Interpersonal Problems of Young Adults With and Without Attention-Deficit/Hyperactivity Disorder

Abstract

Objective:Interpersonal functioning is a core area of impairment for young adults with Attention-Deficit/Hyperactivity Disorder (ADHD), yet the assessment of their interpersonal problems has not been approached using a comprehensive model of interpersonal behaviors. Method: Interpersonal problems of young adults with ADHD (n = 24) were compared to non-ADHD peers (n = 26) by self- and collateral-report using the Inventory of Interpersonal Problems-Circumplex-Item Response Theory (IIP-C-IRT). Results: Both self- and collateral-reports yielded significantly higher scores across interpersonal problem domains, except for self-reported Hostile-Dominant (HD) interpersonal problems. Discrepancy scores between self- and collateral-report supported larger differences in the ADHD versus non-ADHD groups for HD problems. Large correlations between collateral-reported family relationship impairments and HD problems were found only for the ADHD group. Conclusion: Young adults with ADHD have higher levels of interpersonal problems relative to their non-ADHD peers, but also appear to underreport HD interpersonal problems relative to non-ADHD peers, suggesting the presence of a bias. (J. of Att. Dis. XXXX; XX[X] XX-XX)

Keywords

ADHD interpersonal problems assessment young adults positive illusory bias

Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most frequently diagnosed childhood disorders with a prevalence rate of up to 5% in U.S. adults (Kessler et al., 2006). The American Psychiatric Association’s (APA; 2013) Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) defines ADHD as a neurodevelopmental disorder marked by persistent inattention, hyperactivity, or impulsivity resulting in an adverse impact on daily functioning across multiple settings, most of which must have occurred prior to age 12. The social domain and interpersonal functioning in particular is a steady area of impairment for individuals with ADHD from childhood (Hoza et al., 2005), adolescence (Sibley, Evans, & Serpell, 2010), and young adulthood (Biederman et al., 2006).

As core symptoms of ADHD that are common in adolescence and adulthood, restlessness and impulsivity may manifest interpersonally as excessive talking, interrupting others in conversations, and intruding on others’ activities, the functional consequences of which are likely to be conflictual relationships with family members and social rejection. Symptoms of inattention may manifest as aloofness in interactions, which can also be met with social rejection (APA, 2013). Furthermore, inattention may be viewed as being indifferent and uncaring (Friedman et al., 2003). Interpersonal conflict is a common functional consequence for individuals with ADHD into adulthood (APA, 2013). Adolescents with ADHD are generally considered less well liked than their typically developing peers (Hoza et al., 2005) with deficits in social skills that continue to be present in young adults with ADHD (e.g., Friedman et al., 2003; Shaw-Zirt, Popali-Lehane, Chaplin, & Bergman, 2005), who then have fewer close friends and difficulty keeping friendships (Fischer & Barkley, 2006). Adults with ADHD are also less likely to be satisfied with their family and social lives and their relationships with loved ones (Biederman et al., 2006). Increased negative behaviors, poor conflict resolution and low relationship satisfaction have been observed in heterosexual couples where one partner is diagnosed with ADHD-Combined Type (Canu, Tabor, Michael, Bazzini, & Elmore, 2014).

The assessment of the social/interpersonal functioning has typically focused on a single aspect (e.g., social competency; Bourchtein, Langberg, Owens, Evans, & Perera, 2017) or dimension (e.g., specific interpersonal problem; Murphy & Barkley, 1996). Murphy and Barkley (1996) reported higher levels of interpersonal problems by self-report of young adults with ADHD relative to young adults without ADHD, but only a single aspect of interpersonal difficulty was assessed, namely feelings of inadequacy and inferiority in interpersonal relations as measured by the Interpersonal Sensitivity subscale of the SCL-90-R (Derogatis, 1994). Use of a comprehensive model of interpersonal problems would allow for assessment of a broader domain of interpersonal problems, which could help clarify areas of interpersonal impairment for young adults with ADHD. Although research has highlighted interpersonal difficulties faced by young adults with ADHD, there has not been an examination of interpersonal problems from the perspective of the Interpersonal Circumplex model (IPC; Wiggins, 1982), which is a well-established comprehensive model of interpersonal behaviors with strong theoretical and empirical support (e.g., Gurtman, 1996; Sodano & Tracey, 2011; Wiggins, 1982; Wiggins, Phillips, & Trapnell, 1989). The focus of this study was on examining the interpersonal problems from the perspective of the IPC in young adults with ADHD compared to non-ADHD young adults.

The Circumplex Approach to Interpersonal Problems

Interpersonal problems generally take the form of behaviors one does too much (e.g., arguing) or are difficult for one to initiate (e.g., be assertive; Horowitz, Rosenberg, Baer, Ureno, & Villasenor, 1988). Interpersonal problems have been shown to be well represented by the IPC (e.g., Alden, Wiggins, & Pincus, 1990; Sodano & Tracey, 2011), which has its roots in Interpersonal theory (Sullivan, 1953). The IPC consists of the two main interpersonal personality dimensions of Dominance and Affiliation (Wiggins, 1982), representing preferences for both control and communion, respectively, in interpersonal relationships (Leary, 1957). Dominance ranges from dominance to submission and Affiliation ranges from cold/hostile to warm/friendly.

These dimensions are perpendicular and underlie the circular arrangement of specific interpersonal tendencies, with each being a blend of Dominance and Affiliation based on their location on the circumference of the circle (Leary, 1957; Wiggins, 1982; Wiggins, Steiger, & Gaelick, 1981). The correlations among these variables are represented as a circumplex, referring to a rising and falling pattern of subscale intercorrelations as one moves around the circle (Guttman, 1954). The eight interpersonal problem themes, or octant subscales, are labeled as Domineering, Vindictive, Cold, Socially Avoidant, Nonassertive, Exploitable, Overly Nurturant, and Intrusive (Alden et al., 1990).

The IPC is a well-supported model of interpersonal personality that capitalizes on the empirically established linkages between the geometric properties of circles—as a result of circumplex structure—and Interpersonal theory (e.g., Leary, 1957; Wiggins et al., 1989; Wiggins et al., 1981). Figure 1 illustrates the theoretical model, highlighting the connection between the Dominance and Affiliation dimensions and specific octants. In addition, the Figure shows how the combination of dimensions can also yield four quadrants of interpersonal problem themes. These broader domains of interpersonal problems are described as follows (with characteristic problem examples in parentheses): Friendly-Dominant (FD; overly involved with others, intrusive), Hostile-Dominant (HD; too aggressive, critical), Hostile-Submissive (HS; hard to socialize, be assertive), and Friendly-Submissive (FS; hard to set limits, too gullible; Gurtman, 1996).

Figure 1.

The interpersonal problem circumplex shown at the dimensional, quadrant, and octant levels.

Bias in Ratings of Individuals With ADHD

Positive Illusory Bias

Researchers have shown that children with ADHD tend to overestimate their abilities in social domains of functioning when compared to non-ADHD children and objective measures through a Positive Illusory Bias (PIB; see Owens, Goldfine, Evangelista, Hoza, & Kaiser, 2007 for a review). Mikami, Calhoun, and Abikoff (2010) found that for children with ADHD who displayed higher levels of a PIB in social competence, the PIB was stable over time and was associated with poorer response to a well-established Summer Treatment Program (Pelham et al., 1996). Outcomes assessed were number of conduct problems (e.g., verbal abuse, intentional/unintentional aggression toward peers/staff, noncompliance, etc.), peer social preference, and friendship nominations (Mikami et al., 2010). Despite intensive intervention, not only did the PIB in the social domain persist, but it was also shown to undermine response to treatment. The outcomes assessed in Mikami et al. involved several key symptoms of ADHD that also align with hostile and dominant interpersonal behaviors from the perspective of the IPC.

In adolescents with ADHD, a PIB in social competence has been shown to be stable over time (Bourchtein, et al., 2017). Research on PIB in adults and young adults with ADHD has often focused on ability and performance assessments, showing an overestimation of performance relative to non-ADHD comparison groups and objective assessments (e.g., Fabiano, Schatz, et al., 2018; Knouse, Bagwell, Barkley, & Murphy, 2005; Prevatt, Proctor, Baker, Garrett, & Yelland, 2012). Furthermore, a positive bias in self-perceptions over time was shown to be inversely related to depression in adolescents, which is speculated to be a function of the higher need for self-protection in the social domain during this developmental period (Hoza et al., 2010). One study, while not approached specifically from a PIB lens, suggests that by adulthood individuals with ADHD become more aware of their social relative to emotional skill deficits (Friedman et al., 2003). More recently, Knouse and Mitchell (2015) have theorized that adults with ADHD may be inclined to minimize their deficits by relying on overly positive automatic thoughts as a means of self-protection, the consequence of which may be a well-formed habit of overlooking specific areas of difficulties in the short term, leading to more avoidant behaviors in the long term. Examining interpersonal problems from the perspective of the IPC could allow for relative deficits in interpersonal functioning to be identified, which could contribute to knowledge of a bias in the social domain and inform treatment planning.

Self- and Informant-Reports

Due to the concerns regarding accurate self-evaluations noted above, evidence-based assessment approaches for ADHD include collateral-ratings, typically from parents or teachers (Pelham, Fabiano, & Massetti, 2005; Sibley et al., 2012). The use of both self- and informant-report (i.e., collateral-report) is recommended for the assessment of ADHD (e.g., Barkley, Fischer, Smallish, & Fletcher, 2002). Research suggests young adults with ADHD may underreport the severity of their symptoms and be less valid predictors of outcomes (e.g., Barkley et al., 2002; Sibley et al., 2012). There is also evidence that parental ratings may be more valid than self-reports of behaviors that are socially undesirable. Adolescents and young adults with ADHD were less likely to self-report the presence of mild and moderately severe problematic behaviors compared to parent-report (Sibley et al., 2010) or objective observations (e.g., Fabiano, Schatz, et al., 2018).

The above issues of accuracy and validity are consistent with research on the differences between self- and informant-report of observable and evaluative personality traits (John & Robins, 1993; Vazire, 2010). From this perspective, traits that are high in observability are expected to be more accurately judged by others than by the self, while the opposite is expected for traits low in observability. Although we might expect all interpersonal problem domains to have some degree of observability, HD and FD problems could be expected to be higher in observability because dominant behaviors are common to both domains and would thus be more accurately judged by informants. Highly evaluative traits are those that are either very desirable or undesirable, with both expected to be more accurately judged by others than by the self. Problems in the HD domain (e.g., being overly aggressive and critical) would be very undesirable. Therefore, the combination of high observability and undesirability of HD interpersonal problems suggest higher accuracy by informant-report and lower accuracy by self-report, in general.

The Current Study

Given the relatively higher prevalence and the variety of interpersonal difficulties noted among individuals with ADHD, we expected young adults with ADHD would self-report higher levels of interpersonal problems compared to the self-report of their non-ADHD peers, except for the domain of HD interpersonal problems. Given the salience of the HD domain to ADHD symptomology, this may be the area of greater deficit for ADHD individuals. Therefore, we expected there would be a greater tendency for young adults with ADHD to underreport HD interpersonal problems by self-report, relative to the self-report of non-ADHD young adults. In addition, we expected there would be higher levels of collateral-reported interpersonal problems for the ADHD group compared to the non-ADHD group. Furthermore, we expected there would be a discrepancy in the collateral-report versus self-report of interpersonal problems between the ADHD and non-ADHD groups, particularly for the HD quadrant. Finally, we sought to examine the relations between HD interpersonal problems and functional impairments in family relationships (i.e., problems in relationships with siblings and with parents). Both the young adults and the collateral-raters can be expected to have more familiarity for judging these relationships. We expected problems in these family relationships to correlate more with collateral-reported HD problems than with self-reported HD problems for the ADHD group, but not for the non-ADHD group.

Method

Participants and Procedures

Participants consisted of young adults who also participated in a laboratory study of work behaviors and ADHD (Fabiano, Hulme, et al., 2018). Recruitment of participants occurred through use of bulletin postings on university and community college campuses in Western New York, radio advertisements, referrals from local physician offices, and social media advertisements. All participants were screened by telephone for eligibility upon calling the study phone number. Participants meeting initial eligibility criteria were invited to the laboratory to complete an intake visit, consisting of self-report rating scales of ADHD symptoms and impairment, personality, and additional measures including a review of past employment and educational history. Participants received a US$175 gift card at the end of the laboratory visit following the completion of all study activities; however, only measures that were collected during the intake were used for the present study, in addition to measures completed by the collateral-raters (described below).

During the initial interview, participants identified a collateral-rater for responding to ADHD symptom ratings over the past 6 months, and retrospectively from childhood, a brief inventory of interpersonal problems that was modified for other-report, and additional measures utilized for the laboratory-based component of the study. Collateral-raters were mailed their forms after a release of information that was signed by the participant. Each collateral-rater received a US$25 gift card as compensation for filling out the forms. In this study, 96% of collateral-raters were biological or adoptive parents, with the other being another close relative who knew the participant well.

Participants were classified as either non-ADHD young adults or young adults with ADHD based on ADHD symptom endorsement and presence of impairment. Participants were classified as non-ADHD if they had fewer than six symptoms of ADHD endorsed for both the Inattentive and Hyperactive/Impulsive presentations and no historical report of ADHD. Participants in the non-ADHD group could not have a current or past diagnosis of ADHD or have been medicated for ADHD. Participants were classified into the ADHD group if they had six or more inattentive and/or hyperactive impulsive behaviors endorsed, and current psychosocial impairment, and a history of ADHD behaviors, impairment and diagnosis in childhood, as reported by self- and collateral-raters.

As can be seen in, Table 1 participants were diagnosed with ADHD based on criteria of the DSM-5 (APA, 2013) and 26 participants did not meet criteria. All participants identified with ADHD had significantly higher ADHD self-report scores, ADHD collateral-report scores currently and retrospectively, and collateral Impairment Rating Scale (IRS; Fabiano et al., 2006) scores (p < .05). Of those diagnosed with ADHD, 42% met criteria for the primarily inattentive presentation, 54% met criteria for combined presentation, and 4% met criteria for ADHD, unspecified (APA, 2013). Chi-Square tests indicated participants did not differ significantly on gender, race, ethnicity, or educational levels.

Table 1.

Participant Demographics.

	ADHD^a	Non-ADHD^b
	M (SD) or %	M (SD) or %
Age	21.50 (2.22)	22.00 (1.90)
Sex
Male	83%	81%
Ethnicity
Hispanic	8%	4%
Race
Caucasian	79%	46%
Black/African American	8%	15%
Biracial	4%	12%
Asian	4%	27%
Other	4%	0%
Highest education
High school	25%	4%
Some college or associate’s degree	58%	54%
Bachelor’s degree	13%	38%
Master’s degree	4%	4%

Note. Groups did not significantly differ on any of the demographic variables.

n = 24.

n = 26.

Measures

Interpersonal problems

Interpersonal problems were measured by the Inventory of Interpersonal Problems-Circumplex-Item Response Theory (IIP-C-IRT; Sodano & Tracey, 2011), which is a brief 32-item version of the Inventory of Interpersonal Problems-Circumplex (IIP-C; Alden et al., 1990). The psychometric properties of the IIP-C have been well established, including its coverage of interpersonal problem behaviors (Alden et al., 1990), adherence to the interpersonal circumplex model (Alden et al., 1990; Sodano & Tracey, 2011; Tracey, Rounds, & Gurtman, 1996), applicability to both clinical (Gurtman, 1996) and nonclinical populations (Alden et al., 1990), and support for validity of self- and other-ratings (Hill, Zrull, & McIntire, 1998). Beyond the advantage of brevity, the IIP-C-IRT only contains items that were found to be free of gender bias. The brief IIP-C-IRT subscales also showed a good fit to the circumplex model and this fit did not differ from that of the full-length IIP-C in a sample of college students (Sodano & Tracey, 2011).

The collateral-report version of the IIP-C-IRT was identical to the version for self-report, except for a difference in the target of the ratings. Response options for rating how distressing an interpersonal problem has been for an individual range from (0) not at all to (4) extremely. Mean scores are computed for the items in each octant subscale, which can then be transformed into dimensional (or quadrant) scores based on the circular structure of the IPC (e.g., Wiggins et al., 1989). The total score across all items serves as an index of global, nonspecific interpersonal distress (Tracey et al., 1996). Past assessments of internal consistency reliability for the octant subscale scores in a college age sample were adequate (Sodano & Tracey, 2011). Cronbach’s alphas for the octant subscales in the current sample ranged from .69 (Domineering-Controlling) to .83 (Self-Sacrificing) (Mdn = .78) for the self-reported scores and .64 (Vindictive-Self-Centered) to .88 (Self-Sacrificing) (Mdn = .83) for the collateral-reported scores. In addition, the alphas for the total scores of self- and collateral-reports were .90 and .93, respectively. For this study, we utilized quadrant scores, representing FD, FS, HD, and HS, which were derived by similar procedures as those for dimensional scoring (as described above). Quadrant scores provide a level of specificity between the octant and broader dimensional scores. However, since we were also interested in comparing the global interpersonal distress across groups, the total score was utilized as well.

Family relationship impairments

Two items from the IRS (Fabiano et al., 2006) assessing family relationships were selected based on having more relevance for rating by both the young adult and collateral-raters. The IRS is a measure of impairment in seven domains commonly impaired among individuals with ADHD. The scale has been shown to possess good convergent, concurrent, and discriminant validity (Evans et al., 2013; Fabiano et al., 2006). Parent report and young adult self-report versions require the respondent to rate impairment in domains of peer relationship, sibling relationship, parent–child relationship, academic progress, and so on. Only the domains of sibling relationship and parent–child relationship were used as external variables for the current study, as these represented relationships with which both raters were expected to be familiar. For the ADHD group, 86% of collateral-raters and 88% of self-raters rated the item on sibling relationships, while 100% of the raters in the non-ADHD group rated this item.

For each IRS item, respondents draw an X on a line ranging from “No Problem, Definitely does not need treatment or special services” to “Extreme problem, definitely needs treatment or special services.” Each item score is derived by subdividing the line into seven segments corresponding to scores of 0 through 6, with higher scores representing more of a problem/impairment in the particular domain.

Results

We utilized t tests to compare the means of the interpersonal problem (IP) quadrant and total scores for the ADHD versus non-ADHD groups within each of the self- and collateral-report groups. Table 2 presents the means and standard deviations of the IP quadrant and total scores of the ADHD and non-ADHD groups for self- and collateral-reporters. For self-reporters, the ADHD group had higher scores on FD, t (48) = −4.07, p < .001; FS, t (48) = −3.27, p < .01; HS, t (48) = −2.21, p < .05; and total scores, t (48) = −3.64, p < .01; but not on HD, t (48) = -1.36, p = .179. These results indicated that among the self-reporters, the ADHD group reported higher levels of interpersonal problems globally, and for all quadrants except for the HD quadrant, relative to the non-ADHD group. The effect sizes for groups (shown in the right-most column of Table 2) ranged from just under medium to large, with the smallest effect being for HD (d = .39), which did not represent a significant difference. The largest effect was for FD (d = 1.14). Our hypothesis that there would be higher levels of self-reported interpersonal problems for the ADHD group compared to the non-ADHD group, but a lower level reported in the HD domain was partially supported by finding no differences in the HD domain.

Table 2.

Descriptive Statistics for Interpersonal Problems of ADHD and Non-ADHD Groups by Raters.

	ADHD		Non-ADHD		t	d
	M	SD	M	SD	t	d
Self-report
Friendly-Dominant	3.60	1.80	1.90	1.09	−4.07***	1.14
Friendly-Submissive	3.81	1.93	2.24	1.45	−3.27**	0.92
Hostile-Dominant	2.30	1.46	1.80	1.08	−1.36	0.39
Hostile-Submissive	2.62	1.40	1.75	1.37	−2.21*	0.63
Total	1.28	0.54	0.79	0.40	−3.64**	1.03
	(n = 24)		(n = 26)		df(48)
Collateral-report
Friendly-Dominant	2.55	1.67	0.60	0.79	−5.28***	1.49
Friendly-Submissive	2.90	1.79	0.92	1.26	−4.48***	1.28
Hostile-Dominant	1.74	1.23	0.58	0.64	−4.20***	1.15
Hostile-Submissive	2.08	1.73	0.56	0.92	−3.88***	1.10
Total	0.96	0.49	0.27	0.31	−5.95***	1.68
	(n = 22)		(n = 26)		df(46)

Note. Negative t score values indicate ADHD group is higher. Effect size d was calculated by subtracting the Non-ADHD group mean from the ADHD mean and dividing by the pooled standard deviation.

p < .05. **p < .01. ***p < .001.

For collateral-reporters, there were significant differences on all IP quadrant and total scores, ts (46) = −3.88 to −5.95, ps < .001, indicating that the collateral-raters viewed the ADHD group as having higher levels of interpersonal problems at the global and quadrant levels, relative to the Non-ADHD group. The effect sizes for groups were all large, ranging from 1.10 for HS to 1.68 for total score. Furthermore, these effect sizes were all comparatively larger than those that were obtained by self-report (i.e., larger by .35 for FD to .76 for HD). Our hypothesis that there would be higher levels of collateral-reported interpersonal problems for the ADHD group compared to the non-ADHD group was supported.

Next, we examined the Pearson correlations between self- and collateral-reports for IP quadrant scores and total score for the total sample. As shown in the left column of Table 3, the correlations between self- and collateral-reported IP quadrant and total scores were all statistically significant, ranging from medium, r (48) = .33, p < .05, for the HD quadrant, to large, r (48) = .64, p < .001, for the FD quadrant. These results are consistent with those that have been found between general young adult college student samples and their parents on broad personality dimensions (e.g., Funder, Kolar, & Blackman, 1995). We then examined the differences between self- and collateral-reported interpersonal problems across the ADHD and non-ADHD groups. To do this, we utilized standardized difference scores, following recommended practices in the literature (e.g., De Los Reyes & Kazdin, 2004; Owens et al., 2007). The IP quadrant and total scores were converted to standardized scores and the difference scores were calculated by subtracting the standardized collateral-report scores from their respective standardized self-report scores. This was followed by t tests to compare the standardized difference scores of the raters across the ADHD and non-ADHD groups. As can be seen in Table 3, the difference scores for HD problems were higher for the ADHD compared to the non-ADHD groups, t (46) = −1.99, p = .05, d = 0.58, with a medium effect size. The difference scores for the remaining IP domains were nonsignificant, with relatively small effect sizes (d = 0.21−0.35). Our hypothesis that there would be a discrepancy in collateral- versus self-report of interpersonal problems between the ADHD and non-ADHD groups was supported for HD problems.

Table 3.

Differences Between Self- and Collateral-Ratings of Interpersonal Problems for ADHD Versus Non-ADHD Groups.

		Discrepancy scores				t	d
		ADHD		non-ADHD
	r self- vs. collateral-report	M	SD	M	SD
Friendly-Dominant	.64***	.11	1.17	−.08	0.44	−0.77	0.22
Friendly-Submissive	.40**	.14	1.31	−.10	0.92	−0.72	0.21
Hostile-Dominant	.33*	.36	1.15	−.30	1.12	−1.99^†	0.58
Hostile-Submissive	.41**	.21	1.06	−.16	1.13	−1.16	0.33
Total	.47**	.21	1.20	−.16	0.87	−1.22	0.35
	(N = 48)	(n = 22)		(n = 26)		df(46)

Note. Discrepancy scores represent differences between standardized scores. Negative t score values indicate ADHD group is higher. Effect size d was calculated by subtracting the non-ADHD group mean from the ADHD mean and dividing by the pooled standard deviation.

†

p = .05. *p < .05. **p < .01. ***p < .001.

Finally, we examined the relations between HD interpersonal problems and functional impairments in relationships within the family (i.e., problems in relationships with siblings and with parents). The means and standard deviations of these items are shown in Table 4.

Table 4.

Descriptive Statistics for Functional Impairments in Family Relationships.

	ADHD			Non-ADHD			t	df
	M	SD	n	M	SD	n	t	df
Self-report
Relationship with siblings	1.27	1.58	22	0.88	1.62	24	−0.84	44
Relationship with parents	1.29	1.65	24	0.85	0.92	26	−1.19	48
Collateral-report
Relationship with siblings	1.95	1.84	19	0.42	1.06	24	−3.43**	41
Relationship with parents	2.10	1.89	21	0.50	1.10	26	−3.61**	45

Note. Negative t score values indicate ADHD group is higher.

p < .01.

Significantly higher impairments in these family relationships were found for the ADHD compared to the non-ADHD groups by collateral-report, ts(41-45) = −3.43 to −3.61, p < .01, but not for the youths’ report of these relationships. Therefore, the collateral-reported family relationship items were employed to examine the correlations between them and the self- and collateral-reported HD quadrant scores in the ADHD and non-ADHD groups. As can be seen in Table 5, for the ADHD group, the correlations ranged from small to large, with large and significant correlations with family relationship impairments (rs = .61 and .79) only occurring for the collateral-report of HD problems. Testing the differences between the correlations within the ADHD group showed that the correlations between collateral-reported HD problems and the sibling and parent relationships were both significantly greater than the correlations obtained by self-report (zs = 1.72 and 1.99, respectively, p < .05). For the non-ADHD group, the correlations between the family relationship impairments and self- and collateral-reported HD problems were nonsignificant, ranging from small to medium. The differences between these correlations by self- versus collateral-report were also not significant (zs = .51 and .04). Our hypothesis that there would be higher correlations between family relationship impairments and collateral-reported HD problems than with self-reported HD problems for the ADHD group, but not for the non-ADHD group was supported.

Table 5.

Correlations Between Hostile-Dominant Interpersonal Problems and Family Relationship Impairments.

	ADHD		Non-ADHD
	Self	Collateral	Self	Collateral
Relationship with siblings	.09	.61**	.29	.14
Relationship with parents	.38	.79***	.32	.33

p < .01. ***p < .001.

Discussion

The present study adds to the literature on assessment of social and interpersonal functioning of young adults with ADHD. In this study, we examined the interpersonal problems of young adults with ADHD relative to peers without ADHD from the perspective of the Interpersonal Circumplex (Wiggins, 1982). Applying a comprehensive model of interpersonal problems allowed for the comparison of ADHD and non-ADHD individuals across different problem domains. The inclusion of self- and collateral-raters provided a means to address biases inherent in self-report. Our results suggested there are higher levels of interpersonal problems across domains in young adults with ADHD, relative to those without ADHD. Furthermore, young adults with ADHD appear to be minimizing HD interpersonal problems, more than would be expected for young adults, in general. Given the salience of HD problems to ADHD symptoms, the results also suggested the presence of an underreporting bias in the HD domain for young adults with ADHD.

The results indicated that a similar pattern of higher levels of interpersonal problems were found in the ADHD versus non-ADHD groups from both perspectives of self- and collateral-report, with the one notable exception that there was an absence of differences between the ADHD and non-ADHD groups on self-reported HD interpersonal problems. Given the undesirability of HD interpersonal problems, both the ADHD and non-ADHD groups would be expected to rate themselves relatively lower on this domain. The levels of HD problems were not found to be lower in the ADHD versus non-ADHD groups when considering self-report only. Although we might have expected to observe lower scores for the ADHD group on HD problems, the lack of a difference that was observed still offered support for this group underreporting these problems when considering both self- and collateral-reported scores. Because higher levels of HD interpersonal problems were observed in the ADHD group compared to the non-ADHD group by collateral-report, the lack of difference in HD problems by self-report does provide evidence that the ADHD group may have underreported their interpersonal problems in the HD domain. Furthermore, there was a lack of differences in discrepancy scores of the self- and collateral-ratings of IP domains between the groups, except for the HD domain. A medium effect for group was found in the HD domain relative to the small effects found in the other IP areas.

Additional support for an underreporting bias in ratings of HD interpersonal problems by young adults with ADHD, relative to those without ADHD, was found by including assessments of relationships that were familiar to both the self- and collateral-raters. The large correlations between the collateral-ratings of HD problems and the sibling and parent relationship impairments were also larger than the same variables rated by the self for the ADHD group, and this was not the case for the non-ADHD group. Our finding of this pattern in relatively small samples suggests it may be robust and is consistent with previous literature related to the underreporting of problematic behaviors among those with ADHD (e.g., Barkley et al., 2002; Sibley et al., 2010; Sibley et al., 2012).

The implications of the findings of this study are as follows. More interpersonal distress appears to be experienced by young adults with ADHD relative to their non-ADHD peers. Interpersonal problems are frequently the presenting issues for individuals seeking therapy, in general (Horowitz et al., 1988). However, a HD interpersonal style has been associated with negative effects on relationships in different contexts such as collaborations in a virtual working environment (Brown, Poole, & Rodgers, 2004) and couples (Saffrey, Bartholomew, Scharfe, Henderson, & Koopman, 2003). Minimizing HD problems could mean less help-seeking behaviors by young adults with ADHD, despite negative consequences associated with HD behaviors. In the therapy context, HD interpersonal problems have been found to have a negative effect on the therapeutic alliance (Muran, Segal, Samstag, & Crawford, 1994) and poorest improvement in therapy relative to other IP domains (Horowitz, Rosenberg, & Bartholomew, 1993). Thus, minimizing HD problems may make treatment more challenging for young adults with ADHD who do seek help. Interpersonal theory (e.g., Sullivan, 1953) posits that clients’ within-session interactions will represent their characteristic manner of interacting with important persons in their life, particularly over time. Therefore, therapists should note that the interpersonal problems reported by their ADHD clients are not likely to be consistent with the HD interpersonal behaviors when assessed by collateral-report or what might be observed within sessions over time. In addition, prior research has illustrated that having a child in the family with ADHD significantly predicts divorce between parents (Wymbs et al., 2008). This work suggests that the impact of ADHD in the adults may also affect relationship quality and maintenance and is an area in need of additional study.

This study has limitations. With relatively small group sizes, the medium-sized correlations between HD problems and the relationship variables were not significant. However, with bigger groups, the pattern of relatively larger correlations between collateral-ratings of HD problems and relationship variables should still hold for those with ADHD. In addition, the sample did not include representative diversity in age, sex, race, or ethnicity. These results need to be replicated with larger and more varied samples. Although the use of quadrant scores provided a level of specificity for interpersonal problem assessment beyond the two main interpersonal dimensions, future studies employing larger samples could assess problems at the more specific level of octant subscale scores. Finally, this sample was recruited for a study of workplace behavior, and as such, there was no treatment provided. Results may vary in alternative settings, such as clinics, where the individual is presenting for treatment and acknowledging a need for help.

In summary, the results of this study provided further evidence of the deficits in interpersonal functioning among young adults with ADHD by applying a comprehensive assessment of interpersonal problems using self- and informant-report. Results also suggested an underreporting bias among these individuals specific to the highly undesirable HD interpersonal problem domain. Furthermore, results underscored the importance of employing self- and collateral-reports when assessing the interpersonal problems and relationship impairments of young adults with ADHD. The findings can inform assessment and treatment of young adults with ADHD with a focus on interpersonal problems.

Footnotes

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) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Innovative Micro-Programs Accelerating Collaboration in Themes (IMPACT) program of the Office of the Vice President for Research, University at Buffalo and a grant from the Family Self-Sufficiency Research Consortium, Grant 90PD0278, funded by the Office of Planning, Research, and Evaluation in the Administration for Children and Families, U.S. Department of Health and Human Services. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the Office of Planning, Research and Evaluation, the Administration for Children and Families, or the U.S. Department of Health and Human Services.

Author Biographies

Sandro M. Sodano, PhD, is associate professor of Counseling, School, and Educational Psychology at the University at Buffalo. His work focuses on the measurement and assessment of personality in interpersonal and vocational domains.

Jessica P. Tamulonis is a doctoral student in the Combined Counseling Psychology and School Psychology program at the University at Buffalo. Her current area of research focuses on the relationship between school security and mental health. Specifically in evaluating the utility of mental health assessment and crisis intervention as security measures, emphasizing the need for early identification of problems and increased access to mental health resources as proactive measures to maintaining school safety at the high school and collegiate level.

Gregory A. Fabiano, PhD, is professor of Counseling, School, and Educational Psychology at the University at Buffalo. His work focuses on effective assessment and treatment of ADHD across the lifespan.

Abigail M. Caserta is a doctoral student in the Combined Counseling Psychology and School Psychology program at the University at Buffalo. Abigail has worked with Dr. Fabiano throughout her time at UB on projects related to ADHD and group-based behavior management training.

Kevin F. Hulme received his PhD, from the Department of Mechanical and Aerospace Engineering at the University at Buffalo (UB), specializing in multidisciplinary analysis and optimization of complex systems. His current areas of specialty include: game-based approaches for applied modeling and simulation (M&S), human factors research in autonomous and connected vehicles, M&S approaches in STEM and experiential learning, and human performance assessment of distractions on driver performance. As of 2015, Dr. Hulme is a Certified Modeling and Simulation Professional (CMSP).

Karen L. Hulme was formerly project manager at the Department of Counseling, School, and Educational Psychology and is currently at Roswell Park Cancer Institute, Division of Cancer Prevention and Population Sciences, Buffalo, NY.

Gina R. Stephan was formerly a senior research support specialist at the University at Buffalo’s Center for Children and Families and is currently a Master’s Candidate in Sports Administration at Canisius College, Buffalo, NY.

Federica Tronci was formerly a doctoral student in the Combined Counseling Psychology and School Psychology program at the University at Buffalo.

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