Friendship Intimacy Exchange Buffers the Relation between ADHD Symptoms and Later Social Problems among Children Attending an After-School Care Program

The friendships of children displaying symptoms of attention-deficit/hyperactivity disorder (ADHD) have been understudied, particularly in comparison to the domain of peer rejection. This study tested whether friendship intimacy exchange buffers the prospective relation between ADHD symptoms and social problems 1 year later in a sample of children attending a community-based after-school program. Children (N?=?131; 53 % boys; 66 % African American) ranging from 5 to 13 years of age participated in this study. At baseline, children reported on friendship intimacy exchange with their identified best friend, and program staff rated children on ADHD symptoms and social problems. Staff ratings of children’s social problems were collected again 1 year later. Multiple regression analyses indicated that, after controlling for demographic variables and baseline social problems, friendship intimacy exchange significantly moderated the association between ADHD symptoms and social problems at the one-year follow-up. Specifically, the relation between ADHD and social problems was no longer significant for children reporting high levels of friendship intimacy exchange. This moderation was not further qualified by either child age or sex, although boys were more likely than girls to report low rates of friendship intimacy exchange. These findings indicate the importance of friendship intimacy for children displaying ADHD symptoms, who often experience significant peer problems. Friendship quality may be a promising target for prevention and intervention efforts in mitigating some of the long-term social problems associated with ADHD symptomatology, and future research is needed to extend these findings to other domains of friendship quality and clinical samples of children with ADHD.     

A friendship intervention for children with Attention-Deficit/Hyperactivity Disorder: preliminary findings

Children with Attention-Deficit/Hyperactivity Disorder (ADHD) are known to experience difficulty in peer relationships. Neither standard interventions for ADHD nor peer acceptance-oriented interventions fully remedy this problem. We propose that interventions targeting ADHD children's dyadic friendships may be more realistic strategies for improving peer relationships. Hence, a friendship intervention, implemented within the context of an intensive behavioral treatment program with 209 ADHD children, is described. A model is proposed in which the friend's antisocial behavior relates to parental compliance with the friendship intervention, and both the friend's antisocial behavior and parental compliance predict friendship quality and treatment response. Results indicate that children paired with peers lower on antisocial behavior and children whose parents had higher levels of compliance with the friendship intervention achieved higher quality friendships and were rated by teachers as more improved.     

The Importance of Friendship for Youth with Attention-Deficit/Hyperactivity Disorder

It is well-established that youth with attention-deficit/hyperactivity disorder (ADHD) are often peer-rejected and rated by parents, teachers, and observers to have poor social skills, when compared to typically developing peers. Significantly less research, however, has been devoted to the experiences youth with ADHD have in their close friendships. The aim of this article is to draw attention to friendship as a distinct construct from peer rejection and social skills and to summarize what is known about youth with ADHD in their friendships. The potential for stable, high-quality friendships to buffer the negative outcomes typically conferred by peer rejection in this population is discussed. This article concludes with recommendations for interventions that specifically target improving the close friendships of youth with ADHD as a treatment strategy.     

Stable same‐sex friendships with higher achieving partners promote mathematical reasoning in lower achieving primary school children

This study was designed to investigate friend influence over mathematical reasoning in a sample of 374 children in 187 same‐sex friend dyads (184 girls in 92 friendships; 190 boys in 95 friendships). Participants completed surveys that measured mathematical reasoning in the 3rd grade (approximately 9 years old) and 1 year later in the 4th grade (approximately 10 years old). Analyses designed for dyadic data (i.e., longitudinal actor‐partner interdependence model) indicated that higher achieving friends influenced the mathematical reasoning of lower achieving friends, but not the reverse. Specifically, greater initial levels of mathematical reasoning among higher achieving partners in the 3rd grade predicted greater increases in mathematical reasoning from 3rd grade to 4th grade among lower achieving partners. These effects held after controlling for peer acceptance and rejection, task avoidance, interest in mathematics, maternal support for homework, parental education, length of the friendship, and friendship group norms on mathematical reasoning.     

Pre-existing Perceptions of ADHD Predict Children’s Sociometrics Given to Classmates with ADHD

Considerable research documents that even young children possess stigma about mental illness, which may affect how they evaluate peers with mental health conditions. This study examined children’s pre-existing perceptions of Attention Deficit/Hyperactivity Disorder (ADHD) behaviors as predictors of their subsequent sociometric judgments of classmates with ADHD in a 2-week summer day camp. Participants were previously unacquainted children ages 6.8–9.8 years (113 typically-developing and 24 with ADHD; 48.2% boys; 81% White). Children initially more inclined to interact with a hypothetical classmate with ADHD gave fewer “dislike” nominations to real-life classmates with ADHD at camp. Children who initially believed that ADHD symptoms were uncontrollable gave more “dislike” nominations and lower liking ratings to classmates with ADHD when those classmates displayed severe ADHD symptoms. For children who had ADHD, their attribution of uncontrollability for ADHD symptoms predicted fewer “like” nominations and more “dislike” nominations given to classmates with ADHD. Lastly, children who initially reported they would help a hypothetical classmate with ADHD gave higher liking ratings to classmates with ADHD. These results were found after statistical control of the actual level of ADHD behaviors displayed by the classmates with ADHD. In summary, other children’s pre-existing or stigmatizing perceptions of ADHD behaviors may contribute, in part, to the substantial peer rejection typically experienced by ADHD populations. Findings have implications for understanding peer problems in children with this common mental health condition.     

ADHD Correlates, Comorbidity, and Impairment in Community and Treated Samples of Children and Adolescents

Patterns of correlates, comorbidity and impairment associated with attention-deficit hyperactivity disorder (ADHD) in children and youth were examined in representative samples from the community and from treatment facilities serving medically indigent youth in Puerto Rico. Information from caretakers and youths was obtained using the Diagnostic Interview Schedule for Children, (version IV), measures of global impairment, and a battery of potential correlates. In the community (N = 1,896) and the treated samples (N = 763), 7.5 and 26.2% of the children, respectively, met criteria for DSM-IV ADHD in the previous year. Although the prevalence rates and degree of impairment differed, the general patterns of correlates, comorbidity and impairment were similar in both populations. The exceptions were associated with conduct disorder, anxiety, impairment in the ADHD comorbid group, and age factors that appeared to be related to selection into treatment.     

Resilient Adolescent Adjustment Among Girls: Buffers of Childhood Peer Rejection and Attention-Deficit/Hyperactivity Disorder

Examined a risk-resilience model of peer rejection and attention-deficit/hyperactivity disorder (ADHD) in a 5-year longitudinal study of 209 ethnically and socioeconomically diverse girls aged 6-13 at baseline and 11-18 at follow-up. Risk factors were childhood ADHD diagnosis and peer rejection; hypothesized protective factors were childhood measures of self-perceived scholastic competence, engagement in goal-directed play when alone, and popularity with adults. Adolescent criterion measures were multi-informant composites of externalizing and internalizing behavior plus indicators of academic achievement, eating pathology, and substance use. ADHD and peer rejection predicted risk for all criterion measures except for substance use, which was predicted by ADHD only. ADHD and peer rejection predicted lower adolescent academic achievement controlling for childhood achievement, but they did not predict adolescent externalizing and internalizing behavior after controlling for baseline levels of these constructs. Regarding buffers, self-perceived scholastic competence in childhood (with control of academic achievement) predicted resilient adolescent functioning. Contrary to hypothesis, goal-directed play in childhood was associated with poor adolescent outcomes. Buffers were not found to have differential effectiveness among girls with ADHD relative to comparison girls.     

Relational and physical victimization within friendships: nobody told me there'd be friends like these

In past research, relational and physical forms of peer victimization have been identified that have been shown to be significantly associated with social–psychological maladjustment. These forms of victimization, although studied primarily within the group peer context, also occur within dyadic relationships such as friendships. Gender differences in friend victimization and the association between friend victimization and children's social–psychological adjustment were examined. Results showed that boys were more physically victimized by their friends than were girls. Girls were more relationally than physically victimized by their friends. Friend victimization was related to adjustment difficulties for both boys and girls; however, friend physical victimization was particularly related to boys whereas friend relational victimization was particularly related to girls. The implications of these findings for future research and intervention with victimized children are discussed.     

How Do Children with ADHD (Mis)manage Their Real-Life Dyadic Friendships? A Multi-Method Investigation

This multimethod study provides detailed information about the friendships of 87 children (76% boys) with ADHD and 46 comparison children aged 7–13 years. The methods included parent and teacher ratings, self-report measures and direct observation of friends’ dyadic behaviors in three structured analogue tasks. Results indicated that, in contrast with comparison children, children with ADHD had friends with high levels of ADHD and oppositional symptoms; they perceived fewer positive features and more negative features, and were less satisfied in their friendships. Observational data indicated that children with ADHD performed both more legal and more illegal maneuvers than comparison children in a fast-paced competitive game. While negotiating with their friends, children with ADHD made more insensitive and self-centered proposals than comparison children. In dyads consisting of one child with ADHD and one typically developing child, children with ADHD were often more dominant than their friends.     

Early Behavior Problems as a Predictor of Later Peer Group Victimization: Moderators and Mediators in the Pathways of Social Risk

This study is a prospective investigation of the predictive association between early behavior problems (internalizing, externalizing, hyperactivity–impulsiveness, immaturity–dependency) and later victimization in the peer group. Teacher ratings of the behavioral adjustment of 389 kindergarten and 1st-grade children (approximate age range of 5 to 6 years-old) were obtained, using standardized behavior problem checklists. These ratings predicted peer nomination scores for victimization, obtained 3 years later, even after the prediction associated with concurrent behavior problems was statistically controlled. Further analyses suggested that the relation between early behavior problems and later victimization is mediated by peer rejection and moderated by children's dyadic friendships. Behavior problems appear to play an important role in determining victimization within the peer group, although the relevant pathways are complex and influenced by other aspects of children's social adjustment.     

Trajectories of Italian Children’s Peer Rejection: Associations with Aggression,Prosocial Behavior,Physical Attractiveness,and Adolescent Adjustment

In the present study, the predictors and outcomes associated with the trajectories of peer rejection were examined in a longitudinal sample of Italian children (338 boys, 269 girls) ages 10 to 14 years. Follow-up assessments included 60% of the original sample at age 16–17. Low, medium, and high rejection trajectory groups were identified using growth mixture models. Consistent with previous studies, we found that (a) being less prosocial and more physically aggressive at age 10 was characteristic of those children with the high rejection trajectory; (b) being less attractive was related to higher peer rejection from age 10 to 14; and (c) boys with a high rejection trajectory showed high levels of delinquency and anxiety-depression and low levels of academic aspiration at age 16–17, whereas girls with a high rejection trajectory showed low levels of academic aspiration and social competence at age 16–17. Our findings indicate the detrimental consequences of peer rejection on children’s development and adjustment and shed light on the mechanisms that contribute to maintaining or worsening (e.g., being attractive, prosocial, and aggressive) a child’s negative status (e.g., being rejected) within his or her peer group over time.     

Anxiety as a Predictor and Outcome Variable in the Multimodal Treatment Study of Children with ADHD (MTA)

Initial moderator analyses in the Multimodal Treatment Study of Children with ADHD (MTA) suggested that child anxiety ascertained by parent report on the Diagnostic Interview Schedule for Children 2.3 (DISC Anxiety) differentially moderated the outcome of treatment. Left unanswered were questions regarding the nature of DISC Anxiety, the impact of comorbid conduct problems on the moderating effect of DISC Anxiety, and the clinical significance of DISC Anxiety as a moderator of treatment outcome. Thirty-three percent of MTA subjects met DSM-III-R criteria for an anxiety disorder excluding simple phobias. Of these, two-thirds also met DSM-III-R criteria for comorbid oppositional-defiant or conduct disorder whereas one-third did not, yielding an odds ratio of approximately two for DISC Anxiety, given conduct problems. In this context, exploratory analyses of baseline data suggest that DISC Anxiety may reflect parental attributions regarding child negative affectivity and associated behavior problems (unlike fearfulness), particularly in the area of social interactions, another core component of anxiety that is more typically associated with phobic symptoms. Analyses using hierarchical linear modeling (HLM) indicate that the moderating effect of DISC Anxiety continues to favor the inclusion of psychosocial treatment for anxious ADHD children irrespective of the presence or absence of comorbid conduct problems. This effect, which is clinically meaningful, is confined primarily to parent-reported outcomes involving disruptive behavior, internalizing symptoms, and inattention; and is generally stronger for combined than unimodal treatment. Contravening earlier studies, no adverse effect of anxiety on medication response for core ADHD or other outcomes in anxious or nonanxious ADHD children was demonstrated. When treating ADHD, it is important to search for comorbid anxiety and negative affectivity and to adjust treatment strategies accordingly.     

Cross-sectional and longitudinal relations among peer-reported trustworthiness, social relationships, and psychological adjustment in children and early adolescents from the United Kingdom and Canada

Trustworthiness was examined in children and early adolescents from two countries. In Study 1,505 children in the fifth and sixth school years in the United Kingdom (mean age = 9 years 7 months) were tested across an 8-month period. In Study 2,350 sixth- through eighth-grade Canadian children and early adolescents (mean age = 12 years 11 months) were tested across a 1-year period. Participants completed measures assessing trustworthiness (ratings of promise and secret keeping by peer group and also by best friend in Study 1), assertiveness (Study 1), prosocial behavior (Study 2), social relationships (friendships and peer preference), and psychological adjustment (self-esteem, depressive symptoms, and loneliness). Peer-reported trustworthiness was positively associated with, and predicted changes across time in, the number of friendships. The observed relations were found to be statistically independent of peer preference and peer-reported assertiveness or prosocial behavior. Trustworthiness was found to be positively associated with peer preference (Study 1 and Study 2) and psychological adjustment (Study 1).     

Friendship as Protection from Peer Victimization for Girls with and without ADHD

The goal of this study was to examine the ability of friendship to moderate the association between behavioral risk and peer victimization for girls with attention-deficit/hyperactivity disorder (ADHD; n = 140) and comparison girls (n = 88) in a 5-week naturalistic summer camp setting. Participants were an ethnically and socioeconomically diverse group of girls ages 6–12. Parents and teachers reported on pre-summer internalizing behavior, externalizing behavior, and social competence. Participants reported on friendships and peer victimization through a peer report measure at the summer camps; friendship was scored via mutual nominations. Pre-summer externalizing behavior, internalizing behavior, and low social competence predicted peer victimization at the summer camps. Friendship moderated the association between behavioral risk and victimization for the entire sample, such that the presence of at least one friend reduced the risk of victimization. Additional analyses suggested that girls with ADHD were no more or less protected by the presence of a friendship than were comparison girls. Finally, preliminary analyses suggested that girls having only friends with ADHD were not significantly less protected than girls with at least one comparison friend. Future directions and implications for intervention are discussed.     

Stability of aggressive behaviors and children's peer relationships

The present research longitudinally evaluated the association of group and dyadic peer relation factors to the stability of aggression. Beginning in grades 2 through 5, children (N = 212) completed peer nominations for aggressive behaviors, sociometric ratings, sociometric nominations (like most and like least), and friendship nominations for 2 successive years. Children were classified into four Stability of Aggression Groups: Never Aggressive, Stable Aggressive, Discontinued Aggression, Became Aggressive. Aggressive children were evaluated as more disliked at each time of testing (i.e., Stable Aggressive and Discontinued Aggression at Time 1; Stable Aggressive and Became Aggressive at Time 2). Furthermore, sociometric ratings of children at Time 1 who became aggressive by Time 2 foreshadowed this transition. Children who discontinued aggressive behaviors were friends with children who were evaluated by peers as significantly less aggressive than the friends of children who continued aggressive behaviors. These findings suggest that early identification of children at risk for developing aggressive behavior may be possible through group‐level peer evaluations, and identification of those at risk for continuing aggressive behavior may be possible through the evaluation of special dyadic friendships. Aggr. Behav. 26:277–290, 2000. © 2000 Wiley‐Liss, Inc.     

Eating pathology among adolescent girls with attention-deficit/hyperactivity disorder

The authors investigated prospectively assessed eating pathology (body image dissatisfaction and bulimia nervosa symptoms) among an ethnically and socioeconomically diverse sample of adolescent girls with attention-deficit/hyperactivity disorder-combined type (ADHD-C; n=93), ADHD-inattentive type (ADHD-I; n=47), and a comparison group (n=88). The sample, initially ages 6-12 years, participated in a 5-year longitudinal study (92% retention rate). After statistical control of relevant covariates, girls with ADHD-C at baseline showed more eating pathology at follow-up than did comparison girls; girls with ADHD-I were intermediate between these two groups. Baseline impulsivity symptoms, as opposed to hyperactivity and inattention, best predicted adolescent eating pathology. With statistical control of ADHD, baseline peer rejection and parent- child relationship problems also predicted adolescent eating pathology. The association between punitive parenting in childhood and pathological eating behaviors in adolescence was stronger for girls with ADHD than for comparison girls. Results are discussed in terms of the expansion of longitudinal research on ADHD to include female-relevant domains of impairment, such as eating pathology.     

ADHD and delinquency--a developmental perspective

Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent psychiatric disorders of childhood and adolescence. Until now, it has been unclear whether ADHD by itself constitutes a risk factor for later delinquency or does so only in combination with other disruptive symptoms. This article seeks to give a comprehensive account of the literature to shed light on the developmental pathway from childhood ADHD to adult criminality. Comorbid ADHD and conduct disorder (CD) are significantly related to a range of biological and environmental risk factors such as neurocognitive impairment, high parental psychopathology, poor social functioning, and other comorbid mental disorders, particularly substance abuse, that are described in this review. In addition, the results of treatment studies are presented, with a special focus on the results of the Multimodal Treatment Study of Children with ADHD (MTA). Although treatment programs, including medication and psychosocial treatment, can be very effective in improving the functioning of children with ADHD in the social and academic domains in the short term, there is no conclusive evidence that such treatments lower the risk for developing delinquency in adulthood.     

Anxious-Irritable Children: A Distinct Subtype of Childhood Anxiety?

Children with anxiety disorders often present with other co-occurring symptom clusters, of which irritability is among the most highly co-occurring. Despite compelling clinical and pathophysiological evidence linking anxiety and irritability, little is known regarding the clinical presentation and associated impairment of children with both anxiety and irritability. In this study, our aims were to confirm the preponderance of irritability in clinically anxious children and compare clinically anxious children with irritability to those without irritability across sociodemographic, clinical, psychosocial, and family domains. Participants were 230 children with anxiety disorders (ages 6–14 years) and their mothers, and 91 healthy controls (ages 6–17 years) and their mothers. Of the clinically anxious children, 121 were anxious and irritable; 109 were anxious but not irritable. Irritability levels were significantly higher in the clinically anxious children compared with the healthy controls. Children with anxiety disorders and irritability presented with greater severity and impairment across clinical phenomenology, psychosocial, and family domains relative to anxious children without irritability. Regression analysis findings were convergent in that greater severity and impairment across these same domains predicted higher irritability levels in the children with anxiety disorders. Results support the meaningful distinction between anxious children with and without irritability. Implications of the findings are discussed particularly in regard to assessment and treatment and future research directions are delineated.     

Predicting having a best friend in young children: individual characteristics and friendship features

In this study, the authors investigated the characteristics that predict best friend status in young children. One hundred and twenty-four preschool, kindergarten, and first-grade children identified their "best friend" and up to four "other friends" in their class. Teachers completed a questionnaire about each friendship to determine positive and negative features of the relationships. First, the authors used individual characteristics to predict if a child had a best friend. The variables age, gender, and peer acceptance predicted that a child would have a best friend. Second, positive friendship features positively predicted best friendships in analyses of all friendship pairs. Best friendships are meaningful relationships to children even at this young age and offer children more positive experiences than do other friendships.     

Parenting Attitudes and the Self-Esteem of Young Children

Second-, third-, fifth-, and sixth-grade children evaluated relationship qualities of a self-nominated friend and a self-nominated very best friend over a 6-month school year period. Results demonstrated that 76% of the friend relationships and 50% of the very best friend relationships were maintained over the course of the study. Children in maintained friendships evaluated their relationships more positively and also reported having larger friendship networks in general compared with children whose friendships did not endure over time. Thus those with unstable relationships are having difficulty initiating new friendships as well. For very best friends, positive relationship qualities (e.g., caring) did not change over time for children in maintained relationships, while positive relationship qualities decreased over time for children in nonmaintained relationships. Further, no differences emerged between children in maintained and nonmaintained very best friendships on perceptions of negative relationship qualities (e.g., conflict).