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Journal of Attention Disorders
XX(X) 1 –10
© 2012 SAGE Publications
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DOI: 10.1177/1087054712458971
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Articles
Children who have few close reciprocal friendships are more
likely than other children to be poorly adjusted at school, to
be involved with the youth justice system, and to experience
childhood and adult mental health problems (Rose & Asher,
2000). It is therefore concerning that approximately 50% of
children with ADHD have significant difficulties in their
social relationships (see McQuade & Hoza, 2008, for review).
Despite the well-documented social-behavioral and peer
relationship problems of children with ADHD, there are few
studies explicitly examining their friendships (Hoza, Gerdes,
et al., 2005). The overall objective of the present study was to
closely examine the friendship characteristics of children
with and without ADHD. In particular, we were interested in
the number of friends they have, the characteristics of their
friends, the length of their friendships, and the amount of
time they spend with their friends (i.e., companionship).
Friendship is a dyadic relationship based on mutual affec-
tion and reciprocity (Bagwell, Molina, Pelham, & Hoza,
2001). Due to its dyadic nature, friendship can be assessed by
asking children to list their friends and determining how many
of these nominated friends are either reciprocated by the nom-
inated children or corroborated by parent or teacher reports.
Of the large number of benefits that having friends and having
friendships of high quality are believed to serve, six have
received significant theoretical and empirical support (see
Rose & Asher, 2000, for review). That is, friends provide
companionship; feelings of self-validation and ego support;
emotional security; a context for self-disclosure, help, and
guidance; and they are reliable allies. Having a close friend-
ship has been shown to mitigate the consequences of peer
rejection (Parker & Asher, 1993) and buffer against adjust-
ment difficulties (Lauren, Bukowski, & Nurmi, 2007).
During the middle childhood years, children without best
friends report more feelings of loneliness than children with
friends, regardless of how accepted they are by peers (Parker
& Asher, 1993). Even children who were well liked by their
peer group reported feeling more lonely if they did not have
a friend than children who had close friendships (Parker &
Asher, 1993). This finding suggests that friendships provide
emotional supports that are distinct from those provided by
the larger peer group (Asher & Parker, 1989).
Friendship problems have been defined in a number of
ways, including being friendless, having poor quality
458971JADXXX10.1177/108705471245897
1Journal of Attention DisordersMarton et al.
© 2012 SAGE Publications
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1Toronto District School Board, Ontario, Canada
2University of Toronto, Ontario, Canada
3The Hospital for Sick Children, Toronto, Ontario, Canada
4Dalhousie University, Halifax, Nova Scotia, Canada
Corresponding Author:
Imola Marton, Department of Psychology, Toronto District School Board,
Level 3, 140 Borough Drive, Toronto, Ontario M1P 4N6, Canada
Email: imola.marton@tdsb.on.ca
Friendship Characteristics
of Children With ADHD
Imola Marton1, Judith Wiener2, Maria Rogers3, and Chris Moore4
Abstract
Objective: This study explored the friendship characteristics of 8 to 12 year old children with and without Attention-
Deficit/Hyperactivity Disorder (ADHD). Friendship characteristics included number of nominated and corroborated
friends, duration of friendships, amount of contact with friends, and the proportion of friends with learning and behavioral
problems. Method: The sample comprised 92 children, 50 with a diagnosis of ADHD and 42 comparison children. Result:
While children with ADHD did not differ from comparison children in the number of friends they nominated, parents
and teachers of children with ADHD were less likely to corroborate that these friendships existed. The friendships of
children with ADHD were also shorter in duration. While children with ADHD were indistinguishable from comparison
children with regards to the amount of telephone contact with friends, they spent less time with friends outside of school
than comparison children. Children with ADHD had a higher proportion of friends with learning and behavior problems.
Conclusion: While children with ADHD differ from comparison children in the above friendship characteristics, it is
promising that they still fall within the average range for the number of corroborated friendships and they demonstrate
adequate stability in their friendships.(J. of Att. Dis. 2012; XX(X) 1-XX)
Keywords
ADHD, friendship, children
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2 Journal of Attention Disorders XX(X)
friendships, being friends with children who have behavioral
or deviant characteristics, and having short or unstable friend-
ships (Rose & Asher, 2000). Children with such friendship
problems are at an increased risk for being victimized by bul-
lies (Hodges, Boivin, Vitaro, & Bukowski, 1999), engaging
in deviant behaviors (Vitaro, Tremblay, Kerr, Pagani, &
Bukowski, 1997), having difficulties at school (Ladd,
Kochenderfer, & Coleman, 1996), and experiencing feelings
of loneliness (Parker & Seal, 1996).
Because friends support and defend one another, it is not
surprising that studies have reported that friendships serve a
protective function against victimization, even for children
with externalizing problems (Cardoos & Hinshaw, 2011).
Friendships are also believed to be important for school adjust-
ment because friends can provide instrumental (e.g., help with
assignments) and emotional support (e.g., provide encourage-
ment to keep trying when things get difficult), creating more
opportunities for enjoyment at school. Children with friends
look forward to attending school because it provides them with
opportunities to play with friends, talk to them about personal
issues, and work with them on group assignments (Rose &
Asher, 2000). In fact, research shows that children with friends
in their class, especially children with stable friendships, were
more likely than children without friendships to develop posi-
tive perceptions toward school and children with good-quality
friendships were at particular advantage with regard to school
adjustment (Ladd et al., 1996).
The potential influence of friends, however, is not uni-
formly positive; friends who exhibit deviant behaviors can
have negative influences (Berndt, 1999). The similarity-attrac-
tion hypothesis suggests that children with similar attitudes
and attributes are more likely to be attracted to one another,
and thus become friends (Byrne & Nelson, 1965). Friends may
exert bidirectional influences on one another, resulting in
greater similarity over time (Newcomb & Bagwell, 1995).
Thus, aggressive children frequently become friends with
other aggressive children (Cairns, Cairns, Neckerman, Gest,
& Gariepy, 1988) and observational research shows that
these children’s conversations encourage deviant behavior in
one another (Dishion, Spracklen, Andrews, & Patterson, 1996).
Furthermore, longitudinal data suggest that children who had
aggressive friends at the first time of assessment were more
likely to become more aggressive and engage in delinquent
behavior themselves 4 years later than children without aggres-
sive friends (Kupersmidt, Burchinal, & Patterson, 1995).
In a review of the friendship literature pertaining to chil-
dren with ADHD, Normand, Schneider, and Robaey (2007)
indicated that the limited number of studies make it difficult
to draw conclusions about the friendship patterns and char-
acteristics of children with ADHD. Research to date has
shown that girls with ADHD have fewer mutual friends and
are more likely to have no friends in a summer camp context
than girls without ADHD (Blachman & Hinshaw, 2002;
Cardoos & Hinshaw, 2011), and children with ADHD have
fewer reciprocated friendships at school (Hoza, Mrug, et al.,
2005) and fewer friends according to parent report (Bagwell
et al., 2001; Heiman, 2005). Girls with both inattentive and
combined subtypes of ADHD had more difficulty maintain-
ing friendships in the context of a 5-week summer camp
than girls without ADHD (Blachman & Hinshaw, 2002).
Children with ADHD were more likely to meet with friends
at school or on the playground and less likely to meet with
them at home than comparison children (Heiman, 2005). A
recent multimethod study found that children with ADHD
were more likely than comparison children to have friends
with high levels of ADHD and oppositional symptomatol-
ogy, perceived their friendships to have more negative and
fewer positive features, and were generally less satisfied
with their friendships (Normand et al., 2011). Children with
ADHD also exhibited more insensitive and self-centered
proposals than comparison children when negotiating with
their friends and were often more dominant in their friend-
ships (Normand et al., 2011). However, no studies have
reported whether children with and without ADHD are sim-
ilar with respect to the amount of time they spend talking to
their friends on the telephone or interacting with their
friends outside of school.
Objectives and Hypotheses
The overall objective of the present study was to compare
children with and without ADHD with regard to their friend-
ship characteristics. Friendship characteristics considered
included the number of nominated and corroborated friends,
the proportion of corroborated friendships with children who
have learning or behavioral problems, the stability of cor-
roborated friendships (measured as the average length of
friendships), and companionship (measured as the amount of
time spent talking with friends on the telephone and spend-
ing time with friends). In accordance with previous research,
it was hypothesized that although children with ADHD
would likely report that they have a similar number of friends
as children without ADHD, their friendship nominations are
less likely to be corroborated by parents and teachers, sug-
gesting that they have fewer mutual friends. Furthermore,
due to their intrusive style of social interaction, they would
likely have friendships of shorter duration and interact with
their friends less often. The similarity-attraction hypothesis
suggests that children with similar attitudes and attributes are
more likely to be attracted to one another, and thus become
friends (Byrne & Nelson, 1965). Based on this hypothesis
and the high proportion of children with ADHD who have
comorbid learning and behavioral problems (Mayes &
Calhoun, 2000), it is likely that children with ADHD would
have a higher proportion of friends with learning and behav-
ioral problems than children without ADHD.
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Marton et al. 3
Method
Participants
The sample consisted of 92 children (66 boys, 26 girls) 8 to
12 years of age. In all, 50 children had a diagnosis of ADHD
(36 male, 14 female) and 42 were comparison children with-
out any behavior problems (30 male, 12 female). Children
who scored below a standard score of 80 on a standardized
measure of intelligence were excluded from analysis.
Children with ADHD were referred from two local hospital
clinics and from the community through posters at chil-
dren’s mental health centers. Children without ADHD were
recruited from local schools and through newspaper adver-
tisements and posters in community.
For inclusion in the ADHD sample, participants were
required to have an existing diagnosis of ADHD according
to Diagnostic and Statistical Manual of Mental Disorders
(4th ed.; DSM-IV; American Psychiatric Association, 1994)
criteria from a physician or a mental health professional.
Parents and teachers were also asked to complete the
Conners’ Parent/Teacher Rating Scale–Revised: Long Form
(CPRS/CTRS-R:L; Conners, 1997) to ensure that symp-
toms continued to be present. ADHD symptomatology was
confirmed if the participant was rated within the clinical
range (T-score ≥ 70) by one informant and within the bor-
derline (T-score ≥ 65) or clinical range by the second infor-
mant on the DSM-IV-oriented ADHD subscales of the
CPRS and CTRS. For children taking psychostimulant
medication, parents and teachers were asked to think of the
child off medication when completing the questionnaires.
For inclusion in the comparison sample, children were
required to have no diagnosis of ADHD or other behavioral
disorder. Parents and teachers were asked to complete the
CPRS/CTRS to ensure that children did not display a signifi-
cant number of ADHD symptoms. Children in the compari-
son group who received a T-score below 60 on the CPRS
and CTRS were included in the sample. The original sample
consisted of 110 children. Three participants with a previous
ADHD diagnosis were dropped due to low IQ scores, one
because an autism spectrum diagnosis was suspected, and
one was unable to complete most of the assessment due to
behavioral difficulties. In the comparison sample, 8 children
were dropped because they received T-scores above 60 on at
least one of the ADHD DSM-IV subscales of the CTRS-R:L.
In the ADHD sample, 5 participants were dropped because
they did not have T-scores above 70 on any of the relevant
scales on the CPRS or CTRS. With respect to missing data,
teachers for 3 participants did not return data.
Of the remaining sample, 24 participants with ADHD
(48%) were taking psychostimulant medication at the time
of data collection and 27 had at least one comorbid diagno-
sis (54%) from a mental health professional (11 learning
disabilities, 11 anxiety disorder, 10 oppositional defiant
disorder, 4 mood disorder). Chi-square tests were conducted
to determine whether there were any demographic differ-
ences between children with and without ADHD. These
analyses revealed no significant differences in gender, χ2(1,
N = 92) = 0.004, p = .95; languages spoken in the home
(English or other), χ2(1, N = 92) = 1.640, p = .20; or parent
marital status, χ2(1, N = 92) = 3.608, p = .06. A series of
independent samples t tests showed no ADHD status differ-
ences in age, ADHD: M = 10.08, SD = 1.39; comparison: M
= 10.20, SD = 1.46, t(90) = 0.40, p = .69, but children with
ADHD scored lower on standardized measures of intelli-
gence (M = 103.64, SD = 12.81) than comparison children
(M = 112.00, SD = 12.49), t(90) = 3.15, p < .01. Children
with ADHD also attained higher scores on the total DSM-IV
ADHD scales of the parent (M = 78.12, SD = 7.84) and
teacher (M = 70.78, SD = 11.58) forms of the Conners’
Rating Scales than comparison children, M = 46.26, SD =
5.05; M = 48.90, SD = 5.80, t(90) = −22.66, p < .001 and
t(89) = −11.09, p < .001, respectively. Parents in the compari-
son sample generally attained higher levels of education (M
= 9.02, SD = 1.15; on average having completed an under-
graduate university degree) than parents of children with
ADHD (M = 7.76, SD = 1.79; completed a college program
or some university), t(85) = 4.07, p < .001.
Measures
The CPRS-R:L and CTRS-R:L are well-established measures
that assess problem behaviors. Respondents rate children’s
behavior on a 4-point scale ranging from “not true at all” to
“very much true.” The three DSM-IV ADHD subscales (i.e.,
DSM-IV: Inattentive, DSM-IV: Hyperactive-Impulsive, and
DSM-IV: Total) were used in this study. The Conners’ ques-
tionnaires are frequently used in research and have strong
psychometric properties (Conners, 1997).
Wechsler Intelligence Scale for Children–Fourth Edition
(WISC-IV) and Wechsler Abbreviated Scale of Intelligence (WASI).
Clinic-referred children with ADHD (44% of the sample)
were administered the WISC-IV (Wechsler, 2003) as part of
a complete psychological assessment. Community-referred
children with ADHD (56% of the sample) and all of the com-
parison children were administered the WASI (Wechsler,
1999), a screening measure of overall intelligence in children
(Sattler, 2001). The WISC-IV and the WASI are commonly
used measures of intelligence with good reliability, construct
validity and test–retest stability (Sattler, 2001; Wechsler,
2003). The full-scale scores for the WASI and the WISC-IV
were used in analyses.
The friendship interview and questionnaires were adapted
from Berndt (1984) to assess the number of children’s
friends, as well as the length and the amount of contact in
corroborated friendships. In an individual interview, chil-
dren were asked to nominate all of their “best friends” at
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4 Journal of Attention Disorders XX(X)
school and outside of school by first name and last initial
and to indicate how long they have been friends, how often
they speak with them on the telephone, and how frequently
they spend time with each friend. Parents and teachers were
asked parallel questions, in addition to questions about
whether the friend has learning or behavioral problems. The
frequency of telephone contact between friends was assessed
on a 6-point Likert-type scale ranging from 1 = almost every
day to 6 = never and the frequency of contact outside of
school was assessed on a 5-point Likert-type scale ranging
from 1 = once a week to 5 never. Individual children listed
on the friendship interview are referred to as nominated
friends; any of these individuals who were also listed on
either the parent or teacher friendship questionnaire are
referred to as corroborated friends. Using similar method-
ology, Wiener and Schneider (2002) established that parent
and teacher corroboration of friendship serves as a valid
measure of mutual relationships when access to reciprocal
nominations from the nominated friends is restricted. Thus,
in the present study, the number of nominated and corrobo-
rated friends is reported, with larger numbers indicating
more friends. Parents and teachers were also asked to indi-
cate whether each friend they nominated had a learning or
behavioral problem. The number of corroborated friends
with learning or behavior problems was calculated by exam-
ining which of the corroborated friends were rated as having
learning and behavioral problems by either parent or teacher
reports. The number of corroborated friends with learning or
behavior problems was divided by each child’s number of
corroborated friends to derive the proportion of corroborated
friends with learning or behavior problems. The average
length of corroborated friendships was obtained by sum-
ming the length of friendships across all corroborated friends
listed and dividing by the number of friends listed. To take
age effects into account, this average length of corroborated
friendships score was then divided by the age of the child
(in years) to obtain a score reflecting the proportion of chil-
dren’s age on average that they have maintained corrobo-
rated friendships. The amount of telephone and outside of
school contact among corroborated friends was calculated
by reverse coding the friendship questionnaire (so that
higher scores indicate more contact) and adding the amount
of contact between all corroborated friends separately on
the parent- and child forms.
Procedure
This research was conducted at three sites in Toronto,
Canada: the University of Toronto, the Hospital for Sick
Children, and the Centre for Addiction and Mental Health.
During an initial screening, parents provided demographic
and medical information about their child and family and
completed the CPRS. Parents whose children met screen-
ing criteria were scheduled for an assessment. All children
were tested individually by one of two senior doctoral
level students trained in clinical child psychology.
Assessments at the hospitals were completed over two
approximately 5-hr testing sessions and assessments com-
pleted at the University of Toronto were conducted in one
5-hr session. Children with ADHD were medication free
on the day that they completed the research measures.
While children were being tested, parents completed
questionnaires in the waiting room. Once consent was
obtained, teachers were sent the CTRS and the friendship
questionnaire to complete. Families received a written
educational and social-emotional report outlining their
child’s functioning and children received a small toy of
their choice for participating.
Data Analyses
Preliminary analyses indicated that parent education level
was not correlated with any aspect of friendship examined.
Although a group difference was detected on IQ, it was not
covaried because it reflects an attribute commonly associ-
ated with ADHD (Kuntsi et al., 2004). Miller and Chapman
(2001) argued that controlling for preexisting group differ-
ences in a nonrandom research design violates the core
assumption of analysis of covariance that covariates are
statistically independent from the grouping variable.
Five independent samples t tests were conducted to
examine group differences in the number of nominated and
corroborated friends, and the proportion of friends with
leaning or behavior problems. Due to the use of multiple t
tests, the Bonferroni correction was used to control for Type
I error with the resulting alpha being p = .01. To control for
multicollinearity, two separate one-way multivariate analy-
ses were conducted to examine group differences in child-
and parent-reported duration of corroborated friendships,
and the amount of telephone and direct contact. Because
gender differences have been detected in many aspects of
friendship (e.g., Ladd, 2005), post hoc analyses were con-
ducted to examine gender main effects and gender by group
interaction effects. Finally, post hoc analyses were also con-
ducted to explore whether medication status among chil-
dren in the ADHD sample had an impact on friendship
outcomes.
Results
As shown in Table 1, there was no significant difference in
the number of friends children with and without ADHD
nominated. However, fewer friends were corroborated by
teacher and parent reports for children with ADHD than
comparison children. Children with ADHD had a higher
proportion of friends with either a learning or behavior
problem as reported by either their parents or teachers
(43%) than comparison children (16%).
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Marton et al. 5
The first MANOVA investigated child-reported length
of corroborated friendships (proportional to age) and the
amount of telephone and direct contact with corroborated
friends as dependent variables, and ADHD status as the
fixed factor. A significant multivariate effect was detected
for ADHD status, Wilks’s Λ = .88, F(3, 85) = 3.61, p =
.017, η2 = .113. The second MANOVA investigated par-
ent-reported length of corroborated friendships (propor-
tional to age) and the amount of telephone and direct
contact with corroborated friends as dependent variables,
and ADHD status as the fixed factor. A significant multi-
variate effect was detected for ADHD status, Wilks’s Λ =
.88, F(3, 81) = 3.00, p = .017, η2 = .118. Follow-up uni-
variate ANOVAs (Table 2) indicated that children with
ADHD had friendships of shorter duration according to
child and parent reports. Although children with and with-
out ADHD were indistinguishable in terms of amount of
telephone contact they had with friends, both parents and
the children themselves reported that children with ADHD
spent less time with their friends outside of school than
comparison children.
Post Hoc Analyses Involving Gender
and Medication Status Among
the ADHD Sample
Four separate univariate analyses of variance were con-
ducted with the number of nominated and corroborated
friends, and the proportion of friends with learning and
behavioral problems as dependent variables and group and
gender as fixed factors. In addition, two separate MANOVA’s
for child- and parent-reported length of friendship and
amount of telephone and direct contact with friends exam-
ined main effects for gender and group by gender interaction
effects. A gender effect, F(1, 85) = 4.27, p = .042, η2 = .048,
and an ADHD status by gender interaction effect, F(1, 85) =
4.11, p = .046, η2 = .046, were found for only one variable:
proportion of corroborated friends with behavior problems.
The difference between children with and without ADHD in
proportion of friends with behavior problems was greater
for boys (ADHD: M = 35.00, SD = 34.49; comparison: M =
10.23, SD = 15.93) than girls (ADHD: M = 10.07, SD =
15.34; comparison: M = 10.00, SD = 28.92).
Table 1. Nominated and Corroborated Friendships and Proportion of Friends With Learning and Behavioral Problems Among
Children With and Without ADHD
ADHD Comparison
M (SD)M (SD)t(df)p d
Number of child nominated friends 6.32 (3.60) 6.57 (3.51) 0.33 (90) .737 0.07
Number of nominated friends corroborated by parent or teacher 2.98 (1.64) 3.98 (1.86) 2.71 (90) .008 0.57
Proportion of corroborated friends with learning problems 27.79 (25.89) 9.48 (18.02) −3.90 (82)a.000 0.82
Proportion of corroborated friends with behavior problems 27.57 (32.05) 10.17 (20.10) −3.10 (78)a.003 0.65
Proportion of friends with either learning or behavior problems 42.53 (33.02) 15.74 (24.78) −4.35 (84)a.000 0.92
aThe Levene’s test for equality of variances was significant, therefore unequal variances assumed are reported.
Table 2. Child- and Parent-Reported Length of Corroborated Friendships and Amount of Telephone and Direct Contact With
Corroborated Friends in Children With and Without ADHD
ADHD Comparison
M (SD)M (SD)F p η2
Child friendship interview
Average length of corroborated friendshipsa0.28 (0.16) 0.36 (0.16) 5.66 .020 .061
Amount of telephone contactb11.68 (6.92) 13.90 (8.38) 1.87 .174 .021
Amount of direct contactb10.89 (5.91) 14.55 (7.71) 6.36 .013 .068
Parent friendship questionnaire
Average length of corroborated friendshipsa0.31 (0.19) 0.43 (0.17) 8.47 .005 .093
Amount of telephone contactb9.66 (5.74) 12.00 (5.39) 3.73 .057 .043
Amount of direct contactb10.11 (5.56) 12.78 (6.47) 4.16 .044 .048
aThe average length of corroborated friendships was divided by the child’s age to obtain a score reflecting the proportion of children’s age on average
that they have maintained friendships.
bThe amount of telephone and direct contact is a sum of all contact among children’s corroborated friends, with larger scores indicating more contact.
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6 Journal of Attention Disorders XX(X)
Independent-samples t tests were conducted to examine
whether medication status among children with ADHD was
related to friendships outcomes. A difference was found for
only one variable; children with ADHD taking stimulant
medication (M = 36.68, SD = 27.20) were found to have a
higher proportion of friends with learning problems than
children with ADHD not on medication (M = 19.96, SD =
22.39), t(40) = −2.28, p = .028.
Discussion
The present study compared children with and without
ADHD with regard to the number of nominated and cor-
roborated friends, the proportion of friends with learning
and behavior problems, friendship stability, and compan-
ionship. Consistent with previous findings (e.g., Heiman,
2005), there was no difference between children with and
without ADHD in the number of friends they nominated.
However, fewer of the friends nominated by children with
ADHD were corroborated by either their parents or teach-
ers than those of comparison children. On average, children
in the ADHD sample had approximately three corroborated
friends, whereas comparison children had four corrobo-
rated friends. Previous research suggests that school-age
children have between three and five best friends on aver-
age (Hallinan, 1980), suggesting that children with ADHD
in the current sample are not atypical with respect to the
number of friends. In the present study, none of the com-
parison children were friendless, whereas three children
(6%) in the ADHD sample had no corroborated friends. This
finding is different from that reported by Hoza, Mrug, et al.
(2005), which indicated that 56% of children with ADHD
and 32% of comparison children had no dyadic friends.
Unlike Hoza, Mrug, et al., who restricted children’s friend-
ship nominations to their top two choices of children at
school, in accordance with the recommendation of Schneider,
Wiener, and Murphy (1994), we allowed unlimited friend-
ship nominations and collected information regarding
friends in and outside of school. The strength of this
approach is that it did not give children any preconceived
notions about the number of friends they should have
(Furman, 1996), and it captured friends in two important
domains of children’s lives. Using this methodology, we
were able to demonstrate that although children with ADHD
have fewer corroborated friends, their average number of
friends is typical, and only a small proportion of them are
actually friendless. This finding is similar to results reported
by Wiener and Schneider (2002), who found that children
with learning disabilities (a disorder frequently comorbid
with ADHD), had fewer mutual friends, and more of their
friends did not attend their school than friends of compari-
son children.
To our know le dge, thi s is the fi rs t s tu dy t o r ep ort the ave r-
age length of naturally occurring corroborated friendships
among children with ADHD. Our results indicate that the
corroborated friendships of children with ADHD are 9.6 to
14.4 months shorter (according to child and parent reports,
respectively) in duration than those of comparison children.
Blachman and Hinshaw (2002) also reported that girls with
both inattentive and combined subtypes of ADHD exhibited
poorer friendship stability during a 5-week summer camp
than comparison girls, and aggressive children have also
been reported to have difficulty maintaining friendships
(Ellis & Zarbatany, 2007). Although this shorter duration is
concerning because an additional year of friendships can
contribute to more warmth, closeness, companionship, and
better school adjustment among friends (Furman, 1996),
from a clinical perspective, it is promising that children
with ADHD maintain friendships for approximately 3 years.
A meta-analysis that assessed social contact (including
out-of-school contact and amount of talking between friends)
concluded that reciprocal friends spend more time with one
another and engage in more conversation than acquaintances
and nonfriends (Newcomb & Bagwell, 1995). Children with
ADHD in the present study reported spending as much time
as comparison children talking on the telephone with their
friends, but less time with friends outside of school.
Although, to our knowledge, no studies to date have exam-
ined the amount of time children with ADHD spend with
their friends, our findings are similar to those of Heiman
(2005), who reported that only 6% of children with ADHD
met with their friends at home, compared with 30% among
comparison children. There are a few possible reasons that
might explain group differences in the amount of direct con-
tact. First, it is possible that due to their often challenging
behaviors, children with ADHD require more supervision
and are thus less likely to be invited to friends’ houses. In
addition, parents of children with ADHD may be more con-
cerned about their children’s behaviors when they cannot
monitor them, so may be less likely to arrange social activi-
ties with friends. It is also possible that peers are less likely
to seek contact with these children because of their behav-
ioral excesses and less advanced social perspective taking
skills (Marton, Wiener, Rogers, Moore, & Tannock, 2009).
Lower levels of direct contact between friends among chil-
dren with ADHD is concerning because proximity between
friends is an important component of companionship for
children and because some researchers argue that the single
most important function of friends across development is
the fulfillment of needs for enjoyable companionship
(Savin-Williams & Berndt, 1990).
Although friendship problems such as not having a
friend, unstable friendships and friendships of short dura-
tion, and minimal contact between friends contribute to
poorer social-emotional functioning (e.g., Rose & Asher,
2000), the effects of friendships may not be uniformly posi-
tive. Berndt (1999) suggested that children become more
similar to the friends with whom they associate, and the
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Marton et al. 7
nature of this influence may either be positive or negative.
For example, longitudinal studies demonstrated that adoles-
cents became similar to their friends in classroom disrup-
tion and academic achievement, even after controlling for
children’s initial levels of disruptiveness and academic
achievement (Berndt & Hanna, 1995). The finding that chil-
dren with ADHD in the present study had a much higher
proportion of friends with either learning or behavioral
problems than comparison children may be explained by a
number of factors. First, 24% of children with ADHD in the
current sample had a comorbid diagnosis of a learning dis-
ability and 20% had oppositional defiant disorder. It is pos-
sible, as indicated by the similarity-attraction hypothesis
(Byrne & Nelson, 1965), that children with ADHD are
attracted to other children who exhibit learning, attention,
and activity levels similar to them. As such, our findings
add to existing studies reporting that children and adoles-
cents generally select friends who resemble themselves
(e.g., Aboud & Mendelson, 1996). On the other hand, given
that propinquity is important in friendship formation
(Epstein, 1989), and that children with ADHD are more
likely than non-ADHD children to be placed in special edu-
cation classes, it is also likely that proximity with other chil-
dren with behavioral and learning difficulties aids the
formation of such friendships. Because children with learn-
ing disabilities have fewer mutual, less stable, and lower
quality friendships (e.g., Wiener & Schneider, 2002), hav-
ing friends with learning difficulties may contribute, at least
in part, to the peer status and friendship choices available to
children with ADHD. In addition, it is concerning that chil-
dren with ADHD have a larger proportion of friends with
behavior problems given research regarding the iatrogenic
effects of associating with friends with behavior problems
(e.g., Berndt & Hanna, 1995; Poulin, Dishon, & Burraston,
2001). The present study also found that boys, but not girls,
with ADHD were more likely to have friends regarded as
having behavioral problems by either parents or teachers.
Given that externalizing problems are more commonly
reported among boys than girls (Abikoff et al., 2002) and
that children tend to develop friendships with children simi-
lar to themselves (e.g., Aboud & Mendelson, 1996), it is
possible that boys with ADHD have more opportunities to
develop friendships with other boys with behavioral prob-
lems. Our exploratory analysis regarding medication status
revealed that it was only related to one of the friendship
outcomes examined in the present study. Children with
ADHD taking medication were more likely to have friends
with learning problems than children with ADHD not tak-
ing medications. Although data were not collected regard-
ing this, it is possible that children with ADHD taking
medications (possibly because they have more severe
ADHD symptoms) may be more likely to be in special edu-
cation classes and develop friendships with other students
who also have learning difficulties.
Limitations and Implications
for Future Research
This study has some limitations. First, we relied on parent
and teacher reports of learning and behavioral problems of
corroborated friends. This limitation is difficult to over-
come, because gathering diagnostic assessments of the
learning and behavioral profiles of corroborated friends
would be time-consuming and complicated by issues of
consent. Second, one of the strengths of the present study,
that we obtained information about corroborated friends in
and outside of school, also came with a limitation. Although
children’s nominated friends were corroborated by either
parents or teachers, it is unknown how many of the friends
the children nominated would have reciprocated their
nominations. Although technically difficult, future studies
should examine the reciprocated friendships of children
with ADHD in and outside of school.
Implications for Clinical Practice
Given the reported friendship difficulties among children
with ADHD and the potential adverse outcomes of friend-
ship problems, clinicians working with this population
should routinely assess these children’s friendship charac-
teristics and implement interventions that focus on devel-
oping close dyadic friendships. Although psychostimulant
medication might help create better opportunities for chil-
dren with ADHD to develop friendships by reducing their
impulsive and challenging behaviors, the establishment of
mutual friendships requires more complex skills than sim-
ply the absence of aversive behaviors (Normand et al.,
2007). Recent research indicates that friendship interven-
tions that focus on the development of positive relation-
ships with one peer result in positive outcomes for children
with ADHD (Hoza, Mrug, Pelham, Greiner, & Gnagy,
2003). These peer-focused interventions are more likely to
be successful and are simpler to implement than interven-
tions aimed at improving peer status among a group.
Social skills training programs and training parents as
“friendship coaches” to their children may be important in
teaching children with ADHD who have friendship prob-
lems social skills such as sharing, reciprocal help, support,
and consideration of the perspectives of others (Mrug, Hoza,
Pelham, Gnagy, & Greiner, 2007). A recent study in which
parents of children with ADHD were trained to be “friend-
ship coaches” to their children showed improvements in
these children’s friendships (Mikami, Lerner, Griggs,
McGarth, & Calhoun, 2010). Because previous research
shows that the ability to take the perspective of another peer
is related to the establishment of friendships (Selman, 2003),
and children with ADHD have been shown to exhibit
weaker social perspective taking skills (Marton et al., 2009),
it is possible that these children might benefit from social
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8 Journal of Attention Disorders XX(X)
skills interventions that also explicitly teach social perspec-
tive taking. Selman and Schultz (1990) developed an inno-
vative pair therapy that fosters making and keeping friends
by enhancing social perspective taking and has been shown
to engender more consideration of the perspectives of close
peers and result in higher stages of friendship understand-
ing (Selman, 1980). In sum, because research shows that
even a few close friendships buffer against feelings of isola-
tion and adjustment difficulties (Lauren et al., 2007), focus-
ing on interventions that help children with ADHD develop
close dyadic friendships appears to be most critical.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support
for the research, authorship, and/or publication of this article: We
received funding for the study from Social Sciences and Humanities
Research Council of Canada (SSHRC).
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Bios
Imola Marton is currently a psychologist at the Toronto District
School Board, in Ontario, Canada. Previously, she has worked as a
psychologist at various local hospitals. She is registered as a school
and clinical psychologist with the College of Psychologists of
Ontario. Her areas of research interest involve the social-cognitive
skills and friendships of children with ADHD. She is also inter-
ested in parent characteristics that result in better adjustment for
children with ADHD. .
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10 Journal of Attention Disorders XX(X)
Judith Wiener is a professor in the School and Clinical Child
Psychology Program in the Department of Human Development
and Applied Psychology at OISE, University of Toronto. Her
areas of research involve examining the peer relationships and
social adjustment of children and adolescents with learning dis-
abilities and ADHD, parenting of children and adolescents with
ADHD, social and affective impacts of inclusion, and the beliefs
of children and adolescents with learning disabilities and ADHD
about their difficulties.
Maria Rogers is a postdoctoral research fellow in the
Neurosciences and Mental Health Program at the Hospital for
Sick Children in Toronto, Canada. Her research interests involve
the school and family functioning of children with attentional dif-
ficulties. She is also a registered clinical psychologist with the
College of Psychologists of Ontario and has worked in various
school and hospital settings with children with ADHD. She is cur-
rently a visiting scholar in the Department of Educational and
Counselling Psychology at McGill University in Montreal, Canada.
Chris Moore is a professor of Psychology at Dalhousie University.
His research interests include the development of social understand-
ing in infants and preschool children. He has published on joint
attention, theory of mind, mental term use, future-oriented thinking,
and prosocial behavior. He is the author of The Development of
Commonsense Psychology (2006).
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