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Although
an enormous amount of research on ADHD has been conducted over the years, the
vast majority has examined issues related to diagnosis, treatment, or behavioral
functioning. As a result, we know relatively little about other important
aspects of functioning that may be affected in children with ADHD. For
example, the very important domain of emotions has been relatively neglected.
Specifically, there is a lack of research on empathy in children with ADHD.
Despite the shortage of research studies in these important areas, the
comprehensive theory of ADHD that was recently proposed by Dr. Russell Barkley
contains specific predictions about how empathy and emotional responsiveness
would be affected in individuals with ADHD.
Barkley proposed that because of the deficit in behavioral inhibition that he
believes is central to ADHD (the ability to refrain from immediately
responding to stimuli in order to assess the situation and consider
alternatives), individuals with ADHD have difficulty regulating their
emotions. One consequence of this difficulty in emotional regulation is lower
levels of empathy, meaning reduced awareness/appreciation for the needs,
feelings, and opinions of others as well as a reduced ability to evaluate
social events objectively.
The ability to identify and relate to what another person feels can help to
regulate one’s behavior. Therefore, lower levels of empathy could contribute
significantly to the behavioral symptoms displayed by individuals with ADHD.
For example, if a child knows that a certain act will hurt his mother’s
feelings and imagines the hurt his mother will feel, he may refrain from
engaging in that behavior. However, if this capacity were less well developed
in children with ADHD, the hurtful behavior would be more likely to occur.
For this reason, it is important to know whether children with ADHD are
deficient in empathy skills, as these skills may be significant determinants
of other behaviors.
This question was addressed in a study published recently in the
"Journal of Consulting and Clinical Psychology" (Braaten, E.B. and
Rosen, L.A., pp. 313-321, 2000). Participants in this study included 24 boys
diagnosed with ADHD and 19 comparison boys. All boys were between the ages of
6 and 12. During a 2-hour testing session (none of the boys with ADHD were on
medication at the time of testing), each boy was administered a test that is
frequently used to assess children’s empathic responsiveness. First, they
were read eight short stories about a fictitious child who is experiencing
different types of emotions, some positive and some negative. Also, several
of the stories depict characters that experience conflicting emotions.
After each story, participants were asked how the character in the story was
feeling, how the characters made them feel, and why he (the participant) felt
that way. Higher empathy scores were obtained when children consistently
indicated that they felt the same as the child in the story. Higher scores
were also obtained when participants explained their feelings in relation to
the experience of the story character ("I feel sad because his favorite
toy was lost.") rather than providing an egocentric explanation (such as,
"I feel sad because I lost a toy too.").
In addition to this measure of empathic responsiveness, the authors were
interested in the frequency with which participants displayed a variety of
emotions. These different emotions included interest, joy, sadness, fear,
shame, and guilt. This was evaluated by having the boys' parents rate how
often they observed their sons to display behaviors (facial expressions, body
posture, and tone of voice) indicative of each emotion during the previous
two weeks.
Results
The results indicate that
compared to boys without ADHD, the boys with ADHD were significantly less
likely to indicate that their own feelings matched those they attributed to
the story character. This overall difference occurred primarily because ADHD
boys were less likely to match the emotion of the story character when
negative emotions were depicted. In addition, the ADHD boys were
significantly less likely to explain their feelings in reference to what the
story character was experiencing and instead provided explanations of their
feelings that were more egocentric.
According to the parental ratings of emotional expression, boys with ADHD
were rated as having significantly higher scores for the negative emotions,
but did not differ for the positive emotions. In particular, parents of ADHD
boys reported that their sons were significantly more likely to display signs
of sadness, anger, and guilt.
Summary And Implications
Overall, the results of this study suggest that boys with ADHD are less
likely than non-ADHD boys to feel badly when they observe others in difficult
circumstances, and are also less likely to report that their own feelings are
directly affected by what happens to others. According to their parents, ADHD
boys are also more likely than non-ADHD boys to display behaviors that
indicate a variety of negative emotions. What is interesting about this
particular combination of findings is the suggestion that although boys with
ADHD may be more prone to experience negative emotions themselves, they are
apparently less likely to empathize with the negative emotional experience of
others. In fact, one possible explanation for the latter finding is that ADHD
boys are reluctant to empathize with others' negative emotional experiences
in an effort to protect themselves from experiencing negative feelings. This,
of course, is highly speculative.
These findings are consistent with the predictions about emotional
functioning in children with ADHD that stem from Barkley's theory. Several
practical consequences of these findings are noteworthy as well. First,
helping children with ADHD develop their empathic abilities may need to be
included as an essential aspect of social skills training programs. Also, the
parental ratings data highlights that the emotional experience for many boys
with ADHD may be much more negative than that of their peers. This
underscores the need to carefully attend to the emotional experience of
children with ADHD rather than focusing solely on working to improve their
behavioral and academic functioning. When children are getting into
consistent trouble and acting in aversive ways, in can be easy to lose sight
of this important perspective.
One concrete way that parents can help is to make a concerted effort to spend
positive time with their child each day. In many families that I have worked
with, daily life with an ADHD child was so filled with struggle that all of
the parents' time and energy was devoted to disciplining and making sure that
certain important things got done. As a result, little time was devoted to
the essential experience of just trying to have a good time with their child.
One can easily imagine how this could contribute to a more negative emotional
experience for children and their parents. Putting aside even 15 minutes a
day to focus solely on having fun with your child can greatly help to build
and maintain good parent-child relations and enhance the emotional experience
of both parties. This can also help children learn how to share some of their
negative emotions with parents, thus providing parents with a good
opportunity to model empathic skills that can assist the development of
similar abilities in their children.
Despite the interesting and important results from this study, there are
several limitations. First, because the sample was restricted to boys,
one cannot assume that similar results would have been obtained with girls
who have ADHD. Also, the findings should not be generalized to boys outside
of the age range used in this study. As with any study that employs a
relatively small sample, replication is important. Finally, one should not
assume that the findings of this study apply to all boys with ADHD even
though they may be characteristic of ADHD boys overall.
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