Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. ADHD begins in childhood and often persists into adulthood. The worldwide prevalence of ADHD is estimated at around 5% in children and adolescents and 2.5% in adults. There are three subtypes of ADHD:
- Predominantly inattentive
- Predominantly hyperactive/impulsive
- Combined type
People with ADHD often struggle with social issues due to the core symptoms of the disorder. Inattention makes it hard to listen to social cues, sustain conversations, and develop meaningful relationships. Hyperactivity and impulsivity lead to behaviors that may annoy or upset others. The social difficulties associated with ADHD can lead to loneliness, low self-esteem, and problems at school or work.
Do people with ADHD have difficulties with social skills?
Yes, research indicates that people with ADHD often have weaker social skills compared to peers without ADHD. Social skills deficits associated with ADHD include:
- Problems with listening and paying attention during conversations
- Frequently interrupting others
- Difficulty waiting their turn
- Blurting things out without considering the social context
- Struggling to understand nonverbal cues like facial expressions and body language
- Appearing insensitive because they change topics abruptly or don’t respond appropriately
These social difficulties start early in childhood and can persist throughout the lifespan if not addressed. A 2017 study found that children aged 5-12 with ADHD had poorer social skills than peers matched on age, gender, and socioeconomic background. The social skills gaps spanned asserting oneself, self-control, cooperation, responsibility, and empathy.
Some key reasons people with ADHD have poorer social skills include:
- Inattention makes it hard to process social cues or maintain conversations.
- Impulsivity leads to blurting things out and interrupting, which annoys others.
- Hyperactivity can manifest as fidgeting, restlessness, excessive talking, and other behaviors others find disruptive.
- Immature self-regulation makes it hard to wait their turn or control emotions.
- Executive functioning challenges like poor planning and organization interfere with socializing.
- Medication side effects like irritability or emotional flattening inhibit social connection.
Without targeted treatment, these social difficulties tend to persist over time. A 10-year study found that children with ADHD continued to lag in social skills into adolescence and adulthood.
Do people with ADHD have difficulties making and keeping friends?
Yes, many studies show that people with ADHD tend to have weaker friendships and more peer relationship problems compared to those without ADHD.
A 2016 meta-analysis encompassing over 7,700 children found those with ADHD had significantly worse peer functioning than non-ADHD children. Specific friendship problems included:
- Having fewer friends
- More limited friendship quality
- More peer rejection
- More loneliness
- More peer victimization like bullying
These social difficulties can begin early. Preschoolers with ADHD symptoms were found in one study to have fewer reciprocal friendships. Another study found that just having one close friend mitigated peer difficulties for elementary schoolers with ADHD.
What contributes to the friendship challenges faced by people with ADHD?
- Inattention makes them appear aloof or disinterested.
- Forgetfulness leads to missing playdates or letting friends down.
- Impulsiveness results in hurt feelings and strains friendships.
- Hyperactivity and impulsiveness may annoy peers.
- Poor emotion regulation causes fights or frequent frustrations.
Making and keeping friends requires being able to pay attention, pick up on social cues, cooperate with peers, and control impulses and behaviors. The executive functioning and self-regulation deficits of ADHD clearly undermine social success.
Without intervention, the peer difficulties faced by children with ADHD tend to persist over the long term. A longitudinal study found adolescents and young adults who had ADHD as children continued to have strained peer relations and fewer close friends.
Do people with ADHD have trouble in group settings?
Yes, research indicates that many people with ADHD struggle in group social settings due to core symptoms of the disorder.
Inattention makes it hard to follow group conversations. Hyperactivity and impulsivity manifest as interrupting, blurting things out, excessive talking, and not waiting one’s turn. These behaviors often annoy peers in group settings.
A study comparing 8-12 year olds with and without ADHD found those with ADHD were rated by teachers and parents as having more difficulty in group situations. Specific areas of impairment included:
- Paying attention when other children speak
- Waiting their turn in games or conversations
- Staying seated in group activities
- Cooperating and sharing
- Controlling their temper with peers
Another study using playgroup observations found children aged 5-12 with ADHD had more trouble regulating their behavior, made more off-topic remarks, were more verbally aggressive, and showed less cooperation.
Hyperactivity and impulsiveness in groups settings may lead to peer rejection over time. One study found ADHD symptoms in childhood predicted greater exclusion by peers during adolescent social activities.
Group projects at school or team-based activities at work may be challenging for those with ADHD. Strategies like seating the person with ADHD next to a calm peer or assigning responsibilities can help minimize distractibility and impulsive behaviors.
Do people with ADHD have difficulties in the workplace?
Yes, ADHD symptoms frequently impair occupational functioning. Adults with ADHD are more likely to be unemployed, change jobs frequently, underperform at work, and quit or get fired compared to adults without ADHD.
The workplace difficulties associated with ADHD result from the same core symptoms that cause social impairment. Examples include:
- Poor focus leading to distractedness, disorganization, and forgetfulness.
- Impulsiveness resulting in verbal outbursts, impatience, or blurting things out.
- Hyperactivity manifesting as restlessness, excessive talking, and inability to sit still.
- Time management challenges like procrastination, lateness, and missing deadlines.
- Interpersonal problems due to inattention, impulsiveness, emotional dysregulation, and poor communication skills.
Adults with ADHD also tend to have higher rates of other co-occurring conditions that exacerbate work difficulties:
- Educational underachievement
- Low self-esteem
- Symptoms of anxiety or depression
- Substance misuse
- Learning disabilities like dyslexia
Targeted workplace supports and accommodations can help employees with ADHD improve performance and succeed at work. Examples include:
- Providing instructions in writing as well as verbally
- Dividing large assignments into smaller tasks
- Allowing use of white noise or music with headphones to minimize distractions
- Offering flexible work hours to accommodate challenges with sleep
- Providing positive feedback and reminders
- Permitting use of digital aids like smart watches
- Allowing work from home days
With the right modifications and supports, people with ADHD can develop effective coping skills to manage symptoms and thrive in the workplace.
Do people with ADHD have problems sustaining relationships?
Research indicates that many people with ADHD experience challenges in intimate relationships due to core symptoms of the disorder. These relationship problems include:
- More conflict, especially around communication issues, forgetfulness, emotional reactivity, and impulsiveness
- Partners feeling dismissed, invalidated, or uncared for
- More negative communication patterns like criticism, defensiveness, and stonewalling
- Higher rates of separation and divorce
Inattention and distraction characteristic of ADHD may cause partners to feel unheard, unimportant, or neglected. Hyperactivity and impulsiveness manifest in behaviors like interrupting, insensitivity, and volatility that frequently escalate conflict. Emotional dysregulation associated with ADHD also undermines relationship stability through angry outbursts, moodiness, and overreactions.
Studies have uncovered more marital difficulties and divorces among those with ADHD compared to the general population. One study followed nearly 600 adults over 11 years and found presence of ADHD symptoms in childhood predicted relationship troubles and more divorce or separation by age 41.
Treatment with medication and behavioral therapies can help people with ADHD strengthen relationships. Couples counseling also improves partnership success by teaching communication tactics, conflict resolution skills, emotional regulation skills, and relapse prevention strategies. With appropriate support, adults with ADHD can have healthy, lasting relationships.
Do girls and women have different social challenges with ADHD compared to boys and men?
Research indicates some gender differences exist in the social impairments experienced by those with ADHD.
Girls with ADHD tend to have less overt hyperactivity and impulsiveness. They more often present as quietly inattentive, disorganized, scattered, and chatty. These symptoms are less disruptive, so girls may fly under the radar and receive diagnosis and treatment later than boys.
But girls still struggle significantly in social realms. Because their symptoms are less noticeable, girls with ADHD are more likely to be rejected or neglected by peers rather than criticized and scolded.
One study found that girls aged 5-12 with ADHD symptoms had trouble joining conversations and were ignored by classmates. Boys with equivalent symptoms were more often reprimanded for disruptive behaviors. But both had comparable problems making and keeping friends.
Women with undiagnosed ADHD report feeling like lifelong “social outcasts.” Core symptoms like inattention, forgetfulness, disorganization, and distractibility damage friendships and relationships. These socially isolating impacts may be overlooked, leading to depression, anxiety, and low self-esteem.
Treatment needs for women with ADHD should focus on cultivating self-esteem and social skills as well as managing symptoms. Girls and women who understand ADHD’s role in social challenges can learn compensatory strategies to improve outcomes. With the right support, females with ADHD can successfully manage social demands.
What social skills training helps people with ADHD?
Social skills training aims to teach people strategies to improve communication, relationship-building, emotional regulation, and executive functioning. Different approaches that can benefit those with ADHD include:
Behavioral social skills training – Uses techniques like modeling, role playing, social reinforcement, and coaching to teach social behaviors. May focus on skills like:
- Making eye contact
- Listening actively
- Asking questions
- Picking up on social cues
- Cooperating and sharing
- Coping with teasing
- Resolving conflicts
Cognitive behavioral therapy (CBT) – Helps modify unhelpful thought patterns and beliefs that may undermine social success. Can teach perspective-taking, conflict resolution, and coping with peer rejection.
Dialectical behavioral therapy (DBT) – Builds mindfulness, distress tolerance, emotion regulation, and interpersonal skills. Helpful for managing emotional reactivity.
Social skills groups – Allows practice and rehearsal of skills in a structured small group setting. Provides opportunities to give and receive feedback.
Executive functioning coaching – Enhances organizational skills, time management, planning, and goal-setting to reduce distractibility and impulsiveness.
Research shows targeted social skills training improves peer relationships and social adjustment for children and adults with ADHD when combined with medication and therapy. Ongoing practice and support helps sustain social gains over time.
Conclusion
In summary, ADHD significantly impairs social functioning across the lifespan. Core symptoms like inattention, hyperactivity, and impulsivity undermine the ability to pick up on social cues, regulate behavior, communicate effectively, and build meaningful relationships. Without targeted treatment, people with ADHD are at high risk for peer rejection, friendlessness, bullying, loneliness, academic and occupational challenges, and relationship turmoil. However, social skills training, medication, therapy, and coping strategies can improve outcomes. Ongoing support allows people with ADHD to better manage symptoms, increase self-awareness, and thrive socially.