Attention Magazine April 2021

“Your son is getting better at turning in his homework,” said Spencer’s fourth grade teacher. “However, the other students don’t want to sit at his table. I notice that at recess he is often alone, and I worry about him socially.” Spencer’s parents reflect on this statement. Indeed, they have noticed that invitations to birthday parties and playdates stopped around two years ago. Recently, Spencer has said that he doesn’t want to go to school because the other kids are stupid and mean.

For many parents of children with ADHD, this is a familiar scene. Problems getting along with peers, and with making and keeping friends, affect more than half of children with ADHD. These peer problems can hurt, and lead children to dislike school and to feel sad or angry, especially when the problems go on year after year. Medication for ADHD and behavioral management are often more useful for treating other aspects of the disorder—like homework time or morning routine—but less helpful for improving peer relationships.

Because families have shared experiences like this with us, our research team has been working on a specialized approach that helps parents to be friendship coaches for their children with ADHD. There are three main recommendations that we give, and we suggest that parents follow them in this order because each recommendation builds on the one before.

1. First, show your child that you are on the same team.
   Do you ever give your child guidance, and find that even if you are only trying to help, your child puts up a brick wall and gets defensive? It is natural for children with ADHD to feel attacked when their parents give them advice, so it may help to actively work to build a good alliance before you try to be a friendship coach. Try having a special time with your child where you take interest in things that your child likes to do, without teaching or correcting your child. One parent let her child explain the game Fortnite to her during this special time. Her child was overjoyed; the parent, less so, but she enjoyed her child’s reaction. Also, try noticing a genuine, special thing that you like about your child each day, and letting your child know what that is. For example, another parent left a daily note for her child with something that she valued about her child, like her child’s kindness to animals.
2. Next, practice friendship skills with your child at home.
   Just like any other skill, being a good friend takes repeated practice to learn. Many children with ADHD are poor at friendship skills, so they have few friends as a result. However, this means that they lose natural opportunities to practice friendship skills and can fall further behind in this area over time. Parents can help by having a family game night where children practice social skills that are important for friendships, but that are often lacking in children with ADHD. Some examples of skills are: good sportsmanship, turn taking, staying calm when things don’t go your way, finishing the activities you start, and following game rules. Keep the practice fun and have patience with yourself and your child in the learning process! Frequent mistakes and setbacks are normal. This is why it is good to practice these friendship skills at home before your child tries them out with peers.
3. Finally, network with other families to identify and foster friendships for your child.
   While doing drop-off or pick-up, or at school events, take the time to meet other parents. Look for children who might be a good friendship match for your child, because the two of them like to do the same things and are nice to each other. Sometimes parents are uncomfortable with this type of networking because they feel embarrassed about their child’s behavior problems. A good support system, perhaps including other parents of children with ADHD, has helped some families we know to feel less stigma. When you find a good potential friend for your child, think about if your child has made progress with friendship skills at home and is ready to try them out with this peer. When the time is right, create some opportunities for the two children to get together, such as by arranging playdates, and remind your child to show the friendship skills that you have been practicing.

A focused approach to friendship problems

Our research team has been testing these tips in a program called Parental Friendship Coaching (PFC), which was created for families of children with ADHD ages 6-11. PFC contains ten once-per-week parent group sessions with a clinician, and there is no child treatment component.

We recently finished a study that involved 172 families, who were randomly assigned to receive the PFC program or to receive another program that provided psychoeducation and social support about ADHD and friendship difficulties. We found that children’s friendships tended to improve over the treatment period, and eight months after treatment ended, no matter which of the two treatments they received. However, PFC may have been slightly more helpful for children than the psychoeducation and social support program, especially if the children had co-occurring problems with oppositional behavior and aggression. It also seemed that families benefitted more from PFC if they had already tried other psychosocial treatments before. We think this might be because these families are ready to undertake the focused approach to friendship problems that is in PFC.

The peer problems of children with ADHD can be difficult to change, but parents are in a good position to be able to help. The idea also is that parents will not have to do these intensive friendship coaching efforts forever. Once children make some good friends, then the friendships will provide a natural and reinforcing context for children’s friendship skills to grow, and parents can be less involved.

Amori Yee Mikami, PhD, is a professor of psychology at University of British Columbia, Canada, where her research focuses on peer relationships among children and adolescents with ADHD. Her lab has been working on developing interventions that harness the power of parent and teacher influences on children’s peer difficulties. In addition, she has a line of research about adolescents’ peer interactions on social media.

ADDITIONAL READING
Gardner, D. M., & Gerdes, A. C. (2015). A review of peer relationships and friendships in youth with ADHD. Journal of Attention Disorders, 19(10), 844-855. https://doi.org/10.1177/1087054713501552

Hoza, B. (2007). Peer functioning in children with ADHD. Ambulatory Pediatrics, 7(1, Supplement), 101-106. https://doi.org/10.1016/j.ambp.2006.04.011

Mikami, A.Y., Normand, S., Hudec, K.L., Guiet, J., Na, J.J., Smit, S., Khalis, A., & Maisonneuve, M.-F. (in press). Treatment of friendship problems in children with Attention-Deficit/Hyperactivity Disorder: Initial results from a randomized clinical trial. Journal of Consulting and Clinical Psychology.

Mikami, A.Y., Smit, S., & Khalis, A. (2017). Social skills training and ADHD: What works? Current Psychiatry Reports, 19 (2), 93. https://doi.org/10.1007/s11920-017-0850-2

Normand, S., Schneider, B., Lee, M., Maisonneuve, M.-F., Kuehn, S., & Robaey, P. (2011). How do children with ADHD (mis)manage their real-life dyadic friendships? A multi-method investigation. Journal of Abnormal Child Psychology, 39(2), 293-305. https://doi.org/10.1007/s10802-010-9450-x