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Peer Rejection and Friendships in Children with Attention-Deficit/Hyperactivity Disorder: Contributions to Long-Term Outcomes

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Abstract

Even after evidence-based treatment, Attention-Deficit/Hyperactivity Disorder (ADHD) is associated with poor long-term outcomes. These outcomes may be partly explained by difficulties in peer functioning, which are common among children with ADHD and which do not respond optimally to standard ADHD treatments. We examined whether peer rejection and lack of dyadic friendships experienced by children with ADHD after treatment contribute to long-term emotional and behavioral problems and global impairment, and whether having a reciprocal friend buffers the negative effects of peer rejection. Children with Combined type ADHD (N = 300) enrolled in the Multimodal Treatment Study of Children with ADHD (MTA) were followed for 8 years. Peer rejection and dyadic friendships were measured with sociometric assessments after the active treatment period (14 or 24 months after baseline; M ages 9.7 and 10.5 years, respectively). Outcomes included delinquency, depression, anxiety, substance use, and general impairment at 6 and 8 years after baseline (Mean ages 14.9 and 16.8 years, respectively). With inclusion of key covariates, including demographics, symptoms of ADHD, ODD, and CD, and level of the outcome variable at 24 months, peer rejection predicted cigarette smoking, delinquency, anxiety, and global impairment at 6 years and global impairment at 8 years after baseline. Having a reciprocal friend was not, however, uniquely predictive of any outcomes and did not reduce the negative effects of peer rejection. Evaluating and addressing peer rejection in treatment planning may be necessary to improve long-term outcomes in children with ADHD.

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Acknowledgments

Data analysis and preparation of this article were supported by National Institutes of Health grants 1K01DA024700 to the first author and R01MH62583 to the third author. The data used in the current paper were drawn from a larger study conducted by the MTA Cooperative Group and supported by the National Institute of Mental Health, the National Institute on Drug Abuse, the Department of Justice, and the Department of Education. (Grant numbers: U01MH50440, U01MH50447, U01MH50453, U01MH50454, U01MH50461, U01MH50467; and contract numbers: N01MH12004, N01MH12007, N01MH12008, N01MH12009, N01MH12010, N01MH12011, N01MH12012). The content is solely the responsibility of the authors and does not necessarily reflect the views of the funding agencies.

The data set is that of the MTA. The Multimodal Treatment Study of Children with ADHD (MTA) was a National Institute of Mental health (NIMH) cooperative agreement randomized clinical trial, then continued under an NIMH contract as a follow-up study. Collaborators from the National Institute of Mental Health: Benedetto Vitiello, M.D. (Child & Adolescent Treatment and Preventive Interventions Research Branch), Joanne B. Severe, M.S. (Clinical Trials Operations and Biostatistics Unit, Division of Services and Intervention Research), Peter S. Jensen, M.D. (currently at Columbia University), L. Eugene Arnold, M.D., M.Ed. (currently at Ohio State University), Kimberly Hoagwood, Ph.D. (currently at Columbia); previous contributors from NIMH to the early phases: John Richters, Ph.D. (currently at National Institute of Nursing Research); Donald Vereen, M.D. (currently at National Institute on Drug Abuse). Principal investigators and co-investigators from the sites are: University of California, Berkeley/San Francisco: Stephen P. Hinshaw, Ph.D. (Berkeley), Glen R. Elliott, Ph.D., M.D. (San Francisco); Duke University: Karen C. Wells, Ph.D., Jeffery Epstein, Ph.D.; previous Duke contributors to early phases: C. Keith Conners, Ph.D. (former PI); John March, M.D., M.P.H.; University of California, Irvine: James Swanson, Ph.D., Timothy Wigal, Ph.D.; previous contributor from UCLA to the early phases: Dennis P. Cantwell, M.D. (deceased); Long Island Jewish Medical Center/New York University: Howard B. Abikoff, Ph.D.; Montreal Children’s Hospital/ McGill University: Lily Hechtman, M.D.; New York State Psychiatric Institute/Columbia University/Mount Sinai Medical Center: Laurence L. Greenhill, M.D. (Columbia), Jeffrey H. Newcorn, M.D. (Mount Sinai School of Medicine). University of Pittsburgh: Brooke Molina, Ph.D., Betsy Hoza, Ph.D. (currently at University of Vermont), William E. Pelham, Ph.D. (PI for early phases, currently at Florida International University). Follow-up phase statistical collaborators: Robert D. Gibbons, Ph.D. (University of Illinois, Chicago); Sue Marcus, Ph.D (Mt. Sinai College of Medicine); Kwan Hur, Ph.D. (University of Illinois, Chicago). Original study statistical and design consultant: Helena C. Kraemer, Ph.D. (Stanford University). Collaborator from the Office of Special Education Programs/US Department of Education: Thomas Hanley, Ed.D. Collaborator from Office of Juvenile Justice and Delinquency Prevention/Department of Justice: Karen Stern, Ph.D.

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Authors and Affiliations

  1. Department of Psychology, University of Alabama at Birmingham, HMB 195, 1530 3rd Avenue South, Birmingham, AL, 35294-2100, USA

    Sylvie Mrug

  2. Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA

    Brooke S. G. Molina

  3. Department of Psychology, University of Vermont, Burlington, VT, USA

    Betsy Hoza

  4. Department of Psychology, Marquette University, Milwaukee, WI, USA

    Alyson C. Gerdes

  5. Department of Psychology, University of California - Berkeley, Berkeley, CA, USA

    Stephen P. Hinshaw

  6. Department of Psychiatry, McGill University, Montreal, QC, Canada

    Lily Hechtman

  7. Department of Psychiatry, Ohio State University, Columbus, OH, USA

    L. Eugene Arnold

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  1. Sylvie Mrug
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Correspondence to Sylvie Mrug.

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Mrug, S., Molina, B.S.G., Hoza, B. et al. Peer Rejection and Friendships in Children with Attention-Deficit/Hyperactivity Disorder: Contributions to Long-Term Outcomes. J Abnorm Child Psychol 40, 1013–1026 (2012). https://doi.org/10.1007/s10802-012-9610-2

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