Peer Rejection of Students with ADHD:A Group Counseling Approach

Claire Nawojchik

DSM-IV Criteria for ADHD I. Either A or B, at developmentally

inappropriate levels: A: 6 or more inattention symptoms for 6 months B: 6 or more hyperactivity-impulsivity symptoms

for 6 months Symptoms were present before age 7 Impairment in 2 or more settings (e.g., school &

home) Significant impairment in social, school, or work

functioning The symptoms are not accounted for by another

mental disorder

Three Types of ADHD Combined Type: Both inattention &

hyperactivity-impulsivity criteria are met Predominantly Inattentive Type

Predominantly Hyperactive-Impulsive Type

Overview of Issue 9% of students aged 3-17 have ADHD (5

million people)

Difficulties with peer relationships begin in elementary school

52% of children with ADHD are peer rejected in comparison to 14% of typically developing children

Children with ADHD are twice as likely to have no reciprocated friendships

Problematic Social Behaviors

Join in a peer activity at an inappropriate time

Interrupt others Respond with irrelevant information

during a conversation React in an aggressive manner

Consequences of Peer Rejection

Peer rejection of children with ADHD before age 10 is predictive of anxiety, delinquency, tobacco use, and overall emotional, interpersonal, and behavioral impairment during adolescence

A high level of peer rejection is associated with depression and poor academic performance

Students with ADHD are over 3 times more likely to drop out of high school

Preventing Chronic Disease, 2006 April; 3(2): A52Based on parent-report for children aged 4-17 from the 2003 National Health Information Survey

The ADHD Stigma Peers make more negative judgments about an

individual’s behavior when it is labeled “due to ADHD” than they do when the same behavior has no label

Interventions focused solely on improving ADHD behaviors, without addressing biases of typically developing peers, are not sufficient

Girls with ADHD are less peer accepted than boys because ADHD behaviors are in contrast to the feminine ideal and more socially accepted for boys

The ADHD Stigma ADHD is not a visible disability, so behavior

may be viewed as within the child’s control, the result of poor parenting, and not as a legitimate disorder

Parents are reluctant to let their typically-developing children interact with children with ADHD because of their behaviors

Teachers’ frustration with the classroom behavior of children with ADHD encourages peers’ dislike of them

A Social Justice Approach Use strengths-based counseling:

Emphasize positive skills and traits unrelated to academics & relationships

Emphasis on environmental factors: Promote inclusiveness of the peer group and challenge biases

Consider the role social experience plays on other realms, like academics

Avoid using labels, and use person-first language: Use the phrase “student with ADHD” instead of “ADHD student”

Emphasis on equity

The School Counselor’s Role

Delivery System: Direct Student Services

Small Group Counseling

Dyadic Friendship Intervention

Pair child with ADHD with prosocial buddy & encourage pair cooperation

Pairs given special privileges – work together, sit together, & share points on behavioral point system

Counselor meets buddy pair each week (for 7-8 weeks) to discuss social problem solving

Play-based Intervention Pair with typically developing peer of same age in

natural context of play

Encourage empathy, perspective-taking, intrinsic motivation, & modeling

Counselor models prosocial behavior – sharing, supporting, & joint pretend play

Video self-modeling

Weekly feedback on social behaviors for both children

Promoting Inclusiveness of Peer Group

Serve as positive model of acceptance

Focus on strengths unrelated to social/academic functioning (i.e. artistic)

Encourage conversation about common interests & group work

Peers rewarded for patience and kindness

The School Counselor’s Role

Delivery System: Indirect Student Services

Consultation

Advocate for acceptance of students with ADHD by teachers and parents

Collaboration with Teachers

Give buddy pairs privileges like sitting together in class & sharing points

Encourage group work Use behavioral point system, but discuss point

totals privately Minimize social comparisons between students Be warm & model the likability of students

with ADHD Reward students for kind and patient behavior

Collaboration with Parents Arrange weekly play dates outside of

school for buddy pairs

Coordinate with other parents

Practice play tasks, peer modeling, and video self-monitoring at home

The School Counselor’s Role

Accountability

Evaluate interventions, monitor student progress, and present data to others

Results Dyadic friendship intervention: Academic improvement, higher quality friendships, &

normalized behavior Parent, teacher, and counselor ratings pre- and post-

group Play-based intervention: Improvement in social play behavior & interpersonal

empathy for both peers Test of Playfulness Promoting inclusiveness of peer group: Anonymous positive peer sociometric ratings &

reciprocated peer nominations Observations of behavior during recess and lunch

Challenges Not enough prosocial peers willing to

participate in a social skills group Parents reluctant to involve their child with an

antisocial or socially stigmatized child ASCA standard A.11.a & b – peer-helper

programs

Future Research Needed: Potential risks and benefits for typically

developing peer mentors? How long-lasting and generalizable are results? Gender differences?

Summary Friendship interventions at the elementary

level (ages 5 – 12)

Social skills group counseling is more effective when typically developing children act as mentors/companions to children with ADHD

Focusing solely on behavioral training for children with ADHD is not enough – improvements in parent/teacher ratings do not lead to peer likability

ReferencesAmerican School Counselor Association (2012). The ASCA National Model: A

Framework for School Counseling Programs, Third Edition.Alexandria, VA: Author.

Auger, R. (2011). The school counselor’s mental health sourcebook: Strategies to help students succeed. Thousand Oaks, California: Corwin.

Fite, P. J., Wimsatt, A. R., Vitulano, M. L., Rathert, J. L., & Schwartz, S. (2012). Examination of peer rejection and depressive symptoms as mediators of the link between rule-breaking behavior and poor academic performance. Journal of Psychopathology and Behavioral Assessment, 34, 164-171.

doi: 10.1007/s10862-011-9269-y

Holcomb-McCoy, Cheryl. (2007). School Counseling To Close The Achievement Gap. Thousand Oaks, CA: Corwin Press.

Hoza, B., Mrug, S., Gerdes, A. C., Hinshaw, S. P., Bukowski, W. M., Gold, J. A., . . . Arnold, L. E. (2005). What aspects of peer relationships are impaired in

children with attention-deficit/hyperactivity disorder? Journal of Consulting and Clinical Psychology, 73(3), 411-423.

doi: 10.1037/0022-006x.73.3.411

ReferencesHoza, B., Mrug, S., Pelham, W.E., Greiner, A.R., & Gnagy, E. M. (2003). A friendshipintervention for children with attention- deficit/hyperactivitydisorder:Preliminary findings. Journal of Attention Disorders, 6(3), 87-98. doi: 10.1177/108705470300600301

Mikami, A.Y., Griggs, M. S., Lerner, M.D., Emeh, C.C., Reuland, M. M., Jack, A., & Anthony, M.R. (2012). 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, Online First Publication. doi: 10.1037/a0029654

Mrug, S., Molina, B. S. G., Hoza, B., Gerdes, A. C., Hinshaw, S. P., Hechtman, L., & Arnold, L. E. (2012). Peer rejection and friendships in children with attention-deficit/hyperactivity disorder: Contributions to long-term outcomes. Journal of Abnormal Child Psychology, 40, 1013-1026.

Wilkes, S., Cordier, R., Bundy, A., Docking, K., & Munro, N. (2011). A play-based interventionfor children with ADHD: A pilot study. Australian Occupational Therapy Journal, 58, 231-240. doi: 10.1111/j.1440-1630.2011.00928.x