Researchers have clearly established that children with Attention-Deficit Hyperactivity Disorder (ADHD) tend to be socially rejected by their peer groups at school (e.g., Pelham & Bender, 1982
). Less is known about the close friendships of these children. Some theoretical (Sullivan, 1953
) and empirical (e.g., Newcomb & Bagwell, 1995
) writings have emphasized the specific importance of close friendship. Friendship is a voluntary bond co-created by two friends who expect to share intimate, mutually rewarding experience, with mutual commitment, support and validation of each other’s selves (Schneider et al, 1994
). Children and adolescents usually select friends who resemble themselves (e.g., Aboud & Mendelson, 1996
) and friendship skills are thought to prepare children and adolescents for intimate relationships as adults according to Sullivan’s (1953)
influential theory and some longitudinal data (Bagwell et al, 2001
). Having a close friend is also known to mitigate the consequences of being rejected by a larger peer group (Parker & Asher, 1993
) and is associated with important indicators of overall well-being (Newcomb & Bagwell, 1995
Researchers also have recently demonstrated that friendship problems – such as being friendless, having low-quality friendships, having short-lived or unstable friendships or having antisocial friends – often jeopardize children’s academic, behavioural and socio-emotional adjustment (for a review, see Rose & Asher, 2000
). Children with such friendship problems are more likely to experience difficulties in school (e.g., Ladd et al, 1996
), to engage in deviant behaviour (e.g., Vitaro et al, 1997
), to be victimized by bullies (e.g., Hodges et al, 1999
), and to feel lonely (e.g., Parker & Seal, 1996
) than children without friendship difficulties. Inattention, hyperactivity, and impulsivity, core features of ADHD, are likely to interfere with the communication skills needed to establish and consolidate any social relationship, and even more, a friendship. Given the potential deleterious influences that the core features of ADHD may have on children’s friendships and given the growing corpus of research demonstrating the adverse consequences of having friendship problems, a better understanding of ADHD children’s friendships is needed. The main objectives of this paper are to review current knowledge about the friendships of children with ADHD and to consider some implications for pharmacological treatments and peer-relations interventions.
The criteria children typically use in the selection of friends represent challenges for children with ADHD at all ages of development. However, cross-sectional studies indicate reasons for suspecting that ADHD may constitute a more formidable obstacle as children reach middle childhood and adolescence. The distractibility, hyperactivity and impulsivity of children with ADHD may affect their abilities to form and maintain friendships during the middle-childhood period. Although unconstrained, uninhibited behaviour may be well tolerated by kindergarteners (Mendelson et al, 1994
), this tolerance does not persist into the elementary-school years. The impulsivity of children with ADHD may result in displays of temper that are disliked by potential friends and may detract from their companions’ enjoyment of the time spent with them. They may attend insufficiently to the rules of games and to the wishes of their play partners regarding choice of activities.
The symptomatology of ADHD manifests itself differently as children reach adolescence (Barkley et al, 1990
). Impulsivity and hyperactivity may no longer be the primary obstacles to friendship, whereas inattentiveness may become a very substantial liability. In addition, inattention to the needs and feelings of the friend or potential friend may impede the reciprocity, sensitivity, conflict resolution and commitment that are required to form and maintain friendships. It is widely agreed that deficits in executive functions are evident in ADHD (for a review, see Barkley, 1997
). Executive functions are the processes that regulate an individual’s ability to organize thoughts and activities, prioritize tasks, manage time efficiently, and make decisions. Cognitive flexibility is the hallmark of these processes. Cognitive flexibility, as evidenced in the Wisconsin Card Sorting Task, has been shown to be associated with the ability to co-operate with peers by 7-year-old children (Bonino & Cattelino, 1999
). This suggests that, as friendship becomes increasingly dependent on cooperative behaviour as it does in middle childhood, children with ADHD may encounter increasing difficulties in maintaining friendships. This may also restrict them to making friends mainly with peers showing the same deficits.