ADHD - Child
Caroline E. Miller, B.A.
Graduate Student
The University of British Columbia
Vancouver, British Columbia, Canada
Amori Y. Mikami, Ph.D.
Professor
The University of British Columbia
Vancouver, British Columbia, Canada
Linda J. Pfiffner, Ph.D.
Professor
University of California San Francisco
San Francisco, California
Stephen Hinshaw, Ph.D.
Distinguished Professor
University of California at Berkeley
Berkeley, California
Michael J. Kofler, Ph.D.
Associate Professor
Florida State University
Tallahassee, Florida
Sébastien Normand, Ph.D.
Professor
Université du Québec en Outaouais
Gatineau, Quebec, Canada
Introduction: Children with attention-deficit/hyperactivity disorder (ADHD) show impairments in social skills. However, internalizing disorders co-occur with ADHD at rates of 25-49%; externalizing disorders co-occur at rates of 40-50%, and up to 22% have both internalizing and externalizing comorbidities, meaning that the presentation of social skills problems may be heterogenous across children with ADHD. We sought to identify the overall and subdomain-specific social skill deficits associated with the presence of comorbid disorders among children with ADHD.
Method: This study is a secondary data analysis of eight datasets from four research groups across the United States and Canada, creating a sample comprising 1400 children with ADHD aged 7-12. Each child had parent and teacher report on the Social Skills Improvement System (SSIS) or its predecessor, the Social Skills Rating System (SSRS). Both scales generate a global social skills score and subdomain scores (cooperation, communication, assertion, responsibility, empathy, engagement, and self-control). ANCOVAs were conducted with two dichotomous predictors and their interaction: internalizing comorbidity and externalizing comorbidity. Outcomes were global social skills and specific subdomains.
Results: Parents rated global social skills as poorer for children with either comorbidity type compared to ADHD alone. The interaction was also significant such that children with both comorbidities performed similarly to children with externalizing comorbidity. Regarding subdomain scores, there was a main effect of internalizing comorbidity for poorer assertion, and a main effect of externalizing comorbidity for poorer communication and cooperation. Poorer self-control and responsibility were associated with both internalizing and externalizing comorbidities as main effects; interactions were found such that externalizing-associated deficits overshadowed incremental contributions of internalizing comorbidity. There was a main effect of externalizing comorbidity for poorer empathy, but an interaction effect indicating that children with both comorbidities demonstrated better empathy than those with externalizing comorbidity.
Teachers rated global social skills as poorer only for children with externalizing comorbidity. Regarding subdomains, there were main effects of externalizing comorbidity for poorer assertion, communication, cooperation, responsibility, empathy, and self-control.
Discussion: Children with ADHD and comorbidities generally showed poorer social skills compared to children with ADHD alone. According to parents, externalizing comorbidity and internalizing comorbidity were both associated with poorer social skills, but in different subdomains. Some interaction effects between the two comorbidities were found. Such nuanced associations were not reported by teachers, perhaps because the types of social impairments that are associated with externalizing disorders are more disruptive and easier to perceive. The pattern of social skills deficits associated with each comorbidity might allow interventions to become more personalized and effective.