9 March 2022

Beaton DM et al. PLos One 2022; 17: e0263366

Behavioural patterns associated with ADHD are typically perceived negatively, and it has been reported that adults with ADHD show higher perceived criticism than those without ADHD (Beaton et al, 2020), which may contribute to poorer mental health (Aupperle et al, 2016). This study aimed to understand the experience of criticism in adults with ADHD and explored the perception of criticism in these individuals.

This was a qualitative analysis of data collected from a larger study in which adult participants (age >18 years) were recruited between January and March 2019 through online ADHD forums, social media and posters displayed in university disability services and ADHD support group venues in the UK (Beaton et al, 2020). Participants with and without a clinical diagnosis of ADHD anonymously completed self-report questionnaires on demographics, ADHD diagnostic status and self-compassion, and were also screened for ADHD symptoms using the Adult ADHD Self-Report Scale v1.1 (ASRS*). Participants were also offered the opportunity to respond to an open question inviting them to share their experiences of criticism from people in their nearest environment (e.g., family, friends, colleagues). Participants identified as having high levels of traits consistent with ADHD based on their ASRS responses were included in the study sample for this analysis.

Of the 498 participants identified as high in ADHD traits who provided a response to the question about experience of criticism, 162 (n=109 female; mean [standard deviation (SD)] age 33.80 [10.60] years) reported no co-occurring disorders and were included in the final sample. Ninety-six participants reported that they had received a clinical diagnosis of ADHD, whilst the remaining 66 did not report a formal diagnosis of ADHD but were identified as having high ADHD traits through their ASRS scores. Quotes were extracted from the answers collected, and the data were qualitatively analysed using the NVivo-12 software. Thematic analysis identified five themes in the responses:

  • What is criticised? This theme highlighted the behaviours and traits most commonly criticised, according to participants’ responses, and was the most commonly discussed topic (93 quotes, 32% of total statements). Participants reported being most frequently criticised for their impulsivity and self-control (23/93 quotes, 25%), focus and inattention (19/93, 20%), and organisation (18/93, 19%).
  • What is perceived as criticism? This theme showed that indirect methods, such as being compared with other people, were perceived as criticism by some participants (62 quotes, 21%). Misjudgement (or judgement) was the primary reported source of perceived criticism (13/62 quotes, 21%), followed by rejection (12/62, 19%) and expectations (11/62, 18%).
  • Consequences of criticism. This theme captured participants’ reports of the outcomes resulting from criticism, including short- and longer-term effects on their feelings and behaviours (53 quotes, 18%). Approximately half (27/53, 51%) of the quotes concerning consequences of criticism described increased sensitivity to it, whilst 26/53 (40%) reported altered self-perception as a result of criticism.
  • Coping with criticism. Statements contributing to this theme described the approaches that participants reported using to avoid or protect themselves from criticism (45 quotes, 15%). Some participants appeared to take a positive approach when responding to criticism, by showing openness to criticism and acceptance of their condition (10/45 quotes, 22% for both coping mechanisms). However, it was more common for participants (12/45, 27%) to not disclose their condition as a way of coping and avoiding criticism.
  • The role of support and understanding. Statements describing how different experiences of support and understanding about ADHD were associated with participants’ perceptions of criticism were included in this theme (38 quotes, 13%). Many participants highlighted the benefits of receiving support from their family/friends (18/38 quotes, 47%), but other participants acknowledged that their condition is not understood by others, leading to (mis)judgements being made of them (4/38, 11%).

Although this study benefitted from the anonymous, open-text nature of data collection, leading to a reduced potential for sampling or interviewer bias, this also meant it was not possible to follow-up with further questions to gain deeper insights. Another limitation was the decision to not include participants with co-occurring conditions; although this exclusion criterion adds reassurance to the findings being attributed to ADHD traits, the researchers acknowledged that some participants may not have disclosed co-occurring conditions when submitting their responses, and hence might have been included anyway. On the other hand, this exclusion criterion itself may have limited the study, as the results may not be representative of the wider population with ADHD who also experience symptoms of comorbid conditions. Finally, the researchers acknowledged that relying on self-reported diagnoses and ASRS scores to identify ADHD cases may lack external validity and could have resulted in overinclusion of participants who would not receive a clinical diagnosis of ADHD.

The researchers concluded that this study has provided useful information surrounding the experiences and perception of criticism in adults with ADHD traits. Moreover, the authors suggested that the results demonstrate a need to consider what individuals with ADHD perceive as criticism, how they respond to this, and how this may affect their well-being. They emphasised that an improved understanding of ADHD may help to improve the feeling of support for people with ADHD and, in turn, reduce criticism.

Read more about experiences of criticism in adults with ADHD here

 

*The ASRS is an 18-item self-report screening tool that measures the frequency of symptoms of adult ADHD according to Diagnostic and Statistical Manual of Mental Disorders – 4th Edition criteria, and provides a grading system to aid diagnosis (Kessler et al, 2005)

Disclaimer: The views expressed here are the views of the author(s) and not those of Takeda.

Aupperle RL, Morris AS, Silk JS, et al. Neural responses to maternal praise and criticism: relationship to depression and anxiety symptoms in high-risk adolescent girls. Neuroimage Clin 2016; 11: 548-554.

Beaton DM, Sirois F, Milne E. Self-compassion and perceived criticism in adults with attention deficit hyperactivity disorder (ADHD). Mindfulness 2020; 11: 2506-2518.

Beaton DM, Sirois F, Milne E. Experiences of criticism in adults with ADHD: a qualitative study. PLoS One 2022; 17: e0263366.

Kessler RC, Adler L, Ames M, et al. The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in general population. Psychol Med 2005; 35: 245-256.

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