This is the second in a three-part series on ADHD and social development. You can find Part 1 here.
The child who is struggling socially may be reluctant to discuss this difficulty. They may be confused about why peers and siblings seem to navigate friendships with ease. They may feel they are doing their very best but still find themselves isolated. Bullying and scapegoating in the school environment may erode their self-esteem, sense of confidence, and hopefulness. This may lead to isolation, withdrawal, defensiveness, shame or, in more severe cases, depression and anxiety. The child may be asking themselves, “why can’t I make friends?” or, “am I the problem?”
These painful feelings can make it difficult to initiate play confidently, to address and work through conflicts effectively, and to communicate and respect boundaries. We are not at our best when we are isolated or distressed – it becomes difficult to apply solutions creatively and effectively. If difficulties persist, the child may come to the attention of teachers, school staff, parents, and family members.
A common starting point to address this problem is to teach the child specific social skills. Adults may encourage the child to participate in social skills training with the support of school staff or an outside therapist. Some children will refuse intervention. They may feel the problem is located outside of them. They may overestimate their skills in vulnerable areas (a phenomenon in ADHD research known as the “positive illusory bias”). They may feel skeptical that skills training will actually help them. Many children with ADHD receive numerous negative and critical messages about their social skills. By the time interventions are offered, the child may be concerned that intervention will just consist of yet another adult misunderstanding and correcting them.
However, some children are open to this support and may participate wholeheartedly. In these instances, they may proceed by learning about common social interactions and dilemmas and the phrases and strategies they can use to navigate them. Interventions may make use of social stories or peer groups to provide opportunities for the child to apply skills. The intervention may be time-limited, or the child may show mastery of skills by completing a test or activities to satisfaction.
Teaching to the Test
The motivated child may approach social skills interventions in the same way they approach classroom work. Education often focuses on mastery of specific skills and standardized tests are a common measure of a child’s proficiency. So the child completes the activities, studies the social stories, and demonstrates their newfound knowledge in a posttest. In fact, this is how many research studies of social skills interventions are conducted. When posttest scores are higher than pretest scores, the child is thought to improve, and the intervention is thought to be evidence-based.
But what if the child with ADHD does not improve? While interventions such as Social Skills Training (SST) have much to recommend them, research suggests that they do not lead to lasting changes in the child’s peer relationships and standing as observed by parents and teachers. If we put ourselves in the shoes of the child with ADHD who is floundering socially, who has taken the risk of receiving instruction, and who still struggles with friendships, we can begin to empathize with their confusion. Imagine the child who says of a math test, “we didn’t learn anything on the test! It was so unfair!” It may be that the child learned skills but was unable to apply them on the test.
A similar problem presents with social skills training. Children with ADHD have greater difficulty generalizing – or applying skills they learn in new settings. Additionally, social impairment in ADHD does not always result from a lack of knowledge but, more often, from difficulty applying that knowledge. To put it more plainly, many of us are able to choose a good course of action when the other person’s behavior isn’t upsetting us. But when the child is upset, it becomes difficult to apply skills effectively. In the worst case, the child who completes an intervention but does not show social improvement may feel further isolated, more confused, and more reluctant to seek support in the future.
Any treatment that aims to help a child thrive socially must also help them to generalize skills and apply them in settings beyond the treatment room. Bottom line, it must lead to greater satisfaction in their social relationships. In Part 3, I’ll discuss the advantages of a psychodynamic approach in helping children with ADHD to thrive socially.