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12. Social problems in ADHD


12. Social problems in ADHD

12.1. Impulsive disregard of social rules in ADHD

ADHD sufferers are more likely to interfere in the conversations/activities of others without being asked. This correlates with impulsivity and therefore occurs more frequently in ADHD-HI and ADHD-C
Impulsive disregard of social norms and rules leads to social rejection.

12.2. Social withdrawal / social phobia in ADHD

12.2.1. Social withdrawal as an ADHD symptom

Social withdrawal is a limitation in social contacts because either no positive or even negative response is expected (⇒ Rejection Sensitivity) or the need for security and control is too great (too much closeness, ambivalence, closeness-distance pendulum)12

Social withdrawal of ADHD sufferers, which can go as far as social phobia in front of people, seems to correlate with increased being an outsider only in girls3 and has several mechanisms as its cause.

Adult ADHD sufferers performed equally well on Theory of Mind, generating the “best” solution to problematic social situations, and selecting the optimal solution from a range of alternatives in a study of social problem-solving ability. The general ability to generate problem solutions fluently and freely was not tied to executive functions or to the trait of empathy. It was only impaired by fear of social interaction.4
Fear of social contact (social phobia) significantly inhibits social skills.
In contrast, other studies have found reduced ability to recognize the emotions of others (theory of mind problems) in adults with ADHD, which correlated with executive problems.56

In addition, the negative reactions of the environment to one’s symptoms lead to a negative evaluation of social contacts.
According to the results of our symptom test, the symptom of social phobia occurs approximately equally frequently in 73% of ADHD-HI sufferers (with hyperactivity) and 70% of ADHD-I sufferers, but its severity is significantly weaker in ADHD-HI sufferers with 0.63 than in ADHD-I sufferers with 0.73 (on a scale of 0 to 1). Only 15% of nonaffected individuals reached the symptom threshold. ADHD-I sufferers also achieved 98% of the symptom anxiety cutoff (with a severity of 0.89), compared to 93% of ADHD-HI sufferers with a severity of 0.84.

In addition, the excessively wide-open stimulus filter with the resulting increased sensitivity is likely to reduce the limits of tolerable stimuli to such an extent that a withdrawal from third-party influences perceived as stressful represents a plausible defense mechanism. Many heightened-sensitivity people report that they flee parties after a certain time or retreat to quieter rooms (kitchen, balcony, WC).

Neurophysiologically, activation of oxytocin receptors in the ventral tegmentum is essential for reward-driven interest in social contact.7

Interestingly, social competence seems to be higher in girls and women with ADHD than in boys and men. In autism spectrum disorders, this relationship was reversed and age-dependent.8

12.2.2. Social withdrawal as a symptom of stress

Social withdrawal is known as a typical symptom of severe stress.910 A restriction of social contacts during stress is attributed to the fact that:12

  • No positive or even negative response is expected (avoidance or aggression, Rejection Sensitivity)
  • The need for security and control is too great (too much closeness, ambivalence, closeness-distance pendulum)

Increased withdrawal behavior is a direct effect of the stress hormone CRH.1112
An increasing restriction of social contacts is a typical symptom of burnout.13

12.3. Loneliness as an ADHD symptom

Loneliness is often a consequence of social withdrawal and tends to be associated with increased introverted symptoms in ADHD.14 Loneliness is thus more likely to occur in ADHD-I than in ADHD-HI.

  1. Braun, Helmeke, Poeggel, Bock (2005): Tierexperimentelle Befunde zu den hirnstrukturellen Folgen früher Stresserfahrungen. In: Egle, Hoffmann, Joraschky (Hrsg.) Sexueller Missbrauch, Misshandlung, Vernachlässigung. 3. Aufl., S. 44 – 58

  2. Eckerle (2010): Neurobiologische Forschungsergebnisse über den Zusammenhang zwischen Hochbegabung und psychischen Störungen (z.B. ADS) in der Adoleszenz.

  3. Becker, Kneeskern, Tamm (2019): Social anxiety is associated with poorer peer functioning for girls but not boys with ADHD. Psychiatry Res. 2019 Aug 17;281:112524. doi: 10.1016/j.psychres.2019.112524.

  4. Thoma, Sonnenburg, Marcinkowski, Juckel, Edel, Suchan (2019): Social problem solving in adult patients with attention deficit hyperactivity disorder. Psychiatry Res. 2019 Dec 6:112721. doi: 10.1016/j.psychres.2019.112721.

  5. Tatar, Cansız (2020): Executive function deficits contribute to poor theory of mind abilities in adults with ADHD. Appl Neuropsychol Adult. 2020 Mar 18:1-8. doi: 10.1080/23279095.2020.1736074. PMID: 32186409. n = 80

  6. Nejati V (2022): Reading mind from the eyes in individuals with attention deficit-hyperactivity disorder (ADHD): A meta-analysis. Expert Rev Neurother. 2022 Oct;22(10):889-896. doi: 10.1080/14737175.2022.2151899. PMID: 36420829., METASTUDY, n = 1.620

  7. Song, Borland, Larkin, O’Malley, Albers (2016): Activation of oxytocin receptors, but not arginine-vasopressin V1a receptors, in the ventral tegmental area of male Syrian hamsters is essential for the reward-like properties of social interactions; Psychoneuroendocrinology. 2016 Sep 9;74:164-172. doi: 10.1016/j.psyneuen.2016.09.001

  8. Mahendiran, Dupuis, Crosbie, Georgiades, Kelley, Liu, Nicolson, Schachar, Anagnostou, Brian (2019): Sex Differences in Social Adaptive Function in Autism Spectrum Disorder and Attention-Deficit Hyperactivity Disorder. Front Psychiatry. 2019 Sep 12;10:607. doi: 10.3389/fpsyt.2019.00607. eCollection 2019.

  9. Hebold (2004): Stress und Stressverarbeitung bei Kindern und Jugendlichen, in: Schluchter, Tönjes, Elkins (Hrsg.) (2004): Menschenskinder! Zur Lage von Kindern in unserer Gesellschaft. Band zur Vortragsreihe des Humanökologischen Zentrums der BTU Cottbus, Seite 86

  10. Satow (2012): Stress- und Coping-Inventar (SCI); PSYNDEX Test-Nr. 9006508; Test im Testinventar des Leibniz‐Zentrum für Psychologische Information und Dokumentation (ZPID).

  11. Rensing, Koch, Rippe, Rippe (2006): Mensch im Stress; Psyche, Körper Moleküle, Seite 96, Seite 151

  12. Egle, Joraschky, Lampe, Seiffge-Krenke, Cierpka (2016): Sexueller Missbrauch, Misshandlung, Vernachlässigung – Erkennung, Therapie und Prävention der Folgen früher Stresserfahrungen; 4. Aufl., S. 45

  13. Faust: Erschöpfungsdepression; Seelische Störungen erkennen, verstehen, verhindern, behandeln; PSYCHIATRIE HEUTE; Arbeitsgemeinschaft Psychosoziale Gesundheit

  14. Smit, Mikami, Normand (2020): Correlates of Loneliness in Children with Attention-Deficit/Hyperactivity Disorder: Comorbidities and Peer Problems. Child Psychiatry Hum Dev. 2020 Jan 24;10.1007/s10578-020-00959-w. doi: 10.1007/s10578-020-00959-w. PMID: 31981083.