A consistent finding in studies examining the prediction of negative developmental outcomes for children is that peer relationship difficulties are an important predictor of multiple problems.Unfortunately, many children with ADHD struggle to develop positive peer relationships and to establish and maintain supportive friendships. For example, one study reported that over 80% of children with ADHD experience negative peer relationships and that many have no mutual friendships. This is problematic because close friendships have mulitiple 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 who lack friends miss out on these important supports, and may experience more adjustment difficulties as a result.Because children with ADHD frequently experience social difficulties, interventions to help them make and keep friends have been developed and have shown promise. In one such program called Children’s Friendship Training (CFT), parents and children participate in 12 90-minute sessions where children learn a variety of socialization skills, including conversational skills, sportsmanship, how to cope with teasing, and conflict resolution skills. Parents learn to support children’s efforts to make friends and are encouraged to arrange get-togethers where their child can practice newly learned social skills. Results indicate that this program helps many children with ADHD attain more positive social outcomes, although the impact on long-term social outcomes needs further study.
Although supportive peer relationships are equally important for adolescents, research on improving peer relations in adolescents with ADHD is strikingly limited. In fact, I am not aware of a single study that has specifically examined this issue. I was thus pleased to come across a study of this topic that was published recently online in the Journal of Attention Disorders [Gardner et al., (2015). Examination of a parent-assisted, friendship-building program for adolescents with ADHD. Journal of Attention Disorders. DOI: 10.1177/1087054715588188].
Participants were 20 youth with ADHD between the ages of 11-16 and their parents. (Given that some participants were 11 and 12, it is more accurate to describe the sample as including older children and adolescents.) All youth were reported by their parents to have significant difficulties with peer relations; they also all volunteered to participate in the study, suggesting that they were motivated to improve their peer relations.
The intervention tested was called PEERS – Program for the Evaluation and Enrichment of Relational Skills. It consisted of 14 weekly, 90-minute group sessions – one group for youth and one for parents. Participating youth learned a variety of social skills including initiating and maintaining conversations, appropriate use of electronic communication, using humor appropriately, dealing with peer teasing, and how to join groups. The program began by introducing foundational skills, e.g., initiating conversations) and progressed to more advanced skills such as hosting get-togethers and dealing with a negative reputation. Youth were given homework assignments each week that required them to practice the skills they were taught in the group. Parent sessions focused on educating parents about the skills their child was learning and discussing how they could support the development of those skills. Parents were encouraged to discuss homework assignments with their child and to assist them as needed in arranging get-togethers with peers. Essentially, parents were taught to function as ‘friendship coaches’ for their child.
To assess the impact of the program, multiple measures of participants’ social functioning and experience were collected before and after the intervention. This included information on whether youth had initiated a new friendship during the program, their knowledge of appropriate social skills, the perceived quality of their closest friendship, how accepted they felt by peers, and how frequently they initiated get- togethers. Parents were also asked how frequently their child had initiated get-togethers.
Comparisons of ratings provided before and after the intervention indicated positive intervention effects in some areas. These included the following:
- Nearly 80% of parents and 70% of youth reported the initiation of a mutual friendship post-treatment. Thus, the majority of participants seem to have attained this primary intervention goal.
- There was a significant increase in the number of hosted get-togethers that parents and youth reported. At the end of treatment, nearly 95% of parents and 90% of youth reported that the youth had hosted at least one get-together in the past month.
- There was a large increase in participants’ social knowledge and knowledge of appropriate social skills.
Change in adolescents’ report of the quality of their closest friendship was in the predicted direction, but did not reach statistical significance. They also reported higher levels of social acceptance following the intervention, but this increase was not statistically significant.
Summary and Implications
This is the first study to specifically examine whether peer relationships in older children/young adolescents with ADHD can be improved by a parent-assisted friendship-building program. Because positive peer relations play an important role in children’s healthy development – particularly having at least one supportive friendship – and many youth with ADHD struggle in this domain, this is an important and understudied issue.
Results of this initial study suggest that interventions that provide structured practice in friendship making skills, and that help parents become ‘friendship coaches’ for their teen, are potentially helpful. This was evident in the number of participants who initiated new friendships during the program, an increase in hosted get-togethers, and an increase in social knowledge. These are changes in the right direction and highlight the value of additional work to develop and refine the program.
While these initial findings are positive, it is important to recognize that this is only a first step in establishing the benefits of the intervention. As a pilot study, the sample size was small and there was no control group. As noted above, although the authors describe their program as an intervention for adolescents, many participants were not yet teenagers. There was also no information provided on other treatments participants were receiving, e.g., medication. And, a longer-term follow-up to determine whether benefits reported immediately following the intervention persisted for a reasonable time period was not conducted. There is thus considerable work to be done to learn whether this approach will be helpful for older adolescents and whether it can promote improvements in social relationships that are enduring.
While it is important to recognize these limitations, this should not take away from a thoughtful attempt to develop a much needed treatment approach for older children and adolescents. One of the most difficult aspects for youth with ADHD, as well as for their parents, are the peer relationship difficulties that many experience. Efforts to develop effective interventions for these difficulties are important, and hopefully this initial effort will lead to more such studies.
This article was originally published in Attention Research Update, an online newsletter written by Dr. David Rabiner of Duke University that helps parents, professionals, and educators keep up with new research on ADHD and related areas. You can sign up for a complementary subscription at www.helpforadd.com
Reprinted with permission. All rights reserved.
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