Science Brief

Social context influences on children’s peer relationships

Research on parent and teacher influences on children's peer relationships may lead to new interventions for ADHD

By Amori Yee Mikami

Amori Yee Mikami
Amori Yee Mikami
received her BA and MA from Stanford University, her PhD from the University of California at Berkeley, and completed her predoctoral clinical internship and postdoctoral fellowship at the University of California at San Francisco. Currently she is an assistant professor at the University of Virginia, where her research focuses on social contextual influences on children’s peer rejection and friendship problems. Her lab is currently designing and testing psychosocial treatments that train parents and teachers to assist the peer relationships of children with ADHD. Mikami’s work has been supported by the National Institute of Mental Health and the Spencer Foundation, and she received the Young Scientist Research Award from Children and Adults with ADHD (CHADD), a national advocacy group.

Introduction

A visit to a school playground will quickly reveal that while most children cluster with friends, a few children remain left out. Why do some children have persistent peer relationship troubles? Existing research on this question has predominantly focused on the deficits within disliked children as a cause of their ostracism. For example, peer-rejected children have been documented to show maladaptive aggressive or withdrawn behaviors, social information processing biases, and poor emotional regulation (Dodge et al., 2003; Newcomb, Bukowski, & Pattee, 1993; Southam-Gerow & Kendall, 2002). These characteristics are thought to be off-putting to peers and to get in the way of the child’s development of healthy relationships.

While I acknowledge that this child-focused perspective holds value, I argue that existing models lack consideration of ways in which social contextual influences outside of the child may also affect peer problems (Mikami, Lerner, & Lun, 2010). Some children may experience home environments that are supportive of friendship development, where, for example, parents actively create playdate opportunities for their children and peers. Other children may have classroom environments in which teachers encourage the peer group to be socially-accepting, cooperative, and welcoming. Exploring parent and teacher influences on children’s peer relationships has the potential to expand our conceptualization of peer problems beyond deficits within disliked children, and to improve interventions for social difficulties. 

Peer Relationships and ADHD

My work tends to focus on youth with Attention-Deficit/Hyperactivity Disorder (ADHD) because this population provides fertile ground to study peer difficulties. The diagnostic criteria for ADHD (estimated to affect about 5% of school-age children) requires children to display excessive, impairing inattention and/or hyperactivity/impulsivity (American Psychiatric Association, 2000). However, the peer problems faced by this group are difficult to overstate.

In my own research, I have replicated work finding disliking of children with ADHD to occur within the first hours of meeting unfamiliar peers (Erhardt & Hinshaw, 1994; Hodgens, Cole, & Boldizar, 2000; Mikami, Jack, Emeh, & Stephens, 2010; Mikami, Lerner, Griggs, McGrath, & Calhoun, 2010). Peer difficulties among youth with ADHD symptoms persist over time and across situations (Bagwell, Molina, Pelham, & Hoza, 2001; Mikami & Hinshaw, 2003; Mikami, Huang-Pollock, Pfiffner, McBurnett, & Hangai, 2007; Mikami, Szwedo, Allen, Evans, & Hare, 2010). In addition, peer problems and ADHD have additive effects in predicting a wide range of psychopathology in adolescence (Greene et al., 2001; Greene, Biederman, Faraone, Sienna, & Garcia-Jetton, 1997; Mikami & Hinshaw, 2006; Mikami, Hinshaw et al., 2010; Mikami, Hinshaw, Patterson, & Lee, 2008; Mikami, Lee, Hinshaw, & Mullin, 2008). Collectively, these findings underscore the magnitude of social problems for these youth.

The research about peer problems in ADHD contains the same focus on children as the cause of their own difficulties (Whalen & Henker, 1992). Consideration of social contextual influences on the peer relationships of ADHD populations remains novel. In this article I highlight recent work from my lab suggesting that parents and teachers: (1) may assist the peer functioning of children with ADHD; (2) may influence the developmental trajectory of children with peer rejection and ADHD; and (3) can be incorporated into interventions for peer problems.

Parental Influences on Children’s Peer Relationships

Research among families of typically-developing youth suggests that parents help their elementary school-age children make friends by networking with other parents to arrange social opportunities for their children, modeling positive interpersonal skills themselves, and coaching their children during peer interactions (McDowell & Parke, 2009; Putallaz, 1987). Because playdates (arranged play periods between two children outside of organized activities, usually at one child’s home) are considered essential for close friendships to deepen, I have suggested that parents are particularly suited to help their child make friends (Mikami, 2010).

The family relationships of children with ADHD are conflictual (Johnston & Mash, 2001; Mikami & Pfiffner, 2007), which is often due to children with ADHD demonstrating extreme, disruptive behaviors. However, I wondered whether such parenting difficulties may in turn exacerbate the peer problems of children with ADHD. In a dataset of 62 children with ADHD (ages 6-10) and a matched sample of 62 comparison youth without ADHD, I found that parents of children with ADHD did in fact struggle with the behaviors hypothesized to help their children make friends. These parents were less likely than were comparison parents to have strong social networks of their own, and more likely to be critical of their children, even after statistical control of the child’s level of disruptive behaviors (Mikami, Jack et al., 2010).

Importantly, parents’ observed warmth towards their children, parents’ own skilled social interaction with other adults, and parents’ facilitation of the child’s peer interactions all were correlated with children being better accepted by peers -- as assessed by parent and teacher reports and in peer sociometric nominations in a lab-based playgroup. Parents’ criticism (after statistical control of the child’s poor behavior) and, surprisingly, parents’ praise, predicted the child having poorer functioning with peers. Interestingly, associations between parent behaviors and peer status were consistently stronger for children with ADHD relative to typically-developing youth (Mikami, Jack et al., 2010). These findings suggest that parental behaviors may encourage children’s good peer relationships, and that these influences may be particularly important for the clinical population of children with ADHD. However, cross-sectional studies such as this one cannot establish that parental behaviors drive children’s peer functioning, and not vice versa.

Current investigations by my graduate students have found that parents’ own ADHD symptoms may detrimentally affect their ability to coach their children in social skills, but that interestingly, the negative impact of parental ADHD may be stronger for comparison children than for children with ADHD (Griggs & Mikami, under review). Another student has found that peers’ liking of children with ADHD is influenced by peers’ observations of the interactions between the child with ADHD and his/her parent (Jack, Mikami, & Calhoun, under review). Parents’ relationships with their children may also affect whether those children maintain accurate self-perceptions of their own peer competence (Emeh & Mikami, in preparation).

Teacher Influences on Children’s Peer Relationships

Who children like or dislike is often established at school. However, extremely little is known about whether the classroom teacher can influence the peer status of children with ADHD. Research among typically-developing samples suggests that young children develop social preferences about their peers, in part, based on their observations of whether the teacher thinks the peer is desirable (Hughes & Kwok, 2006). Although not yet studied among ADHD populations, I propose that teachers who sincerely value and like children with ADHD may set an example for peers to follow in their own judgments. It is also common for children with ADHD to have poor reputations within their peer group; even when a child with ADHD improves in his or her behavior, peers may not like them any better because the child’s reputation perpetuates rejection (Harris, Milich, Corbitt, Hoover, & Brady, 1992). A teacher may help to dismantle such negative reputations held by the peer group by drawing positive attention to the child with ADHD (Mikami, Lerner, & Lun, 2010).

Unfortunately, in my own work I have replicated findings that many teachers struggle to connect with students who have ADHD, owing to these children’s difficult behaviors (Mikami, Chi, & Hinshaw, 2004; Mikami & Hinshaw, 2003; Stormont, 2001).  Among 26 elementary school teachers and 490 students in their classrooms followed over one school year, I found that children with high ADHD symptoms tended to become progressively more disliked, as rated by peers, from the fall to the spring in their classrooms. However, teachers who established positive relationships with students and who used instructional practices that communicated that all students were capable of learning had less peer rejection in their classrooms, and were able to break the typically strong relationship between ADHD symptoms and peer problems (Mikami, Griggs, Reuland, & Gregory, under review).

These preliminary results suggest that the classroom environment, shaped by the teacher, may affect the likelihood that children will get along with peers. This study does not imply that child-level factors are irrelevant; in fact, there were findings, similar to those in previous work (Erhardt & Hinshaw, 1994; Hodgens et al., 2000; Mikami, Jack et al., 2010), that children’s ADHD symptoms predicted peer dislike. But crucially, teacher practices exerted an influence on this relationship, suggesting that the trajectory from ADHD to peer rejection is not immutable.

Developmental Trajectory of Peer Problems

What are the consequences of having negative peer experiences for children with ADHD, and how might parents and teachers influence this path? Although both peer rejection and childhood ADHD may contribute to academic and psychological difficulties in adolescence (Mikami & Hinshaw, 2003, 2006; Mikami, Hinshaw et al., 2008; Mikami, Lee et al., 2008), good interactions with parents and with teachers may buffer these negative trajectories. Specifically, positive relationships with the counselors at a research-based summer camp mitigated the cross-sectional association between peer rejection and aggressive behavior (Mikami & Hinshaw, 2003). In addition, although girls with ADHD were at elevated risk for bulimia nervosa symptoms in adolescence, and childhood peer rejection increased such risk, having supportive, non-intrusive parents protected youth from eating pathology (Mikami, Hinshaw et al., 2008). The effects of these parenting variables were stronger for girls with ADHD than for comparison girls (Mikami, Hinshaw et al., 2008), again suggesting the potential importance of parents for this clinical population.

Treatment Implications

To date, the predominant treatments for peer problems follow from the conceptualization that deficits within disliked children cause their ostracism. They provide intervention to the child to remediate deficits on the presumption that this will result in peers’ increasing their liking. For example, it is common to provide medication, behavior therapy, or social skills training to the child with ADHD to reduce the child’s maladaptive behaviors and increase his or her prosocial overtures (Chronis, Jones, & Raggi, 2006; Mikami, Calhoun, & Abikoff, 2010; Mikami & Pfiffner, 2006). Yet, these child-focused treatments receive mixed empirical support for improving peers’ regard (as opposed to improving ADHD symptoms or parent- and teacher-rated behavior problems, where they are more successful). Even when these interventions lead to improvement in the child’s behaviors, it is common for treated children with ADHD to remain impaired in their peer-rated acceptance and friendship (Hoza et al., 2005). Incorporating social contextual influences into treatment for peer problems may potentially improve efficacy.

As one example of involving parents in interventions for children’s peer problems, my lab has developed a psychosocial treatment, Parental Friendship Coaching (PFC), to teach parents how to enhance the social skills of children with ADHD. PFC was influenced by findings that parents actively involved in their children’s behavioral treatment may potentiate child improvements (Frankel, Myatt, Cantwell, & Feinberg, 1997; Pfiffner et al., 2007). However, PFC differs from other interventions in that it targets parents alone, with no child treatment component. This manualized intervention was delivered in 90-minute sessions, once per week for eight weeks, and instructed parents in practicing friendship skills with their children and in arranging structured social opportunities where their children were likely to get along with peers.

In a small pilot study (n=62 families of children with ADHD), if parents were randomly assigned to receive PFC, their children showed better social competence, as assessed by multiple informants, including teachers unaware of intervention status (Mikami, Lerner, Griggs et al., 2010). Intervention-related changes in parent behaviors mediated the link between treatment and child social functioning (Mikami, Lerner, Griggs et al., 2010). These findings strengthen contentions from cross-sectional research that parental behaviors may influence child peer functioning, and suggest that parental behaviors may be able to be manipulated to assist children’s peer relationships. A graduate student has found that a strong parent-therapist alliance predicts optimal treatment response for the children, again supporting the model that parental behavior change (encouraged by a strong therapeutic alliance) supports children’s friendships (Lerner, Mikami, & McLeod, under review).

I am also excited by the prospect that treatments might encourage a socially-accepting classroom peer group that is more welcoming of students with ADHD. In a pilot study, I randomly assigned 24 teachers of regular education classrooms to receive a program that I created which trains teachers to encourage positive interactions among students using cooperative learning instructional practices. Results suggested that intervention classrooms led to increases in student self-reporting of positive relationships with their peers (Mikami, Boucher, & Humphreys, 2005). My lab is currently building on this intervention while attempting to tailor it specifically to the needs of children with ADHD. The aim is to train the classroom teacher in practices to increase the tolerance of the classroom peer group and to reduce the rigidity of the negative reputations that the peer group carries against children with ADHD.

Classroom interventions have the potential for ripple effects that extend beyond children receiving treatment at that moment. A lasting change in the tolerance of the peer group may encourage acceptance of new children who enter that group in the future. In addition, a durable change in teacher practices might prevent new peer rejection of children with ADHD from occurring in future cohorts of students. Therefore, a classroom intervention has the potential to be more cost effective by reaching larger numbers of children beyond those being targeted by child-focused interventions.

Summary

Children’s peer relationships are an important topic for study, because of evidence that peer experiences carry long-lasting effects. The peer relationship problems of children with ADHD are particularly severe, persistent, and treatment-refractory. Although the majority of the research about these issues to date has focused on problem behaviors and deficits within disliked children that contribute to their peer difficulties, my lab is most interested in social contextual factors, such as the home and school environment, that may also influence peer relationships. Such parent and teacher behaviors may help to facilitate peer acceptance and friendship, particularly for the at-risk clinical population of youth with ADHD.

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