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Examining the potential protective effects of emotion attribution accuracy on the relationship between ADHD symptoms and children’s social competence

Anna Elizabeth Morgan

Psychology Honors Thesis

University of North Carolina at Chapel Hill



Symptoms of Attention Deficit Hyperactivity Disorder (ADHD) can negatively affect children’s peer social competence, which is often influenced by various emotional factors. Emotion attribution accuracy, or the ability to effectively appraise the emotional state of others, may be a distinct factor that moderates the relationship between ADHD symptoms and social competence in children. Through a secondary analysis, this study aims to examine the


Attention Deficit Hyperactivity Disorder (ADHD) is a widely studied and commonly diagnosed disorder, that affects approximately 6.1 million children in the United States according to the latest National Survey of Children’s Health (Centers for Disease Control and Prevention, 2019a). ADHD is characterized by continuous patterns of inattention and hyperactivity-

impulsivity levels that are much greater than their peers, which can seriously interfere with children’s socio-emotional functioning and development (American Psychiatric Association, 2017; The National Institute of Mental Health, 2019). Studies have found that children displaying ADHD symptoms are more likely to have significant social skills deficits than children who do not display ADHD symptoms and are particularly likely to experience peer- conflicts and problems with authority (Merrell & Wolfe, 1998). In such cases, children may experience higher levels of ADHD symptoms, but not meet clinical diagnosis and still display impaired socio-emotional functioning particularly within school contexts (Poulou, 2014). Thus, it is important to examine ADHD symptoms in addition to understanding differences within higher risk ADHD groups in social competence.

Poor social competence in children with ADHD symptoms may negatively impact peer relationships and social functioning, hindering children’s mental health and development. For example, researchers have found that children with ADHD are often demoralized due to ADHD- related impairments that affect academic, social, and athletic success, in turn influencing

children’s self-esteem and increasing the likelihood of developing depressive symptoms


These findings demonstrate an increased likelihood of mental health issues in children with ADHD and reinforce the need for effective treatment of symptoms of ADHD.

While higher levels of ADHD symptoms can bring greater adversity, children with ADHD are also capable of demonstrating resilience. Through the promotion of both social and emotion identification skills, studies have found that children with ADHD demonstrate

significant improvements in behavior and social interactions (Pfiffner & McBurnett, 1997). Research also indicates that interventions that reinforce emotion identification and expression positively affect children with ADHD more than interventions that focus solely on social skills (Choi & Lee, 2013). This indicates that emotion identification skills may be an important protective factor for children’s social skills and can perhaps be promoted to moderate the relationship between children’s ADHD symptoms and social skills.

Social Competence

Social competence is the successful initiation of peer relationships (Denham et al., 2003). Assessments of children’s social competence typically encompass the child, their behavior, the situation in which the behavior occurs, and the individual that evaluates the behavior (Dirks, Treat & Weersing, 2007). This four-factor model effectively addresses social competence as a product of various factors and demonstrates the complexities involved with assessing children’s social competence. The literature suggests that different contexts and individual evaluations of children’s social interactions contribute to weak correlations between observational and teacher reported measures of social competence, strengthening the argument for multimodal measures of social competence (Milfort & Greenfield, 2002). Due to the multifaceted nature of social

competence, it is important to assess all aspects that contribute to children’s poor social


important aspects of social competence and contribute to children’s social success (McKown et al., 2009). These factors are often particularly difficult for children with neurodevelopmental disorders such as ADHD and can seriously impact children’s ability to socialize with peers, which in turn affects different aspects of healthy development (Solanto et al., 2009).

A significant relationship exists between adolescent mental health and peer relationships, suggesting that students with close friends and better relationships with parents were more likely to be mentally healthier (Kim, 2015). By third grade, up to 70% of children with ADHD may have no close friends and have an increased risk of being bullied by their peers (Wehmeier, Schacht & Barkley, 2009). This statistic demonstrates the severe social difficulties that children with ADHD face and emphasizes the significance of studying social outcomes of ADHD symptoms and the factors that contribute to reduced peer social competence. For example, researchers have found that ADHD symptoms such as hyperactivity and impulsivity negatively affect children’s peer functioning (Andrade & Tannock, 2014). While these children display symptoms of hyperactivity and impulsivity, they may not be clinically diagnosed with ADHD. It is important to recognize such populations of children in addition to those with clinical

diagnoses, as their social competence and peer relationships may also be affected by ADHD symptoms.


contribute to poor social competence (Hoza, 2007). Various issues influence poor social

competence; however, there may be evidence for examining emotional factors that contribute to social competence as a means of promoting social skills in children (Havighurst et al., 2015). More specifically, the ability to accurately attribute emotions in others may play an important role in peer social competence in children with ADHD symptoms.

Emotion Attribution Accuracy

Emotion attribution accuracy refers to the ability to effectively appraise the emotional state of others using contextual information and nonverbal cues (Levitch, 2016; Williams et al., 2008). This skill often requires a mutual regulation of affective signals which help children encode and interpret others’ affective cues while interacting with peers, and it is thought that deficits in this skill contribute to social and behavioral problems (Lemerise & Arsenio, 2000). Children’s ability to attribute emotions is also highly influenced by their current emotional state or emotionality, as it affects what is noticed during a social interaction, thereby influencing children’s interpretation of social cues (Lemerise & Arsenio, 2000; Schultz, Izard & Bear, 2004). Although this emotionality makes children who struggle with emotion-regulation especially prone to misattributions of emotions during social interactions, it also indicates that this is malleable. This ability to improve emotion attribution is an important factor in successful socialization and may be especially relevant for populations of children, such as those with ADHD symptoms, that exhibit social and emotional difficulties.


problems (Havighurst et al., 2015). Similarly, intervention programs successfully improved children’s ability to read facial expressions, demonstrating that children can improve their emotion identification skills (Grinspan, Hemphill & Nowicki, 2003). Researchers were surprised to find that children with ADHD performed as well as healthy controls on facial or contextual emotion attribution tasks, demonstrating that although they did have ADHD, they still exhibited high levels of emotion attribution accuracy (Levitch, 2016). The promotion of emotion

identification skills demonstrates an important means through which children with ADHD symptoms might improve their social competence, illustrating children’s capacity for resiliency and the potential protective effects of emotion attribution accuracy on children’s social


The Present Study

The larger study is a federally funded study that sought to evaluate the effectiveness of the Incredible Years © child group treatment program within schools with first and second graders displaying self-regulation difficulties. The present study is a secondary data analysis using data from baseline prior to the intervention to understand the relationship between children’s emotion attribution accuracy, ADHD symptoms, and teacher-reported and observed social competence. A preliminary research question is to examine differences in teacher-reported and observed social competence among children displaying clinical levels of ADHD versus those who do not. High risk and low risk groups for ADHD will be observed.


children’s ADHD symptoms and social competence? Outcomes include both teacher-reported and observed social competence.

I hypothesize that ADHD symptoms will be associated with lower levels of children’s observed and teacher reported social competence while emotion attribution accuracy will be associated with higher levels of children’s observed and teacher reported social competence. I also expect that emotion attribution accuracy will moderate the association between ADHD symptoms and children’s social competence such that, ADHD symptoms will be associated with higher levels of observed and teacher reported social competence at high levels of emotion attribution accuracy whereas ADHD symptoms will be associated with lower levels of observed and teacher reported social competence at lower levels of emotion attribution accuracy.

Method Participants

Participants in the present study consisted of 138 first and second grade students who met the criteria for a small-group intervention to support students’ self-regulation in local elementary schools. Students were from 9 schools located in the South Eastern United States. Teachers from the students’ previous school year nominated students that would benefit from a self-regulation intervention, and school counselors reached out to families of these students (e.g., called,

distributed recruitment packets). Once families consented to participate, students were randomly assigned to control and intervention groups. Sample demographics are displayed in Table 1. Baseline data collection occurred during the two months prior to the beginning of intervention. Procedure


children’s social competence along with observed assessments of children’s social competence by research staff would produce a more contextualized model of children’s social competence. All data used were pre-treatment baseline scores.


Strengths and Weaknesses of ADHD Symptoms and Normal Behavior (SWAN) scale. The SWAN scale is a teacher-completed 26-item report of children’s hyperactivity and impulsivity, inattention, and oppositional defiant disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (Swanson et al., 2012). Items were scored using a 7- point scale from 3 (far below average) to -3 (far above average). Nine items assessed the Hyperactivity and Impulsivity subscale, nine items assessed the Inattention subscale, and eight items assessed the Oppositional Defiant Disorder subscale. For the purpose of this study, only the Hyperactivity/Impulsivity and Inattention subscales were used to assess ADHD symptoms with each having a Cronbach’s alpha of .90 and factor loadings of .72.


subscale was used to assess teacher reported social competence with a factor loading of -.71 and a Cronbach’s alpha of .18.

Assessment of Children’s Emotions Scales (ACES). The ACES scale was used to assess children’s emotion attribution accuracy (Schultz, Izard, & Bear, 2004). The scale is separated into sections on facial expressions, social behaviors, and social situations, each of which include randomized items that are happy, sad, mad, or scared. For the facial expressions section, participants were presented with 26 photographs of similarly aged children presenting specific facial expressions. Ten of these photographs expressed ambiguous emotions, while sixteen of the photographs presented archetypal happy, sad, angry, or sad expressions. This study included 6 items in both the social behaviors and social situations sections, resulting in a total of 12 items. Each one-to three-sentence item described a social situation or behavior. After the examiner described the scenario or behavior, the examiner asked the participant, “Does s/he feel happy, sad, mad, or scared?” In order to prevent biases toward anger attributions, 8 items reflect mad as the correct answer, 20 items for which happy, sad, or scared are the correct answer, and 10 ambiguous items. The present study is limited to the ACES emotion attribution accuracy score, which is the sum of correct responses to the 20 happy, sad, and scared items across the three sections. Scores are based on a scale that ranges from 0 (all incorrect) to 20 (all correct). For the present sample, internal consistency was .43.


from the original teacher preferred social behaviors subscale. Scores were calculated using a 5- point Likert-type scale 1 (never) to 5 (frequently). A prosocial behavior subscale (8 items) with an item loading of .51-.70 and a social competence with peers subscale (11 items) with an item loading of .57-.81 were used, with a Cronbach’s alpha of .88 and .94 respectively. These subscales were used in tandem with the 5-item reverse scored peer problems subscale from the SDQ to create a composite score for teacher’s perceptions of children’s social competence.

Coder Observation of Classroom Adaptation – Revised (COCA-R) scale. The COCA-R scale is an observation version of the Teacher Observation of Child Adaptation (Werthamer-Larsson, Kellam, & Oveson- McGregor, 1990), created by Webster-Stratton et al. (2004). The COCA-R was used to assess children’s peer social interactions by an observer in a

25-30 minute observation of a child’s free play during recess. Data collectors received 40 hours of training before observing children on the playground and were required to reach 80%

reliability on each indicator with a master coder for at least two video coding sessions and two field coding sessions. Observers met weekly to minimize observer drift. Twelve items from the original measure were selected for the purpose of the study and scores were averaged across the two poor social health and poor social contact subscales. Items were scored using a 0-5 scale that indicated the frequency of behavior from 0 (almost never) to 5 (almost always). Because items on the COCA-R scale were negatively worded, the scale was reverse scored so that high scores reflected higher observed social competence. The COCA-R scale assessed children’s observed social competence as a separate construct from teacher reported social competence. Inter-rater reliability for this scale was .81 calculated based on 20% of all observations.


Preliminary analyses were conducted using Bivariate Pearson Correlations to assess the associations among ADHD symptoms, emotion attribution accuracy, teacher reported social competence, and observed social competence. Analyses also included an independent samples T- test to examine differences in teacher-reported and observed social competence among children displaying clinical levels of ADHD versus those who do not.

Using SPSS 26.0, hierarchal regression analyses were used to assess the main effect of ADHD symptoms and emotion attribution accuracy on children’s teacher reported and observed social competence. The moderating effect of emotion attribution accuracy on the association between ADHD symptoms and teacher-reported and observed social competence was tested by including the main effects in Model 1 (variables were standardized to reduce risk of

multicollinearity) and the interaction effect was entered in Model 2. In order to examine the nature of this interaction, Andrew F. Hayes PROCESS version 3 (Hayes, 2017) was used with SPSS software.



significant difference in levels of observed social competence between children with and without clinical levels of ADHD symptoms.

Moderating Effect of Emotion Attribution Accuracy

Hierarchical regression analyses indicated that the main effects of ADHD symptoms and emotion attribution accuracy on teacher reported social competence were not significant.

However; there was a significant interaction between emotion attribution accuracy and ADHD symptoms in regards to teacher-reported social competence, F(3, 134) = 2.34, p < .05, which explained an additional 3.7% of the variance (Table 4). Using Process, the effect of ADHD symptoms on teacher reported social competence was significantly different from zero for 8% of children above the upper bound and 7.2% of children below the lower bound of significance (Figure 1). Children with higher levels of emotion attribution accuracy were rated by their

teachers as displaying higher social competence, despite also being rated as demonstrating higher ADHD symptoms whereas their counterparts with lower levels of emotion attribution accuracy were rated as showing lower social competence. For observed social competence, results of hierarchical multiple regression analyses indicated that the main effects of ADHD symptoms and emotion attribution accuracy were not significant and there was not a significant interaction effect.



ADHD symptoms and social competence in children. Findings support the hypothesis that emotion attribution accuracy moderates the relationship between ADHD symptoms and teacher reported social competence and the directionality of the interaction indicates that there is a potential protective effect of emotion attribution accuracy on teacher reported social competence in children with ADHD symptoms.

The regions of significance for the interaction suggested that emotion attribution accuracy moderated the relationship between ADHD symptoms and teacher reported social competence when children exhibited emotion attribution accuracy scores on the high and low end of the scale. Most notably, the children exhibiting higher levels of emotion attribution accuracy and higher levels of ADHD symptoms showed higher levels of teacher reported social competence than children with lower levels of emotion attribution accuracy. As suggested by previous research, children with ADHD symptoms are capable of exhibiting higher levels of emotion attribution accuracy and higher levels of teacher reported social competence (Levitch, 2016). While our results are indicative of a potential protective effect, the overall interaction had a small effect size and few children exhibited levels of emotion attribution accuracy past the upper (n = 11) and lower (n = 10) bounds of regions of significance. The lack of variability in emotion attribution scores may have been due to the dichotomous nature of the ACES items and the targeted sample of students requiring tier 2 to tier 3 services, which could have reduced the size of the observed effect (Allen, 2017). These factors suggest that future research may seek to use a continuous measure of emotion attribution accuracy to increase variability and the effect size of the observed interaction.


protective factor), contrasting with the hypotheses. This is surprising as there is a growing body of literature suggesting that such constructs would be significantly related (Havighurst et al., 2015; Lemerise & Arsenio, 2000; Merrell & Wolfe, 1998). Given the observational assessment taps into the frequencies and quality of social behaviors during 30 minutes of recess at one time, it may not capture a true picture of students’ social competence compared to teacher’s

cumulative assessment of social behaviors. Teachers, while susceptible to bias, occupy significant portions of children’s life-space, which enables them to provide a more contextualized report of children’s social competence (Weisz et al., 1995). The COCA-R

measure taps into similar aspects of social competence as the teacher reported measures but may be limited by the single-context in which it is employed. It has been suggested that observations across structured (e.g., classroom) and unstructured (e.g., recess, cafeteria) settings may be advantageous in creating a more contextual assessment of children’s social competence (Leff & Lakin, 2005). Perhaps implementing observational measures across various contexts would produce more significant results in the future.

The weak correlations between ADHD symptoms, emotion attribution accuracy, and teacher reported and observed social competence may be due to the relatively small sample size, but it is important to note that weak correlations are not indicative of non-relationships, but instead suggest that other factors may influence relationships between variables. Also, the correlations appear to be moving in the predicted direction, which may indicate that associations between variables exist, but they are not entirely linear.


in children with higher levels of ADHD symptoms (Thorell & Rydell, 2008). Such findings strengthen the argument for investigating contributing factors to social competence in children with ADHD, as previous research indicates that poor social competence may have negative implications for children’s healthy development (Andrade & Tannock, 2014). Moreover, our findings suggest that emotion attribution accuracy may be a key factor in moderating and

perhaps promoting children’s social competence, thus reducing the disparity that we see between children with clinical and non-clinical levels of ADHD symptoms.


Various limitations hindered this investigation but were accompanied by factors that also helped to strengthen the study. Although smaller in size, this was a targeted sample, meaning that the children selected for the study could individually benefit from the findings of the

investigation. While this targeted sample reflected students with a higher need of services at school or clinic, there was also lower variability on the range of the moderator and reduced generalizability to larger groups of students. Thus, future research may elect to use a larger, more diverse sample to produce more representative results.

Another limitation of the study was the use of multimethod measures to assess social competence. While the use of separate measures produced a more contextualized model of children’s social competence, if the constructs of observed and teacher reported social


may indicate that the measure of observed social competence should be modified to better accommodate the multifaceted nature of children’s social competence.

The final limitation of this study was the low reliability of the ACES scale. The scale had a Cronbach’s alpha of .43, which is considerably lower than other studies have seen. This may be attributed to the dichotomous nature of the ACES scale (e.g. correct, incorrect) which is often linked to lower reliability (MacCallum, 2002). For the present study, modifications to the ACES scale that reduced the number of items may have also lowered the reliability of the scale.

Although the ACES scale is a well-established measure of children’s emotion attribution accuracy, it is possible that the ACES scale was not an entirely reliable measure for the purpose of this study.

Implications and Future Directions


Future research should seek to determine an effective means of promoting emotion attribution accuracy in children with ADHD symptoms, as our findings suggest that promoting these skills may positively affect social competence in children with ADHD symptoms. Previous studies have found that a multi-systemic emotion-focused intervention approach with parents, school staff, and children was successful in improving children’s emotion understanding and social functioning (Havighurst et al. 2015). While this intervention was successful, it is probably not feasible in a real-world context due to the extensive time needed to implement the

intervention. Researchers have found; however, that integrating social-emotional learning into literacy instruction has the potential to promote social and emotional competence in children at risk for emotional and behavioral disorders (Duanic et al., 2013). While a multi-systemic intervention approach may improve children’s social functioning and emotion understanding across contexts, interventions through readily available resources may provide a more feasible means of improving children’s social and emotional competence in a school setting. Future research may seek to promote emotion attribution accuracy through interventions across contexts (e.g. home, school) that can be easily incorporated into daily lessons and activities (e.g.

academics, after school activities, chores) to produce a more feasible, yet effective intervention approach. Longitudinal assessments of the effectiveness of interventions may also provide evidence for the long-term impacts of promoting children’s emotion attribution accuracy.


emotional development may improve their ability to address the needs of students exhibiting challenging behavior and promote their social and emotional skills (Jennings & Greenberg, 2009). Future research should investigate means of supporting teachers in this way so that they can more effectively engage with students with ADHD symptoms, as these children may require additional social and emotional support that they otherwise may not receive outside of school. Conclusion

In summary, the present findings indicate that emotion attribution accuracy has a moderating and potentially protective effect on the relationship between ADHD symptoms and social competence in children. These findings contribute to the growing body of literature on social and emotional outcomes for children with ADHD and offer evidence for the promotion of emotion attribution accuracy through emotion-focused interventions as a means of bolstering children’s social competence. Due to the small effect size of the observed interaction, further research may be necessary to better understand the exact nature of the protective effect. Future research may also seek to modify or employ different measures to assess emotion attribution accuracy and observed social competence, while still including input from educators through teacher reported measures. These findings have implications for future assessment of children’s socioemotional skills and the potential protective effects of emotion attribution accuracy propose implications for interventions in both school and clinical settings. Future research should



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Table 1

Sample Demographics

Variable Total Sample (N = 138)

Ethnicity %

European American 23

African American 61

Latinx 9

Multiracial 7

Gender %

Male 68

Female 32

Free/Reduced Lunch %

Yes 75

No 24

Age (years)

M 7.2


Table 2

Bivariate Correlations Among Study Variables and Descriptive Statistics (N = 138)

Variable M SD 1 2 3 4

1. ADHD Symptoms 3.63 1.12

2. Emotion Attribution Accuracy 15.87 2.10 -0.13 3. Teacher Reported Social



Table 3

Independent Sample T-test for Teacher Reported and Observed Social Competence

Variable n M SD t p

Teacher Reported Social Competence

Clinical ADHD Symptoms 75 4.03 1.00 2.24 .026* Non-Clinical ADHD Symptoms 63 4.42 1.06

Observed Social Competence

Clinical ADHD Symptoms 74 0.77 0.82 0.82 .415 Non-Clinical ADHD Symptoms 63 0.89 0.87


Table 4

Summary of Hierarchical Regression Analysis of Variables Predicting Teacher Reported Social Competence

Model 1, Main Effects Model 2, Two-way Interactions

Variable B SE B β B SE B β

ADHD Symptoms 0.00 0.09 0.00 0.01 0.09 0.01

Emotion Attribution Accuracy 0.12 0.09 0.11 0.10 0.09 0.10 ADHD Symptoms x Emotion

Attribution Accuracy

0.23 0.10 0.19*

R2 0.01 0.05

R2 0.01 0.04

F for change in R2 0.85 5.26




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