Relationships in young people with attention deficit hyperactivity disorder: a thesis portfolio

Abstract

OBJECTIVE: This thesis aimed to meet two objectives relating to relationships in young people with attention deficit hyperactivity disorder (ADHD). The first was to examine which biopsychosocial factors related to loneliness in children and adolescents with ADHD, and to provide a critical review of findings. The second objective was to explore peer difficulties in adolescents with ADHD from a relational perspective. This was achieved through an empirical study exploring the role of parent-adolescent conflict and parental psychological wellbeing in explaining peer difficulties in adolescents with ADHD.

METHOD: To meet the first objective, six databases were searched for quantitative studies exploring relations between loneliness and biopsychosocial factors amongst child and adolescent ADHD populations. Results were screened against inclusion criteria, and included studies assessed for quality by the primary researcher. A second reviewer was used to ensure the consistent screening and quality assessment of studies. A narrative synthesis of included studies was undertaken. To meet the second objective, cross-sectional quantitative data from an archived data set was analysed. Measures of ADHD symptoms, conflict, parental psychological wellbeing and peer difficulties from 278 11–17-year-olds with ADHD and their parents were analysed.

RESULTS: Twenty-one studies were eligible for inclusion in the systematic review. Twenty-seven biopsychosocial factors were examined in relation to loneliness and synthesised into six categories: ADHD diagnosis, COVID-19, social, mental health, demographic and contextual factors. Overall, both social and mental health factors were found to relate to loneliness, as did specific contextual factors. Neither age, gender nor family living arrangements were found to relate to loneliness. COVID-19’s influence on loneliness was less clear. ADHD diagnosis was found to relate to loneliness compared to neurotypical samples, but not when compared to other clinical samples. In the empirical study, the relationship between ADHD symptoms and peer difficulties was not mediated by conflict and parental psychological wellbeing. This remained true regardless of ADHD subtype or medication status.

CONCLUSION: The findings of the systematic review provide a comprehensive assessment of existing research relating to loneliness in children and adolescents in ADHD. The vulnerability of young people with ADHD, and the relevant factors underpinning this, are discussed. Understanding which biopsychosocial factors influence loneliness in this population may inform the delivery of person-centred services and formulation-led interventions. Opportunities for future research to deepen our understanding of factors relating to loneliness in ADHD are identified. The findings of the empirical study do not support a relational understanding of peer difficulties in adolescents with ADHD. Results are discussed within the context of the developmental nature of attachment relationships through adolescence and consideration of peer-specific factors. Additional research is required to explore alternative explanations in depth.