Many children with Attention-Deficit/Hyperactivity Disorder suffer through a range of problems, from poor grades to poor relations with parents and teachers. But more than half of these children also have serious problems making friends. Too often they live lonely lives, never learning to develop the social skills they need to make friends as children or as adults.
"Children with ADHD often are peer-rejected, and their difficulties multiply as they grow to adulthood," said Amori Yee Mikami, assistant professor of psychology at the University of Virginia and principal investigator for a new clinical study designed to help children with ADHD become better at making friends.
"Children with ADHD often grow up with depression and relationship problems, some may develop criminal behavior and substance abuse problems," Mikami said. "There can be a spiral of failure that is partly the result of not having learned to make and keep friends as children."
About 5 percent of school-age children are affected by ADHD. Symptoms include a short attention span, poor organization, excessive talking, disruptive and aggressive behavior, restlessness and irritability. Children with ADHD often are uncooperative and may make their own rules.
"These symptoms get in the way of making and keeping friends," Mikami said. "The child with ADHD can become stigmatized, known as 'the bad kid,' and this can lead to more inappropriate behavior. It can become a vicious cycle resulting in more social isolation."
Treatment for ADHD usually involves medication and counseling designed to help the children improve their attention spans and control impulses. But little intervention is focused on helping children with ADHD to become better at developing and maintaining good relationships with their peers.
Mikami is working to change that. Through her new "Friendship Clinic," she is developing new methods to help parents help their children with ADHD improve social skills and develop positive behaviors. So far, the results are promising.
Parents and teachers are reporting that the children with ADHD who have participated in the intervention program are making friends more easily, are better behaved, and more willing to cooperate with peers.
"These skills are not easily taught," Mikami said. "Making friends is a proactive process that does not come naturally to children with ADHD. We really have to work closely with the parents and children to set the stage for life-long social skills."
Mikami's clinic offers children with ADHD and their parents an eight-week program involving weekly 90-minute parent group training sessions, three one-hour supervised playgroups and "homework" assignments designed to put into practice the techniques learned for making friends. The parents learn new skills as a group working with a therapist, helping each other in the process.
"We teach the parents how to be friendship coaches," Mikami said.
Parents in the program learn ways to help their children play cooperatively, how to settle social disputes, how to foster a relationship than can last. They learn to help the child pick the right playmate, they learn to structure time for positive activities and to intervene in a positive way when problems develop. Several play dates are arranged to allow Mikami and her colleagues to assess the effectiveness of the training, to see the work in practice.
"We help the parents build a relationship with their child," Mikami said. "We do some role-playing, where the parent steps into the role of the child, to try to understand the world from the child's point of view."
One parent who participated in the treatment group, Stephanie Shelton, said her son Brandon and her entire family have benefited from the program.
"I came to know other people who are dealing with the same issues of having a child with ADHD," she said. "It meant we didn't have to deal with this alone. We had a focus group that positively helped us work through issues."
The techniques Shelton learned, such as "active listening," have made her personal time with her son a rich experience. "We look forward to our time together," she said. "And his teacher said she has seen a tenfold improvement in his social skills."
Mikami recently worked with two groups in her study: the "treatment" group, which received training, and a control group of children with ADHD who did not receive training. She is comparing the outcomes of the two groups and is finding that the treatment group children are exhibiting a marked improvement over the ADHD group that did not receive treatment.
The families in the study, from both groups, represent a range of income and education levels and both genders. So far Mikami has worked with 20 families, 10 from each group, and she is planning another phase of the study.
"The idea is to help them when they're young, so they may have a lifetime of successful relationships, the kind of positive experiences that will carry over into everything they do," she said.