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Attention-Deficit/Hyperactivity Disorder and the Challenges of Social Exclusion

Abstract and Keywords

Attention-Deficit/Hyperactivity Disorder (ADHD) is a prevalent diagnosis among school-age children and symptoms frequently persist into adolescence and adulthood. This chapter describes the high levels of social exclusion faced by individuals with ADHD. Distinctions are made between children and adults with this disorder, as well as between males and females, when possible. In addition, ways in which ADHD subtype and comorbidity impact social relationships are also considered. Reasons why individuals with ADHD tend to be excluded by their peers, and the effectiveness of existing interventions for social problems in ADHD, are next summarized. The chapter concludes with suggestions for future research directions, including speculation regarding ways to improve the treatment of social exclusion.

Keywords: ADHD, behavior problems, disorders, intervention, psychopathology, treatment

Introduction

Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most prevalent disorders, beginning in childhood but often continuing to impair functioning across the life span. It has been well-established that youth with ADHD are at high risk for maladjustment in multiple areas including delinquency and conduct problems; school failure; substance abuse; depression and anxiety; and poor interpersonal relationships with family, teachers, and peers (Barkley, 2002; Mannuzza & Klein, 2000). Although each domain of impairment merits attention, this chapter focuses primarily on the social exclusion from peers faced by individuals with ADHD.

It is estimated that ADHD affects 3% to 7% of elementary school-aged children in the United States (American Psychiatric Association, 2000; Jensen et al., 1995). To receive a diagnosis of ADHD, individuals must display developmentally inappropriate, clinically significant symptoms of (a) inattention, and/or (b) hyperactivity/impulsivity. Symptoms must have been present prior to age 7 and are required to cause impairment. Furthermore, symptoms must show themselves in more than one setting (e.g., both home and school).

The current chapter begins by summarizing the magnitude of social exclusion that individuals with ADHD experience, with consideration of individuals’ age, gender, and ADHD subtype. Next, reasons for this social exclusion are discussed. Third, interventions for individuals with ADHD that target social exclusion from peers are reviewed. The chapter concludes with recommendations for future research and suggestions for improving the effectiveness of interventions for social exclusion in ADHD.

Magnitude of Social Exclusion in ADHD

It is difficult to overstate the level of social exclusion from peers that individuals with ADHD typically face. In fact, social exclusion is so extreme in magnitude that, although interpersonal difficulties are not currently part of the diagnostic criteria (p. 229) for ADHD, some have argued that they should be included (Greene, Biederman, Faraone, Sienna, & Garcia-Jetton, 1997; Whalen & Henker, 1985; Wheeler & Carlson, 1994).

Among elementary school-aged children, the age group in which ADHD is typically diagnosed and most commonly studied, it is estimated that over 50% of children with ADHD are peer-rejected, relative to peer rejection base rates of 10% to 15% in typical classrooms (Hoza, Mrug et al., 2005). The definition of being peer- rejected is that the majority of peers name this child, during confidential sociometric interviews, as being someone whom they dislike, whereas few peers name the child as being someone whom they like (Coie, Dodge, & Coppotelli, 1982). Although children with ADHD are also rated by parents and teachers as being peer-rejected (Solanto, Pope-Boyd, Tyron, & Stepak, 2009), having peers directly report on their liking and disliking preferences to assess rejection is considered the gold standard in defining peer rejection.

Another study using peer sociometric measures found that 82% of a sample of 49 children with ADHD scored one standard deviation above their classroom average of being disliked by peers (Pelham & Bender, 1982). Fully 60% of children with ADHD scored two standard deviations above the average of being disliked, that is, in the top 2.5% of their class (Pelham & Bender, 1982). Some research suggests that children with ADHD are more actively disliked (e.g., nominated by peers as someone they do not want to be around) than are children with Conduct Disorder or depressive disorders, but not ADHD (Asarnow, 1988).

Social rejection of children with ADHD happens extremely quickly—occurring within less than one day (Erhardt & Hinshaw, 1994) or even within one hour of meeting unfamiliar peers (Hodgens, Cole, & Boldizar, 2000; Mikami, Jack, Emeh, & Stephens, 2010). Further, once established, the rejection of children with ADHD tends to be highly stable. Correlations between nominations of being disliked by peers are as high as r =.7–.8 over six weeks among an ADHD sample (Blachman & Hinshaw, 2002).

Yet, it is relatively unknown the extent to which peers’ affective disliking of children with ADHD manifests itself in behavioral forms of social exclusion, such as observable ostracism or victimization. Although it has been established that peer rejection typically increases the likelihood of subsequent victimization more than vice versa (Schwartz, McFayden-Ketchum, Dodge, Pettit, & Bates, 1999), these studies have not been specific to ADHD populations. Despite the peer rejection of children with ADHD being well documented, the literature on behavioral ostracism or victimization among ADHD youth is not as advanced, particularly when multimeasure assessment procedures are involved. Nonetheless, there are suggestions that children with ADHD are more likely to be victimized, based on self-report, teacher report, and parent report, relative to comparison youth (Shea & Wiener, 2003; Wiener & Mak, 2009). However, children with ADHD may also have elevated rates of being bullies and bully-victims, as well as victims (Wiener & Mak, 2009). It is unknown whether the predictors of victimization are similar for children with ADHD relative to comparison children. To summarize, the rejection of children with ADHD has been extremely well established, but an area for future research is the ways in which this affective dislike may be behaviorally displayed in bullying and ostracism.

ADHD Subtype and Comorbidity

Children with ADHD are not a homogenous group, and their social behaviors and type of social exclusion faced may differ depending on ADHD subtype and patterns of comorbidity with other disorders. The DSM-IV-TR criteria specify that individuals with ADHD can be classified into three subtypes (American Psychiatric Association, 2000). The Combined Type (ADHD-C) is designated for individuals with both inattention and also hyperactivity/impulsivity. The Predominantly Inattentive Type (ADHD-I) is appropriate for the presence of inattention without hyperactivity/impulsivity, and the Predominantly Hyperactive/Impulsive Type (ADHD-HI) for hyperactivity/impulsivity without inattention. The majority of the research to date has involved participants with ADHD-C. The most common subtype in epidemiological studies is ADHD-I, but children with this subtype are underdiagnosed and underreferred for treatment (Robison, Sclar, Skaer, & Galin, 2004), and ADHD-HI is most salient for children younger than school-age (Lahey et al., 1998).

Evidence suggests that elementary school-age children with ADHD-C tend to have an intrusive, aggressive interpersonal style that may lead to them being rejected by peers, that is, actively disliked. By contrast, children with ADHD-I may behave passively or seem apathetic during peer interactions, which contributes to them being more (p. 230) neglected and ignored by their peers as opposed to actively rejected (Hodgens et al., 2000; Mikami, Huang-Pollock, Pfiffner, McBurnett, & Hangai, 2007; Milich, Balentine, & Lynam, 2001). This suggests that the nature of social exclusion may be different for the two subtypes; it may be purposeful for youth with ADHD-C but accidental for youth with ADHD-I.

To date, the different types of social exclusion experienced by youth with ADHD-C versus ADHD-I have been conceptualized to result from pre-existing differences in interpersonal behaviors between the two subtypes. Unstudied is whether the impact of active exclusion (rejection) versus passive exclusion (neglect) may also contribute to subsequent differential functioning among youth with ADHD-C versus ADHD-I. Recent work, using a college undergraduate sample, suggests that active exclusion experiences lead to participants reporting increased agitation, thoughts about actions one should not have taken, and withdrawal from contact; by contrast, passive exclusion experiences may evoke dejection, thoughts about actions one should have taken, and increased engagement in social contact (Molden, Lucas, Gardner, Dean, & Knowles, 2009). Whether these processes would apply to children with ADHD and their naturalistic exclusion experiences, and potentially exacerbate behavioral differences between the two subtypes, remains unknown.

Confounded with subtype is comorbidity. Half of children with ADHD have comorbid disruptive behavior problems (e.g., Oppositional Defiant Disorder, Conduct Disorder), and about 25% to 33% are estimated to have comorbid internalizing disorders such as anxiety or depression (Jensen, Martin, & Cantwell, 1997). Children with ADHD-C are more likely to have comorbid disruptive behavior disorders than are children with ADHD-I, and the presence of comorbid aggression exacerbates peer rejection (Milich et al., 2001; Pfiffner, Calzada, & McBurnett, 2000). Less studied are internalizing comorbidities with ADHD, but these are suggested to be equal among ADHD subtypes (Power, Costigan, Eiraldi, & Leff, 2004), and to be associated with peer neglect (Karustis, Power, Rescorla, Eiraldi, & Gallagher, 2000). However, some children with ADHD have both disruptive and internalizing comorbidities (Jensen et al., 1997), and little is known about the compounding effect of both types of comorbidities on peer relationships.

To summarize, the social relationships of children with ADHD appear to differ based on subtype and comorbidity, suggesting the importance of considering these factors when depicting interpersonal functioning. Collectively, evidence suggests that children who have ADHD-C and disruptive comorbidities are most at risk for being actively rejected. By contrast, children who have ADHD-I and internalizing comorbidities may be more neglected by peers.

Adolescents and Young Adults

The current ADHD literature has an under-representation of participants past elementary school age. Nonetheless, all available evidence suggests that adolescents and adults with ADHD remain impaired socially with peers (Bagwell, Molina, Pelham, & Hoza, 2001) and in their romantic relationships (Canu & Carlson, 2003). Notably missing from this work, however, is research that links behavioral forms of exclusion with these relationship difficulties among adolescents and adults with ADHD. In adult peer groups, social exclusion may take more subtle forms (e.g., coworkers don’t invite a colleague to lunch; college classmates are hesitant to work with the student) that are more difficult to measure. However, these forms of ostracism may be relevant for adults with ADHD. In conclusion, extremely little is known about how adults with ADHD may experience social exclusion. However, because work suggests continuing interpersonal impairment among adults with this disorder, the social exclusion of adults with ADHD may represent a valuable topic for future study.

Gender Differences

The existing ADHD literature also has an under-representation of girls with the disorder relative to boys. Males outnumber females 3:1 in community samples, and up to 9:1 in clinical samples (Lahey et al., 1994). However, the research that does exist suggests that girls with ADHD face at least the same level of social exclusion from peers as do boys, if not more (Blachman & Hinshaw, 2002; Gaub & Carlson, 1997). For instance, rates of peer rejection among girls with ADHD far exceed those found for girls without ADHD (Hoza, Mrug et al., 2005). Similar to boys who have this disorder, the rejection of girls with ADHD is established very quickly in previously unfamiliar groups of peers (Blachman & Hinshaw, 2002).

Interestingly, it is possible that girls with ADHD may have additional trouble socially, relative to their male counterparts, because ADHD symptoms and conduct problems commonly associated (p. 231) with ADHD are more norm violating among girls (Mikami & Lorenzi, 2011). Further, inattentive and hyperactive/impulsive behaviors may interfere with the greater verbal give-and-take that characterizes female peer groups (Keenan & Shaw, 1997). Thus, although little research has been conducted among girls with ADHD, social exclusion is likely quite salient for females with this disorder.

Reasons for Social Difficulties in ADHD

Deficits among Individuals with ADHD

To date, the vast majority of the research on reasons for social exclusion has focused on problem behaviors enacted by youth with ADHD that are off-putting to peers. One of the main findings is that the core symptoms of ADHD interfere with appropriate social behavior. Among children, inattention not only affects schoolwork, but it also may compromise ability to read social cues, to attend to the rules of a game, and to follow fast-paced conversations with peers. Hyperactivity and impulsivity may interfere with the ability to wait one’s turn in line or in a game, to listen to peers’ concerns patiently, and to be a good sport by restraining impulses to be upset when losing (Landau, Milich, & Diener, 1998).

In addition, children with ADHD have deficient social-cognitive skills, which may also contribute to their peer problems. During peer interactions, children with ADHD have social goals of “winning”; by contrast, comparison youth are more likely to have the goal of “having fun and making a new friend” (Melnick & Hinshaw, 1996). Children with ADHD may struggle with taking the perspective of a peer, as is reflected in their difficulty giving directions to a peer who is prevented from seeing the same information as the child with ADHD (Whalen & Henker, 1992; Whalen, Henker, Collins, McAuliffe, & Vaux, 1979). Finally, children with ADHD may be more likely than comparison youth to interpret ambiguous peer provocations as hostile in intent, and less likely to propose adaptive strategies to solve hypothetical social conflicts (Matthys, Cuperus, & van England, 1999; Mikami, Lee, Hinshaw, & Mullin, 2008). Collectively, these behaviors on the part of children with ADHD are thought to cause their social exclusion from peers. In fact, children with ADHD have been called “negative social catalysts” (Whalen & Henker, 1985, 1992), reflecting the perspective that they possess characteristics that they bring to every interpersonal situation, which cause their relationship problems.

Biases of the Peer Group

Although children with ADHD do have behavior problems that contribute to their ostracism by peers, peer rejection does not occur in a vacuum in which only the behaviors of the child with ADHD are important. Rather, social exclusion is a mutual, reciprocal process that also involves the behaviors and values of the larger peer group that excludes the child with ADHD (Mikami, Lerner, & Lun, 2010).

One factor that may influence peer relationships above and beyond deficits within the child with ADHD is the extent to which the peer group views a child with ADHD as deviant and not like themselves. Research in developmental and social psychology, not specific to ADHD, supports this hypothesis. Even after accounting for a rejected child’s behaviors, the magnitude that a child is disliked increases if his/her behavior is more deviant from whatever the norm is in that particular peer group (Boivin, Dodge, & Coie, 1995; Stormshak et al., 1999; Wright, Giammarino, & Parad, 1986). Thus, aggressive children are more rejected in peer groups in which aggressive behavior is unusual than those in which others also behave aggressively; similarly, withdrawn children are more rejected in peer groups in which withdrawal is unusual than those in which withdrawal is common. As an example of the robustness of this relationship, in one study of 4,650 children, the peer group norm of aggression accounted for 19% of the between-group variation in the association between peer rejection and aggressive behavior (Chang, 2004). These findings demonstrate that there is no set path between any particular behavior and rejection, and that rejection depends on the interpretations and values of the larger peer group.

Children may also be marginalized by peers if they are atypical demographically, not just behaviorally, demonstrating the strength of children’s tendencies to reject individuals who violate group norms in a variety of ways (including harmless ways). Children who are a racial minority in their classroom are more likely to be disliked than are children in the majority (Jackson, Barth, Powell, & Lochman, 2006). Specifically, African-American children are more peer-rejected in predominantly white relative to predominantly black classrooms, but white children are more likely to be rejected in predominantly black relative to predominately white classrooms (Kistner, Metzler, Gatlin, & Risi, 1993). In sum, a body of literature suggests that simply being different from the group norm may encourage rejection from that peer group. (p. 232)

The peer group may also have cognitive biases against disliked children that perpetuate these children’s rejected status (Hymel, Wagner, & Butler, 1990). Peers interpret the ambiguous behaviors of children whom they dislike as hostile in intent while interpreting the ambiguous behaviors of children whom they like as benign (Peets, Hodges, Kikas, & Salmivalli, 2007; Peets, Hodges, & Salmivalli, 2008). Peers selectively remember disliked children’s negative behavior while forgetting their positive behaviors (Flannagan & Bradley, 1999), and attribute the negative behavior of a disliked child to internal, stable traits, while attributing positive behavior to situational causes; these attributions are reversed to favor popular children (Guerin, 1999; Hymel, 1986). Even children as young as preschool to first grade have been found to possess these cognitive biases (Denham & Holt, 1993; Mrug & Hoza, 2007). Collectively these findings suggest that peers are disposed to give the benefit of the doubt to their friends, whereas the identical actions by a disliked child are interpreted in such a way as to maintain that child’s negative reputation and peer-rejected status.

Although the aforementioned research has not specifically focused on youth with ADHD, there is reason to believe that factors in the peer group affect the social status of children with this disorder. Children with ADHD engage in behaviors that may tax the patience of even the most inclusive peer group. However, behavior change among youth with ADHD is a necessary but probably not sufficient condition for improvements in social exclusion to occur. There are two reasons for this. First, even if child-focused treatment succeeds in reducing the most noxious disruptive and aggressive behaviors common among children with ADHD, clinicians often comment that many treated children remain awkward, odd, prone to daydreaming, or persist in engaging in socially off-time behaviors (Landau et al., 1998). Peer groups that are tolerant of harmless, but still deviant, behaviors such as these may be more likely to accept a child with ADHD, or the magnitude of the social rejection faced by a child with ADHD may be less extreme among such peers than it would be in a less tolerant peer group. Recent work has suggested that the correlation between ADHD symptoms and sociometrically-assessed peer rejection varies across classrooms, and may be attenuated when teachers personally like children with ADHD (McAuliffe, Hubbard, & Romano, 2009; Mikami, Griggs, Reuland, & Gregory, 2012).

Second, the tenacity of the negative reputations of children with ADHD is also likely to be just as strong, if not stronger, than for typically developing children. Therefore, even when a child with ADHD displays more positive behaviors, the peer group may be resistant to altering their impressions about that child. This may occur because peers’ awareness that a child has the disorder of ADHD evokes rejection in and of itself. Merely labeling a target as “ADHD” (even if s/he does not in fact have ADHD) has been shown to create a stereotype such that unfamiliar peers make negative judgments about the target that extend beyond the information provided (Whalen, Henker, Dotemoto, & Hinshaw, 1983), and report lowered desire to be friends with the target (Canu, Newman, Morrow, & Pope, 2008). In another study, peers were told that certain children with whom they were about to interact had ADHD. In reality, the label of ADHD was falsely applied to randomly selected children who were unaware that their peers had been given this information. During the interaction afterwards, peers were more likely to reject children whom they thought had ADHD, and children labeled as ADHD were judged by observers to have poorer social skills than were children not labeled as ADHD (Harris, Milich, Corbitt, Hoover, & Brady, 1992).

Interventions for Social Exclusion in ADHD

To date, existing interventions for peer problems largely attempt to remediate deficits within the child with ADHD, but they have made only circumscribed progress towards improving peer relationships (Landau et al., 1998; Mrug, Hoza, & Gerdes, 2001). The first-line treatments for ADHD, stimulant medication and behavior management, are well validated for ameliorating the core symptoms of the disorder (MTA Cooperative Group, 1999), yet their usefulness for peer problems is modest. These treatments do reduce children’s intrusive and disruptive behaviors (Chronis, Jones, & Raggi, 2006; Hinshaw, Henker, Whalen, Erhardt, & Dunnington, 1989; Murphy, Pelham, & Lang, 1992), and may result in improved social skills as rated by adults (Klein & Abikoff, 1997). Unfortunately, a corresponding reduction in peer exclusion (as assessed on sociometric measures wherein peers name their liking, disliking and friendship preferences) often does not follow (Hoza, 2007; Hoza, Gerdes et al., 2005). Because peer reports have greater validity in predicting subsequent adjustment than do adult informant ratings of social skills (p. 233) (Parker & Asher, 1987) gains on peer-reported acceptance and friendship are the desirable standard.

Some exceptions exist whereby, in small samples, children receiving stimulant medication (Whalen et al., 1989) and behavioral management (Pelham & Bender, 1982) may improve in peer-reported acceptance after treatment. Nonetheless, in both these studies, peer relationships were far from normalized. These positive outcomes must also be considered in light of a larger collection of null effects on peer-reported measures (Hoza, Gerdes et al., 2005; Landau et al., 1998; Landau & Moore, 1991; Mrug et al., 2001). For example, in the Multimodal Treatment Study of Children with ADHD (MTA Cooperative Group, 1999), both intensive medication and behavioral management failed to increase peer reports of acceptance or friendship at the immediate conclusion of the 14-month active treatment period (though treatments produced gains in adult informant-reported social skills). Relative to a matched sample of comparison youth, children with ADHD remained profoundly socially impaired, no matter which treatment they had received (Hoza, Gerdes et al., 2005). As discussed by the authors, it is notable that even the state-of-the-art treatments, delivered under ideal circumstances, did not improve peer relationships significantly.

Although social skills training is a widely used treatment for children with ADHD (Mrug et al., 2001; Nixon, 2001; Stormont, 2001), its efficacy for improving peer-assessed acceptance has received inconsistent empirical support (Gresham, Cook, Crews, & Kern, 2004; Mikami & Pfiffner, 2006; Pfiffner et al., 2000). In a study of 103 children with ADHD, Abikoff et al. (2004) found no added benefit of receiving social skills training plus stimulant medication over medication alone on adult-informant ratings or observations of social skills, either at the end of a 1-year intensive treatment period or a 2-year follow-up wherein treatment was provided less frequently. Although this study lacks a comparison condition of unmedicated children, other investigations have compared short-term, less intensive social skills training to no treatment and failed to find improvement in peer relationships, particularly when peer reports of liking are used to assess effectiveness (Abikoff et al., 2004; Antshel & Remer, 2003; Kolko, Loar, & Sturnick, 1990). Although some social skills training programs appear promising, especially when parents are involved to encourage generalization (Frankel, Myatt, Cantwell, & Feinberg, 1997; Pfiffner & McBurnett, 1997; Pfiffner et al., 2007), multiple investigators have concluded that social skills training is not as useful for children with ADHD as originally hoped (Abikoff, 1985; Barkley, 2004; de Boo & Prins, 2007; Guevremont & Dumas, 1994; Mrug et al., 2001; Pelham, Wheeler, & Chronis, 1998).

One reason why medication, behavioral management, and social skills training interventions may have circumscribed effectiveness on peer relationships is because none of these interventions consider factors in the peer group that contribute to social status. To the extent that these treatments reduce disruptive behaviors among youth with ADHD (MTA Cooperative Group, 1999), this may explain findings that adult informants report improvements in children’s social skills. However, improvements in sociometrically-assessed peer exclusion may not always follow from such interventions (Hoza, Gerdes et al., 2005; Mikami & Pfiffner, 2006) because these treatments do nothing to encourage the peer group to be more tolerant of a child with ADHD who remains socially awkward after treatment in harmless ways, to eliminate the stigma associated with this diagnosis, or to make the peer group notice positive behavior changes resulting from treatment that would alter their impressions. In support of this hypothesis, Mikami et al. (in press) found that children with ADHD who received an intervention that supplemented behavioral management with procedures to increase the inclusiveness of the peer group displayed better peer sociometric acceptance relative to those children who receive behavioral management alone.

In sum, more research is needed to improve the efficacy of interventions for social exclusion among ADHD populations. Including novel targets of intervention, such as addressing the biases among the peer group that rejects the child with ADHD, is a potentially worthwhile direction.

Conclusions

The social exclusion from peers that children with ADHD face is pronounced, and may persist into adolescence and adulthood. Peer rejection occurs for both boys and girls with ADHD, which may be exacerbated if other comorbid disorders are present. Research has traditionally focused on deficits within youth with ADHD that are off-putting to peers and contribute to their ostracism. However, factors in the peer group may also be relevant in determining the extent to which children with ADHD are socially excluded. Interventions most commonly attempt to remediate deficits within children with ADHD, but peer rejection is often resistant to (p. 234) treatment. It is possible that, in addition to focusing on behavior change in the child with ADHD, other interventions may be needed to encourage the peer group to be more inclusive and accepting.

Future Directions

Overall, the social exclusion of individuals with ADHD is profound and does not fully remediate in response to existing treatments. Future studies would benefit from incorporation of understudied populations, in particular, adolescents and adults with ADHD. All available evidence suggests that individuals this age with ADHD continue to struggle with social relationships, but the nature of social exclusion may change and be more difficult to measure in adulthood relative to in childhood. This may be because of the fact that adults’ social networks are not confined to a single classroom. The field is in need of studies with sensitive, developmentally appropriate measures of social exclusion in ADHD populations past childhood. In addition, girls with ADHD, the Inattentive Type of ADHD, and youth with ADHD and internalizing comorbidities, are all understudied groups in the existing research. Incorporation of these populations would lead to a more complete understanding of how social exclusion operates for individuals with ADHD.

Because peer relationship problems may exacerbate maladjustment in ADHD populations (Mikami & Hinshaw, 2006), treatments for social exclusion have high public health significance. Yet the limited effectiveness of existing interventions suggests that the field is in need of alternative ways to facilitate peer relationships among youth with ADHD. Although speculative, interventions that also target the peer group to be more accepting of youth with ADHD, and to notice positive behavior changes among youth with ADHD, may be a promising direction.

References

Abikoff, H. B. (1985). Efficacy of cognitive training intervention with hyperactive children: A critical review. Clinical Psychology Review, 5, 479–512.Find this resource:

    Abikoff, H. B., Hechtman, L., Klein, R. G., Gallagher, R., Fleiss, K., Etcovitch, J., et al. (2004). Social functioning in children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 820–829.Find this resource:

      American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision). Washington, DC: Author.Find this resource:

        Antshel, K. M., & Remer, R. (2003). Social skills training in children with Attention Deficit Hyperactivity Disorder: A randomized-controlled clinical trial. Journal of Clinical Child and Adolescent Psychology, 32, 153–165.Find this resource:

          Asarnow, J. R. (1988). Peer status and social competence in child psychiatric inpatients: A comparison of children with depressive, externalizing, and concurrent depressive and externalizing disorders. Journal of Abnormal Child Psychology, 16, 151–162.Find this resource:

            Bagwell, C., Molina, B. S. G., Pelham, W. E., & Hoza, B. (2001). Attention-deficit hyperactivity disorder and problems in peer relations: Predictions from childhood to adolescence. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 1285–1292.Find this resource:

              Barkley, R. A. (2002). ADHD: Long-term course, adult outcome, and comorbid disorders. In P. S. Jensen & J. R. Cooper (Eds.), Attention-Deficit/Hyperactivity Disorder: State of the Science and Best Practices (pp. 4-1–4-12). Kingston, NJ: Civic Research Institute.Find this resource:

                Barkley, R. A. (2004). Adolescents with attention-deficit/hyperactivity disorder: An overview of empirically based treatments. Journal of Psychiatric Practice, 10, 39–56.Find this resource:

                  Blachman, D. R., & Hinshaw, S. P. (2002). Patterns of friendship among girls with and without attention-deficit/hyperactivity disorder. Journal of Abnormal Child Psychology, 30, 625–640.Find this resource:

                    Boivin, M., Dodge, K. A., & Coie, J. D. (1995). Individual-group behavioral similarity and peer similarity and peer status in experimental play groups of boys: The social misfit revisited. Journal of Personality & Social Psychology, 69, 269–279.Find this resource:

                      Canu, W. H., & Carlson, C. L. (2003). Differences in heterosocial behavior and outcomes of ADHD-symptomatic subtypes in a college sample. Journal of Attention Disorders, 6, 123–133.Find this resource:

                        Canu, W. H., Newman, M. L., Morrow, T. L., & Pope, D. L. W. (2008). Social appraisal of adult ADHD: Stigma and influences of the beholder’s Big Five personality traits. Journal of Attention Disorders, 11, 700–710.Find this resource:

                          Chang, L. (2004). The role of classroom norms in contextualizing the relations of children’s social behaviors to peer acceptance. Developmental Psychology, 40, 691–702.Find this resource:

                            Chronis, A. M., Jones, H. A., & Raggi, V. L. (2006). Evidence-based psychosocial treatments for children and adolescents with attention-deficit/hyperactivity disorder. Clinical Psychology Review, 26, 486–502.Find this resource:

                              Coie, J. D., Dodge, K. A., & Coppotelli, H. (1982). Dimensions and types of social status: A cross-age perspective. Developmental Psychology, 18, 557–570.Find this resource:

                                de Boo, G. M., & Prins, P. J. M. (2007). Social incompetence in children with ADHD: Possible moderators and mediators in social skills training. Clinical Psychology Review, 27, 78–97.Find this resource:

                                  Denham, S., & Holt, R. W. (1993). Preschoolers’ likeability as a cause or consequence of their social behavior. Developmental Psychology, 29, 271–275.Find this resource:

                                    Erhardt, D., & Hinshaw, S. P. (1994). Initial sociometric impressions of attention-deficit hyperactivity disorder and comparison boys: Predictions from social behaviors and from nonbehavioral variables. Journal of Consulting and Clinical Psychology, 62, 833–842.Find this resource:

                                      Flannagan, D., & Bradley, L. (1999). Judging the behaviors of friends and unfamiliar peers: Patterns associated with age and gender. Journal of Early Adolescence, 19, 389–404. (p. 235) Find this resource:

                                        Frankel, F., Myatt, R., Cantwell, D. P., & Feinberg, D. (1997). Parent-assisted transfer of children’s social skills training: Effects on children with and without attention-deficit hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1056–1064.Find this resource:

                                          Gaub, M., & Carlson, C. L. (1997). Gender differences in ADHD: A meta-analysis and critical review. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1036–1045.Find this resource:

                                            Greene, R. W., Biederman, J., Faraone, S. V., Sienna, M., & Garcia-Jetton, J. (1997). Adolescent outcome of boys with attention-deficit/hyperactivity disorder and social disability: Results from a 4-year longitudinal follow-up study. Journal of Consulting and Clinical Psychology, 65, 758–767.Find this resource:

                                              Gresham, F. M., Cook, C. R., Crews, S. D., & Kern, L. (2004). Social skills training for children and youth with emotional and behavioral disorders: Validity considerations and future directions. Behavioral Disorders, 30, 32–46.Find this resource:

                                                Guerin, B. (1999). Children’s intergroup attribution bias for liked and disliked peers. Journal of Social Psychology, 139, 583–589.Find this resource:

                                                  Guevremont, D. C., & Dumas, M. C. (1994). Peer relationship problems and disruptive behavior disorders. Journal of Emotional and Behavioral Disorders, 2, 164–172.Find this resource:

                                                    Harris, M. J., Milich, R., Corbitt, E. M., Hoover, D. W., & Brady, M. (1992). Self-fulfilling effects of stigmatizing information on children’s social interactions. Journal of Personality and Social Psychology, 63, 41–50.Find this resource:

                                                      Hinshaw, S. P., Henker, B., Whalen, C. K., Erhardt, D., & Dunnington, R. E. (1989). Aggressive, prosocial, and nonsocial behavior in hyperactive boys: Dose effects of methylphenidate in naturalistic settings. Journal of Consulting and Clinical Psychology, 57, 636–643.Find this resource:

                                                        Hodgens, J. B., Cole, J., & Boldizar, J. (2000). Peer-based differences among boys with ADHD. Journal of Child Clinical Psychology, 29, 443–452.Find this resource:

                                                          Hoza, B. (2007). Peer functioning in children with ADHD. Journal of Pediatric Psychology, 32, 655–663.Find this resource:

                                                            Hoza, B., Gerdes, A. C., Mrug, S., Hinshaw, S. P., Bukowski, W. M., Gold, J. A., et al. (2005). Peer-assessed outcomes in the Multimodal Treatment Study of children with Attention Deficit Hyperactivity Disorder. Journal of Clinical Child and Adolescent Psychology, 34, 74–86.Find this resource:

                                                              Hoza, B., Mrug, S., Gerdes, A. C., Bukowski, W. M., Kraemer, H. C., Wigal, T., et al. (2005). What aspects of peer relationships are impaired in children with Attention-deficit/Hyperactivity Disorder? Journal of Consulting and Clinical Psychology, 73, 411–423.Find this resource:

                                                                Hymel, S. (1986). Interpretations of peer behavior: Affective bias in childhood and adolescence. Child Development, 57, 431–445.Find this resource:

                                                                  Hymel, S., Wagner, E., & Butler, L. J. (1990). Reputational bias: View from the peer group. In S. R. Asher & J. D. Coie (Eds.), Peer Rejection in Childhood (pp. 156–186). New York: Cambridge University Press.Find this resource:

                                                                    Jackson, M. F., Barth, J. M., Powell, N., & Lochman, J. E. (2006). Classroom contextual effects of race on children’s peer nominations. Child Development, 77, 1325–1337.Find this resource:

                                                                      Jensen, P. S., Martin, D., & Cantwell, D. P. (1997). Comorbidity in ADHD: Implications for research, practice, and DSM-V. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1065–1079.Find this resource:

                                                                        Jensen, P. S., Watanabe, H. K., Richters, J. E., Cortes, R., Roper, M., & Liu, S. (1995). Prevalence of mental disorder in military children and adolescents: A two-stage community survey. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 1514–1524.Find this resource:

                                                                          Karustis, J. L., Power, T. J., Rescorla, L. A., Eiraldi, R. B., & Gallagher, P. R. (2000). Anxiety and depression in children with ADHD: Unique associations with academic and social functioning. Journal of Attention Disorders, 4, 133–149.Find this resource:

                                                                            Keenan, K., & Shaw, D. S. (1997). Developmental and social influences on young girls’ early problem behavior. Psychological Bulletin, 121, 95–113.Find this resource:

                                                                              Kistner, J. A., Metzler, A., Gatlin, D., & Risi, S. (1993). Classroom racial proportions and children’s peer relations: Race and gender effects. Journal of Educational Psychology, 85, 446–452.Find this resource:

                                                                                Klein, R. G., & Abikoff, H. B. (1997). Behavior therapy and methylphenidate in the treatment of children with ADHD. Journal of Attention Disorders, 2, 89–114.Find this resource:

                                                                                  Kolko, D. J., Loar, L. L., & Sturnick, D. (1990). Inpatient social-cognitive skills training with conduct disordered and attention deficit disordered children. Journal of Child Psychology & Psychiatry, 31, 737–748.Find this resource:

                                                                                    Lahey, B. B., Applegate, B., McBurnett, K., Biederman, J., Greenhill, L. L., Hynd, G. W., et al. (1994). DSM-IV field trials for attention deficit/hyperactivity disorder in children and adolescents. American Journal of Psychiatry, 151, 1673–1685.Find this resource:

                                                                                      Lahey, B. B., Pelham, W. E., Stein, M. A., Loney, J., Trapani, C., Nugent, K., et al. (1998). Validity of DSM-IV attention-deficit/hyperactivity disorder for younger children. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 695–702.Find this resource:

                                                                                        Landau, S. L., Milich, R., & Diener, M. B. (1998). Peer relations of children with attention-deficit hyperactivity disorder. Reading and Writing Quarterly, 14, 83–10 5.Find this resource:

                                                                                          Landau, S. L., & Moore, L. A. (1991). Social skills deficits in children with Attention-Deficit Hyperactivity Disorder. School Psychology Review, 20, 235–251.Find this resource:

                                                                                            Mannuzza, S., & Klein, R. G. (2000). Long term prognosis in attention-deficit/hyperactivity disorder. Child and Adolescent Psychiatric Clinics of North America, 9, 711–726.Find this resource:

                                                                                              Matthys, W., Cuperus, J. M., & van England, H. (1999). Deficient social problem-solving in boys with ODD/CD, with ADHD, and with both disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 311–321.Find this resource:

                                                                                                McAuliffe, M., Hubbard, J., & Romano, L. (2009). The role of teacher cognition and behavior in children’s peer relations. Journal of Abnormal Child Psychology, 37 (5), 665–677.Find this resource:

                                                                                                  Melnick, S. M., & Hinshaw, S. P. (1996). What they want and what they get: The social goals of boys with ADHD and comparison boys. Journal of Abnormal Child Psychology, 24, 169–185.Find this resource:

                                                                                                    Mikami, A. Y., Griggs, M. S., Lerner, M. D., Emeh, C. C., Reuland, M. M., Jack, A., & Anthony, M. R. (in press). A randomized trial of a classroom intervention to increase peers’ social inclusion of children with Attention-Deficit/Hyperactivity Disorder. Journal of Consulting and Clinical Psychology.Find this resource:

                                                                                                      Mikami, A. Y., Griggs, M. S., Reuland, M. M., & Gregory, A. (2012). Teacher practices as predictors of children’s classroom social preference. Journal of School Psychology, 50 (1), 95–11 1. (p. 236) Find this resource:

                                                                                                        Mikami, A. Y., & Hinshaw, S. P. (2006). Resilient adolescent adjustment among girls: Buffers of childhood peer rejection and attention-deficit/hyperactivity disorder. Journal of Abnormal Child Psychology, 34, 823–837.Find this resource:

                                                                                                          Mikami, A. Y., Huang-Pollock, C. L., Pfiffner, L. J., McBurnett, K., & Hangai, D. (2007). Social skills differences among Attention-Deficit/Hyperactivity Disorder subtypes in a chat room assessment task. Journal of Abnormal Child Psychology, 35, 509–521.Find this resource:

                                                                                                            Mikami, A. Y., Jack, A., Emeh, C. C., & Stephens, H. F. (2010). Parental influences on children with ADHD: I. Parental behaviors associated with children’s peer relationships. Journal of Abnormal Child Psychology, 38, 721–736.Find this resource:

                                                                                                              Mikami, A. Y., Lee, S. S., Hinshaw, S. P., & Mullin, B. C. (2008). Relationships between social information processing and aggression among adolescent girls with and without ADHD. Journal of Youth and Adolescence, 37, 761–771.Find this resource:

                                                                                                                Mikami, A. Y., Lerner, M. D., & Lun, J. (2010). Social context influences on children’s rejection by their peers. Child Development Perspectives, 4, 123–130.Find this resource:

                                                                                                                  Mikami, A. Y., & Lorenzi, J. (2011). Gender and conduct problems predict peer functioning among children with attention-deficit/hyperactivity disorder. Journal of Clinical Child & Adolescent Psychology, 40, 777–786.Find this resource:

                                                                                                                    Mikami, A. Y., & Pfiffner, L. J. (2006). Social skills training for youth with disruptive behavior disorders: A review of best practices. Emotional and Behavioral Disorders in Youth, 6, 3–23.Find this resource:

                                                                                                                      Milich, R., Balentine, A., & Lynam, D. (2001). ADHD combined type and ADHD predominantly inattentive type are distinct and unrelated disorders. Clinical Psychology: Science and Practice, 8, 463–488.Find this resource:

                                                                                                                        Molden, D. C., Lucas, G. M., Gardner, W. L., Dean, K., & Knowles, M. L. (2009). Motivations for prevention or promotion following social exclusion: Being rejected versus being ignored. Journal of Personality and Social Psychology, 96, 415–431.Find this resource:

                                                                                                                          Mrug, S., & Hoza, B. (2007). Impression formation and modifiability: Testing a theoretical model. Merrill-Palmer Quarterly, 53, 631–659.Find this resource:

                                                                                                                            Mrug, S., Hoza, B., & Gerdes, A. C. (2001). Children with Attention-Deficit/Hyperactivity Disorder: Peer relationships and peer-oriented interventions. New Directions for Child and Adolescent Development, 91, 51–77.Find this resource:

                                                                                                                              MTA Cooperative Group. (1999). A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 56, 1073–1086.Find this resource:

                                                                                                                                Murphy, D. A., Pelham, W. E., & Lang, A. R. (1992). Aggression in boys with Attention-Deficit/Hyperactivity Disorder: Methylphenidate effects on naturalistically observed aggression, provocation, and social information processing. Journal of Abnormal Child Psychology, 20, 451–466.Find this resource:

                                                                                                                                  Nixon, E. (2001). The social competence of children with Attention Deficit Hyperactivity Disorder: A review of the literature. Child Psychology and Psychiatry Review, 6, 172–180.Find this resource:

                                                                                                                                    Parker, J. G., & Asher, S. R. (1987). Peer relations and later personal adjustment: Are low-accepted children at risk? Psychological Bulletin, 102, 357–389.Find this resource:

                                                                                                                                      Peets, K., Hodges, E. V. E., Kikas, E., & Salmivalli, C. (2007). Hostile attributions and behavioral strategies in children: Does relationship type matter? Developmental Psychology, 43, 889–900.Find this resource:

                                                                                                                                        Peets, K., Hodges, E. V. E., & Salmivalli, C. (2008). Affect-congruent social-cognitive evaluations and behaviors. Child Development, 79, 170–185.Find this resource:

                                                                                                                                          Pelham, W. E., & Bender, M. E. (1982). Peer relationships in hyperactive children: Description and treatment. In K. D. Gadow & I. Bailer (Eds.), Advances in Learning and Behavioral Disabilities (Vol. 1, pp. 365–436). Greenwich, CT: JAI Press.Find this resource:

                                                                                                                                            Pelham, W. E., Wheeler, T., & Chronis, A. M. (1998). Empirically supported psychosocial treatments for attention deficit hyperactivity disorder. Journal of Child Clinical Psychology, 27, 190–205.Find this resource:

                                                                                                                                              Pfiffner, L. J., Calzada, E., & McBurnett, K. (2000). Interventions to enhance social competence. Child and Adolescent Psychiatric Clinics of North America, 9, 689–709.Find this resource:

                                                                                                                                                Pfiffner, L. J., & McBurnett, K. (1997). Social skills training with parent generalization: Treatment effects for children with attention deficit disorder. Journal of Consulting and Clinical Psychology, 65, 749–757.Find this resource:

                                                                                                                                                  Pfiffner, L. J., Mikami, A. Y., Huang-Pollock, C. L., Easterlin, B., Zalecki, C. A., & McBurnett, K. (2007). A randomized controlled trial of integrated home-school behavioral treatment for ADHD, Predominantly Inattentive Type. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1041–1050.Find this resource:

                                                                                                                                                    Power, T. J., Costigan, T. E., Eiraldi, R. B., & Leff, S. S. (2004). Variations in anxiety and depression as a function of ADHD subtypes defined by DSM-IV: Do subtype differences exist or not? Journal of Abnormal Child Psychology, 32, 27–37.Find this resource:

                                                                                                                                                      Robison, L. M., Sclar, D. A., Skaer, T. L., & Galin, R. S. (2004). Treatment modalities among U.S. children diagnosed with attention-deficit hyperactivity disorder: 1995–1999. International Clinical Psychopharmacology, 19, 17–22.Find this resource:

                                                                                                                                                        Schwartz, D., McFayden-Ketchum, S., Dodge, K. A., Pettit, G. S., & Bates, J. E. (1999). Early behavior problems as a predictor of later peer group victimization: Moderators and mediators in the pathways of social risk. Journal of Abnormal Child Psychology, 27, 191–201.Find this resource:

                                                                                                                                                          Shea, B., & Wiener, J. (2003). Social exile: the cycle of peer victimization for boys with ADHD. Canadian Journal of School Psychology, 18, 55–90.Find this resource:

                                                                                                                                                            Solanto, M. V., Pope-Boyd, S. A., Tyron, W. W., & Stepak, B. (2009). Social functioning in predominantly inattentive and combined subtypes of children with ADHD. Journal of Attention Disorders, 13, 27–35.Find this resource:

                                                                                                                                                              Stormont, M. (2001). Social outcomes of children with AD/HD: Contributing factors and implications for practoce. Psychology in the Schools, 38, 521–531.Find this resource:

                                                                                                                                                                Stormshak, E. A., Bierman, K. L., Bruschi, C., Dodge, K. A., Coie, J. D., & Conduct Problems Prevention Research Group. (1999). The relation between behavior problems and peer preference in different classroom contexts. Child Development, 70, 169–182.Find this resource:

                                                                                                                                                                  Whalen, C. K., & Henker, B. (1985). The social worlds of hyperactive (ADDH) children. Clinical Psychology Review, 5, 447–478.Find this resource:

                                                                                                                                                                    Whalen, C. K., & Henker, B. (1992). The social profile of attention-deficit hyperactivity disorder: Five fundamental facets. Child and Adolescent Psychiatric Clinics of North America, 1, 395–410. (p. 237) Find this resource:

                                                                                                                                                                      Whalen, C. K., Henker, B., Buhrmester, D., Hinshaw, S. P., Huber, A., & Laski, K. (1989). Does stimulant medication improve the peer status of hyperactive children? Journal of Consulting & Clinical Psychology, 57, 545–549.Find this resource:

                                                                                                                                                                        Whalen, C. K., Henker, B., Collins, B. E., McAuliffe, S., & Vaux, A. (1979). Peer interaction in a structured communication task: Comparisons of normal and hyperactive boys and of methylphenidate (Ritalin) and placebo effects. Child Development, 50 (388–401).Find this resource:

                                                                                                                                                                          Whalen, C. K., Henker, B., Dotemoto, S., & Hinshaw, S. P. (1983). Child and adolescent perceptions of normal and atypical peers. Child Development, 54, 1588–1598.Find this resource:

                                                                                                                                                                            Wheeler, J., & Carlson, C. L. (1994). The social functioning of children with ADD with hyperactivity and ADD without hyperactivity: A comparison of peer relations and social deficits. Journal of Emotional and Behavioral Disorders, 2, 2–12.Find this resource:

                                                                                                                                                                              Wiener, J., & Mak, M. (2009). Peer victimization in children with attention-deficit/hyperactivity disorder. Psychology in the Schools, 46, 116–131.Find this resource:

                                                                                                                                                                                Wright, J. C., Giammarino, M., & Parad, H. W. (1986). Social status and small groups: Individual-group similarity and the social “misfit.” Journal of Personality & Social Psychology, 50, 523–536.Find this resource: