Perceived social acceptance and peer status differentially predict adjustment in youth with and without ADHD

Research Review: Social cognition and everyday social skills in children and adolescents with attention-deficit/hyperactivity disorder: a meta-analysis of case-control studies

BACKGROUND

Previous studies that have assessed social cognition in Attention-Deficit/Hyperactivity Disorder (ADHD) have produced inconsistent findings. To summarize these data and shed light upon moderators that may explain observed inconsistencies, we conducted a systematic review and meta-analysis exploring social cognition (Theory of Mind (ToM), Empathy, Facial and Non-Facial Emotion Recognition) and Everyday Social Skills in children and adolescents with ADHD.

METHODS

The current meta-analysis involved 142 studies including 652 effect sizes. These studies compared children and adolescents with ADHD (n = 8,300) and with typical development (n = 7,983).

RESULTS

Participants with ADHD exhibited moderate to very large deficits in ToM (SMD = 0.84, 95% CI = 0.68-0.99), Facial Emotion Recognition (SMD = 0.63, 95% CI = 0.46-0.81), and Everyday Social Skills (SMD = 1.23, 95% CI = 1.08-1.37). The magnitude of these impairments was similar when considering effect sizes adjusted for some covariates and the methodological quality of the studies. Few studies have investigated Empathy and Non-Facial Emotion Recognition, which precludes definitive conclusions.

CONCLUSIONS

Children and adolescents with ADHD experience robust impairments in ToM, Facial Emotion Recognition and Everyday Social Skills. Future studies should explore whether these deficits are a consequence of difficulties in other areas of cognition (e.g., executive functioning). We have made all our raw data open access to facilitate the use of the present work by the community (e.g., clinicians looking for tools, assessing social impairments, or researchers designing new studies).

Peer-Based Intervention for Socioemotional Concerns Among Children with ADHD

This study examined the potential benefits of peer-based dyadic interventions for improving the socioemotional functioning of children with ADHD. Participants included children ages 8-12 diagnosed with ADHD-combined type (n = 34) pooled from a larger randomized study comparing peer-based dyadic interventions. Self-concept and depressive symptoms were evaluated at pre- and post-treatment using single group design. Results showed significantly positive child responses to intervention for self-concept. Further, improvements in self-concept were not moderated by the type of dyadic intervention received or by treatment related changes in externalizing behaviors. The severity of reported depressive symptoms, however, did not significantly change. This suggests therapeutic interaction with peers, as demonstrated in peer-based dyadic intervention models, can improve self-concept in children with ADHD even when socioemotional concerns are not a primary target of treatment and independent of behavioral outcomes achieved. These preliminary findings support promoting prosocial peer behavior as a critical domain for ADHD intervention for children.

Risk Factors for Depression in Adolescents With ADHD: The Impact of Cognitive Biases and Stress

Objective: Youth diagnosed with ADHD are at heightened risk of depression. However, many do not develop depression. Individuals with specific cognitive biases are more likely to develop depression yet it remains untested whether these vulnerability-stress models apply to depression risk in youth with ADHD. Method: We examined whether interpretation and attention biases moderated the relation between stressful life events and depressive symptoms in a sample of adolescents (M_age = 14.42) with ADHD (n = 59) and without ADHD (n = 36). Results: Youth with ADHD experienced more stressful life events compared with those without ADHD. Interpretation biases moderated the association between stress and depressive symptoms in youth with and without ADHD. Attention biases moderated the association between stress and depressive symptoms in the non-ADHD youth only. Conclusion: These results enhance our understanding of vulnerability for depression in adolescence with ADHD and inform targeted prevention and treatment models during this critical developmental juncture.

Does Positive Illusory Bias Affect Self-Concept and Loneliness in Children With Symptoms of ADHD?

Objective: Positive illusory bias (PIB) has been amply studied in children with ADHD, but its function is still limited understanding. Method: In a sample of 21 children with symptoms of ADHD, this study investigated whether they were more likely to be rejected by peers and examined PIB, and its influence on self-concept and loneliness, comparing the children with symptoms of ADHD with children who had weak social skills, but no ADHD. The children's and teachers' perception of social difficulties were compared, and self-concept and loneliness were analyzed in the two groups, which were also compared with typically developing (TD) children. Results: The results showed the presence of PIB on social skills in children with symptoms of ADHD, but this phenomenon did not give them a higher self-concept, which was similar to that of children with weak social skills and lower than in TD children. Conclusion: The implications of these findings are discussed.

Do Children with Autism Spectrum Disorder Understand Their Academic Competencies?

Research suggests that individuals with autism spectrum disorder (ASD) are unaware of their competencies in many domains. The current study examines whether self-perception of academic competency differs in children with ASD compared to typically-developing (TD) controls and whether estimations change after providing feedback. Sixty participants, 10-15 years of age, completed academic tasks and were asked to predict their performance before and after each task. The ASD group overestimated their performance compared to the TD group except when provided with feedback. The ASD group was significantly more accurate with their perceptions when receiving feedback, which suggests that they are able to process concrete feedback. Future research should attempt to understand the underlying mechanisms and functions of this bias.

Interpersonal Perceptions of Adverse Peer Experiences in First-Grade Students

Aim: The aim of this study was to identify which adverse peer experiences better predict perceived negative peer relationships among elementary school first graders according to sex. The peer experiences examined were peer rejection, peer victimization, and mutual antipathy; the interpersonal perceptions studied were perceived peer victimization, dyadic meta-perception of peer disliking, and loneliness. Methods: The participants were 809 children (Mage = 6.4 years, SD = 0.32; ngirls = 412, 50.9%) enrolled in 35 first-grade classes from 15 schools in 4 Spanish regions: Valencia, n = 276, 34.1%; Balearic Islands, n = 140, 17.3%; Andalusia, n = 199, 24.6%; Castile-Leon, n = 194, 24%. We calculated sex differences in peer experiences and interpersonal perceptions by means of one-way ANOVA for means differences and Fisher's r-to-z transformation for correlations differences. We used a multilevel regression analysis (nesting variables: class and region) to determine whether the associations between each peer experiences and each perception were unique. Results: Each adverse peer relationship predicted each interpersonal perception differentially. Peer victimization was a good predictor of the three interpersonal perceptions, and the only predictor of perceived peer victimization. Peer rejection predicted loneliness, whereas mutual antipathies predicted dyadic meta-perception of peer disliking, although more so among girls. A significant effect at region level was found but not at class level. Conclusion: Our findings suggest that research should take into account the different levels of the social peer system when analyzing peer experiences within the classroom context. The study contributes to sensitize teachers about the greater responsiveness of 6-year-old girls to adverse peer experiences, and it could be useful for designing interventions that would help children oppose rejection and empower active bystanders to fight against peer mistreatment.

Peer Rejection and Perceived Quality of Relations With Schoolmates Among Children With ADHD

OBJECTIVE

The main aim of the current study was to investigate the links between ADHD diagnosis and the objective and subjective dimensions of social relationships among children from primary schools.

METHOD

We used the data from 36 regular classrooms, consisting of 718 students, with each containing at least one child with an established clinical diagnosis of ADHD (38 children).

RESULTS

For children with ADHD, the level of the perceived quality of social relations was lower than that of children without such a diagnosis. After controlling for sociometric status, the impact of ADHD on perceived status proved to be statistically nonsignificant but the indirect impact of ADHD on this status through sociometric status was statistically significant.

CONCLUSION

Children diagnosed with ADHD are more often rejected by their peers and have a more pessimistic view of their social world. Moreover, ADHD diagnosis does not have a direct influence on the perceived quality of social relations otherwise than through sociometric status.

Trajectories of Global Self-Worth in Adolescents with ADHD: Associations with Academic, Emotional, and Social Outcomes

Resilience models suggest that there are likely to be multiple trajectories of self-worth and that despite experiencing impairment, some youth with attention deficit/hyperactivity disorder (ADHD) may maintain a positive self-worth, which could buffer them against negative outcomes. The present study used a cohort-sequential longitudinal design to evaluate developmental trajectories of global self-worth in a sample of 324 middle-school-age adolescents (71% male) diagnosed with ADHD between ages 11 and 14 in predicting outcomes at age 15. Sex, medication status, and ADHD/oppositional defiant disorder symptom severity were included as covariates in the models. Using growth mixture modeling, 3 distinct self-worth trajectory groups were identified: (a) high and increasing (44.4% of participants), (b) moderate and decreasing (48.8%), and (c) low and decreasing (6.8%). Participants with high and increasing global self-worth were less likely to exhibit co-occurring depressive symptoms and had better social functioning and higher grades at age 15 relative to those in either decreasing trajectory. Implications of these findings for monitoring and supporting positive global self-worth for adolescents with ADHD are discussed.

What Predicts a Good Adolescent to Adult Transition in ADHD? The Role of Self-Reported Resilience

OBJECTIVE

ADHD is a disorder associated with impairment and comorbid psychiatric problems in young adulthood; therefore, factors that may imply a more favorable outcome among adolescents with ADHD are of interest.

METHOD

This study used a longitudinal design to assess whether adolescent personal resilience characteristics during adolescence protected against psychosocial impairment, depression, and anxiety 3 years later. Self-reported protective factors were used as baseline measures in the assessment of 190 clinically referred adolescents with ADHD. A semi-structured diagnostic interview was performed at the follow-up.

RESULTS

In a group of youth with ADHD, personal resilience characteristics were associated with better psychosocial functioning in young adulthood, and less depression and anxiety.

CONCLUSION

Although further research is needed, these results indicate that personal resilience characteristics may be protective factors in the transitional period from adolescence to early adulthood.

A Review of Factors that Promote Resilience in Youth with ADHD and ADHD Symptoms

The vast majority of research on youth with ADHD has focused on risk factors and describing the types of impairment individuals with ADHD experience. However, functional outcomes associated with ADHD are heterogeneous, and although many youth with ADHD experience significant negative outcomes (e.g., school dropout), some are successful in multiple domains of functioning (e.g., pursue and graduate college). There is a growing body of literature supporting the existence of factors that protect youth with ADHD from experiencing negative outcomes, but there is no published synthesis of this literature. Accordingly, the goals of this review are to conceptualize risk-resilience in the context of ADHD using a developmental psychopathology framework and to systematically review and critique evidence for promotive and protective factors in the context of ADHD. The literature search focused specifically on resilience in the context of ADHD symptoms or an ADHD diagnosis and identified 21 studies, including clinic, school, and community samples. Findings of promotive and/or protective factors are summarized across individual, family, and social-community systems. Overall, we know very little of the buffering processes for these youth, given that the study of promotive and protective factors in ADHD is in its infancy. The strongest evidence to date was found for social- and family-level systems. Specifically, multiple longitudinal studies support social acceptance as a protective factor, buffering against negative outcomes such as poor academic performance and comorbid depressive symptoms for youth with ADHD. There was also compelling evidence supporting positive parenting as a promotive factor. In terms of individual-level factors, positive or modest self-perceptions of competence were identified as a promotive factor in multiple studies. Future directions for research that will catalyze the study of resilience with ADHD are provided, and the potential for targeting protective mechanisms with intervention and prevention is discussed.

Examination of the Effects of Intelligence on the Test of Variables of Attention for Elementary Students

OBJECTIVE

To examine the performance differences on the Test of Variables of Attention (TOVA) among different IQ level groups.

METHOD

The present study examined the results of the TOVA with 138 elementary students aged 6 to 10 years who were assigned to one of four different groups based on their scores from the Wechsler Nonverbal Scale of Ability (WNV; low average: IQ < 90, average: IQ between 90 and 109, high average: IQ between 110 and 119, superior: IQ between 120 and 129, and very superior: IQ > 129). The latter two groups were combined.

RESULTS

On all TOVA measures (response time, response time variability, errors of omission and commission, and ADHD scores), intellectual functioning significantly influenced performance.

CONCLUSION

The results of the present study indicate that performance on the TOVA was affected by intellectual functioning.

Psychotherapy for Adolescents With Attention-Deficit Hyperactivity Disorder: A Pediatrician's Guide

Attention-deficit hyperactivity disorder (ADHD) presents with high levels of inattention, impulsiveness, and hyperactivity. ADHD starts in childhood and results in impairments that continue into adulthood. ADHD symptoms lead to decreased functionality in various life domains and result in poor academics, behavioral challenges, delayed independence, and strained relationships. Despite advances in diagnosis and treatment, persistent residual symptoms are common, highlighting the need for novel treatment strategies. This article aims to provide a review of the psychotherapeutic interventions available for teens that receive pharmacotherapy but continue to struggle with the residual symptoms of ADHD that interfere with academic function, relationship formation, and psychological development.

Self-perceived competence and social acceptance of young children who stutter: Initial findings

PURPOSE

The goals of this study were to determine whether young children who stutter (CWS) perceive their own competence and social acceptance differently than young children who do not stutter (CWNS), and to identify the predictors of perceived competence and social acceptance in young speakers.

METHOD

We administered the Pictorial Scale of Perceived Competence and Social Acceptance for Young Children (PSPCSA; Harter & Pike, 1984) to 13 CWS and 14 CWNS and examined group differences. We also collected information on the children's genders, temperaments, stuttering frequencies, language abilities, and phonological skills to identify which of these factors predicted PSPCSA scores.

RESULTS

CWS, as a group, did not differ from CWNS in their perceived general competence or social acceptance. Gender predicted scores of perceived general competence, and stuttering frequency predicted perceived social acceptance. Temperament, language abilities, and phonological skills were not significant predictors of perceived competence or social acceptance in our sample.

CONCLUSIONS

While CWS did not significantly differ from CWNS in terms of perceived competence and social acceptance, when both talker groups were considered together, girls self-reported greater perceived competence than boys. Further, lower stuttering frequency was associated with greater perceived social acceptance. These preliminary findings provide motivation for further empirical study of the psychosocial components of childhood stuttering.

LEARNING OUTCOMES

Readers will be able to describe the constructs of perceived competence and social acceptance in young children, and whether early stuttering plays a role in the development of these constructs.

Meta-analysis of social cognition in attention-deficit/hyperactivity disorder (ADHD): comparison with healthy controls and autistic spectrum disorder

BACKGROUND

Impairment in social cognition is an established finding in autism spectrum disorders (ASD). Emerging evidence suggests that attention-deficit/hyperactivity disorder (ADHD) might be also associated with deficits in theory of mind (ToM) and emotion recognition. However, there are inconsistent findings, and it has been debatable whether such deficits persist beyond childhood and how similar social cognitive deficits are in ADHD v. ASD.

METHOD

We conducted a meta-analysis of social cognition, including emotion recognition and ToM, studies in ADHD compared with healthy controls and ASD. The current meta-analysis involved 44 studies comparing ADHD (n = 1999) with healthy controls (n = 1725) and 17 studies comparing ADHD (n = 772) with ASD (n = 710).

RESULTS

Facial and vocal emotion recognition (d = 0.40-0.44) and ToM (d = 0.43) abilities were significantly impaired in ADHD. The most robust facial emotion recognition deficits were evident in anger and fear. Social cognitive deficits were either very subtle (emotion recognition) or non-significant (ToM) in adults with ADHD. Deficits in social cognition, especially ToM, were significantly more pronounced in ASD compared with ADHD. General cognitive impairment has contributed to social cognitive deficits in ADHD.

CONCLUSIONS

Performance of individuals with ADHD on social cognition lies intermediate between ASD and healthy controls. However, developmental trajectories of social cognition probably differ between ADHD and ASD as social cognitive deficits in ADHD might be improving with age in most individuals. There is a need for studies investigating a potential subtype of ADHD with persistent social cognitive deficits and exploring longitudinal changes in social cognition during development.

School-related social support and subjective well-being in school among adolescents: The role of self-system factors

This 6-week longitudinal study aimed to examine a moderated mediation model that may explain the link between school-related social support (i.e., teacher support and classmate support) and optimal subjective well-being in school among adolescents (n = 1316). Analyses confirmed the hypothesized model that scholastic competence partially mediated the relations between school-related social support and subjective well-being in school, and social acceptance moderated the mediation process in the school-related social support--> subjective well-being in school path and in the scholastic competence--> subjective well-being in school path. The findings suggested that both social contextual factors (e.g., school-related social support) and self-system factors (e.g., scholastic competence and social acceptance) are crucial for adolescents' optimal subjective well-being in school. Limitations and practical applications of the study were discussed.

Improved quality of life among adolescents with attention-deficit/hyperactivity disorder is mediated by protective factors: a cross sectional survey

BACKGROUND

The aim of this study was to assess the role of protective factors as mediators and/or moderators of the relationship between coexisting emotional and conduct problems and quality of life (QoL) among adolescents with attention-deficit/hyperactivity disorder (ADHD).

METHODS

The sample consisted of 194 adolescents with ADHD. Participants completed measures of individual competencies, family cohesion and social support, and QoL. Coexisting emotional and conduct problems were assessed using the Strength and Difficulties Questionnaire.

RESULTS

Individual competencies and social support mediated the association between emotional and conduct problems and QoL. Family cohesion was associated with both emotional and conduct problems. No moderating effects of protective factors and coexisting problems were found.

CONCLUSIONS

The assessment of individual competencies, social resources, and family cohesion may identify potential treatment goals for adolescents with ADHD and coexisting problems, and may contribute to improvements in QoL.

Emotion dysregulation in attention deficit hyperactivity disorder

Although it has long been recognized that many individuals with attention deficit hyperactivity disorder (ADHD) also have difficulties with emotion regulation, no consensus has been reached on how to conceptualize this clinically challenging domain. The authors examine the current literature using both quantitative and qualitative methods. Three key findings emerge. First, emotion dysregulation is prevalent in ADHD throughout the lifespan and is a major contributor to impairment. Second, emotion dysregulation in ADHD may arise from deficits in orienting toward, recognizing, and/or allocating attention to emotional stimuli; these deficits implicate dysfunction within a striato-amygdalo-medial prefrontal cortical network. Third, while current treatments for ADHD often also ameliorate emotion dysregulation, a focus on this combination of symptoms reframes clinical questions and could stimulate novel therapeutic approaches. The authors then consider three models to explain the overlap between emotion dysregulation and ADHD: emotion dysregulation and ADHD are correlated but distinct dimensions; emotion dysregulation is a core diagnostic feature of ADHD; and the combination constitutes a nosological entity distinct from both ADHD and emotion dysregulation alone. The differing predictions from each model can guide research on the much-neglected population of patients with ADHD and emotion dysregulation.

Does childhood positive self-perceptual bias mediate adolescent risky behavior in youth from the MTA study?

OBJECTIVE

This study's primary aim was to examine whether the positive self-perceptual bias present in many youth with attention-deficit/hyperactivity disorder (ADHD; Hoza et al., 2004; Hoza, Pelham, Dobbs, Owens, & Pillow, 2002) mediates the relation of childhood ADHD status to later risky behaviors.

METHOD

Using a subset of children with ADHD and comparison children (n = 645) from the Multimodal Treatment Study of Children With ADHD, we predicted that a positive bias in childhood would partially or fully mediate the relation between having ADHD and risky driving and sexual behaviors 8 years later.

RESULTS

Results strongly supported this hypothesis for risky driving behavior but only provided limited support for risky sexual behavior.

CONCLUSIONS

Taken together, findings suggest that future research should explore whether self-perceptual bias may be a useful target of intervention for children with ADHD.