by David Rabiner
A limitation of research on how ADHD influences children’s development is that the focus has primarily been on how ADHD symptoms and comorbid difficulties are linked to negative outcomes. For example, there is a large body of work documenting the fundamental importance of inattentive symptoms as a risk factor for negative academic outcomes.
Missing from this work, however, are studies in which factors that may protect youth from these negative outcomes are examined. For example, although youth with ADHD frequently experience negative academic outcomes, this is not universally true and some successful throughout their academic careers. What accounts for this disparity? Identifying factors that buffer some youth with ADHD from negative developmental outcomes is important as it could inform efforts to minimize the negative long-term effects of ADHD.
A study published online recently in the Journal of Clinical Child and Adolescent Psychology represents an initial effort to address this issue [Dvorsky, et al., (2016). The protective effects of social factors on the academic functioning of adolescents with ADHD. DOI: 10.1080/15374416.2016.1138406] . In this study, 93 middle school students with ADHD were followed over an 18-month period to examine how ADHD symptoms in conjunction with social factors predicted important academic outcomes. The authors were especially interested in whether being liked and accepted by peers would protect youth with ADHD from the poor school performance that frequently occurs.
There are several reasons why positive peer relationships may protect youth with ADHD from more negative academic outcomes. Youth who are accepted by peers tend to feel greater belonging at school, are more motivated to achieve, and have easier access to academic help/support from peers; they also tend to be more highly involved in school, to befriend students who are high achievers, and to get along better with teachers. Alternatively, youth who are rejected by peers tend to congregate with other youth experiencing social difficulties – these youth tend to be less engaged with school, to experience more negative relations with teachers. Not surprisingly, they are at elevated risk for academic failure.
At the beginning of the study (T1), participants were in 5th,6th, or 7th grade. Baseline assessments included parent and teacher ratings of children’s ADHD symptoms and oppositional behavior. The degree of acceptance by was rated by parents and by the children themselves. Children’s grades for the most recent school year were obtained and converted into GPAs for core subject areas (English, social studies, math, and science) with a range of 0 to 4 (0=F, 4=A); teachers also rated children’s level of academic impairment. IQ estimates and each child’s medication status was also collected. Eighteen months later, (T2)children’s grades and teacher ratings of impairment were collected from their current teachers.
Using these data, the researcher examined the prediction of school grades and teacher impairment ratings at T2 using T1 ratings of ADHD symptoms, oppositional behavior, and ratings of social acceptance. T1 school grades and impairment ratings, as well as medication status and IQ were included as control variables. By controlling for these variables, the authors could test whether T1 symptom ratings and ratings of social acceptance predicted subsequent school performance after taking earlier school performance, IQ, and medication status into account.
As has been previously demonstrated, inattentive symptoms – but not hyperactive-impulsive symptoms or oppositional – behavior predicted grades and teacher impairment ratings at T2.
Particularly noteworthy was that parent and teacher ratings of children’s social acceptance at T1 also predicted grades and impairment ratings at T2, even after inattentive symptoms were accounted for. Specifically, better social acceptance was associated with higher grades and lower impairment ratings.
The relationship between inattention and peer acceptance was especially interesting in relation to children’s grades. Because all children had ADHD, attention difficulties were elevated for all. However, when inattentive symptoms were relatively low, social acceptance was not related to subsequent grades. In contrast, among youth who were the most inattentive, peer acceptance at T1 was an important predictor of subsequent grades. In fact, those with high levels of peer acceptance (defined as being in roughly the top 15% of the sample) had average grades that were nearly a full grade point higher than those with low levels of peer acceptance, i.e., the bottom 15% of the sample. Thus, among the most inattentive children, strong social acceptance seemed to protect against poor school grades.
Summary and implications
An important contribution of this study is that it illustrates an approach to studying the impact of ADHD on development that goes beyond documenting the risks associated with ADHD to identifying factors that can mitigate those risks. In a more frequently conducted type of study, the authors would have simply shown that inattentive symptoms during middle school, but not hyperactivity or oppositional behavior, predicts poorer school grades 1.5 years later. This would be a useful empirical finding that could inform efforts to enhance academic outcomes in youth with ADHD by highlighting that inattentive symptoms are the dimension of the disorder that most need to be addressed.
The authors went beyond documenting that inattentive symptoms are a key risk factor for negative academic outcomes, however, by studying whether this risk is moderated by children’s social acceptance. And, in fact, they found that better social relations play an important role in reducing academic risk among children with the greatest attention difficulties. This suggests that promoting better academic performance during middle school for youth with ADHD may require specific efforts to improve their social acceptance, rather than focusing exclusively on managing inattentive symptoms through medication or other means. Thus, results from this study nicely illustrate how research that moves beyond documenting risk factors to identifying protective factors, can be a fruitful approach.
Beyond replicating these findings, which would certainly be important, a next step in this line of work would be to better understand the mechanism by which peer acceptance may promote better school performance for middle schoolers with ADHD. For example, peer acceptance may protect against negative academic outcomes because these children have higher quality friendships, are less likely to associate with antisocial peers, get along better with teachers, etc. Feeling better connected at school may enhance motivation to do better academically. The current study only suggests that better social relations protect youth with ADHD from more negative academic outcomes but does not go the next step to try and identify what that is.
The answer to this question, along with efforts to identify other important protective factors for youth with ADHD, can potentially diminish important gaps in current knowledge of how ADHD affects development. Hopefully, more such work will be forthcoming.
Copyright © 2020 by David Rabiner