2 - (SYM 34) Is There a Cognitive Triad of Cognitive Distortions That Typifies Adult ADHD?

Although thoughts and beliefs do not cause adult ADHD, such cognitions influence the lived experience of clients. There is ample research about unhelpful thinking patterns in adult ADHD, including positive avoidant automatic thoughts. Two related studies offer preliminary evidence of three specific distorted thoughts patterns in adults with ADHD, a potential cognitive triad like that associated with depression.

The first study was a published chart review of 30 adults identified with ADHD via a thorough diagnostic evaluation. The results showed a significant positive correlation between distorted thoughts (measured by the Inventory of Cognitive Distortions [ICD]) and total ADHD (measured by the Brown Attention Deficit Disorder scale). Of relevance to the current paper, Perfectionism was the most endorsed cognitive distortion. Emotional reasoning and decision-making, Comparison to others, and general Emotional reasoning followed in descending order of the top four cognitive distortions.

A recent unpublished chart review study examined the relationship between generally negatively valanced ICD items and the distorted positive thoughts as measured by the ADHD Cognition Scale (ACS) in a sample of 370 adults diagnosed with ADHD. In addition to a significant positive correlation between the ICD and ACS, the results for the most common negative distorted cognitions in this study were, in descending order, Emotional reasoning and decision-making, Externalization of Self-worth, Perfectionism, and Emotional reasoning.

Reviewing the results of these studies side by side, the top distortions in both included Perfectionism, Emotional reasoning (including emotional decision making), and Externalization of self-worth (including Comparison to others).

Probing the individual items for each of the distortion categories, although Perfectionism still stood alone, Emotional reasoning and Emotional reasoning and decision-making easily blended into a single Emotional reasoning factor. Similarly, Comparative thinking and Externalization of self-worth captured a distinct issue reflecting perceived Inadequacy.

In this presentation, we describe the (1) proposed cognitive triad of adult ADHD for future study, (2) the relationship of this triad to the contemporary understanding of adult ADHD, and (3) clinical practice implications.