Automatic and negative thought patterns in children and adolescents with ADHD: associations with anxiety and self-esteem in a cross-sectional study

Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder in childhood, associated not only with core symptoms but also with difficulties in cognitive and emotional processes. Recent studies have shown that automatic and negative thought patterns in individuals diagnosed with ADHD may be closely related to anxiety symptoms and self-esteem. However, studies that examine these cognitive processes together in the context of ADHD in children and adolescents are limited. Therefore, the aim of this study is to evaluate automatic and negative thought patterns in children and children and adolescents diagnosed with ADHD and to assess their relationship with anxiety and self-esteem. The study included data from 127 participants in the ADHD group and 152 participants in the control group, all aged 9–15 years. Following a comprehensive psychiatric evaluation by a child and adolescent psychiatry specialist and the completion of a sociodemographic data form, participants were requested to undertake The Coopersmith Self-Esteem Inventory (CSEI), the Children’s Negative Cognitive Errors Questionnaire (CNCEQ), the Children’s Automatic Thoughts Scale (CATS), and the State-Trait Anxiety Inventory for Children (STAIC). Children and adolescents diagnosed with ADHD had significantly higher total and subscale scores on the CNCEQ, CATS, and STAIC scales, and significantly lower CSEI scores. Furthermore, in the ADHD group, CNCEQ scores were consistently associated with anxiety and self-esteem, whereas CATS total scores and selected subscale scores showed significant associations with anxiety and self-esteem. Children and adolescents diagnosed with ADHD showed higher levels of negative cognitive distortions, negative automatic thoughts, and anxiety symptoms, as well as lower self-esteem, compared with typically developing controls. Within the ADHD group, negative cognitive distortions and automatic thoughts were associated with anxiety symptoms and self-esteem. Given the cross-sectional design, these findings should be interpreted as associations rather than causal relationships. Assessment of maladaptive cognitive content may provide additional information when evaluating emotional and self-evaluative difficulties in children and adolescents with ADHD.