Conference Posters: Don’t miss the poster sessions at the 2020 Annual Meeting of APSARD. Hear new voices and see new research!
Bullying, Aggression and ADHD
Jessica Simmons, M.A.
Kevin Antshel, Ph.D.
Department of Psychology
ADHD Lifespan Treatment, Education and Research (ALTER) program
Bullying is a repetitive aggressive behavior that occurs in an unequal power dynamic between a bully and victim. Bullying is associated with significant negative mental health outcomes for both victims and perpetrators. Youth who both bully others and are bullied by others (“bully-victims”) have the worst outcomes. Not surprisingly, within the past decade, youth bullying was labeled a public health problem by the Centers for Disease Control (CDC). ADHD represents a diathesis for bullying involvement, both as a perpetrator and a victim. In fact, multiple studies have suggested that youth with ADHD are up to 50% more likely to be involved in bullying, both perpetration and victimization, than their typically developing peers.
The links to victimization are clear in ADHD; bullying victims (not specific to ADHD) exhibit poor social behaviors, including hyperactivity and impulsivity, which irritate or annoy others and/or cause them stand out from their same-age peers. Violating social expectations (i.e., acting or saying things that are immature), missing social cues, and disregarding personal space are other reasons why children may be victimized by their peers.
The links to bully perpetration and being a “bully-victim”, however, require additional consideration. Certainly, youth with ADHD can act aggressively toward their peers. For example, youth with ADHD may respond aggressively if bullied. Indeed, aggression is one of the primary reasons that youth with ADHD are socially rejected. Nonetheless, not all aggression is bullying.
Aggression in ADHD appears to be linked to frustration, unsatisfied anticipation of reward, and difficulties controlling impulses. Aggression in ADHD seems to be more reactive and be an impulsive emotional response to environmental stimuli. Proactive aggression is an intentional response viewed as an acceptable way to achieve a goal. Proactive aggression is less common in ADHD and most likely to occur in those with comorbid oppositional defiant disorder (ODD) and/or conduct disorder (CD).
Distinguishing whether aggression is reactive and/or proactive is clinically important to better understand trajectories of behavior and plan interventions. Understanding whether aggression is reactive and/or proactive is also important for understanding the extant bullying literature. Insufficient operationalization of “bullying” has been an ongoing problem in the literature, leading researchers to question whether youth and adults have a similar idea of the behaviors that meet the standards of “bullying”.
A study by Murray and colleagues1 examined this important distinction and longitudinally considered whether proactive or reactive aggression has a stronger association with symptoms of ADHD. Data on ADHD symptoms and reactive and proactive aggressive behaviors were annually collected from teachers of 1,571 students in Zurich, Switzerland over eight years, beginning when the children were 7 years old and ending at age 15. Growth curve models were used to assess how symptoms of ADHD were related to reactive and proactive aggressive behaviors over the eight data collection points. Results indicated that the average growth curves for reactive and proactive aggression declined from ages 7 to 15 years of age. However, ADHD symptoms showed stronger and more significant developmental relations with reactive aggression than proactive aggression. Notably, the declines in reactive aggression were strongly and significantly correlated with declines in hyperactivity / impulsivity more so than inattention symptoms.
The results of the Murray et al. study are important for understanding bullying behaviors in ADHD. Despite being aggressive, reactive aggression often does not meet the standards of bullying. Murray and colleagues’ data should encourage us as a field to clearly operationalize bullying in our research and to question the data suggesting youth with ADHD (without comorbid ODD/CD) are more likely to be bully perpetrators than their peers. This distinction is more than semantic; important clinical, research and public policy implications depend upon correctly identifying the aggressive behavior.
If you too share my passion and interest for understanding bullying in ADHD, please visit my poster at the upcoming APSARD conference. I would love to continue this dialogue!
1 Murray, A. L., Obsuth, I., Zirk-Sadowski, J., Ribeaud, D., & Eisner, M. (2016). Developmental relations between ADHD symptoms and reactive versus proactive aggression across childhood and adolescence. Journal of Attention Disorders, 1-10. doi: 10.1177/1087054716666323.