Child Psychiatry & Human Development

, Volume 42, Issue 2, pp 134–151 | Cite as

Social Adjustment Among Taiwanese Children with Symptoms of ADHD, ODD, and ADHD Comorbid with ODD

  • Wan-Ling Tseng
  • Yoshito Kawabata
  • Susan Shur-Fen Gau
Original Article


This study examined social problems at school and relationships with peers, siblings, mothers, and fathers among children with ADHD only (n = 41), ODD only (n = 14), ADHD + ODD (n = 47), and normal controls (n = 204) from a school-based sample of 2,463 first to ninth graders in Taiwan. ADHD and ODD symptoms were determined by teacher and mother reports on the Conners’ Rating Scales and social adjustment problems were assessed by mother reports on the Social Adjustment Inventory for Children and Adolescents. Results indicated that relative to normal controls, children with ADHD + ODD displayed greater levels of social adjustment problems across domains (i.e., school, peers, siblings, and parents) while children with ADHD were significantly more impaired only in social adjustment at schools and children with ODD were more impaired only in social adjustment at home. Some similarities and differences in our findings, in relation to the Western literature, were discussed.


ADHD ODD Comorbidity Social adjustment problems Peer relationships Sibling relationships Parent–child relationships 



This study was funded by grants from Eli Lilly and Company (Taiwan) and National Health Research Institute, Taiwan (NHRI-EX94-9407PC) to the corresponding author. We thank the principals, teachers, parents, and children for their participation in this study.


  1. 1.
    Faraone SV, Sergeant J, Gillberg C, Biederman J (2003) The worldwide prevalence of ADHD: is it an American condition? World Psychiatry 2:104–113PubMedGoogle Scholar
  2. 2.
    Gau SS, Chong MY, Chen TH, Cheng AT (2005) A 3-year panel study of mental disorders among adolescents in Taiwan. Am J Psychiatry 162:1344–1350PubMedCrossRefGoogle Scholar
  3. 3.
    Diamantopoulou S, Henricsson L, Rydell A (2005) ADHD symptoms and peer relations of children in a community sample: examining associated problems, self-perceptions, and gender differences. Int J Behav Dev 29:388–398Google Scholar
  4. 4.
    Hoza B (2007) Peer functioning in children with ADHD. J Pediatr Psychol 32:655–663PubMedCrossRefGoogle Scholar
  5. 5.
    Hoza B, Mrug S, Gerdes AC, Hinshaw SP, Bukowski WM, Gold JA et al (2005) What aspects of peer relationships are impaired in children with attention-deficit/hyperactivity disorder? J Consult Clin Psychol 73:411–423PubMedCrossRefGoogle Scholar
  6. 6.
    Landau S, Moore LA (1991) Social skills deficits in children with attention deficit hyperactive disorder. School Psych Rev 20:235–251Google Scholar
  7. 7.
    Mikami AY, Pfiffner LJ (2008) Sibling relationships among children with ADHD. J Atten Disord 11:482–492PubMedCrossRefGoogle Scholar
  8. 8.
    Johnston C, Mash EJ (2001) Families of children with attention deficit hyperactivity disorder: review and recommendations for future research. Clin Child Fam Psychol Rev 4:183–207PubMedCrossRefGoogle Scholar
  9. 9.
    Greene RW, Biederman J, Zerwas S, Monuteaux MC, Goring JC, Faraone SV (2002) Psychiatric comorbidity, family dysfunction, and social impairment in referred youth with oppositional defiant disorder. Am J Psychiatry 159:1214–1224PubMedCrossRefGoogle Scholar
  10. 10.
    Greene RW, Biederman J, Faraone SV, Monuteaux MC, Mick E, DuPre EP et al (2001) Social impairment in girls with ADHD: patterns, gender comparisons, and correlates. J Am Acad Child Adolesc Psychiatry 40:704–710PubMedCrossRefGoogle Scholar
  11. 11.
    Kuhne M, Schachar R, Tannock R (1997) Impact of comorbid oppositional or conduct problems on attention-deficit hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 36:1715–1725PubMedCrossRefGoogle Scholar
  12. 12.
    Schachar RJ, Wachsmuth R (1990) Oppositional disorder in children: a validation study comparing conduct disorder, oppositional disorder and normal control children. J Child Psychol Psychiatry 31:1089–1102PubMedCrossRefGoogle Scholar
  13. 13.
    Frankel F, Feinberg D (2002) Social problems associated with ADHD vs. ODD in children referred for friendship problems. Child Psychiatry Hum Dev 33:125–146PubMedCrossRefGoogle Scholar
  14. 14.
    Matthys W, Cuperus JM, Van Engeland H (1999) Deficient social problem-solving in boys with ODD/CD, with ADHD, and with both disorders. J Am Acad Child Adolesc Psychiatry 38:311–321PubMedCrossRefGoogle Scholar
  15. 15.
    Carlson CL, Tamm L, Gaub M (1997) Gender differences in children with ADHD, ODD, and co-occuring ADHD/ODD identified in a school population. J Am Acad Child Adolesc Psychiatry 36:1706–1714PubMedCrossRefGoogle Scholar
  16. 16.
    Ohan JL, Johnston C (2007) What is the social impact of ADHD in girls? A multi-method assessment. J Abnorm Child Psychol 35:239–250PubMedCrossRefGoogle Scholar
  17. 17.
    Atkins MS, Pelham WE, Licht MH (1989) The differential validity of teacher ratings of inattention/overactivity and aggression. J Abnorm Child Psychol 17:423–435PubMedCrossRefGoogle Scholar
  18. 18.
    Gerdes AC, Hoza B, Pelham WE (2003) Attention-deficit/hyperactivity disordered boys’ relationships with their mothers and fathers: child, mother, and father perceptions. Dev Psychopathol 15:363–382PubMedCrossRefGoogle Scholar
  19. 19.
    Pfiffner LJ, McBurnett K, Rathouz PJ, Judice SM (2005) Family correlates of oppositional and conduct disorders in children with attention-deficit/hyperactivity disorder. J Abnorm Child Psychol 33:551–563PubMedCrossRefGoogle Scholar
  20. 20.
    Johnston C (1996) Parent characteristics and parent–child interactions in families of nonproblem children and ADHD children with higher and lower levels of oppositional-defiant behavior. J Abnorm Child Psychol 24:85–104PubMedCrossRefGoogle Scholar
  21. 21.
    Edwards G, Barkley RA, Laneri M, Fletcher K, Metevia L (2001) Parent–adolescent conflict in teenagers with ADHD and ODD. J Abnorm Child Psychol 29:557–572PubMedCrossRefGoogle Scholar
  22. 22.
    Lewis C, Lamb ME (2003) Fathers’ influences on children’s development: the evidence from two-parent families. Eur J Psychol Educ 18:211–228CrossRefGoogle Scholar
  23. 23.
    Lifford KJ, Harold GT, Thapar A (2008) Parent-child relationships and ADHD symptoms: a longitudinal analysis. J Abnorm Child Psychol 36:285–296PubMedCrossRefGoogle Scholar
  24. 24.
    Newman J (1994) Conflict and friendship in sibling relationships: a review. Child Study 24:119–152Google Scholar
  25. 25.
    García Coll C, Akerman A, Cicchetti D (2000) Cultural influences on developmental processes and outcomes: implications for the study of development and psychopathology. Dev Psychopathol 12:333–356CrossRefGoogle Scholar
  26. 26.
    Sameroff AJ (2000) Developmental systems and psychopathology. Dev Psychopathol 12:297–312PubMedCrossRefGoogle Scholar
  27. 27.
    Chen X, French DC (2008) Children’s social competence in cultural context. Annu Rev Psychol 59:591–616PubMedCrossRefGoogle Scholar
  28. 28.
    Mah JWT, Johnston C (2007) Cultural variations in mothers’ attributions: influence of child attention-deficit/hyperactivity disorder. Child Psychiatry Hum Dev 38:135–153PubMedCrossRefGoogle Scholar
  29. 29.
    Cicirelli V (1994) Sibling relationships in cross-cultural perspective. J Marriage Fam 56:7–20CrossRefGoogle Scholar
  30. 30.
    Brody GH, Stoneman Z, McCoy JK, Forehand R (1992) Contemporaneous and longitudinal associations of sibling conflict with family relationship assessments and family discussions about sibling problems. Child Dev 63:391–400PubMedCrossRefGoogle Scholar
  31. 31.
    Kutner MH, Nachtsheim CJ, Neter J, Li W (2005) Applied linear statistical models, 5th edn. McGraw-Hill/Irwin, BostonGoogle Scholar
  32. 32.
    Conners CK (1997) Conners’ rating scales-revised technical manual. Multi-Health Systems, North TonawandaGoogle Scholar
  33. 33.
    Gau SS, Soong WT, Chiu YN, Tsai WC (2006) Psychometric properties of the Chinese version of the conners’ teacher and parent rating scales-revised: short form. J Atten Disord 9:648–659PubMedCrossRefGoogle Scholar
  34. 34.
    John K, Gammon GD, Prusoff BA, Warner V (1987) The social adjustment inventory for children and adolescents (SAICA): testing of a new semistructured interview. J Am Acad Child Adolesc Psychiatry 26:898–911PubMedCrossRefGoogle Scholar
  35. 35.
    Biederman J, Faraone SV, Chen WJ (1993) Social adjustment inventory for children and adolescents: concurrent validity in ADHD children. J Am Acad Child Adolesc Psychiatry 32:1059–1064PubMedCrossRefGoogle Scholar
  36. 36.
    Gau SS, Shen HY, Soong WT, Gau CS (2006) An open-label, randomized, active controlled equivalent trial of OROS methylphenidate in children with attention-deficit/hyperactivity disorder in Taiwan. J Child Adolesc Psychopharmacol 16:439–453Google Scholar
  37. 37.
    Cunningham CE, Siegel LS, Offord DR (1985) A developmental dose-response analysis of the effects of methylphenidate on the peer interactions of attention deficit disordered boys. J Child Psychol Psychiatry 26:955–971PubMedCrossRefGoogle Scholar
  38. 38.
    Landau S, Milich R (1988) Social communication patterns of attention-deficit-disordered boys. J Abnorm Child Psychol 16:69–81PubMedCrossRefGoogle Scholar
  39. 39.
    Whalen CK, Henker B (1985) The social worlds of hyperactive (ADDH) children. Clin Psychol Rev 5:447–478CrossRefGoogle Scholar
  40. 40.
    Coie JD, Dodge KA, Kupersmidt JB (1990) Peer group behavior and social status. In: Asher SR, Coie JD (eds) Peer rejection in childhood. Cambridge University Press, Cambridge, pp 17–59Google Scholar
  41. 41.
    Dishion TJ, Andrews DW, Crosby L (1995) Antisocial boys and their friends in early adolescence: relationship characteristics, quality and interactional process. Child Dev 66:139–151PubMedCrossRefGoogle Scholar
  42. 42.
    Dishion TJ, Patterson GR, Stoolmiller M, Skinner ML (1991) Family, school, and behavioral antecedents to early adolescent involvement with antisocial peers. Dev Psychol 27:172–180CrossRefGoogle Scholar
  43. 43.
    Chao RK (2001) Extending research on the consequences of parenting style for Chinese Americans and European Americans. Child Dev 72:1832–1843PubMedCrossRefGoogle Scholar
  44. 44.
    Ho DYF (1986) Chinese pattern of socialization: a critical review. In: Bond MH (ed) The psychology of the Chinese people. Oxford University Press, Oxford, pp 1–37Google Scholar
  45. 45.
    Chen X, Chang L, He Y (2003) The peer group as a context: mediating and moderating effects on relations between academic achievement and functioning in Chinese children. Child Dev 74:710–727PubMedCrossRefGoogle Scholar
  46. 46.
    Schwartz D, Chang L, Farver J (2001) Correlates of victimization in Chinese children’s peer groups. Dev Psychol 37:520–532PubMedCrossRefGoogle Scholar
  47. 47.
    Pfiffner LJ, Calzada E, McBurnett K (2000) Interventions to enhance social competence. Child Adolesc Psychiatr Clin N Am 9:689–709PubMedGoogle Scholar
  48. 48.
    Gau SSF (2007) Parental and family factors for attention-deficit hyperactivity disorder in Taiwanese children. Aust N Z J Psychiatry 41:688–696PubMedCrossRefGoogle Scholar
  49. 49.
    Johnston C, Murray C, Hinshaw S, Pelham W, Hoza B (2002) Responsiveness in interactions of mothers and sons with ADHD: relations to maternal and child characteristics. J Abnorm Child Psychol 30:77–88PubMedCrossRefGoogle Scholar
  50. 50.
    Kashdan TB, Jacob R, Pelham W, Lang AR, Hoza B, Blumenthal JD et al (2004) Depression and anxiety in parents of children with ADHD and varying levels of oppositional defiant behaviors: modeling relationships with family functioning. J Clin Child Adolesc Psychol 33:169–181PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Wan-Ling Tseng
    • 1
  • Yoshito Kawabata
    • 1
  • Susan Shur-Fen Gau
    • 2
  1. 1.Institute of Child DevelopmentUniversity of MinnesotaMinneapolisUSA
  2. 2.Department of PsychiatryNational Taiwan University Hospital and College of MedicineTaipeiTaiwan

Personalised recommendations