Social
Information Processing not helped by ADHD medication
Difficulty
establishing and maintaining positive peer relationships has been
linked to negative developmental outcomes in multiple studies.
And, an unfortunate aspect of ADHD for many children is difficulty with
peer relations. In fact, prior research has shown that many children
with ADHD begin to be rejected by unfamiliar children after only a
single day of contact.
Rejection by
peers can have a negative effect on children's self-esteem and
contribute to the development of loneliness and depression. In
addition, children who are excluded from the main-stream peer group
often gravitate towards one another during adolescence, and can wind up
reinforcing and escalating the types of negative behaviors that
initially contributed to their being disliked in the first place.
Understanding the reasons for peer rejection and developing effective
ways to help disliked children develop more positive peer relationships
has thus been the subject of extensive research in developmental and
clinical psychology.
Social Information
Processing: A Framework for Understanding Children's Social
Relationship Difficulties
Social
information processing (SIP) is a widely-studied framework for
understanding why some children have difficulty getting along with
peers. A particularly well-known SIP model developed by Crick and
Dodge (1994) describes six stages of information processing that
children cycle through when evaluating a particular social situation:
1. Encoding - The child must attend to
and encode the relevant cues. Failing to encode the relevant cues
will lead to problems in subsequent information processing steps.
2. Interpretation - The child makes a
judgment about what is going on. For example, if a child is
bumped into by a peer while waiting in line the child must decide
whether this was by accident or intentional. How the child answers this
question can have important implications for how they choose to respond.
3. Clarification of goals - The child
must decide what their goal is in the particular situation. In
the example above, the goal of 'standing up for oneself' would likely
lead to different action than the goal of 'maintaining harmonious
relations'.
4. Response generation - The child must
generate different behavioral strategies for attaining the goal they
have decided on.
5. Response decision - The child must
evaluate the likelihood that each potential strategy will help reach
their goal and decide on which strategy to implement.
6. Response enactment - The child must
behavioral enact the chosen response.
It is assumed
that the steps outlined above operate in real time and frequently
outside of conscious awareness.
Numerous
studies have shown that unpopular children - especially those who are
aggressive - have deficits at multiple stages of the SIP model.
For example, they tend to encode fewer social cues before deciding on
peers' intent, are more likely to assume that peers' have acted towards
them with hostile intent, are less likely to adopt prosocial goals, are
more likely to access aggressive strategies for handling potential
conflicts, evaluate aggressive responses more favorably, and are less
skillful at enacting assertive and prosocial strategies.
Although these
deficits do not apply to all unpopular children, the SIP framework
provides a useful way for understanding children's social difficulties
and for identifying ways to help them. For example, children whose
social difficulties result from failing to adopt prosocial goals would
require a different intervention approach than children who are prone
to believe that peers are acting towards them with hostile
intent. When multiple SIP stages are contributing to a child's
problems - as would often be the case - intervention would need to
address compromised processing at these different stages.
Because the SIP
framework has been prominent in research on children's peer relations,
and children with ADHD are known to struggle with establishing
friendships, it is surprising that little work on SIP in children with
ADHD has been conducted. In addition, there has been little work
on whether medication treatment improves SIP in children with ADHD. A
study published recently in the Journal
of Abnormal Child Psychology [King, et.at., (2009). Social
information processing in elementary school children with ADHD:
Medication effects and comparisons with typical children. JACP, 37, 579-589.] begins to
address these gaps in the literature.
Participants
were 75 children (596 boys, 19 girls) aged 6-12 years, including 41
with ADHD and 34 controls. All children were shown scenarios
depicting two types of peer interactions - either attempting to join a
group of peers, e.g., asking to join peers playing a baseball game and
being denied, or being provoked under ambiguous circumstances, e.g.,
being hit in the back of the head with a ball thrown by another
child. Children were asked to imagine that they were the child in
the situation described and asked "why he/she believed the children in
the scenario behaved the way they did" and "what he/she would do in the
situation".
The first
question was intended to asses the interpretation stage of the SIP
model and the second question assessed the response decision
stage. Responses to question one were coded according to whether
or not the child attributed hostile intent to the peers, e.g., that
peers intended to cause harm in some way. The second question was
coded on a 5-point scale of increasing retaliation, ranging from doing
nothing to seeking revenge.
Children
responded to 4 scenarios of each type and their responses were averaged
across the vignettes so that summary scores for interpretation and
response generation were computed for both types of social situations.
This enabled the researchers to compares whether these 2 aspects of SIP
differed for children with and without ADHD. Also, because
children with ADHD were randomized into medication conditions so that
20 participated after receiving placebo and 21 participated after
receiving methylphenidate (MPH) they could examined whether medication
treatment altered SIP patterns in children with ADHD.
- Results -
Interpretation
of intent - Children were more likely to infer hostile intent in peers
when responding to the provocation scenarios then the group entry
scenarios. However, there were no differences between children
with and without ADHD, regardless of whether children with ADHD were on
medication.
Response
generation - In response to the group entry scenarios, children with
ADHD did not differ from comparison peers in their tendency to generate
responses that focused on retaliation. However, in response to
the provocation scenarios, children with ADHD who were on medication
suggested responses that were more likely to involve retaliation than
comparison children. The magnitude of the difference would be
considered large by conventional standards. In contrast, although the
retaliation scores for children with ADHD not on meds were in the same
direction, they were not significantly higher. And, both groups
of children with ADHD generated more hostile response to the peer
provocation scenarios than to the group entry scenarios; control
children, however, did not show this pattern.
Although the
number of girls in the sample was relatively small, there was no
indication that the results differed by gender.
- Summary and Implications -
The good news
from this study is that children with ADHD are not more likely than
peers to assume that others have acted towards them with hostile
intent, regardless of whether the social situation is one of being
denied entry to the peer group or being ambiguously provoked by peers.
Thus, there was no evidence that this important aspect of SIP is likely
to be compromised in children with ADHD, regardless of whether they are
taking medication.
However, in
situations that involved ambiguous provocation by peers, children with
ADHD who are on medication generated ideas for dealing with the
situation that are more likely to include elements of retaliation,
which could certainly lead to making things worse. While
differences between comparison children and children with ADHD on
placebo were not significant, they were certainly in the same
direction.
Because the 2
groups of children with ADHD did not differ from each other, it would
be going beyond the data to conclude that medication led to more
aggressive responding. However, it is clearly the case that
medication was in no way associated with more adaptive and prosocial
responding, and may have possibly exacerbated it. And, it is
noteworthy that the only prior study to examine the effects of
medication on social cognition in children with ADHD also provided
evidence that medication may increase aggressive responding in at least
some children with ADHD.
As noted above,
both groups of children with ADHD generated more hostile response to
the peer provocation scenarios than to the group entry scenarios, a
pattern not shared by control children. As the authors note,
"...the implication of these findings is that response to provocation
is an area of impairment in children with ADHD and may be an important
target for intervention."
While being
careful not to conclude that medication contributed to more aggressive
responding, they also speculate about mechanisms that might underlie
such an effect. Here they suggest that MPH may have increased
attention, "...which was used to selectively focus on hostile negative
cues presented in the vignettes, which in turn prompted the children to
generate more hostile responses. They also suggest that MPH may
have enabled children to refrain from generating impulsive responses
and allowed them to "...generate and select non-impulsive yet
aggressive responses." As the authors clearly note, these are
both speculative suggestions and emphasize that additional research is
required to better determine whether medication treatment even leads to
more aggressive SIP patterns in the first place, especially since the
actual behavior of children with ADHD tends to become less aggressive
when they receive medication.
As is often the
case in relatively new lines of research, this study raises a number of
interesting questions. In addition to the possibility that
medication may possibly increase the tendency of children with ADHD to
generate aggressive responses, it is curious that no difference in the
interpretation stage was found. This is because believing that
peers have acted with hostile intent is generally associated with
generating more aggressive ideas for responding. However, children with
ADHD - at least those tested while on meds - generated more aggressive
responses even though they were not more likely than peers to make
hostile attributions.
The authors
note that additional research is necessary to better understand the SIP
patterns of children with ADHD, how they related to their actual
behavior, and whether there medication is associated with changes in
SIP patterns. In the meantime, the SIP framework is a useful one
for conceptualizing factors that may contribute to peer relationship
problems in all children - including those with ADHD - as well as
suggesting areas were intervention may need to be targeted for a
particular child.