Peer Relationships in Undergraduates With ADHD Symptomatology: Selection and Quality of Friendships

Abstract

Objective: This study investigated the relationships between ADHD symptomatology and friendship formation, social skills, and the quality of specific friendships in college students. Method: A total of 156 students, 75 of whom had high self-reported ADHD symptomatology, participated. Friends of 68 participants completed measures of friendship quality. Results: Students had more positive first impressions of and reported being friends with others whose ADHD symptom severity matched their own. Participants with high ADHD symptoms reported greater difficulty providing emotional support and managing interpersonal conflict than their low-symptom peers. Greater ADHD symptoms in participants and friends were related to reduced quality of specific relationships, but similarity of severity of symptomatology in the dyad benefited the relationship. Conclusion: These findings have implications for the kind of support offered to students with high ADHD symptomatology when they transition to college. Future longitudinal research examining relationships of varying levels of closeness should be conducted.

Keywords

ADHD friendship social skills college students

The transition to college can be challenging even for a well-adjusted student. Those students who enter college with symptoms associated with ADHD can face even more difficulty with the transition. ADHD is a neurodevelopmental disorder characterized by inattention and/or hyperactivity-impulsivity (American Psychiatric Association [APA], 2013). The disorder is thought to affect approximately 5% of school-age children, and symptoms and impairment can continue into adulthood (APA, 2013). Federal legislation (e.g., Section 504 of the Rehabilitation Act of 1973 and the Americans With Disabilities Act of 1990) has helped elementary and secondary schools become better at identifying students with ADHD and addressing their needs. As a result, young adults with ADHD symptoms are attending college in increasing numbers (Javorsky & Gussin, 1994; Wolf, 2001).

Notwithstanding their high level of functioning compared with the general population of individuals diagnosed with ADHD, college-bound students with ADHD are known to be at risk for academic difficulties and some research has shown them to have poorer psychological functioning than their non-afflicted peers (see DuPaul, Weyandt, O’Dell, & Varejao, 2009, for a review). However, little research has examined the social functioning of those students who arrive at college exhibiting ADHD symptoms. Adapting to the social life of college and making new friends are important components of the overall college adjustment process (Swenson, Nordstrom, & Hiester, 2008). Moreover, prominent theories of college persistence (e.g., Tinto, 1975) postulate that the more integrated a student is in the social system of college, the more committed that person will be to the institution itself and to completing college. Findings by Milem and Berger (1997) suggested that social integration may even be more important than academic integration in terms of predicting institutional commitment and persistence in college. Therefore, it is important to determine what needs students with ADHD symptomatology might have in terms of social functioning. As a first step in determining those needs, two studies were conducted with varying methodologies that examined the relationships between ADHD symptomatology and friendship formation, social skills, and friendship quality in college students.

Friendship Formation: First Impressions

One important aspect of friendship is formation, or with whom an individual chooses to become friends. First impressions can be important determinants of future contact and eventual friendship. There is some research examining initial impressions of children with ADHD. Boys with ADHD were rated as less popular and less desirable as a friend (Bickett & Milich, 1990), received fewer positive peer nominations and more negative peer nominations (Erhardt & Hinshaw, 1994), and had peers who reported that they did not like playing with them (Pelham & Bender, 1982) after only brief periods of exposure with no prior interaction and no knowledge of diagnostic status. It appears that this rejection stems from specific behaviors associated with ADHD such as aggression and defiance (Erhardt & Hinshaw, 1994) as well as cognitive inattention (Sandler, Hooper, Watson, & Coleman, 1993).

Similar questions have been examined in college samples. It seems that the average college student viewed a hypothetical peer with ADHD negatively: Endorsing more negative than positive adjectives to describe a peer who presented as having a known ADHD diagnosis (Chew, Jensen, & Rosen, 2009) and indicating that they would be less likely to want to work with such an individual on a group project, to get to know him or her better, and to become friends than with an individual described as having a medical problem or an ambiguous weakness (Canu, Newman, Morrow, & Pope, 2008). Both these findings suggest that there is a stigma associated with an ADHD diagnosis in college students. Even without being presented with a label, college students responded with more rejection and hostile mood after viewing a video segment of a peer simulating ADHD behaviors compared with typical behaviors (Paulson, Buermeyer, & Nelson-Gray, 2005). Only one study has examined initial impressions following in-person interactions with college students with ADHD. Canu and Carlson (2003) found that female confederates who had no information about participants’ diagnostic status rated male college students with primarily inattentive ADHD symptoms more negatively than students with combined hyperactive/impulsive and inattentive symptoms and students with no ADHD symptoms after sitting with them in a waiting room for 1 min. Additional research on how ADHD symptom-matology is related to first impressions based on personal contact is warranted. One specific research question addressed by Study 1 was as follows: Will individuals with high ADHD symptomatology be viewed more negatively by their peers, regardless of the ADHD symptomatology level of those peers?

Friendship Formation: The Role of Similarity

It is also important to examine other factors associated with friendship formation and a great deal of research has supported the old adage that birds of a feather flock together. McPherson, Smith-Lovin, and Cook (2001) reviewed the research on homophily, or the tendency to associate with others who are similar. They noted that, in addition to various demographic characteristics, research supports homophily by psychological characteristics such as intelligence, attitudes, and beliefs as well as positive and negative behaviors (e.g., school achievement, delinquent behavior). McPherson et al. reviewed longitudinal data that indicated that homophily by attitudes and behaviors seems to be more a function of choosing to have relationships with similar others rather than being influenced by others in one’s friendship network. Therefore, not only do we associate with others who look like and have the same background as us in terms of race, sex, age, and social class, but we also choose to affiliate with others whom we perceive to think and act like us. This perceived similarity can make these individuals attractive to us as potential friends. Communication scholars have also found that students were attracted to and formed friendships with others with similar levels of social skills, more specifically, functional communication skills such as conflict management (Burleson & Samter, 1996). What is unclear is whether or not these findings regarding homophily extend to mental health problems such as ADHD, which could be the case as it is likely that ADHD symptomatology is related to functional communication skills. Therefore, a second research question addressed by Study 1 was as follows: Will a person with high ADHD symptomatology be more likely to view positively and affiliate with another person with high ADHD symptomatology compared with someone with low ADHD symptomatology?

Study 1

Method

Participants

In all, 88 first-year students (44 women) from a small, liberal arts college who ranged in age from 17 to 19 years (M = 18.03, SD = 0.36) participated in the study. Parental consent was obtained for the four 17-year-old participants. All participants were invited to complete the College ADHD Response Evaluation (CARE; Glutting, Sheslow, & Adams, 2002) at a mandatory meeting during their first-year college orientation. Participants were then recruited for the study via email, telephone, and campus mail based on their percentile scores on this measure. Men who scored at or above the 93rd percentile on the Inattention subscale and at or above the 90th percentile on the total scale were classified as high ADHD symptomatology. Men who scored at or below the 70th percentile on both scales were classified as low symptomatology. Women who scored at or above the 93rd percentile on the Inattention subscale and at or above the 82nd percentile on the total scale were classified as high symptomatology. Women who scored at or below the 60th percentile on both scales were classified as low symptomatology. These criteria were chosen because they resulted in groups with adequate numbers from which to recruit participants (i.e., had the 95th and 50th percentiles been chosen for the high and low groups, respectively, the groups would have been too small to recruit an adequate number of participants).

The majority (86.4%) of the participants were White and approximately 51% met criteria for high ADHD symptomatology. Students were offered both extra credit in their psychology class if they were enrolled in one and entry into a lottery with the chance to win one of five US$200 cash prizes as compensation.

Procedure

Students who met the percentile criteria described above were contacted via email and phone at the end of their first semester and asked to participate. In addition to completing questionnaires for a separate study, those who agreed to participate provided the names of up to seven of their closest friends at college. Participants were then contacted a second time by phone and email approximately 3 months later and asked to participate in a lab activity (45% agreed). For the lab activity, participants were placed in groups of four to six students: two to three members of the high ADHD symptomatology group and two to three members of the low ADHD symptomatology group. Students were placed in a group with others who were not considered friends per participants’ reports. A total of seven groups completed this portion of the study (high ADHD symptomatology n = 18, 11 women; low ADHD symptomatology n = 22, 10 women). The students in each group interacted by introducing themselves, describing three interesting facts about themselves, and participating in a team-building activity that required them to work together for 10 min to build as tall a tower as they could out of 30 random books. The activity allowed students to interact freely while working toward a common goal. This activity was followed by a snack, during which participants were encouraged to interact. After the snack, each member of the group reported his or her initial impressions for every other member of the group.

Measures

CARE

Students were screened for ADHD symptomatology using this 59-item self-report questionnaire (Glutting et al., 2002). Students indicated the degree to which they agreed with statements such as “I get down to assigned work easily” using a 3-point scale (0 = disagree, 1 = undecided, 2 = agree). This measure yields a total ADHD score as well as three factors scores corresponding to the three main symptoms of ADHD: inattention, hyperactivity, and impulsivity. Scores can also be computed for two scales that use the 18 Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; APA, 2000) criteria: inattention and hyperactivity/impulsivity. Percentile scores can be computed for this measure using gender-based norms. Data presented in the CARE Manual indicate that these factor scores have high levels of internal consistency and test–retest reliability, can discriminate between college students with and without ADHD, and are related to other adult ADHD measures (Glutting et al., 2002).

Initial impressions

Participants assessed the extent to which they found each group member interesting, liked his or her personality, felt a connection with the person, and could see the possibility of future friendship using a 4-point scale (1 = not at all; 4 = extremely/definitely). These four ratings were combined into one measure of initial impressions (Cronbach’s α = .86).

Results

First impressions

To examine the first research question, averages across subsets of participants within each lab group were calculated to determine whether ADHD symptomatology of the rater and of the person being rated was related to how individuals form first impressions. Initial impressions scores were calculated for the following subsets of participants within each group: high-symptomatology group members’ average rating of other high-symptomatology group members, high-symptomatology group members’ average rating of low-symptomatology group members, low-symptomatology group members’ average rating of high-symptomatology group members, and low-symptomatology group members’ average rating of other low-symptomatology group members. These average scores per group were subjected to a two-way repeated-measures ANOVA with group as unit, type of person completing the rating as one factor (high symptomatology vs. low symptomatology), and person being rated as another factor (high symptomatology vs. low symptomatology). No main effects were found for the rater or the person being rated, F(1, 6) = 0.06, p = .818, η² = .01, and F(1, 6) = 0.07, p = .798, η² = .01, respectively. Therefore, no differences were found between those with high and low ADHD symptomatology in terms of their initial impressions of others or how they were rated by others.

One test of the second research question entailed examining the interaction from the above two-way repeated-measures ANOVA. As shown in Figure 1, those with high ADHD symptomatology reported having more positive first impressions of others who also had high symptomatology (M = 2.58, SD = 0.54) than of those who had low symptomatology (M = 2.27, SD = 0.24). Conversely, students with low symptomatology provided more positive ratings of others with low symptomatology (M = 2.58, SD = 0.28) than of those with high symptomatology (M = 2.19, SD = 0.28), F(1, 6) = 25.34, p = .002, η² = .81.

Figure 1.

Mean rating of initial impressions as a function of symptomatology status of rater and person being rated.

Friendship formation

To determine if homophily by ADHD symptom severity extended beyond first impressions to forming peer relationships, averages were calculated for the four percentile scores from the CARE across all first-year friends listed by each participant. The average total percentile score of friends of participants in the high-symptomatology group (M = 79.63, SD = 9.27) was greater than the average total percentile score of friends of participants in the low-symptomatology group (M = 73.12, SD = 9.72); t(85) = −3.20, p = .002, η² = .11. Similarly, across all friends of high-symptomatology participants, the average inattention percentile score (M = 84.39, SD = 8.91) was greater than the same score across all friends of low-symptomatology participants (M = 75.72, SD = 9.80); t(85) = −4.32, p < .001, η² = .18. There were no differences in the average hyperactivity or impulsivity percentile scores of the friends of high versus low ADHD symptomatology participants.

Discussion

Students had more positive first impressions of other students who matched their severity of ADHD symptomatology (i.e., highs with highs, lows with lows) than with students who did not match their ADHD symptomatology severity (i.e., highs with lows; lows with highs). In addition, participants with high ADHD symptomatology reported being friends with students who themselves reported greater ADHD symptomatology, most notably problems with inattention, than the friends of participants with low ADHD symptomatology.

It makes sense that those with low ADHD symptomatology would prefer others with low symptomatology compared with high symptomatology and such findings are consistent with prior literature indicating that college students respond negatively to peers who exhibit ADHD behaviors (Paulson et al., 2005). The more unique finding is that those with high ADHD symptomatology are attracted to each other, specifically those exhibiting problems with inattention. It may be the case that symptoms of hyperactivity and/or impulsivity are more impairing to relationships, therefore the potential bond of sharing those symptoms is not enough to overcome that impairment and increase the likelihood of forming a friendship. However, the shared experience of attention problems could generate emotional support, such that the members of the pair know what each other is going through, can sympathize with each other’s struggle, and can tolerate each other’s deficits. It would be interesting to determine whether the social support offered by friends of those with high ADHD symptomatology differed depending upon the friends’ ADHD symptomatology status. One could predict that when the friend also has high ADHD symptomatology he or she will be less likely to provide problem-focused support (e.g., reminders, help with studying) than when the friend has low ADHD symptomatology. What is also unclear is the extent to which this tendency to be friends with others who have a similar level of ADHD symptomatology is related to adjustment. Is there something about being friends with others who also have high ADHD symptomatology that puts a student who exhibits these behaviors at risk academically or psychologically? Future research should explore this question.

Study 2

In addition to examining friendship formation, it is also important to examine social skills more broadly in college students with ADHD symptomatology as those skills will come into play when making the social transition to college. The social impairment of children diagnosed with ADHD is well documented (e.g., Nijmeijer et al., 2008; Nixon, 2001), and has been shown to persist into adolescence and adulthood (Weiss & Hechtman, 1993). Despite these findings, only a handful of researchers have examined the social functioning of college students with ADHD symptomatology. Such students are often aware of their difficulties in this area and express greater social concerns than their non-diagnosed peers (Blase et al., 2009). Semi-structured interviews to determine the factors that help college students with ADHD adjust to their new environment revealed that transitioning from parents to peers as the main source of support was important as peers could help the students study, remind them of due dates, and help them get to class on time (Meaux, Green, & Broussard, 2009). Even though such assistance is deemed important, students without an ADHD diagnosis rated their support from their friends significantly higher than students diagnosed with ADHD (Wilmshurst, Peele, & Wilmshurst, 2011).

College students with ADHD may have difficulty in social relationships as a result of deficits in social skills. Shaw-Zirt, Popali-Lehane, Chaplin, and Bergman (2005) compared 21 students who met Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; APA, 1994) criteria for ADHD with 20 non-ADHD-matched control participants on various measures of social skills and adjustment. They found that those students who met criteria for ADHD reported poorer social adjustment and lower levels of overall social skills than their non-ADHD peers. In particular, women with ADHD reported engaging in significantly more negative social behaviors than non-ADHD women (Shaw-Zirt et al., 2005) and reported in interviews that their ADHD symptoms created challenges for them in their social relationships (e.g., impulsively blurting out a hurtful comment; Meaux et al., 2009). Kern, Rasmussen, Byrd, and Wittschen (1999) found that undergraduate students who had been previously diagnosed and treated for ADHD reported being more independent, more prone to confrontation and aggression under stressful situations, and less likely to be influenced positively or negatively by constructive feedback from others compared with a control group. Such attributes can be important in understanding a person’s approach to social relationships and ability to adjust socially to the college setting. These authors suggested that those with ADHD may have more difficulties accessing social support from others, which can interfere with adjustment.

Contrastingly, some research has shown no differences between students with and without ADHD on various measures of social satisfaction and behavior. Rabiner, Anastopoulos, Costello, Hoyle, and Swartzwelder (2008) compared students with self-reported current ADHD, previous ADHD, and no ADHD and found that satisfaction with friendships and social life during the first semester in college did not differ among the three groups. Similarly, Heiligenstein, Guenther, Levy, Savino, and Fulwiler (1999) found that those with and without ADHD did not differ on the Interpersonal Relationships subscale of the Inventory of Common Problems (Hoffman & Weiss, 1986). Finally, Canu and Carlson (2007) found no significant differences in the frequency of contact with close friends or perceived support from one’s friendship network when they compared non-diagnosed controls with individuals with ADHD-Combined Type and individuals with ADHD-Primarily Inattentive Type.

At this point, it is unclear what can account for such discrepant findings other than methodological differences. The above studies examined a wide range of friendship variables, all from the perspective of the participant. It is also important to examine data from both members of a friendship dyad to help determine the consistency between self-and friend report and whether or not that varies as a function of ADHD symptomatology.

Therefore, the research questions addressed by Study 2 include the following: Will students who report high ADHD symptoms also report poorer social skills and poorer quality friendships than students who report low ADHD symptoms? Will friends of students with high ADHD symptomatology report poorer quality relationships with the participants than friends of students with low ADHD symptomatology? Finally, will friendships with a high-symptomatology participant be characterized by less consistency in reports of quality between the two members of the dyad than friendships with low-symptomatology participants?

Method

Participants

There were 68 undergraduates from a small, liberal arts college in the study (51 women); the majority of the students (54%) were seniors, 19% were juniors, and 27% were sophomores; no first-year students were included. Participants were screened for ADHD symptomatology and recruited based on their percentile scores as described in Study 1. Thirty (44%) of the students met criteria for high ADHD symptomatology. Participants ranged in age from 18 to 22 years (M = 20.24, SD = 0.96), and the majority were White (87%). All participants had a close friend at the same college complete a portion of the study. For compensation, participants and friends enrolled in a psychology course received extra credit, whereas those not enrolled in a psychology course were entered into a lottery to win a US$50 gift card.

Procedure

Students who met percentile criteria described in Study 1 were contacted by email and campus mail and asked whether they would be willing to participate in a study on friendship styles. If they were interested, then they were asked to respond with the names and email addresses of their three closest friends who attended the same college. The three friends were then contacted through email and told that they had been identified by the participant as a close friend and were invited to participate in a portion of the study. If a friend was willing to participate, then he or she was asked to reply by email. Once one of the friends responded, the other two friends received emails stating that their participation was not needed. No two participants had the same friend agree to complete the study. Once a close friend was identified, participants and their friends were sent links to online surveys and detailed instructions. In the instructions, participants and their friends were told that it was important that they complete the surveys separately and not discuss any of the items with each other. They were also told that their responses to the survey would be completely confidential.

Measures

Interpersonal Competence Questionnaire (ICQ)

The ICQ is composed of 40 items measuring “five domains of interpersonal competence: (a) initiating relationships, (b) disclosing personal information, (c) asserting displeasure with others, (d) providing emotional support and advice, and (e) managing interpersonal conflict” (Buhrmester, Furman, Wittenberg, & Reis, 1988, p. 993). Each item poses a common situation or interaction; for example, “Introducing yourself to someone you might like to get to know.” Participants were instructed to respond to each of these items on a 5-point rating scale originally developed by Levenson and Gottman (1978) based on how comfortable or competent they felt they were in each situation (1 = I’m poor at this; I’d feel so uncomfortable and unable to handle this situation, I’d avoid it if possible, 2 = I’m only fair at this; I’d feel uncomfortable and would have lots of difficulty handling this situation, 3 = I’m okay at this; I’d feel somewhat uncomfortable and have some difficulty handling this situation, 4 = I’m good at this; I’d feel quite comfortable and able to handle this situation, 5 = I’m extremely good at this; I’d feel very comfortable and could handle this situation very well). The original version of the measure required participants to make two ratings for each item: one for a same-sex friend and the other for an opposite-sex friend. In the current study, the gender of the friend was not specified and participants provided only one rating per item. Internal consistency for the five domains was adequate in the present sample (α ranged from .78 to .90). Previous research has shown evidence for concurrent, discriminant, and convergent validity of this measure (Buhrmester et al., 1988).

Network of Relationships Inventory (NRI)

This version of the NRI consisted of 30 items that assessed different domains of relationship quality (Furman & Buhrmester, 1985). It included seven scales from the standard version: Conflict (e.g., “How much do you and this person argue with each other?”), Instrumental Aid (e.g., “How much does this person help you figure out or fix things?”), Antagonism (e.g., “How much do you and this person get on each other’s nerves?”), Intimacy (e.g., “How much do you talk about everything with this person?”), Relative Power (e.g., “Who tells the other person what to do more often, you or this person?”), Nurturance (e.g., “How much do you protect and look out for this person?”), and Reliable Alliance (e.g., “How sure are you that this relationships will last no matter what?”). Students also completed three scales from a recently developed version: Support (e.g., “How much do you turn to this person for support with personal problems?”), Criticism (e.g., “How much does this person criticize you?”), and Dominance (e.g., “How much does this person get you to do things his/her way?”). Participants and friends were asked to keep each other in mind and respond separately to each of the questions using a 5-point scale: for conflict, instrumental aid, antagonism, intimacy, nurturance, support, criticism, and dominance (1 = never, 5 = always), for relative power (1 = always me, 3 = both of us, 5 = always my friend), and for reliable alliance (1 = not sure, 5 = very sure). Internal consistency in the present sample was adequate for the 10 participant scales (α ranged from .69 to .87) and for the 10 friend scales (α ranged from .70 to .86). A variety of evidence has accumulated in support of the validity of this measure (see Furman, 1996).

Results

Social skills

To determine whether there were differences in social skills based on severity of ADHD symptoms, t tests were conducted on the five domains of the ICQ. Individuals in the high-symptom group reported significantly less competence in providing emotional support and advice to friends (M = 4.20, SD = 0.56) than individuals in the low-symptom group (M = 4.49, SD = 0.38); t(66) = 2.50, p = .015, η² = .09. In addition, participants with high ADHD symptomatology reported more difficulty managing interpersonal conflict (M = 3.32, SD = 0.57) than participants with low ADHD symptom-tology (M = 3.73, SD = 0.39); t(66) = 3.51, p = .001, η² = .16. There were no significant differences between the two groups in initiating relationships, disclosing personal information, or asserting displeasure with others.

Quality of friendships

To understand differences in the quality of friendships for those high and low in ADHD symptomatology, mean differences were examined on the NRI for the two groups of students. There were no significant differences in participants’ or friend’s reports based on symptom severity. Another way to examine the relationship between ADHD symptomatology and NRI reports is to correlate the two measures to take advantage of the continuous nature of the ADHD scales. Participants who scored high on the CARE Inattention subscale indicated that they often depended on their friends for support, r(48) = .29, p = .04, but also rated their friends high in dominance, r(46) = .29, p = .045. Participants who scored high on the DSM-based Inattention and Hyperactivity-Impulsivity subscales from the CARE rated their relationships with their friends as being high in antagonism, r(66) = .31, p = .009, r(65) = .26, p = .032, respectively. Participants’ ADHD scores were unrelated to friend’s reports of the quality of the relationship.

Considering the results of Study 1, it is possible that the evaluation of a specific friendship might vary as a function of not only the ADHD symptomatology status of the participants but also the severity of ADHD symptomatology of the friends, or some combination of both measures. DSM-based inattention and hyperactivity-impulsivity percentile scores from the CARE were available for 61 of the 68 close friends in Study 2. Similar to the participants, these data were obtained when the friends volunteered to participate in the ADHD screen during their first-year orientation. Regression analyses were conducted with either participant or friend NRI subscales as the dependent variable and participant ADHD status (e.g., low vs. high symptomatology), centered friend ADHD percentile score (e.g., DSM-based inattention or hyperactivity-impulsivity), and the interaction between the participant and centered friend ADHD data as the independent variables. The greater inattention symptomatology the friends reported, the less they reported sharing intimate information with participants (β = −.37, p = .033), seeking support from participants (β = −.42, p = .014), providing nurturance to participants (β = −.57, p = .001), and believing that their relationships with participants would last (reliable alliance: β = −.36, p = .037). Greater inattention symptomatology in friends was also associated with participants seeking less support from their friends (β = −.41, p = .015).

Furthermore, DSM-based inattention scores of friends significantly interacted with participant symptomatology status to predict participants’ reports of how critical their friends were of them, t(60) = −2.06, p = .044, η² = .07. Similarly, DSM-based hyperactivity/impulsivity scores of friends significantly interacted with participant symptomatology status to predict friends’ reports of how much they nurtured the relationship, t(59) = 2.02, p = .049, η² = .06. Graphs of these interactions revealed the same pattern (see Figure 2). For low-symptomatology participants, the lower their friends were in ADHD symptoms, the less critical participants reported their friends being and the more nurturance the friends reported providing to the participants. Alternatively, for high-symptomatology participants, less criticism and greater nurturance tended to be associated with higher ADHD scores for the friends. However, none of the simple slopes in the figures were significant.

Figure 2.

Mean rating of friend-reported nurturance as a function of symptomatology status of participant and severity of DSM-based hyperactivity/impulsivity (H/I) score of friend.

As both participants and friends completed the NRI about their relationship, the quality of friendships at the dyad level can also be examined to determine whether there are differences based on ADHD symptom severity. Difference scores were calculated by subtracting the participant’s score on the NRI from the score of his or her friend for each subscale. As can be seen in Table 1, most difference scores did not vary as a function of participant symptom severity; participants with high ADHD symptomatology had discrepancies between themselves and their friends that were similar to the discrepancies seen with low-symptom participants and their friends. The one exception was that participants low in ADHD symptomatology reported greater average nurturance of their friends than their friends reported of them, resulting in a negative average difference score. In contrast, participants with high ADHD symptomatology reported nurturing their friends slightly less than the friends reported nurturing them, resulting in a positive average difference score. The difference between these two means was statistically significant, and the strength of that relationship was small (η² = .09). Friend ADHD scores and the interaction between participant and friend ADHD scores were unrelated to NRI difference scores.

Table 1.

Means of Difference Scores Between Friend and Participant Report for Students Low and High in ADHD Symptoms.

Friend score minus participant score	Low ADHD		High ADHD
Friend score minus participant score	M	SD	M	SD	t	p
Conflict	.02	.60	−.07	.77	0.52	.607
Antagonism	−.03	.80	.01	.79	−0.20	.846
Reliable alliance	.11	.99	.04	.79	0.31	.755
Instrumental aid	.12	.85	−.11	.72	1.17	.245
Support	−.02	.80	−.08	.84	0.28	.781
Criticism	−.04	.87	−.01	.72	−0.12	.903
Dominance	.05	.80	−.11	.71	0.85	.400
Intimacy	−.02	.67	−.03	.82	0.08	.933
Nurturance	−.39	.88	.17	.90	−2.54	.014
Relative power	.27	.83	.16	.87	0.56	.578

Discussion

Consistent with previous literature (e.g., Shaw-Zirt et al., 2005), individuals with more severe ADHD symptoms felt that they were less competent than their peers with less severe symptoms when it came to providing emotional support and managing interpersonal conflict. They reported being just as skilled as their symptom-free peers in initiating social contact, disclosing personal information, and asserting displeasure with a companion. Because ADHD is not typically associated with social anxiety, shyness, or reticence, it makes sense that initiating and disclosing skills are not impaired in a person with high ADHD symptomatology. In contrast, the items that assess conflict management require a certain degree of restraint and calmness (e.g., refraining from saying things, putting resentful feelings aside, not exploding), which can be difficult when one is struggling with ADHD symptomatology. These findings are consistent with the fact that undergraduate students with ADHD reported being more confrontational and aggressive under stressful situations (Kern et al., 1999). In addition, the items assessing emotional support require a high degree of attentiveness and impulse control (e.g., patiently listening, being a good and sensitive listener, showing genuine concern even when a problem is uninteresting), which individuals with high ADHD symptomatology may lack.

It is important to note that these social skills findings were based on self-report, not friend report or observations. On one hand, such findings show that individuals with high ADHD symptoms can possess enough awareness of their own behavior that they can report social skills deficits in areas that are linked to their symptoms. However, to understand the social skills deficits of such individuals more fully, a multi-informant and multi-method approach is necessary. Future research can help determine which skill deficits are more readily acknowledged by individuals exhibiting ADHD symptomatology and which deficits are only apparent to their interaction partners or third-party observers. The latter skill deficits may require more intense and targeted intervention efforts.

Study 2 also examined reports of the quality of a specific relationship between each participant and one of his or her close friends; data were obtained from both members of the dyad. Participants with greater symptomatology described relationships that were higher in antagonism with somewhat dominant friends whom they depended on for support and who reported providing slightly more nurturance than they received from participants. Friends who reported greater inattention symptomatology also reported having more difficulty engaging in behaviors indicative of high-quality relationships and participants reported seeking less support from them. However, when participants and friends matched in terms of their ADHD symptom severity (i.e., high-symptom participants and greater severity for friends), participants reported that their friends tended to be less critical of them and the friends reported that they tended to provide more nurturance to the participants, both of which are indicative of higher quality relationships.

Despite these differences, there appears to be much similarity in the quality of friendships of those students with high and low ADHD symptomatology. One potential reason that more significant differences in reports of friendship quality based on participant symptom severity were not found is that friendship was examined based on whom the participant reported as being a “close friend.” It may be the case that few differences exist between high- and low-symptom participants when one is examining close friendships, those relationships where the partners have presumably weathered conflict and found a mutually satisfying interaction pattern with each other. However, ADHD symptomatology could be more highly associated with the quality of interactions when examining people who are less close to the participant (e.g., mere friends and acquaintances). Future research can help determine whether such differences exist within relationships of varying levels of closeness.

General Discussion

The results from these two studies complement each other and contribute to our understanding of the social development of college students who are exhibiting ADHD symptomatology. If the dyadic data in Study 2 had not been examined, one could have a skewed view of friendship formation and social skills in this population. However, the dyadic data indicated that high ADHD symptomatology on the part of participants and close friends can interfere with the quality of certain aspects of relationships, but there were also several similarities in the quality of specific friendships between students with high and low ADHD symptomatology. Furthermore, when severity of ADHD symptomatology was similar in the dyad, there seemed to be the potential for benefits to the relationship.

The findings from these two studies need to be interpreted in light of several limitations that have not already been discussed. First and foremost, both studies focused only on self-reported ADHD symptomatology. Examining self-report is an important initial step in this research because it is so heavily relied upon for assessment at the adult level, especially when reports from significant others or parents are unavailable. Even so, comprehensive information to diagnose students was not collected, nor was adequate information concerning those who already had a diagnosis of ADHD or another comorbid psychiatric condition. Nevertheless, it is important to examine the entire continuum of symptomatology because one may miss important information if only those individuals who meet criteria for a diagnosis were examined. For a variety of disorders, subclinical levels of symptomatology can be associated with impairment.

Another limitation is that the current samples were drawn from a fairly homogeneous population of White, middle- to upper-class students from a small, liberal arts college and were not representative of the population of college students as a whole. Therefore, the results need to be replicated and should not be generalized to all college students or to young adults who do not attend college. Finally, participants who completed the first impressions activity in Study 1 had varying levels of prior interaction with each other. None of the participants in each group reported being friends, but some had prior initial interaction with each other, whereas others did not. A more accurate test of true first impressions would have controlled for exposure to the people in the group.

Future research should examine other important aspects of friendship such as the stability and maintenance of friendships over time. For instance, students can participate once a year for each of the 4 or more years they are in college, providing information about their current close friends and the quality of those relationships. Such a study can help determine whether participants with high ADHD symptomatology are maintaining their friendships in a manner that is comparable with their low-symptom peers, whether that maintenance is related to the quality of those relationships, and whether there are differences in the evolution of friendships over time.

The current studies shed new light on the social development of college students with ADHD symptomatology by showing that such symptomatology was most related to first impressions, social skills, and with whom one chooses to be friends. Once friendships were established, high participant and friend ADHD symptomatology were related separately to a somewhat poorer quality of friendship; however, similarity in severity of ADHD symptomatology in dyads appeared to enhance the quality of some aspects of the friendship. The findings of the present studies have important implications for understanding the transition to college for students with ADHD symptomatology. Much of one’s initial college experience involves meeting others for the first time and determining which acquaintances one would like to have develop into friendships. Providing additional support for individuals with high ADHD symptomatology during this time may make the social transition to college life more successful. Such support can include didactic information to help such individuals understand how their behaviors during initial interactions may be interpreted by others who exhibit fewer ADHD symptoms, as well as social skills training to improve their ability to provide emotional support and manage conflict in friendships. Because the beginning of one’s college experience can be such a critical juncture in determining future college and post-college success, improving the experience for individuals with high ADHD symptomatology can have a lifelong impact.

Footnotes

Acknowledgements

I would like to thank Dan Fiore and Rita Fisher for their assistance with data collection and Diana Robins for her comments on this manuscript.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author Biography

Tara E. McKee, PhD, is a licensed clinical psychologist and an associate professor at Hamilton College. She has conducted research on parent training for parents of children with ADHD, the association between parental ADHD symptomatology and parenting of children with ADHD, the prevalence of ADHD symptomatology in college students, and the relation of ADHD symptomatology to social-emotional functioning following the transition to college.

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