Specific AD/HD Symptoms and Social Skills

Specific AD/HD Symptoms and Social Skills

Inattention

Tips for identifying subtext:¹⁴

• Look for clues in your environment to help you decipher the subtext. Be mindful of alternative possibilities. Be observant.
• Be aware of body language, tone of voice, behavior, or the look of someone's eyes to better interpret what they are saying.
• Look at a person's choice of words to better detect the subtext. ("I'd love to go" probably means yes. "If you want to" means probably not, but I'll do it.)
• Actions speak louder than words. If someone's words say one thing but their actions reveal another, it would be wise to consider that their actions might be revealing their true feelings.
• Find a guide to help you with this hidden language. Compare your understanding of reality with their understanding of reality. If there is a discrepancy, you might want to try the other person's interpretation and see what happens, especially if you usually get it wrong.
• Learn to interpret polite behavior. Polite behavior often disguises actual feelings.
• Be alert to what others are doing. Look around for clues about proper behavior, dress, seating, parking and the like.

A momentary lapse in attention may result in the adult with AD/HD missing important information in a social interaction. If a simple sentence like "Let's meet at the park at noon," becomes simply "Let's meet at noon," the listener with AD/HD misses the crucial information about the location of the meeting. The speaker may become frustrated or annoyed when the listener asks where the meeting will take place, believing that the listener intentionally wasn't paying attention and didn't value what they had to say. Or even worse, the individual with AD/HD goes to the wrong place, yielding confusion and even anger in the partner. Unfortunately, often neither the speaker nor listener realizes that important information has been missed until it is too late.

A related social skills difficulty for many with AD/HD involves missing the subtle nuances of communication. Those with AD/HD will often have difficulty "reading between the lines" or understanding subtext. It is difficult enough for most to attend to the text of conversations without the additional strain of needing to be aware of the subtext and what the person really means. Unfortunately, what is said is often not what is actually meant.

Assessment of Social Skills

Interviews and self-report questionnaires are the primary tools for assessing social skill deficits and interpersonal interaction problems in adults with AD/HD. During the course of a diagnostic evaluation for AD/HD (see the information and resource sheet entitled, "Diagnosis of AD/HD in Adults"), a mental health professional will thoroughly assess the social interactions of the adult. When questionnaires are used, it is important to include both a self-report by the individual with AD/HD and reports by spouses, significant others, and friends on a comparable version of the questionnaire. The questionnaire may include the following types of items:

• Difficulty paying attention when spoken to, missing pieces of information
• Appears to ignore others
• Difficulty taking turns in conversation (tendency to interrupt frequently)
• Difficulty following through on tasks and/or responsibilities
• Failure to use proper manners
• Missed social cues
• Disorganized lifestyle
• Sharing information that is inappropriate
• Being distracted by sounds or noises
• Become flooded or overwhelmed, shutting down
• Disorganized or scattered thoughts
• Rambling or straying off topic during conversations
• Ending a conversation abruptly

Readers who wish to self-assess their social skills in depth should see the resource list at the end of this paper for further information.

Treatment Strategies

When the social skill areas in need of strengthening have been identified, obtaining a referral to a therapist or coach who understands how AD/HD affects social skills is recommended (see the coaching information and resource sheet for further discussion of coaching [coming soon]). Medications are often helpful in the management of AD/HD symptoms; in many cases, an effective dose of medication will give the adult with AD/HD the boost in self-control and concentration necessary to utilize newly acquired social skills at the appropriate time. However, medications alone are usually not sufficient to help gain the necessary skills (see the medication information and resource sheet for further discussion of medication [coming soon]).

As discussed earlier, social skills training for children and adolescents with AD/HD usually involves instruction, modeling, role-playing, and feedback in a safe setting such as a social skills group run by a therapist. In addition, arranging the environment to provide reminders has proven essential to using the correct social behavior at the opportune moment. These findings suggest that adults with AD/HD wishing to work on their social skills should consider the following elements when seeking an effective intervention. It is important to note that these treatment strategies are suggestions based on clinical practice, rather than empirical research.

• Knowledge. Oftentimes social skills can be significantly improved when there is an understanding of social skills as well as the areas in need of improvement. Reading books such as What Does Everybody Know That I Don't?¹⁴, ADD and Romance,¹⁵ or You, Your Relationship, & Your ADD ¹⁶ can provide some of that knowledge.
• Attitude. Individuals with AD/HD should have a positive attitude and be open to the growth of their social skills. It is also important to be open and appreciative of feedback provided by others.
• Goals. Adults with AD/HD may want to pick and work on one goal at a time, based on a self-assessment and the assessments of others. Tackling the skill areas one at a time allows the individual to master each skill before moving on to the next.
• The echo. Those who struggle with missing pieces of information due to attentional difficulties during conversation may benefit from developing a system of checking with others what they heard. "I heard you say that . . . Did I get it right? Is there more?" Or an individual with AD/HD could ask others to check with them after providing important information. "Please tell me what you heard me say." In this way, social errors due to inattention can be avoided.
• Observe others. Adults with AD/HD can learn a great deal by watching others do what they need to learn to do. They may want to try selecting models both at work and in their personal lives to help them grow in this area. Television may also provide role models.
• Role play. Practicing the skills they need with others is a good way for individuals with AD/HD to receive feedback and consequently improve their social skills.
• Visualization. Visualization can be used to gain additional practice and improve one's ability to apply the skill in other settings. Those who need practice in social skills can decide what they want to do and rehearse it in their minds, imagining actually using the skill in the setting they will be in with the people they will actually be interacting with. They can repeat this as many times as possible to help "overlearn" the skill. In this manner, they can gain experience in the "real" world, which will greatly increase the likelihood of their success.
• Prompts. Adults with AD/HD can use prompts to stay focused on particular social skill goals. The prompts can be visual (an index card), verbal (someone telling them to be quiet), physical (a vibrating watch set every 4 minutes reminding them to be quiet), or a gesture (someone rubbing their head) to help remind them to work on their social skills.
• Increase "likeability." According to social exchange theory, people maintain relationships based on how well those relationships meet their needs. People are not exactly "social accountants," but on some level, people do weigh the costs and benefits of being in relationships. Many with AD/HD are considered to be "high maintenance." Therefore, it is helpful to see what they can bring to relationships to help balance the equation. Investigators have found that the following are characteristics of highly likeable people: sincere, honest, understanding, loyal, truthful, trustworthy, intelligent, dependable, thoughtful, considerate, reliable, warm, kind, friendly, happy, unselfish, humorous, responsible, cheerful, and trustful. ³ Developing or improving any of the likeability characteristics should help one's social standing.