Reviewing peer functioning in school-aged girls with ADHD

Objectives: To gain insight into peer functioning difficulties in school-aged girls with ADHD. These girls experience many peer interaction problems and are at risk of peer rejection and victimisation. Although many studies have investigated problematic peer functioning in boys with ADHD, disregarding inherent sex differences. Hence this literature review focused on peer functioning in girls with ADHD compared to typically developing (TD) girls. Methods: A systematic electronic database search was performed to identify relevant literature comparing peer functioning in school-aged girls with ADHD to their TD counterparts. Peer relationship domains were grouped into ‘friendship’, ‘peer status’, ‘social skills/competence’, and ‘peer victimisation and bullying’. In total, thirteen studies were included in the review. Results: All included studies reported increased difficulties in the domains of friendship, peer interaction, social skills and functioning, peer victimization and externalising behaviour in girls with ADHD relative to TD girls. Studies consistently showed higher ‘social disability’, very high levels of peer victimisation (large effects), very high levels of social impairment and social skills deficits (large effects), lower rates of friendship participation and stability (small to medium effects) and higher levels of peer rejection (small to large effects) in girls with ADHD. The latter were predicted by girls’ conduct problems. Peer rejection in turn predicted poor social adjustment and multiple problem behaviours. Levels of pro-social behaviour varied across studies, but were mostly lower in girls with ADHD (small to large effects). Conclusions: Congruous evidence was found for peer functioning difficulties in the peer relationship domains of friendship, peer status, social skills/competence, and peer victimisation and bullying in girls with ADHD. Externalising and gender-atypical behaviours often seen in girls with ADHD put them at risk of impairment in many aspects of social functioning. These findings are discussed in light of a social learning model describing a negative spiral of problematic peer functioning and the development of social skills [Mikami and Hinshaw, J Abnorm Child Psychol, 2003].