Journal of Abnormal ChiM Psychology, Vol. 18, No. 3, 1990, pp. 297-316
Social Judgment Processes in Hyperactive Boys: Effects of Methylphenidate and Comparisons with Normal Peers Carol K. Whalen, 1,3 Barbara Henker, z and Douglas A. Granger I
Although there is consensus that ADHD children have serious social problems, there is tittle understanding of the mechanisms underlying or accompanying such problems. To examine the possibility o f atypical or faulty social reasoning, we presented ADHD and normal boys with a social perception task that entailed evaluating the behaviors of unknown peers. ADHD 'Judges'participated under both methylphenidate and placebo conditions, and on each occasion they evaluated an unfamiliar A D H D "target" in each medication state. In contrast to placebo, methylphenidate appeared to dampen overall response rates in A D H D judges, but there was no effect on sensitivity to medication-related differences. Regardless o f their own medication state, ADHD judges identified more undesirable behaviors in peers on placebo than in those taking methylphenidate~ Judges with the most serious behavior problems tended to identify the greatest number of negative behaviors in peers, especially when both judge and target were unmedicated. There were no effects of target medication status on detections of positive behaviors and few differences in detection patterns of ADHD versus normal judges. Discussion focused on the need to distinguish general regulatory from specific social-cognitive processes.
Manuscript received in final form December 15, 1989. This study was conducted at the Fernald Child Study Center, UCLA, and we very much appreciate the many contributions of Stephen P. Hinshaw, codirector of the program. We are also grateful to the resourceful and devoted staff and the energetic children who served as judges and targets. 1Program in Social Ecology, University of California, Irvine, California 92717. 2Department of Psychology, University of California, Los Angeles, California 90024. 3Address all correspondence to Carol K. Whalen, Social Ecology, University of California, Irvine, California 92717. 297 0091-0627/90/0600-0297506.00/0 9 1990PlenumPublishingCorporation
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One of the most robust findings in the child psychopathology literature is that children with attention-deficit hyperactivity disorder (ADHD) 4 have pervasive problems getting along with other people. Not only do social difficulties degrade and delimit everyday experiences and opportunities during childhood, but these early problems also predict serious maladjustment during adolescence and adulthood (Parker & Asher, 1987). In addition, there is a negative catalytic effect on others who come into contact with hyperactive children. When interacting with an ADHD (in contrast to a normal) child, siblings, peers, parents, teachers, and even strangers are more likely to behave in a less than desirable fashion (e.g., Cunningham & Siegel, 1987; Landau & Milich, 1988; Mash & Johnston, 1983; Whalen, Henker, & Dotemoto, 1981). It is, of course, always difficult to distinguish cause from effect in the complex interpersonal realm, but the fact that a hyperactive child's significant others show behavioral improvements when the child receives treatment (e.g., Barkley, 1985; Schachar, Taylor, Wieselberg, Thorley, & Rutter, 1987; Whalen et al., 1981) attests to the child's active role in the construction of unsalutary social worlds. Several mechanisms have been identified as possible contributors to the breadth and tenacity of social impairments of the type associated with ADHD, including deficient social skill repertoires, deviant hierarchies of social goals or agendas, and expectancy or reputational bias in parents, peers, and teachers (e.g., Dodge, Asher, & Parkhurst, 1989; Hymel, 1986; Whalen & Henker, 1985). Another prime candidate is deficient social information processing by hyperactive children. There is intriguing evidence that children who have difficulty making and keeping friends make inaccurate interpersonal inferences, and that faulty social reasoning may result in maladaptive behavioral decisions. Although the strongest evidence of atypical social reasoning has emerged in children identified as aggressive or rejected (e.g., Dodge, Pettit, McClaskey, & Brown, 1986), there is substantial overlap between groups of aggressive, rejected, and hyperactive children, and there are also scattered indication that youngsters diagnosed ADHD may indeed have social cognition deficits (Grenell, Glass, & Katz, 1987; Milich & Dodge, 1984). Stimulant medication, the most prevalent treatment modality for ADHD, effects marked and at times even dramatic improvement in the ADHD child's social modes and manners, decreasing the rate and intensity of aversive actions and enhancing interpersonal harmony (e.g., Whalen & Henker, in press). The gaps in our knowledge about the roots of the ADHD child's social problems are matched, however, by gaps in our understanding of these beneficial medication effects. We know that social exchanges be4Theterms hyperactivity, attention deficit disorder with hyperactivity (ADHD),and attentiondeficit hyperactivity disorder (ADHD) are used synonymously.
Social Judgment Processes in Hyperactive Boys
299
come more amicable and productive when ADHD children take medication in contrast to placebo, and we know that, quite often, the number of noxious or clumsy acts diminishes, but changes in the more covert and elusive realms of cognition and affect remain uncharted (Henker & Whalen, 1989). Such information is crucial if child specialists are to understand, predict, and ameliorate the social problems endemic to ADHD. As a step toward filling the gaps in our understanding of social cognition in hyperactive children, this study examined the effects of medication on social thinking rather than on social doing. There are several components of social information processing, including the encoding and interpretation of cues, the generation and assessment of response options, and the enactment and monitoring of behavioral responses (e.g., Dodge et al., 1986). Recent research with aggressive children has highlighted the importance of examining not only a child's cognitive capacity to process social information but also the ways he evaluates such information (e.g., Guerra & Slaby, 1989). Children who are competent decoders of social cues may still have serious problems getting along with peers because of the criteria they use to distinguish appropriate from inappropriate acts and events. The focus of the present study is on this interpretation or evaluation phase of social information processing, the processes of judgment and inference, given the pivotal role such processes play in linking social cues to social acts. More specifically, ADHD and normal boys performed a social judgment task that involved tracking and evaluating the behaviors of other (unknown) boys of similar age. Modeled after procedures developed by Patterson and colleagues to compare the perceptions of parents with normal versus problem children (Holleran, Littman, Freund, & Schmaling, 1982; Patterson & Reid, 1984), the task was designed to tap simple evaluative (good/bad) processes as well as more complex, qualitative facets of social judgment. The task was done twice, with the ADHD boys participating in both methylphenidate and placebo states. On each occasion, the judges evaluated two hyperactive boys, one medicated and the other on placebo when the videotapes were recorded. The judges were, of course, unaware of any diagnostic or medication information. The ability of hyperactive boys to detect medication-related differences in peer behaviors, and the role of their own medication status in this process, were primary foci of the present study. In a sense, this was a study of a study: A medication-placebo crossover design was used to assess hyperactive boys' perceptions of other ADHD boys who were themselves participants in a different medication-placebo crossover study. Additional analyses compared ADHD and normal boys. To avoid terminological confusion, the (subject) child who made the social evaluations is called the judge, and the (stimulus) child who is evaluated from videotape is called the target.
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Whalen, Henker, and Granger METHOD
Context Participants were from a 5-week summer assessment and research program at UCLA for both ADHD and normal boys. The 6-hour days included a variety of school and camp activities as well as diverse individual and smallgroup assessments focusing on patterns of attention, cognition, and social interaction. Two certified teachers conducted all classroom sessions, while a staff of 34 undergraduate and graduate students served as research assistants, classroom aides, and playground supervisors. Because the participants and procedures have been described elsewhere (e.g., Hinshaw, Henker, Whalen, Erhardt, & Dunnington, 1989; Whalen, Henker, Buhrmester, et al., 1989), this information is merely summarized here.
Participants Ranging in age from 6 years 4 months to 12 years 5 months (M = 9 years 1 month), the 25 ADHD boys were recruited through contacts with the medical community and school districts. All had received a diagnosis of hyperactivity from their referring physicians, and, as in any ADHD sample, many were also oppositional or aggressive. None showed signs of mental retardation or gross neurological dysfunction. Before the program, 23 of these boys were taking maintenance doses of stimulants, and 2 had recently completed a monthlong clinical trial and were about to begin a regular regimen. The 14 comparison boys-recruited through bulletin board notices, newspaper advertisements, and local schools-ranged in age from 7 years to 10 years 4 months (M = 8 years 8 months). None had known behavioral, intellectual, or academic problems, nor were any of these boys taking psychoactive medication. Prior to the program, parents completed the Conners Abbreviated Symptom Questionnaire or CASQ. All of the ADHD boys received a score of at least 15, typically considered the ADHD cutoff, on either the maternal (M = 21.32) or the paternal rating (M = 18.95), and most met this criterion on both. For the comparison group, maternal and paternal ratings averaged 5.36 and 5.67, respectively, with only two instances of scores slightly above the cutoff.
Medication Dosage, Design, and Procedure Each boy served as a judge on two occasions, approximately 1 to 2 weeks apart. The hyperactive judges were taking placebo on one occasion and 0.3
Social Judgment Processes in Hyperactive Boys
301
mg/kg methylphenidate on the other, in a double-blind crossover design. Dosages were prepared by a pharmacist to the nearest 2.5 mg and placed in opaque capsules to disguise any taste differences between active drug and placebo. Absolute doses of medication, administered at school once in the morning and again just before lunch, ranged between 5 and 15 mg (M = 9.2). To ensure that the social judgment task was conducted within the effective time span of methylphenidate, the boys participated from 89 to 3 hours after medication ingestion.
Social Judgment Task Overview. Working individually with a staff member, the judge viewed videotapes of four boys playing a game and pushed a button each time a designated target child "did something good or something bad." Following each button push, the staff member paused the videotape, asked the judge to describe what the target had just done that was good or bad, and then restarted the tape. Social (Target) Stimuli. The videotaped segments were selected from a previous study of social interaction styles that used a structured interaction game called Adventure. Designed to simulate routine problem-solving demands that children confront in typical peer interactions, this board game has proven to be a useful vehicle for assessing communication styles and negotiation strategies across diagnostic groups and medication conditionS. There are two parallel versions of the game, Space Adventure and Mountain Adventure, each taking about 20 to 25 minutes. In the study that provided the stimuli for the present investigation, 24 hyperactive participants between the ages of 6 years 4 months and 13 years 2 months (M = 9 years 8 months) played both versions on consecutive days, with order of game version counterbalanced. Formed on the basis of age, the four-member teams remained the same for each version of the game. Medication-placebo order was counterbalanced, with two members from each team on a standard (0.3 mg/kg) dose of methylphenidate during the first game and placebo during the second, and the other two taking placebo first followed by medication. Neither the staff nor the children were aware of medication status. The games were videotaped, and each player was later evaluated from the tape by seven undergraduate raters who were unfamiliar with the children and knew nothing about the research design or focus. The raters used the University of California-Conners Child Behavior Scale or UC-CCBS, a 14-item modification of the CASQ that yields a score for behavior problems (11 items) and another for dysphoria (3 items). More detailed information about the Adventure procedures and the UC-CCBS instrument appears in Whalen, Henker, and Granger (1989).
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In the selection of targets for this study, one team was excluded because they did not complete one of the games, and another because, during one session, the behaviors of the two children taking placebo were especially aggressive and disruptive. Tapes of this team raised both ethical and methodological concerns: We did not want to provide models of highly deviant behavior for the children to emulate, and we were concerned that the extremity of the behaviors might reduce the interindividual variability in social judgments. The two female players were also excluded, given that all of the judges were male. For the remaining 14 Adventure players, we computed average scores across raters on the behavior problem subscale of the UC-CCBS and selected the 8 boys with the clearest indications of medication-related improvement. With high scores denoting undesirable behaviors, UC-CCBS scores for these targets ranged from 4.00 to 8.29 (M = 5.62) when they were taking methylphenidate, and from 8.86 to 17.14 (M = 13.17) when they were taking placebo. The average medication-placebo difference was 7.55 (range: 3.36 to 12.00). Instructions. The judges were told that they would see videotapes of other children playing a game, and they were to watch a particular boy very carefully. This boy was described as doing a number of especially good things and a number of especially bad things. The judge's job was to find as many of the good and bad things as he could, pressing a "smile button" each time he saw the boy do something good, and a "frown button" each time he saw him do something bad. The judge was asked not to do anything when the boy on the tape was being "just regular or sorta OK." Procedures and Apparatus. The equipment consisted of a videocassette playback unit and monitor, a standard remote-control device, and the response panel containing a happy-face button for positive behaviors and a frowning-face button for negative behaviors. Two colored lights signaled the boy's responses to the staff assistant, who used the remote control to pause the videotape whenever the boy pushed either button. The boy was asked to describe what he had seen, and each response was recorded in writing and on audiotape. For practice, the boys first watched a 4-minute sample tape (involving targets not selected for the study), with the assistant encouraging them to push both buttons. Next, they evaluated two 10-minute excerpts, one having a target on methylphenidate and the other a target on placebo. This sequence was repeated approximately 1 to 2 weeks later, with each judge evaluating a different practice target followed by different medicated and placebo targets. Using a constrained random assignment procedure, targets were balanced across testing occasion as well as across the diagnostic group and medication status of the judges. Approximately half of the judges viewed targets in the medication-placebo order and half in the placebo-medication order.
Social Judgment Processes in Hyperactive Boys
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Social Judgment Measures There were two analytic approaches. First, frequencies of positive and negative detections were examined, and then a behavioral catalog was constructed for coding the judges' descriptions and elaborations. The Behavioral Catalog. This catalog was based on a content analysis of a preliminary sample of responses. Twelve types of negative behavior were identified: physical aggression (e.g., "Stuck the boy with a pencil"), verbal aggression ("Said 'yes' in a snotty attitude"), nonverbal aggression ("Makes a mean face"), attempts to damage or destroy property ("Trying to break the intercom"), bossy/domineering ("Wouldn't let others talk"), violations of implicit or explicit game rules ("Not sharing opinions with other kids"), violations of social norms ("Talks out of turn"), inappropriate or immature (but nonaggressive) verbal acts ("He said 'he doesn't want it' a million times"), inappropriate motoric behavior or bodily position ("Jumping up and down"), inattention ("Not listening"), withdrawal or lethargy ("Not ever joining in"), and global negative labeling ("Being a jerk"). Analogously, eight types of positive behavior were identified: appropriate or regular task behavior ("He was talking over what to get with the other kids"), facilitative leadership or planning ("He told the tape what they wanted so the other boys wouldn't argue"), nurturance or helping ("He was helping the kid to understand how to do the money thing"), behavioral advice ("Telling other kids they should share"), rule following ("He was being quiet and cooperating"), showing good manners ("He said may I please have it back"), absence of bad behavior ("He wasn't yelling out"), and global positive labeling ("He's being good"). Rules of precedence were established that gave priority to aggressive over bossy or domineering behavior, specific over global behavior, and presence over absence of behavior. A coding manual is available from the authors. Coding Procedures and Unitizing of Responses. The verbal response accompanying each button push was later typed on an index card. Before coding began, one coder read through all the cards and marked the individual units to be coded. Multiple units per button push were scored only when the description contained separate elements that could not be captured by a single category. Each category could occur only once per button push response, even if the child elaborated or gave multiple examples, and only one code was allowed per response unit. This procedure decreased the probability that multiple codes would be given not only for dual responses but also for a single response that was ambiguous or otherwise difficult to categorize. A second coder independently unitized approximately 15% of the responses, and the agreement rate was 98%. There were only three discrepancies, which were resolved through discussion.
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Individual Differences in Judges Relations were examined between social judgments and diverse domains of the judges' own problematic behavior assessed during other components of the summer program. The criteria for selection of measures were that they show strong stability and reflect a diversity of settings, sources, and problems. There was specific interest in the role of aggression, given recent suggestions that aggressive and nonaggressive hyperactive children may differ along key dimensions related to etiology, prognosis, or treatment response (e.g., Hinshaw, 1987; Loney & Milich, 1982). Three types of measures were included: Peer Sociometric Nominations. Toward the end of each of the middle 3 weeks of the program, the boys were asked to identify their three best friends and to nominate all of the boys in their cohort who cooperated, those who caused trouble, and those who were fun to be with. The descriptor "tall" was also included as a validity check. These nominations were used during a dose-response study of medication effects on peer status (Whalen, Henker, Buhrmester et al., 1989). UC-Conners Child Behavior Scale. Three distinct sources provided UCCCBS ratings of the judges. First, the staff who presented the social judgment task to the child completed this scale immediately after the session, having been instructed to base their evaluation exclusively on the preceding session. Second, all research staff (N = 34) provided an integrative summary UC-CCBS rating for each child during the final week of the program. Finally, a group of 11 undergraduate students who had not participated in the summer program and did not know the boys completed the UC-CCBS independently, immediately after viewing tapes of the judges themselves playing Adventure. Staff Summary Ratings and Assessment Procedures. During the final week of the program, the staff provided global, 4-point ratings of each boy on a set of behavioral and personality descriptors (e.g., "fun to be with," "predictable"). In addition, the five senior staff members who knew the boys best rated their overall aggression level on a 5-point scale. The two teachers also independently completed the Matthews Youth Test for Health (MYTH), designed to assess Type A behavior in children. This 17-item measure yields a total score, a 9-item Impatience-Aggression subscale score, and an 8-item Competition subscale score. Although recent studies have demonstrated that the MYTH is sensitive to behaviors typically considered to reflect Type A behavior (e.g., Matthews & Woodall, 1988), questions have surfaced about the specificity of this measure, given extensive overlap between the MYTH, especially the Impatience-Aggression subscale, and measures of the externalizing behavior problems that characterize ADHD (Whalen, Henker, Hinshaw, & Granger, 1989). For all individual difference measures, teachers and the majority of staff were unaware of the boys' group status (ADHD vs. comparison), and un-
Social Judgment Processes in Hyperactive Boys
305
dergraduate raters did not even know that the research focus was on A D H D and methylphenidate. For the measures that were obtained during both medication states (i.e., peer nominations and UC-CCBS ratings for the social judgment and Adventure tasks), respondents were blind as to medication status. Placebo scores were used in the present analyses to reflect behavior under natural or untreated conditions. Additional information about these measures appears in Whalen, Henker, Hinshaw, and Granger (1989).
RESULTS For the frequency measures, data from the hyperactive judges were analyzed in a 2 x 2 x 2 repeated-measures ANOVA design that included a medication factor (methylphenidate vs. placebo) for both judges and targets, as well as a valence factor reflecting positive versus negative detections. To provide normative information, scores from methylphenidate and placebo conditions for A D H D judges were also contrasted with those from the comparison group, with the latter averaged across the two sessions.
Detection Frequencies for Positive and Negative Behaviors Valence. Approximately 63% of detections were for negative behaviors, yielding a significant main effect for valence, F(1, 24) = 5.76, p < .05. Across all conditions, the boys detected an average of 3.96 negative or "bad" responses (range = 0-21) and 2.38 positive or "good" responses (range = 0-16) per 10-minute target segment. Medication Effects. Significant medication main effects emerged for judges and also for targets, Ps(1, 24) = 10.42 and 11.69, respectively, p's < .01. Detection rates for both positive and negative behaviors were higher when the judges were taking placebo than when they were taking methylphenidate, as can be seen in Figure 1. The medication main effect for targets was qualified by a significant target • valence interaction, F ( I , 24) = 19.01, p < .001, reflecting the fact that hyperactive judges detected significantly more unacceptable behaviors when targets were taking placebo in contrast to methylphenidate, F(1, 24)= 26.64, p < .001. This differential pattern was not repeated for detections of positive behaviors, and no other interactions reached significance. The pattern indicates that the boys were sensitive to medication-related decreases in peer negative behaviors regardless of their own medication status, although medication did dampen overall response rates. ADHD versus Comparison Judges. There were no significant differences for positive behavior detections between medicated A D H D judges and
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"GOODS"
~
5
L"I~ -
~
~
~
~&
Placebo 0 Comparison
I I Medication Placebo TARGET MEDICATION STATUS
"BADS" 7
/A
6 5
/
>-
~4
/
/
/
/ / /
/
Ptocebo
/
0
Comparison .'~
Medication
~3 2 D" I I Medication Piacebo TARGET MEDICATION STATUS
Fig. 1. Judges' total detections of positive ("good") and negative ("bad") behaviors in peer targets taking methylphenidateversus placebo. Judges were ADHD boys taking methylphenidateversus placebo and normal comparison boys.
the comparison group. In contrast, A D H D judges taking placebo reported significantly more good behaviors on the part of the medicated target (M = 3.64) than did the comparison group (M = 1.43), t(34.7) = 2.3, p < .05. For negative detections, no comparison-ADHD differences reached significance.
Types of Behaviors Detected: A Behavioral Catalog The vast majority of button push responses were accompanied by singleunit descriptions. Of the 991 detections, 933 (94.1%o)yielded single-category descriptions, 57 (5.8%)involved two categories, and only 1 response involved three categories. The total number of units coded was 1,050. Interjudge Agreementfor Behavioral Categories. Because of the qualitative nature of the behavioral categories, a consensus rating procedure was used. Three trained coders independently coded all responses, and the criterion was agreement between at least two coders. All three coders agreed on 875 (83.3O/o) and two of the three agreed on another 160 (15.2%) of the total
Social Judgment Processes in Hyperactive Boys
307
number of response units coded. There were only 16 responses (1.5%) for which consensus was not reached. The three authors scored each of these responses and, once again, the consensus criterion was applied. For negative detections, the most problematic distinction was between bossy/domineering and violations of game rules; the most troublesome distinctions for positive detections were between appropriate task behavior and either rule following or leadership/planning. Profile of Behavioral Detections. As with any comprehensive behavioral system, some categories occurred rarely and thus did not yield meaningful data. All categories with occurrence rates less than 5 % of the total responses were eliminated from subsequent analyses. This criterion led to elimination of five negative categories (nonverbal aggression, destruction of property, inattention, social withdrawal, and global negative) and four positive categories (nurturance/helping, behavioral advice, good manners, and global positive). For the remaining 11 categories, which comprised 91% of the original units, Table I presents a descriptive summary of frequencies for comparison, ADHD-1 medication, and ADHD-placebo judges separately for targets on medication versus placebo. Two response rate indexes are provided, one based on the judges' total number of detections, and the other computed within the positive and negative domains. For negative detections, it is clear that physical and verbal aggression were salient categories, as were rule violations and inappropriate motor activity. Rule following was the dominant positive category, and the percentages for the other three positive categories were also in double digits.
Effects o f Medication and Group Status on Identification of Specific Behaviors. For each category, data from the hyperactive judges were analyzed in a 2 • 2 repeated-measures ANOVA design that included a medication factor (methylphenidate vs. placebo) for both judges and targets. When on placebo in contrast to medication, ADHD judges detected significantly more instances of several negative behaviors (i.e., verbal aggression, verbal inappropriate/immature, and norm violations) as well as positive behaviors (i.e., appropriate behavior and rule following), as can be seen in Table I. There were also significant target main effects, with physical and verbal aggression, rule violations, verbal inappropriate/immature, and motor inappropriate all detected more frequently in placebo than in medicated targets. There were no significant target main effects for positive detections, nor were any interactions significant. In sum, the pattern that emerged with these behavioral descriptors mirrors that found for overall detection rates, with the ADHD-placebo judges showing elevated response rates in several instances, and the ADHD-placebo targets eliciting higher rates of negative detections for some but not all categories.
1.24 a'b (1.16) 0.36 (0.64) 0.92 a (1.63) 0.84 b (1.91) 0.76 ~'~ (1.20)
Bossy/domineering
Violate game rules
Violate social norms
Verbal inappropriate/ immature
6.72 ~'~ (5.35) 1.04 a (1.21)
0.24 (0.52)
0.36 (1.04)
0.24 (0.52)
0.20 (0.50)
0.56 (1.45)
3.52 (3.54) 0.40 (0.71)
MPH
PBO
Target:
Verbal aggression
Physical aggression
Negative detections
ADHD-PBO c
Judge:
0.28 (0.74)
0.32 (0.90)
0.52 (0.82)
0.24 (0.60)
0.52 (0.77)
4.08 (3.80) 0.76 (0.97)
PBO
0.00 (0.00)
0.12 (0.33)
0.32 (1.03)
0.32 (0.56)
0.12 (0.44)
1.40 (1.61) 0.24 (0.72)
MPH
ADHD-MPH ~
0.29 (0.38)
0.21 (0.43)
0.43 (0.62)
0.61 (1.26)
0.86 a (0.84)
4.79 (3.90) 1.21" (1.87)
PBO
O. 11 (0.29)
0.18 (0.46)
0.64 (0.91)
0.32 (0.46)
0.21 (0.32)
3.25 (4.81) 0.71 (2.00)
MPH
Comparison
4.20
5.00
7.73
5.30
8.80
11.22
62.52
Across
6.75
7.95
12.29
8.43
13.97
17.83
100.00
Within
Percent occur
Table L Evaluations of Social Behaviors in Medicated and Unmedicated Peers: Means, Standard Deviations (in parentheses), and Percent Occurrence
r
gs g~
~r
O0
0.56 b (0.87) 0.44 (1.08) 1,48 b (1.73) 0.20 (0.50)
Appropriate
Leader/planner
Rule following
Absence of bad
0.40 (0.87)
1.76 (2.26)
0.96 (3.05)
0.68 (1.18)
3.64 (4.21)
0.88 (2.t7)
0.64 (1.63)
0.88 (1.30)
0.28 (0.54)
0.20 (0.50)
2.04 (2.54)
1.44 (2.61)
0.16 (0.37)
1.12 (1.51)
0,16 (0.47)
0.36 (0.70)
1.76 (1.83)
0.12 (0.60)
0.36 (0.53)
0.64 (0.89)
0.46 (0.80)
0.78 (0,91)
2.46 (2.30)
1.00 (1.11)
0.07 (0.27)
0,64 (1.44)
0.14 (0.31)
0.46 (0,63)
1.43 (1.72)
0.93 (2.64)
4.54
16.21
6.06
7.73
37.48
14.10
12.24
43.67
16.33
20.82
100.00
22.41
aTarget medication effect, p < .05. bJudge medication effect, p < .05. CADHD = attention-deficit hyperactivity disorder, PBO = placebo, M P H = methylphenidate. Analyses were conducted separately for A D H D and comparison judges. Percent occurrence for each category was calculated across all detections and within positive and negative subtypes.
3.08 b (2.75)
1.20 a (1.89)
Positive detections
Motor inappropriate
t~
O
r~
O m.
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Whalen, Henker, and Granger
Once again, the performance of comparison judges was contrasted to that of the ADHD judges provide normative information. Of the 44 t tests (11 categories • 2 judge medication states • 2 target medication states), there was only one significant difference: When observing medicated targets, comparison judges detected a greater number of appropriate behaviors than did ADHD-medicated judges. Given the number of statistical tests, this isolated finding is likely due to chance and will not be considered further. The most reasonable conclusion is that there are few if any differences in the types of behaviors that normal and hyperactive boys identify when evaluating peers.
Associations Between Social Judgments and Problem Behaviors In these correlational analyses, two variables were examined, total detections and differential detections, corresponding to two distinct but potentially overlapping conceptualizations of performance on this social judgment task. The total number of button pushes (across type of response, session, and condition) was viewed as an index of detection threshold and perhaps of impulsivity or motoric activity level as well, and the average difference between detection frequencies for targets on placebo versus targets on medication was viewed as an index of social judgment. This latter variable was, of course, considered separately for good and bad responses, given the expectation that the medication status of the target child would influence negative and positive detections differentially. Because of a modest but significant correlation between detection frequency and age, r(37) = - .37, p < .05, first-order partial correlations were computed, controlling for a g e : Total response detection frequency was significantly associated with diverse assessments of problematic behaviors, reflecting the fact that judges with the most serious difficulties tended to have the highest button push rates. These relations held whether the measure of problematic behavior indexed a discrete 25-minute task activity (e.g., UC-CCBS ratings from Adventure) or a summary impression covering the entire 5-week program (e.g., staff ratings of intensity or troublesomeness), as can be seen in Table II. Moreover, these relations held across information source, emerging for peers, teachers, research staff, and naive undergraduates who had no prior experience with hyperactive boys in general or these youngsters in particular. The robustness of these findings across source and setting adds confidence to their validity. 5Becauseof this relationship, the main analysesof positive and negative detections-for both the hyperactiveand the comparisonboys-were redone using age as a covariate. The pattern of significant effects remained unchanged.
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Table I I . Social J u d g m e n t s a n d I n d i v i d u a l D i f f e r e n c e s in B e h a v i o r a n d P e r f o r m a n c e : P a r t i a l Correlations, Controlling for Age D i f f e r e n t i a l detections b
T o t a l detections ~
ADHD-PBO c "Good .... Peer nominations Cooperates F u n to be with Causes trouble Tall Best friends UC-CCBS Behavior Problems Social j u d g m e n t task Adventure game Staff summary
ADHD-MPH e
Bad . . . .
Good ....
Bad"
- .561 -.12 .50 t -.09 -.26
.15 -.04 .04 - .18 .02
- .49 a -.01 .55 e - .20 -.17
.25 -.29 -.35 - .13 -.23
.10 -.35 -.01 - .34 -.11
.48 e .56t .53 /
-.01 -.16 .08
.53 ~ .37 .47 a
-.33 -.29 .25
-.06 -.01 -.03
-.34 -.21 - .08
.25 -.12 - .31
.37 -.26 .29
UC-CCBS Dysphoria Social j u d g m e n t t a s k Adventure game Staff summary
-.16 -.26 - . 12
.06 .03 .34
Staff descriptors Intense Predictable T a k e s risks F u n to be with Causes trouble Cooperates G o o d athlete Isolated Popular Aggressive
.46 e - .49 r .55Y -.20 .52: - .49 e .08 - .06 - .04 .45 e
- .05 - .05 -.05 -.13 .06 - .05 -.43 a .36 - .27 - .06
.53 e - .48 d .52 e -.24 .48 d - .52 e .20 - .10 .01 .42 ~
- .31 .25 -.41 a -.08 -.38 .28 -.19 .20 - .23 - .22
- .20 .08 -.23 -.13 -.09 .09 -.31 .36 - .32 - .18
- .28 - .01 - .13
.26 .32 .32
- .20 - .23 - .24
- .28 - .23 - .27
- .07 - .22 -.23
- .10 - .06 - .11
.04 - .21 - .11
.31 .17 .15
MYTH Competition Impatience/aggression Total Academic achievement Reading Arithmetic Writing
.14 .37 a .32 a
- .09 - .25 - .19
" T o t a l detections across p o s i t i v e - n e g a t i v e valence, A D H D - c o m p a r i s o n judges, a n d m e d i c a t i o n p l a c e b o c o n d i t i o n s f o r b o t h j u d g e s a n d t a r g e t s , N = 39. b H y p e r a c t i v e j u d g e s ' ( N = 25) d e t e c t i o n s f o r p l a c e b o targets m i n u s d e t e c t i o n s f o r m e d i c a t e d targets. ~Medication state o f j u d g e . A D H D = a t t e n t i o n - d e f i c i t h y p e r a c t i v i t y d i s o r d e r , P B O = placebo, M P H = methylphenidate.
~p < .os. ep < .Ol.
(p < .ool.
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The nonassociations that emerged from these analyses may also be instructive. It appears as though detection threshold is linked specifically to externalizing behavior disorders, and not to social status or style, competitiveness, achievement, or dysphoric affect. For example, neither staff ratings of popularity nor peer nominations of best friends or "fun to be with" correlated significantly with total detections. Turning next to the relations between problematic behaviors and differential detections (i.e., rates for targets on placebo versus methylphenidate), there were only two significant findings. Negative behavior differentials were related to UC-CCBS ratings of problem behaviors during the social judgment task itself, r(36) = .41, p < .01, and positive behavior differentials were related to UC-CCBS problem behavior ratings during the Adventure game, r(35) = - .39, p < .05. Stated alternatively, it was the boys who were evaluated as difficult during one of the structured task activities who were most likely to detect disproportionate levels of undesirable behaviors in targets taking placebo and desirable behaviors in targets taking medication. These isolated findings should be interpreted cautiously, however, because they are embedded in a matrix of nonsignificant results and may, indeed, be spurious. Taken together, the findings suggest that overall response rates are associated with problematic behaviors, but that sensitivity to medication-related behavioral differences is not. In other words, the more difficult children are more likely than their counterparts to identify noteworthy peer behaviors but they are not more likely to distinguish methylphenidate from placebo states. The one exception to this conclusion occurred within the ADHD sample, when judges were taking placebo, as can be seen in Table II. Those who were the most sensitiveto medication-related differences in the negative behaviors of targets were perceived as more intense, aggressive, troublesome, and less cooperative by peers. The associations were substantially weaker, and generally nonsignificant, for positive detections by judges taking placebo, as well as for both positive and negative detections by medicated judges.
DISCUSSION When ADHD boys evaluated the behaviors of unknown peers, they were sensitive to medication-related differences, identifying more undesirable behaviors in unfamiliar peers who were taking placebo than in those taking methylphenidate. There were no target medication effects for positive behaviors, which were identified less frequently in all conditions. Nor were there any indications of social judgment deficits in ADHD boys when their performance was compared with that of normal peers.
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In terms of medication status of judges, ADHD boys taking placebo showed elevated behavior detection rates in general, whether they were identifying positive or negative behaviors, and whether targets were on medication or placebo. Especially noteworthy is the fact that the social perspicacity of ADHD judges was not altered by their own medication status: Their discriminations between targets on methylphenidate versus placebo were just as accurate when they themselves were unmedicated as when they were medicated. This study differed from previous examinations of social cognition in ADHD in that the task enabled distinctions between the more cognitive aspects of social perspicacity and the more overt behavioral aspects of hyperactivity, the former indexed by discriminations between medication and placebo conditions in other children, and the latter by overall response rates. In this situation, the hyperactive youngsters proved to be at least as socially discerning as their normal age-mates. Nor were there indications of medicationrelated enhancement of social cognition. The only other study known to the authors that examined medication effects on social information processing in ADHD children used very different procedures but reached similar conclusions (Murphy, Pelham, & Lang, 1989). Taken together, these findings support the supposition that ADHD children carry their problems with attention, impulsivity, or overactivity from one domain to the next and that it is general regulatory processes- rather than specific competencies- that are enhanced by methylphenidate. The differential medication effects on response totals and social sensitivity also have methodological implications. Tests and tasks that confound these two domains by using global response rate measures to index social judgment may yield misleading results, suggesting specific deficits in social cognition that may, instead, be attributable to more pervasive problems with behavioral regulation. This study yielded scattered suggestions that those children considered to be the most difficult were the ones most likely to detect undesirable behaviors in ADHD peers taking placebo, and these links were most evident when the judges themselves were unmedicated. If negative detections are construed as criticisms, then disinhibition may be a key factor: Perhaps untreated aggressive-hyperactive boys are more likely than their peers to identify deviant behavior in others because they are tess concerned with impression management and social desirability. In short, they may use less self-censorship. Another possibility is that it is the most difficult children who are most prone to interpret ambiguous events negatively. The competent performance of the ADHD boys in the present study appears to contrast with the findings of Milich and Dodge (1984), who reported that hyperactive-aggressive boys showed deficits in social information
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processing. There were several differences in the procedures of the two studies that might have contributed to the different findings, including the fact that the earlier task carried a substantial memory burden, while the present one did not. Moreover, in the Milich and Dodge study, deficits surfaced only with neutral cues; there were no problems with hostile and benevolent cues, and, in fact, the hyperactive-aggressive group was somewhat superior to normal controls in recalling positive information. The present task focused exclusively on valenced or irregular behaviors- those deemed especially positive or negative. The youngsters were instructed to ignore the numerous neutral acts, and, because the target stimuli reflected medication-placebo differences, undesirable behaviors were spotlighted. When cue valence is taken into account, the two sets of findings no longer appear contradictory. Indeed, this overall pattern is supported by findings from another recent study suggesting that children with conduct disorder are particularly likely to make statements with positive or negative "affective coloring" (Matthys, Walterbos, Njio, & van Engeland, 1989). Perhaps the extremity and salience of the interpersonal cues play an integral role in the social information-processing competence of children with externalizing behavior disorders. Whether ADHD (or, for that matter, normal) boys would respond in this way to more subtle or ambiguous medication differences remains an unanswered question. Diverse tasks, settings, and procedures have been used in attempts to document social information-processing problems in hyperactive children. Although sporadic evidence of deficits has emerged, such findings are elusive and difficult to replicate, generally showing neither cross-task nor crosssample consistency (Milich & Dodge, 1984; Murphy et al., 1989). In a review of social cognition in unpopular (but not necessarily hyperactive) children, Dodge and Feldman (1990) concluded that, when social-cognitive deficiencies do emerge in unpopular children, both the proportion who show such problems and the amount of variance in popularity accounted for by this domain tend to be relatively small. The failure to find pervasive diagnostic or medication differences in social sensitivity in the present study converges with these previous findings to suggest that social information processing, as currently viewed and measured, may not be a key component of either peer status or interpersonal functioning. On the other hand, greater attention to task and situational facets of social cognition is indicated, both to inform theories of social cognition and to optimize treatment strategies for hyperactive children. The peer-generated behavioral catalog that emerged is also of interest independent of diagnostic or medication differences. Negative behaviors were reported more frequently than positive acts, and this difference may have been even greater had we omitted the instructions to the judges to try to find good as well as bad acts. The most frequently reported negative behaviors
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were aggression or oppositionality; identification o f i n a t t e n t i o n or withdrawal was especially rare. This profile, o f course, reflects actual b e h a v i o r a l activity o f the v i d e o t a p e d targets a n d m a y also be partly a t t r i b u t a b l e to the dem a n d s o f the p a r t i c u l a r interactive game. O t h e r studies using these tapes, however, have d o c u m e n t e d the occurrence of i n t e r n a l i z i n g p r o b l e m s (Granger, 1987; W h a l e n , H e n k e r , & G r a n g e r , 1989). T h u s , the b e h a v i o r a l catalog that emerged here c a n be c o n s t r u e d - a t least in p a r t - a s a salience or interest profile for school-age boys. Clearly, negative behaviors are perceived as more consequential t h a n positive behaviors, a n d externalizing transgressions as m o r e n o t e w o r t h y t h a n i n t e r n a l i z i n g d i m e n s i o n s .
REFERENCES Barkley, R. A. (1985). The parent-child interaction patterns of hyperactive children: Precursors to aggressivebehavior? In M. Wolraich & D. K. Routh (Eds.), Advances in developmental and behavioral pediatrics (Vol. 6, pp. 117-150). Greenwich, CT: JAI Press. Cunningham, C. E., & Siegel, L. S. (1987). Peer interactions of normal and attention-deficitdisordered boys during free-play, cooperative task, and simulated classroom situations. Journal of Abnormal Child Psychology, 15, 247-268. Dodge, K. A., Asher, S. R., & Parkhurst, J. T. (1989). Social life as a goal-coordination task. In C. Ames & R. Ames (Eds.), Research on motivation in education (Vol. 3). Goals and cognitions (pp. 107-138). San Diego: Academic Press. Dodge, K. A., & Feldman, E. (1990). Issues in social cognition and sociometric status. In S. R. Asher & J. D. Coie (Eds.), Peer rejection in childhood (pp. 119-155). New York: Cambridge University Press. Dodge, K. A., Pettit, G. S., McClaskey, C. L., & Brown, M. M. (1986). Social competence in children. Monographs of the Society for Research in Child Development, 51(2, Serial No. 213). Granger, D. A. (1987). Peer interaction in hyperactive (ADD-H) children: Effects of methylphenidate. Unpublished master's thesis, University of California, Irvine. Grenell, M. M., Glass, C. R., & Katz, K. S. (1987). Hyperactive children and peer interaction: Knowledge and performance of social skills. Journal o f Abnormal Child Psychology, 15, 1-13. Guerra, N. G., & Slaby, R. G. (1989). Evaluative factors in social problem solving by aggressive boys. Journal of Abnormal Child Psychology, 17, 277-289. Henker, B., & Whalen, C. K. (1989). Hyperactivity and attention deficits. American Psychologist, 44, 216-223. Hinshaw, S. P. (1987). On the distinction between attentional deficits/hyperactivity and conduct problems/aggressionin child psychopathology.Psychological Bulletin, 101, 443-463. Hinshaw, S. P., Henker, B., Whalen, C. K., Erhardt, D., & Dunnington, R. E., Jr. (1989). Aggressive, prosocial, and nonsocialbehavior in hyperactiveboys: Dose effects of methylphenidate in naturalistic settings. Journal of Consulting and Clinical Psychology, 57, 636-643. Holleran, P. A., Littman, D. C., Freund, R. D., & Schmaling, K. B. (1982). A signal detection approach to social perception: Identification of negative and positive behaviors by parents of normal and problem children. Journal of Abnormal Child Psychology, 10, 547-558. Hymel, S. (1986). Interpretations of peer behavior: Affective bias in childhood and adolescence. Child Development, 57, 431-445. Landau, S., & Milich, R. (1988). Social communication patterns of attention-deficit-disordered boys. Journal of Abnormal Child Psychology, 16, 69-81.
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Loney, J., & Milich, R. (1982). Hyperactivity, inattention, and aggression in clinical practice. In M. Wolraich & D. K. Routh (Eds.), Advances in behavioralpediatrics (Vol. 2, pp. 113-147). Greenwich, CT: JAI Press. Mash, E. J., & Johnston, C. (1983). Sibling interactions of hyperactive and normal children and their relationship to reports of maternal stress and self-esteem. Journal of Clinical Child Psychology, 12, 91-99. Matthews, K. A., & WoodaU, K. L. (1988). Childhood origins of overt Type A behaviors and cardiovascular reactivity to behavioral stressors. Annals of BehavioralMedicine, 10, 71-77. Matthys, W., Walterbos, W., Njio, L., & van Engeland, H. (1989). Person perception in children with conduct disorders. Journal of Child Psychology and Psychiatry, 30, 439-448. Milich, R., & Dodge, K. A. (1984). Social information processing in child psychiatric populations. Journal of Abnormal Child Psychology, 12, 471-489. Murphy, D. A., Pelham, W. E., & Lang, A. R. (1989). Aggression in boys with attention deficit disorder: Methylphenidate effects on naturalistically observed aggression, response to provocation, and social information processing. Manuscript submitted for publication. Parker, J. G., & Asher, S. R. (1987). Peer relations and later personal adjustment: Are lowaccepted children at risk? Psychological Bulletin, 102, 357-389. Patterson, G. R., & Reid, J. B. (1984). Social interactional processes within the family: The study of the moment-by-moment family transactions in which human social development is imbeded. Journal of Applied Developmental Psychology, 5, 237-262. Schachar, R., Taylor, E., Wieselberg, M., Thorley, G., & Rutter, M. (1987). Changes in family function and relationships in children who respond to methylphenidate. Journal of the American Academy of Child and Adolescent Psychiatry, 26, 728-732. Whalen, C. K., & Henker, B. (1985). The social worlds of hyperactive children. Clinical Psychology Review, 5, 1-32. Whalen, C. K., & Henker, B. (in press). The social impact of stimulant treatment for hyperactive children. Journal of Learning Disabilities. Whalen, C. K., Henker, B., Buhrmester, D., Hinshaw, S. P., Huber, A., & Laski, K. (1989). Does stimulant medication improve the peer status of hyperactive children? Journal of Consulting and Clinical Psychology, 57, 545-549. Whalen, C. K., Henker, B., & Dotemoto, S. (1981). Teacher response to the methylphenidate (Ritalin) versus placebo status of hyperactive boys in the classroom. Child Development, 52, 1005-1014. Whalen, C. K., Henker, B., & Granger, D. A. (1989). Ratings of medication effects in hyperactive children: Viable or vulnerable? Behavioral Assessment, 11, 179-199. Whalen, C. K., Henker, B., Hinshaw, S. P., & Granger, D. A. (1989). Externalizing behavior disorders, situational generality, and the Type A Behavior Pattern. Child Development, 60, 465-491.
Social Judgment Processes in Hyperactive Boys: Effects of Methylphenidate and Comparisons with Normal Peers Carol K. Whalen, 1,3 Barbara Henker, z and Douglas A. Granger I
Although there is consensus that ADHD children have serious social problems, there is tittle understanding of the mechanisms underlying or accompanying such problems. To examine the possibility o f atypical or faulty social reasoning, we presented ADHD and normal boys with a social perception task that entailed evaluating the behaviors of unknown peers. ADHD 'Judges'participated under both methylphenidate and placebo conditions, and on each occasion they evaluated an unfamiliar A D H D "target" in each medication state. In contrast to placebo, methylphenidate appeared to dampen overall response rates in A D H D judges, but there was no effect on sensitivity to medication-related differences. Regardless o f their own medication state, ADHD judges identified more undesirable behaviors in peers on placebo than in those taking methylphenidate~ Judges with the most serious behavior problems tended to identify the greatest number of negative behaviors in peers, especially when both judge and target were unmedicated. There were no effects of target medication status on detections of positive behaviors and few differences in detection patterns of ADHD versus normal judges. Discussion focused on the need to distinguish general regulatory from specific social-cognitive processes.
Manuscript received in final form December 15, 1989. This study was conducted at the Fernald Child Study Center, UCLA, and we very much appreciate the many contributions of Stephen P. Hinshaw, codirector of the program. We are also grateful to the resourceful and devoted staff and the energetic children who served as judges and targets. 1Program in Social Ecology, University of California, Irvine, California 92717. 2Department of Psychology, University of California, Los Angeles, California 90024. 3Address all correspondence to Carol K. Whalen, Social Ecology, University of California, Irvine, California 92717. 297 0091-0627/90/0600-0297506.00/0 9 1990PlenumPublishingCorporation
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One of the most robust findings in the child psychopathology literature is that children with attention-deficit hyperactivity disorder (ADHD) 4 have pervasive problems getting along with other people. Not only do social difficulties degrade and delimit everyday experiences and opportunities during childhood, but these early problems also predict serious maladjustment during adolescence and adulthood (Parker & Asher, 1987). In addition, there is a negative catalytic effect on others who come into contact with hyperactive children. When interacting with an ADHD (in contrast to a normal) child, siblings, peers, parents, teachers, and even strangers are more likely to behave in a less than desirable fashion (e.g., Cunningham & Siegel, 1987; Landau & Milich, 1988; Mash & Johnston, 1983; Whalen, Henker, & Dotemoto, 1981). It is, of course, always difficult to distinguish cause from effect in the complex interpersonal realm, but the fact that a hyperactive child's significant others show behavioral improvements when the child receives treatment (e.g., Barkley, 1985; Schachar, Taylor, Wieselberg, Thorley, & Rutter, 1987; Whalen et al., 1981) attests to the child's active role in the construction of unsalutary social worlds. Several mechanisms have been identified as possible contributors to the breadth and tenacity of social impairments of the type associated with ADHD, including deficient social skill repertoires, deviant hierarchies of social goals or agendas, and expectancy or reputational bias in parents, peers, and teachers (e.g., Dodge, Asher, & Parkhurst, 1989; Hymel, 1986; Whalen & Henker, 1985). Another prime candidate is deficient social information processing by hyperactive children. There is intriguing evidence that children who have difficulty making and keeping friends make inaccurate interpersonal inferences, and that faulty social reasoning may result in maladaptive behavioral decisions. Although the strongest evidence of atypical social reasoning has emerged in children identified as aggressive or rejected (e.g., Dodge, Pettit, McClaskey, & Brown, 1986), there is substantial overlap between groups of aggressive, rejected, and hyperactive children, and there are also scattered indication that youngsters diagnosed ADHD may indeed have social cognition deficits (Grenell, Glass, & Katz, 1987; Milich & Dodge, 1984). Stimulant medication, the most prevalent treatment modality for ADHD, effects marked and at times even dramatic improvement in the ADHD child's social modes and manners, decreasing the rate and intensity of aversive actions and enhancing interpersonal harmony (e.g., Whalen & Henker, in press). The gaps in our knowledge about the roots of the ADHD child's social problems are matched, however, by gaps in our understanding of these beneficial medication effects. We know that social exchanges be4Theterms hyperactivity, attention deficit disorder with hyperactivity (ADHD),and attentiondeficit hyperactivity disorder (ADHD) are used synonymously.
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come more amicable and productive when ADHD children take medication in contrast to placebo, and we know that, quite often, the number of noxious or clumsy acts diminishes, but changes in the more covert and elusive realms of cognition and affect remain uncharted (Henker & Whalen, 1989). Such information is crucial if child specialists are to understand, predict, and ameliorate the social problems endemic to ADHD. As a step toward filling the gaps in our understanding of social cognition in hyperactive children, this study examined the effects of medication on social thinking rather than on social doing. There are several components of social information processing, including the encoding and interpretation of cues, the generation and assessment of response options, and the enactment and monitoring of behavioral responses (e.g., Dodge et al., 1986). Recent research with aggressive children has highlighted the importance of examining not only a child's cognitive capacity to process social information but also the ways he evaluates such information (e.g., Guerra & Slaby, 1989). Children who are competent decoders of social cues may still have serious problems getting along with peers because of the criteria they use to distinguish appropriate from inappropriate acts and events. The focus of the present study is on this interpretation or evaluation phase of social information processing, the processes of judgment and inference, given the pivotal role such processes play in linking social cues to social acts. More specifically, ADHD and normal boys performed a social judgment task that involved tracking and evaluating the behaviors of other (unknown) boys of similar age. Modeled after procedures developed by Patterson and colleagues to compare the perceptions of parents with normal versus problem children (Holleran, Littman, Freund, & Schmaling, 1982; Patterson & Reid, 1984), the task was designed to tap simple evaluative (good/bad) processes as well as more complex, qualitative facets of social judgment. The task was done twice, with the ADHD boys participating in both methylphenidate and placebo states. On each occasion, the judges evaluated two hyperactive boys, one medicated and the other on placebo when the videotapes were recorded. The judges were, of course, unaware of any diagnostic or medication information. The ability of hyperactive boys to detect medication-related differences in peer behaviors, and the role of their own medication status in this process, were primary foci of the present study. In a sense, this was a study of a study: A medication-placebo crossover design was used to assess hyperactive boys' perceptions of other ADHD boys who were themselves participants in a different medication-placebo crossover study. Additional analyses compared ADHD and normal boys. To avoid terminological confusion, the (subject) child who made the social evaluations is called the judge, and the (stimulus) child who is evaluated from videotape is called the target.
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Context Participants were from a 5-week summer assessment and research program at UCLA for both ADHD and normal boys. The 6-hour days included a variety of school and camp activities as well as diverse individual and smallgroup assessments focusing on patterns of attention, cognition, and social interaction. Two certified teachers conducted all classroom sessions, while a staff of 34 undergraduate and graduate students served as research assistants, classroom aides, and playground supervisors. Because the participants and procedures have been described elsewhere (e.g., Hinshaw, Henker, Whalen, Erhardt, & Dunnington, 1989; Whalen, Henker, Buhrmester, et al., 1989), this information is merely summarized here.
Participants Ranging in age from 6 years 4 months to 12 years 5 months (M = 9 years 1 month), the 25 ADHD boys were recruited through contacts with the medical community and school districts. All had received a diagnosis of hyperactivity from their referring physicians, and, as in any ADHD sample, many were also oppositional or aggressive. None showed signs of mental retardation or gross neurological dysfunction. Before the program, 23 of these boys were taking maintenance doses of stimulants, and 2 had recently completed a monthlong clinical trial and were about to begin a regular regimen. The 14 comparison boys-recruited through bulletin board notices, newspaper advertisements, and local schools-ranged in age from 7 years to 10 years 4 months (M = 8 years 8 months). None had known behavioral, intellectual, or academic problems, nor were any of these boys taking psychoactive medication. Prior to the program, parents completed the Conners Abbreviated Symptom Questionnaire or CASQ. All of the ADHD boys received a score of at least 15, typically considered the ADHD cutoff, on either the maternal (M = 21.32) or the paternal rating (M = 18.95), and most met this criterion on both. For the comparison group, maternal and paternal ratings averaged 5.36 and 5.67, respectively, with only two instances of scores slightly above the cutoff.
Medication Dosage, Design, and Procedure Each boy served as a judge on two occasions, approximately 1 to 2 weeks apart. The hyperactive judges were taking placebo on one occasion and 0.3
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mg/kg methylphenidate on the other, in a double-blind crossover design. Dosages were prepared by a pharmacist to the nearest 2.5 mg and placed in opaque capsules to disguise any taste differences between active drug and placebo. Absolute doses of medication, administered at school once in the morning and again just before lunch, ranged between 5 and 15 mg (M = 9.2). To ensure that the social judgment task was conducted within the effective time span of methylphenidate, the boys participated from 89 to 3 hours after medication ingestion.
Social Judgment Task Overview. Working individually with a staff member, the judge viewed videotapes of four boys playing a game and pushed a button each time a designated target child "did something good or something bad." Following each button push, the staff member paused the videotape, asked the judge to describe what the target had just done that was good or bad, and then restarted the tape. Social (Target) Stimuli. The videotaped segments were selected from a previous study of social interaction styles that used a structured interaction game called Adventure. Designed to simulate routine problem-solving demands that children confront in typical peer interactions, this board game has proven to be a useful vehicle for assessing communication styles and negotiation strategies across diagnostic groups and medication conditionS. There are two parallel versions of the game, Space Adventure and Mountain Adventure, each taking about 20 to 25 minutes. In the study that provided the stimuli for the present investigation, 24 hyperactive participants between the ages of 6 years 4 months and 13 years 2 months (M = 9 years 8 months) played both versions on consecutive days, with order of game version counterbalanced. Formed on the basis of age, the four-member teams remained the same for each version of the game. Medication-placebo order was counterbalanced, with two members from each team on a standard (0.3 mg/kg) dose of methylphenidate during the first game and placebo during the second, and the other two taking placebo first followed by medication. Neither the staff nor the children were aware of medication status. The games were videotaped, and each player was later evaluated from the tape by seven undergraduate raters who were unfamiliar with the children and knew nothing about the research design or focus. The raters used the University of California-Conners Child Behavior Scale or UC-CCBS, a 14-item modification of the CASQ that yields a score for behavior problems (11 items) and another for dysphoria (3 items). More detailed information about the Adventure procedures and the UC-CCBS instrument appears in Whalen, Henker, and Granger (1989).
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In the selection of targets for this study, one team was excluded because they did not complete one of the games, and another because, during one session, the behaviors of the two children taking placebo were especially aggressive and disruptive. Tapes of this team raised both ethical and methodological concerns: We did not want to provide models of highly deviant behavior for the children to emulate, and we were concerned that the extremity of the behaviors might reduce the interindividual variability in social judgments. The two female players were also excluded, given that all of the judges were male. For the remaining 14 Adventure players, we computed average scores across raters on the behavior problem subscale of the UC-CCBS and selected the 8 boys with the clearest indications of medication-related improvement. With high scores denoting undesirable behaviors, UC-CCBS scores for these targets ranged from 4.00 to 8.29 (M = 5.62) when they were taking methylphenidate, and from 8.86 to 17.14 (M = 13.17) when they were taking placebo. The average medication-placebo difference was 7.55 (range: 3.36 to 12.00). Instructions. The judges were told that they would see videotapes of other children playing a game, and they were to watch a particular boy very carefully. This boy was described as doing a number of especially good things and a number of especially bad things. The judge's job was to find as many of the good and bad things as he could, pressing a "smile button" each time he saw the boy do something good, and a "frown button" each time he saw him do something bad. The judge was asked not to do anything when the boy on the tape was being "just regular or sorta OK." Procedures and Apparatus. The equipment consisted of a videocassette playback unit and monitor, a standard remote-control device, and the response panel containing a happy-face button for positive behaviors and a frowning-face button for negative behaviors. Two colored lights signaled the boy's responses to the staff assistant, who used the remote control to pause the videotape whenever the boy pushed either button. The boy was asked to describe what he had seen, and each response was recorded in writing and on audiotape. For practice, the boys first watched a 4-minute sample tape (involving targets not selected for the study), with the assistant encouraging them to push both buttons. Next, they evaluated two 10-minute excerpts, one having a target on methylphenidate and the other a target on placebo. This sequence was repeated approximately 1 to 2 weeks later, with each judge evaluating a different practice target followed by different medicated and placebo targets. Using a constrained random assignment procedure, targets were balanced across testing occasion as well as across the diagnostic group and medication status of the judges. Approximately half of the judges viewed targets in the medication-placebo order and half in the placebo-medication order.
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Social Judgment Measures There were two analytic approaches. First, frequencies of positive and negative detections were examined, and then a behavioral catalog was constructed for coding the judges' descriptions and elaborations. The Behavioral Catalog. This catalog was based on a content analysis of a preliminary sample of responses. Twelve types of negative behavior were identified: physical aggression (e.g., "Stuck the boy with a pencil"), verbal aggression ("Said 'yes' in a snotty attitude"), nonverbal aggression ("Makes a mean face"), attempts to damage or destroy property ("Trying to break the intercom"), bossy/domineering ("Wouldn't let others talk"), violations of implicit or explicit game rules ("Not sharing opinions with other kids"), violations of social norms ("Talks out of turn"), inappropriate or immature (but nonaggressive) verbal acts ("He said 'he doesn't want it' a million times"), inappropriate motoric behavior or bodily position ("Jumping up and down"), inattention ("Not listening"), withdrawal or lethargy ("Not ever joining in"), and global negative labeling ("Being a jerk"). Analogously, eight types of positive behavior were identified: appropriate or regular task behavior ("He was talking over what to get with the other kids"), facilitative leadership or planning ("He told the tape what they wanted so the other boys wouldn't argue"), nurturance or helping ("He was helping the kid to understand how to do the money thing"), behavioral advice ("Telling other kids they should share"), rule following ("He was being quiet and cooperating"), showing good manners ("He said may I please have it back"), absence of bad behavior ("He wasn't yelling out"), and global positive labeling ("He's being good"). Rules of precedence were established that gave priority to aggressive over bossy or domineering behavior, specific over global behavior, and presence over absence of behavior. A coding manual is available from the authors. Coding Procedures and Unitizing of Responses. The verbal response accompanying each button push was later typed on an index card. Before coding began, one coder read through all the cards and marked the individual units to be coded. Multiple units per button push were scored only when the description contained separate elements that could not be captured by a single category. Each category could occur only once per button push response, even if the child elaborated or gave multiple examples, and only one code was allowed per response unit. This procedure decreased the probability that multiple codes would be given not only for dual responses but also for a single response that was ambiguous or otherwise difficult to categorize. A second coder independently unitized approximately 15% of the responses, and the agreement rate was 98%. There were only three discrepancies, which were resolved through discussion.
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Individual Differences in Judges Relations were examined between social judgments and diverse domains of the judges' own problematic behavior assessed during other components of the summer program. The criteria for selection of measures were that they show strong stability and reflect a diversity of settings, sources, and problems. There was specific interest in the role of aggression, given recent suggestions that aggressive and nonaggressive hyperactive children may differ along key dimensions related to etiology, prognosis, or treatment response (e.g., Hinshaw, 1987; Loney & Milich, 1982). Three types of measures were included: Peer Sociometric Nominations. Toward the end of each of the middle 3 weeks of the program, the boys were asked to identify their three best friends and to nominate all of the boys in their cohort who cooperated, those who caused trouble, and those who were fun to be with. The descriptor "tall" was also included as a validity check. These nominations were used during a dose-response study of medication effects on peer status (Whalen, Henker, Buhrmester et al., 1989). UC-Conners Child Behavior Scale. Three distinct sources provided UCCCBS ratings of the judges. First, the staff who presented the social judgment task to the child completed this scale immediately after the session, having been instructed to base their evaluation exclusively on the preceding session. Second, all research staff (N = 34) provided an integrative summary UC-CCBS rating for each child during the final week of the program. Finally, a group of 11 undergraduate students who had not participated in the summer program and did not know the boys completed the UC-CCBS independently, immediately after viewing tapes of the judges themselves playing Adventure. Staff Summary Ratings and Assessment Procedures. During the final week of the program, the staff provided global, 4-point ratings of each boy on a set of behavioral and personality descriptors (e.g., "fun to be with," "predictable"). In addition, the five senior staff members who knew the boys best rated their overall aggression level on a 5-point scale. The two teachers also independently completed the Matthews Youth Test for Health (MYTH), designed to assess Type A behavior in children. This 17-item measure yields a total score, a 9-item Impatience-Aggression subscale score, and an 8-item Competition subscale score. Although recent studies have demonstrated that the MYTH is sensitive to behaviors typically considered to reflect Type A behavior (e.g., Matthews & Woodall, 1988), questions have surfaced about the specificity of this measure, given extensive overlap between the MYTH, especially the Impatience-Aggression subscale, and measures of the externalizing behavior problems that characterize ADHD (Whalen, Henker, Hinshaw, & Granger, 1989). For all individual difference measures, teachers and the majority of staff were unaware of the boys' group status (ADHD vs. comparison), and un-
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305
dergraduate raters did not even know that the research focus was on A D H D and methylphenidate. For the measures that were obtained during both medication states (i.e., peer nominations and UC-CCBS ratings for the social judgment and Adventure tasks), respondents were blind as to medication status. Placebo scores were used in the present analyses to reflect behavior under natural or untreated conditions. Additional information about these measures appears in Whalen, Henker, Hinshaw, and Granger (1989).
RESULTS For the frequency measures, data from the hyperactive judges were analyzed in a 2 x 2 x 2 repeated-measures ANOVA design that included a medication factor (methylphenidate vs. placebo) for both judges and targets, as well as a valence factor reflecting positive versus negative detections. To provide normative information, scores from methylphenidate and placebo conditions for A D H D judges were also contrasted with those from the comparison group, with the latter averaged across the two sessions.
Detection Frequencies for Positive and Negative Behaviors Valence. Approximately 63% of detections were for negative behaviors, yielding a significant main effect for valence, F(1, 24) = 5.76, p < .05. Across all conditions, the boys detected an average of 3.96 negative or "bad" responses (range = 0-21) and 2.38 positive or "good" responses (range = 0-16) per 10-minute target segment. Medication Effects. Significant medication main effects emerged for judges and also for targets, Ps(1, 24) = 10.42 and 11.69, respectively, p's < .01. Detection rates for both positive and negative behaviors were higher when the judges were taking placebo than when they were taking methylphenidate, as can be seen in Figure 1. The medication main effect for targets was qualified by a significant target • valence interaction, F ( I , 24) = 19.01, p < .001, reflecting the fact that hyperactive judges detected significantly more unacceptable behaviors when targets were taking placebo in contrast to methylphenidate, F(1, 24)= 26.64, p < .001. This differential pattern was not repeated for detections of positive behaviors, and no other interactions reached significance. The pattern indicates that the boys were sensitive to medication-related decreases in peer negative behaviors regardless of their own medication status, although medication did dampen overall response rates. ADHD versus Comparison Judges. There were no significant differences for positive behavior detections between medicated A D H D judges and
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Whalen, Henker, and Granger
"GOODS"
~
5
L"I~ -
~
~
~
~&
Placebo 0 Comparison
I I Medication Placebo TARGET MEDICATION STATUS
"BADS" 7
/A
6 5
/
>-
~4
/
/
/
/ / /
/
Ptocebo
/
0
Comparison .'~
Medication
~3 2 D" I I Medication Piacebo TARGET MEDICATION STATUS
Fig. 1. Judges' total detections of positive ("good") and negative ("bad") behaviors in peer targets taking methylphenidateversus placebo. Judges were ADHD boys taking methylphenidateversus placebo and normal comparison boys.
the comparison group. In contrast, A D H D judges taking placebo reported significantly more good behaviors on the part of the medicated target (M = 3.64) than did the comparison group (M = 1.43), t(34.7) = 2.3, p < .05. For negative detections, no comparison-ADHD differences reached significance.
Types of Behaviors Detected: A Behavioral Catalog The vast majority of button push responses were accompanied by singleunit descriptions. Of the 991 detections, 933 (94.1%o)yielded single-category descriptions, 57 (5.8%)involved two categories, and only 1 response involved three categories. The total number of units coded was 1,050. Interjudge Agreementfor Behavioral Categories. Because of the qualitative nature of the behavioral categories, a consensus rating procedure was used. Three trained coders independently coded all responses, and the criterion was agreement between at least two coders. All three coders agreed on 875 (83.3O/o) and two of the three agreed on another 160 (15.2%) of the total
Social Judgment Processes in Hyperactive Boys
307
number of response units coded. There were only 16 responses (1.5%) for which consensus was not reached. The three authors scored each of these responses and, once again, the consensus criterion was applied. For negative detections, the most problematic distinction was between bossy/domineering and violations of game rules; the most troublesome distinctions for positive detections were between appropriate task behavior and either rule following or leadership/planning. Profile of Behavioral Detections. As with any comprehensive behavioral system, some categories occurred rarely and thus did not yield meaningful data. All categories with occurrence rates less than 5 % of the total responses were eliminated from subsequent analyses. This criterion led to elimination of five negative categories (nonverbal aggression, destruction of property, inattention, social withdrawal, and global negative) and four positive categories (nurturance/helping, behavioral advice, good manners, and global positive). For the remaining 11 categories, which comprised 91% of the original units, Table I presents a descriptive summary of frequencies for comparison, ADHD-1 medication, and ADHD-placebo judges separately for targets on medication versus placebo. Two response rate indexes are provided, one based on the judges' total number of detections, and the other computed within the positive and negative domains. For negative detections, it is clear that physical and verbal aggression were salient categories, as were rule violations and inappropriate motor activity. Rule following was the dominant positive category, and the percentages for the other three positive categories were also in double digits.
Effects o f Medication and Group Status on Identification of Specific Behaviors. For each category, data from the hyperactive judges were analyzed in a 2 • 2 repeated-measures ANOVA design that included a medication factor (methylphenidate vs. placebo) for both judges and targets. When on placebo in contrast to medication, ADHD judges detected significantly more instances of several negative behaviors (i.e., verbal aggression, verbal inappropriate/immature, and norm violations) as well as positive behaviors (i.e., appropriate behavior and rule following), as can be seen in Table I. There were also significant target main effects, with physical and verbal aggression, rule violations, verbal inappropriate/immature, and motor inappropriate all detected more frequently in placebo than in medicated targets. There were no significant target main effects for positive detections, nor were any interactions significant. In sum, the pattern that emerged with these behavioral descriptors mirrors that found for overall detection rates, with the ADHD-placebo judges showing elevated response rates in several instances, and the ADHD-placebo targets eliciting higher rates of negative detections for some but not all categories.
1.24 a'b (1.16) 0.36 (0.64) 0.92 a (1.63) 0.84 b (1.91) 0.76 ~'~ (1.20)
Bossy/domineering
Violate game rules
Violate social norms
Verbal inappropriate/ immature
6.72 ~'~ (5.35) 1.04 a (1.21)
0.24 (0.52)
0.36 (1.04)
0.24 (0.52)
0.20 (0.50)
0.56 (1.45)
3.52 (3.54) 0.40 (0.71)
MPH
PBO
Target:
Verbal aggression
Physical aggression
Negative detections
ADHD-PBO c
Judge:
0.28 (0.74)
0.32 (0.90)
0.52 (0.82)
0.24 (0.60)
0.52 (0.77)
4.08 (3.80) 0.76 (0.97)
PBO
0.00 (0.00)
0.12 (0.33)
0.32 (1.03)
0.32 (0.56)
0.12 (0.44)
1.40 (1.61) 0.24 (0.72)
MPH
ADHD-MPH ~
0.29 (0.38)
0.21 (0.43)
0.43 (0.62)
0.61 (1.26)
0.86 a (0.84)
4.79 (3.90) 1.21" (1.87)
PBO
O. 11 (0.29)
0.18 (0.46)
0.64 (0.91)
0.32 (0.46)
0.21 (0.32)
3.25 (4.81) 0.71 (2.00)
MPH
Comparison
4.20
5.00
7.73
5.30
8.80
11.22
62.52
Across
6.75
7.95
12.29
8.43
13.97
17.83
100.00
Within
Percent occur
Table L Evaluations of Social Behaviors in Medicated and Unmedicated Peers: Means, Standard Deviations (in parentheses), and Percent Occurrence
r
gs g~
~r
O0
0.56 b (0.87) 0.44 (1.08) 1,48 b (1.73) 0.20 (0.50)
Appropriate
Leader/planner
Rule following
Absence of bad
0.40 (0.87)
1.76 (2.26)
0.96 (3.05)
0.68 (1.18)
3.64 (4.21)
0.88 (2.t7)
0.64 (1.63)
0.88 (1.30)
0.28 (0.54)
0.20 (0.50)
2.04 (2.54)
1.44 (2.61)
0.16 (0.37)
1.12 (1.51)
0,16 (0.47)
0.36 (0.70)
1.76 (1.83)
0.12 (0.60)
0.36 (0.53)
0.64 (0.89)
0.46 (0.80)
0.78 (0,91)
2.46 (2.30)
1.00 (1.11)
0.07 (0.27)
0,64 (1.44)
0.14 (0.31)
0.46 (0,63)
1.43 (1.72)
0.93 (2.64)
4.54
16.21
6.06
7.73
37.48
14.10
12.24
43.67
16.33
20.82
100.00
22.41
aTarget medication effect, p < .05. bJudge medication effect, p < .05. CADHD = attention-deficit hyperactivity disorder, PBO = placebo, M P H = methylphenidate. Analyses were conducted separately for A D H D and comparison judges. Percent occurrence for each category was calculated across all detections and within positive and negative subtypes.
3.08 b (2.75)
1.20 a (1.89)
Positive detections
Motor inappropriate
t~
O
r~
O m.
310
Whalen, Henker, and Granger
Once again, the performance of comparison judges was contrasted to that of the ADHD judges provide normative information. Of the 44 t tests (11 categories • 2 judge medication states • 2 target medication states), there was only one significant difference: When observing medicated targets, comparison judges detected a greater number of appropriate behaviors than did ADHD-medicated judges. Given the number of statistical tests, this isolated finding is likely due to chance and will not be considered further. The most reasonable conclusion is that there are few if any differences in the types of behaviors that normal and hyperactive boys identify when evaluating peers.
Associations Between Social Judgments and Problem Behaviors In these correlational analyses, two variables were examined, total detections and differential detections, corresponding to two distinct but potentially overlapping conceptualizations of performance on this social judgment task. The total number of button pushes (across type of response, session, and condition) was viewed as an index of detection threshold and perhaps of impulsivity or motoric activity level as well, and the average difference between detection frequencies for targets on placebo versus targets on medication was viewed as an index of social judgment. This latter variable was, of course, considered separately for good and bad responses, given the expectation that the medication status of the target child would influence negative and positive detections differentially. Because of a modest but significant correlation between detection frequency and age, r(37) = - .37, p < .05, first-order partial correlations were computed, controlling for a g e : Total response detection frequency was significantly associated with diverse assessments of problematic behaviors, reflecting the fact that judges with the most serious difficulties tended to have the highest button push rates. These relations held whether the measure of problematic behavior indexed a discrete 25-minute task activity (e.g., UC-CCBS ratings from Adventure) or a summary impression covering the entire 5-week program (e.g., staff ratings of intensity or troublesomeness), as can be seen in Table II. Moreover, these relations held across information source, emerging for peers, teachers, research staff, and naive undergraduates who had no prior experience with hyperactive boys in general or these youngsters in particular. The robustness of these findings across source and setting adds confidence to their validity. 5Becauseof this relationship, the main analysesof positive and negative detections-for both the hyperactiveand the comparisonboys-were redone using age as a covariate. The pattern of significant effects remained unchanged.
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311
Table I I . Social J u d g m e n t s a n d I n d i v i d u a l D i f f e r e n c e s in B e h a v i o r a n d P e r f o r m a n c e : P a r t i a l Correlations, Controlling for Age D i f f e r e n t i a l detections b
T o t a l detections ~
ADHD-PBO c "Good .... Peer nominations Cooperates F u n to be with Causes trouble Tall Best friends UC-CCBS Behavior Problems Social j u d g m e n t task Adventure game Staff summary
ADHD-MPH e
Bad . . . .
Good ....
Bad"
- .561 -.12 .50 t -.09 -.26
.15 -.04 .04 - .18 .02
- .49 a -.01 .55 e - .20 -.17
.25 -.29 -.35 - .13 -.23
.10 -.35 -.01 - .34 -.11
.48 e .56t .53 /
-.01 -.16 .08
.53 ~ .37 .47 a
-.33 -.29 .25
-.06 -.01 -.03
-.34 -.21 - .08
.25 -.12 - .31
.37 -.26 .29
UC-CCBS Dysphoria Social j u d g m e n t t a s k Adventure game Staff summary
-.16 -.26 - . 12
.06 .03 .34
Staff descriptors Intense Predictable T a k e s risks F u n to be with Causes trouble Cooperates G o o d athlete Isolated Popular Aggressive
.46 e - .49 r .55Y -.20 .52: - .49 e .08 - .06 - .04 .45 e
- .05 - .05 -.05 -.13 .06 - .05 -.43 a .36 - .27 - .06
.53 e - .48 d .52 e -.24 .48 d - .52 e .20 - .10 .01 .42 ~
- .31 .25 -.41 a -.08 -.38 .28 -.19 .20 - .23 - .22
- .20 .08 -.23 -.13 -.09 .09 -.31 .36 - .32 - .18
- .28 - .01 - .13
.26 .32 .32
- .20 - .23 - .24
- .28 - .23 - .27
- .07 - .22 -.23
- .10 - .06 - .11
.04 - .21 - .11
.31 .17 .15
MYTH Competition Impatience/aggression Total Academic achievement Reading Arithmetic Writing
.14 .37 a .32 a
- .09 - .25 - .19
" T o t a l detections across p o s i t i v e - n e g a t i v e valence, A D H D - c o m p a r i s o n judges, a n d m e d i c a t i o n p l a c e b o c o n d i t i o n s f o r b o t h j u d g e s a n d t a r g e t s , N = 39. b H y p e r a c t i v e j u d g e s ' ( N = 25) d e t e c t i o n s f o r p l a c e b o targets m i n u s d e t e c t i o n s f o r m e d i c a t e d targets. ~Medication state o f j u d g e . A D H D = a t t e n t i o n - d e f i c i t h y p e r a c t i v i t y d i s o r d e r , P B O = placebo, M P H = methylphenidate.
~p < .os. ep < .Ol.
(p < .ool.
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Whalen, Henker, and Granger
The nonassociations that emerged from these analyses may also be instructive. It appears as though detection threshold is linked specifically to externalizing behavior disorders, and not to social status or style, competitiveness, achievement, or dysphoric affect. For example, neither staff ratings of popularity nor peer nominations of best friends or "fun to be with" correlated significantly with total detections. Turning next to the relations between problematic behaviors and differential detections (i.e., rates for targets on placebo versus methylphenidate), there were only two significant findings. Negative behavior differentials were related to UC-CCBS ratings of problem behaviors during the social judgment task itself, r(36) = .41, p < .01, and positive behavior differentials were related to UC-CCBS problem behavior ratings during the Adventure game, r(35) = - .39, p < .05. Stated alternatively, it was the boys who were evaluated as difficult during one of the structured task activities who were most likely to detect disproportionate levels of undesirable behaviors in targets taking placebo and desirable behaviors in targets taking medication. These isolated findings should be interpreted cautiously, however, because they are embedded in a matrix of nonsignificant results and may, indeed, be spurious. Taken together, the findings suggest that overall response rates are associated with problematic behaviors, but that sensitivity to medication-related behavioral differences is not. In other words, the more difficult children are more likely than their counterparts to identify noteworthy peer behaviors but they are not more likely to distinguish methylphenidate from placebo states. The one exception to this conclusion occurred within the ADHD sample, when judges were taking placebo, as can be seen in Table II. Those who were the most sensitiveto medication-related differences in the negative behaviors of targets were perceived as more intense, aggressive, troublesome, and less cooperative by peers. The associations were substantially weaker, and generally nonsignificant, for positive detections by judges taking placebo, as well as for both positive and negative detections by medicated judges.
DISCUSSION When ADHD boys evaluated the behaviors of unknown peers, they were sensitive to medication-related differences, identifying more undesirable behaviors in unfamiliar peers who were taking placebo than in those taking methylphenidate. There were no target medication effects for positive behaviors, which were identified less frequently in all conditions. Nor were there any indications of social judgment deficits in ADHD boys when their performance was compared with that of normal peers.
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313
In terms of medication status of judges, ADHD boys taking placebo showed elevated behavior detection rates in general, whether they were identifying positive or negative behaviors, and whether targets were on medication or placebo. Especially noteworthy is the fact that the social perspicacity of ADHD judges was not altered by their own medication status: Their discriminations between targets on methylphenidate versus placebo were just as accurate when they themselves were unmedicated as when they were medicated. This study differed from previous examinations of social cognition in ADHD in that the task enabled distinctions between the more cognitive aspects of social perspicacity and the more overt behavioral aspects of hyperactivity, the former indexed by discriminations between medication and placebo conditions in other children, and the latter by overall response rates. In this situation, the hyperactive youngsters proved to be at least as socially discerning as their normal age-mates. Nor were there indications of medicationrelated enhancement of social cognition. The only other study known to the authors that examined medication effects on social information processing in ADHD children used very different procedures but reached similar conclusions (Murphy, Pelham, & Lang, 1989). Taken together, these findings support the supposition that ADHD children carry their problems with attention, impulsivity, or overactivity from one domain to the next and that it is general regulatory processes- rather than specific competencies- that are enhanced by methylphenidate. The differential medication effects on response totals and social sensitivity also have methodological implications. Tests and tasks that confound these two domains by using global response rate measures to index social judgment may yield misleading results, suggesting specific deficits in social cognition that may, instead, be attributable to more pervasive problems with behavioral regulation. This study yielded scattered suggestions that those children considered to be the most difficult were the ones most likely to detect undesirable behaviors in ADHD peers taking placebo, and these links were most evident when the judges themselves were unmedicated. If negative detections are construed as criticisms, then disinhibition may be a key factor: Perhaps untreated aggressive-hyperactive boys are more likely than their peers to identify deviant behavior in others because they are tess concerned with impression management and social desirability. In short, they may use less self-censorship. Another possibility is that it is the most difficult children who are most prone to interpret ambiguous events negatively. The competent performance of the ADHD boys in the present study appears to contrast with the findings of Milich and Dodge (1984), who reported that hyperactive-aggressive boys showed deficits in social information
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Whalen, Henker, and Granger
processing. There were several differences in the procedures of the two studies that might have contributed to the different findings, including the fact that the earlier task carried a substantial memory burden, while the present one did not. Moreover, in the Milich and Dodge study, deficits surfaced only with neutral cues; there were no problems with hostile and benevolent cues, and, in fact, the hyperactive-aggressive group was somewhat superior to normal controls in recalling positive information. The present task focused exclusively on valenced or irregular behaviors- those deemed especially positive or negative. The youngsters were instructed to ignore the numerous neutral acts, and, because the target stimuli reflected medication-placebo differences, undesirable behaviors were spotlighted. When cue valence is taken into account, the two sets of findings no longer appear contradictory. Indeed, this overall pattern is supported by findings from another recent study suggesting that children with conduct disorder are particularly likely to make statements with positive or negative "affective coloring" (Matthys, Walterbos, Njio, & van Engeland, 1989). Perhaps the extremity and salience of the interpersonal cues play an integral role in the social information-processing competence of children with externalizing behavior disorders. Whether ADHD (or, for that matter, normal) boys would respond in this way to more subtle or ambiguous medication differences remains an unanswered question. Diverse tasks, settings, and procedures have been used in attempts to document social information-processing problems in hyperactive children. Although sporadic evidence of deficits has emerged, such findings are elusive and difficult to replicate, generally showing neither cross-task nor crosssample consistency (Milich & Dodge, 1984; Murphy et al., 1989). In a review of social cognition in unpopular (but not necessarily hyperactive) children, Dodge and Feldman (1990) concluded that, when social-cognitive deficiencies do emerge in unpopular children, both the proportion who show such problems and the amount of variance in popularity accounted for by this domain tend to be relatively small. The failure to find pervasive diagnostic or medication differences in social sensitivity in the present study converges with these previous findings to suggest that social information processing, as currently viewed and measured, may not be a key component of either peer status or interpersonal functioning. On the other hand, greater attention to task and situational facets of social cognition is indicated, both to inform theories of social cognition and to optimize treatment strategies for hyperactive children. The peer-generated behavioral catalog that emerged is also of interest independent of diagnostic or medication differences. Negative behaviors were reported more frequently than positive acts, and this difference may have been even greater had we omitted the instructions to the judges to try to find good as well as bad acts. The most frequently reported negative behaviors
Social Judgment Processes in Hyperactive Boys
315
were aggression or oppositionality; identification o f i n a t t e n t i o n or withdrawal was especially rare. This profile, o f course, reflects actual b e h a v i o r a l activity o f the v i d e o t a p e d targets a n d m a y also be partly a t t r i b u t a b l e to the dem a n d s o f the p a r t i c u l a r interactive game. O t h e r studies using these tapes, however, have d o c u m e n t e d the occurrence of i n t e r n a l i z i n g p r o b l e m s (Granger, 1987; W h a l e n , H e n k e r , & G r a n g e r , 1989). T h u s , the b e h a v i o r a l catalog that emerged here c a n be c o n s t r u e d - a t least in p a r t - a s a salience or interest profile for school-age boys. Clearly, negative behaviors are perceived as more consequential t h a n positive behaviors, a n d externalizing transgressions as m o r e n o t e w o r t h y t h a n i n t e r n a l i z i n g d i m e n s i o n s .
REFERENCES Barkley, R. A. (1985). The parent-child interaction patterns of hyperactive children: Precursors to aggressivebehavior? In M. Wolraich & D. K. Routh (Eds.), Advances in developmental and behavioral pediatrics (Vol. 6, pp. 117-150). Greenwich, CT: JAI Press. Cunningham, C. E., & Siegel, L. S. (1987). Peer interactions of normal and attention-deficitdisordered boys during free-play, cooperative task, and simulated classroom situations. Journal of Abnormal Child Psychology, 15, 247-268. Dodge, K. A., Asher, S. R., & Parkhurst, J. T. (1989). Social life as a goal-coordination task. In C. Ames & R. Ames (Eds.), Research on motivation in education (Vol. 3). Goals and cognitions (pp. 107-138). San Diego: Academic Press. Dodge, K. A., & Feldman, E. (1990). Issues in social cognition and sociometric status. In S. R. Asher & J. D. Coie (Eds.), Peer rejection in childhood (pp. 119-155). New York: Cambridge University Press. Dodge, K. A., Pettit, G. S., McClaskey, C. L., & Brown, M. M. (1986). Social competence in children. Monographs of the Society for Research in Child Development, 51(2, Serial No. 213). Granger, D. A. (1987). Peer interaction in hyperactive (ADD-H) children: Effects of methylphenidate. Unpublished master's thesis, University of California, Irvine. Grenell, M. M., Glass, C. R., & Katz, K. S. (1987). Hyperactive children and peer interaction: Knowledge and performance of social skills. Journal o f Abnormal Child Psychology, 15, 1-13. Guerra, N. G., & Slaby, R. G. (1989). Evaluative factors in social problem solving by aggressive boys. Journal of Abnormal Child Psychology, 17, 277-289. Henker, B., & Whalen, C. K. (1989). Hyperactivity and attention deficits. American Psychologist, 44, 216-223. Hinshaw, S. P. (1987). On the distinction between attentional deficits/hyperactivity and conduct problems/aggressionin child psychopathology.Psychological Bulletin, 101, 443-463. Hinshaw, S. P., Henker, B., Whalen, C. K., Erhardt, D., & Dunnington, R. E., Jr. (1989). Aggressive, prosocial, and nonsocialbehavior in hyperactiveboys: Dose effects of methylphenidate in naturalistic settings. Journal of Consulting and Clinical Psychology, 57, 636-643. Holleran, P. A., Littman, D. C., Freund, R. D., & Schmaling, K. B. (1982). A signal detection approach to social perception: Identification of negative and positive behaviors by parents of normal and problem children. Journal of Abnormal Child Psychology, 10, 547-558. Hymel, S. (1986). Interpretations of peer behavior: Affective bias in childhood and adolescence. Child Development, 57, 431-445. Landau, S., & Milich, R. (1988). Social communication patterns of attention-deficit-disordered boys. Journal of Abnormal Child Psychology, 16, 69-81.
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