ADHD Outcomes: Being Rejected Can Have a Bigger Impact than Having Friends

By Anita M. Schimizzi, Ph.D.

As with any childhood disorder, we want to know what can protect the child from long-term negative outcomes.  When it comes to ADHD, studies demonstrate all sorts of long-term problems that we would rather prevent, such as delinquency, depression, and anxiety. 

As I mentioned in a recent editorial, data from the Multimodal Treatment Study of ADHD (MTA) revealed some surprising results about long-term outcomes for children with ADHD.  Among the results include a finding that what we typically do to treat ADHD (medication and/or psychosocial treatment) does not significantly improve peer problems.  And long-term peer difficulties can lead to a host of externalizing and internalizing problems that can last into the adult years.

A recent study published in the Journal of Abnormal Child Psychology looked at two different areas of peer relationships in children with ADHD: peer rejection and friendship.  The authors predicted that children with ADHD that were rejected by peers and did not have friends would suffer poorer outcomes in adolescence.  They further predicted that having friends would help lessen the impact of peer rejection and thereby lead to better outcomes.  Their results revealed a surprising finding: friendships did not have the protective impact that they thought they would find.  Peer rejection was the big dog in negative outcomes, period.

Mrug and colleagues used MTA data to look at peer rejection and friendship in about 300 children with ADHD that were in 1st to 4th grade and received treatment for 14 months.  They then studied follow-up data 24 months and six and eight years later.  They took a look at things like ADHD symptoms, delinquency, alcohol use, cigarette smoking, marijuana use, depression, anxiety, and global impairment (defined as impairment across emotional, behavioral, interpersonal and task-related functioning).

The findings revealed that rejected youth were more likely to have higher rates of cigarette smoking, delinquency, anxiety and global impairment at the six-year follow-up and higher rates of global impairment at eight years.  These findings occurred even if the child had a reciprocal friend at the 24-month follow-up.  An interesting tidbit, at the six-year mark the kids with at least one friend were more likely to smoke cigarettes, which the authors suggest may be due to a tendency to be drawn to other rejected youth that are more likely to engage in antisocial behavior.  All of these findings occurred even while controlling for a bunch of other factors, such as ADHD symptoms.

The researchers discuss a variety of reasons that may have led to these outcomes.  One, children who are rejected lose out on important social interactions regardless of whether they have learned new social skills in treatment.  Without the opportunity to practice them in real-world situations, the child is left right where he started in the social arena.  Two, childhood friendships can shift quickly and a child that had a friend at the 24-month data collection may have not had that friend or any others for long enough to act as a buffer for peer rejection.   Three, peer rejection tends to be long-lasting and experiencing it over the long haul can lead to a sort of cyclical effect where rejected kids withdraw and/or act out in order to cope with the inner turmoil that being rejected can cause, which then leads to more rejection.

I understand that this study paints a pretty bleak picture for long-term ADHD outcomes, but the authors also offer some sound recommendations. 

  1. Keep teaching all of those important social skills and make sure to couple the teaching with real-world experiences where they can be practiced.  (Role plays can only take you so far.)
  2. School is a big part of the child’s world, but not the whole world.  Find social opportunities outside of school where children can make friends.
  3. Monitor kids and teens for the negative outcomes mentioned earlier (e.g., depression, anxiety, delinquency) and intervene early and meaningfully.

I’ve stated it before and I’ll state it again.  Open the doors of communication so a child that is rejected by peers can at least find acceptance and understanding with an adult.  It matters. 

Thanks for reading.  -Anita

Source:  Mrug, S., Molina, B., Hoza, B., Gerdes, A., Hinshaw, S., Hechtman, L., & Arnold, L. (2012). Peer Rejection and Friendships in Children with Attention-Deficit/Hyperactivity Disorder: Contributions to Long-Term Outcomes Journal of Abnormal Child Psychology DOI: 10.1007/s10802-012-9610-2