Why do so many children and adults with ADD/ADHD seem to lack the normal social graces or ability to make and keep friends, and what can be done about it?

Sandra’s parents looked across the table at me with a deep sadness in their eyes.

“We can handle her struggles with academics,” said Bonnie. “She’s in a private school and has a tutor, and is learning how to learn. But at twelve years old she should know how to make friends.”

“It’s even worse than that,” interjected Joe. “Whenever it looks like she might be making a new friend, she invariably ruins the friendship. She doesn’t attend to the other kids’ needs. She almost frantic about other kids, wanting them to like her, but she has to be the center of attention, she’s always bouncing around, and the result is that she sabotages any possibility for a friendship to develop.”

Bonnie and Joe were not incompetent parents, and ADHD wasn’t a new idea for them. Joe had been diagnosed almost a decade earlier, in his thirties, and Bonnie - a clinical psychologist who runs a shelter for battered women - had both academic and clinical exposure to it.

Bonnie added, “It really makes you think that maybe those who say ADHD is a mental illness are right. I mean, why else would Sandra have failed to learn social skills?”

And here we came to the core of the issue. Why, indeed, are so many ADHD children and adults relatively incompetent at social interactions?

Conventional wisdom is so firmly entrenched in the pathology view of ADHD that other options are generally not even considered. When the MTA study was done of the relative efficacy of therapy versus medication for schoolchildren, the type, quality, and style of the children’s instruction in school wasn’t even considered. (In fact the teachers were both paid a stipend and assured explicitly that their performance and the school’s teaching styles would not be evaluated in any way.)

The result, of course, is predictable. If you’re only looking for one thing - in this case, evidence that supports a theory of a mental disorder - then there is little doubt you can easily design studies to find it, even if it’s not there.

“Bonnie,” I said, “what was your worst day in the past year, the one that really hit your self-esteem the hardest?”

She thought for a moment, then, frowning, said in a soft voice, “It was when our agency brought in an outside consultant to do evaluations, and he concluded that I wasn’t doing my job right. He did what he called a 360 degree evaluation, and solicited feedback from both the people funding our program, the people using it, and our staff. Everybody got to criticize me, although they called it a critique. And then he shared with me the things people said, and some of them weren’t all that flattering. I know he was trying to be constructive, but I was devastated. I was depressed for a week.” She looked at her hands, which were fists on the table, and relaxed them with an effort. “I guess I’m still upset about it.”

“How would you perform if that happened to you every single day?” I said.

Her eyes widened. “I’d be a mess. I’d quit my job.”

“What if you couldn’t quit your job? What if you were told the police would come and get you if you tried to?”

“You’re kidding, right?”

“No, I’m not kidding,” I said. “And you have all the mental and emotional resources of a grown-up adult, and training in these things as well. What if you were six years old?”

“Ahhhh,” she said, leaning forward on the table. “Now I get it. But what does that have to do with Sandra not knowing how to make friends?”

“I know,” Joe said. “I remember how terrible school was. To this day, I still feel like a fraud whenever I’m successful, because they so managed to convince me I was no good.” He turned to me. “She was so wounded by school during the early years when she should have been learning social skills that she wasn’t available to learn them. Her self-esteem was so low she couldn’t even imagine herself interacting with the other kids on an equal basis. Is that what you’re saying?”

“It’s exactly what I’m saying,” I said. “The style of instruction our schools use - including most of our private schools - is so dissonant with the style of learning these children have that they can’t succeed. It’s a set-up. And when they don’t succeed - even in the first grade - the teachers don’t question their own style of teaching. After all, it works with other kids: it must be the child’s fault. So the child is blamed for her own failure. We try to sugar coat it by calling it a diagnosis, but she knows she’s being blamed. It’s her fault. And every single day in school is, for her, like Bonnie’s worst day in the office. Every day. Over and over and over. Year after year after year. When you think about it that way, it’s amazing she learns anything and that she even developed the most rudimentary of social skills. She’s the victim of severe, ongoing, institutional child abuse. And she’s responding in the way that many abused children respond: she’s shutting down in some times and situations, and becoming reactive at other times.”

“So what’s the solution?” Joe said.

“It’s twofold. First, stop the pain. Get her out of a school situation where there’s only one, limited style of teaching that doesn’t match her style of learning. Get her, instead, into an alternative school or homeschool her. Anything is better than the wounds that are being inflicted on her right this moment.

“And, second, start systematically teaching her the social skills she missed learning as a child because she was in so much pain and so ostracized that she wasn’t available to learn them when the other kids did.”

“How do we do that?” Joe asked.

“There are lots of books and trainings on social skills,” I said, “but I’ve always thought the best was written by Dale Carnegie three-quarters of a century ago. It’s a book titled ‘How to Win Friends and Influence People.’ It contains thirty specific techniques that embody the best of interpersonal skills. Every week, read her one of the chapters, and give her the assignment of trying out that technique on somebody at school. When she reports back on the result, she gets a reward. By the time you’ve finished the book, I guarantee she will be more socially competent.”

“It’s that simple?” Joe said.

“It could be,” Bonnie said. “Social skills are learned, not born. Every culture has different versions of them. And interactions with groups of non-related peers are learned mostly in school, in the primary grades. If she was in that much pain during those years - and when I think back to how many times she begged me not to send her to school I realize she clearly was - she probably just missed that developmental stage because of all that pain.”

“And it’s never too late to learn,” I added. “The success of the Dale Carnegie Course for adults - where very week you have to try out two of the techniques and report back to the class the following week - proves it.”

Resource:
Montessori schools information

Homeschooling information:
Oak Meadow school

Dale Carnegie information:
Summary of Carnegie's teachings
The Dale Carnegie organization
Dale Carnegie's book on social skills

(Note: I’ve changed the names of the people in this story to protect their privacy, and built into the conversation parts and pieces of other conversations with other parents. This is more of a teaching story than an exact transcript of a conversation.)