DO PRESCHOOL CHILDREN WITH ADHD LEARN SOCIAL SKILLS?

Typically, preschool children learn how to interpret social cues from their parents, and therefore,

behave appropriately by observing them. Their parents teach them how to behave in a social situation and specifically how to learn the meaning of what another child is saying to them.

However, preschool children with ADHD cannot pay attention to their parent’s words or actions because they are paying attention to something else. Their focus is also inconsistent, so they may hear only a part of what their parent is saying to them. The result of this inconsistent focus is that

these children behave in a socially inappropriate way, leaving the other children to look at them in a strange way, not understanding their peer’s inappropriate behavior. Children may look at the preschool child with ADHD as different. They may ask themselves why their peer does not understand how to behave. These children appear vulnerable, which may lead to them bullying others and to be bullied themselves even at a preschool age! (We will talk about bullying in another blog post.) They may misunderstand other children’s social cues as well.

THE DEFINITION OF SOCIAL SKILLS

What are social skills? “Social skills may be defined as socially acceptable learned behaviors that enable a person to interact with others in ways that elicit positive responses and assist in avoiding negative responses” (Elliott and Gresham, 1993, p. 287).

THE IMPORTANCE OF PARENTAL KNOWLEDGE OF THEIR PRESCHOOL CHILD WITH ADHD’S SOCIAL SKILLS

Why do parents of preschool children with ADHD need to know the importance of learning social skills? Typically, preschool children with ADHD have poorly developed social skills. They have difficulty following instructions, they do not listen well, and therefore interrupt others, among other negative behaviors. When a child appears to be vulnerable as these preschool children with ADHD often appear to be, they are at risk for negative and difficult social experiences. Social situations which typical children find easy to manage may be treacherous for preschool children with ADHD. They may have difficulty making friends and even their families may find them annoying, which is very sad! Here is what one mom told me about her son:

“He has this behavior that really pisses people off. Some ADD or ADHD is either manageable or they’re so charming or sometimes it passes. We have one. His personality

makes people really upset. And that was pretty evident early on.”

I was troubled by her statement about her son because I knew that his life and his parent’s life had to be very difficult. I was especially heartbroken hearing any mother talk about her child in such negative terms. How do preschool children with ADHD who have social skills deficits

behave? They either talk excessively without realizing that they are doing so, or they may talk so infrequently that their parents hardly know that they are in the same room. Additionally, they may not understand social cues that other children are expressing in conversations. Social cues are signals, either verbal or nonverbal, that help to communicate behavior. Some of these social cues may be facial expressions or body language. Preschool children with ADHD typically misinterpret social cues, which we will discuss in a later blog.

There are many other examples of poor social skills, including touching another child, pushing, hitting, etc. I am sure that we all know the definition of social skills. However, in terms of

accuracy, Elliott and Gresham (1993) stated that “social skills may be defined as socially acceptable learned behaviors that enable a person to interact with others in ways that elicit positive responses and assist in avoiding negative responses” (p. 287).  Preschool children with ADHD need to learn and exhibit positive social skills in order to make friends, get along with their family, and build positive self-esteem. These children have experienced rejection and criticism constantly because of their inappropriate behavior and their lack of social skills. If

they live in the same house as their siblings, why do they do not learn the same social skills as them?

DO PRESCHOOL CHILDREN WITH ADHD LEARN THE

SAME SOCIAL SKILLS AS THEIR SIBLINGS?

If you look at the previously stated definition, preschool children with ADHD have difficulty learning social skills. How can that be? Aren’t they being brought up in the same house as their siblings who exhibit positive social skills? If you are a parent of one of these children, you know very well that your child has immature social skills. In fact, due to the point that they do not have a complete repertoire of intact, positive social skills, they are not only difficult to manage but sadly, annoy many people (as I have said before, but will emphasize again here), due to their excessive verbiage and socially inappropriate behavior.

One of the parents with whom I worked described her child’s behavior this way:

I can remember when he was four and he talked back to his grandfather.

I said nothing, because it was like, you know what the situation

was with the grandfather. I don’t want to say he asked for it, but the

tone and attitude and the behavior was such that Aaron was “back at

ya,” you know. I did correct him. I told him, Aaron that was not right,

even though my thinking was, I’d have done the same thing as an

adult. You’re a child, you don’t behave that way. So, it’s always been a

very tricky situation. I talked to him at that point. I did say to him,

Aaron, you know, you need to apologize; that was wrong. To let him

know that it was unacceptable, but at that same point in time I knew

that what he said was something that anyone, any adult would have

said in the same situation. But the problem was that he wasn’t an adult.

He was a child. He didn’t know he wasn’t supposed to say that. That

was how he felt, so that’s how he handled it (Rapoport, 2009, p. 23).

Another parent described her son’s inability to control his own behavior:

As far as social skills go, I do think that kids with ADHD have significant

issues with this. Sometimes it seems to be a matter of the fact that

they do not notice their own behavior as being unusual or inappropriate

in any way. Thus, they make no effort to control it. But, even when

pointed out, they often seem unable to control odd or inappropriate

behavior. (Rapoport, 2009, p. 24).

Okay, so let’s get to the bottom of these children’s social skills difficulties. Preschool children with ADHD of all types may have social skills problems, even though their behavior may be varied. Why? They have social skills deficits. These deficits typically have been described as either “can’t do” or “won’t do” (Gresham, Sugai, and Horner, 2001, p. 33). They either do not have the knowledge to behave in a socially appropriate manner or they know how to behave in a socially appropriate manner but do not do so (p. 33). Social skills deficits prevent these children from learning positive social skills. They typically do not pick up and internalize positive social skills that are modeled by their parents at home in the same way as preschool children without ADHD do.

  

So, why don’t preschool children with ADHD learn the same social skills as their siblings who live in the same house? Check out my next blog!

HOW DO THE SYMPTOMS OF ADHD PRESENT THEMSELVES IN PRESCHOOL CHILDREN?

The Diagnostic and Statistical Manual for Mental Disorders- (DSM-5) states that “In preschool, the main manifestation (of ADHD) is hyperactivity” (American Psychiatric Association, 2013, p. 62). The CDC also found that the most typical and paramount symptom of ADHD in preschool is hyperactivity (www.CDC.gov, np). It does not mean that preschool children with ADHD are not inattentive and unfocused because many are characterized by these symptoms as well. I will concentrate on young children who are four- or five-years old specifically, because these are the ages that it is possible to differentiate their behavior from the more variable behaviors they exhibit before they are four-years-old. As the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) states, “Many parents first observe excessive motor activity when the child is a toddler, but symptoms are difficult to distinguish from highly variable normative behaviors before age 4 years” (APA, 2013, p. 62). However, if your child is younger than four-years- old, my interventions will definitely help your child anyway!

The Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) states that preschoolers with ADHD are more likely to have difficulty in daycare, including problems with peer relationships, and learning, as well as a higher risk of injuries than preschool children without ADHD. Frequently, these children are suspended or expelled from preschool for their behavior, which I know sounds extreme, but it does happen. Preschool children with ADHD experience difficulty in their relationships with their parents, as well as struggles in their social interactions.

Why do these things happen? These children do not have intact positive social skills. They either do not have knowledge of effective social skills or they have knowledge of the appropriate social skills, yet do not perform them. Wait! You KNOW that you have taught social skills to all of your children? Why and how did your preschool child with ADHD not learn positive social skills? Tune into my next blog post!

The Definition of Attention-Deficit/Hyperactivity Disorder (ADHD)

THE DEFINITION OF ATTENTION-DEFICIT/HYPERACTIVITY DISORDER

Even though as parents, you are acutely aware of your child’s behavior, it is imperative to know the accepted definition of ADHD, as stated in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Here is the well-accepted and current definition:

A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development as characterized by (1) and/or (2):

Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/ occupational activities:

Often fails to give close attention to details or makes careless mistakes in

            schoolwork, at work, or during other activities                          

often has difficulty sustaining attention in tasks or play activities

often does not seem to listen when spoken to directly

often does not follow through on instructions and fails to finish

schoolwork, chores, or duties in the workplace

often has difficulty organizing tasks and activities

often avoids, dislikes, or is reluctant to engage in tasks that require

sustained mental effort

often loses things necessary for tasks or activities

is often easily distracted by extraneous stimuli

is often forgetful in daily activities

Hyperactivity and impulsivity: Six (or more) of the following symptoms

have persisted for at least 6 months to a degree that is inconsistent

with and that negatively impacts directly on social and academic/

occupational activities

often fidgets with or taps hands or feet or squirms in seat

often leaves seat in situations when remaining seated is expected

often runs about or climbs in situations where it is inappropriate

often unable to play or engage in leisure activities quietly

is often “on the go,” as if “driven by a motor”

often talks excessively

often blurts out an answer before a question has been completed

often has difficulty waiting his or her turn

often interrupts or intrudes on others

Several inattentive or hyperactive-impulsive symptoms were present

prior to age 12 years.

Several inattentive or hyperactive-impulsive symptoms are present in

two or more settings.

There is clear evidence that the symptoms interfere with, or reduce the

quality of, social, academic, or occupational functioning.

Specify whether:

314.01 (F90.2) Combined presentation: If both Criterion A1 (inattention)

and Criterion A2 (hyperactivity-impulsivity) are met for the past 6 months.

314.00 (F90.0) Predominantly inattentive presentation: If Criterion

A1 (inattention) is met but Criterion A2 (hyperactivity-impulsivity)

is not met for the past 6 months.

314.01 (F90.1) Predominantly hyperactive/impulsive presentation:

If Criterion A2 (hyperactivity-impulsivity is met and Criterion

A1 (inattention) is not met for the past 6 months (American

Psychiatric Association, 2013, pp. 59–60).

THE DIAGNOSTIC FEATURES

According to the American Psychiatric Association (AAP),

The essential feature of attention-deficit/hyperactivity disorder

(ADHD) is a persistent pattern of inattention and/or hyperactivity-impulsivity

that interferes with functioning or development. Inattention

manifests behaviorally in ADHD as wandering off task, lacking

persistence, having difficulty sustaining focus, and being disorganized

and is not due to defiance or lack of comprehension. Hyperactivity

refers to excessive motor activity (such as a child running about) when

it is not appropriate, or excessive fidgeting, tapping, or talkativeness.

. . . Impulsivity refers to hasty actions that occur in the moment

without forethought and that have high potential for harm to the individual

. . . Impulsivity may reflect a desire for immediate rewards or an

inability to delay gratification. Impulsive behaviors may manifest as

social intrusiveness (e.g., interrupting others excessively) and/or as

making important decisions without consideration of long-term consequences

(American Psychiatric Association, 2013, p. 61).

How do the symptoms of ADHD present themselves in preschool children? Check out my next blog post!

I am Back! Let Us Learn about Preschool ADHD

For the past several years, I have been writing my new book. It is entitled, Positive Behavior, Social Skills, and Self-Esteem: A Parent's Guide to Preschool ADHD, published by Rowman and Littlefield.

It is available at https://smile.amazon.com/Positive-Behavior-Social-Skills-Self-Esteem/dp/1475850409/ref=sxts_sxwds-bia?keywords=preschool+adhd&pd_rd_i=1475850409&pd_rd_r=c682dcd5-ba39-45cb-a611-d331566748f4&pd_rd_w=BQY1R&pd_rd_wg=R3rNa&pf_rd_p=a5491838-6a74-484e-8787-eb44c8f3b7ff&pf_rd_r=THWJQ6CS87WTY2S7VVPH&psc=1&qid=1571770958 

I am back now, and am ready to help parents who have preschool children with ADHD and educators who teach them to learn how to encourage positive behavior, social skills and positive self-esteem, as my title states!  First of all, how do parents know if their preschool child has a diagnosis of ADHD?

HOW DO I KNOW IF MY PRESCHOOL CHILD HAS A DIAGNOSIS OF ADHD?

Parents who have a child of the preschool age who suspect that he has ADHD typically know from a young age that their child’s behavior looks different from another child’s behavior of the same age. Even though we try not to label a child and try to look at his behavioral symptoms instead of a diagnosis, many preschool children exhibit behaviors that resemble the symptoms of ADHD. The difference in these children’s behavior is the degree to which they exhibit hyperactive or inattentive behaviors. I have seen many children who are jumping off of the couch one minute seemingly out of control, who are sitting looking at a book with focus and concentration the next minute.

This inconsistency of behavior also makes it somewhat difficult to make a clear diagnosis of ADHD in preschool children. However, the correct diagnosis is based upon the intensity and the persistence of these symptoms, as well as how their behavior impacts their interactions with other people in their lives. In addition, a diagnosis of ADHD may not be determined unless the child exhibits socially inappropriate behavior in at least two settings.

What are the symptoms and/or the behavior that the Diagnostic and Statistical Manual of Mental Disorders, 5^th Edition, (DSM-5) states is present in a preschool child with ADHD, as is consistent with the accepted definition? Read on to my next blog post!

* For clarity purposes, I am referring to a preschool child with a diagnosis of ADHD as "he" instead of "she" in my blog, even though clearly there are many girls who have a diagnosis of preschool ADHD, as well.