Social Skills and Children with ADHD

byKarla Fife, LCSW, BCBA

Children with ADHD can experience varying degrees of social challenges that may interfere with friendship development and a positive sense of self. An impulsive child might grab toys, have difficulty waiting his/her turn, or overreact to peer conflict in ways that make classmates annoyed or uneasy. Difficulty paying attention can inhibit a child’s ability to pick up social cues. So the child might not even realize he/she is invading a peer’s space, talking too loud, or being perceived as “bossy,” all of which can become aversive to the peer group. As a result, children with ADHD can have difficulty making friends and getting along with others. Some children with ADHD can experience loneliness and rejection.

We’ve learned through research and clinical experience that it is very important to teach social skills across multiple environments, (e.g., home, school, therapy, play dates, community outings), and to involve as many people in the child’s life as possible. It is also important that therapy considers the individual needs and learning style of the child and incorporates appropriate strategies such as role-play, visual cues, coaching, conversational practice, parent guidance, and positive reinforcement, accordingly.

It can be painful to see your child struggling socially. So it is understandable that a parent would want to address what’s not working quickly. Sometimes knowing where to start can be a challenge. One suggestion is to prioritize the skills you want to address, placing a higher priority on those that cause most conflict between the child and peers. For instance, aggression or name-calling would be a focus before conversational exchanges (reciprocal, back and forth, comments and questions that are on-topic). Skills should be broken down as well. The skill of conversing or playing cooperatively encompasses many subskills such as knowing how to start a conversation, on-topic responses that keep it going, how to interrupt, joining kids already at play, tolerating change, recognizing when others are bored versus interested, and recalling information about others. So if a child isn’t initiating with his/her peers to play or to talk, observe what specific skills, or subskills, are lacking. This kind of observation(s) can provide insight towards identifying the subskills that need to be addressed for the child to become successful in the overall task of playing cooperatively or talking to others. Formal assessment by a therapist could be required to assist in this process.

By prioritizing, and then breaking down the skills that a child needs to learn, all those working with the child have a focus, or target, for teaching and supporting behavioral change. It is the targeted skill that becomes the focus of instruction, practice, and reinforcement. As the targeted skill is acquired in multiple environments (i.e. school, home, Boy Scouts), you can then add on another skill, or few skills, to focus your attention and support.

Even with numerous teaching opportunities, a child with ADHD is likely to need preparation, practice, and reminders/cueing before entering into social activities. This could be as simple as a Q&A before entering the social situation. For example, a parent might ask, “So if you see a toy that you want at Tom’s house, but another kid is playing with it, what can you say?” It could require specific practice such as role-playing the appropriate skill, or playing a “cool” or “not cool” game, where you act out different responses, both appropriate and inappropriate, and have the child determine when he sees the “cool” (targeted skill) behavior versus “not cool” (behavior you want to decrease or eliminate). Once the child identifies whether the behavior is “cool” or “not cool,” ask “why?” to determine if he/she can explain their response. You then want to explicitly say to the child, “So that’s the cool behavior I am looking for when you are at soccer practice today.”

During, or immediately following, social situations, reinforcement for demonstrating the targeted skill can increase the likelihood of it occurring again. By definition, a reinforcer is anything that follows a behavior and increases the likelihood of the behavior occurring again. If you’ve tried positive reinforcement in the past, but haven’t seen a change in behavior, it might be helpful to discuss this strategy with a therapist. Just because a child likes something and you give it to him/her doesn’t mean that it will result in an increase in the targeted behavior. So discriminating true reinforcers from things a child simply enjoys or likes can take some work. A trained clinician can assist you in selecting appropriate reinforcers and designing a positive reinforcement system that really targets the social behavior you want to see increase. Regardless, getting into a habit of positively recognizing the appropriate social skills your child demonstrates is a good starting place. From your child’s perspective, hearing what he/she is doing well more often than hearing what he/she is doing wrong can be rewarding.

Take a look at the links provided for some quick information on ADHD and social challenges, along with parenting tips for supporting socialization. It should be noted that the suggestions on the websites are general. Individualized support can be gained by accessing a trained clinician, and/or pulling together your child’s school team for regularly scheduled meetings to follow up on what’s working and what’s not. Again, when all those working with the child are on the same page, focused on the same goals in a positive way, change is more likely.

Priming Kids with ADHD for Interpersonal Success, Social Skill Builder

Center for Disease Control and Prevention, Peer Relationships and ADHD

Making Friends – How Parents Can Help Their Kids With Friendship

Role Playing to Teach Children with ADHD Social Skills

Teaching Social Skills to the ADHD Child

National Institute of Mental Health, ADHD Fact Sheet

Books:

Smart but Scattered: The Revolutionary “Executive Skills” Approach to Helping Kids Reach Their Potential by Peg Dawson (Author), Richard Guare

Scattered: How Attention Deficit Disorder Originates And What You Can Do About It by Gabor Mate

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