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12. Social problems with ADHD


12. Social problems with ADHD

People with ADHD often show impulsive behavior by interfering in the conversations and activities of others without being asked. Impulsiveness goes hand in hand with hyperactivity (in adults: inner restlessness). The disregard for social norms and rules often leads to social rejection.
Social withdrawal is a common symptom of ADHD. It arises for various reasons, e.g. because no positive feedback is expected or the need for security and control is too great. Girls with ADHD are more likely to show social withdrawal and have more difficulty being recognized. Adult people with ADHD have difficulty solving problems in social situations, especially due to fears of social interaction.
ADHD can lead to a reduced ability to recognize the emotions of others as well as increased social anxiety, which naturally exacerbates social problems.
Loneliness often occurs as a consequence of social withdrawal and is associated with increased introverted symptoms.
ADHD is associated with an increased risk of social exclusion.

12.1. Impulsive disregard of social rules in ADHD

People with ADHD are more likely to interfere in the conversations / activities of others without being asked. This correlates with impulsivity and therefore occurs more frequently with ADHD-HI and ADHD-C
Impulsive disregard for social norms and rules leads to social rejection.
Children with ADHD often exhibit inappropriate social behavior.1

12.2. Problems with friendships

12.2.1. Problems with mutual friendships

People with ADHD often suffer from social problems in interpersonal relationships.234
This symptom usually persists throughout the lifetime of the Disorder.5
Adults with ADHD often have problems with friendships and poorer social interaction.6

12.2.2. Relationship problems

Adults with ADHD are more likely to have poorer intimate relationships and show poorer marital adaptability.78

12.2.3. Problems with empathy and theory of mind

Children with ADHD show impairments in empathy.9
Children with ADHD showed significantly poorer Theory of Mind (ToM) performance, which appears to correlate with executive functions problems.10 MPH normalized ToM performance to the level of non-affected individuals.11 MPH also improves empathy in persons with ADHD.12
Adults with ADHD were also found to have impairments in empathy, but no impairments in ToM.13

12.2.2. Social withdrawal / social phobia with ADHD Social withdrawal as an ADHD symptom

Social withdrawal is a restriction in social contacts because either no positive or even negative feedback is expected (⇒ Rejection sensitivity) or the need for security and control is too great (too much closeness, ambivalence, closeness-distance pendulum).1415 Other studies suggest a connection between an increased desire for withdrawal and loneliness and internalizing symptoms.16
Social withdrawal of people with ADHD, which can go as far as social phobia in front of people, apparently correlates only in girls with an increased feeling of being an outsider17 and has several mechanisms as its cause.
Adult people with ADHD 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 linked to executive functions or the trait of empathy. It was only impaired by fear of social interaction.18
Fear of social contact (social phobia) significantly inhibits social skills.
In contrast, other studies found reduced ability to recognize the emotions of others (theory of mind problems) in adults with ADHD, which correlated with executive problems.1920
In addition, the negative reactions of the environment to one’s own symptoms lead to a negative evaluation of social contacts.
According to the results of our symptom test, the symptom of social phobia occurs with approximately the same frequency in 73% of people with ADHD-HI (with hyperactivity) and 70% of people with ADHD-I, but its severity is significantly weaker in people with ADHD-HI at 0.63 than in people with ADHD-I at 0.73 (on a scale of 0 to 1). Only 15% of those not affected reached the symptom threshold. In addition, 98% of people with ADHD-I reached the cut-off of the symptom anxiety (with a severity of 0.89), compared to 93% of people with ADHD-HI with a severity of 0.84.
In addition, the overly open stimulus filter with the resulting increased sensitivity is likely to reduce the limits of tolerable stimuli to such an extent that withdrawing from the perceived stressful influences of third parties is a plausible and necessary defense mechanism. Many people with heightened sensitivity report that they flee from parties after a certain time or withdraw to quieter rooms (kitchen, balcony, toilet).
Neurophysiologically, the activation of oxytocin receptors in the ventral tegmentum is essential for a reward-driven interest in social contact.21
Interestingly, social skills appear to be higher in girls and women (as everywhere) than in boys and men with ADHD. In autism spectrum disorders, this correlation was reversed and age-dependent.22
ADHD is associated with an increased risk of social exclusion.23 This could be independent of a tendency towards social withdrawal on the part of the person with ADHD themselves and could add up to this effect. Social withdrawal as a symptom of stress

Social withdrawal is known to be a typical symptom of severe stress.2425 A restriction of social contacts during stress is attributed to the fact that:1415

  • No positive or even negative response is expected (avoidance or aggression, ⇒ rejection sensitivity) 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.2627
    An increasing restriction of social contacts is a typical symptom of burnout.28

12.3. Loneliness as an ADHD symptom

Loneliness is an ADHD symptom29 and often a consequence of social withdrawal and tends to be associated with increased introverted symptoms in ADHD.30 Loneliness is therefore more likely to occur in ADHD-I than in ADHD-HI.

12.4. Social jet lag due to shifted daily rhythm

As up to 80 % of people with ADHD have a circadian rhythm that is shifted backwards31, the entire biological daily routine is shifted compared to most other people. Consequences of this often lead to social problems (for which lack of sleep is only one of several causes), which are referred to as social jet lag. The term social jet lag was first coined by Roenneberg et al. in 2013 and refers to the mismatch between biological and social time rhythms.32
More on this under Sleep problems with ADHD in the following article.

12.5. Problems with social cognition (recognition of social signs)

ADHD is associated with more frequent deficits in social cognition. This includes impairments in social cognition related to the perception of faces and prosody (subtleties in the meaning of stress, intonation and relative duration of sounds and syllables in spoken language). These recognition deficits can further impair the quality of social functioning and exacerbate social problems.33343536 In FASD, this mechanism appears to be even more pronounced.37

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  16. Inci Izmir SB, Aktan ZD, Ercan ES (2023): The relationships of neuropsychological factors and loneliness preference in children with attention deficit hyperactivity disorder and cognitive disengagement syndrome. Appl Neuropsychol Child. 2023 Dec 11:1-10. doi: 10.1080/21622965.2023.2291448. PMID: 38079419.

  17. 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.

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  19. 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

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