Attention Research Update

September 2012

"Helping parents, professionals and educators stay informed about new research on ADHD"

David Rabiner, Ph.D.  Associate Research Professor, Duke University


                 
                 Friendship Characteristics of Children with ADHD

A consistent finding in studies that identify children at risk for negative developmental outcomes is that peer relationship difficulties predict a number of subsequent problems. 

Unfortunately, many children with ADHD struggle in their relations with peers and in establishing and maintaining high quality and supportive friendships.  This is problematic because good friendships serve a number of important functions for children including providing companionship, enabling feelings of self-validation, contributing to emotional security, creating a context for self-disclosure, offering guidance and support, and serving as a reliable ally.  Children whose development occurs in the absence of supportive friendships miss out on these important supports, and may experience a greater number of adjustment difficulties as a result. 

Despite the documented importance of healthy friendships for children's positive development, and the difficulty in peer relations experienced by many children with ADHD, important questions about the friendship characteristics in children with ADHD remain unanswered.  I was thus pleased to come across a recently published study in the Journal of Attention Disorders [Marton et.al., (2012). Friendship characteristics of children with ADHD. Journal of Attention Disorders. DOI: 10. 1177/1087054712458971] that provides new information on this important issue.

Participants were 92 9 to 12 year old children - 50 with ADHD and 42 comparison children - their parents, and their teachers.  Sixty-six of the participants were boys and 26 were girls; the percentage of boys and girls were similar among ADHD and comparison groups was similar. 

Children were interviewed individually and asked to identify all their 'best friends' in and out of school, to indicate how long they had been friends with each child they identified, how often they spoke with each child on the phone, and how frequently they spent time with each child outside of school.  Parents and teachers were asked a parallel series of questions; this enabled the researchers to learn whether the 'best friends' that participants identified were corroborated by another source.  Parents and teachers were also asked whether the friends they identified had learning or behavioral problems so that these characteristics could be compared between children with and without ADHD.


Results

Key findings from this study are shown below.

  • The number of 'best friends' reported by children with and without ADHD did not differ. 
  • The number of 'best friends' that were corroborated by parents or teachers were fewer for children with ADHD than for comparison children.  On average, children with ADHD had 3 corroborated friends compared to 4 such friends for comparison children.
  • Among boys, those with ADHD had a substantially higher percentage of friends with learning or behavior problems relative to comparison children (43% vs. 16%).  No such differences were found among females.
  • The average length of corroborated friendships was significantly shorter for children with ADHD than for comparison children - about 10 months less based on child report and 14 months less based on parent report.
  • Although the amount of telephone contact with best friends was similar in both groups, children with ADHD had significantly less direct contact with friends outside of school.  This was found for both child and parent report.

Summary and Implications

Although children with ADHD did not report fewer friends than other children, they may have overestimated their friends based on the fact that their parents and teachers corroborated fewer of their friendships.  Even so, however, it is positive to note that the they only had one fewer friend on average than other children and that nearly all had corroborated friends.  In fact, in this sample, only 3 of the 50 children with ADHD were without such friendships.

Other aspects of the data were also noteworthy.  First, among boys, a significantly higher percentage of the friends of children with ADHD had learning and/or behavior problems according to parents and teachers.  This is not necessarily negative but does indicate that boys with ADHD are more likely to have friends who are struggling in some important ways.  Having friends with significant behavior problems may promote or exacerbate negative behavior among boys with ADHD and children may mutually reinforce these tendencies in one another.  This is an important issue to be aware of.

It was also noteworthy that friendships among children with ADHD were of shorter duration than for other children by about a year.  For children in this age range, this is substantial and may reflect greater turnover in the friendships of children with ADHD.  It is concerning because "...an additional year of friendships can contribute to more warmth, closeness, companionship, and better school adjustment among friends."  This would be an important issue to examine more carefully in subsequent research.  It would also be interesting to learn whether this tendency towards shorter duration friendships in children with ADHD is also found among adolescents.

Children with ADHD were also found to have less contact with their friends outside of school.  This may occur for a variety of reasons.  Because of their challenging behavior, children with ADHD may require more supervision and thus be less likely to be invited to friends' houses.  Parents may be more concerned about their child's behavior when they cannot monitor them, and thus be more reluctant to permit 'play dates' away from home.

Regardless of the reason for this finding, lower levels of direct contact suggests that friendships among children with ADHD may provide less companionship and offer fewer opportunities to develop the kind of closeness between friends that encourages self-disclosure and the provision of emotional support.  This is another issue to look at more carefully in subsequent research.

It is important to note that the findings discussed above reflect differences found on average between children with and without ADHD and the conclusions do not apply to all children with ADHD, many of whom can do very well in their social relationships.  As with any study, it would be important to replicate these findings in a new sample in order to better establish the reliability of the results.

When children with ADHD are struggling in their peer relationships, it is important to know that their are some promising approaches for helping them.  One particularly interesting approaches involves having parents take on the role of 'friendship coaches' for their child, which is based on the notion that is based on the notion that parents can play an important role in creating social opportunities for their child by arranging play dates for them and by 'coaching' their child so that those play dates go well.

I reviewed a study of this approach in a prior issue of Attention Research Update and I would encourage you to take a look at it.  You can find the article at http://www.helpforadd.com/2010/november.htm


(c) 2012 David Rabiner, Ph.D.

Information presented in Attention Research Update is for informational purposes only, and is not a substitute for professional medical advice.  Although newsletter sponsors offer products and services that I believe will be of interest to subscribers, sponsorship of Attention Research Update does not constitute a specific endorsement or guarantee of any company's product or services.