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Old 04-14-05, 12:56 PM
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Post Social Skills in Adults with ADHD (long post)

Social Skills in Adults with ADHD
National Resource Center on AD/HD


Individuals with ADHD often experience social difficulties, social rejection, and interpersonal relationship problems as a result of their inattention, impulsivity, and hyperactivity. Such negative interpersonal outcomes cause emotional pain and suffering. They also appear to contribute to the development of co–morbid mood and anxiety disorders. This information and resource sheet will:

Describe the ways in which the core symptoms of ADHD can result in social and interpersonal relationship problems
Summarize research on children's social skills and ADHD
Describe the implications of this research for adult ADHD
Suggest approaches to assessing social and interpersonal difficulties in adults with ADHD
Suggest ways to treat social and interpersonal problems in adults with ADHD
Because very little research has been published regarding social skills in adults with ADHD, the suggestions given in this information and resource sheet are based primarily upon sound clinical practices and upward extrapolations from the research on children's social skills and ADHD.

Overall Impact of ADHD on Social Interactions
It is not difficult to understand the reasons why individuals with ADHD often struggle in social situations. Interacting successfully with peers and significant adults is one of the most important aspects of a child's development, yet 50 to 60 percent of children with ADHDhave difficulty with peer relationships.1 Over 25 percent of Americans experience chronic loneliness.2 One can only speculate that the figure is much higher for adults with ADHD.

To interact effectively with others, an individual must be attentive, responsible and able to control impulsive behaviors.3 Adults with ADHDare often inattentive and forgetful and typically lack impulse control. Because ADHDis an "invisible disability," often unrecognized by those who may be unfamiliar with the disorder, socially inappropriate behaviors that are the result of ADHDsymptoms are often attributed to other causes. That is, people often perceive these behaviors and the individual who commits them as rude, self–centered, irresponsible, lazy, ill–mannered, and a host of other negative personality attributes. Over time, such negative labels lead to social rejection of the individual with ADHD. Social rejection causes emotional pain in the lives of many of the children and adults who have ADHDand can create havoc and lower self–esteem throughout the life span. In relationships and marriages, the inappropriate social behavior may anger the partner or spouse without ADHD, who may eventually "burn out" and give up on the relationship or marriage.

Educating individuals with ADHD, their significant others, and their friends about ADHDand the ways in which it affects social skills and interpersonal behaviors can help alleviate much of the conflict and blame. At the same time, the individual with ADHDneeds to learn strategies to become as proficient as possible in the area of social skills. With proper assessment, treatment and education, individuals with ADHD can learn to interact with others effectively in a way that enhances their social life.

ADHD and the Acquisition of Social Skills
Social skills are generally acquired through incidental learning: watching people, copying the behavior of others, practicing, and getting feedback. Most people start this process during early childhood. Social skills are practiced and honed by "playing grown–up" and through other childhood activities. The finer points of social interactions are sharpened by observation and peer feedback.

Children with ADHD often miss these details. They may pick up bits and pieces of what is appropriate but lack an overall view of social expectations. Unfortunately, as adults, they often realize "something" is missing but are never quite sure what that "something" may be.

Social acceptance can be viewed as a spiral going up or down. Individuals who exhibit appropriate social skills are rewarded with more acceptance from those with whom they interact and are encouraged to develop even better social skills. For those with ADHD, the spiral often goes downward. Their lack of social skills leads to peer rejection, which then limits opportunities to learn social skills, which leads to more rejection, and so on. Social punishment includes rejection, avoidance, and other, less subtle means of exhibiting one's disapproval towards another person.

It is important to note that people do not often let the offending individual know the nature of the social violation. Pointing out that a social skill error is being committed is often considered socially inappropriate. Thus, people are often left on their own to try to improve their social skills without understanding exactly what areas need improvement.

Research on Children with ADHD and Social Skills
Researchers have found that the social challenges of children with ADHDinclude disturbed relationships with their peers, difficulty making and keeping friends, and deficiencies in appropriate social behavior.4,5,6,7 Long—term outcome studies suggest that these problems continue into adolescence and adulthood and impede the social adjustment of adults with ADHD.8

At first, these difficulties of children with ADHD were conceptualized as a deficit in appropriate social skills, such that the children had not acquired the appropriate social behaviors. Based upon this model, social skills training, which is commonly conducted with groups of children, became a widely accepted treatment modality. In the typical social skills training group, the therapist targets specific social behaviors, provides verbal instructions and demonstrations of the target behavior, and coaches the children to role–play the target behaviors with one another. The therapist also provides positive feedback and urges the group to provide positive feedback to one another for using the appropriate social behavior. The children are instructed to apply their newly acquired skills in their daily lives.

More recently, ADHD has been re–conceptualized as an impairment of the executive or controlling functions of the brain.9 It follows from this conceptualization that the social deficits of the individual with ADHDmay not be primarily the result of a lack of social skills, but rather a lack of efficiency in reliably using social skills that have already been acquired. Social skills training addresses the lack of skills, but does not address inefficient use of existing skills. Medication produces direct changes in the executive function of the brain and may therefore help children with ADHDmore reliably use newly acquired social skills. Researchers have also added components to social skills training that help children with ADHDreliably apply what they have learned in various settings. To accomplish this goal, parents and teachers are trained to prompt and reinforce children with ADHDto use newly acquired social skills at home and in school.

Only a small number of controlled investigations have studied the effectiveness of social skills training for children with ADHD. These studies have found that social skills training improves the children's knowledge of social skills and improves their social behavior at home as judged by parents, and these positive changes last up to the 3 or 4 month follow–up periods in the studies.7,10,11,12 However, these changes only partially generalize to school and other environments.

Researchers have also found that embedding social skills training within an intensive behavioral intervention, such as a specialized summer camp program, is a highly effective way of increasing the chances that the children will maintain and generalize the gains that they have made.13 There is no research yet that addresses the question of whether children with ADHDwho benefit from social skills training have more friends, are better accepted by their peers, and have better interpersonal relationships as they move into adolescence and adulthood. Clearly, this is an area where more research is necessary.

Specific ADHD Symptoms and Social Skills
Inattention
A related social skills difficulty for many with ADHDinvolves missing the subtle nuances of communication. Those with ADHDwill often have difficulty "reading between the lines" or understanding subtext. It is difficult enough for most to attend to the text of conversations without the additional strain of needing to be aware of the subtext and what the person really means. Unfortunately, what is said is often not what is actually meant.

Tips for identifying subtext:

1. Look for clues in your environment to help you decipher the subtext.
2. Be mindful of alternative possibilities.
3. Be observant.
4. Be aware of body language, tone of voice, behavior, or the look of someone's eyes to better interpret what they are saying.
5. Look at a person's choice of words to better detect the subtext. ("I'd love to go" probably means yes. "If you want to" means probably not, but I'll do it.)
6. Actions speak louder than words. If someone's words say one thing but their actions reveal another, it would be wise to consider that their actions might be revealing their true feelings.
7. Find a guide to help you with this hidden language.
8. Compare your understanding of reality with their understanding of reality. If there is a discrepancy, you might want to try the other person's interpretation and see what happens, especially if you usually get it wrong.
9. Learn to interpret polite behavior. Polite behavior often disguises actual feelings.

Be alert to what others are doing. Look around for clues about proper behavior, dress, seating, parking and the like.
A momentary lapse in attention may result in the adult with ADHDmissing important information in a social interaction. If a simple sentence like "Let's meet at the park at noon," becomes simply "Let's meet at noon," the listener with ADHDmisses the crucial information about the location of the meeting. The speaker may become frustrated or annoyed when the listener asks where the meeting will take place, believing that the listener intentionally wasn't paying attention and didn't value what they had to say. Or even worse, the individual with ADHDgoes to the wrong place, yielding confusion and even anger in the partner. Unfortunately, often neither the speaker nor listener realizes that important information has been missed until it is too late.

Impulsivity
Impulsivity negatively affects social relationships because others may attribute impulsive words or actions to lack of caring or regard for others. Failure to stop and think first often has devastating social consequences. Impulsivity in speech, without self–editing what is about to be said, may appear as unfiltered thoughts. Opinions and thoughts are shared in their raw form, without the usual veneer that most people use to be socially appropriate. Interruptions are common.

Impulsive actions can also create difficulties as individuals with ADHDmay act before thinking through their behavior. Making decisions based on an "in the moment" mentality often leads to poor decision–making. Those with ADHD often find themselves lured off task by something more inviting. Impulsive actions can include taking reckless chances, failure to study or prepare for school– or work–related projects, affairs, quitting jobs, making decisions to relocate, financial overspending, and even aggressive actions, such as hitting others or throwing items.

Rapid and excessive speech can also be a sign of impulsivity. The rapid–fire speech of an individual with ADHD leaves little room for others who might want to participate in the conversation. Monologues rather than dialogues leave many with ADHDwithout satisfying relationships or needed information.

Hyperactivity
Physical hyperactivity often limits the ability to engage in leisure activities. Failure to sit still and concentrate for concerts, religious ceremonies, educational events, or even leisure vacations and the like may be interpreted by others as a lack of caring or concern on the part of the person with ADHD. In addition, difficulties looking attentive leave others feeling unattended.

Assessment of Social Skills
Interviews and self–report questionnaires are the primary tools for assessing social skill deficits and interpersonal interaction problems in adults with ADHD. During the course of a diagnostic evaluation for ADHD (see the information and resource sheet entitled, "Diagnosis of ADHD in Adults"), a mental health professional will thoroughly assess the social interactions of the adult. When questionnaires are used, it is important to include both a self–report by the individual with ADHD and reports by spouses, significant others, and friends on a comparable version of the questionnaire.

The questionnaire may include the following types of items:

Difficulty paying attention when spoken to, missing pieces of information
Appears to ignore others
Difficulty taking turns in conversation (tendency to interrupt frequently)
Difficulty following through on tasks and/or responsibilities
Failure to use proper manners
Missed social cues
Disorganized lifestyle
Sharing information that is inappropriate
Being distracted by sounds or noises
Become flooded or overwhelmed, shutting down
Disorganized or scattered thoughts
Rambling or straying off topic during conversations
Ending a conversation abruptly
Readers who wish to self–assess their social skills in depth should see the resource list at the end of this paper for further information.

Treatment Strategies
When the social skill areas in need of strengthening have been identified, obtaining a referral to a therapist or coach who understands how ADHDaffects social skills is recommended (see the coaching information and resource sheet for further discussion of coaching ). Medications are often helpful in the management of ADHD symptoms; in many cases, an effective dose of medication will give the adult with ADHDthe boost in self–control and concentration necessary to utilize newly acquired social skills at the appropriate time. However, medications alone are usually not sufficient to help gain the necessary skills. See the medication information and resource sheet for further discussion of medication.

As discussed earlier, social skills training for children and adolescents with ADHD usually involves instruction, modeling, role–playing, and feedback in a safe setting such as a social skills group run by a therapist. In addition, arranging the environment to provide reminders has proven essential to using the correct social behavior at the opportune moment. These findings suggest that adults with ADHDwishing to work on their social skills should consider the following elements when seeking an effective intervention. It is important to note that these treatment strategies are suggestions based on clinical practice, rather than empirical research.

Knowledge
Oftentimes social skills can be significantly improved when there is an understanding of social skills as well as the areas in need of improvement. Reading books such as What Does Everybody Know That I Don't?14, ADD and Romance,15 or You, Your Relationship, & Your ADD 16 can provide some of that knowledge.

Attitude
Individuals with ADHD should have a positive attitude and be open to the growth of their social skills. It is also important to be open and appreciative of feedback provided by others.

Goals
Adults with ADHD may want to pick and work on one goal at a time, based on a self–assessment and the assessments of others. Tackling the skill areas one at a time allows the individual to master each skill before moving on to the next.

The echo
Those who struggle with missing pieces of information due to attentional difficulties during conversation may benefit from developing a system of checking with others what they heard. "I heard you say that . . . Did I get it right? Is there more?" Or an individual with ADHDcould ask others to check with them after providing important information. "Please tell me what you heard me say." In this way, social errors due to inattention can be avoided.

Observe others
Adults with ADHD can learn a great deal by watching others do what they need to learn to do. They may want to try selecting models both at work and in their personal lives to help them grow in this area. Television may also provide role models.

Role play
Practicing the skills they need with others is a good way for individuals with ADHDto receive feedback and consequently improve their social skills.

Visualization
Visualization can be used to gain additional practice and improve one's ability to apply the skill in other settings. Those who need practice in social skills can decide what they want to do and rehearse it in their minds, imagining actually using the skill in the setting they will be in with the people they will actually be interacting with. They can repeat this as many times as possible to help "overlearn" the skill. In this manner, they can gain experience in the "real" world, which will greatly increase the likelihood of their success.

Prompts
Adults with ADHD can use prompts to stay focused on particular social skill goals. The prompts can be visual (an index card), verbal (someone telling them to be quiet), physical (a vibrating watch set every 4 minutes reminding them to be quiet), or a gesture (someone rubbing their head) to help remind them to work on their social skills.

Increase "likeability"
According to social exchange theory, people maintain relationships based on how well those relationships meet their needs. People are not exactly "social accountants," but on some level, people do weigh the costs and benefits of being in relationships. Many with ADHDare considered to be "high maintenance." Therefore, it is helpful to see what they can bring to relationships to help balance the equation. Investigators have found that the following are characteristics of highly likeable people: sincere, honest, understanding, loyal, truthful, trustworthy, intelligent, dependable, thoughtful, considerate, reliable, warm, kind, friendly, happy, unselfish, humorous, responsible, cheerful, and trustful. 3 Developing or improving any of the likeability characteristics should help one's social standing.

Summary
Although ADHD certainly brings unique challenges to social relationships, information and resources are available to help adults with ADHDimprove their social skills. Most of this information is based upon sound clinical practice and research on social skills and ADHDin children and adolescents; there is a great need for more research on social skills and ADHD in adults. Seek help through reading, counseling, or coaching and, above all, build and maintain social connections.
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  #2  
Old 04-14-05, 04:59 PM
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In this post,

External Reference Hierarchical Mind (ERHM) = "normals" or "linears"
Internally Referenced Contextual Mind (IRCM) = "ADD"

Yes, it is true... we are very different and since the majority is does not have internal reference; we must "play along".
Why do I say, "Play along"? Because we must maintain our integrity... we are not externally referenced to the culture at large and never will be. We can be very successful at mitigating the impacts on a day-to-day basis with people we are not close to. But we have just as much a right to be "ourselves" as anyone else... just as long as we are generally sensitive to the feelings of others.

Learn the skills but understand that they are just skills like any other... you will not be fully accepted by the externally referenced and that is OK too... Always have ADD friends in your life. Believe me, it really goes a long way to helping you feel comfortable in your own skin.

If your partner is externally referenced, it is their duty to understand you as well...you cannot change for them it causes extreme depression! Can you imagine what would happen if a "normal" tried to be ADD?

Close relationships are much trickier!

Here is a quick map of misunderstandings (I am working a bigger version)
Please understand that these are extreme prototypes and nobody fits them perfectly (ERHM *can* be culturally questioning and IRCM *can* be culturally compliant)

Internally Referenced Contextual Mind (IRCM or "ADD") reality
1. Prioritization is done moment to moment
2. Cultural signs cannot be read or "written" (we are like a dog with a broken tail...gotta love Vonnegut's writing!)
3. Language is used to communicate concepts and ideas
4. Reality is built internally from external observation
5. Social rules are learned through impulse/response behavior throughout life (It is generally supplanted and in some cases replaced by observation of others after puberty)
6. CM does not display status in order to find place in society. There is little or no attachment to age, gender or position.
7. CM does not attach easily to external definitions of individual (we define ourselves) There are fewer displays of status.

Externally Referenced Hierarchical Mind (ERHM or Normal) reality
1. Prioritization is either externally directed or follows patterns learned externally (from culture) It tends to be uniformly applied (unless gains can be had by not doing that) and less time dependant
2. Cultural signs are learned primarily during childhood and cemented during puberty. They then disappear from awareness. After that point the signs only appear in new social situations and can be read.
3. Language is primarily used to confirm status of self and other individuals in the culture and is more of a carrier wave..with body language doing a great degree of the "speaking" (small talk)
4. Abstract cultural reality is preassembled externally and installed into the mind below the level of awareness. (It can be brought to awareness with heavy questioning... but there is little ROI for that)
5. Social rules are learned through Impulse/response behavior in two phases in life. Once during childhood then through puberty and young adulthood. This method decreases in use after each phase and is followed by "below awareness pattern matching"
6. ERHM displays signs of status through many methods including stature, voice control, material possessions and processional relationships. There is strong attachment to age, gender and position.
7. ERHM attaches to title and external definition of worth through signs of status.

IRCM often sees ERHM as:
1. Rigid in priorities, stiff, boring, unable to "get over it"
2. Expecting IRCM to be "mind readers", dishonest, plays by hidden rules
3. Talking about nothing, Shallow, boring conversationalists, women act prude and distant, men are aggressive
4. Living in a "fantasy world" with no connection to reality
5. Unable to be themselves... marionettes, unquestioning of standard beliefs, close minded.
6. Shallow, possessive of people, materialistic, shaming, playing mind games to get what they want, Uniform, unable to from opposite gender friendships outside marriage
7. Macho, Foofy, show offs, neat freaks, too worried about fashion and makeup, no sense of personal style

ERHM probably sees IRCM as:
1. Putting ERHM partner lower in priority than other people or things, flakey, irresponsible, selfish, putting self first
2. Unable to understand ERHM individual even when they are being "clear". Inappropriate, giving "TMI", Plays by hidden rules, untrustworthy, hurtfully honest, rude, deceptive, petty
Talks too much, uses odd vocabulary, self centered discussions, arrogant, smart *ss, Incomprehensible, manipulating conversation, women are "c***teases", Men are overly s*x*aly aggressive, inappropriate staring and facial expressions
3. Rude, rebellious, can't let things be, does not have common sense, odd, bizarre, insensitive
4. Impulsive, boundary pushing, overt, button pusher, mean, hurtful, wild, uncontrollable
5. Does not know their place, authority challenging, unaware of important people, hangs out with the wrong crowd, dates people too young or too old, friends are not from the "same side of the tracks", wife has too many close male friends, husband has too many close female friends
6. Unable to commit in relationships and jobs, no drive, immature, tomboyish, effeminate, women are too assertive, mean have weak spines, unable to manage people, permissive parent, lazy
7. Masculine women, girlish men, shy, unkempt, too lazy to wear correct clothes or makeup, bizarre taste in clothes, wears teenage clothes in 40's


ERHM in positive state:
Is happy with place in society or trying to achieve better position
ERHM in negative state:
Is unhappy with place in society not trying to achieve better position

IRCM in positive state:
Is happy with self, loves the way they are and think
IRCM In negative state:
Believes what ERHM thinks (see list above) about them and wants to be like ERHM. Does not like self. Considers self to be disordered

ERHM and IRCM get along best when both individuals are in positive state.

I personally like the positive state. See what we have to overcome in bridging the gap? I will post this in the non-ADD partner side as well.
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Old 11-03-08, 06:02 PM
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Re: Social Skills in Adults with ADHD (long post)

Great Posts. Thanks to both of you. I would like to use the first one in my work. Are there any copyright limitations?
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Old 01-15-10, 08:48 PM
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Re: Social Skills in Adults with ADHD (long post)

So basically if you have add/ADHD and you are in the negative spectrum, you wont rest until you are in the positive. and you emulate people without add/adhd and try to think and act like them.... if so thats me.

My dad has add/adhd

was extremely smart and wealthy. my parents got divorced and i lived with my italian non add/adhd mother. she doesn't care about being poor but I do. I don't care about anything but making money now. Make sense with what you were saying???
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Old 01-15-10, 08:52 PM
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Re: Social Skills in Adults with ADHD (long post)

Also,

this might be a stretch but, we can guess then that there are more upper class add/adhd people then lower class. because if someone is lower class, they will claw and chew there way to the top and thus there family will then be upper class. no?
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Old 01-16-10, 12:03 AM
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Re: Social Skills in Adults with ADHD (long post)

Assimilate just enough to make your money. If you're looking to please a man, then you've picked the wrong master.
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Old 01-16-10, 12:25 AM
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Re: Social Skills in Adults with ADHD (long post)

Those posts look really good and I hope one day to be able to read them, so I bookmarked this thread!
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Old 01-16-10, 10:48 AM
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Re: Social Skills in Adults with ADHD (long post)

Im not sure i know what you mean by pleasing a man. I am in college and dont know what to do with my life. i grew up being very goodlooking and athletic with inattentive add/adhd. so i fit in with the popular crowd and people just thought i was cocky because i didnt like talking. so i kept going with the popular crowd and kept thinking i would snap out of whatever was making me feel weird (my add adhd). My parents kept telling me it was a stage I was going through. Now I'm starting to learn its a permanent thing and I should stop fighting it and do what makes me happy.

I'm not sure what to do with my life though...
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