Adolescents with ADHD may recognise that relationships are difficult without fully understanding why—and that distinction could matter well into adulthood
When adolescents with ADHD struggle socially, the explanation often defaults to a familiar phrase: poor social skills.
It sounds clinical, measurable and reassuringly straightforward. Teach the missing skills, practise the correct behaviours and the problem should improve.
Yet two recent studies suggest that this explanation may be too narrow. Together, they point towards a more complicated interaction between social ability, self-perception, anxiety, feedback and the quality of the relationships available to the adolescent.
The first study, by Crisci and Mammarella, examined how children and adolescents with ADHD judged their own social abilities compared with their parents. The second, by Elashram and colleagues, examined social anxiety and friendship quality among adolescents with ADHD.
Read separately, one paper concerns how young people see themselves, while the other concerns how they experience their relationships. Read together, they raise a more interesting possibility:
Adolescents with ADHD may know that social life is difficult without having a complete or stable explanation for why it is difficult.
That is not the same as lacking social awareness. Nor is it the same as possessing all the necessary skills but merely failing to use them. It suggests a gap between experiencing social difficulty, understanding its causes and predicting how one is being perceived by others.
They know something is wrong
Crisci and Mammarella found that children and adolescents with ADHD did not describe their social abilities as equivalent to those of non-diagnosed peers. They recognised that they experienced social challenges.
The disagreement was one of degree.
Parents generally rated the young person’s social difficulties as more severe than the young person did. The authors therefore describe a self–other discrepancy: the adolescent acknowledges the problem but appears to underestimate its extent relative to parental observation.
This is an important distinction.
The findings do not support the crude image of an adolescent with ADHD who is entirely unaware of their social difficulties. Instead, the adolescent may be aware that friendships go wrong, conversations become awkward or conflict appears more often than expected, while still having a different interpretation of what happened.
The adolescent might experience the incident as situational:
the other person was unfair;
the group was unwelcoming;
the conversation moved too quickly;
the friendship was simply a poor match.
The parent may interpret the same pattern as evidence of a broader social difficulty.
Neither perspective is automatically complete.
Parents see patterns across time, but they do not occupy the adolescent’s internal world. Adolescents experience the anxiety, confusion and effort involved, but they may not see how their behaviour appears from outside.
The discrepancy is therefore not necessarily proof that one party is accurate and the other mistaken. It may indicate that they are observing different parts of the same process.
Social anxiety adds the missing internal layer
Elashram and colleagues examined Egyptian adolescents aged 13 to 17. Compared with typically developing peers, the ADHD group reported substantially higher social anxiety and lower friendship quality.
The differences covered fear of negative evaluation, social avoidance, physical symptoms of anxiety and difficulty interpreting social cues. Friendship quality was also lower across support, intimacy, companionship, security and conflict resolution.
This adds something that a social-skills rating alone cannot capture.
An adolescent may appear socially overconfident to a parent while internally feeling highly uncertain. They may believe that they are generally capable of being a good friend, yet still enter each social situation expecting embarrassment, rejection or misunderstanding.
Those positions can coexist:
“I am not socially incapable.”
and
“I am never quite sure whether people actually want me there.”
The first protects the broader self-concept. The second reflects the immediate emotional experience.
What appears from outside as limited insight may therefore be a more fragile arrangement: enough confidence to remain socially engaged, but enough anxiety to make that engagement exhausting.
The apparent confidence may serve a purpose
Crisci and Mammarella found that adolescents with ADHD who rated their social abilities more positively than their parents did also reported greater self-confidence. The authors suggest that this discrepancy may have a self-protective function.
That does not mean the positive self-perception is false in any simple sense.
It may be psychologically useful.
Adolescence is a period in which belonging becomes increasingly important, while peer relationships become less direct and more socially complex. Feedback is rarely delivered as a helpful performance review. It arrives through delayed messages, altered tone, exclusion from plans, private jokes and friendships that quietly become less available.
A moderately positive view of oneself may allow the adolescent to continue approaching people rather than withdrawing entirely.
The difficulty is that the same protection may reduce access to useful feedback. If criticism feels inconsistent with the person’s self-understanding, it may be dismissed, resisted or experienced as an attack.
Crisci and Mammarella found that larger self–parent discrepancies were also associated with more externalising behaviour. They propose that conflicting feedback may trigger defensiveness or aggression when the young person feels that their self-image is being threatened.
The protective belief may therefore do two things at once:
preserve enough confidence to remain socially active;
make corrective feedback harder to interpret or tolerate.
Calling this merely an “inflated self-view” misses the trade-off.
Knowing there is a problem is not the same as knowing what the problem is
The intersection between the two papers may sit here.
An adolescent with ADHD may recognise the consequences:
friendships feel insecure;
conflict happens too easily;
other people become irritated;
social situations produce anxiety;
rejection feels frequent or unpredictable.
But recognising the consequences does not automatically reveal the mechanism.
Was the conversation disrupted by impulsive interruption? Did working-memory overload cause the adolescent to lose track of what the other person had said? Did anxiety produce avoidance that appeared as disinterest? Was a neutral facial expression interpreted as rejection? Did emotional reactivity turn a small disagreement into a larger rupture?
Or was the peer group itself intolerant, exclusionary or unwilling to accommodate a different style of communication?
The answer may differ between interactions.
Crisci and Mammarella suggest that social feedback is often subtle and ambiguous. They also propose that adolescents with ADHD may interpret difficulties as responses to context or interpersonal dynamics rather than as evidence of a fixed personal deficit.
Elashram’s findings add that the adolescents themselves report difficulty interpreting social signals and heightened fear of negative judgement.
Together, this points towards a problem of social calibration, not merely social knowledge.
The adolescent may know what friendship is supposed to require. The difficulty may lie in detecting what is happening quickly enough, regulating the emotional response and adjusting without losing the thread of the interaction.
Friendship quality is not an individual skill
There is another danger in describing the problem as a social-skills deficit: it locates the entire difficulty inside the adolescent.
Friendship quality is relational.
It depends on the adolescent’s abilities, but also on:
the patience and flexibility of peers;
the social culture of the school;
opportunities to repair misunderstandings;
previous experiences of bullying or rejection;
whether the friendship allows direct communication;
whether neurodivergent behaviour is treated as difference or misconduct.
Elashram and colleagues found that the largest friendship differences concerned intimacy, security, support and conflict resolution. Companionship was affected less strongly.
That suggests some adolescents with ADHD may not struggle primarily to find people with whom to spend time. They may struggle to experience those relationships as secure, dependable and resilient enough to survive conflict.
They may have company without confidence in the relationship.
That is not solved by teaching better eye contact or rehearsing conversation starters.
A possible developmental loop
Neither paper establishes causation, but their findings allow a tentative developmental model.
ADHD-related differences in attention, impulse control, emotional regulation or social cue processing may contribute to awkward or conflictual interactions. Those interactions may produce criticism, rejection or exclusion. Repeated negative experiences may then increase social anxiety and threat sensitivity.
As anxiety rises, the adolescent may monitor interactions more intensely, avoid situations or interpret ambiguous feedback negatively. That can make social participation even less natural and more cognitively demanding.
At the same time, maintaining a relatively positive social self-concept may protect against complete withdrawal.
The result may be an unstable loop:
difficulty leads to negative feedback; negative feedback increases anxiety; anxiety interferes with social processing; positive self-belief protects participation but may complicate the acceptance of feedback.
This model does not reduce the adolescent to a deficit. It also does not pretend that confidence alone resolves the difficulty.
Can this be extrapolated into adulthood?
The papers cannot answer that directly. Both are cross-sectional, and neither follows participants into adulthood.
Any adult extrapolation must therefore remain a hypothesis rather than a conclusion.
However, Crisci and Mammarella found some evidence that self–parent discrepancies decreased with age in their broader sample, although this was not replicated in the narrower age range of their second study.
One possible interpretation is that self-awareness becomes more accurate with maturity and accumulated feedback.
But greater awareness may not produce greater ease.
An adult with ADHD may become acutely aware of how they are perceived while still lacking certainty about how to respond. Years of social consequences can improve pattern recognition, but they can also produce anticipatory anxiety, self-monitoring and reluctance to enter unfamiliar relationships.
The developmental shift might therefore be from:
“I do not fully see what others are reacting to.”
to:
“I am constantly watching for what others might react to.”
That is not automatically an improvement. It may represent a move from under-calibration towards over-monitoring.
The adolescent may miss social feedback. The adult may become unable to stop looking for it.
Where lived experience may complicate the model
My early experience of friendship was not marked by unusually mature self-awareness. It was shaped by a repeated pattern that I understood in the only way available to me at the time.
I would make a friend, and then that friend would leave.
In hindsight, their departures were mostly ordinary features of childhood. Children rarely control where their families live or when they move. A parent’s work, relationship or financial circumstances can remove a child from one social world and place them into another. They were not necessarily choosing to leave me. They were simply moving into the next chapter of a life they did not yet control.
That explanation was not available to the six- or eight-year-old version of me.
What remained was a much simpler association:
I make friends. They leave.
Over time, that could easily become:
People leave because there is something about me that does not make them stay.
There is inevitably some retrospective storytelling involved here. Adult memory does not provide a perfect recording of childhood thought. We reconstruct earlier experiences through what followed, and a later pattern can make separate events appear more coherent than they felt at the time.
But reconstructed does not mean invented.
The exact thought may not have existed in those words. The emotional association may still have formed long before I could articulate it.
The meaning may matter more than the event
This introduces a different layer to the social-skills question.
Nothing in the original event necessarily demonstrated poor social ability. Making friends suggests at least some capacity to connect. The friendships ended because of circumstances outside either child’s control.
Yet the child does not respond only to what objectively happened. The child responds to what the event appears to mean.
Repeated departures may therefore have shaped later relationships not by proving that I lacked social skills, but by teaching me that attachment was unstable.
That expectation changes how future relationships are approached.
A new friendship is no longer simply a new friendship. It contains an unresolved question:
How long until this person leaves?
The resulting uncertainty can look like social awkwardness, dependence, withdrawal or overinvestment. But those behaviours may be attempts to manage anticipated loss rather than evidence that the person does not know how friendship works.
This matters when interpreting the two studies. The adolescent may be aware that relationships feel difficult while misunderstanding the origin of that difficulty. The problem may not be a lack of social knowledge. It may be that every new relationship is being processed through an earlier prediction of abandonment.
Sensitivity and the rules of belonging
A second strand concerns sensitivity.
An emotionally expressive boy may encounter a social environment in which male belonging is conditional. Feelings are permitted, but preferably in limited quantities, expressed privately, and never in a way that makes other boys uncomfortable.
A boy who “felt his feelings out loud” could therefore be treated as excessive, soft or socially out of step—not necessarily because he lacked relational ability, but because the accepted range of male behaviour was narrow.
The same sensitivity could make him attentive, emotionally available and safe in friendships with girls. Those qualities may have supported genuine closeness.
But another meaning could then form:
I can be trusted as a friend, but I am not someone people choose romantically.
The issue here is not whether every friendship should have become a romantic relationship. Friendship is not a consolation prize, and romantic interest is not owed in exchange for emotional availability.
The developmental consequence lies in the meaning assigned to the recurring role. “Friend-zoned” may become less a description of one person’s romantic preference and more an identity statement:
This is where I belong in relation to other people.
That belief can be reinforced even when the actual relationships are valuable. The person is accepted, but experiences the acceptance as evidence of a limit.
From uncertainty to hypervigilance
Seen this way, later social anxiety may not develop primarily from an awareness that one lacks social skills.
It may grow from repeated uncertainty about what relationships mean.
Several questions begin operating beneath the interaction:
Does this person actually like me?
Am I misreading friendliness as closeness?
Is the relationship secure, or merely convenient?
Have I become too invested?
Am I useful as a confidant but not desirable as a partner?
Will the relationship continue once the shared setting disappears?
This is not simply self-awareness. It is social surveillance.
The person becomes attentive not only to what is happening, but to signs that the relationship may be changing. Delayed replies, altered tone, reduced contact or shifts in routine become potentially meaningful.
Some of that vigilance may improve social observation. It may also make relationships harder to inhabit naturally. Attention moves away from the connection itself and towards monitoring whether the connection is still intact.
The adult may therefore appear more socially aware than the child, while carrying forward the same underlying uncertainty.
Friendships held together by context
A further observation becomes that relationships are difficult to maintain outside shared situations and adds another important distinction.
School, work, a club or a regular activity provides a structure for friendship:
repeated contact;
a shared subject;
predictable opportunities to interact;
less need to initiate;
fewer decisions about when and how to reconnect.
Once that structure disappears, maintaining the relationship requires a different set of processes. Someone must remember to make contact, tolerate uncertainty about whether the invitation is welcome, propose an activity, coordinate schedules and continue doing so without the environment providing reminders.
For an ADHD person, those demands may interact with executive-function difficulties. But there may also be an emotional component. Initiating contact creates the possibility of discovering that the other person is less invested.
Not reaching out preserves ambiguity, while reaching out risks confirmation.
What appears to be an inability to maintain friendships may therefore involve several overlapping processes:
difficulty sustaining relationships without external structure;
uncertainty about whether contact is wanted;
fear of appearing needy;
sensitivity to non-response;
a learned expectation that relationships naturally disappear.
The friendship may not end because affection has ended. It may fade because neither structure nor confidence is sufficient to carry it forward.
Beyond conventional social-skills training
If these papers are read together, intervention cannot begin and end with teaching socially approved behaviour.
A fuller approach would need to distinguish between:
Social ability
What the person can understand or do in an interaction.Social self-perception
How the person judges their own competence.Social threat perception
How likely they are to anticipate judgement, rejection or embarrassment.Feedback processing
How they recognise, interpret and emotionally tolerate social feedback.Relationship ecology
Whether the surrounding peers and environments permit difference, direct communication and repair.
The intervention target might therefore be less “correct the adolescent’s social behaviour” and more:
make feedback clearer and less shaming;
help the person separate one difficult interaction from a global judgement of self;
identify patterns without imposing a deficit identity;
reduce anxiety-driven interpretation of ambiguous cues;
build relationships in which misunderstandings can be repaired openly;
recognise when the environment, rather than the adolescent, is the poor fit.
The more useful conclusion
The combined findings suggest something more nuanced than either social incompetence or social unawareness:
Adolescents with ADHD appear aware that they encounter social and friendship difficulties, but their understanding of those difficulties may differ from that of parents. Their broad self-perception may remain partly positive and protective, even while they experience substantial anxiety, insecurity and reduced relationship quality. The problem therefore involves not only the possession of social skills, but also feedback processing, emotional regulation, social interpretation, peer responses and the relational environment.
The implication is not that social skills are irrelevant.
It is that skills form only one part of a larger system.
The adolescent may need support not because they have failed to learn how people work, but because people are inconsistent, feedback is obscure, anxiety changes perception and relationships rarely operate according to the clean rules presented in social-skills programmes.
Adulthood may bring greater awareness. Whether it also brings better social outcomes depends on what that awareness becomes: useful understanding, or relentless self-surveillance.
