What is the Social Impact of ADHD in Girls? A Multi-Method Assessment

Attention-Deficit/Hyperactivity Disorder Symptoms and Anger and Aggression in Russian Adolescents

Objective

Aggression is a multifaceted behavior that involves cognitive, behavioral, and affective components. Although aggressive behaviors are commonly observed among individuals with attention-deficit/hyperactivity disorder (ADHD), potential sex-specific aspects of the association between ADHD symptoms and different components of aggression need to be evaluated, while also controlling for comorbid problems.

Method

In the present cross-sectional study, self-reported data were collected from 2,838 adolescents (mean age = 14.89 years) from Russia on ADHD symptoms and cognitive (anger rumination, aggressive beliefs), behavioral (physical, verbal, social, proactive), and affective (trait anger) aspects of aggression as well as comorbid emotional and conduct problems. Generalized linear model analyses were used to examine the associations between ADHD symptoms and aggression and to explore sex differences, while also adjusting for comorbid problems.

Results

Clinically significant levels of ADHD symptoms were associated with all components of aggression, and the associations remained significant after adjusting for emotional and conduct problems. Overall, females had higher levels of trait anger and anger rumination, whereas males had higher levels of aggressive beliefs, proactive aggression, and physical and verbal aggression. There was also a sex-specific association, where males with ADHD symptoms reported higher levels of social aggression. Conduct problems moderated the association between ADHD and aggression, increasing the likelihood of trait anger and social aggression in adolescents without ADHD symptoms.

Conclusion

Clinically significant levels of ADHD symptoms seem to impact all components of aggression independent of comorbidity. It is therefore important to consider aggression when evaluating and treating ADHD.

The profile of pragmatic language impairments in children with ADHD: A systematic review

This systematic review synthesizes the empirical literature examining pragmatic language in children diagnosed with attention-deficit/hyperactivity disorder (ADHD). Using a taxonomy of pragmatic language, we compared the pragmatic language profiles of children with ADHD to those of typically developing (TD) children and children with autism. Three databases were searched up to October 2019: PsychInfo; PubMed; and CSA Linguistics and Language Behavior Abstracts. We included 34 studies reporting on 2,845 children (ADHD = 1,407; TD = 1,058; autism = 380). Quality and risk of bias assessments included sample size and representativeness; measure reliability and validity; and missing data management. Children with ADHD were found to have higher rates of pragmatic difficulties than their TD peers. Specific difficulties were identified with inappropriate initiation, presupposition, social discourse, and narrative coherence. Children with ADHD appear to differ from those with autism in the degree of their pragmatic language impairments. General language skills contribute to, but do not explain, pragmatic difficulties in samples of children with ADHD. Though the extant evidence is limited, a preliminary profile of the pragmatic language impairments in children with ADHD is indicated. This supports a call for evidence-based interventions that include pragmatic language skills training.

Attention Deficit Hyperactivity Disorder Assessment Based on Patient Behavior Exhibited in a Car Video Game: A Pilot Study

Symptoms of Attention Deficit Hyperactivity Disorder (ADHD) include excessive activity, difficulty sustaining attention, and inability to act in a reflective manner. Early diagnosis and treatment of ADHD is key but may be influenced by the observation and communication skills of caregivers, and the experience of the medical professional. Attempts to obtain additional measures to support the medical diagnosis, such as reaction time when performing a task, can be found in the literature. We propose an information recording system that allows to study in detail the behavior shown by children already diagnosed with ADHD during a car driving video game. We continuously record the participants' activity throughout the task and calculate the error committed. Studying the trajectory graphs, some children showed uniform patterns, others lost attention from one point onwards, and others alternated attention/inattention intervals. Results show a dependence between the age of the children and their performance. Moreover, by analyzing the positions by age over time using clustering, we show that it is possible to classify children according to their performance. Future studies will examine whether this detailed information about each child's performance pattern can be used to fine-tune treatment.

Serious Video Games: Angels or Demons in Patients With Attention-Deficit Hyperactivity Disorder? A Quasi-Systematic Review

OBJECTIVE

To carry out a quasi-systematic review of the use of serious video games for health as a cognitive rehabilitative tool in patients diagnosed with attention-deficit hyperactivity disorder.

METHOD

A quasi-systematic review of serious video games used as an evaluative and rehabilitative tool in patients with ADHD was conducted. It included behavioral patterns in the use of video games and addiction problems in this population. For its elaboration the PRISMA GUIDES were followed. The search was carried out in three PubMed databases, MEDLINE, and PsycInfo using the keywords: [game OR serious game OR computer game) AND (psychotherapy OR rehabilitation OR intervention OR mental disorders) AND (adhd)], [(adhd) AND (Video game addiction)]. All articles written in English, Spanish, or Portuguese from January 1970 to June 2021 were included: those in which reference was made to the use of video games and/or new technologies as a therapeutic and evaluative tool in children and adults diagnosed with ADHD, as well as those that referred to behavioral and clinical patterns in the use of video games.

RESULTS

We found 605 articles of which 128 were reviewed (44 observational studies, 26 quasi-experimental studies, 26 experimental studies, 8 systematic reviews, 9 narrative texts, 6 case reports, 7 pilot studies, 8 systematic reviews, and 2 meta-analyses). Serious video games can be used to ameliorate ADHD symptoms while improving adherence to treatment. Some serious video games show high accuracy properties assessing ADHD features.

CONCLUSION

Serious video games for health are increasingly being used as a cognitive rehabilitation tool in patients with attention-deficit hyperactivity disorder (ADHD).

SYSTEMATIC REVIEW REGISTRATION

[www.crd.york.ac.uk/prospero], identifier [CRD42021247784].

El compromiso con la tarea en el alumnado Con TDAH: análisis del tiempo de escritura digital

La evolución de las nuevas tecnologías y la reciente situación de la Pandemia por COVID-19, han modificado las condiciones de la docencia educativa pasando mayoritariamente a una docencia digital. La utilización del ordenador se ha convertido en una herramienta necesaria para el aprendizaje. El alumnado con Trastorno por Déficit de Atención e Hiperactividad (TDAH) presenta especiales dificultades en la escritura y en la composición escrita. La presente investigación tiene como objetivo analizar la velocidad de la escritura (mecanografiado) en el alumnado con TDAH utilizando el ordenador en diferentes tareas. La muestra está formada por 48 niños y niñas entre 8-12 años, 24 forman el grupo con TDAH y 24 el grupo con desarrollo típico. Los tiempos de escritura se valoran mediante una tarea de dictado de frases a mecanografiar y con una tarea de chat de interacción social en tres momentos, al inicio, durante y al finalizar el chat social. Los resultados muestran que el alumnado con TDAH presenta significativamente mayor lentitud en la tarea de dictado de frases que el grupo de desarrollo típico. Sin embargo, el perfil de tiempo de escritura en la tarea de chat social es similar a sus compañeros/as. Los hallazgos evidencian que el tiempo de escritura (mecanografiado) empleado por el alumnado, está relacionado con el tipo de tarea, independientemente de la complejidad de esta. Se concluye que la motivación hacia la tarea es un aspecto crucial en el TDAH, que afecta a la variabilidad de la ejecución en las tareas digitales.

Identifying Neural Markers of Peer Dysfunction in Girls with ADHD

Very little research has prioritized girls with ADHD, despite accumulating evidence showing that girls with ADHD experience broader and more severe peer dysfunction relative to boys with ADHD. Attention to identifying the neural mechanisms underlying the peer difficulties of girls with ADHD is critical in order to develop targeted intervention strategies to improve peer functioning. New efforts to address the peer dysfunction of girls with ADHD are discussed.

Friendship Quality in Adolescents With ADHD

Objective: This study compared the quality of friendships (same- and other-sex) in adolescents with and without ADHD, across age and gender. Method: A community sample of 115 participants (61 ADHD, 54 Comparison), ages 13 to 18, completed a questionnaire assessing perceived levels of social support and negative interactions experienced in their friendships. Results: Ratings of friendship social support diminished across age in youth with ADHD, but increased in typically developing youth. Adolescents with and without ADHD, however, did not differ on ratings of negative interactions experienced in their friendships. Compared with males, females rated their friendships to be more supportive, irrespective of ADHD status. Adolescents with and without ADHD rated their same-sex friendships to be simultaneously more supportive and more conflictual than their other-sex friendships. Conclusion: Assessments of adolescents with ADHD should include a careful examination of their social functioning with particular attention devoted to the quality of their friendships.

Behavioral Treatment for the Social-Emotional Difficulties of Preadolescent and Adolescent Girls with ADHD

Girls with attention-deficit/hyperactivity disorder (ADHD) are at high risk for peer difficulties that often persist into adolescence and adulthood and portend risk for additional difficulties, such as depression, anxiety, and borderline personality disorder. However, very little research has examined interventions that address the widespread peer difficulties of girls with ADHD. This paper describes two open trials of behavior therapy aimed at addressing their social-emotional difficulties. The first trial includes 33 preadolescent girls (ages 7-11) with ADHD enrolled in an eight-week treatment and the second trial includes 22 adolescent girls (ages 12-16) with ADHD enrolled in a 12-week treatment. Measures of treatment feasibility and acceptability and measures of social functioning and psychopathology were collected in both trials. High levels of treatment feasibility and acceptability were reported in both the preadolescent and adolescent trial. In addition, improvements were reported in areas of social functioning and reductions in psychopathology, although the magnitude and specific areas of improvement differed somewhat in the preadolescent versus adolescent group. These preliminary findings provide a first step towards addressing the widespread social-emotional difficulties of girls with ADHD and offer insight into continuing efforts to address their treatment needs.

Borderline Personality Features Mediate the Association Between ADHD, ODD, and Relational and Physical Aggression in Girls

OBJECTIVE

This study investigates borderline personality features (BPF) as a mediator of the association between ADHD and ODD symptoms and aggression in girls.

METHOD

Parents of 118 girls ( M_age = 11.40 years old) with and without ADHD completed ratings of ADHD and ODD severity, and parents and youth provided ratings of physical and relational aggression.

RESULTS

ADHD, ODD, and their subfactors were significantly correlated with BPF, and these variables were associated with aggression measures. BPF fully mediated the association between total ODD symptom severity and relational and physical aggression by parent and youth report. At the subfactor level, BPF fully mediated the association between hyperactivity/impulsivity and oppositional behavior and physical and relational aggression.

CONCLUSION

These findings add to a growing literature showing the relevance of BPF as a risk factor for poor social functioning in youth and point to the importance of continued work examining BPF among girls with ADHD and ODD.

Exploring how adolescents with ADHD use and interact with technology

INTRODUCTION

The ubiquity of technology is reshaping the way teens express themselves and interact with peers. Considering that teens with attention-deficit/hyperactivity disorder (ADHD) experience a range of social impairments and that risk behaviors have the potential to be more widespread and damaging online, understanding how teens with ADHD use the Internet is important.

METHODS

The current study included 58 teens (72.4% boys; 13-16 years old) from the United States of America with ADHD. Study aims were to examine these teens' Internet use frequency, preferred online activities, Facebook interactions, and online risk behaviors (i.e., cyberbullying and sexting). Associations between online behaviors and offline symptoms and behaviors were explored to identify potential risk and protective factors.

RESULTS

Findings suggested that teens with ADHD use technology in similar ways as do the general population of teens described in previous research but appeared at unique risk of cyberbullying behaviors. Offline risks were associated with online risk behaviors. Using Facebook was associated with online risks (e.g., weak online connections) and offline risks (e.g., poorer social skills and more internalizing symptoms).

CONCLUSIONS

Online social platforms permit the exploration of social behaviors via naturalistic observation. It is imperative researchers gain understanding of the increasingly prevalent online social worlds of teens. Such an understanding may enable researchers to formulate effective social interventions for teens with ADHD.

Experiences of physical and relational victimization in children with ADHD: The role of social problems and aggression

The social risk factors for physical and relational peer victimization were examined within a mixed-gender sample of children with and without attention-deficit/hyperactivity disorder (ADHD). Participants were 124 children (ages 8-12 years; 48% boys), with 47% exhibiting sub-clinical or clinical elevations in ADHD symptoms. ADHD and oppositional defiant disorder (ODD) symptom counts were assessed based on parent- and teacher-reports; parents rated children's social problems and teachers rated children's use of physical and relational aggression and experiences of physical and relational victimization. A multiple mediator model was used to test whether there were indirect effects of ADHD or ODD symptoms on physical and relational victimization through social problems, physical aggression, or relational aggression. At the bivariate level, ADHD and ODD symptoms were both significantly associated with higher rates of physical and relational victimization. In the mediational model, there were significant indirect effects of ADHD symptoms on relational victimization via social problems, of ODD on relational victimization via relational aggression, and of ODD symptoms on physical victimization via physical aggression. Results suggest that there are distinct risk factors implicated in the physical and relational victimization of youth with ADHD and that the co-occurrence of ODD symptoms is important to assess. Clinical implications for addressing victimization in children with ADHD are discussed.

Social Skills Deficits in a Virtual Environment Among Spanish Children With ADHD

OBJECTIVE

Research assessing the social skills of children with ADHD has predominantly relied upon North American samples. In addition, most existing work has been conducted using methodology that fails to use a controlled peer stimulus; such methods may be more vulnerable to cultural influence.

METHOD

We examined the social skills of 52 Spanish children (ages 8-12) with and without ADHD using a controlled Chat Room Task, which simulates a virtual social environment where peers' responses are held constant, so that participants' social skills may be assessed.

RESULTS

After statistical control of typing and reading comprehension skills, Spanish children with ADHD gave fewer prosocial comments and had greater difficulty remembering central details from the conversation between the peers, relative to comparison children.

CONCLUSION

The virtual Chat Room Task may be useful to assess social skills deficits using a controlled paradigm, resulting in the identification of common social deficiencies cross-culturally.

Executive Functioning and Engagement in Physical and Relational Aggression among Children with ADHD

Although evidence suggests that executive functioning (EF) impairments are implicated in physically aggressive behavior (e.g., hitting) these cognitive impairments have rarely been examined with regard to relational aggression (e.g., gossip, systematic exclusion). Studies also have not examined if EF impairments underlie the expression of aggression in children with attention-deficit/hyperactivity disorder (ADHD) and if child gender moderates risk. Children with and without clinical elevations in ADHD symptoms (N = 124; ages 8-12 years; 48 % male) completed a battery of EF tests. Parent and teacher report of ADHD and oppositional defiant disorder (ODD) symptoms and teacher report of engagement in physical and relational aggression were collected. Models tested the unique association of EF abilities with physical and relational aggression and the indirect effect through the expression of ADHD or ODD behaviors; child gender was also tested as a moderator. EF impairment was uniquely associated with physical aggression, but better EF ability was associated with relational aggression. For boys, poor EF also was indirectly associated with greater physical aggression through the expression of ADHD behaviors. However, ADHD symptoms were unrelated to relational aggression. ODD symptoms also predicted physical aggression for boys but relational aggression for girls. Results suggest that there are multiple and distinct factors associated with engagement in physical and relational aggression and that better EF may actually promote relational aggression. Established models of physical aggression should not be assumed to map on to explanations of relational aggression.

Inattention and hyperactivity/impulsivity among children with attention-deficit/hyperactivity-disorder, autism spectrum disorder, and intellectual disability

BACKGROUND

Attention-Deficit/Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), and Intellectual Disability (ID) are common co-occurring neurodevelopmental disorders; however, limited research exists regarding the presentation and severity of overlapping symptomology, particularly inattention and hyperactivity/impulsivity, when a child is diagnosed with one of more of these neurodevelopmental disorders.

AIMS

As difficulties with inattention and hyperactivity/impulsivity are symptoms frequently associated with these disorders, the current study aims to determine the differences in the severity of inattention and hyperactivity/impulsivity in children diagnosed with ADHD, ASD, ID, and co-occurring diagnosis of ADHD/ID, ASD/ADHD, and ASD/ID.

METHODS AND PROCEDURES

Participants in the current study included 113 children between the ages of 6 and 11 who were diagnosed with ADHD, ASD, ID, ADHD/ID, ASD/ADHD, or ASD/ID. Two MANOVA analyses were used to compare these groups witih respsect to symptom (i.e., inattention, hyperactivity/impulsivity) severity.

OUTCOMES AND RESULTS

Results indicated that the majority of diagnostic groups experienced elevated levels of both inattention and hyperactivity/impulsivity. However, results yielded differences in inattention and hyperactivity/impulsivity severity. In addition, differences in measure sensitivity across behavioral instruments was found.

CONCLUSIONS AND IMPLICATIONS

Children with neurodevelopmental disorders often exhibit inattention and hyperactivity/impulsivity, particularly those with ADHD, ASD, ASD/ADHD, and ADHD/ID; therefore, differential diagnosis may be complicated due to similarities in ADHD symptom severity. However, intellectual abilities may be an important consideration for practitioners in the differential diagnosis process as children with ID and ASD/ID exhibited significantly less inattention and hyperactive/impulsive behaviors. Additionally, the use of multiple behavior rating measures in conjunction with other assessment procedures may help practitioners determine the most appropriate diagnosis.

The influence of comorbid asthma on the severity of symptoms in children with attention-deficit hyperactivity disorder

OBJECTIVE

The current study examined the association between asthma and attention-deficit hyperactivity disorder (ADHD) symptoms in a clinical pediatric sample.

METHODS

Demographic and neuropsychological data for children with a billing diagnosis of ADHD were extracted from a clinical database. Families completed standard rating scales. Seventy-one patients with a co-morbid asthma diagnosis were identified and matched by age to a group of 71 patients with only ADHD.

RESULTS

Children with asthma and ADHD were more likely to display clinically elevated levels of hyperactivity, externalizing behaviors, anxiety, and hyperactive/impulsive behaviors compared to children with ADHD alone. Boys with asthma and ADHD had more symptoms than boys with only ADHD of somatization and emotional internalizing, while girls with asthma and ADHD had more symptoms of hyperactivity/impulsivity, conduct problems, anxiety, and emotional internalizing compared to girls with only ADHD.

CONCLUSIONS

Findings suggest that in children with ADHD, co-morbid asthma is associated with increased behavioral and internalizing symptoms, with distinct gender differences present. Increased behavioral and internalizing symptoms seen in children with both asthma and ADHD may be due to the burden of their medical condition. No difference was found on cognitive variables, suggesting chronic hypoxia may be less influential in explaining these differences. Future research should determine the specific mechanisms of these differences.

Problematic Peer Functioning in Girls with ADHD: A Systematic Literature Review

Objective

Children with attention deficit hyperactivity disorder (ADHD) experience many peer interaction problems and are at risk of peer rejection and victimisation. Although many studies have investigated problematic peer functioning in children with ADHD, this research has predominantly focused on boys and studies investigating girls are scant. Those studies that did examine girls, often used a male comparison sample, disregarding the inherent gender differences between girls and boys. Previous studies have highlighted this limitation and recommended the need for comparisons between ADHD females and typical females, in order to elucidate the picture of female ADHD with regards to problematic peer functioning. The aim of this literature review was to gain insight into peer functioning difficulties in school-aged girls with ADHD.

Methods

PsychINFO, PubMed, and Web of Knowledge were searched for relevant literature comparing school-aged girls with ADHD to typically developing girls (TDs) in relation to peer functioning. The peer relationship domains were grouped into ‘friendship’, ‘peer status’, ‘social skills/competence’, and ‘peer victimisation and bullying’. In total, thirteen studies were included in the review.

Results

All of the thirteen studies included reported that girls with ADHD, compared to TD girls, demonstrated increased difficulties in the domains of friendship, peer interaction, social skills and functioning, peer victimization and externalising behaviour. Studies consistently showed small to medium effects for lower rates of friendship participation and stability in girls with ADHD relative to TD girls. Higher levels of peer rejection with small to large effect sizes were reported in all studies, which were predicted by girls’ conduct problems. Peer rejection in turn predicted poor social adjustment and a host of problem behaviours. Very high levels of peer victimisation were present in girls with ADHD with large effect sizes. Further, very high levels of social impairment and social skills deficits, with large effect sizes, were found across all studies. Levels of pro-social behaviour varied across studies, but were mostly lower in girls with ADHD, with small to large effect sizes. Overall, social disability was significantly higher among girls with ADHD than among TD girls.

Conclusion

Congruous evidence was found for peer functioning difficulties in the peer relationship domains of friendship, peer status, social skills/competence, and peer victimisation and bullying in girls with ADHD.

Real-time hostile attribution measurement and aggression in children

Hostile attributions are an important predictor of aggression in children, but few studies have measured hostile attributions as they occur in real-time. The current study uses an interactive video racing game to measure hostile attributions while children played against a presumed peer. A sample of 75 children, ages 10-13, used nonverbal and verbal procedures to respond to ambiguous provocation by their opponent. Hostile attributions were significantly positively related to parent-rated reactive aggression, when controlling for proactive aggression. Hostile attributions using a nonverbal response procedure were negatively related to proactive aggression, when controlling for reactive aggression. Results suggest hostile attributions in real-time occur quickly and simultaneously with social interaction, which differs from the deliberative, controlled appraisals measured with vignette-based instruments. The relation between real-time hostile attributions and reactive aggression could be accounted for by the impulsive response style that is characteristic of reactive aggression, whereas children exhibiting proactive aggression may be more deliberate and intentional in their responding, resulting in a negative relation with real-time hostile attributions. These findings can be used both to identify children at risk for aggression and to enhance preventive interventions.

The Link between Peer Relations, Prosocial Behavior, and ODD/ADHD Symptoms in 7-9-Year-Old Children

Oppositional defiant disorder (ODD) and attention-deficit/hyperactivity disorder (ADHD) are characterized by symptoms that hinder successful positive interaction with peers. The main goal of this study was to examine if the presence of symptoms of ODD and ADHD affects the relationship between positive social behavior and peer status found in 7–9-year-old children who show symptoms typical of ADHD and/or ODD. Furthermore, the possible interaction with sex was investigated. We used data collected in the first wave of The Bergen Child Study of mental health (BCS), a prospective longitudinal total population study of children's developmental and mental health. The target population consisted of children in the second to the fourth, in all public, private, and special schools in Bergen, Norway, in the fall of 2002 (N = 9430). All 79 primary schools in Bergen participated in the study. Both teacher (8809 complete cases) and parent (6253 complete cases) report were used in the analyses. ADHD and ODD scores were estimated using the Swanson Noland and Pelham rating scale version IV (SNAP-IV), and peer problems and prosocial behavior were assessed using the Strengths and Difficulties Questionnaire (SDQ). We replicated the relationship between peer problems and prosocial behavior found previously in typically developing children. Our results showed that the relationship between peer problems and prosocial behavior became weaker as the ODD symptoms increased in number and severity. For ADHD this effect was only found in the teacher report of the children. A sex effect for ODD symptoms was found only using the parent report: boys with ODD symptoms showed less prosocial behavior than girls with similar levels of ODD symptoms. Since this effect was not found using the teacher data, it may imply a situational effect (school/home) for girls with high levels of ODD. The moderator effect of ODD/ADHD was comparable for boys and girls. Our findings suggest that even if children with ADHD/ODD symptoms have the opportunity to practice their social skills in peer relationships, this is not necessarily accompanied by an increase in prosocial behavior.

Bullying and peer victimisation in adolescent girls with Attention-Deficit/Hyperactivity Disorder

Emerging evidence suggests that adolescent girls with Attention-Deficit/Hyperactivity Disorder (ADHD) are more socially impaired compared with their peers; however, research has yet to elucidate the nature of this impairment. We investigated overt (e.g., physical, such as hitting or kicking or verbal, such as teasing and taunting) and relational (e.g., social manipulation, such as social exclusion) bullying and victimisation in adolescent girls with and without ADHD. Adolescent girls (mean age = 15.11) with (n = 22) and without (n = 20) ADHD and their primary caregivers completed measures of overt/relational bullying and victimisation and social impairment. Adolescent girls with ADHD experienced more social problems and more relational and overt victimisation than adolescent girls without ADHD. Although adolescent girls with ADHD engaged in more overt and relational bullying than adolescent girls without ADHD, this difference was not statistically significant. Oppositional Defiant Disorder symptoms appeared to be more strongly related to bullying behaviour, while victimisation appeared to be more strongly related to ADHD.

Relations of inattention and hyperactivity/impulsivity to preadolescent peer functioning: the mediating roles of aggressive and prosocial behaviors

This study examined the structural relations of preadolescents' inattention and hyperactivity/impulsivity, aggressive and prosocial behaviors, and peer functioning. There were 739 fourth (n = 239) and fifth (n = 500) graders (52.23% boys) in Taiwan who participated in this study. Preadolescents' inattention and hyperactivity/impulsivity were assessed using parent reports on the Swanson, Nolan, and Pelham IV Rating Scale. Aggressive behaviors, including physical aggression and relational aggression, and prosocial behaviors were assessed using teacher and peer reports. Peer acceptance and the number of reciprocated friendships were obtained through peer nomination administered 6 months later after initial assessment and were combined to assess children's peer functioning. Results of structural equation modeling demonstrated that inattention was indirectly linked to impaired peer functioning through low levels of prosocial behavior, regardless of gender. In addition, inattention was directly related to less optimal peer functioning only for girls. Hyperactivity/impulsivity was neither directly nor indirectly related to impaired peer functioning in boys, although it was related to more physical and relational aggression. However, for girls, a positive and direct path existed between hyperactivity and peer functioning. Further, hyperactivity in girls was associated with more physical aggression, which in turn led to poorer peer functioning. These findings suggested that the processes related to each core domain of ADHD and peer functioning may be varied, depending on the mediating factors (e.g., aggression or prosocial behavior) and gender.

ADHD and female specific concerns: a review of the literature and clinical implications

ADHD was once thought of as a predominantly male disorder. While this may be true for ADHD in childhood, extant research suggests that the number of women with ADHD may be nearly equal to that of men with the disorder (Faraone et al., 2000). There is accumulating research which clearly indicates subtle but important sex differences exist in the symptom profile, neuropathology and clinical course of ADHD. Compared to males with ADHD, females with ADHD are more prone to have difficulties with inattentive symptoms than hyperactive and impulsive symptoms, and females often receive a diagnosis of ADHD significantly later than do males (Gaub & Carlson, 1997; Gershon, 2002a, 2002b). Emerging evidence suggests differences exist in the neuropathology of ADHD, and there are hormonal factors which may play an important role in understanding ADHD in females. Although research demonstrates females with ADHD differ from males in important ways, little research exists that evaluates differences in treatment response. Given the subtle but important differences in presentation and developmental course of ADHD, it is essential that both clinical practice and research be informed by awareness of these differences in order to better identify and promote improved quality of care to girls and women with ADHD.

Positive illusions of social competence in girls with and without ADHD

We compared social self-competence ratings in 9-12 year old girls with (n = 42) versus without (n = 40) ADHD, relative to ratings of the girls' social competence made by mothers, teachers, and blind raters during a social laboratory task. Relative to scores from mothers, teachers, and the lab-task, girls with ADHD over-estimated their competence significantly more than control girls. Over-estimates were greater for girls with ADHD who also had heightened oppositional-defiant symptoms, or lower depressive symptoms. Over-estimates were positively related to a socially desirable reporting bias for girls with ADHD, but not for control girls, suggesting that girls with ADHD attempt to present themselves in an unduly positive, self-protective light. For girls with ADHD, over-estimates also were positively related to maladjustment and negatively related to adjustment. However, for girls without ADHD, over-estimates were positively related to adjustment. Overall, over-estimates of competence function differently in girls with and without ADHD.

Social adjustment among Taiwanese children with symptoms of ADHD, ODD, and ADHD comorbid with ODD

This study examined social problems at school and relationships with peers, siblings, mothers, and fathers among children with ADHD only (n = 41), ODD only (n = 14), ADHD + ODD (n = 47), and normal controls (n = 204) from a school-based sample of 2,463 first to ninth graders in Taiwan. ADHD and ODD symptoms were determined by teacher and mother reports on the Conners' Rating Scales and social adjustment problems were assessed by mother reports on the Social Adjustment Inventory for Children and Adolescents. Results indicated that relative to normal controls, children with ADHD + ODD displayed greater levels of social adjustment problems across domains (i.e., school, peers, siblings, and parents) while children with ADHD were significantly more impaired only in social adjustment at schools and children with ODD were more impaired only in social adjustment at home. Some similarities and differences in our findings, in relation to the Western literature, were discussed.

The importance of friendship for youth with attention-deficit/hyperactivity disorder

It is well-established that youth with attention-deficit/hyperactivity disorder (ADHD) are often peer-rejected and rated by parents, teachers, and observers to have poor social skills, when compared to typically developing peers. Significantly less research, however, has been devoted to the experiences youth with ADHD have in their close friendships. The aim of this article is to draw attention to friendship as a distinct construct from peer rejection and social skills and to summarize what is known about youth with ADHD in their friendships. The potential for stable, high-quality friendships to buffer the negative outcomes typically conferred by peer rejection in this population is discussed. This article concludes with recommendations for interventions that specifically target improving the close friendships of youth with ADHD as a treatment strategy.

Oculomotor anomalies in attention-deficit/hyperactivity disorder: evidence for deficits in response preparation and inhibition

OBJECTIVE

To examine patterns of executive and oculomotor control in a group of both boys and girls with attention-deficit/hyperactivity disorder (ADHD).

METHOD

Cross-sectional study of 120 children aged 8 to 12 years, including 60 with ADHD (24 girls) and 60 typically developing controls (29 girls). Oculomotor paradigms included visually guided saccades (VGS), antisaccades, memory-guided saccades, and a go/no-go test, with variables of interest emphasizing response preparation, response inhibition, and working memory.

RESULTS

As a group, children with ADHD demonstrated significant deficits in oculomotor response preparation (VGS latency and variability) and response inhibition but not working memory. Girls, but not boys with ADHD, had significantly longer VGS latencies, even after controlling for differences in ADHD symptom severity. The ADHD subtypes did not differ on response preparation or inhibition measures; however, children with the Inattentive subtype were less accurate on the working memory task than those with the Combined subtype.

CONCLUSIONS

Sex differences in children with ADHD extend beyond symptom presentation to the development of oculomotor control. Saccade latency may represent a specific deficit among girls with ADHD.

Analysis of critical incidents and shifting perspectives: transitions in illness careers among adolescents with ADHD

Adolescence represents a developmental period during which the severity of mental health problems for children with attention deficit/hyperactivity disorder (ADHD) might change. It is a time when teens are consolidating their self-identity and possibly questioning the label of an ADHD diagnosis, treatment, and types of interventions. In this study we investigated the shared critical events related to help seeking reported by 8 teenagers with ADHD, their mothers, and their teachers and how the reported events and constructed shared focus on specific problems might explain teenagers' transitions in their illness careers. Data collected through a qualitative application of the experience sampling method illuminated diverse illness career transitions, including continuing treatment, transitioning from being treated to untreated or from being untreated to treated, and remaining untreated. Our findings support a model of shifting perspectives on illness and wellness among adolescents with ADHD, rather than a progression of adaptation to a chronic disorder.

The neurobiological profile of girls with ADHD

Since boys are more commonly diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) than girls, the majority of theories and published research studies of ADHD have been based on samples comprised primarily (or exclusively) of boys. While psychosocial impairment in girls with ADHD is well established, the neuropsychological and neurobiological basis of these deficits is less consistently observed. There is growing evidence that boys' and girls' brains develop and mature at different rates, suggesting that the trajectory of early anomalous brain development in ADHD may also be sex-specific. It remains unclear, however, whether earlier brain maturation observed in girls with ADHD is protective. In this review, we outline the current theory and research findings that seek to establish a unique neurobiological profile of girls with ADHD, highlighting sex differences in typical brain development and among children with ADHD. The review highlights findings from neurological, neurocognitive, and behavioral studies. Future research directions are suggested, including the need for longitudinal neuroimaging and neurobehavioral investigation beginning as early as the preschool years, and continuing through adolescence and adulthood, with consideration of identified sex differences in the development of ADHD.

Attention-deficit/hyperactivity disorder and social dysfunctioning

Attention-deficit/hyperactivity disorder (ADHD) is associated with functional impairments in different areas of daily life. One such area is social functioning. The purpose of this paper is to critically review research on social dysfunctioning in children with ADHD. Children with ADHD often have conflicts with adults and peers, and suffer from unpopularity, rejection by peers, and a lack of friendships, in part as a consequence of their ADHD symptoms. Comorbid oppositional defiant or conduct disorder aggravates these impairments. In some cases the inadequate social behavior of children with ADHD may be phenomenologically and etiologically related to pervasive developmental disorders (PDD). However, the causes and consequences of PDD symptoms in ADHD are understudied. Also, the relative contributions of ADHD, on the one hand, and comorbid disorders, on the other, to the course of social impairments are unknown. Social dysfunctioning in children with ADHD appears to increase their risk of later psychopathology other than ADHD. Thus far effective treatment for social dysfunctioning is lacking. Future research should address the exact nature and long-term consequences of social dysfunctioning in children with ADHD, and focus on development of effective treatment strategies.