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Empathy and Emotional Functioning in Boys with ADHD
Although there has been a vast amount of research on ADHD conducted over the years, the vast majority of this work has examined issues related to diagnosis, treatment, or behavioral functioning in children with ADHD. As a result, we know relatively little about other important aspects of functioning may be affected in children with ADHD. One very important domain that has been relatively neglected is the role of emotions in children with ADHD. Related to this general lack of information on emotional characteristics, there is a specific lack of research on empathy in children with ADHD.
Despite the lack of research studies in these important areas, the comprehensive theory of ADHD that was recently proposed by Russell Barkley contains specific predictions about how empathy and emotional responsivity would be affected in individuals with ADHD (Phil – The newsletter had an article on Barkley’s theory that would be good to provide a link to here.) Barkley proposed that because of the deficit in behavioral inhibition that he believes is central to ADHD (e.g. the ability to refrain from immediate responding to stimuli in order to size up the situation and consider alternatives) individuals with ADHD have difficulty regulating their emotions. One consequence of this difficulty in emotional regulation is lower levels of empathy – i.e. reduced awarenenss/appreciation for the needs, feelings, and opinions of others as well as a reduced ability to evaluate social events from another’s perspective.
Because being able to identify what another feels and then put oneself in that person’s shoes can help to regulate one’s behavior, lower levels of empathy could contribute significantly to the behavioral symptoms displayed by individuals with ADHD. For example, if a child knows that a certain act will hurt his mother’s feelings, and is able to really imagine the hurt his mother will feel, he may refrain from engaging in that behavior. If this capacity is less well developed in children with ADHD, however, the same hurtful behavior would be more likely. For this reason, it would be important to know whether children with ADHD are deficient in empathy skills, as these skills may be significant determinants of other behavior.
This question was addressed in an interesting study published recently in the Journal of Consulting and Clinical Psychology (Braaten, E.B. & Rosen, L.A. (2000). Self-regulation of affect in ADHD and non-ADHD boys: Differences in empathic responding. Journal of Consulting and Clinical Psychology, 68, 313-321.) Participants in this study 24 boys diagnosed with ADHD and 19 comparison boys. All boys were between the ages of 6 and 12. During a 2-hour testing session (none of the boys with ADHD were on medication at the time of testing), boys in both groups were individually administered a test that is frequently used to assess children’s empathic responding. In this test, children were read eight short stories about a fictitious child who is experiencing different types of emotions, some of which are positive and some of which are negative. In addition, several of the stories depict characters who are experiencing conflicting emotions.
After each story, participants were asked how the child in the story was feeling, how the child made them feel, and why he (i.e. the participant) felt that way. Higher empathy scores were obtained when children consistently indicated that they felt the same as the child in the story (i.e. their feeling matched the feeling they attributed to the story character). Higher scores were also obtained when participants explained their feelings in relation to the experience of the story character (e.g. “I feel sad because his favorite toy was lost.”) rather than providing an egocentric explanation (e.g. “I feel sad because I lost a toy too.”)
In addition to this measure of empathic responding, the authors were interested in the frequency with which participants displayed a variety of emotions. These different emotions included interest, joy, sadness, fear, shame, and guilt. This was evaluated by having the boys’ parents rate how often they observed their sons to display behaviors (e.g. facial expressions, body posture, tone of voice) indicative of each emotion during the prior two weeks.
Results
Results indicated that compared to boys without ADHD, boys with ADHD were significantly less likely to indicate that their own feelings matched those they attributed to the story character (i.e. they obtained lower match scores). This overall difference occurred primarily because ADHD boys were less likely to match the emotion of the story character when negative emotions were depicted. In addition, the ADHD boys were significantly less likely to explain their feelings in reference to what the story character was experiencing and instead provided explanations of their feelings that were more egocentric.
On the parent ratings of emotional expression, boys with ADHD were rated as having significantly higher scores for the negative emotions, but did not differ for the positive emotions. In particular, parents of ADHD boys reported that their sons were significantly more likely to display more outward signs of sadness, anger, and guilt.
Summary And Implications
Overall, the results of this study suggest that boys with ADHD are less likely than non-ADHD boys to feel bad when they observe others in difficult circumstances, and are also less likely report that their own feelings are directly affected by what happens to others. In other words, their ability to respond empathically may be deficient relative to other boys. According to their parents, ADHD boys are also more likely than non-ADHD boys to display behavior indicators of a variety of negative emotions. What is interesting about this particular combination of findings is the suggestion that although boys with ADHD may be more prone to experience negative emotions themselves, they are apparently less likely to empathize with the negative emotional experience of others. In fact, one possible explanation for the latter finding is that ADHD boys are reluctant to empathize with others negative emotional experience to protect themselves from experiencing even more negative affect. This, of course, is highly speculative.
These findings are consistent with the predictions about emotional functioning in children with ADHD that emanate from Barkley’s theory. Several practical consequences of these findings are noteworthy as well. First, because empathizing with others can play an important role in prosocial behavior towards others, helping children with ADHD develop their empathic abilities may need to be included as an essential aspect of social skills training programs. Second, the parent report data highlights that the emotional experience for many boys with ADHD may be much more negative than that of their peers. This underscores the need to carefully attend to the emotional experience of children with ADHD rather than focusing solely on working to improve their behavioral and academic functioning. When children are getting into consistent trouble and acting in aversive ways, this important perspective can be easy to lose sight of.
One concrete way that parents can help with this is to make a concerted effort to spend positive time with their child each and every day. In many families that I worked with, daily life with an ADHD child could be so filled with struggle that all of parents’ time and energy was devoted to discipline and making sure that certain important things got done. As a result, there was little if any time that was devoted to the essential experience of just trying to have a good time with one’s child. One can easily imagine how this could contribute to a more negative emotional experience for children – and parents. Putting aside even 15 minutes a day to focus solely having fun with your child can play a critical role in helping to build and maintain good parent-child relations and enhancing the emotional experience of both parties. This can also contribute to children eventually being better able to share some of their negative emotions with parents, thus providing parents with a good opportunity to model empathic skills, which can be helpful in fostering the development of such skills in children.
Despite the interesting and important results from this study, there are several limitations that need to be kept in mind. First, because the sample was restricted to boys, one can not assume that similar results would have been obtained with girls who have ADHD. Also, the findings should not be generalized to boys outside of the age range used in this study. As with any study that employs a relatively small sample, replicating these results would also be important. Finally, one should not assume that the findings reported would apply to all boys with ADHD even though they may be characteristic of ADHD boys overall.
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.