Observed Free-Play Patterns of Children with ADHD and Their Real-Life Friends

Prenatal allergic inflammation in rats confers sex-specific alterations to oxytocin and vasopressin innervation in social brain regions

Prenatal exposure to inflammation via maternal infection, allergy, or autoimmunity increases one's risk for developing neurodevelopmental and psychiatric disorders. Many of these disorders are associated with altered social behavior, yet the mechanisms underlying inflammation-induced social impairment remain unknown. We previously found that a rat model of acute allergic maternal immune activation (MIA) produced deficits like those found in MIA-linked disorders, including impairments in juvenile social play behavior. The neuropeptides oxytocin (OT) and arginine vasopressin (AVP) regulate social behavior, including juvenile social play, across mammalian species. OT and AVP are also implicated in neuropsychiatric disorders characterized by social impairment, making them good candidate regulators of social deficits after MIA. We profiled how acute prenatal exposure to allergic MIA changed OT and AVP innervation in several brain regions important for social behavior in juvenile male and female rat offspring. We also assessed whether MIA altered additional behavioral phenotypes related to sociality and anxiety. We found that allergic MIA increased OT and AVP fiber immunoreactivity in the medial amygdala and had sex-specific effects in the nucleus accumbens, bed nucleus of the stria terminalis, and lateral hypothalamic area. We also found that MIA reduced ultrasonic vocalizations in neonates and increased the stereotypical nature of self-grooming behavior. Overall, these findings suggest that there may be sex-specific mechanisms underlying MIA-induced behavioral impairment and underscore OT and AVP as ideal candidates for future mechanistic studies.

The friendships of children and youth with attention-deficit hyperactivity disorder: A systematic review

BACKGROUND

Children with attention-deficit hyperactivity disorder (ADHD) experience substantial difficulty maintaining meaningful friendships, which has implications for social functioning and mental health. No systematic review has investigated their friendship difficulties.

OBJECTIVES

To systematically review and methodologically appraise the quality of existing studies reporting on friendships of children with ADHD. To compare their friendships to typically-developing children, and examine associations between friendship and children's social-emotional wellbeing and mental health.

METHOD

Six databases were searched. The methodological quality of studies was assessed using the QualSyst appraisal tool and the Appraisal tool for Cross-Sectional Studies. Aspects of friendships measured were charted, along with comparisons between children with ADHD and typically-developing children and the associations between friendships and social-emotional wellbeing and mental health.

RESULTS

Twenty-three cross-sectional studies and one longitudinal follow-up study were included. Studies included 1509 participants with ADHD, with 1197 typically-developing participants used as a companion in 19 of the 24 studies. Friendship quantity was the most investigated aspect of friendship. Children and youth with ADHD had significantly fewer friends, lower quality friendships and poorer friendship interactions. There were mixed findings from studies investigating the role or impact of friendship on social-emotional wellbeing and mental health. Twenty-two had strong methodological quality.

CONCLUSION

Limited longitudinal studies, small sample sizes and variability in measurement restrict the interpretations of friendship over time and the causal impact of friendship on social and emotional outcomes. Further research should investigate the role and impact of friendships on the social-emotional wellbeing of children and youth with ADHD.

Contributions of Friends' Problem Behaviors to Friendship Quality in a Sample of Children with ADHD

OBJECTIVE

It is often assumed that children with attention-deficit/hyperactivity disorder (ADHD) experience friendship difficulties because of their own problem behaviors. However, friendships are dyadic relationships between two children. This study sought to understand the incremental contributions of friends' problem behaviors to dyadic friendship quality in a clinically diagnosed sample of children with ADHD.

METHOD

One hundred and sixty-five dyads consisting of a target child with ADHD and social impairment (age 6-11; 67% male; 72% white) and a reciprocated, real-life friend were recruited. Parents and teachers rated the ADHD symptom severity, externalizing problems, and callous-unemotional (CU) traits of target children and friends. Friendship quality in the dyad was measured with: (a) questionnaires independently completed by target children, their parents, their friends, and the parents of their friends; and (b) observations of child-friend interactions.

RESULTS

The severity of ADHD symptoms and externalizing problems (but not CU traits) in target children was associated with more negative friendship quality reported on questionnaires. Adjusting for the corresponding problem behavior in target children, each type of friends' problem behaviors incrementally predicted less positive friendship quality (on questionnaires). Friends' ADHD symptoms and CU traits also incrementally predicted more negative friendship quality (on questionnaires and observations).

CONCLUSIONS

Considering problem behaviors in friends of children with ADHD (in addition to those in children with ADHD) may be important for identifying dyads at risk for lower quality friendships. These findings could possibly lead to new directions when designing and evaluating treatments targeting the friendship problems of children with ADHD.

Assessment of Social Self-perceptions of Acceptance and Enmity in Children with Attention-Deficit/Hyperactivity Disorder

This study analyzes the self-perceptions of social competence in children with attention-deficit/hyperactivity disorder (ADHD). It compares two groups of participants, children with ADHD ( N = 20) and children without ADHD ( N = 20) ages between 8 and 12 years old. Sociometric questionnaires were completed by two groups of participants and 707 peers, as well as a questionnaire that evaluates children’s behavior from parents’ and teachers’ perspectives. Results indicate that children with ADHD correctly perceive enmity, but incorrectly perceive friendship. Children with ADHD have low rates of positive reciprocity and qualities that indicate friendship differs considerably from the children without ADHD. The children with ADHD have a different profile of social self-perception than children without ADHD, especially regarding recognizing friendship. The results contribute to the understanding of perceptions of elements of peer relationship and friendships with strong ecological validity. This small scale study provides a proof of concept for improving ecological validity in the methods of evaluating social skills and social emotion learning programming for children with ADHD.

Prioritising Targets for School-Based ADHD Interventions: A Delphi Survey

Many studies have investigated the effectiveness of school-based ADHD interventions at modifying different social, emotional and behavioural target outcomes. However, there is a lack of evidence about which targets stakeholders perceive to be most important. This study sought to obtain consensus on which outcomes are perceived to be most important. A total of 114 people with ADHD, educational professionals, parents of children with ADHD, clinicians and researchers participated in a Delphi survey with 3 rounds. The importance of 52 intervention targets was rated on a scale from 0 to 8 (8 being extremely important). Consensus was reached if >70% of a stakeholder group rated a target as between 6–8 and <15% rated it as 0–2. Targets were dropped from subsequent rounds if more than 50% of stakeholder groups rated it as 0–5. Targets that all four stakeholder groups reached consensus on in any round were automatically included in our final outcome set. Comments were analysed using Thematic Analysis. All four stakeholder groups reached consensus on the importance of seven targets: ability to pay attention, conflict with teachers and peers, executive functioning, global functioning and quality of life, inattention symptoms, organisation skills and self-esteem. Four overarching themes were identified: Complexity of ADHD, Relationships, School Context, and What ADHD means to me. School-based ADHD interventions should target outcomes identified as most important to those who stand to benefit from such interventions. Some outcomes prioritised by our participants have not yet been targeted in school-based ADHD interventions. Implications of our findings for intervention and research design are discussed.

Can We Play Together? A Closer Look at the Peers of a Peer-Mediated Intervention to Improve Play in Children with Autism Spectrum Disorder

Peer-mediated interventions (PMIs) are often used to support children with autism spectrum disorder (ASD) to develop social skills. However, more investigation is needed to better understand the role of peers as both intervention recipients and models. Sixty-five typically developing peers who participated in a PMI for children with ASD were investigated using a randomised control trial. Play sessions of the dyads were scored using the Test of Playfulness. Results showed a significant moderate intervention effect for the peers from pre- to post-intervention; outcomes for children with ASD were not influenced by peer characteristics; and, the children demonstrated a similar pattern of play interaction. Implications for practice are discussed.Clinical Trials Registry Australian New Zealand Clinical Trials Registry, https://www.anzctr.org.au/ (ACTRN12615000008527; Universal Trial Number: U1111-1165-2708).