Beruflich Dokumente
Kultur Dokumente
2
=0.00. A 22 analysis of variance with Child-Reported
Empathy as the dependent variable indicated that girls rated
themselves to be more empathic than boys, F (1, 88)=
35.11, p<0.001, partial
2
=0.29. No main effect was found
for ADHD status, F(1, 88)=0.00, p=0.96,
2
=0.00 and
Table 2 Univariate Analysis of Social Perspective Taking and Child and Parent Empathy by ADHD Status and Gender
ADHD Total Comparison Total ADHD status Gender ADHD status
gender
Male Female Male Female
M (SD) M (SD) M (SD) M (SD) M (SD) M (SD) M (SD) M (SD) M (SD)
Parent
empathy
68.49 (8.97) 72.00 (10.60) 69.43 (9.46) 73.23 (6.89) 78.58 (5.24) 74.76 (6.85) 8.60** (0.09) 5.26* (0.06) 0.22 (0.00)
Child
empathy
11.66 (3.17) 15.92 (2.20) 12.86 (3.49) 11.53 (3.54) 16.00 (3.07) 12.80 (3.95) 0.002 (0.00) 35.11** (0.29) 0.01 (0.00)
INS total 1.72 (0.33) 1.91 (0.29) 1.77 (0.32) 2.06 (0.29) 2.16 (0.20) 2.08 (0.27) 16.75** (0.16) 4.00* (0.04) 0.36 (0.00)
Parent empathy = parent-reported empathy on My Child; child empathy = child-reported empathy on the Index of Empathy for Children and
Adolescents; INS total is the total score on the Interpersonal Negotiation Strategies
INS Interpersonal negotiation strategies
*p<0.05;**p<0.01;***p<0.001
112 J Abnorm Child Psychol (2009) 37:107118
there was no ADHD status by Gender interaction effect, F
(1, 88)=0.01, p=0.89,
2
=0.00.
A 2 (ADHD status)2 (Gender) analysis of variance was
conducted to examine main and interaction effects on the
Total INS scale. As indicated in Table 2, children with
ADHD had less developed SPT skills overall than children
without ADHD, F(1, 86)=16.75, p<0.001,
2
=0.16 and
boys attained lower overall SPT scores than girls, F(1, 86)=
4.00, p<0.05,
2
=0.05. There was no ADHD status by
Gender interaction effect, F(1, 86)=0.36, p=0.54,
2
=0.00.
Analyses were also conducted on the five INS problem-
solving subscales. First, a two-way MANOVAwith the five
INS problem-solving subscales as dependent variables, and
ADHD status and Gender as the fixed factors were used to
examine differences in SPT. A significant multivariate
effect was detected for ADHD status, Wilkss =0.62, F
(5, 82)=9.87, p<0.001,
2
=0.37, but not for Gender,
Wilkss =0.92, F(5, 82)=1.32, p=0.26,
2
=0.07 and
there was no Gender by ADHD status interaction effect,
Wilkss =0.91, F(5, 82)=1.56, p=0.17,
2
=0.08. Using
the Bonferroni method, univariate ANOVAs for each
subscale of the INS were tested at the 0.01 level. As
indicated in Table 3, children with ADHD used less
advanced SPT in their Definition of the Problem, Identifi-
cation of Feelings and Evaluation of the Outcome than
comparison children. Children with and without ADHD did
not differ on their level of SPT when Selecting the Best
Strategy or when an average was taken of all of their
Alternative Strategies.
Independent samples t-tests were conducted to compare
children with and without ADHD on the number of
Alternative Strategies generated and the type of Interper-
sonal Orientation used to solve social dilemmas. As
indicated in Table 4, when asked to generate as many
strategies as possible to solve social dilemmas, children
with ADHD generated fewer ways to solve problems than
comparison children. Independent samples t-tests were used
to examine ADHD status differences in Interpersonal
Orientation on the Alternative Strategies and Selecting the
Best Strategy subscales. Children with ADHD used fewer
self-transforming and collaborative strategies than compar-
ison children when generating alternative strategies to
problem-solving. There were no group differences, howev-
er on the number of indeterminate and other-transforming
strategies in Alternative Strategies or on any of the
Interpersonal Orientation methods in Selecting the Best
Strategy.
Objective 2: Predictors of Empathy and Social Perspective
Taking
As previously mentioned, variables theoretically related to
each social-cognitive factor were considered in the analy-
ses. Because previous research has documented a relation-
ship between CP and empathy, and because CP is
frequently comorbid with ADHD, we examined whether
ADHD status predicted empathy above CP. Parent-
Reported Empathy was negatively correlated with both
CP (r=0.37, p<0.001) and ADHD status (r=0.30, p<
0.01). Because language and IQ have not been theoretically
related to empathy and were not correlated with empathy in
the current sample (r=0.11, p=0.27 and r=0.03, p=0.72,
respectively) they were not included in the regression
analysis. As indicated by the hierarchical regression
analysis shown in Table 5, when CP was entered first in
the regression it explained 14% of the variance in Parent-
Reported Empathy, R
2
=0.14, F (1, 88)=14.01, p<0.001;
ADHD status did not explain additional variance, R
2
change=0.00, F (1, 87)=0.30, p=0.58.
Previous research has shown that SPT is related to IQ,
language, and CP. In this sample, language and IQ were
positively correlated with SPT (r=0.42, p<0.001 and
r=0.39, p<0.001, respectively), and CP was negatively
correlated with SPT (r=0.27, p<0.01). Given these
relationships and that children with ADHD in the current
sample also demonstrated weaker IQ and language skills
and were rated to have higher levels of CP (Table 1), a
hierarchical regression was conducted to determine whether
ADHD status explained unique variance in SPT above
variance accounted for by language, IQ and CP (Table 5).
The order of the predictors was determined based on
previous research findings. Because the INS is a narrative
task that requires receptive and expressive language skills,
language was entered as the first predictor and it explained
Table 3 Multivariate Analysis
on the Interpersonal
Negotiations Strategies
Subscales by ADHD Status
INS Interpersonal negotiation
strategies
ADHD (n=48) Comparison (n=50) F p
2
M (SD) M (SD)
Social perspective taking (INS) subscales
Definition of problem 1.60 (0.35) 2.02 (0.31) 30.60 0.000 0.262
Identification of feelings 1.57 (0.39) 1.99 (0.48) 22.49 0.000 0.207
Alternative strategies 1.97 (0.34) 2.07 (0.34) 0.15 0.700 0.002
Selecting best strategy 2.06 (0.40) 2.26 (0.41) 2.27 0.135 0.026
Evaluating outcome 1.48 (0.64) 2.00 (0.50) 14.98 0.000 0.148
J Abnorm Child Psychol (2009) 37:107118 113 113
18% of the variance in SPT, R
2
=0.18, F(1, 88)=18.91, p<
0.001. As intelligence has also been strongly related to SPT,
it was entered next in the regression and it explained an
additional 4% of the variance, R
2
change=0.04, F(1, 87)=
3.99, p<0.05. Because CP has not been as strongly related
to SPT as language and IQ, it was entered in step 3 of the
regression but it did not explain additional variance in SPT,
R
2
change=0.02, F(1, 86)=2.18, p=0.14. To examine the
unique variance associated with ADHD status, it was
entered last in the regression, and it explained an additional
8% of the variance in SPT, R
2
change=0.08, F(1, 85)=9.53,
p<0.01, even after variance attributed to language, IQ and
CP in SPT was considered.
Discussion
Empathy
The goals of the current study were to establish whether
children with ADHD were less empathic than comparison
children and to examine the extent to which ADHD status
predicted empathy after variability associated with CP was
addressed. Although there was no difference between
ADHD and comparison children in self-reported empathy,
children with ADHD were rated as less empathic by their
parents. It is possible that children experience more
empathy internally than they exhibit behaviorally, making
it difficult for their parents to detect their affect. Conversely,
as found in previous studies, it is possible that childrens
ratings of empathy on self-report questionnaires in the
current sample was influenced by social desirability effects
(Eisenberg et al. 1991). Aggressive children (Hymel et al.
1993) and children with ADHD have been shown to
significantly overestimate their own competencies in
various areas of functioning, including academic, behav-
ioral and social domains (e.g. Hoza et al. 2004; Owens and
Hoza 2003). This positive illusory bias may serve a self-
protective function that counterbalances feelings of inade-
quacy among children, especially those with difficulties
(Diener and Milich 1997).
The finding in the current study that parents report
children with ADHD to exhibit lower levels of empathy is
consistent with existing studies (Braaten and Rosen 2000;
Dyck et al. 2001) using different methods of assessing
empathy in children with ADHD. Together, the results of
these studies suggest that children with ADHD demonstrate
less state empathy (i.e. picture-story measure, facial cues,
etc.), and exhibit behaviors that are perceived to be less
empathic by their parents. Parent-reported empathy was
used to further examine the role of CP and ADHD status in
empathy to avoid the potential confound of the positive
illusory bias commonly reported among this population.
Table 4 Independent Samples
t-tests for Children with and
without ADHD on the Number
of Alternative Strategies and
the Interpersonal Orientation of
Alternative Strategies and
Selecting the Best Strategy
a
Levenes test for equality of
variances was significant for #
of alternative strategies and #
of self-transforming strategies,
therefore scores for equality of
variances not assumed are
reported
ADHD Comparison t (df) p
M (SD) M (SD)
# Alternative strategies
a
7.77 (2.39) 9.60 (3.56) 2.80 (70) 0.007
Alternative strategies
# of indeterminate 3.50 (2.07) 3.60 (1.86) 0.22 (88) 0.820
# of self-transforming
a
0.88 (0.86) 1.40 (1.06) 2.57 (79) 0.012
# of other-transforming 2.13 (1.04) 2.60 (1.43) 1.79 (88) 0.076
# of collaborative 1.27 (1.08) 2.00 (1.46) 2.70 (88) 0.008
Selecting best strategy
# of indeterminate 1.54 (0.74) 1.33 (0.68) 1.37 (88) 0.173
# of self-transforming 0.19 (0.53) 0.19 (0.45) 0.02 (88) 0.977
# of other-transforming 1.21 (0.71) 1.10 (0.90) 0.66 (88) 0.510
# of collaborative 1.06 (0.83) 1.38 (0.98) 1.65 (88) 0.101
Table 5 Hierarchical Linear Regressions with CP and ADHD Status
as Predictors of Parent-Reported Empathy and Language, IQ, CP and
ADHD Status as Predictors of Social Perspective Taking
Parent-reported empathy
Variable B SE (B)
Step 1 Conduct problems 0.389 0.104 0.371***
Step 2 Conduct problems 0.328 0.151 0.313*
ADHD status 1.388 2.504 0.080
Social perspective taking
Step 1 Core language (CELF-4) 0.013 0.003 0.421***
Step 2 Core language (CELF-4) 0.009 0.003 0.291*
IQ 0.006 0.003 0.230*
Step 3 Core language (CELF-4) 0.007 0.004 0.235*
IQ 0.006 0.003 0.236*
Conduct problems 0.006 0.004 0.149
Step 4 Core language (CELF-4) 0.006 0.003 0.205
IQ 0.005 0.003 0.176
Conduct problems 0.005 0.005 0.110
ADHD status 0.274 0.089 0.403**
Predicting parent-reported empathy: R
2
=0.14 for Step 1; R
2
=0.00
for Step 2. Predicting SPT: R
2
=0.18 for Step 1; R
2
=0.04 for Step 2;
R
2
=0.02 for Step 3; R
2
=0.08 for Step 4
*p<0.05; **p<0.01; ***p<0.001
114 J Abnorm Child Psychol (2009) 37:107118
ADHD diagnosis, however, did not explain additional
variance in empathy once CP was accounted for. This
suggests that children with ADHD who have clinical levels
of CP are at increased risk of deficits in empathy, but
children with ADHD who do not have clinical levels of
these behaviors exhibit similar levels of empathy to
comparison children. This finding is in accordance with
various other studies indicating that children with aggres-
sive behaviors exhibit lower levels of empathy than
children who are not aggressive (e.g. de Wied et al.
2005), and comorbid ADHD does not contribute variance
in explaining lack of empathy in children with conduct
problems (Enebrink et al. 2005). These findings also
highlight that it is critical to consider comorbid CP when
examining empathy in clinical populations.
Consistent with the existing research, in the current
study girls were more empathic than boys according to self-
and parent-ratings (Karniol et al. 1998; Olweus and
Endresen 1998). Eisenberg and Lennon (1983) found that
self-report measures of empathy evoke demand character-
istics; children may become aware that empathy is being
assessed and attempt to provide responses in line with
prevailing gender stereotypes. As such, girls may rate
themselves more favorably than boys as a means of
adhering to gender-specific conceptions. On the other hand,
it is possible that girls do in fact exhibit more empathy,
perhaps because empathic tendencies are better fostered and
reinforced during the socialization of girls than boys (e.g.,
mothers engage in more emotion talk with girls; Cervantes
and Callanan 1998). Research shows that girls exhibit more
empathy as assessed through various methods, such as
evocative films, slides and puppet shows, observational
measures of empathy and parent and teacher reports (e.g.,
Eisenberg and Fabes 1998; Strayer and Roberts 1997).
Social Perspective Taking
A major goal of this study was to examine whether children
with and without ADHD differ in their SPT ability, and
whether variability in language ability, IQ and CP predicted
SPT skills. Our results build on the Cohen et al. (1985)
findings by demonstrating that children formally diagnosed
with ADHD have poorer overall SPT skills than children
without ADHD. They employed less advanced SPT at
various problem-solving stages. Although formal age
norms do not exist for the interview, scores between 2
and 3 would be expected for children in the age range of
this study (Cohen et al. 1998). In the current sample,
average scores for children in the comparison sample fell in
the age-appropriate range, whereas children with ADHD
typically attained lower scores than would be expected for
their age. This suggests that they are less likely to take
multiple perspectives and coordinate perspectives than is
typical of children their age. Because understanding another
persons thoughts and feelings facilitates other-oriented
processes and behaviors, including sympathy, sharing,
comforting, and helping, all skills that foster prosocial
behaviors and healthy social relationships (Hoffman 2000),
the SPT problems of children with ADHD is concerning. In
fact, Selman and his colleagues found that lower SPT
performance during various play and group activities was
associated with poorer peer relationships, so that children
who displayed lower levels of SPT had difficulties forming
and maintaining friendships and received lower peer
nominations (Selman 2003; Selman et al. 1977). Thus, it
is plausible that the lower overall SPT skills of children
with ADHD contributes, at least in part, to their difficulties
in the social realm.
Consistent with findings from a study conducted by
Matthys et al. (1999), when asked to generate as many
ways to solve interpersonal dilemmas as they could,
children with ADHD in the present study produced
significantly fewer strategies than comparison children.
This may be a manifestation of their impulsivity and
broader executive functioning deficits, which might be
reflected in INS performance as difficulties with planning
and organizing a verbal response, keeping the strategies
provided in mind, or wanting to get the task completed as
quickly as possible. In addition, it is also possible that
children with ADHD have a smaller repertoire of solutions
to social dilemmas because their difficulties with social
skills and peer relationships (e.g. Greene et al. 1996; Hoza
et al. 2005) afford them fewer opportunities to practice
collaborative problem solving in social interactions.
Selman (2003) referred to the interpersonal orientation
aspect of the INS as a biographical lens through which
individual differences in childrens preference for giving
precedence to either the needs of the self, the other, or
effectively balancing the needs of both may be detected.
When providing alternative strategies, children with ADHD
in the current study were less likely to generate collabora-
tive and self-transforming strategies than comparison
children. Assuming that children identify with the protag-
onist in the dilemmas, this would suggest that children with
ADHD are less likely to give up some of their needs in
interpersonal situations (e.g. waiting to go second when
taking turns). Using collaborative strategies by effectively
integrating perspectives and occasionally giving up some of
ones own needs in an effort to resolve social conflicts is an
important social skill because it is related to the develop-
ment of closeness in relationships and to prosocial
behaviors (Menna and Cohen 1997); presumably closer
bonds develop between children when they feel that the
other understands their needs, beliefs and feelings, and
considers these in their interactions. The tendency for
children with ADHD to put their needs first and be less
J Abnorm Child Psychol (2009) 37:107118 115 115
cooperative may manifest in their social environment as
bossiness (Pelham and Bender 1982) and an inability to
compromise and cooperate (Cunningham and Siegel 1987).
The current study investigated the potential influence of
language proficiency, IQ, CP and ADHD diagnosis because
they are associated with SPT skills. Overall, language
ability and IQ were significant predictors of SPT, CP did
not explain variance after language and IQ were accounted
for, but ADHD diagnosis explained an additional 8% of the
variance in SPT. As predicted, our results confirm that
language abilities and IQ play an important role in SPT. CP
did not explain additional variance in SPT once language
and IQ were accounted for, likely because a significant
proportion of children with CP and ADHD have co-
occurring language impairment (Cohen et al. 1998) and
because language and CP were correlated in this study.
ADHD status, however, explained unique variance in SPT
over language. Cohen et al. (1998), who used the INS to
investigate SPT in children with language impairments,
many of whom had comorbid ADHD or ODD diagnoses,
reported that these children were impaired in SPT relative
to children with normally developing language skills. The
current study extends the Cohen et al. (1998) findings by
showing that ADHD symptomatology combines with
language difficulties to compromise the SPT skills of
children with ADHD. These results also corroborate
previous research suggesting that SPT is related to language
and intelligence and highlight the importance of assessing
these variables when examining SPT in children with
ADHD.
In the present study, girls had more developed overall
SPT skills than boys as measured by the Total INS (e.g.
Yeates et al. 1991). Earlier development of SPT in girls has
been linked to mothers and older siblings engaging in more
supportive and emotion talk with girls than boys (e.g.
Cervantes and Callanan 1998). These differences in early
interactions are believed to enhance the SPT skills of girls
from an early age (Charman et al. 2002) and are likely
reinforced in later gender-specific peer environments.
Limitations and Implications for Future Research
This study has a few limitations. First, recent research
suggests that the combined and predominantly inattentive
subtypes of ADHD may be different disorders altogether
(Milich et al. 2001). Because only two children (4%) in the
current sample met criteria for ADHD Inattentive Type
(94% were ADHD Combined and 2% were Hyperactive
Impulsive), subtype differences could not be examined.
Second, although questionnaire methods of assessing
empathy provide information about empathy as a trait, they
are also heavily influenced by childrens tendency to
present themselves favorably. Future researchers should
consider including a social desirability scale along with
self-report measures of empathy. Third, in the absence of
teacher ratings of CP, we needed to rely on parent reports,
raising the possibility that shared method variance may
have confounded the results. Future studies should examine
this further.
Implications for Clinical Practice
The findings from the present study show that deficits in
empathy are associated with oppositional and conduct
problems rather than ADHD. Consequently, clinicians
may find it helpful to assess empathy in children with
ADHD who have co-occurring oppositional and conduct
problems and to select behavioral intervention programs
that include the fostering of empathy and SPT skills
(Antshel and Remer 2003; Webster-Stratton and Reid
2003). Deficits in SPT, on the other hand, are associated
with language ability, intelligence and ADHD symptoms. It
may therefore be beneficial to explicitly teach SPT to
children with ADHD in the context of social skills training
interventions. Grizenko et al. (2000), for example, found
that 811 year old children with disruptive and impulsive
behaviors who received additional training in SPT showed
more short- and long-term improvements in behavior than
children in a traditional social skills training program. In
summary, assessing the social-cognitive skills of children
with ADHD can be an important adjunct to tradition
behavioral assessment because it provides rich information
for case formulation and can drive treatment delivery.
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