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Do Boys with ADHD Overestimate Their Social Competance?
One of the most common problems for children with ADHD is the difficulty they experience in relationships with peers. In fact, some authors have noted that social problems are so pervasive among ADHD children that they ought to be included in the diagnostic criteria. Of these problems, rejection by peers is the most widely documented and the source of greatest concern. The reason for this concern is that a number of studies have linked peer rejection in childhood to a number of adjustment problems later in life.
Why do children with ADHD tend to have such consistent difficulty in establishing friends and getting along with peers? One contributing factor is clearly the behavior that is closely linked to ADHD symptoms. Just as such behavior can be aversive to adults, it can be equally aversive to children. Another factor that may contribute to the social problems of ADHD children is the that may they frequently misperceive the quality of their interactions with peers. Some researchers have suggested that children with ADHD are prone to overestimate how much peers like them, and to be relatively unaware of how they actually come across. In addition, boys with ADHD have been shown to be less likely than peers to accept personal responsibility for social failures. If children with ADHD have difficulty recognizing their problems, and tend to attribute problems they do recognize to something other than themselves, motivation for corrective action could be quite low. This raises the possibility that a positive and illusory bias could be as important an impediment to developing better peer relations as are behavioral factors.
This interesting hypothesis was examined in a study published recently in Child Development, perhaps the leading journal in developmental psychology. In this study (Hoza, et al., (2000). Attention-deficit/ hyperactivity disordered and control boys' responses to social success and failure. Child Development, 71, 432-446.) the authors looked at how boys with and without ADHD responded to experiences of social success and social failure. They were especially interested in how accurate boys with ADHD were in their evaluation of their interactions with peers, and the degree to which they assumed personal responsibility for their positive and negative social experiences.
Participants in this study were120 7 to13-year-old boys with ADHD (average age was 9.5 years) and 65 boys without ADHD who served as control subjects. Unfortunately, no girls were included in this study, which the authors clearly recognize as a limitation. The ADHD boys were participating in an intensive 8-week summer treatment program. At the time of the study to be described below, children were not receiving medication.
The procedure used in this study was interesting and a bit complicated. The study used a social acquaintance task in a controlled laboratory setting in which participants interacted briefly with a child whom they did not know. Prior to this interaction, each participant was told that the experimenter needed his help in recruiting a new child to participate in the summer camp program next year. He was thus instructed to "try and get him to like you" and "try to talk him into coming to camp here".
Unbeknownst to the subjects, however, the unfamiliar child they were introduced to was actually a "confederate" of the experimenter who had been instructed to act in particular ways. In one condition, the confederate was instructed to behave in a friendly manner towards the child and to express his interest in attending the camp next summer. Thus, this condition was intended to provide study participants with a clear experience of social success. In the other condition, confederates were told to behave in the opposite manner. They behaved in ways that clearly indicated they were not enjoying themselves and expressed a strong desire not to attend camp the following summer. The intent was to create an experience in which children would feel they had not been successful in getting the other child to like them or to want to attend camp. (Note: After these negative interactions, children were always provided with a positive social experience with that same confederate before leaving to ensure that all interaction sessions ended on a positive note.)
Each child participated in both the success and failure interaction task. The different conditions occurred on separate days during the summer. The order of these tasks - i.e. success followed by failure or failure followed by success - occurred equally often for ADHD and control children.
After both the success and failure interaction, boys were asked a number of different questions to learn about their perceptions for what had occurred. One set of questions focused on having the boys evaluate their performance by asking them to rate how well they did at getting the other child to like them and to want to attend the camp. They were also asked how much they liked the boy they had just met. A second set of questions asked the boys to explain why they believed they had either succeeded or failed on the task. These explanations focused on ability (e.g. "I failed because I'm not good at getting kids to like me."), task difficulty (e.g. "It's not hard to get kids to want to come to a camp like this."), effort (e.g. "He didn't like me because I didn't really try that hard to make him like me."), or luck ("I guess it was just lucky that he liked me."). As you can see, these 4 types of attributions (i.e. explanations for what happened) either involve something about the child himself (i.e. ability and effort attributions) or something that has little to do with the child himself (i.e. task difficulty and luck).
In addition to asking boys these questions, their interactions with the confederate were videotaped so their behavior during the sessions could later be studied and analyzed. Boys' behavior was rated by adult raters who were unaware of whether or not the child being rated had ADHD. They were asked a number of different questions about each boys' performance during both the success and failure interaction tasks. Ratings of individual questions were collapsed to provide summary scores for 2 general factors: how effective each boy was at the task (i.e. how effective was their behavior for getting another child to like them to want to attend camp) and how frustrated and helpless each boy appeared during the interaction.
Results
The results of this study were quite interesting. As expected, boys with ADHD were rated by observers as being less effective than control boys in being able to act in ways that would get the other child to like them and want to attend the camp. Despite being seen as less effective, however, they were also regarded as appearing less frustrated and helpless. This was true regardless of whether the confederate was acting towards them in a friendly or unfriendly manner.
One reason ADHD boys may have appeared to feel less frustrated and helpless is that in their own self-evaluations, they rated themselves as doing significantly better at accomplishing the goals than control boys. Thus, even though they were judged by objective observers to be less effective, they rated their own performance as more effective. This suggests that boys with ADHD are prone to overestimate the success of their social overtures towards peers, and may also misperceive others' feelings towards them.
Interestingly, despite reporting that they were more successful than they actually were, boys with ADHD tended not to give themselves credit for that success. In the condition where confederates had been instructed to act in a friendly manner, ADHD boys were more likely than controls to say that they succeed either because the task was an easy one or because they were lucky. After failing in the task, however, (i.e. the condition in which confederates were not friendly) they were less likely than controls to attribute the failure to their own lack of effort. Together, these findings suggest that boys with ADHD may have a tendency to deny responsibility for both their social success and social failure.
Summary And Implications
This study adds to our understanding of the social difficulties of boys with ADHD by documenting what may be important non- behavioral reasons for their problems. The results of this study suggest that boys with ADHD tend to overestimate their actual social competence, are less prone to experience frustration and helplessness in social situations, and tend to attribute their social successes and failures to factors outside themselves. One can imagine how this combination would not promote a child's motivation to act differently towards peers in an effort to improve one's social situation. After all, if you overestimate how well you are doing, experience little social frustration, and tend not to feel responsible for what happens anyway, then why bother trying to change?
Despite the interesting nature of these results, it is important to note the limitations of a study such as this. First, as noted above, because only boys were included as participants there is no way of knowing whether these findings would generalize to girls with ADHD. It is probably safer to assume that they do not until a similar study with females is conducted.
Second, although the findings reported above characterized boys with ADHD overall, one should not take this to mean that every boy with ADHD would display a similar pattern. In fact, that would certainly not be the case. Many children with ADHD tend to feel quite negatively about their social competence and to blame themselves - often unfairly - for the difficulties they experience. What is important, therefore, is to try and determine whether the issues highlighted in this study are applicable to an individual child, and if so, to develop an appropriate way for addressing these issues. Doing this effectively is likely to require high levels of sensitivity and skill, and may best be approached in consultation with an experienced child mental health professional.
It is also important to emphasize that the pattern of results obtained were found after boys with ADHD had a relatively brief encounter with an unfamiliar child. Thus, the tendency to overestimate success and deny responsibility for both positive and negative outcomes may be restricted to new relationships and may not necessarily persist in situations where children know each other for a longer period of time. For example, one can imagine how an initial tendency to believe that one is better-liked by a child than is actually the case would eventually crumble in the face of repeated negative feedback. Of course, that would still not mean that these findings are not important in the social problems of some boys with ADHD. This is because misreading the reality of a relationship early on can eventuate problems that make developing a positive relationship with a new peer less likely.
Finally, this study was conducted when children were not on medication. As medication is the most commonly prescribed treatment for ADHD, it would be interesting to know whether similar results would be obtained in ADHD children who were medicated.
In summary, this study should be regarded as in interesting initial effort to obtain a more comprehensive understanding of the social difficulties experienced by many children with ADHD. Additional research addressing these interesting issues is certainly required to help translate these findings into more effective interventions. In the meantime, the study acts as an effective reminder to parents and practitioners of how important it is to attend to the peer relationships of children with ADHD, and provides interesting insights about issues to consider when trying to help a child with ADHD become more successful with peers.
Note: This article originally appeared in Attention Research Update, an online newsletter written by Dr. David Rabiner, a Duke University psychologist and former member of CHADD's Professional Advisory Board. You can learn more about Attention Research Update and sign up for a free subscription at www.helpforadd.com.