Are Social Problems in Children with ADHD Due to Knowledge Gaps or Performance Difficulties? An Examination of...

Emerging evidence suggests that social skills difficulties in children with ADHD are not due to difficulty learning/acquiring age-expected social skills, but instead to difficulty performing known social skills in the moment. The current study reflects the largest investigation to date to disentangle social knowledge vs. performance difficulties in children with and without ADHD, while also probing the extent to which children with ADHD exhibit strengths in specific social domains.

A clinically evaluated and carefully phenotyped sample of children ages 8-13 with and without ADHD (N = 277; 42.6% girls; 66.8% White Non-Hispanic) was assessed using the well-validated social behavioral analysis framework to quantify social skills acquisition difficulties, performance difficulties, and strengths across settings (home, school).

Acquisition difficulties were rare and idiosyncratic for both groups; parents and teachers perceived fewer than 15% of children with ADHD as missing any specific social skill. In contrast, performance difficulties were predominant in the ADHD group and occurred at significantly higher rates across informants relative to the non-ADHD group in the domains of communication, cooperation, empathy, responsibility, and self-control (all p < .001), but not assertion or engagement (both p > .56). Interestingly, children with ADHD were also perceived across informants as having strengths in specific communication and engagement skills, despite exhibiting significantly fewer social strengths overall vs. the non-ADHD group (p < .001).

These findings are consistent with updated conceptualizations suggesting social skills difficulties in children with ADHD are not primarily due to a lack of social knowledge but rather from the inconsistent execution of known social skills.