Isolation can increase bad behavior in kids with ADHD

UAB study finds kids with ADHD rejected by peers may smoke, drink and behave poorly in early adolescence, anxious behavior continues beyond.

Kids with ADHD who are rejected by peers suffer from anxiety and are more prone to substance use and delinquency during adolescence, according to University of Alabama at Birmingham-led research published online Feb. 16, 2012, in the Journal of Abnormal Child Psychology. Finding a social environment in which they can succeed is critical to long-term success.

Sylvie Mrug, Ph.D.

It is difficult to improve a child’s acceptance, even with treatment, after they have been rejected by peers because peers may not notice behavioral changes or continue to reject the child based on their reputation, said Sylvie Mrug, Ph.D., associate professor in the UAB Department of Psychology and lead author.

Mrug’s study followed 300 kids diagnosed with ADHD, which means they are both inattentive and hyperactive, from the Multimodal Treatment Study of Children with ADHD conducted in six locations across the United States and Canada for eight years. The children were divided into four groups, each receiving a different treatment for 14 months: medication, behavioral treatment, medication plus behavioral treatment and non-guided care from their regular pediatrician. They were assessed at the end of treatment, then again at six years and eight years after treatment began.

At the six-year mark, researchers reported that children who were rejected by peers were more likely to smoke, engage in delinquent behaviors plus experience anxiety and impaired functioning by age 14; two years later, those children continued to be more impaired.

“The good news is that most of the negative effects of childhood peer rejection seem to dissipate by late adolescence,” said Mrug. “But the global impairment — the ability to function in social settings — continues, so peer rejection at a young age is something parents and teachers must notice and try to improve.”

The researchers also looked at children’s friendships, an area they believed would be protective for children with ADHD rejected by peers. However, the results reveal that having a reciprocal friend in the child’s classroom did not alter the outcomes.

“It may be that friendships are more transient than peer rejection or that children with ADHD don’t have very good friendships,” Mrug explained. “It also is possible that friendships outside the child’s class are more protective, but we were not able to study those.” 

Mrug says the findings suggest that identifying and addressing peer rejection of children with ADHD is vital to their short- and long-term success in society. In addition to standard treatments for ADHD, such as behavior therapy and medication, parents and teachers should help these children make friends. Finding a social environment in which these children can succeed may not be easy, but Mrug says it may help prevent emotional and behavioral problems.