Attention Deficit Hyperactivity Disorder (ADHD) as defined by the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is “a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, presenting in two or more settings, and negatively impacts directly on social, academic or occupational functioning.” The symptoms must be present before age 12. It is the most common behavior disorder that occurs in childhood and affects many areas of a child’s life.
Having ADHD may affect the way a child can keep and make friends. Some of the problems that may arise in making friends are impulsivity and restlessness. Children with ADHD may exhibit unpredictable behavior, which can make their peers feel scared in their company.
I once worked with an 8-year-old girl. She was extremely bright, friendly and funny and always had a positive and bright mood and affect. She was on medication which helped with her inattentiveness, hyperactivity, and impulsivity. When her mother told me that she struggled with making friends, I provided her with many suggestions and used many techniques in my session that helped her daughter to make friends.
Children with ADHD have to learn the skills needed to make friends and be good friends. It is important for children and their families to work on carrying out social interactions not only outside the home, but inside the home as well. I used the following social skills tools to help my client make friends.
- Reward program.I told my client’s mother to create a fun reward program where she and her daughter could choose to work on one or two social skills a week, such as sharing, or taking turns. Every time my client demonstrated the appropriate behavior they were working on, her mother provided the agreed-upon incentive. If sharing was the social behavior of the week, the mother was to explain why sharing is important in social situations, have her daughter model that behavior and then practice with her on ways to share.
The mother reported to me on how well her daughter performed various social skills. I suggested that she have her daughter interact with peers and observe her behaviors. She was to monitor her daughter during play time with others and to give her a praise or a token for displaying the appropriate behaviors. If her daughter showed difficulty with some of the social behaviors, the mother was instructed to call her over, explain how to improve the behavior and ask her to try again. Some of the social behaviors that she had difficulty with were also worked on in session.
- Video tape/tape record.I have found this to be useful for teaching social skills to children because it is a sample of the child’s interactions with others. You want to be discreet when taping them because you want to catch them in a typical behavior. These recordings can be a teaching tool to point out what needs to be improved with others and also to praise appropriate social behavior. Make sure to find positive interactions and give them a lot of positive feedback. Then pick one or two inappropriate behaviors and discuss why it was inappropriate. Recordings offer a concrete visual tool and can be useful for children with ADHD since they are not aware of how to act or how they are acting with peers.
The recordings that the mother took of her daughter were given to me to review in session. Positive social interactions were pointed out, such as turn-taking, asking other kids to play tag, and helping another child to get up after she fell. There were some negative social behaviors that were pointed out in session and worked on such as interrupting another child, and pushing a boy after he pushed her.
- “I” Statements.Since it was evident from the recording that she had a hard time expressing her feelings, I practiced implementing “I” statements in our next session. It is a technique that helped my client to identify and express her feelings and to learn to be able to say how she feels without hurting other people’s feelings. I explained to her that “I” statements have a special formula. First you state the problem (“When I was pushed…”). Then you state how you feel (“… I felt really hurt…”). Finally, you tell the person what you want them to do differently next time (“…and next time I would prefer that you do not push me…”). This was an important tool because it taught her to tell her peers how she feels and what she wants without judging or blaming.
- Cooperation.I explained what cooperation is and then encouraged my client to think of situations in which she had cooperated with another person in school, at home or in a game. I played a game to show her that cooperation is especially important in a social setting. I had a piece of rope where I tied it loosely to my right ankle and then tied the other end of the rope to her left ankle. We then walked around the room together reminding her that we need to cooperate in order to achieve our goal.
“Asking questions” in a social setting is another game I played with her. I explained that asking questions is the best way to get information from a friend and also shows that she is interested in what the other person has to say. We played this game by having her focus on something in the room (such as a clock) and having her give me clues about what she was focusing on. I then asked questions based on what she told me until I guessed the correct object. This game was suggested to her mother so it could be practiced at home as well as be played with a new friend.
- Listening.I played a game where I began a sentence to a story and my client added another sentence until the story was finished. This forced her to listen to the prior sentence in order to contribute relevant information to the story. This was also suggested to her mother to practice at home.
Over time, my client got better at controlling her behavior. With the techniques mentioned above and practicing at home with her mother, she made friends and built her self-esteem.