Mediators of social impairment among children with ADHD

The long-term objective of this study is to determine the role of three potential mediators (social cognition, social performance, and self-control deficits) in the social and academic functioning of children with attention-deficit/hyperactivity disorder (ADHD). In addition to the hallmark symptoms of inattention, hyperactivity, and impulsivity, children with ADHD also typically suffer from social problems. These problems are so pervasive and persistent that some have argued that social impairment should be considered a cardinal feature of ADHD. Further, there is substantial evidence that social impairment can compromise academic success, although the specific nature of this relation is not well understood (e.g., Gifford-Smith & Brownell, 2003; Schwartz et al., 2005; Wentzel, 1993). Given the impact of social impairment on the ability of children with ADHD to function at school, home and in the community, significant efforts have been directed towards developing and testing social skills treatment programs (Hoza, 2007). However, with very few exceptions (e.g., Pfiffner & McBurnett, 1997), initial results have been disappointing. One explanation for this limited success is that these interventions have been developed without a sufficient understanding of the underlying mechanisms that account for the social impairment experienced by children with ADHD. Although the development of interventions for social problems has been guided by the documentation of group differences in potentially important domains, studies that explicitly examine possible mediators of social difficulties are rare, if nonexistent. No studies have evaluated a full mediation model that includes the relation between ADHD symptoms and social and academic functioning. The proposed study will address this gap in the literature by examining these relations in a sample of children with varying degrees of ADHD symptomatology. Findings from this study will: (a) inform the intervention development process to maximize impact on the mediators that are most strongly associated with social impairment among children with ADHD, and (b) clarify the relation between social problems and academic functioning among this population. A total of 240 8-10 year old children will be recruited to participate in this study, with 120 children recruited at each of two sites (University of South Carolina, Columbia, SC and Ohio University, Athens/Columbus, OH). The populations at these sites consist of potential participants from a diverse set of racial and ethnic backgrounds and socio-economic levels. Although we will utilize a continuous measure of ADHD in our analyses, 60 participants at each site will meet diagnostic criteria for ADHD to ensure a wide distribution of symptoms. Each child will participate in individual and group data collection sessions. Each child and his/her parent will attend a 2-3 hour individual session, in which the diagnostic, social cognition and self-control measures will be administered. In addition, each child will participate in a 3-hour Saturday social group session with nine other children in which the social performance and sociometric status measures will be collected. In each social group session with 10 children, half will meet diagnostic criteria for ADHD. Structural equation modeling will be used to examine the factors that account for the relation between ADHD and social functioning, as well as how the hypothesized mediators and social functioning may impact the academic functioning of children with ADHD.