Peer victimization in children with Attention-Deficit/Hyperactivity Disorder

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  • Psychology in the Schools, Vol. 46(2), 2009 C 2008 Wiley Periodicals, Inc.Published online in Wiley InterScience (www.interscience.wiley.com) DOI: 10.1002/pits.20358

    PEER VICTIMIZATION IN CHILDREN WITH ATTENTION-DEFICIT/HYPERACTIVITYDISORDER

    JUDITH WIENER

    Department of Human Development and Applied Psychology, Ontario Institute for Studies in Education,University of Toronto

    MEGHAN MAK

    Psychology Department, Mount Royal College

    This study explored peer victimization in 9- to 14-year-old children with and without Attention-Deficit/Hyperactivity Disorder (ADHD). The sample comprised 104 children, 52 of whom hada previous ADHD diagnosis. Children with ADHD had higher overall rates of self-reported vic-timization by peers and parent- and teacher-reported bullying behavior than did children withoutADHD. The rates of victimization were especially high for girls with ADHD. Furthermore, chil-dren with ADHD reported higher frequencies of verbal, physical, and relational victimization thandid children without ADHD. When data were pooled from children, parents, and teachers, chil-dren with ADHD were categorized as victims, bullies, and bully/victims significantly more oftenthan were children without ADHD. Parent ratings of ADHD symptoms predicted self-reportedvictimization by peers. Neither parent-rated anxious-shy behaviors nor parent- and teacher-ratedsocial skills predicted victimization by peers over and above ADHD symptoms. Parent ratingsof oppositional behavior mediated the relationship between ADHD symptoms and parent- andteacher-rated bullying. C 2008 Wiley Periodicals, Inc.

    This study is an investigation of peer victimization in 9- to 14-year-old children with andwithout Attention-Deficit/Hyperactivity Disorder (ADHD). Peer victimization occurs when one ormore children perform negative actions toward another child repeatedly and over time (Olweus,1993). These negative behaviors entail physical, verbal, or relational aggression, and involve animbalance of power. Bullies are the perpetrators of these negative actions; victims are the targets ofbullies and cannot defend themselves adequately (Crick, 1995).

    Children who are chronically victimized by peers or who bully others are at risk for serious ad-justment problems. Chronic victimization by peers increases risk for anxiety, loneliness, depression,social withdrawal, low self-esteem, suicidal tendencies, dislike and avoidance of school, and pooracademic performance (Boivin, Hymel, & Bukowski, 1995; Olweus, 1991; Perry, Hodges, & Egan,2001). Victimization contributes to later social adjustment problems such as friendlessness and peerrejection (Ladd, Kochenderfer, & Coleman, 1997). Bullies are often impulsive, frequently exhibitantisocial behavior, and are at increased risk for maladaptive outcomes such as criminal behavior(Olweus, 1995). Children who are bullies more often display characteristics of conduct disorder,oppositional defiant disorder, and ADHD than do children who are not bullies (Coolidge, DenBoer,& Segal, 2002; Salmon, James, Cassidy, & Javaloyes, 2000). Some children fit the profile of bothvictims and bullies and are referred to as provocative victims or bully/victims (Olweus, 1978). Thesechildren tend to display the anxiety, depression, and low self-esteem seen in victims, concurrent withthe high levels of dominance, aggression, and antisocial behavior typical of bullies (Olweus, 2001).They often provoke bullying through their aggressive behavior, but are unable to defend themselvesadequately (Olweus, 1993). Bully/victims appear to be at higher risk for maladjustment and rejectionby their peers than do children who are solely victimized or who solely bully others (Schwartz, 2000).

    Despite the negative outcomes associated with peer victimization, there is a paucity of researchwith samples of children with diagnosed ADHD. Consequently, the present study was guided

    Correspondence to: Dr. Judith Wiener, Department of Human Development and Applied Psychology, OISE/University of Toronto, 252 Bloor Street West, Toronto, Ontario, M5S IV6, Canada. E-mail: jwiener@oise.utoronto.ca

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  • ADHD Peer Victimization 117

    by two objectives: 1) to determine whether 9- to 14-year-old children with and without ADHDdiffer in frequency of self-reported victimization by peers and self-, parent-, and teacher-reportedbullying; and 2) to determine whether factors that predict peer victimization in typically developingchildren account for significant portions of the variance in peer victimization over and above ADHDsymptoms. The specific factors that were explored were anxious and shy behavior, social skills, andoppositional behavior.

    Frequency of Peer VictimizationAlthough children with ADHD often have associated aggression, anxiety, and depression

    (American Psychiatric Association, 1994), are frequently rejected by their peers (e.g., Bagwell,Molina, Pelham, & Hoza, 2001; Gresham & MacMillan, 1997; Gresham, MacMillan, Bocian, Ward,& Forness, 1998; Hinshaw, 2002), are intrusive, inappropriate, disorganized, aggressive, impulsive,emotional, uncooperative, and bossy in their peer relationships (see Stormont, 2001, for a review),and have a behavioral profile similar to children who are both bullies and victims (i.e., problems withconcentration, hyperactivity, and impulsivity) (Barkley, 2006; Kumpulainen et al., 1998; Olweus,2001), frequency of peer victimization in this population has only been explicitly investigated in oneprevious study. Unnever and Cornell (2003) found that children classified as having ADHD on thebasis of self-reports of taking stimulant medication were at increased risk for being victimized bypeers and for being perpetrators of bullying when compared to their classmates.

    The results of this study raise several questions. First, as indicated by Unnever and Cornell(2003), studies should be carried out with children with ADHD where a diagnosis can be confirmed.Second, the proportion of children with ADHD who had peer victimization problems was not clear.In school-based studies using self-report measures, classification as bully, victim, or bully/victimvaries depending on the cutoff score used. The ranges in studies using various modified versions ofa questionnaire developed by Olweus (1991, 1993) with similar cutoffs to the present study were11%11.4% for victims, 9%14% for bullies, and 2%5% for bully/victims (Pellegrini, Bartini, &Brooks, 1999; Rigby, 1994, 1998).

    Third, peer victimization is often described based on the type of aggression it involves. Physicalvictimization includes such actions as hitting, kicking, punching or tripping. Verbal victimizationincludes threats of physical harm, name-calling, teasing, or general verbal harassment. Relationalvictimization includes gossip, exclusion from a group, or threatening the withdrawal of a friendshipor group acceptance (Crick, 1995). There are no published studies that investigated the relativefrequency of verbal, relational, and physical victimization in children with ADHD. In a qualitativestudy, however, Shea and Wiener (2003) found that social exclusion was the most salient form ofvictimization by peers for four chronically victimized boys with ADHD.

    Fourth, it is not clear whether there are gender differences in peer victimization in children withADHD. Unnever and Cornell (2003) did not find gender differences, and the participants in the Sheaand Wiener (2003) study were all boys. Gaub and Carlsons (1997) meta-analysis showed no genderdifferences in peer acceptance and rejection. Berry, Shaywitz, and Shaywitz (1985), however, foundthat both preschool and school-age girls with ADHD were more at risk for being rejected by peersthan were boys with ADHD, and Rucklidge and Tannock (2001) found that parents and teachers ratedfemale adolescents with ADHD as having more social problems than their male counterparts. Perryet al. (2001) and Espelage, Mebane, and Swearer (2004) reviewed the substantial literature on genderdifferences in peer victimization and bullying. Both reviews indicated that boys and girls are equallylikely to be victims of bullying, and that gender differences are entangled with developmental effectsand type of aggression. Boys are more likely to engage in and be subject to physical aggression bypeers, whereas girls typically perpetrate or are victims of relational aggression. Boys and girls do not

    Psychology in the Schools DOI: 10.1002/pits

  • 118 Judith Wiener and Meghan Mak

    differ in the frequency of being targets of verbal aggression (Kochenderfer & Ladd, 1997). Althoughpeer victimization is frequent in the older elementary school grades, it is generally highest inmiddle school (National Center for Educational Statistics, 1995). Girls tend to progress more rapidlythan boys in terms of the kind of bullying in which they are involved (Craig, Pepler, Connolly,& Henderson, 2001). Tremblay et al. (1995), for example, found that girls physical aggressiondecreases and relational aggression increases at an earlier age than boys.

    The fifth question pertains to measurement of peer victimization. Although trained observersand peers typically provide reliable and valid indicators (Juvonen, Nishina, & Graham, 2001;Pellegrini, 2001), it is not practical to do observational or sociometric studies if each participantattends a different school, as is typical of a clinically referred sample. Self-reports, parent reports,and teacher reports are more practical, but have some limitations. Children with ADHD, whomay have a hostile attribution bias (e.g., Milich & Dodge, 1984), may attribute gentle teasingor accidental physical altercation as intentional and malicious, and thus may overreport beingvictimized. Nevertheless, much of the victimization may not be observable by parents and teachers(Craig & Pepler, 1997; Pellegrini, 2001), who also may not be aware of victimized childrenspsychological distress (Schwartz, McFayden-Ketchum, Dodge, Pettit, & Bates, 1998). Most childrentend to be reluctant to report that they are perpetrators of bullying (Pellegrini, 2001; Pellegrini &Bartini, 2000). Failure to report being a perpetrator of bullying may be especially problematic forchildren with ADHD who have been found to have a positive illusory bias (e.g., Hoza, Pelham,Milich, Pillow, & McBride, 1993; Hoza, Pelham, Dobbs, Owens, & Pillow, 2002).1 Therefore,teacher-, parent-, and self-reports were used in the present study to assess bullying, and self-reportwas used to assess victimization by peers.

    This study tested three hypotheses that pertain to frequency of peer victimization in childrenwith ADHD. 1) Children with ADHD will report higher levels of victimization by peers than willchildren without ADHD. We will explore whether the hypothesized higher levels of victimization bypeers include verbal, relational, and physical victimization and whether there are gender differencesin frequency of victimization. 2) Parents and teachers will report that children with ADHD bully andthreaten others more often than children without ADHD. It is unclear, however, whether self-reportsof bullying of children with and without ADHD would differ. We will also explore whether thereare gender differences in frequency of bullying. 3) Using a multisource (i.e., self-, parent-, andteacher-report) method of classification, children with ADHD will be categorized as victims, bullies,and bully/victims more often than comparison children.

    Predictors of Peer VictimizationThe social-ecological perspective on peer victimization suggests that both individual and envi-

    ronmental factors influence peer victimization (Swearer & Espelage, 2004). Although we acknowl-edge the importance of environmental factors such as the family, school, peer, community, andcultural contexts, the objective of this study was to identify individual factors (i.e., anxious-shybehaviors, social skills, and oppositional behaviors) that predict peer victimization in children withADHD.

    Anxiety and social withdrawal are correlates of victimization by peers (Boivin et al., 1995;Hodges & Perry, 1999; Swearer, Grills, Haye, & Tam Cary, 2004). There is some controversyas to whether children who are anxious and socially withdrawn are more likely to be victimized

    1 Hoza et al. (1993) defined the positive illusory bias as the propensity of children with ADHD to overinflate theirreports of their competencies in comparison with parent or teacher reports, or with their performance on an academicor social task.

    Psychology in the Schools DOI: 10.1002/pits

  • ADHD Peer Victimization 119

    because of the bullys perception that they are weaker, or whether being bullied leads to anxietyand social withdrawal. In a longitudinal study, however, Hodges and Perry found that internalizingsymptoms contributed to increased victimization over time and that initial victimization predictedincreases in internalizing symptoms. The findings of this longitudinal study suggest that anxiety andsocial withdrawal are both risk factors for chronic victimization by peers and a consequence of it.Investigation of these risk factors was warranted, given the high levels of anxiety found in childrenwith ADHD (Tannock, 2000).

    Several studies have demonstrated that children who are victims have social skills deficits(Champion, Vernberg, & Shipman, 2003; Fox & Boulton, 2005, 2006a, 2006b). Victims oftendisplay behavioral vulnerability (i.e., they look scared and unhappy, stand in a way that looks likethey are weak), and are nonassertive (i.e., put up with other children being nasty to them). Somevictims also engage in provocative behaviors such as annoying other children and spoiling their games(Fox & Boulton, 2005). Similarly, Champion et al. found that adolescent victims had lower scoreson the Cooperation and Assertiveness scales of the self- and parent-report versions of the SocialSkills Rating System (SSRS; Gresham & Elliott, 1990) than did adolescents who were not victims.Stormont (2001) reviewed the extensive literature on social outcomes of children with ADHD thatshows deficits in social knowledge, social perspective taking, and social interaction. Shea and Wiener(2003) found that social skills deficits, emotional volatility, a lack of insight, and immaturity werenoted by parents and teachers of boys with ADHD as at times causing them to be victimized by theirpeers or exacerbating chronic victimization. Consequently, in this study we investigated whethersocial skills predict variance in victimization by peers over and above ADHD symptoms.

    Children with ADHD have high levels of conduct problems, including oppositional and defiantbehavior and aggression (Barkley, 2006, p. 190), with more than 65% of clinic-referred samplesbeing noncompliant and verbally hostile toward others. Angold, Costello, and Erkanlis (1999)meta-analysis showed that children with ADHD were highly likely to have comorbid oppositionaldefiant and conduct disorder. Because the link between antisocial behavior and oppositional andhyperactive-impulsive symptoms is...

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