Children with ADHD often struggle in social situations. This sometimes only start showing up later on (not necessarily before the present cut-off diagnostic age of 7 according to the DSM-IV). This might have to do with executive functioning.
Since ADHD is often unrecognised by the man on the street, socially inappropriate behaviours are easily attributed to other causes and these children are regularly seen as rude, self-centred, ill-mannered, irresponsible, lazy, or their behavior is considered even as poor parenting. Yet negative labelling leads to social rejection over time not only in the peer group but also later on their adult relationships.
So, a serious question is why do these children so often struggle in social situations?
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) describes ADHD behaviour as being easily distracted, missing details, forgetting things, difficulty maintaining focus, easily becoming bored, struggling to complete chores or tasks, daydreaming, struggling to follow instructions, often loosing
things, fidgeting and squirming, talking non-stop, can become very impatient, inability to tolerate frustration, needing immediate gratification (struggling to wait for things or taking turns), acting without considering the consequences, blurting out answers, and showing emotions without restraint.
It is not difficult to understand why such behaviour might generate unhappiness in peer groups and interfere with relationships.
In the DSM-IV problematic executive functioning is not directly spelled out under ADHD but rather under neurocognitive disorders (of course, problematic executive functioning also occurs during or after brain traumas which really necessitates a correct diagnoses of ADHD). However, behaviour such as the required diagnostic symptoms for ADHD does cluster under executive functioning. Basically it is those behaviours that drive parents and teachers up the wall! Executive functions can be considered an umbrella term for those vital tasks required for planning, strategy, organisation, self-control, regulation of attention, and of
course, social insight and interactions.
For this reason the DSM-V which is to be published during 2013, proposed various changes to the diagnostic criteria of ADHD amongst others possibly changing the cut off age to twelve. Previously the problem behaviour had to have been present before the age of seven. However, problems with executive functioning do not necessarily show up by age seven... (The DSM-IV criteria for ADD/ADHD have also been heavily criticised for reasons such as subtypes being unstable over time, impulsivity being under presented while lack of attention receives the primary focus, subtype classifications leading to borderline cases for example. The child fulfils only five criteria of a subtype and therefore can receive no official diagnoses, and so forth - Hence, no offical help.)
How and where, does executive functioning and social relations interlink?
Firstly, we do not even know about the term executive functions. So nobody informs us to look out for additional problems besides attention or hyperactivity. Neither are we told that the medication does not address that particular issues re ADHD. While focus and hyperactivity almost always react positively to medication, it is not necessarily the case with executive functions (possibly one of the reasons why so many parents give up on medication and believe it doesn't work). Parents in particular are confronted by the social and emotional behavior of the child, while the teachers struggle with the academy. So, while medication might assist the child to improve at school, it still does not help with the "home bound" or "socialising" issues which parents, mostly, are confronted with.
However, if a child's attention span and hyperactivity is not medically addressed it denies him the opportunity to function on the same level as his peers and also to interact according to the social requirements of his group. Now I am referring to only "sporadically" medication provided to the ADHD. One of the things I have never understood is why practitioners often tell parents the ADHD child only needs the medication during school hours or when studying. This I find irresponsible as the child socialises also in the afternoons, over weekends and during holidays, and for this attention and hyperactivity also need to be addressed.
Let's face it, children can be cruel. Those who march to a different beat are often ridiculed, bullied, and rejected. No wonder they are more prone to seek the company of so-called delinquent groups. There they are more easily accepted for who they are.
What I am also trying to say here, is that medication is the first step. Without medication you can forget about addressing all the other issues that accompanies ADHD.
Getting back to the ADHD child’s social relationships, the ADHD child therefore needs [over and above mediation] more parental guidance during his forming years than so-called normal children. The ADHD child in particular often/regularly requires monitoring and feedback in social situations as he already struggles with amongst others meta-cognition (the ability to read the impact of his behaviour on others and to adjust it accordingly) and internalizing language (using "self-talk" to control one's thoughts and behaviour and direct future actions). His often disability to tolerate frustration and to think before acting or speaking regularly leads to misunderstandings and conflict. It is therefore not simply a question of correct medication, but also addressing the various other problems that regularly accompany ADHD.
Various interventions to assist parents and ADHD children are available, such as specialised parental guidance, behavioural therapy, neuro-therapy and biofeedback, cognitive or rational emotive therapy (especially where the ADHD child has already developed a mood disorder) and social skills training. In
addition the ADHD child often also requires specialised support with schoolwork, where comorbids (other learning disorders such as problems with reading, writing, mathematical) are also present.
Problems with executive skills therefore require that ADHD needs an integrated, holistic approach, not only medication. It is well-known that IQ does not “rule” the world” anymore, but EQ as well. What is the use of passing high school, if you cannot cope otherwise in the world out there....
We would therefore do well when we also assist our children to develop their social (and EQ) skills. ADHD parents in particular would do well if they remember that over and above medication, they also need to pay attention to their ADHD’s child’s social skills (yes, at risk of repeating myself constantly…)
Afterthought - As one teenager states: "When in doubt, ask us! We do not wilfully misbehave." (Cashin 1997).
With ADHD, we really have to start thinking outside the Box instead of being boxed in by what we can expect from these children; versus what we ourselves are willing to contribute.
References
Barkley, R.A, Biederman, J. (1997).Toward a broader definition of the age of onset criterion for attention-deficit hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 1997:36(9): 12-4-1210
Cashin, J. (1997). Jamie Trying to Fit In A Former Student's Perspective. Available at http://adhd.kids.tripod.com/jamie.html.
Clinical Practice Guideline: Diagnosis and Evaluation of the Child with Attention-Deficit/Hyperactivity Disorder. Pediatrics 105 (5): 1158-70 2000.
Denckla, M. (1996). A theory and model of executive function: A neuropsychological perspective. In G. Lyon & N. Krasnegor (Eds.), Attention, memory and executive function. Baltimore, MD.: Paul Brookes. pp.
263-278.
DSM-IV. Diagnostic and Statistical Manual of Mental Disorders. 4th Ed. Washington, DC, American Psychiatric Association, 1994.
Guevremont, D. C., & Dumas, M. C. (1994). Peer relationship problems and disruptive behavior disorders. Journal of Emotional and Behavioral Disorders, 2(3), 164-173.
Russell A. (2010). Against the Status Quo: Revising the Diagnostic Criteria for ADHD. Barkley Journal of the American Academy of Child & Adolescent Psychiatry.2010; 49 (3):205-207.
http://www.chrisdendy.com/executive.htm
Since ADHD is often unrecognised by the man on the street, socially inappropriate behaviours are easily attributed to other causes and these children are regularly seen as rude, self-centred, ill-mannered, irresponsible, lazy, or their behavior is considered even as poor parenting. Yet negative labelling leads to social rejection over time not only in the peer group but also later on their adult relationships.
So, a serious question is why do these children so often struggle in social situations?
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) describes ADHD behaviour as being easily distracted, missing details, forgetting things, difficulty maintaining focus, easily becoming bored, struggling to complete chores or tasks, daydreaming, struggling to follow instructions, often loosing
things, fidgeting and squirming, talking non-stop, can become very impatient, inability to tolerate frustration, needing immediate gratification (struggling to wait for things or taking turns), acting without considering the consequences, blurting out answers, and showing emotions without restraint.
It is not difficult to understand why such behaviour might generate unhappiness in peer groups and interfere with relationships.
In the DSM-IV problematic executive functioning is not directly spelled out under ADHD but rather under neurocognitive disorders (of course, problematic executive functioning also occurs during or after brain traumas which really necessitates a correct diagnoses of ADHD). However, behaviour such as the required diagnostic symptoms for ADHD does cluster under executive functioning. Basically it is those behaviours that drive parents and teachers up the wall! Executive functions can be considered an umbrella term for those vital tasks required for planning, strategy, organisation, self-control, regulation of attention, and of
course, social insight and interactions.
For this reason the DSM-V which is to be published during 2013, proposed various changes to the diagnostic criteria of ADHD amongst others possibly changing the cut off age to twelve. Previously the problem behaviour had to have been present before the age of seven. However, problems with executive functioning do not necessarily show up by age seven... (The DSM-IV criteria for ADD/ADHD have also been heavily criticised for reasons such as subtypes being unstable over time, impulsivity being under presented while lack of attention receives the primary focus, subtype classifications leading to borderline cases for example. The child fulfils only five criteria of a subtype and therefore can receive no official diagnoses, and so forth - Hence, no offical help.)
How and where, does executive functioning and social relations interlink?
Firstly, we do not even know about the term executive functions. So nobody informs us to look out for additional problems besides attention or hyperactivity. Neither are we told that the medication does not address that particular issues re ADHD. While focus and hyperactivity almost always react positively to medication, it is not necessarily the case with executive functions (possibly one of the reasons why so many parents give up on medication and believe it doesn't work). Parents in particular are confronted by the social and emotional behavior of the child, while the teachers struggle with the academy. So, while medication might assist the child to improve at school, it still does not help with the "home bound" or "socialising" issues which parents, mostly, are confronted with.
However, if a child's attention span and hyperactivity is not medically addressed it denies him the opportunity to function on the same level as his peers and also to interact according to the social requirements of his group. Now I am referring to only "sporadically" medication provided to the ADHD. One of the things I have never understood is why practitioners often tell parents the ADHD child only needs the medication during school hours or when studying. This I find irresponsible as the child socialises also in the afternoons, over weekends and during holidays, and for this attention and hyperactivity also need to be addressed.
Let's face it, children can be cruel. Those who march to a different beat are often ridiculed, bullied, and rejected. No wonder they are more prone to seek the company of so-called delinquent groups. There they are more easily accepted for who they are.
What I am also trying to say here, is that medication is the first step. Without medication you can forget about addressing all the other issues that accompanies ADHD.
Getting back to the ADHD child’s social relationships, the ADHD child therefore needs [over and above mediation] more parental guidance during his forming years than so-called normal children. The ADHD child in particular often/regularly requires monitoring and feedback in social situations as he already struggles with amongst others meta-cognition (the ability to read the impact of his behaviour on others and to adjust it accordingly) and internalizing language (using "self-talk" to control one's thoughts and behaviour and direct future actions). His often disability to tolerate frustration and to think before acting or speaking regularly leads to misunderstandings and conflict. It is therefore not simply a question of correct medication, but also addressing the various other problems that regularly accompany ADHD.
Various interventions to assist parents and ADHD children are available, such as specialised parental guidance, behavioural therapy, neuro-therapy and biofeedback, cognitive or rational emotive therapy (especially where the ADHD child has already developed a mood disorder) and social skills training. In
addition the ADHD child often also requires specialised support with schoolwork, where comorbids (other learning disorders such as problems with reading, writing, mathematical) are also present.
Problems with executive skills therefore require that ADHD needs an integrated, holistic approach, not only medication. It is well-known that IQ does not “rule” the world” anymore, but EQ as well. What is the use of passing high school, if you cannot cope otherwise in the world out there....
We would therefore do well when we also assist our children to develop their social (and EQ) skills. ADHD parents in particular would do well if they remember that over and above medication, they also need to pay attention to their ADHD’s child’s social skills (yes, at risk of repeating myself constantly…)
Afterthought - As one teenager states: "When in doubt, ask us! We do not wilfully misbehave." (Cashin 1997).
With ADHD, we really have to start thinking outside the Box instead of being boxed in by what we can expect from these children; versus what we ourselves are willing to contribute.
References
Barkley, R.A, Biederman, J. (1997).Toward a broader definition of the age of onset criterion for attention-deficit hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 1997:36(9): 12-4-1210
Cashin, J. (1997). Jamie Trying to Fit In A Former Student's Perspective. Available at http://adhd.kids.tripod.com/jamie.html.
Clinical Practice Guideline: Diagnosis and Evaluation of the Child with Attention-Deficit/Hyperactivity Disorder. Pediatrics 105 (5): 1158-70 2000.
Denckla, M. (1996). A theory and model of executive function: A neuropsychological perspective. In G. Lyon & N. Krasnegor (Eds.), Attention, memory and executive function. Baltimore, MD.: Paul Brookes. pp.
263-278.
DSM-IV. Diagnostic and Statistical Manual of Mental Disorders. 4th Ed. Washington, DC, American Psychiatric Association, 1994.
Guevremont, D. C., & Dumas, M. C. (1994). Peer relationship problems and disruptive behavior disorders. Journal of Emotional and Behavioral Disorders, 2(3), 164-173.
Russell A. (2010). Against the Status Quo: Revising the Diagnostic Criteria for ADHD. Barkley Journal of the American Academy of Child & Adolescent Psychiatry.2010; 49 (3):205-207.
http://www.chrisdendy.com/executive.htm
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