Targeting Peer Contagion Dynamics in Children with ADHD: Effects from a Two-Site Randomized Controlled Trial.

OBJECTIVE: Parental Friendship Coaching (PFC) teaches parents to coach their children in friendship skills. This paper examines whether PFC fosters positive peer contagion processes (i.e. dyadic mutuality) and reduces negative peer contagion processes (i.e. coercive joining) within the friendships of children with attention-deficit/hyperactivity disorder (ADHD). METHOD: Participants were 134 families of children with ADHD and peer problems (age 6-11 years; 69% male; 72% white) at two Canadian sites, randomized to PFC or CARE (an active comparison intervention). Children were observed in the lab at baseline, post-treatment, and at 8-month follow-up during cooperation and competition tasks with a real-life friend. Amount and reciprocity of dyadic mutuality indicators (i.e. positive affect and positive behaviors) and coercive joining indicators (i.e. aggressive, controlling, and rule-breaking behaviors) between friends were coded. RESULTS: Across treatment conditions, children showed an increase in the amount of dyadic mutuality during cooperation and a decrease in the amount of coercive joining during competition over time. Relative to CARE, PFC induced a reduced amount of coercive joining behaviors during cooperation at post-treatment and follow-up. However, PFC led to decreases in the reciprocity of positive affect during cooperation at post-treatment and to increases in the reciprocity of coercive joining during competition at follow-up relative to CARE. Moderation analyses suggest PFC was associated with better outcomes for children with externalizing comorbidity, and for those with a stable or a best friend. CONCLUSIONS: Findings highlight the importance of transactional processes, contextual differences, externalizing comorbidities, and friendship status when assessing the efficacy of PFC.

Contributions of Friends' Problem Behaviors to Friendship Quality in a Sample of Children with ADHD.

OBJECTIVE: It is often assumed that children with attention-deficit/hyperactivity disorder (ADHD) experience friendship difficulties because of their own problem behaviors. However, friendships are dyadic relationships between two children. This study sought to understand the incremental contributions of friends' problem behaviors to dyadic friendship quality in a clinically diagnosed sample of children with ADHD. METHOD: One hundred and sixty-five dyads consisting of a target child with ADHD and social impairment (age 6-11; 67% male; 72% white) and a reciprocated, real-life friend were recruited. Parents and teachers rated the ADHD symptom severity, externalizing problems, and callous-unemotional (CU) traits of target children and friends. Friendship quality in the dyad was measured with: (a) questionnaires independently completed by target children, their parents, their friends, and the parents of their friends; and (b) observations of child-friend interactions. RESULTS: The severity of ADHD symptoms and externalizing problems (but not CU traits) in target children was associated with more negative friendship quality reported on questionnaires. Adjusting for the corresponding problem behavior in target children, each type of friends' problem behaviors incrementally predicted less positive friendship quality (on questionnaires). Friends' ADHD symptoms and CU traits also incrementally predicted more negative friendship quality (on questionnaires and observations). CONCLUSIONS: Considering problem behaviors in friends of children with ADHD (in addition to those in children with ADHD) may be important for identifying dyads at risk for lower quality friendships. These findings could possibly lead to new directions when designing and evaluating treatments targeting the friendship problems of children with ADHD.

Peer contagion dynamics in the friendships of children with ADHD.

BACKGROUND: Friendships in middle childhood carry high developmental significance. The majority of children with attention-deficit/hyperactivity disorder (ADHD) have few friendships, unstable friendships, or poor relationship quality in any friendships they have. The current study used time-window sequential analysis to map the dynamics within the friendships of children with ADHD, specifically the peer contagion processes of dyadic mutuality and coercive joining. METHODS: Participants were 164 dyads consisting of a target child with ADHD and peer problems (age 6-11 years; 68% male; and 73% white) and a reciprocated friend. Dyads were observed in the lab during a cooperative task eliciting verbal negotiation processes to decide how to share a limited resource and during a fast-paced, engrossing, and competitive task. Both tasks were designed to mirror the real-world interactions of friends. Sequences of dyadic mutuality (i.e., reciprocity of positive affect and positive behaviors) and coercive joining (i.e., reciprocity of aggressive, controlling, and rule-breaking behaviors) between target children and friends were coded. RESULTS: Regarding dyadic mutuality, target children reciprocated their friends' positive affect in both tasks. They also reciprocated their friends' positive behaviors but only in the cooperative task. In contrast, they only reciprocated their friends' coercive joining behaviors in the competitive task. Medium to large reciprocity effects was found for 36%-53% (dyadic mutuality) and 38%-55% (coercive joining) of target children. CONCLUSIONS: These results extend findings of peer contagion processes to the friendships of children with ADHD and suggest that contagion may vary according to interaction context (i.e., competition vs. cooperation). Understanding the spread of peer contagion may illuminate how children with ADHD and their friends influence each other's adjustment over time and may guide friendship-focused psychosocial interventions for this population.

Effects of the Parental Friendship Coaching Intervention on Parental Emotion Socialization of Children with ADHD.

Parental emotion-related socialization behaviors shape children's socioemotional functioning and appear important for children with attention-deficit/hyperactivity disorder (ADHD). The Parental Friendship Coaching (PFC) intervention teaches parents to coach their children with ADHD in friendship skills, which includes managing emotions. We examined whether PFC, relative to psychoeducation and social support (Coping with ADHD through Relationships and Education; CARE), improved parental emotion-related socialization behaviors, child affect with a friend, and child social behaviors related to emotional difficulties. Participants were 172 families of children with ADHD (ages 6-11, 30% female), randomized to PFC or CARE. At baseline, children and their real-life friends interacted and their affect was coded. Parents coached their child in friendship skills before and after the child-friend interaction, and parents' praise, warmth, criticism, and discussion of emotion-related friendship strategies were coded. Parents and teachers reported children's withdrawn/depressed and aggressive behaviors. Results suggested that PFC (relative to CARE) led to parents providing more emotion strategies and praise at post-treatment and follow-up, and more warmth at follow-up, and to children showing less withdrawn/depressed behavior at follow-up. For bidirectional relationships from baseline to post-treatment, more parental warmth was associated with less child withdrawn/depressed behavior, and more parental criticism with more child aggression. More child withdrawn/depressed behavior and positive affect at post-treatment were associated with more parental criticism at follow-up. After corrections for multiple comparisons, only PFC effects on praise and emotion strategies at post-treatment, and praise and withdrawn/depressed behavior at follow-up, maintained. Implications are discussed for supporting socioemotional functioning in children with ADHD.

Treatment of friendship problems in children with attention-deficit/hyperactivity disorder: Initial results from a randomized clinical trial.

OBJECTIVE: This study evaluated a novel intervention for friendship problems in children with attention-deficit/hyperactivity disorder (ADHD). Parental Friendship Coaching (PFC) teaches parents to coach their children in targeted friendship behaviors that are lacking in children with ADHD and that help children develop good quality friendships. METHOD: Participants were 172 families of children with ADHD and social impairment (ages 6-11; 29.7% female) at two Canadian sites, randomized to PFC or to an active comparison intervention (Coping with ADHD through Relationships and Education; CARE) to control for common therapy factors. Questionnaire and observational measures assessing primary outcomes of children's friendship quality and secondary outcomes of children's friendship behaviors were collected at baseline, posttreatment, and 8-month follow-up. RESULTS: Across both treatment conditions, children showed improvements in positive friendship quality and in friendship behaviors. Relative to CARE, PFC was associated with somewhat more positive and less negative friendship behaviors at posttreatment and follow-up, but no difference between conditions was found in friendship quality. However, moderation analyses suggested that PFC may contribute to better friendship quality among families who had previous psychosocial treatment, as well as children with comorbid externalizing disorders. CONCLUSIONS: Although PFC showed some efficacy for affecting children's friendship behaviors, these changes may not translate into friendship quality. Nevertheless, PFC may improve friendship quality for at-risk subgroups of children with ADHD. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Implementing Group Parent Training in Telepsychology: Lessons Learned During the COVID-19 Pandemic.

OBJECTIVE: We recently transitioned from in-person delivery of a brief behavioral parent intervention to telepsychology delivery to meet families' needs during the COVID-19 pandemic. In this topical review, we describe how we used treatment fidelity as a guiding principle to orient adaptations for telepsychology, as well as preliminary findings and early lessons learned in this implementation. Methods: Using rapid-cycle quality improvement methods, we adapted a brief parent training group (Bootcamp for Attention-Deficit/Hyperactivity Disorder; BC-ADHD) to three groups of caregivers (i.e., 5-7 families) of school-aged children with ADHD (n = 20; 85% males). Families were from the following ethnic backgrounds: 75% White non-Hispanic, 15% White Hispanic, and 10% Black. Clinicians completed measures on their implementation experience. Observers completed measures on content/process fidelity and attendance. Caregivers completed measures on demographics, treatment satisfaction, and telepsychology experience. RESULTS: Telepsychology BC-ADHD can be implemented with comparably high levels of content and process fidelity and treatment satisfaction to in-person groups; and it appears to be feasible and acceptable to caregivers. Caregiver and clinician qualitative feedback revealed themes of appreciating the convenience of telepsychology, while experiencing some challenges in relating to others and sharing over video. CONCLUSIONS: When treatment fidelity is used as a guiding tool, telepsychology parent training groups can be delivered with high fidelity and appear to be acceptable and feasible to caregivers and clinicians. Future research using larger and more diverse samples, multimethod and multi-informant measurement approaches, and controlled designs is needed to further assess the generalizability and efficacy of telepsychology parent training groups.

A Multiple Indicators Multiple Causes (MIMIC) model of friendship quality and comorbidities in children with attention-deficit/hyperactivity disorder.

The unique objectives of the current investigation were: (a) to assess the fit of a multiinformant 2-factor measurement model of friendship quality in a clinical sample of children with attention-deficit/hyperactivity disorder (ADHD); and (b) to use a multiple indicators multiple causes approach to evaluate whether comorbid externalizing and internalizing disorders incrementally predict levels of positive and negative friendship quality. Our sample included 165 target children diagnosed with ADHD (33% girls; aged 6-11 years). Target children, their parents, their friends, and the parents of their friends independently completed a self-report measure of friendship quality about the reciprocated friendship between the target child and the friend. Results indicated that a multiinformant 2-factor measurement model with correlated positive friendship quality and negative friendship quality had good fit. The friendships of children with ADHD and a comorbid externalizing disorder were characterized by less positive friendship quality and more negative friendship quality than the friendships of children with ADHD and no externalizing disorder after controlling for the presence of a comorbid internalizing disorder. However, the presence of a comorbid internalizing disorder did not predict positive or negative friendship quality. These findings suggest that soliciting reports from parents in addition to children and friends, and measuring comorbid externalizing disorders, may be valuable evidence-based strategies when assessing friendship quality in ADHD populations. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Correlates of Loneliness in Children with Attention-Deficit/Hyperactivity Disorder: Comorbidities and Peer Problems.

Children with attention-deficit/hyperactivity disorder (ADHD) are well-documented to experience social-emotional difficulties; however, little is known about their loneliness-an aspect of social-emotional functioning. Using a cross-sectional design, we examined how loneliness relates to comorbid internalizing disorders, externalizing disorders, and peer problems in a sample of 213 children with ADHD. Children (66 girls, Mage = 8.58, SDage = 1.55) reported their loneliness. Comorbid internalizing and externalizing disorders were assessed via a multi-informant procedure. Proportion of classmates who accepted, rejected, and ignored the child, friendship quantity, and friendship quality were peer problem indicators. Results suggested that children with comorbid internalizing disorders, fewer friendships, or potentially more negative friendship quality, reported more loneliness. Gender appeared to moderate the association between peer rejection and loneliness, such that boys with peer rejection reported more loneliness than girls. Clinical implications include targeting loneliness as a social-emotional problem to assess and treat in children with ADHD.

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.

Behaviors associated with negative affect in the friendships of children with ADHD: An exploratory study.

Our objective was to identify behaviors and contextual situations associated with negative affect observed in the interactions of children with and without ADHD and their real-life friends. We expected negative affect to be linked to rule violations and disagreements about the choice of games. Loss of game was associated with episodes of negative affect in a structured game. Negative appraisal of friend's ability was most frequently associated with negative affect during unstructured free play. Comparison children expressed greater frustration regarding their own abilities, whereas children with ADHD commented more frequently about the inabilities of their friends.

Screening for working memory deficits in the classroom: the psychometric properties of the working memory rating scale in a longitudinal school-based study.

OBJECTIVE: The aim of this 18-month longitudinal study was to explore the psychometric properties of the recently developed Working Memory Rating Scale (WMRS) within a general school population of 524 six- to nine-year-old children (259 boys, 265 girls) and with an examination of sex and time differences. METHOD: Teachers completed the WMRS and children completed objective measures of WM and standardized measures of academic achievement. RESULTS: Confirmatory factor analyses indicated a poor fit for the 20 original WMRS items. Post hoc analyses, however, revealed that the factor structure of an alternative five-item short form was strong for both boys and girls and at the two time points, spanning two consecutive academic years. Internal consistency, criterion-related validity, and convergent validity of this alternative five-item WMRS were also excellent. CONCLUSION: The short five-item WMRS may eventually provide teachers with a useful and time-effective method to screen for WM deficits at school.

Continuities and changes in the friendships of children with and without ADHD: a longitudinal, observational study.

We examined how the real-life dyadic friendships of 87 children with ADHD and 46 comparison children (76 % boys) aged 7-13 years evolved during a 6-month follow-up period. The methods included friendship quality self-report measures and direct observation of friends' dyadic behaviors in three structured analogue tasks. At Time 2, the friends of the participants with ADHD reported less positive friendship quality and more conflict with their friends than at Time 1. They were also considerably less satisfied with their friendship than 6 months prior. In contrast, the friends of comparison children reported fewer negative friendship features, more positive friendship features and a slightly greater friendship satisfaction than at Time 1. In sharp contrast with the invited friends' reports, referred children with ADHD did not report deterioration in their friendship quality over time. Unlike comparison children who significantly reduced violations of game rules between Time 1 and Time 2, children with ADHD broke more game rules during the same period. In negotiating with friends, comparison children, but not children with ADHD, reduced the number of self-centered and insensitive proposals at Time 2. Controlling for Time 1 variance, violations of game rules and a self-centered, insensitive negotiation approach predicted deterioration in friendship quality for children with and without ADHD over time.

Evidence for a general ADHD factor from a longitudinal general school population study.

Recent factor analytic studies in Attention-Deficit/Hyperactivity Disorder (ADHD) have shown that hierarchical models provide a better fit of ADHD symptoms than correlated models. A hierarchical model includes a general ADHD factor and specific factors for inattention, and hyperactivity/impulsivity. The aim of this 12-month longitudinal study was to test the generalizability of the hierarchical models of ADHD within an elementary school population of 6-9 year old children (250 boys, 260 girls). Examination of differences as a function of informant (parent vs. teacher ratings), sex, and time was conducted. Six potential factor structures for the 18 items of the SWAN (Strengths and Weaknesses of ADHD-symptoms and Normal-behavior) scale were tested using confirmatory and exploratory factor analyses. Hierarchical models with a general ADHD factor and two or three specific factors best accounted for parent and teacher reports of symptoms for both boys and girls and at two time points separated by a 12-month interval. Findings indicate that the 18 SWAN items measure a common latent trait as well as orthogonal factors or dimensions of inattention and hyperactivity/impulsivity.

Distinguishing Features of Cuban Children Referred for Professional Help Because of ADHD: Looking Beyond the Symptoms

Objective: To distinguish Cuban children clinically referred because of ADHD from an at-risk community sample and a community control group in terms of symptoms, associated difficulties and impairment of family and peer relations. Method: Parents and teachers of 1,036 children (6-8 years old) completed an established ADHD rating scale and a behavioral screening measure, including peer functioning. We also administered a structured clinical interview and measures of family impairment to the clinical sample and to an at-risk community-based subsample. Results: Although both clinical and at-risk groups displayed more externalizing and internalizing symptoms than controls, referred children were not only characterized by higher levels of ADHD symptoms, but also by greater impairment of family and peer relations than at-risk community children or community controls. Conclusion: The findings suggest that ADHD has major consequences on the family and peer functioning of Cuban children, which may lead to their referral for treatment(AU)

How do children with ADHD (mis)manage their real-life dyadic friendships? A multi-method investigation.

This multimethod study provides detailed information about the friendships of 87 children (76% boys) with ADHD and 46 comparison children aged 7-13 years. The methods included parent and teacher ratings, self-report measures and direct observation of friends' dyadic behaviors in three structured analogue tasks. Results indicated that, in contrast with comparison children, children with ADHD had friends with high levels of ADHD and oppositional symptoms; they perceived fewer positive features and more negative features, and were less satisfied in their friendships. Observational data indicated that children with ADHD performed both more legal and more illegal maneuvers than comparison children in a fast-paced competitive game. While negotiating with their friends, children with ADHD made more insensitive and self-centered proposals than comparison children. In dyads consisting of one child with ADHD and one typically developing child, children with ADHD were often more dominant than their friends.

Distinguishing features of cuban children referred for professional help because of ADHD: looking beyond the symptoms.

OBJECTIVE: To distinguish Cuban children clinically referred because of ADHD from an at-risk community sample and a community control group in terms of symptoms, associated difficulties and impairment of family and peer relations. METHOD: Parents and teachers of 1,036 children (6-8 years old) completed an established ADHD rating scale and a behavioral screening measure, including peer functioning.We also administered a structured clinical interview and measures of family impairment to the clinical sample and to an at-risk community-based subsample. RESULTS: Although both clinical and at-risk groups displayed more externalizing and internalizing symptoms than controls, referred children were not only characterized by higher levels of ADHD symptoms, but also by greater impairment of family and peer relations than at-risk community children or community controls. CONCLUSION: The findings suggest that ADHD has major consequences on the family and peer functioning of Cuban children, which may lead to their referral for treatment.

Attention-Deficit/Hyperactivity Disorder and the challenges of close friendship.

INTRODUCTION: Much has been learned about the social rejection of children with Attention-Deficit Hyperactivity Disorder (ADHD) by their schoolmates. Although these group processes are clearly important, recent advances in theory and research have revealed the importance of close friendship. METHOD: In this paper, we review the current knowledge about the close friendships of children with ADHD RESULTS: Although children with ADHD tend to be excluded from close friendship, the data on the features of the friendships they do have are too limited and too flawed to permit conclusions about patterns of inter-action between children with ADHD and their friends. Few data are actually available to indicate why children with ADHD have difficulty keeping the friends they do have. CONCLUSION: We conclude by briefly discussing some implications for pharmacological treatments and peer-relations interventions.