ADHD In Children: How To Help Your Child Make And Keep Friends

Some of the ways in which attention-deficit hyperactivity disorder (ADHD) manifests can have a knock-on effect on the way children interact with their friends.

It’s estimated almost 882,000 children in the UK have ADHD, which is typically characterised by symptoms such as struggling to pay attention, hyperactivity and impulsive behaviour.

Many of the core features of ADHD can ultimately impact friendships and social situations, which can occasionally lead to children struggling to connect with those around them – or feeling left out.

There are multiple factors that can play into this. Dr Mukesh Kripalani, consultant psychiatrist at The ADHD Centre, told HuffPost UK that a child’s impulsivity might mean they interrupt, blurt things out, struggle to wait for their turn or occasionally invade other people’s personal space.

“To another child, that can sometimes be interpreted as being rude, bossy or controlling, when that is not the child’s intention at all,” he said.

Those with inattention might miss some of the subtle verbal and non-verbal cues that are part of social interaction. “They may not notice that a friend is getting bored or annoyed, or they may zone out while somebody else is talking, which can unfortunately be interpreted as a lack of interest,” he added.

Emotional regulation can also play a role. If a child experiences emotions very intensely, and they’ve not yet developed the strategies to manage those feelings, something relatively small, such as losing a board game or having a disagreement with a friend, can sometimes trigger a huge reaction.

And lastly, executive functioning difficulties can make it harder to adapt when a game or activity changes. “A child may have a very fixed idea about how a game should be played, struggle to compromise or find it difficult to shift from one activity to another,” said the psychiatrist.

“Again, this can sometimes be perceived by other children as controlling behaviour, when in reality the child is struggling with flexibility and shifting attention.”

“The aim is not to make a child change who they are, but to give them the language and tools to understand social situations and communicate what they need,” said Dr Sasha Hall, a senior educational and child psychologist.

Just as you’d teach a child to use the toilet, read or write their name, teaching and nurturing social skills is crucial.

Here are some ways to do just that.

Social skills can be taught explicitly through role play at home, suggested Dr Hall. You can practise asking questions such as, “Can I play too?” or “What do you want to play?”.

“Parents can practise things such as taking turns, listening when somebody else is speaking, asking questions about another person’s interests, joining a game appropriately and recognising when somebody else wants to change the activity,” she said.

Dr Kripalani also recommends role play, agreeing that children need an opportunity to understand and practise the skills involved. He notes that if something goes wrong socially, it can be helpful to talk it through afterwards when the child is calm.

“Rather than criticising, parents can gently ask questions such as, ‘How do you think your friend felt when that happened?’ or ‘What could we try differently next time?’. It is almost like having a short social debrief,” he added.

If your child is impulsive or can become overwhelmed quickly, Dr Hall said it can be helpful to practise short phrases they can say when something doesn’t feel right. For example: “I don’t like this”, “I’m getting cross”, “I need some space” or “Can we stop for a minute?”.

“The child may not always remember to use these phrases initially, so they need to be practised when the child is calm,” she said.

“The benefit is that the child has a way of communicating their discomfort before it turns into shouting, hitting, lashing out or walking away. It also gives the adults and other children around them an opportunity to recognise that something is wrong and help.”

Children with ADHD can sometimes miss subtle social cues because they are very focused on what they are doing. They might also act before they’ve had time to process what somebody else is communicating.

Parents can help develop this skill by turning this into a game at home. “Look at different facial expressions in a mirror, use emotion cards, play games such as Guess Who, or draw faces showing different emotions,” Dr Hall said.

“Start with obvious emotions such as happy, sad and angry, then move on to more subtle expressions such as bored, uncomfortable, disappointed or irritated.”

Books and TV shows can also help explore these emotions further. “Parents can pause and ask: ‘How do you think they are feeling?’, ‘What makes you think that?’, ‘What could they do now?’ or ‘How would you feel if that happened to you?’,” said Dr Hall.

The key is to talk about what happened and what might help them feel better.

One-on-one playdates can provide a great first place to test the socialising water. Shorter and more structured playdates can work better than long periods of unstructured socialising, suggested Dr Kripalani.

“An hour may be enough, particularly while a child is learning these skills, because managing their behaviour and remembering social strategies takes effort,” he said.

It might also help to invite one carefully chosen friend rather than having several children together, as larger groups can contribute to cognitive and sensory overload.

The psychiatrist also recommended setting up structured activities to make socialising easier: “Instead of simply asking children to go off and play, parents could organise something specific such as baking, Lego, a craft activity or a game. Having an activity gives the child something to focus on and removes some of the pressure of completely unstructured interaction.”

Keep those initial playdates at home so you can monitor the dynamic and intervene subtly if necessary. “If tensions are beginning to rise, something as simple as introducing a snack break can help reset the situation,” he added.

Before going to a party, playdate or other social event, Dr Kripalani advises parents to talk through what is likely to happen and agree one or two manageable goals. For example, “Today we’re going to practise taking turns on the trampoline.”

“Making the situation more predictable can help children feel less overwhelmed,” he said.

“Some families also develop a discreet signal that a child can use if they are becoming overwhelmed or overstimulated. That allows the parent to step in and give the child a quiet break before they reach the point of a meltdown.”

Friendships have their high points – they also inevitably have their low points. Sometimes we say the wrong thing, become frustrated or misunderstand our friends – even as adults.

The trick is to teach children what to do after something has gone wrong – and that means saying “sorry”, “I didn’t mean to upset you”, “are you okay?” or “can we try again?”.

“For children who are impulsive, learning how to repair a situation can be just as valuable as learning how to prevent the difficulty in the first place,” said Dr Hall.

Dr Kripalani noted “praise is extremely important” for children with ADHD, as they can receive a great deal of negative feedback about their behaviour and may internalise criticism strongly.

“Parents should actively notice and reinforce the things that go well: ‘I loved how you let your friend choose the game,’ or ‘That was really kind’,” said the psychiatrist.

“Praising the process and the social skills the child is developing can help build confidence and reduce the sense that they are always getting things wrong.”