depression is characterized by a low positive affect. Moreover, anxiety but not depression is characterized by physiological hyperarousal (Anderson & Hope, 2008; De Bolle & De Fruyt, 2010; Clark & Watson, 1991). Thus, while it seems likely adolescents with ASD and adolescents with ADHD do not differ in depression and anxiety related symptoms, in this current study this result is likely more due the lack of a clear distinction between anxiety and depression symptoms. Indeed, Mayes and colleagues (2011) found adolescents with ASD actually do seem to experience more anxiety related symptoms than adolescents with ADHD, but in fact do not differ in depression symptoms. Given this, the need to consider anxiety and depression as separate categories when dealing with the emotional states of either ASD or ADHD adolescents becomes apparent.
Focusing on the differences in self-perception between adolescents with ASD and adolescents with ADHD, the main finding of this current study suggests how adolescents with ASD do perceive themselves as less athletically capable when compared to adolescents with ADHD. This is in line with the study of Bauminger and colleagues (2004), who found a similar result when adolescents with ASD were compared to their neurotypical peers. Athletic competence is probably more noticeable for adolescents with ASD, because they’re not only (generally) more clumsy, but at the same time exhibit stereotype and repetitive motoric mannerisms and impairments (Piek & Dyck, 2004; Siaperas, et al., 2012). On top of this people with ASD also need to cope with the social rules which form an integral part of sport/team related physical activities (Miltenberger & Charlop, 2014). Children with ASD
21
seem to lack the confidence to participate in such athletic activities (Orsmond, Shattuck, Cooper, Sterzing, & Anderson, 2013) and don’t describe themselves as being ‘sporty’ (Lee & Hobson, 1998). On the other hand, adolescents with ADHD will declare themselves as being rather sporty, as their high levels of activity (Greenfield Spira & Fichel, 2005) and their tendency to overestimate their own performance generally likely enables them to engage in such activities much quicker and easier (Hoza et al., 2004; Mikami et al., 2010).
Focusing on the overlap in self-perception between adolescents with ASD and adolescents with ADHD, the current study did not find significant differences in self-perceived social acceptance, physical appearance, behavioral conduct, close friendships, and global self-worth. Possible reasons for this may very well be the forensic and orthopsychiatric setting where this study took place. Brown and Ireland (2006) found how in the first six weeks of admittance incarcerated male adolescents move away from emotion coping (e.g. ‘feeling worthless and unimportant’) towards the direction of detachment (e.g. ‘just taking nothing personally’). Results of Ireland, Boustead and Ireland (2005) indicate a high use of detachment coping in young and juvenile offenders as well. Possibly through these detached coping styles, adolescents with ASD inch more towards how adolescents with ADHD (or possibly vice versa) perceive themselves when specifically questioned on this during their stay in a secure residential care. In addition, other risk factors might influence levels of self-esteem forensic and orthopsychiatric setting, such as an increasing risk of experiencing victimization (Ireland, 2005).
While the above would suggest adolescents with ASD and adolescents with ADHD tend to express a similar if not equal response when confronted with their self-perception by dealing with a strict orthopsychiatric setting, this observation on itself does not serve as a satisfactory and/or reliable explanation why two separate DSM-classified developmental disorders seemingly overlap. Indeed, contrary to what one might expect when dealing with
22
what officially are to be considered two separate developmental disorders, results from this study might (partially) confirm adolescents with ASD and adolescents with ADHD perceiving themselves in a more identical manner, rather than a strict different one. While the context of a forensic and orthopsychiatric setting may serve as a promising explanation for why adolescents diagnosed with different developmental disorders display an almost entirely equal self-perception, another direction could also be considered. The identical manner of self-perception in ASD or ADHD adolescents is consistent with recent research which observe children diagnosed with ADHD showing symptoms related to ASD, as well as the other way around (Holtman, Bӧlte, & Pousta, 2007; Ronald, Larsson, Anckarsäter, & Lichtenstein, 2009; Yoshida & Uchiyama, 2004). Furthermore, an increasing body of research documents various shared characteristics and even overlap between individuals with ASD or ADHD when looking at not merely genetically based factors, but also at cognitive functions and capability (Corbett, Constantine, Hendren, Rocke, & Ozonoff, 2009; Rich, Loo, Yang, Dang, & Smalley, 2009; Rommelse, Franke, Geurts, Hartman, & Buitelaar, 2010). Indeed, when considering the current debate regarding either differences or overlapping between ASD or ADHD in the current field of orthopsychiatric research, this study seems to provide support that adolescents with ASD and adolescents with ADHD aren’t mutually exclusive groups when the manner how they perceive themselves is considered.
Implications
Despite no significant differences in self-perceived social competence between adolescents with ASD and adolescents with ADHD, results show a trend of adolescents with ASD perceiving themselves as less social when compared to adolescents with ADHD. A possible explanation may lie in the fact how social impairment is considered a key symptom of ASD (American Psychiatric Association, 2000), but when the fact adolescents with ADHD also suffer from problems in the social domain is considered, this could very well point towards a
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need to reconsider the manner in which social impairment is defined (Cervantes et al., 2013; Rich et al., 2009). As it stands, both adolescents with ASD and adolescents with ADHD seems each forced to cope and deal with social rejection from peers, albeit in a slightly different manner (Mrug et al., 2009; Symes & Humphrey, 2010). In line with this, results indicate that the selected group scored significant lower on self-perceived social competence than the other adolescents in the forensic and orthopsychiatric setting. Improving (self-perceived) social competence might be an important part in the treatment of adolescents with ADHD, but more so for adolescents with ASD.
Further research
Further research needs to consider anxiety and depression as separate categories when dealing with the emotional states of both ASD adolescents as well as ADHD adolescents. In comparison with adolescents with ADHD, adolescents with ASD seem to experience more anxiety related symptoms than depressive related symptoms (Mayes et al., 2011). Anxiety, but not depression, is linked to physiological hyperarousal (Anderson & Hope, 2008; De Bolle & De Fruyt, 2010; Clark & Watson, 1991). In turn, physiological hyperarousal is associated with individuals with ASD (McDonnell, McCreadie, Richard, Roy, & Judy, 2015). Perhaps it is thus important to make a clear distinction between anxiety and depression when comparing and contrasting adolescents with ASD to adolescents with ADHD. Due to a lack of distinction in this current study between anxiety and depression symptoms, further research is needed in order to credibly establish or at least determine if and how adolescents with ASD are more anxious than adolescents with ADHD.
In this study a clear distinction in self-perceived competence between adolescents with ASD and adolescents with ADHD was failed to have been observed or found. This may have to do with the forensic psychiatric and orthopsychiatric context which engenders a more uniform coping method for admitted youth in general. Adapting a more detached coping style
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seems to decrease both anxiety and depression and might as such be helpful when dealing with an incarcerated context (Brown and Ierland, 2006). Consequently, whereas high functioning adolescents with ASD in a general environments (i.e. regular daily life) might be more conscious of their troubles in social situations (Attwood, 2000), this same self-awareness could possibly decline/decrease within a forensic and orthopsychiatric setting. This would suggest both adolescents with ASD or with ADHD seeming to protect their self-esteem using a similar and common coping style found among young and juvenile offenders in general. Further research is required to confirm if a detached coping style in adolescents with ASD causes the general lack of difference between adolescents with ASD and adolescents with ADHD. Adding to this, it should be examined if adolescents with ASD do differ on self-perceived competence, in both forensic and orthopsychiatric settings, as well as beyond these settings. If these above recommendations are taken to heart, possible findings from future research may very well give the debate on the differences, shared characteristics, or even overlap between ASD and ADHD the proper push it needs in the direction of a better understanding of the relation between these two developmental disorders.
Limitations
One of the main motivations in using self-reports was to understand the perceptions of adolescents themselves. The probable danger of underreporting in using self-reports notwithstanding, depression and anxiety symptoms are still less frequently reported through adolescents in a forensic psychiatry and orthopsychiatry samples (Breuk, Clauser, Stams, Slot, & Doreleijers, 2007; Salbach-Andrae, Klinkowski, Lenz, & Lehmkuhl, 2009). A possible explanation could be the way how adolescents may not acknowledge that problems occur, or even completely deny their problems exist, when in search for treatment for their problems (De Los Reyes & Kazdin, 2005). Underreporting may have caused differences in anxiety and depression symptoms and as such resulted in these being overlooked. Indeed,
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some studies have indicated individuals with ASD tending to self-report their own social functioning in a more positive manner than their parents’ scores (Lerner, Calhoun, Mikami, & De Los Reyes, 2012) and likewise tend to report their autistic symptoms as being less severe (Johnson, Filliter, & Murphy 2009). Breuk and colleagues (2007) argued that relying on self-reports may not yield valid scores in juvenile delinquents with severe behavioral problems. For further research it is advisable to combine self-reporting with reports from other informants or clinical interviews.
The second limitation is the fact that this current study was cross-sectional, meaning found associations could not be interpreted as causal relations. Longitudinal research is needed to give meaningful direction to this connection. Furthermore, longitudinal research is required to see if there are possible differences in self-esteem and anxiety on a long-term period. The third and final limitation is the small, unequal sample size. This limited the power and reliability of the comparisons, and may have affected the (lack of) found results.
Conclusion
In anxiety and depression symptoms of both adolescents with ASD and adolescents with ADHD there seem to be more similarities than differences. Adolescents with ASD perceive themselves as being less athletic than adolescents with ADHD. No differences were found in other aspects of self-perceived competence. Noteworthy here is that adolescents with ASD and adolescents with ADHD scored significant lower on self-perceived social competence than the other adolescents in the forensic and orthopsychiatric setting. Improving (self-perceived) social competence seems to be an important part in the treatment of adolescents with ADHD, but even more for adolescents with ASD. When considering the current debate regarding either the differences or the overlap between adolescents with ASD and adolescents with ADHD, this study appears to provide support that adolescents with ASD and adolescents with ADHD aren’t mutually exclusive groups when considering the manner of how they
26
perceive themselves. Further research is advisable make a clear distinction between anxiety and depression when comparing and contrasting adolescents with ASD to adolescents with ADHD. Adding to this, it should be examined if adolescents with ASD do differ on self-perceived competence, in both forensic and orthopsychiatric settings, as well as beyond these settings. If these above recommendations are taken to heart, possible findings from future research may very well give the debate regarding either the differences or the overlap between ASD and ADHD the proper push it needs in the direction of a better understanding of the relation between these two developmental disorders.
Acknowledgement
My special thanks goes to Mrs. prof. Dr. Ch. van Nieuwenhuizen, Mrs. Dr. I.L. Bongers, Mrs. Drs. E. Hofstra, Mrs. Drs A. X. Rutten and Mrs. Drs. E. Kornelis for their guidance and advice during this research. Their critical and valuable suggestions for improving this research have contributed to the achievements and final version of this master thesis.
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References
American Psychiatric Association, & American Psychiatric Association. (2000). Diagnostic
and Statistical Manual of Mental Disorders (revised 4th ed.). Washington, DC:
American Psychiatric Association.
Anderson, E. R., & Hope, D. A. (2008). A review of the tripartite model for understanding the link between anxiety and depression in youth. Clinical Psychology Review, 28, 275-287. doi:10.1016/j.cpr.2007.05.004
Attwood, T. (2000). Strategies for improving the social integration of children with Asperger syndrome. Autism, 4, 85-100. doi:10.1177/1362361300004001006
Bagwell, C. L., Molina, B. S., Pelham, W. E., & Hoza, B. (2001). Attention-deficit hyperactivity disorder and problems in peer relations: predictions from childhood to adolescence. Journal of the American Academy of Child and Adolescent Psychiatry,
40, 1285-1292. doi:10.1097/00004583-200111000-00008
Baron-Cohen, S., Leslie, A. M., & Frith, U. (1985). Does the autistic child have a “theory of mind”? Cognition, 21, 37-46. doi:10.1016/0010-0277(85)90022-8
Bauminger, N., & Kasari, C. (2000). Loneliness and friendship in high‐functioning children with autism. Child Development, 7, 447-456. doi:10.1111/1467-8624.00156
Bauminger, N., Shulman, C., & Agam, G. (2004). The link between perceptions of self and of social relationships in high-functioning children with autism. Journal of
Developmental and Physical Disabilities, 16, 193-214.
doi:10.1023/B:JODD.0000026616.24896.c8
Biederman, J., Monuteaux, M. C., Mick, E., Spencer, T., Wilens, T. E., Silva, J. M., ... & Faraone, S. V. (2006). Young adult outcome of attention deficit hyperactivity disorder: A controlled 10-year follow-up study. Psychological Medicine, 36, 167-179. doi:10.1017/S0033291705006410
28
Breuk, R. D., Clauser, C. A. C., Stams, G. J. J. M., Slot, N. W., & Doreleijers, T. A. H. (2007). The validity of questionnaire self-report of psychopathology and parent–child relationship quality in juvenile delinquents with psychiatric disorders. Journal of
Adolescence, 30, 761-771. doi:10.1016/j.adolescence.2006.10.003
Brown, S. L., & Ireland, C. A. (2006). Coping style and distress in newly incarcerated male adolescents. Journal of Adolescent Health, 38, 656-661.
doi:10.1016/j.jadohealth.2005.09.005
Brozina, K., & Abela, J. R. Z. (2006). Symptoms of depression and anxiety in children: Specificity of the hopelessness theory. Journal of Clinical Child and Adolescent
Psychology, 35, 515-527. doi:10.1207/s15374424jccp3504_3
Burwell, R. A., & Shirk, S. R. (2006). Self processes in adolescent depression: The role of self‐worth contingencies. Journal of Research on Adolescence, 16, 479-490. doi:10.1111/j.1532-7795.2006.00503.x
Bussing, R., Zima, B. T., & Perwien, A. R. (2000). Self-esteem in special education children with ADHD: Relationship to disorder characteristics and medication use. Journal of
the American Academy of Child and Adolescent Psychiatry, 39, 1260-1269.
doi:10.1097/00004583-200010000-00013
Capps, L., Sigman, M., & Yirmiya, N. (1995). Self-competence and emotional understanding in high-functioning children with autism. Development and Psychopathology, 7, 137-149. doi:10.1017/S0954579400006386
Cervantes, P. E., Matson, J. L., Adams, H. L., Williams, L. W., Goldin, R. L., & Jang, J. (2013). Comparing social skill profiles of children with autism spectrum disorders versus children with attention deficit hyperactivity disorder: Where the deficits lie.
Research in Autism Spectrum Disorders, 7, 1104-1110.
29
Cath, D. C., Ran, N., Smit, J. H., Van Balkom, A., & Comijs, H. C. (2008). Symptom overlap between autism spectrum disorders, generalized social anxiety disorder and obsessive-compulsive disorder in adults: A preliminary case-controlled study. Psychopathology,
41, 101–110. doi:10.1159/000111555
Clark, L. A., & Watson, D. (1991). Tripartite model of anxiety and depression: Psychometric evidence and taxonomic implications. Journal of Abnormal Psychology, 100, 316-336. doi:10.1037/0021-843X.100.3.316
Corbett, B. A., Constantine, L. J., Hendren, R., Rocke, D., & Ozonoff, S. (2009). Examining executive functioning in children with autism spectrum disorder, attention deficit hyperactivity disorder and typical development. Psychiatry Research, 166, 210-222. doi:10.1016/j.psychres.2008.02.005
Daviss, W. B. (2008). A review of co-morbid depression in pediatric ADHD: Etiologies, phenomenology, and treatment. Journal of Child and Adolescent
Psychopharmacology, 18, 565-571. doi:10.1089/cap.2008.032.
De Bolle, M., & De Fruyt, F. (2010). The tripartite model in childhood and adolescence: Future directions for developmental research. Child Development Perspectives, 4, 174-180. doi:10.1111/j.1750-8606.2010.00136.x
De Los Reyes, A., & Kazdin, A. E. (2005). Informant discrepancies in the assessment of childhood psychopathology: a critical review, theoretical framework, and recommendations for further study. Psychological Bulletin, 131, 483. doi:10.1037/0033-2909.131.4.483
Fitzgerald, M., & Molyneux, G. U. Y. (2004). Overlap between alexithymia and Asperger’s syndrome. American Journal of Psychiatry, 161, 2134-2135.
30
Fombonne, E. (2009). Epidemiology of pervasive developmental disorders. Pediatric
Research, 65, 591-598. doi:10.1203/PDR.0b013e31819e7203
Gadow, K. D., Guttmann-Steinmetz, S., Rieffe, C., & DeVincent, C. J. (2012). Depression symptoms in boys with autism spectrum disorder and comparison samples. Journal of
Autism and Developmental Disorders, 42, 1353-1363.
doi:10.1007/s10803-011-1367-x
Greenfield Spira, E., & Fischel, J. E. (2005). The impact of preschool inattention, hyperactivity, and impulsivity on social and academic development: A review.
Journal of Child Psychology and Psychiatry, 46, 755–773.
doi:10.1111/j.1469-7610.2005.01466.x
Harter, S. (1988). Manual for the self-perception profile for adolescents. University of Denver.
Harter, S. (2003). The development of self-representations during childhood and adolescence (pp. 610–642). M.R. Leary, J.P. Tangney (Eds.), Handbook of Self and Identity, Guilford: New York
Heinrich, L. M., & Gullone, E. (2006). The clinical significance of loneliness: A literature review. Clinical Psychology Review, 26, 695-718. doi:10.1016/j.cpr.2006.04.002 Holtmann, M., Bölte, S., & Poustka, F. (2007). Attention deficit hyperactivity disorder
symptoms in pervasive developmental disorders: Association with autistic behavior domains and coexisting psychopathology. Psychopathology, 40, 172-177. doi:10.1159/000100007
Hoza, B., Gerdes, A. C., Hinshaw, S. P., Arnold, L. E., Pelham Jr, W. E., Molina, B. S., ... & Wigal, T. (2004). Self-perceptions of competence in children with ADHD and comparison children. Journal of Consulting and Clinical Psychology, 72, 382-391. doi:10.1037/0022-006X.72.3.382
31
Huang-Pollock, C. L., Mikami, A. Y., Pfiffner, L., & McBurnett, K. (2009). Can executive functions explain the relationship between attention deficit hyperactivity disorder and social adjustment? Journal of Abnormal Child Psychology, 37, 679–691. doi:10.1007/s10802-009-9302-8
Ireland, J.L. (2005). Psychological health and bullying behavior among adolescent prisoners: A study of young and juvenile offenders. Journal of Adolescent Health, 36, 236-243. doi:10.1016/j.jadohealth.2004.02.026
Ireland, J. L., Boustead, R., & Ireland, C. A. (2005). Coping style and psychological health among adolescent prisoners: A study of young and juvenile offenders. Journal of
Adolescence, 28, 411-423. doi:10.1016/j.adolescence.2004.11.002
Johnson, S. A., Filliter, J., & Murphy, R. (2009). Discrepancies between self- and parent perceptions of autistic traits and empathy in high functioning children and adolescents on the autism spectrum. Journal of Autism and Developmental Disorders, 39, 1706– 1714. doi:10.1007/ s10803-009-0809-1
Kazdin, A. E. (2005). Evidence-based assessment for children and adolescents: issues in measurement development and clinical applications. Journal of Clinical Child and
Adolescent Psychology, 34, 548–558. doi:10.1207/s15374424jccp3403_10
Kordelaar, W. F. J. M. (2002). BOOG. Beslissingsondersteuning onderzoek geestvermogens
in het strafrecht voor volwassenen. Een forensisch psychologische studie (Doctoral
dissertation, Proefschrift Katholieke Universiteit Brabant. Deventer: Kluwer).
Kuusikko, S., Pollock-Wurman, R., Jussila, K., Carter, A. S., Mattila, M. L., Ebeling, H., … & Mayes, S. D., Calhoun, S. L., Murray, M. J., Ahuja, M., & Smith, L. A. (2011). Anxiety, depression, and irritability in children with autism relative to other neuropsychiatric disorders and typical development. Research in Autism Spectrum
32
Larson, K., Russ, S. A., Kahn, R. S., & Halfon, N. (2011). Patterns of comorbidity, functioning, and service use for US children with ADHD, 2007. Pediatrics, 127, 462-470. doi:10.1542/peds.2010-0165
Laurent, J., & Ettelson, R. (2001). An examination of the tripartite model of anxiety and depression and its application to youth. Clinical Child and Family Psychology
Review, 4, 209–230. doi:10.1023/A:1017547014504
Lawson, R. A., Papadakis, A. A., Higginson, C. I., Barnett, J. E., Wills, M. C., Strang, J. F., ... & Kenworthy, L. (2015). Everyday executive function impairments predict comorbid psychopathology in autism spectrum and attention deficit hyperactivity disorders. Neuropsychology, 29, 445-453. doi:10.1037/neu0000145
Lee, A., & Hobson, R. P. (1998). On developing self-concepts: A controlled study of children and adolescents with autism. Journal of Child Psychology and Psychiatry, 39, 1131-1144. doi:10.1111/1469-7610.00417
Lerner, M. D., Calhoun, C. D., Mikami, A. Y., & De Los Reyes, A. (2012). Understanding parent–child social informant discrepancy in youth with high functioning autism spectrum disorders. Journal of Autism and Developmental Disorders, 42, 2680–2692. doi:10.1007/s10803-0121525-9
Locke, K. D. (2009). Aggression, narcissism, self-esteem, and the attribution of desirable and humanizing traits to self versus others. Journal of Research in Personality, 43, 99-102. doi:10.1016/j.jrp.2008.10.003
Loe, I. M., & Feldman, H. M. (2007). Academic and educational outcomes of children with ADHD. Journal of Pediatric Psychology, 32, 643-654. doi:10.1093/jpepsy/jsl054 Lopata, C., Toomey, J. A., Fox, J. D., Volker, M. A., Chow, S. Y., Thomeer, M. L., ... &
33
levels and source differences. Journal of Abnormal Child Psychology, 38, 765-776. doi:10.1007/s10802-010-9406-1
Losh, M., & Capps, L. (2006). Understanding of emotional experience in autism: Insights from the personal accounts of high-functioning children with autism. Developmental
Psychology, 42, 809-818. doi:10.1037/0012-1649.42.5.809
Mayes, S. D., Calhoun, S. L., Murray, M. J., Ahuja, M., & Smith, L. A. (2011). Anxiety, depression, and irritability in children with autism relative to other neuropsychiatric disorders and typical development. Research in Autism Spectrum Disorders, 5, 474-485. doi:10.1016/j.rasd.2010.06.012
McDonnell, A., McCreadie, M., Mills, R., Deveau, R., Anker, R., & Hayden, J. (2015). The role of physiological arousal in the management of challenging behaviours in individuals with autistic spectrum disorders. Research in Developmental Disabilities,
36, 311-322. doi:10.1016/j.ridd.2014.09.012
Mikami, A. Y., Calhoun, C. D., & Abikoff, H. B. (2010). Positive illusory bias and response to behavioral treatment among children with attention-deficit/hyperactivity disorder.
Journal of Clinical Child & Adolescent Psychology, 39, 373-385. doi:10.1080/15374411003691735
Mikami, A. Y., & Hinshaw, S. P. (2006). Resilient adolescent adjustment among girls: buffers of childhood peer rejection and attention-deficit/hyperactivity disorder.
Journal of Abnormal Child Psychology, 34, 823-837. doi:10.1007/s10802-006-9062-7
Mikami, A. Y., Ransone, M. L., & Calhoun, C. D. (2011). Influence of anxiety on the social functioning of children with and without ADHD. Journal of Attention Disorders, 15, 473–484. doi:10.1177/1087054710369066.
34
Miltenberger, C. A., & Charlop, M. H. (2014). Increasing the athletic group play of children with autism. Journal of Autism and Developmental Disorders, 44, 41-54. Doi:10.1007/s10803-013-1850-7
Moran, J. M., Young, L. L., Saxe, R., Lee, S. M., O'Young, D., Mavros, P. L., & Gabrieli, J. D. (2011). Impaired theory of mind for moral judgment in high-functioning autism.
Proceedings of the National Academy of Sciences, 108, 2688-2692.
doi:10.1073/pnas.1011734108
Mrug, S., Hoza, B., Gerdes, A. C., Hinshaw, S., Arnold, L. E., Hechtman, L., & Pelham, W. E. (2009). Discriminating between children with ADHD and classmates using peer variables. Journal of Attention Disorders, 12, 372-380. doi:10.1177/1087054708314602
Mulder, E., Vermunt, J., Brand, E., Bullens, R., & Marle, H. (2012). Recidivism in subgroups of serious juvenile offenders: Different profiles, different risks? Criminal Behaviour
and Mental Health, 22, 122-135. doi:10.1002/cbm.1819
Murray-Close, D., Hoza, B., Hinshaw, S. P., Arnold, L. E., Swanson, J., Jensen, P. S., ... & Wells, K. (2010). Developmental processes in peer problems of children with attention-deficit/hyperactivity disorder in the multimodal treatment study of children with ADHD: Developmental cascades and vicious cycles. Development and
Psychopathology, 22, 785-802. doi:10.1017/S0954579410000465
Orsmond, G. I., Shattuck, P. T., Cooper, B. P., Sterzing, P. R., & Anderson, K. A. (2013). Social participation among young adults with an autism spectrum disorder. Journal of
Autism and Developmental Disorders, 43, 2710-2719.
35
Orth, U., Robins, R. W., Trzesniewski, K. H., Maes, J., & Schmitt, M. (2009). Low self-esteem is a risk factor for depressive symptoms from young adulthood to old age.
Journal of Abnormal Psychology, 118, 472-478. doi:10.1037/a0015922
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, 335-351. doi:10.1007/s10567-007-0027-3
Piek, J. P., & Dyck, M. J. (2004). Sensory-motor deficits in children with developmental coordination disorder, attention deficit hyperactivity disorder and autistic disorder.
Human Movement Science, 23, 475-488. doi:10.1016/j.humov.2004.08.019
Rich, E. C., Loo, S. K., Yang, M., Dang, J., & Smalley, S. L. (2009). Social functioning difficulties in ADHD: Association with PDD risk. Clinical Child Psychology and
Psychiatry, 14, 329-344. doi:10.1177/1359104508100890
Rommelse, N. N., Altink, M. E., Fliers, E. A., Martin, N. C., Buschgens, C. J., Hartman, C. A., ... & Oosterlaan, J. (2009). Comorbid problems in ADHD: Degree of association, shared endophenotypes, and formation of distinct subtypes. Implications for a future DSM. Journal of Abnormal Child Psychology, 37, 793-804. doi:10.1007/s10802-009-9312-6
Rommelse, N. N., Franke, B., Geurts, H. M., Hartman, C. A., & Buitelaar, J. K. (2010). Shared heritability of attention-deficit/hyperactivity disorder and autism spectrum disorder. European Child and Adolescent Psychiatry, 19, 281-295. doi:10.1007/ s00787-010-0108-6
Ronald, A., Larsson, H., Anckarsäter, H., & Lichtenstein, P. (2014). Symptoms of autism and ADHD: A Swedish twin study examining their overlap. Journal of Abnormal
36
Russell, E., & Sofronoff, K. (2005). Anxiety and social worries in children with Asperger syndrome. Australian and New Zealand Journal of Psychiatry, 39, 633–638. doi:10.1080/j.1440-1614.2005.01637.x
Salbach-Andrae, H., Klinkowski, N., Lenz, K., & Lehmkuhl, U. (2009). Agreement between youth-reported and parent-reported psychopathology in a referred sample. European
Child & Adolescent Psychiatry, 18, 136-143. doi:10.1007/s00787-008-0710-z
Sandstrom, M. J., & Jordan, R. (2008). Defensive self-esteem and aggression in childhood.
Journal of Research in Personality, 42, 506-514. doi:10.1016/j.jrp.2007.07.008
Shaw-Zirt, B., Popali-Lehane, L., Chaplin, W., & Bergman, A. (2005). Adjustment, social skills, and self-esteem in college students with symptoms of ADHD. Journal of
Attention Disorders, 8, 109-120. doi:10.1177/1087054705277775
Siaperas, P., Ring, H. A., McAllister, C. J., Henderson, S., Barnett, A., Watson, P., & Holland, A. J. (2012). Atypical movement performance and sensory integration in Asperger’s syndrome. Journal of Autism and Developmental Disorders, 42, 718-725. doi:10.1007/s10803-011-1301-2
Sjöwall, D., Roth, L., Lindqvist, S., & Thorell, L. B. (2013). Multiple deficits in ADHD: Executive dysfunction, delay aversion, reaction time variability, and emotional deficits. Journal of Child Psychology and Psychiatry, 54, 619-627. doi: 10.1111/jcpp.12006
Sobanski, E. (2006). Psychiatric comorbidity in adults with attention-deficit/hyperactivity disorder (ADHD). European Archives of Psychiatry and Clinical Neuroscience, 256, 26-31. doi:10.1007/s00406-006-1004-4
Solomon, M., Goodlin-Jones, B. L., & Anders, T. F. (2004). A social adjustment enhancement intervention for high functioning autism, Asperger’s syndrome, and
37
pervasive developmental disorder NOS. Journal of Autism and Developmental
Disorders, 34, 649-668. doi:10.1007/s10803-004-5286-y
Sowislo, J. F., & Orth, U. (2013). Does low self-esteem predict depression and anxiety? A meta-analysis of longitudinal studies. Psychological Bulletin, 139, 213-240. doi:10.1037/a0028931
Sterling, L., Dawson, G., Estes, A., & Greenson, J. (2008). Characteristics associated with presence of depressive symptoms in adults with autism spectrum disorder. Journal of
Autism and Developmental Disorders, 38, 1011-1018.
doi:10.1007/s10803-007-0477-y
Stewart, M. E., Barnard, L., Pearson, J., Hasan, R., & O’Brien, G. (2006). Presentation of depression in autism and Asperger syndrome A review. Autism, 10, 103-116. doi:10.1177/1362361306062013
Symes, W., & Humphrey, N. (2010). Peer-group indicators of social inclusion among pupils with autistic spectrum disorders (ASD) in mainstream secondary schools: A comparative study. School Psychology International, 31, 478-494. doi:10.1177/0143034310382496
Tantam, D. (2003). The challenge of adolescents and adults with Asperger syndrome. Child
and Adolescent Psychiatric Clinics of North America, 12, 143-163.
doi:10.1016/S1056-4993(02)00053-6
Thomas, R., Sanders, S., Doust, J., Beller, E., & Glasziou, P. (2015). Prevalence of attention-deficit/hyperactivity disorder: A systematic review and meta-analysis. Pediatrics, 135, 994-1001. doi:10.1542/peds.2014-3482
Treffers, Ph.,D.,A., Goedhardt, A.W., Veerman, J.W., Van den bergh, B.R.H., Ackaert, L. & de Rycke, L. (2002). Handleiding Competentie Belevingsschaal voor Adolescenten. Lisse: Swets Test Publishers.
