Social Functioning in Children with Attention Deficit/Hyperactivity Disorder: A Meta-Analytic Review

Considerable work has demonstrated significant impairment in social functioning for children with Attention-Deficit/Hyperactivity Disorder (ADHD). The social functioning profiles of children with ADHD are marked by impairments across diverse domains as they tend to experience greater rates of peer rejection, have lower levels of social skills, and have impaired social cognitions. Objective: The purpose of this study was to quantitatively examine the effects of ADHD across several domains of social functioning (peer, behavioral, cognitive). Method: The current meta-analysis identified 109 studies (n = 104,813) that examined the association between social functioning deficits and ADHD. Studies were coded for demographic and methodological factors and classified into domains of social functioning (peer, behavioral, cognitive). Results: Children with ADHD have the most impairment within the peer domain of social functioning (weighed ES r = .33) followed by more modest effects within the behavioral (weighted ES r = .27) and cognitive domains of social functioning (weighted ES r = .27). The association between ADHD and deficits within the behavioral domain of social functioning was weaker among studies that controlled for co-occurring conduct problems. The largest effects within the peer domain of social functioning were documented by studies that utilized sociometric and teacher reports of peer status as well as those utilizing the “gold standard” approach to diagnosing ADHD within both the behavioral and peer domains. Conclusions: Results suggest that children with ADHD do not simply have a “skills deficit” within the behavioral and cognitive domains, but more importantly experience great peer impairment. Hence, rather than focusing on didactic efforts to improve social skills which encompasses the majority of treatments aimed to reduce social impairments the field should shift towards focusing on a “performance” approach in terms of helping children with ADHD implement such skills in ecologically valid settings.