Advertisement

Social Problems in ADHD: Is it a Skills Acquisition or Performance Problem?

  • Paula A. Aduen
  • Taylor N. Day
  • Michael J. Kofler
  • Sherelle L. Harmon
  • Erica L. Wells
  • Dustin E. Sarver
Article

Abstract

Recent models suggest that social skills training’s inefficacy for children with ADHD may be due to target misspecification, such that their social problems reflect inconsistent performance rather than knowledge/skill gaps. No study to date, however, has disentangled social skills acquisition from performance deficits in children with ADHD. Children ages 8–12 with ADHD (n = 47) and without ADHD (n = 23) were assessed using the well-validated social behavioral analysis framework to quantify cross-informant social skills acquisition deficits, performance deficits, and strengths. Results provided support for the construct and predictive validities of this Social Skills Improvement System (SSIS) alternate scoring method, including expected magnitude and valence relations with BASC-2 social skills and ADHD symptoms based on both parent and teacher report. Acquisition deficits were relatively rare and idiosyncratic for both the ADHD and Non-ADHD groups, whereas children with ADHD demonstrated cross-informant social performance deficits (d = 0.82–0.99) on several specific behaviors involving attention to peer directives, emotion regulation, and social reciprocity. Relative to themselves, children with ADHD were perceived by parents and teachers as exhibiting more social strengths than social acquisition deficits; however, they demonstrated significantly fewer social strengths than the Non-ADHD group (d = −0.71 to −0.89). These findings are consistent with recent conceptualizations suggesting that social problems in ADHD primarily reflect inconsistent performance rather than a lack of social knowledge/skills. Implications for refining social skills interventions for ADHD are discussed.

Keywords

Attention-deficit/hyperactivity disorder ADHD Social skills Social behavioral analysis framework 

Notes

Acknowledgements

This work was supported in part by a UVa Curry School of Education Foundation grant (PI: Kofler) from the Galant Family and an NIH grant (R34 MH102499-01, PI: Kofler). The sponsors had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript. The authors thank Jamie Spiegel for her helpful comments on the manuscript.

Compliance with Ethical Standards

Conflict of Interest

Paula A. Aduen, Taylor N. Day, Michael J. Kofler, Sherelle L. Harmon, Erica L. Wells, Dustin E. Sarver declare that they have no conflicts of interest.

Experiment Participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

References

  1. Abikoff, H., Gallagher, R., Wells, K. C., Murray, D. W., & Petkova, E. (2013). Remediating organizational functioning in children with ADHD: Immediate and long-term effects from a randomized controlled trial. Journal of Consulting and Clinical Psychology, 81, 113–128.CrossRefPubMedGoogle Scholar
  2. Antshel, K. M., & Remer, R. (2003). Social skills training in children with ADHD: A randomized-controlled clinical trial. Journal of Clinical Child and Adolescent Psychology, 32, 153–165.CrossRefPubMedGoogle Scholar
  3. Baddeley, A. (2007). Working memory, thought, and action (Vol. 45). OUP Oxford.Google Scholar
  4. Bagwell, C. L., Molina, B. S. G., Pelham, W. E., & Hoza, B. (2001). Attention-deficit hyperactivity disorder and problems in peer relations: Predictions from childhood to adolescence. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 1285–1292.CrossRefPubMedGoogle Scholar
  5. Bunford, N., Evans, S. W., & Wymbs, F. (2015a). ADHD and emotion dysregulation among children and adolescents. Clinical Child and Family Psychology Review, 18(3), 185–217.CrossRefPubMedGoogle Scholar
  6. Bunford, N., Evans, S. W., Becker, S. P., & Langberg, J. M. (2015b). Attention-deficit/hyperactivity disorder and social skills in youth: A moderated mediation model of emotion dysregulation and depression. Journal of abnormal child psychology, 43(2), 283–296.Google Scholar
  7. Clark, C., Prior, M., & Kinsella, G. (2002). The relationship between executive function abilities, adaptive behavior, and academic achievement in children with externalizing behavior problems. Journal of Child Psychology and Psychiatry, 43, 107–112.CrossRefGoogle Scholar
  8. Cunningham, C. E., & Siegel, L. S. (1987). Peer interactions of normal and attention-deficit-disordered boys during free-play, cooperative task, and simulated classroom situations. Journal of Abnormal Child Psychology, 15, 247–268.CrossRefPubMedGoogle Scholar
  9. de Boo, G. M., & Prins, P. J. (2007). Social incompetence in children with ADHD: Possible moderators and mediators in social-skills training. Clinical Psychology Review, 27, 78–97.CrossRefPubMedGoogle Scholar
  10. Erhardt, D., & Hinshaw, S. P. (1994). Initial sociometric impressions of ADHD and comparison boys: Predictions form social behaviors and from nonbehavioral variables. Journal of Consulting and Clinical Psychology, 62(4), 833–842.CrossRefPubMedGoogle Scholar
  11. Evans, S. W., Owens, J. S., & Bunford, N. (2014). Evidence-based psychosocial treatments for children and adolescents with ADHD. Journal of Clinical Child & Adolescent Psychology, 43, 527–551.CrossRefGoogle Scholar
  12. Flicek, M. (1992). Social status of boys with academic problems and attention-deficit hyperactivity disorder. Journal of Abnormal Child Psychology, 20, 353–366.CrossRefPubMedGoogle Scholar
  13. Frey, J. R., Elliott, S. N., & Gresham, F. M. (2011). Preschoolers’ social skills: Advances in assessment for intervention using social behavior ratings. School Mental Health, 3(4), 179–190.CrossRefGoogle Scholar
  14. Friedman, S. R., Rapport, L. J., Lumley, M., Tzelepis, A., Stettner, L., & Kakaati, L. (2003). Aspects of social and emotional competence in adult attention deficit/hyperactivity disorder. Neuropsychology, 17, 50–58.CrossRefPubMedGoogle Scholar
  15. Gadow, K. D., & Sprafkin, J. N. (2002). Child symptom inventory 4 (CSI-4): Screening and norms manual. Stony Brook: Checkmate Plus.Google Scholar
  16. Graziano, P. A., & Garcia, A. (2016). ADHD and children's emotion dysregulation: A meta-analysis. Clinical Psychology Review, 46, 106–123.CrossRefPubMedGoogle Scholar
  17. Gresham, F. M., & Elliott, S. N. (1989). Social skills deficits as a primary learning disability. Journal of Learning Disabilities, 22, 120–124.CrossRefPubMedGoogle Scholar
  18. Gresham, F. M., Elliott, S. N., & Kettler, R. J. (2010). Base rates of social skills acquisition/ performance deficits, strengths, and problem behaviors: An analysis of the social skills improvement system-rating scales. Psychological Assessment, 22, 809–815.CrossRefPubMedGoogle Scholar
  19. Heiman, T. (2005). An examination of peer relationships of children with and without attention deficit hyperactivity disorder. School Psychology International, 26, 330–339.CrossRefGoogle Scholar
  20. Hollingshead, A. B. (1975). Four factor index of social status. Department of Sociology, Yale University: Unpublished working paper.Google Scholar
  21. Hoza, B., Mrug, S., Gerdes, A. C., Hinshaw, S. P., Bukowski, W. M., Gold, J. A., & Arnold, L. E. (2005). What aspects of peer relationships are impaired in children with attention-deficit/hyperactivity disorder? Journal of Consulting and Clinical Psychology, 73(3), 411.CrossRefPubMedGoogle Scholar
  22. Huang-Pollock, C. L., Mikami, A. Y., Pfiffner, L., & McBurnett, K. (2009). Can executive functions explain relation between ADHD and social adjustment? Journal of Abnormal Child Psychology, 37, 679–691.CrossRefPubMedGoogle Scholar
  23. Humphreys, K. L., Galán, C. A., Tottenham, N., & Lee, S. S. (2016). Impaired social decision-making mediates the association between ADHD and social problems. Journal of Abnormal Child Psychology, 44, 1023–1032.CrossRefPubMedGoogle Scholar
  24. Kaufman, J., Birmaher, B., Brent, D., Rao, U., Flynn, C., Moreci, P., et al. (1997). Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): Initial reliability and validity data. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 980–988.CrossRefPubMedGoogle Scholar
  25. Kofler, M. J., Rapport, M. D., Bolden, J., Sarver, D. E., Raiker, J. S., & Alderson, R. M. (2011). Working memory deficits and social problems in children with ADHD. Journal of Abnormal Child Psychology, 39, 805–817.CrossRefPubMedGoogle Scholar
  26. Kofler, M. J., Larsen, R., Sarver, D. E., & Tolan, P. H. (2015). Developmental trajectories of aggression, prosocial behavior, and social–cognitive problem solving in emerging adolescents with clinically elevated attention-deficit/hyperactivity disorder symptoms. Journal of Abnormal Psychology, 124(4), 1027.CrossRefPubMedPubMedCentralGoogle Scholar
  27. Kofler, M. J., Sarver, D. E., Spiegel, J. A., Day, T. N., Harmon, S. L., & Wells, E. L. (2016). Heterogeneity in ADHD: Neurocognitive predictors of peer, family, and academic functioning. Child Neuropsychology, 1–27.Google Scholar
  28. Lane, K. L., Givner, C. C., & Pierson, M. R. (2004). Teacher expectations of student behavior social skills necessary for success in elementary school classrooms. The Journal of Special Education, 38(2), 104–110.CrossRefGoogle Scholar
  29. Langberg, J. M., Dvorsky, M. R., & Evans, S. W. (2013). What specific facets of executive function are associated with academic functioning in youth with ADHD? Journal of Abnormal Child Psychology, 41, 1145–1159.CrossRefPubMedPubMedCentralGoogle Scholar
  30. Leonard, M. A., Milich, R., & Lorch, E. P. (2011). The role of pragmatic language use in mediating the relation between hyperactivity and inattention and social skills problems. Journal of Speech, Language, and Hearing Research, 54(2), 567–579.CrossRefPubMedGoogle Scholar
  31. Lerner, J.V., Phelps, E., Forman, Y., & Bowers, E.P. Positive Youth Development. (pp. 524-558). In R.M. Lerner & L. Steinberg, (2009). Handbook of Adolescent Psychology, Volume 1: Individual Bases of Adolescent Development (Vol. 1). John Wiley & Sons.Google Scholar
  32. Melnick, S. M., & Hinshaw, S. P. (1996). What they want and what they get: The social goals of boys with ADHD and comparison boys. Journal of Abnormal Child Psychology, 24(2), 169–185.CrossRefPubMedGoogle Scholar
  33. Merrell, K. W., & Boelter, E. (2001). An investigation of relationships between social behavior and ADHD in children and youth. Journal of Emotional and Behavioral Disorders, 9(4), 260–269.CrossRefGoogle Scholar
  34. Mikami, A. Y. (2014). Social skills training for youth with ADHD. In R. A. Barkley (Ed.), Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (4 th ed.) (pp. 569–595). New York: Guilford Press.Google Scholar
  35. Mikami, A. Y., & Hinshaw, S. P. (2006). Resilient adolescent adjustment among girls: Buffers of childhood peer rejection and attention-deficit/hyperactivity disorder. Journal of Abnormal Child Psychology, 34, 825–839.CrossRefPubMedPubMedCentralGoogle Scholar
  36. Mikami, A. Y., Huang-Pollock, C. L., Pfiffner, L. J., McBurnett, K., & Hangai, D. (2007). Social skills differences among attention-deficit/hyperactivity disorder types in a chat room assessment task. Journal of Abnormal Child Psychology, 35(4), 509–521.CrossRefPubMedGoogle Scholar
  37. Mikami, A. Y., Lerner, M. D., Griggs, M. S., McGrath, A., & Calhoun, C. D. (2010). Parental influence on children with ADHD. Journal of Abnormal Child Psychology, 38, 737–749.CrossRefPubMedPubMedCentralGoogle Scholar
  38. Mikami, A. Y., Griggs, M. S., Lerner, M. D., Emeh, C. C., Reuland, M. M., Jack, A., & Anthony, M. R. (2013). A randomized trial of a classroom intervention to increase peers' social inclusion of children with attention-deficit/hyperactivity disorder. Journal of Consulting and Clinical Psychology, 81(1), 100–112.CrossRefPubMedGoogle Scholar
  39. Owens, J. S., Goldfine, M. E., Evangelista, N. M., Hoza, B., & Kaiser, N. M. (2007). A critical review of self-perceptions and the positive illusory bias in children with ADHD. Clinical Child and Family Psychology Review, 10(4), 335–351.CrossRefPubMedGoogle Scholar
  40. Pelham Jr., W. E., & Fabiano, G. A. (2008). Evidence-based psychosocial treatments for attention-deficit/hyperactivity disorder. Journal of Clinical Child & Adolescent Psychology, 37(1), 184–214.CrossRefGoogle Scholar
  41. Reynolds, C. R., & Kamphaus, R. W. (2004). BASC-2: Behavior assessment system for children: Second edition, manual. Bloomington: Pearson.Google Scholar
  42. Ronk, M. J., Hund, A. M., & Landau, S. (2011). Assessment of social competence of boys with attention-deficit/hyperactivity disorder: Problematic peer entry, host responses, and evaluations. Journal of Abnormal Child Psychology, 39(6), 829–840.CrossRefPubMedGoogle Scholar
  43. Saunders, B., & Chambers, S. M. (1996). A review of the literature on ADHD children: Peer interactions and collaborative learning. Psychology in the Schools, 33, 333–340.CrossRefGoogle Scholar
  44. Sibley, M. H., Evans, S. W., & Serpell, Z. N. (2010). Social cognition and interpersonal impairment in young adolescents with ADHD. Journal of Psychopathology and Behavioral Assessment, 32(2), 193–202.Google Scholar
  45. Sibley, M. H., Pelham Jr., W. E., Molina, B. S., Gnagy, E. M., Waxmonsky, J. G., Waschbusch, D. A., et al. (2012). When diagnosing ADHD in young adults emphasize informant reports, DSM items, and impairment. Journal of Consulting and Clinical Psychology, 80(6), 1052.CrossRefPubMedPubMedCentralGoogle Scholar
  46. Stroes, A., Alberts, E., & van der Meere, J. (2003). Boys with ADHD in social interaction with a nonfamiliar adult: An observational study. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 295–302.CrossRefPubMedGoogle Scholar
  47. Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statistics (5th ed.). Needham Heights: Allyn & Bacon.Google Scholar
  48. Tseng, W. L., & Gau, S. S. F. (2013). Executive function as a mediator in the link between attentiondeficit/hyperactivity disorder and social problems. Journal of Child Psychology and Psychiatry, 54(9), 996–1004.Google Scholar
  49. Tseng, W. L., Kawabata, Y., Gau, S. S. F., & Crick, N. R. (2014). Symptoms of ADHD and peer functioning: A transactional model of development. Journal of Abnormal Child Psychology, 42, 1353–1365.CrossRefPubMedGoogle Scholar
  50. Valo, S., & Tannock, R. (2010). Diagnostic instability of DSM–IV ADHD subtypes: Effects of informant source, instrumentation, and methods for combining symptom reports. Journal of Clinical Child & Adolescent Psychology, 39, 749–760.CrossRefGoogle Scholar
  51. van der Oord, S., van der Meulen, E. M., Prins, P. J. M., Oosterlaan, J., Buitelaar, J. K., & Emmelkamp, P. M. G. (2005). A psychometric evaluation of the social skills rating system in children with attention deficit hyperactivity disorder. Behaviour Research and Therapy, 43, 733–746.CrossRefPubMedGoogle Scholar
  52. Wheeler Maedgen, J., & Carlson, C. L. (2000). Social functioning and emotional regulation in the attention deficit hyperactivity disorder subtypes. Journal of Clinical Child Psychology, 29(1), 30–42.CrossRefGoogle Scholar
  53. Winsler, A. (1998). Parent-child interaction and private speech in boys with ADHD. Applied Developmental Science, 2, 17–39.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Curry School of EducationUniversity of VirginiaCharlottesvilleUSA
  2. 2.Department of PsychologyFlorida State UniversityTallahasseeUSA
  3. 3.Department of Pediatrics, Center for Advancement of YouthUniversity of Mississippi Medical CenterJacksonUSA

Personalised recommendations