Thinking about Thinking: an Exploration of Basic Processes and Higher Order Functions and Metacognition in Adult ADHD

Attention Deficit Hyperactivity Disorder (ADHD) in adults is associated with various cognitive deficits. First, we explored metacognition in adult ADHD. Metacognition refers to “thinking about thinking”, the awareness and regulation of our cognitive processes. To illustrate, think of driving down the highway. If you notice you get tired and less concentrated (self-awareness), you could drive to the nearest gas station and rest (self-regulation), so when you drive again you might be more concentrated. Patients with ADHD may show deficits in some aspects of metacognition, but other aspects may not be affected. This raises concerns about the widespread reliance on self-reports in clinical assessments and calls for a multidimensional assessment approach. Metacognition influences daily functioning (rated by patients and their relatives), which may have important implications for treatment strategies.
Second, we investigated the impact of basic processes on higher order functions. The rationale is: if the foundation is impaired, any functions building on it may be affected. For example, if someone in a conversation does not register and encode some information (basic process), they may be unable to remember and act on it later (higher order function). A central finding is that basic processes may be part of the foundation of cognitive impairment in adult ADHD. This was replicated with different tests in an independent sample, reinforcing the importance of basic processes. As stimulants may improve basic processes, clinicians could use deficits in basic processes as indication that stimulant treatment may be beneficial.