Are you Trying to Decide if a Child with ADHD you know has Social Skills Problems?

Perhaps some examples of social skills deficits/problems might be helpful. Read and see if the child in question in your classroom or home exhibits any of these behaviors.

 

Among some examples of social skills deficits are the following, accompanied by the specific behaviors characterizing these deficits below, so please keep reading:

 

✱ Deficits in social perception and social cognition that inhibit students’ abilities to interact with others

✱ Lack of consequential thinking

✱ Difficulty expressing feelings

✱ Difficulty in feeling empathy for others

✱ Difficulty delaying gratification (impulsive)

✱ Inappropriate grooming and hygiene

✱ Failure to understand and fulfill the role of listener

✱ Inability to take the perspective of another

✱ Less time spent looking and smiling at a conversational partner

✱ Unwilling to act in a social situation to influence the outcome

✱ Less likely to request clarification when given ambiguous or incomplete information

✱ Tendency to talk more or less

✱ More likely to approach teacher and ask inappropriate questions

✱ Less proficient in interpersonal problem solving. (Vaughn, Bos, & Schumm, 2007, p. 255)

 

Before you check to see if the children in question have social skills deficits, let me give you some specific behaviors that may occur if a child has these deficits:

 

✱ Difficulties in social perception: A child walks up to two children who are disagreeing and asks “Can I play?” Even though the child clearly sees the ongoing argument between the two children, he seemingly is unaware that they may be so involved with disagreeing that they may not consider including him at that moment. Additionally, they may become annoyed with him if he intercedes.

 

✱ Lack of consequential thinking: A child walks up to another and pulls the chair out from under him. The child who pulled the chair out does not realize that the child who was sitting on the chair will fall down on the floor, possibly hurting himself.

 

✱ Difficulty expressing feelings: A child pushes another one down and cannot say he was sorry.

 

✱ Difficulty delaying gratification: A child walks up to another who is using a shovel at a sand table. Instead of asking to use the shovel, he grabs it and knocks the child down. The child did not have the patience to wait until the other child finished with the shovel. Instead, he acted on impulse.

 

✱ Inappropriate grooming and hygiene: A child arrives at school with dirty hands wearing the same soiled clothes he wore the day before. He may not pay attention to how others view his physical appearance.

 

✱ Failure to understand and fulfill the role of listener: In conversations

with peers or adults, the child talks incessantly and continuously interrupts. He does not understand that when one person talks the other person listens.

✱ Inability to take the perspective of another: One child is upset because the other children did not permit him to play. The child with ADHD does not understand why that child is upset.

✱ Less time spent looking and smiling at a conversational partner: As a child is playing with another, the child with ADHD does not look or smile frequently at the other.

✱ Unwilling to act in a social situation to influence the outcome:

A child is playing by himself on the playground while watching the others play together. He is unwilling to go over to those children to ask them to play.

 

✱ Less likely to request clarification when given ambiguous or incomplete information: A teacher hands out permission slips and tells the children to return them to school signed by their parents. She does not tell the children when they

have to return it. The child with social skills deficits does not ask the teacher when to return the permission slip and, typically, forgets to hand it in to the teacher.

 

✱ Tendency to talk more or less: A child either talks too little or excessively to peers and adults.

 

✱ More likely to approach teacher and ask inappropriate questions: A teacher gives instructions on speaking out in class. She instructs the children to raise their hands when they have something important to ask her or to tell to the class.

The child with ADHD raises his hand and asks “Can we stand up in our seats and shout out our questions?”

 

✱ Less proficient in interpersonal problem solving: A child feels rejected by another child. He has not actually been rejected but does not understand how to go about trying to be friends. (Vaughn et al., 2007, p. 255)

How do you know if your Child has ADHD?

 

Typically, parents do not seemingly realize when certain symptoms are present in their child or adolescent. How can that be? We often see what we want to see, because to see the child or adolescent’s negative or inappropriate behavior is often too difficult to accept, nonetheless manage.

There has been so much talk lately about the overdiagnosis of ADHD. The fact that a child has a diagnosis or does not have a diagnosis does not matter to me. Instead, I look for persistent symptoms that interfere with (or as the new DSM states, impacts) the life of a child or adolescent with ADHD.

The operational word here is persistent. I am not talking about behaviors that the child exhibits once in a while, but rather, those that occur consistently over time. Some of the behaviors that parents should notice, as I state in my book[1] are the following, as adapted from the Conners Rating Scale:

✱ Restless in the “squirmy” sense

✱ Excitable, impulsive

✱ Fails to give close attention to details or makes careless

     mistakes in schoolwork, work, or other activities

✱ Is an emotional child

✱ Restless or overactive

✱ Does not appear to listen to what is being said to him

✱ Leaves seat in classroom or in other situations in which

     remaining seated is expected

✱ Inattentive, easily distracted

✱ Has difficulty waiting his turn

✱ Does not know how to make friends

✱ Fidgeting

✱ Disturbs other children

✱ Talks excessively

✱ Runs about in situations where it is inappropriate

✱ Has poor social skills

✱ Fidgets with hands or feet

 ✱ Demands must be met immediately—easily frustrated

✱ Blurts out answers to questions before the questions have

     been completed

✱ Interrupts or intrudes on others

✱ Easily distracted by extraneous stimuli

✱ Restless, always up and on the go

If you have noticed any of these behaviors, please feel free to send me your questions about how to manage those behaviors.

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[1] Rapoport, E. (2009). ADHD and Social Skills: A Step-by-Step Guide for Teachers and Parents. Maryland: Rowman and Littlefield Publishers.

Read my comments in the New York Journal News on April 2, 2013 on the arguable overdiagnosis of ADHD. Send me your thoughts.

ADHD may be overdiagnosed, Lower Hudson Valley experts fear

Study: 20% of H.S. boys classified with disorder

Apr 2, 2013 |

2Comments

 

Student in class / Getty Images/Comstock Images

Written by

Gary Stern

 

·         Filed Under

·         News

·         Westchester Medical Center In Valhalla

The decades-long debate over how many children have attention-deficit hyperactivity disorder — and whether those who do should be treated with medication — will only intensify with a new study that shows ADHD diagnoses soaring across the country.

Eleven percent of all school-age children have received a medical diagnosis of ADHD, including 20 percent of all high school boys, according to a New York Times analysis of a new national survey done by the U.S. Centers for Disease Control and Prevention.

Experts in the Lower Hudson Valley who deal with the diagnosis and resulting treatment needs say the figures may indicate too many children are being classified with the disorder.

“My impression is that it is definitely overdiagnosed,” said Eric Neblung, a Nyack-based psychologist and president of the New York State Psychological Association.

“A lot of times, the diagnosis is made by primary care physicians who aren’t trained to do it,” he said. “Parents may say that their son or daughter has trouble concentrating, and the physician will jump on it based on a quick screening. It could be typical adolescent behavior or other things like depression or anxiety.”

Neblung can’t see how one in five high school boys could have ADHD, a disorder characterized by inattentiveness and impulsiveness that is attributed to genetic and possibly environmental factors.

“The consensus traditionally is that it’s 1 to 10 percent, but even 10 percent is pushing it,” he said.

The Times report, based on a CDC telephone survey of more than 76,000 parents between February 2011 and June 2012, found that about 6.4 million children between 4 and 17 had received a diagnosis of ADHD at some point. This would represent a 16 percent increase from 2007, when the CDC did its last survey, and a 53 percent upsurge over the last decade.

The Times found that about two-thirds of all school-age children currently diagnosed with ADHD receive prescribed stimulants like Ritalin.

The CDC was not involved in the Times’ study, and a representative for the federal agency said it did not have enough information to assess the report. The CDC will have its own report analyzing the data later in the spring. The agency’s survey sought information on children’s overall health.

(Page 2 of 3)

 

Esta Rapoport of Chappaqua, the author of “ADHD and Social Skills: A Step-by-Step Guide for Teachers and Parents” (2009), said that many will be alarmed by the possible overdiagnosis of ADHD because they assume that children will be medicated. But this doesn’t have to be so.

“People become hysterical because of medication,” she said. “But we should be trying conservative methods first — teaching kids to self-regulate their behavior, to recognize when their behavior is inappropriate or when their academic work is ineffective. These kids struggle and need help, but they may not need medication.”

There is no simple test for ADHD, so it’s up to individual pediatricians, psychiatrists and psychologists to make the diagnosis.

A lot of factors have come into play to drive up the number of diagnoses, local experts said. Dr. Ronald Jacobson, chief of pediatric neurology at the Maria Fareri Children’s Hospital at Westchester Medical Center in Valhalla, said that it can be simpler and cheaper to get a prescription for Ritalin than to seek ongoing counseling.

“We should insist that patients have a comprehensive evaluation, but you don’t always see that,” he said. “You may want to think about therapy and counseling and medication or all of those, but many families don’t have the resources or care to make use of all options.”

State rules governing prescriptions also have an impact, Jacobson said, and a new New York law that takes effect in August will create a “real time” online registry that tracks who prescribes drugs to whom.

“People may be more thoughtful about what gets prescribed,” he said.

Regardless of whether the growing number of diagnoses are accurate, the higher profile of ADHD should produce more public awareness of the challenges facing children, said Christine Reinhard, executive director of the Rockland County Association for Learning Disabilities.

“There are not enough support services,” she said. “We need more services like specialized tutoring and skills training to help them identify strategies that might reduce the need for medication.”

(Page 3 of 3)

 

Robert Fraum, a psychologist who provides counseling for attention deficit disorder and hyperactivity in White Plains and Manhattan, said that it’s very difficult to judge the numbers without having another survey for comparison.

“But if the numbers turned out to be true, I wouldn’t be surprised,” he said. “You would be talking about a wide range. Not everyone with attention-deficit disorder is hyperactive. There are a lot of daydreamers who are inattentive and try to keep their restlessness down as much as they can.”

Fraum said that while school districts may resist the diagnosis, suburban parents can be very aggressive in seeking services that come in the wake of an ADHD diagnosis and other accommodations such as “extra time on the SAT exam.”

Michael Schulman, assistant director of special services for Southern Westchester Board of Cooperative Educational Services, said that schools have to be careful about how they explain children’s behaviors to parents and doctors.

“What is the message we send to parents when a student may be behaving outside the norm?” he said. “We need to see if these behaviors can be ameliorated in a simpler fashion without a diagnosis. If a child isn’t sitting still, is it ADHD or is the child bored?”

Come to Hear Me Speak!!!

Tonight, I will be arriving at the CHADD International Conference in San Francisco. I will be speaking in a breakout session this Friday at 9:00 A.M., so come to hear me speak. I will be speaking on ADHD and social skills, of course. 

The conference is being held at the San Francisco Airport Hyatt Hotel, so come on down.

Suggestions for Helping your Teenager with ADHD

Hopefully, the first time that both parents and teachers reach out to help teenagers with ADHD is not when they are teenagers. That being said, there are certain strategies that you can employ that will help to diminish the symptoms of ADHD.

First, it is imperative that you make sure that these teenagers get enough sleep. Teenagers always seem tired, as I am sure that you have witnessed when they get up at noon on the weekend. When they have not accumulated enough sleep, they do not have any reserve in order to retain patience and resolve.

Second, teenagers with ADHD, even more so than children with ADHD, need a structured routine with the same wake-up time, mealtime, and bedtime each and every day of the week. Additionally, they require clear, consistent rules and direction to guide their behavior at home as well as at school. They must be made responsible for keeping a precise, rigid schedule that will allow for the optimal success at homework, activities and chores. It would also be effective to set up a reminder schedule that is engaging and reflective of their interests.  

Third, they should be encouraged to learn a skill in which they have a particular strength. In that way, they will be more likely to make friends who also have a strength and interest in that skill, which will inadvertently build their self-esteem.

By making sure that teenagers get enough sleep, adhere to a consistent schedule and learn a particular skill, the symptoms of their ADHD will be diminished and they will develop positive self-esteem.

The Importanceof Teachers having Prior Knowledge of their Students with ADHD's Life Experiences

We read and/or have read many descriptions or models of ADHD, some of which have defined ADHD in a similar fashion and others that have offered varied descriptions. In my experience over many years of teaching children with ADHD as well as in my field research, I have found that most children with ADHD do not fit into a specific diagnostic category. Therefore, teachers must be cognizant of the specific and unique behavioral characteristics of each child with ADHD.

 Even though most children with ADHD are distractible, for example, not all are impulsive. Additionally, they do not all have social skills problems, although arguably, a large percentage of children with ADHD do.  However, some of these children may exhibit organizational difficulties, among other symptoms. Being familiar with the types of symptoms that a child exhibits reflects whether or not a teacher has background or prior knowledge of the child’s real-life experiences.

 If a teacher does have this knowledge, she will likely be able to help the child

with ADHD learn how to manage his behavior, so he can attend more effectively to his teacher’s instructions. Additionally, as part of that prior knowledge, a teacher will know if the child interrupts others’ conversations.

 If the teacher has prior knowledge of her student’s behavior, she will also be able to look into the possibility that other children may reject and ostracize the child with ADHD. If the child is indeed rejected by his peers, he will have a very difficult time trying to make friends.

  If he has difficulty making friends, his self-esteem will be negatively affected. Presumably, he will also have difficulty interacting with adults in a reciprocal way, which will generalize to his experiencing great difficulty obtaining a job.

 Therefore, when the teacher has prior knowledge of her student’s background, behavior and life experiences, she will be more successful in terms of helping a student with ADHD to succeed socially, and therefore, increase his positive self- esteem.

Methods to Teach Children with ADHD how to Introduce themselves to their Peers

Introducing oneself might be a skill that you think is something only adults should have within their repertoire. It is just as important for a child with ADHD to know how to introduce himself to others as it is for an adult to do so. The reason that

it is so important for a child with ADHD to do so is that if he does not introduce himself, he will feel that he does not know anyone in that situation, and he will not! It is no wonder why children with ADHD often feel that they are on the periphery of social interaction.

When children with ADHD feel isolated, they may exhibit socially inappropriate behavior. When a child with ADHD exhibits one socially inappropriate behavior, that behavior often sets off other socially inappropriate behaviors. Feeling isolated

and apart from a group of people might be a reason that a child with ADHD may exhibit socially inappropriate behavior. However, if he introduces himself, he may avoid that empty feeling of isolation. The social skill of introducing oneself may
incur some anxiety. However, the social isolation that results from not doing so is more painful.

The child with ADHD whom I observed in New England had a great deal of anxiety. He especially became anxious when he did not feel that he was familiar with the people who were interacting in close proximity to him. When I first met him, his mom was talking to me and had not introduced him to me as of yet. By the time she got around to introductions, he was already running in circles around us, jumping up and down and pulling on his mom’s dress.

A good thing for her to do before she got into any complex discussion with me might have been to whisper to him, “Michael, this lady is Dr. Rapoport. Tell her your name.” If he was too anxious to tell me his name, she could have just said “Say hello to her.” Greetings are a very important skill for children with ADHD to learn. Instead of greeting an oncoming person, children with ADHD or similar disorders seem to look down at their feet when they pass someone in the hall, for example.

 It is very important to teach a child with ADHD what to do after the initial nonverbal or verbal interaction, and that is to introduce himself to the other person. Make this task as simple as possible by teaching him to turn his body to the person, as I have said before, and then say his first and last name. For example, have the child with ADHD say, “Hi, my name is John Smith.” This social skill among others must be practiced. Using puppets is a good way for children to take on the role of another person and practice the social skill of introducing themselves.

One puppet says: “Hi, my name is Ellen Jones.” Then, hopefully, the other puppet says, “Hi, my name is Bill Evans.” You can have everyone in the classroom practice this skill. They can either use real puppets or paper bag puppets. If the child with ADHD has difficulty role playing using the puppets, then you can try finger puppets. If he still has too much anxiety to talk through role playing with puppets, you can ask him to draw the two people involved in the introduction.

The teacher can draw bubbles and write words within them herself, or have the child with ADHD write the words in the bubbles. Additionally, the teacher can place pictures within the bubbles for young children who cannot write. The best picture to use, of course, which is so easy with today’s digital photography, is the child’s own picture. (Please obtain permission from the child’s parents before you use any pictures of the child to teach him social skills!) If the child does not want to use his own picture, you can use pictures from magazines that you can glue onto craft sticks. Believe me, there are many ways to show a child with ADHD an image that will affect him in a way so he can learn to introduce himself to others, especially to other children. When they know how to introduce themselves to other

people, they can begin to learn to initiate conversations.