peer rejection of students with adhd: a group counseling approach claire nawojchik
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Peer Rejection of Students with ADHD:A Group Counseling Approach
Claire Nawojchik
DSM-IV Criteria for ADHD I. Either A or B, at developmentally
inappropriate levels: A: 6 or more inattention symptoms for 6 months B: 6 or more hyperactivity-impulsivity symptoms
for 6 months Symptoms were present before age 7 Impairment in 2 or more settings (e.g., school &
home) Significant impairment in social, school, or work
functioning The symptoms are not accounted for by another
mental disorder
Three Types of ADHD Combined Type: Both inattention &
hyperactivity-impulsivity criteria are met Predominantly Inattentive Type
Predominantly Hyperactive-Impulsive Type
Overview of Issue 9% of students aged 3-17 have ADHD (5
million people)
Difficulties with peer relationships begin in elementary school
52% of children with ADHD are peer rejected in comparison to 14% of typically developing children
Children with ADHD are twice as likely to have no reciprocated friendships
Problematic Social Behaviors
Join in a peer activity at an inappropriate time
Interrupt others Respond with irrelevant information
during a conversation React in an aggressive manner
Consequences of Peer Rejection
Peer rejection of children with ADHD before age 10 is predictive of anxiety, delinquency, tobacco use, and overall emotional, interpersonal, and behavioral impairment during adolescence
A high level of peer rejection is associated with depression and poor academic performance
Students with ADHD are over 3 times more likely to drop out of high school
Preventing Chronic Disease, 2006 April; 3(2): A52Based on parent-report for children aged 4-17 from the 2003 National Health Information Survey
The ADHD Stigma Peers make more negative judgments about an
individual’s behavior when it is labeled “due to ADHD” than they do when the same behavior has no label
Interventions focused solely on improving ADHD behaviors, without addressing biases of typically developing peers, are not sufficient
Girls with ADHD are less peer accepted than boys because ADHD behaviors are in contrast to the feminine ideal and more socially accepted for boys
The ADHD Stigma ADHD is not a visible disability, so behavior
may be viewed as within the child’s control, the result of poor parenting, and not as a legitimate disorder
Parents are reluctant to let their typically-developing children interact with children with ADHD because of their behaviors
Teachers’ frustration with the classroom behavior of children with ADHD encourages peers’ dislike of them
A Social Justice Approach Use strengths-based counseling:
Emphasize positive skills and traits unrelated to academics & relationships
Emphasis on environmental factors: Promote inclusiveness of the peer group and challenge biases
Consider the role social experience plays on other realms, like academics
Avoid using labels, and use person-first language: Use the phrase “student with ADHD” instead of “ADHD student”
Emphasis on equity
The School Counselor’s Role
Delivery System: Direct Student Services
Small Group Counseling
Dyadic Friendship Intervention
Pair child with ADHD with prosocial buddy & encourage pair cooperation
Pairs given special privileges – work together, sit together, & share points on behavioral point system
Counselor meets buddy pair each week (for 7-8 weeks) to discuss social problem solving
Play-based Intervention Pair with typically developing peer of same age in
natural context of play
Encourage empathy, perspective-taking, intrinsic motivation, & modeling
Counselor models prosocial behavior – sharing, supporting, & joint pretend play
Video self-modeling
Weekly feedback on social behaviors for both children
Promoting Inclusiveness of Peer Group
Serve as positive model of acceptance
Focus on strengths unrelated to social/academic functioning (i.e. artistic)
Encourage conversation about common interests & group work
Peers rewarded for patience and kindness
The School Counselor’s Role
Delivery System: Indirect Student Services
Consultation
Advocate for acceptance of students with ADHD by teachers and parents
Collaboration with Teachers
Give buddy pairs privileges like sitting together in class & sharing points
Encourage group work Use behavioral point system, but discuss point
totals privately Minimize social comparisons between students Be warm & model the likability of students
with ADHD Reward students for kind and patient behavior
Collaboration with Parents Arrange weekly play dates outside of
school for buddy pairs
Coordinate with other parents
Practice play tasks, peer modeling, and video self-monitoring at home
The School Counselor’s Role
Accountability
Evaluate interventions, monitor student progress, and present data to others
Results Dyadic friendship intervention: Academic improvement, higher quality friendships, &
normalized behavior Parent, teacher, and counselor ratings pre- and post-
group Play-based intervention: Improvement in social play behavior & interpersonal
empathy for both peers Test of Playfulness Promoting inclusiveness of peer group: Anonymous positive peer sociometric ratings &
reciprocated peer nominations Observations of behavior during recess and lunch
Challenges Not enough prosocial peers willing to
participate in a social skills group Parents reluctant to involve their child with an
antisocial or socially stigmatized child ASCA standard A.11.a & b – peer-helper
programs
Future Research Needed: Potential risks and benefits for typically
developing peer mentors? How long-lasting and generalizable are results? Gender differences?
Summary Friendship interventions at the elementary
level (ages 5 – 12)
Social skills group counseling is more effective when typically developing children act as mentors/companions to children with ADHD
Focusing solely on behavioral training for children with ADHD is not enough – improvements in parent/teacher ratings do not lead to peer likability
ReferencesAmerican School Counselor Association (2012). The ASCA National Model: A
Framework for School Counseling Programs, Third Edition.Alexandria, VA: Author.
Auger, R. (2011). The school counselor’s mental health sourcebook: Strategies to help students succeed. Thousand Oaks, California: Corwin.
Fite, P. J., Wimsatt, A. R., Vitulano, M. L., Rathert, J. L., & Schwartz, S. (2012). Examination of peer rejection and depressive symptoms as mediators of the link between rule-breaking behavior and poor academic performance. Journal of Psychopathology and Behavioral Assessment, 34, 164-171.
doi: 10.1007/s10862-011-9269-y
Holcomb-McCoy, Cheryl. (2007). School Counseling To Close The Achievement Gap. Thousand Oaks, CA: Corwin Press.
Hoza, B., Mrug, S., Gerdes, A. C., Hinshaw, S. P., Bukowski, W. M., Gold, J. A., . . . Arnold, L. E. (2005). What aspects of peer relationships are impaired in
children with attention-deficit/hyperactivity disorder? Journal of Consulting and Clinical Psychology, 73(3), 411-423.
doi: 10.1037/0022-006x.73.3.411
ReferencesHoza, B., Mrug, S., Pelham, W.E., Greiner, A.R., & Gnagy, E. M. (2003). A friendshipintervention for children with attention- deficit/hyperactivitydisorder:Preliminary findings. Journal of Attention Disorders, 6(3), 87-98. doi: 10.1177/108705470300600301
Mikami, A.Y., Griggs, M. S., Lerner, M.D., Emeh, C.C., Reuland, M. M., Jack, A., & Anthony, M.R. (2012). A randomized trial of a classroom intervention to increase peers’ social inclusion of children with attention-deficit/hyperactivity disorder. Journal of Consulting and Clinical Psychology, Online First Publication. doi: 10.1037/a0029654
Mrug, S., Molina, B. S. G., Hoza, B., Gerdes, A. C., Hinshaw, S. P., Hechtman, L., & Arnold, L. E. (2012). Peer rejection and friendships in children with attention-deficit/hyperactivity disorder: Contributions to long-term outcomes. Journal of Abnormal Child Psychology, 40, 1013-1026.
Wilkes, S., Cordier, R., Bundy, A., Docking, K., & Munro, N. (2011). A play-based interventionfor children with ADHD: A pilot study. Australian Occupational Therapy Journal, 58, 231-240. doi: 10.1111/j.1440-1630.2011.00928.x