Interventions for peer relationships (how the child gets along with other children) are a critical component of treatment for children with ADHD. Very often, children with ADHD have serious problems in peer relationships. Children who overcome these problems do better in the long run than those who continue to have problems with peers. There is scientific basis for child-based treatments for ADHD that focus on peer relationships. These treatments usually occur in group settings outside of the therapist’s office.
There are five effective forms of intervention for peer relationships:
There are several settings for providing these interventions to children, including groups in office clinics, classrooms, small groups at school and summer camps. All of the programs use methods that include coaching, use of examples, modeling, role- playing, feedback, rewards and consequences and practice. It is best if these child-directed treatments are used when a parent is participating in parent training and school personnel are conducting an appropriate school intervention. When parent and school interventions are integrated with child-focused treatments, problems getting along with other children (such as being bossy, not taking turns, and not sharing) that are being targeted in the child treatments are also included as target behaviors in the home and school programs so that the same behaviors are being monitored, prompted and rewarded in all three settings.
Social skills training groups are the most common form of treatment, and they typically focus on the systematic teaching of social skills. They are typically conducted at a clinic or in school in a counselor’s office for 1–2 hours on a weekly basis for 6–12 weeks. Social skills groups with children with ADHD are only effective when they are used with parent and school interventions and rewards and consequences to reduce disruptive and negative behaviors.
There are several models for working on peer relationships in the school setting that integrate several of the interventions listed above. They combine skills training with a major focus on decreasing negative and disruptive behavior and are typically conducted by school staff. Some of these programs are used with individual children (for instance, token programs in the classroom or at recess) and some are school wide (such as peer mediation programs).
Generally, the most effective treatments involve helping children get along better with other children. Programs in which children with ADHD can work on peer problems in classroom or recreational settings are the most effective. One model involves establishing a summer camp for children with ADHD in which child-based management of peer problems and academic social problem solving difficulties are integrated with parent training. All five forms of peer intervention are incorporated in a 6–8 week program that runs for 6–9 hours on weekdays. Treatment is conducted in groups, with recreational activities (e.g., baseball, soccer) for the majority of the day, along with two hours of academics. One major focus is teaching skills in and knowledge of sports to the children. This is combined with intensive practice in social and problem-solving skills, good team work, decreasing negative behaviors, and developing close friendships.
Some approaches to child-based treatment for peer problems fall somewhere between clinic-based programs and intensive summer camps. Versions of both are conducted on Saturdays during the school year or after school. These involve 2–3 hour sessions in which children engage in recreational activities that integrate many of the forms of social skills intervention.
Finally, preliminary research suggests that having a best friend may have a protective effect on children with difficulties in peer relations as they develop through childhood and into adolescence. Researchers have developed programs that help children with ADHD build at least one close friendship. These programs always begin with the other forms of intervention described above and then add having the families schedule monitored play dates and other activities for their child and another child with whom they are attempting to foster a friendship.
It is important to emphasize that simply inserting a child with ADHD in a setting where there is interaction with other children—such as Scouts, Little League or other sports, day care, or playing in the neighborhood without supervision—is not effective treatment for peer problems. Treatment for peer problems is quite complex and involves combining careful instruction in social and problem-solving skills with supervised practice in peer settings in which children receive rewards and consequences for appropriate peer interactions. It is very difficult to intervene in the peer domain, and Scout leaders, Little League coaches and day-care personnel are typically not trained to implement effective peer interventions. Finding social skills programs for children with ADHD can provide the skills needed to successfully interact with others.