How Does ADHD Impact Friendships in Children?
ADHD impacts people throughout their lifespan. For children, ADHD can cause a child to have difficulty focusing during class, keeping track of assignments and their due dates, blurt out responses to questions before they have been completed, and talk excessively. ADHD can also impact children’s peer relationships. Children diagnosed with ADHD may engage in behaviors such as complaining, not following rules for activities, and not paying attention to peers in social settings. Despite pharmaceutical, behavioral, or combined therapeutic interventions, researchers have found that children with ADHD continue to struggle with peer relationships despite reported improvement of ADHD symptoms (Hoza, Gerdes, et al., 2005). In this blog post, we discuss 3 ways ADHD impacts friendships in children.
1) Children with ADHD will seek friends with ADHD or ADHD-like symptoms.
Normand et. al (2011) found in a study of 87 children with ADHD and 46 children without ADHD. This study concluded that children with ADHD tended to have friends that had ADHD or exhibited ADHD-like symptoms. Friendships are a big concern for parents and teachers of children with ADHD, as 50-80% of these children are found to be rejected by their peers and classmates (Bagwell, Schmidt et al., 2001).
In the study, it was found that children without ADHD did not seek out friends with ADHD like symptoms unlike their peers with ADHD. Some theories exist as to why this happens. One, researchers posit that children may seek peers with similar social goals (i.e. having fun rather than following the rules). Another theory posits that children with ADHD may have a limited pool of potential friends, due to parental desires to prevent their child from associating with children who exhibit disruptive behavior or that children with ADHD tend to be disliked by more socially-successful classmates (Hoza, Mrug et al., 2005).
2) Children with ADHD have poorer friendship quality than do children without ADHD.
Normand et. al (2011) found that children with ADHD expressed experiencing more conflict, friendship exclusivity, and aggression compared to children without ADHD in regards to their friendships. Children with ADHD also reported experiencing less conflict resolution, feeling validation, and companionship in their friendships than did children without ADHD. These results can offer some explanation as to why children with ADHD have difficulty maintaining friends long-term. Normand et. al (2011) posits that the rockiness of friendships that children with ADHD experience could be caused by the behavioral problems associated with their ADHD. As children with ADHD have less positive exchange as a result of behavioral issues, it may inhibit these children from learning that problems can be resolved when feelings are heard and shared appropriately.
3) Children with ADHD tend to exhibit more controlling behavior in their friendships.
Normand et. al (2011) had studied children with and without ADHD as they played different games with peers. Normand et. al(2011) found that children with ADHD were less likely to accept a game proposal by a friend in comparison to other children without ADHD. When children with ADHD proposed games to play with peers, observers found that children with ADHD made proposals that favored their interests without regard to their friend’s social cues, needs, and preferences. In previous studies examining dyadic relationships of children with ADHD, researchers have found that children with ADHD have poorer social-perspective skills than children without ADHD (Marton, Wiener, Rogers, Moore, & Tannock, 2009). This finding in regards to dyadic behavior of children with ADHD and friends may also explain why children with ADHD tend to lose friends overtime.
What can clinicians do to help children with ADHD make and maintain friends?
Researchers have found that social skills training for children with ADHD tends to not be effective, as it is difficult to work on social skills in an office setting. However, researchers have posited that it may be beneficial for children with ADHD to work on social skills in a camp-like program that challenges them to perform activities, learn, and apply social skills ( Pelham et al., 2005; Waschbusch, Pelham, Gnagy, Greiner, & Fabiano, 2008). Another approach suggested is providing pair therapy, in which a therapist works with two or more children who have the potential to become friends to learn effective social strategies that can help them build and maintain a friendship (Selman & Schultz, 1990). From the literature, it appears that social skill interventions that take place in an interactive group setting may be more beneficial than just individual social skill training.
Children with ADHD commonly have difficulty making and maintaining friends throughout their life. Researchers have found that children with ADHD tend to make friends with other children who have ADHD or ADHD-like symptoms, have poorer friendship quality, and exhibit more controlling behavior in their dyadic interactions with peers than do peers without ADHD. Social skills training for children with ADHD has been reported to not be effective, as this kind of training is difficult to generalize outside of an office setting. Research suggests that providing a camp-like program in which children with ADHD can learn and practice social skills may be more effective than individual social skill work.
Bagwell, C. L., Molina, B. S. G., Pelham, W. E., Newcomb, A. F., & Bukowski, W. M. (2001). Friendship and peer rejection as predictors of adult adjustment. In D. W. Nangle & C. A. Erdley (Eds.), The role of friendship in psychological adjustment. New directions for child and adolescent development, Vol. 91 (pp. 25-49). San Francisco: Jossey-Bass.
Hoza, B., Mrug, S., Gerdes, A. C., Hinshaw, S. P., Bukowski, W. M., Gold, J. A. et al. (2005).
What aspects of peer relationships are impaired in children with attention deficit/hyperactivity disorder? Journal of Consulting and Clinical Psychology, 73, 411-423.
Marton, I., Wiener, J., Rogers, M., Moore, C., & Tannock, R. (2009). Empathy and social perspective taking in children with Attention-Deficit/Hyperactivity Disorder. Journal of Abnormal Child Psychology, 37, 107-118.
Normand, S., Schneider, B. H., Lee, M. D., Maisonneuve, M. F., Kuehn, S. M., & Robaey, P. (2011). How do children with ADHD (mis) manage their real-life dyadic friendships? A multi-method investigation. Journal of Abnormal Child Psychology, 39(2), 293-305.
Pelham, W. E., Fabiano, G. A., Gnagy, E. M., Greiner, A. R. & Hoza, B. (2005). The role of summer treatment programs in the context of comprehensive treatment for attention deficit/hyperactivity disorder. In E. D. Hibbs & P. S. Jensen (Eds.), Psychosocial Treatments for Child and Adolescent Disorders: Empirically Based Strategies for Clinical Practice, 2nd Ed. (pp. 377-409). Washington: American Psychological Association
Selman, R. L., & Schultz, L. (1990). Making a Friend in Youth. Chicago: University of Chicago Press.
Waschbusch, D. A., Pelham, W. E., Gnagy, E. M., Greiner, A. R., Fabiano, G. A. (2008). Friendship Interactions of Children with ADHD 89 Summer treatment programs for children with ADHD. In K. McBurnett & L. Pfiffner (Eds.), Attention Deficit Hyperactivity Disorder: Concepts, Controversies, New Directions. (pp. 199-209). New York: Informa Healthcare USA Inc.