ADHD can have a significant effect on social functioning in both obvious and subtle ways. Social interactions are actually pretty complex, with a subtle and constantly changing interplay between two or more people. A lot goes on moment to moment. To be successful, each person needs to be continually monitoring where the other person is going in the conversation and adjust accordingly. ADHD symptoms can interfere with this process in several ways:

• Hyperactivity can be tiring for others who find the constant activity and need for stimulation hard to keep up with.
• Impulsive actions and comments can be off-putting or jarring if they are too unexpected.
• Distractibility and forgetfulness can cause the ADHD person to miss or forget important things that the other person said, causing the other person to feel that she isn’t being listened to or valued.

Although we all have the occasional social blunder, most people are pretty forgiving if it doesn’t happen too often. However, those with ADHD tend to use up their free passes too quickly, causing others to make deeper assumptions about their character. As a result, ADHD people are often seen as irresponsible, self-centered, or rude, even though they’re really not. I met a woman at a conference who described how she can come across as brash, but she’s really quite caring if someone can see beyond her initial demeanour. Unfortunately, as this woman knows, the other person is left to make assumptions based on what he sees, even if he misinterprets the reasons for that behaviour. We’re all guilty of this to some extent. We all tend to assign our own motives to others’ behaviour as a way to understand why they do what they do. For example, if someone without ADHD doesn’t pay attention to something, it’s usually because he views it as unimportant. Therefore, when the ADHD person seems to not be attending, he assumes that the conversation or his opinions generally aren’t important to her. This makes sense in a way and is usually accurate, even though it turns out to be wrong in this case.

Studies have found that ADHD children are not chosen as frequently to be best friends or partners in activities as other children are. Unfortunately, ADHD children tend to be aware of these difficulties and, predictably, generally feel bad about it. They know the phone doesn’t ring as much as it could – and that their calls don’t get answered as often. Unlike the really oppositional kids who create big, dramatic crises, ADHD kids’ social missteps are usually small but frequent. Any one incident is easy to ignore, but in total, other kids choose not to deal with it and to distance themselves. Even if the child is aware of what he is doing that isn’t going over well, he still may not be able to reliably behave differently. For example, I met with a fifth-grader and his mother because he was alienating his friends with impulsive actions that too often crossed the line. He went back on his medication and we talked about tricky situations that could come up and how he could better respond to them. Treatment helped him, but his story would have a very different ending without it.

ADHD adults can have many of the same difficulties. As in children, they know what they should and shouldn’t do but have trouble sticking with that plan. They have trouble with engaging others in conversation and in managing how they present themselves, including tactfulness and adjusting their behaviour to be appropriate to the situation, moderating expressions of strong emotions, and controlling nonverbal displays. They too frequently put their foot in their mouth either saying the wrong things or having it come out wrong. A fellow presenter on a panel told of literally having to bite her lip to stop herself from blurting out.

ADHD adults also have a tendency to miss the nonverbal cues that are so important in social interactions. They may miss subtle signs about the other person’s mood or how that mood changes through the discussion. Or they may not realize that the other person is trying to change the topic or end the conversation. They know how to read social cues, but they don’t do so well if they get distracted or caught up in what they are thinking or saying. They may get so absorbed in their next comment that they can barely hold it in until the other person finally stops talking. If they do blurt it out, they may be seen as self-centered or controlling because they don’t give the other person a chance to talk. Alternatively, they may completely miss what the other person is saying but not even realize it. This may come out only later when it becomes obvious that the two people remember the discussion differently.

There was this fellow who described a job interview where halfway through he wondered to himself, “Have I sounded like an asshole yet?” Fellow ADHD people know what it is. There are actually two things that are striking about his comment. The first is his pessimism about being able to pull off an interview smoothly. The other is that he knows that he could easily have said something wrong and not even realized it at the time, even if he walks out feeling good, he might still have blown it.

It should not be surprising that ADHD adults tend to have significantly fewer social acquaintances and close friends than those without ADHD. This isn’t necessarily by choice, since they often would like more friends but have trouble keeping them. Sometimes they know why those friendships end; sometimes they don’t. This lack of connection is a cause for concern since close, supportive relationships are good, not only for our mental health, but also for our physical health.