Observed Free-Play Patterns of Children with ADHD and Their Real-Life Friends
Previous observational studies conducted in highly structured, analog situations indicate that children with Attention-Deficit/Hyperactivity Disorder (ADHD) mismanage their relationships with same-age peers and friends. Such structured situations may not, however, fully represent the true nature of children’s play, which is typically characterized by free choice, intrinsic motivation, and spontaneity. The unique objective of the current observational study was to describe how 87 children with ADHD and 46 comparison (76% boys) aged 7–13 years behave when interacting with their real-life dyadic friends during an unstructured, free-play situation. Results indicate that dyads comprising one referred child with ADHD and an invited friend (“ADHD dyads”) engaged in less cooperative play, displayed less companionship, and showed less sensitivity to friends than comparison dyads. ADHD dyads also engaged in more conflict and exhibited significantly more negative affect than comparison dyads. These findings complement and extend, possibly with somewhat enhanced ecological validity, results obtained in previous studies on the friendships of children with ADHD featuring closed-field observations and questionnaire methodology.
KeywordsADHD friendship peer relationships observational study free play
This research was financially supported by a grant from the Canadian Institutes of Health Research. We express appreciation to all the children, parents, and teachers who participated in our study, and the schools and health professionals who provided referrals. The dedicated assistance of several research assistants, coders, and volunteers is also gratefully acknowledged. Some of the research reported herein was completed for a doctoral thesis (Marie Michèle Soucisse) and for an honors thesis (Marie Pier Vézina Melançon) at the Université du Québec en Outaouais, supervised by Sébastien Normand.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
All procedures performed in the study involving human participants were in accordance with the ethical standards of the University of Ottawa and Children’s Hospital of Eastern Ontario institutional research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included.
- Al-Yagon, M. (2016). Perceived close relationships with parents, teachers, and peers: Predictors of social, emotional, and behavioral features in adolescents with LD or comorbid LD and ADHD. Journal of Learning Disabilities, 49, 597–615. https://doi.org/10.1177/0022219415620569.CrossRefGoogle Scholar
- Asher, S. R., Parker, J. G., & Walker, D. L. (1996). Distinguishing friendship from acceptance: Implications for intervention and assessment. In W. M. Bukowski, A. F. Newcomb, & W. W. Hartup (Eds.), The company they keep: Friendship in childhood and adolescence (pp. 366–406). New York: Cambridge University Press.Google Scholar
- Bagwell, C. L., & Schmidt, M. E. (2011). Friendships in childhood & adolescence. New York: Guilford Press.Google Scholar
- Bagwell, C. L., Molina, B. S. G., Pelham, W. E., & Hoza, B. (2001). Attention-deficit hyperactivity disorder and problems in peer relations: Predictions from childhood to adolescence. Journal of the American Academy of Child & Adolescent Psychiatry, 40(11), 1285–1292. https://doi.org/10.1097/00004583-200111000-00008.CrossRefGoogle Scholar
- Becker, S. P., Luebbe, A. M., & Langberg, J. M. (2012). Co-occuring mental health problems and peer functioning among youth with attention-deficit/hyperactivity disorder: A review and recommendations for future research. Clinical Child and Family Psychology Review, 15, 279–302. https://doi.org/10.1007/s10567-012-0122-y.CrossRefGoogle Scholar
- Berndt, T. J. (1996). Exploring the effects of friendship quality on social development. In W. M. Bukowski, A. F. Newcomb, & W. W. Hartup (Eds.), The company they keep: Friendship in childhood and adolescence (pp. 346–365). England: Cambridge University Press.Google Scholar
- Bukowski, W. M., Motzoi, C., & Meyer, F. (2009). Friendship as process, function, and outcome. In K. H. Rubin, W. M. Bukowski, & B. Laursen (Eds.), Handbook of peer interactions, relationships, and groups (pp. 217–231). New York: Guilford Press.Google Scholar
- Burghardt, G. M. (2011). Defining and recognizing play. In P. E. Nathan (Series Ed.) & A. D. Pelligrini (Vol. Ed.), The Oxford handbook of the development of play (pp. 9–18). New York: Oxford University Press.Google Scholar
- Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale: Lawrence Earlbaum Associates.Google Scholar
- Conners, C. K., Sitarenios, G., Parker, J. D. C., & Epstein, J. N. (1998b). Revision and restandardization of the Conners Teacher Rating Scale (CTRS-R): Factor structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26, 279–291. https://doi.org/10.1023/A:1022606501530.CrossRefGoogle Scholar
- Coplan, R. J. (2011). Not just “Playing alone”: Exploring multiple forms of nonsocial play in childhood. In P. E. Nathan (Series Ed.) & A. D. Pelligrini (Vol. Ed.), The Oxford Handbook of the Development of Play (pp. 185–201). New York: Oxford University Press.Google Scholar
- Coplan, R. J., & Arbeau, K. A. (2009). Peer interactions and play in early childhood. In K. H. Rubin, W. M. Bukowski, & B. Laursen (Eds.), Handbook of peer interactions, relationships, and groups (pp. 143–161). New York: Guilford Press.Google Scholar
- Fonzi, A., Schneider, B. H., Tani, F., & Tomada, G. (1997). Predicting children's friendship status from their dyadic interaction in structured situations of potential conflict. Child Development, 68, 496–506. https://doi.org/10.1111/j.1467-8624.1997.tb01954.x.CrossRefGoogle Scholar
- Hoza, B., Gerdes, A. C., Mrug, S., Hinshaw, S. P., Bukowski, W. M., Gold, J. A., … Wigal, T. (2005a). Peer-assessed outcomes in the multimodal treatment study of children with Attention Deficit Hyperactivity Disorder. Journal of Clinical Child and Adolescent Psychology, 34, 74–86. doi: https://doi.org/10.1207/s15374424jccp3401_7.
- Hoza, B., Mrug, S., Gerdes, A. C., Hinshaw, S. P., Bukowski, W. M., Gold, J. A., … Arnold, L. E. (2005b). What aspects of peer relationships are impaired in children with Attention-Deficit/Hyperactivity Disorder? Journal of Consulting and Clinical Psychology, 73, 411–423. doi: https://doi.org/10.1037/0022-006X.73.3.411.
- Masten, C. L., Telzer, E. H., Fuligni, A. J., Lieberman, M. D., & Eisenberger, N. I. (2012). Time spent with friends in adolescence relates to less neural sensitivity to later peer rejection. Social Cognitive and Affective Neuroscience, 7, 106–114. https://doi.org/10.1093/scan/nsq098.CrossRefGoogle Scholar
- Mikami, A. Y. (2015). Social skills training for youth with ADHD. In R. A. Barkley (Ed.), Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (pp. 569–595). New York: Guilford Publications.Google Scholar
- Mikami, A.Y. & Normand, S. (2015). The importance of social contextual factors in peer relationships of children with ADHD. Current Developmental Disorders Reports. doi: https://doi.org/10.1007/s40474-014-0036-0.
- Mikami, A. Y., Jack, A., Emeh, C. C., & Stephens, H. F. (2010a). Parental influence on children with attention-deficit/hyperactivity disorder: I. Relationships between parent behaviors and child peer status. Journal of Abnormal Child Psychology, 38, 721–736. https://doi.org/10.1007/s10802-010.CrossRefGoogle Scholar
- Mikami, A. Y., Lerner, M. D., Griggs, M. S., McGrath, A., & Calhoun, C. D. (2010b). Parental influences on children with Attention-Deficit/Hyperactivity Disorder: II. A pilot intervention training parents as friendship coaches for their children. Journal of Abnormal Child Psychology, 38, 737–749. https://doi.org/10.1007/s10802-010-9403-4.CrossRefGoogle Scholar
- Normand, S., Schneider, B. H., Lee, M. D., Maisonneuve, M.-F., Kuehn, S., & Robaey, P. (2011). How do children with ADHD (mis)manage their real-life dyadic friendships? A multimethod investigation. Journal of Abnormal Child Psychology, 39, 293–305. https://doi.org/10.1007/s10802-010.CrossRefGoogle Scholar
- Normand, S., Schneider, B. H., Lee, M. D., Maisonneuve, M.-F., Chupetlovska-Anastasova, A., Kuehn, S. M., & Robaey, P. (2013). Continuities and changes in the friendships of children with and without ADHD: A longitudinal, observational study. Journal of Abnormal Child Psychology, 41, 1161–1175. https://doi.org/10.1007/s10802-013-9753-9.CrossRefGoogle Scholar
- Parker, J. G., & Seal, J. (1996). Forming, losing, renewing, and replacing friendships: Applying temporal parameters to the assessment of children's friendship experiences. Child Development, 67, 2248–2268. https://doi.org/10.1111/j.1467-8624.1996.tb01855.x.CrossRefGoogle Scholar
- Pelham, W. E., & Hoza, B. (1996). Intensive treatment: A summer treatment program for children with ADHD. In E. D. Hibbs & P. S. Jensen (Eds.), Psychosocial treatments for child and adolescent disorders: Empirically based strategies for clinical practice (pp. 311–340). Washington: American Psychological Association.CrossRefGoogle Scholar
- Pellegrini, A. D. (2011). The Oxford handbook of the development of play. New York: Oxford University Press.Google Scholar
- Pellegrini, A. D. (2013). Observing children in their natural worlds: A methodological primer (3rd ed.). New York: Psychology Press.Google Scholar
- Prinstein, M. J., & Giletta, M. (2016). Peer relations and developmental psychopathology. In D. Cicchetti (Ed.), Developmental psychopathology (3rd ed., pp. 1–53). Hoboken: Wiley.Google Scholar
- Roberts, W., Milich, R., & Barkley, R. A. (2014). Primary symptoms, diagnostic criteria, subtyping and prevalence of ADHD. In R. A. Barkley (Ed.), Attention-deficit hyperactivity disorder: A handbook for diagnosis & treatment (4 th ed.) (pp. 51–80). New York: The Guilford Press.Google Scholar
- Selman, R. L., Watts, C. L., & Schultz, L. H. (1997). Fostering friendship: Pair therapy for treatment and prevention. Hawthorne: Aldine de Gruyter.Google Scholar
- Shantz, C. U., & Hartup, W. W. (1992). Conflict in child and adolescent development. New York: Cambridge University Press.Google Scholar
- Smith, P. K. (2011). Observational methods in studying play. In P. E. Nathan (Series Ed.) & A. D. Pelligrini (Vol. Ed.), The Oxford Handbook of the Development of Play (pp. 138–149). New York: Oxford University Press.Google Scholar
- Stone, A. A., Turkkan, J. S., Bachrach, C. A., Jobe, J. B., Kurtzman, H. S., & Cain, V. S. (2000). The science of self-report: Implications for research and practice. Mahwah: Lawrence Erlbaum Associates.Google Scholar