Peer relationships in boys with attention-deficit hyperactivity disorder with and without comorbid aggression

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Abstract
Peer relationship difficulties and peer rejection are common in youngsters with attention-deficit hyperactivity disorder (ADHD), mandating focus on assessment issues, underlying reasons for peer approval and disapproval, links with comorbid aggression, and the mediating role of sociocognitive mechanisms as well as emotion regulation strategies. With previously unfamiliar ADHD and comparison boys who attended naturalistic summer research programs, we found the following: (a) parent and teacher estimates (but not self-reports) showed moderate correspondence with peer-nominated social preference; (b) ADHD boys were more likely than their comparison peers to accept other ADHD agemates; (c) aggression and noncompliance Predominated as self-reported reasons for rejecting agemates in both ADHD and comparison groups, with Perceived similarity the chief mediator of peer acceptance; (d) the high-aggressive subgroup of ADHD boys showed markedly worse peer sociometric status than did ADHD boys without aggression, for whom social isolation was also a predictor of peer reputation; and (e) self-reported social goals of a sensation-seeking nature and observed emotional reactivity characterized high-aggressive boys with ADHD and predicted end-of-program peer disapproval. We discuss implications for normal developmental processes and for intervention efforts.