A consistent finding in studies designed to identify children at risk for
negative developmental outcomes is that peer relationship difficulties predict
a number of subsequent problems. Rejected children (particularly those
who act aggressively towards peers) fare significantly worse in adolescence
and adulthood than children with more harmonious peer relations. This
may occur because rejected children often gravitate towards one another during
adolescence, and reinforce/escalate each other's antisocial behavior.
Rejection by peers can also have a negative affect on children's self-esteem
and contribute to the development of loneliness and depression.
Unfortunately, many children with ADHD struggle in their relations with
peers, and may begin to be rejected after only a single day of contact. Although
this is concerning, a child's overall standing in his or her peer group can
be relatively independent of whether the child has a close friend and what
the quality of that friendship is like. And, having a good quality friendship
may be just as important as overall peer acceptance to children's current
and future adjustment. For example, even if a child is disliked by
many peers, having a close friend is associated with less loneliness, more
positive family relationships, and higher feelings of general self-worth.
Thus, having a close friend can help compensate for the negative effects of
being rejected by the larger peer group.
Because many children with ADHD can be unpopular in their peer group, learning
about the quality of their friendships established is an interesting and important
topic to pursue. This was the focus of a study recently published online
in the Journal of Abnormal Child Psychology [Normand, et.al. (2010).
How do children with ADHD (mis)manage their real-life dyadic friendships?
A multi-method investigation. Journal of Abnormal Child Psychology.]
Participants were 87 children with ADHD (76% boys; ages 7-13) and 46 comparison
children without ADHD. Eighty-two percent of the children with ADHD
were being treated with medication. Each child was asked to invite his/her
best friend to the lab where they engaged in a number of different activities
to enable the researchers to learn about the quality of their friendship.
(Parental permission to participate was obtained from both the participants
as well their friends.) The tasks children completed were as follows:
Friendship Quality Measure - This is a 43-item measure that children
use to rate the quality of their relationship with their best friend. The
items inquire about both positive and negative aspects of the friendship including
providing support, companionship, confiding in one another, degree of conflict,
demands for exclusivity, and aggression. An overall score for positive
and negative friendship features is calculated based on the child's responses.
Car-Race Task - This task was designed to stimulate interaction between
friends in a fast-paced and engrossing game. The goal of the game is
to win a race that involves transporting a number of wooden blocks from one
end of a 'race track' to another using a toy truck. The track cannot
accommodate two trucks side by side and the rules prohibit players from lifting
their truck from the track or deliberately blocking the other truck.
Players can thus compete energetically without breaking the rules, can compete
in ways that violate the rules, or can choose to avoid conflict with their
opponent even if it reduces their chances of winning.
This task was designed to observe difference in how children with and without
ADHD behaved towards their friends during a competitive task.
Card sharing and Game-choice tasks - In the card sharing task, children
were presented with 15 appealing trading cards and asked to select 5 cards
that they both liked the most. Then, they were instructed to decide
together how to share the 5 cards. They could share them any way they
liked, as long as they both agreed. This task allowed the researchers
to observe how children with and without ADHD negotiated with their best friend.
For the game-choice task, participants were presented with a number of appealing
games and asked to choose together which games they would play at the end
of the session. This task provided another opportunity to observe how
children were able to negotiate and resolve potential disagreements.
In addition to these activities, the researchers obtained behavioral ratings
from parents and teachers of all children, including the best friends.
This enabled them to see whether the friends of children with and without
ADHD differed on a variety of behavioral dimensions according to parents and
- Results -
Behavioral and Social Characteristics of the Invited Friends - Friends
of children with ADHD were rated as displaying more ADHD symptoms than friends
of comparison children by both parents and teachers. Of the friends
with symptom ratings in the clinically elevated range (n=22), all were friends
of children with ADHD. They were also rated as being more oppositional.
Friendship Quality - Children with ADHD rated their best friendships
as higher on negative qualities and lower on positive qualities than the comparison
children. In addition, the friends of children with ADHD rated their
friendships less positively than did the friends of comparison children.
Furthermore, both children with ADHD and their invited friends were significantly
less satisfied overall with their friendship than were comparison children
and their friends.
Car-race task - Children with ADHD displayed both more legal and
illegal maneuvers during the game with their friend. On average, they
engaged in twice as many illegal maneuvers as comparison children.
Card sharing task - Children with ADHD made more insensitive
and self-centered proposals for sharing the cards with their friend than comparison
children made with their friend. They also asked their friends for
their sharing preferences less frequently and the exchange was more likely
to be characterized as displaying a power differential between the friends.
Of the 7 dyads that never agreed on how to divide the cards, all of these
involved a child with ADHD.
Game-choice task - Children with ADHD made more proposals that were
rated as insensitive and also refused their friend's proposal more often.
In addition to the primary analyses summarized above, the researchers conducted
supplementary analyses to test whether the main results were modified by children's
gender, age, and medication status. Results of these analyses indicated
that the effects described above did not vary according to the age or gender
of the children, and also did not depend on whether children with ADHD were
receiving medication treatment.
- Summary and Implications
This ambitious study provided detailed information on the quality of friendships
in children with ADHD from multiple perspectives. Overall, the best
friends of ADHD had more ADHD symptoms and oppositional behavior than the
best friends of comparison children. Children with ADHD and their best
friends reported enjoying their friendship less than other children and children
with ADHD were generally less sensitive to their friends needs/wishes during
the social interaction tasks. Overall, it appears that the friendships
of children with ADHD were of lower quality. Of course, it is important
to remember that this overall average difference does not apply to all children
with ADHD, many of whom are involved in high quality, positive friendships.
Results from this study highlight the potential value of coaching children
with ADHD in friendship skills in an effort to improve the quality of their
friendships. Medication by itself did not appear to diminish the difference
in friendship quality of children with and without ADHD highlighting the importance
of interventions that target children's friendships directly. Such
efforts need to focus on increasing the positive attributes of their friendships
and increasing their awareness of - and responsiveness to - their friend's
wishes and desires.
Results of other recently conducted research indicate that parents can play
an important role in these efforts; in subsequent issues of Attention Research
Update I will include summaries of this research.