Raising Socially ADHD-ept Kids
Friendship groups can work wonders for kids with ADHD, but pragmatic social skills problems require a different approach. Here’s how to get the specialized help your child with ADD may need.
Most parents know that ADHD symptoms can be a problem in the classroom. Not being able to sit still, pay attention, or complete work has its consequences, none of them good. Those same symptoms — hyperactivity, inattention, problems with organization and time planning, and impulsivity — also prevent kids from making and keeping friends. The good news is that using appropriate attention deficit disorder (ADHD or ADD) medications, attending social skills classes, and using cognitive behavioral therapy can help a child improve socially.
This is not the case for the challenges called pragmatic social skills problems. These are neurologically based, and are related to the brain’s ability to receive and process visual and auditory social cues. These problems are a major obstacle to a child trying to make and hold on to friends.
Missing the Cues
Some children, adolescents, and adults with ADHD can’t read others’ social cues, and don’t perceive how their body language and tone of voice are read by others.
Communicating with friends involves more than words. We communicate with facial expressions, gestures, eye contact, posture, and tone of voice. These make up nonverbal communication. Current studies suggest that nonverbal communication is a fully developed language, different from verbal communication (words) and processed in different areas of the brain than visual or auditory communication. Nonverbal communication is not taught. It is learned through observation, interactions, and feedback from others.
Nonverbal communication problems generally take one of two forms. In one scenario, the child or adult is unable to correctly read the nonverbal social cues of others. For example, the teacher stands in front of Billy’s desk, looking directly at him, her face taut. But it’s not until she says, “Stop that right now!” that Billy looks up, surprised. Billy did not pick up on the earlier cues that indicated his behavior was upsetting the teacher.
In other cases, a child or adult is unable to recognize how others perceive her nonverbal cues. Ellen talks to a friend but is standing so close that she is almost in her face. Ellen’s voice is loud, and she is jumping up and down. Her friend pushes her away and says, “Leave me alone.” Ellen is hurt because her friend rejected her.
Listening and Seeing Incorrectly
Nonverbal communication problems can be auditory or visual. Auditory problems involve using the wrong tone of voice, rate of speech, and variations in volume and word emphasis. For instance, a child might speak too loudly or his tone might not match the emotional message he wants to convey.
Visual communication problems involve everything from not being able to recognize the emotions expressed by others’ facial expressions to violating another’s personal space. For instance, a child may not be able to recognize a happy or fearful face. He may stand too close to someone while talking, or hug and kiss a stranger. His posture may indicate anger when he intends to express friendliness.
Nonverbal communication challenges rarely respond to the typical social skills training groups that help many ADHD kids. Children with this challenge need specialized training.
In specialized social skills groups, the child is made aware of and sensitive to his social problems. This step is critical. Some children have little awareness of their difficulties and may deny their problems or blame others for them. Once the individual begins to accept the problem, the second step is to help the child develop new strategies for interacting with others. The third step requires the child to practice these new strategies outside of the group and to report back on how they worked.
The children in a specialized group are taught to recognize social cues. The leader might say, “Kids, let’s look at these pictures. This one is a happy face. What makes it look like a happy face? This one is an angry face. What makes it look angry?” As children learn, the leader asks one of the children to show a happy face and another to show an angry face. As the class progresses, training may include asking a child to make or draw a face — a fearful one, say — and seeing if others in the group can guess the feeling that she is actually expressing.
If you suspect that your child has nonverbal communication problems, consult with a mental health professional. If he or she concurs, seek a referral to a pragmatic social skills group. It could make the difference between your child being lonely and being able to make and keep friends throughout life.
Larry Silver, M.D., is a member of ADDitude’s ADHD Medical Review Panel.