by Patrice B.F. Garver, PhD
PEER SUPPORT AMONG GIRLS WITH ADHD WITHIN A GROUP SETTING — irls face—can be an effective, therapeutic, and empowering experience. The power of group support and the group process allows each member to be herself, express her pain, and realize that she is not the only one experiencing social, emotional, or personal challenges.This is readily discovered by the professional who facilitates a psychoeducational, support, or therapy group for adolescent girls.
"Mary," an articulate, intellectually curious middle school student with ADHD, has been a member of my middle school girl’s group for several years. Mary would rather provide various quotes of past presidents or from Albert Einstein than enter a room with classmates and initiate a conversation. Mary loves to read and can get lost in books or technology for hours, isolating herself in her room. Mary’s parents continually pry her out of her room to visit with guests or interact with family members. When joining the group, Mary’s personal goals were to be less shy, feel more comfortable talking to peers and adults (especially in groups), and try to get a better handle on organizing her time so she will feel less stressed. As Mary progressed in the group, other members provided input, challenged her hesitancy, and validated her insights and intellectual interpretations to social problem solving. She was eventually able to share and disclose various conflicting social experiences of bullying or times of social isolation.
Eventually, Mary was voluntarily participating in group role-playing, leading the group in relaxation and mindfulness exercises, and even volunteered to rehearse her audition in front of the group. After taking that first scary step to audition for a play, Mary discovered her personal passion: acting and singing. Additionally, Mary was chosen to be the eighth-grade graduation speaker. Her speech was beautifully written and chosen from all the other speeches written by her classmates. Here is part of her speech.
When I was little, I loved animals and books. My plan for the future was to become a zookeeper. But then I hit middle school. In fourth grade, I was diagnosed with ADD, and concentration and organization became obstacles. I struggled with my grades, especially math, which was always hard to understand. But the biggest thing I didn’t understand was myself. Before, I was the smart, shy, and book worm-ish nerd. I started to believe that that would be my label forever, and it was clear I wasn’t going to be a zookeeper. To help me adjust to new demands, my mother placed me in a "middle school group session" that my psychologist was starting. I had to be dragged there. I was terrified. But when I saw it was only me and a few other girls, I relaxed a little. I learned that no one is completely sporty, nerdy, or etc... I saw myself in a new light.
Goals for girls’ groups
The process of developing groups for adolescent girls, particularly girls with ADHD, evolved and has been refined over the years. Group goals and formats were developed after studying, experiencing, and learning so much from each girl. Leading these groups has been challenging, but also enriching.
Although each group takes on individual direction, identity, and energy, there are goals particularly pertinent to the group experience, which are important for any population, as well as with adolescent girls who have ADHD. These goals are:
- Learn to trust oneself and others
- Increase awareness and self-knowledge, to develop a sense of one’s unique identity
- Recognize the commonality of members’ needs and problems and to develop a sense of connectedness
- Help members learn how to establish meaningful and intimate relationships
- Increase self-acceptance, self-confidence, and self-respect, and to achieve a new view of oneself and others
- Learn how to express one’s emotions in a healthy, constructive way
- Become aware of one’s choices and to make choices wisely
- Make specific plans to change certain behaviors
- Learn more effective social skills
- Become more sensitive to the needs of others
These goals and others determined by the group members can be addressed through mindfulness exercises, discussions, role-playing, and other collective experiences providing a guided and safe social environment to work through challenges and practice behaviors.
Mary’s story is one of many examples of how girls can grow and benefit from the group experience and group dynamic. Mary changed from a quiet, hesitant observer to an engaged group participant. Helping girls like Mary address the social pressures and obstacles that surface in middle school and hearing how group work can help with outside social challenges have been the most rewarding experiences.
Challenges of adolescence
The psychosocial challenges of adolescence are well documented. Adolescence is a time of opportunities and risks. The central concern during the adolescent years is the search for identity, which has interpersonal, sexual, and values components. Identity confusion (Erikson, 1950) is normal at this age and accounts for the chaotic nature of this stage of development with extreme self-consciousness, impulsive behaviors, and regressive, immature behaviors.
The influence of the peer group is strongest in early adolescence. The structure of the peer group becomes more elaborate, involving cliques, crowds and friendships. Friendships, especially among girls, can become more stable, intimate, and supportive during this time, with security and development of self-worth created through group experience (Bouchey & Furman, 2003). Adolescence can be a tumultuous time for the young person and his or her parents. Family conflict, depression, and risky behavior are more common during this time, as compared to other stages of development (Arnett, 1999; Papalia, Olds & Feldman, 2007).
There exists the "normal" developmental and physiological challenges of being a teen, then add the additional psychosocial and executive function struggles of also having ADHD. Adolescents with ADHD struggle with socializing comfortably, poor self-esteem, and immature social skills. Watching teen girls with ADHD bond, look forward to group, and become the cheering squad for a group member going through a rough experience at school, reaffirms how the power of the group experience, in a safe and accepting setting, can help each girl vent and practice coping skills, addressing the roller-coaster existence of being an adolescent girl who happens to have ADHD.
The focus of personal and interpersonal growth in group is always the same, but how the group is run and managed can be different each time. Due to coexisting psychiatric conditions and/or self-regulatory challenges, the group format and experiences may need to be adjusted as each group is formed and as it evolves. The overall makeup of each group and their group goals can influence an increase or decrease in structure, generate the need for more role-playing activities, more mindfulness practice, or more social skill practice and rehearsal.
In general, my groups for adolescent girls with ADHD include these components:
- Develop group rules and norms
- Develop goals that are ADHD-related
- Develop individual and group goals
- Provide a psychoeducational component (to the girls and parents)
- Maintain parent, when necessary, school feedback and communication
- Consider that some groups need more structure and smaller membership
- Provide repeated experiences, discussions, and practice regarding self-regulation, pragmatics and social problem solving, addressing behavioral/social challenges and social skill development
The group as social "laboratory"
When change and personal growth happens, the "power of the group" appears to create its own qualities and dynamics. The group experience becomes a safe place to take risks, to disclose, and to express feelings openly and honestly. The group experience can become a place in which it is okay to fail, to laugh about personal vulnerabilities and commiserate about embarrassing incidents while celebrating achievements.
The group experience can be a social "laboratory" to work through how it feels when confronting peers, and to practice self-regulation or appropriate conversational skills. From the group process and exposure, adolescent girls with ADHD can learn to take risks or engage in other group activities, such as joining a club, a theater program, youth group, sports team, dance class, or an "outward-bound" program that can result in a fun or even life-changing experience.
Here are some more words of wisdom from Mary’s graduation speech:
I don't know if everyone in my class found their passion yet, so I will give you all some advice. If you want to try a new sport, try it! If you want to play a new instrument or be in a play, do it! If you want to join the club, join! Who cares if your friends don’t want to do it. You will make new friends! If you aren’t good at whatever it is, try something else! Don’t be afraid if someone thinks you can’t do it. Vincent van Gogh once said, "If a voice tells you cannot paint, then by all means paint and the voice will be silenced."
… I know I just said a few quotes, but I have one more, one of my favorites. It’s from Louisa May Alcott, who said, "I am not afraid of storms for I am learning to steer my ship." To me, that is the eighth-grade motto. Soon we will journey out alone without parental guidance. There will be storms, but we will not be afraid, we are learning how to steer.
Arnett, J. J. (1999). Adolescent Storm and Stress, Reconsidered. American Psychologist, 54, pp. 317-326. Barkley, R.A. (2000). Taking Charge of ADHD: The Complete Authoritative Guide for Parents (Rev. ed.). New York, NY: The Guilford Press.
Bouchey, H.A. & Furman, W. (2003). Dating and romantic experiences in adolescence. In G.R. Adams and M.D. Berzonsky. (eds.). Blackwell Handbook of Adolescence. pp. 313-329.
Corey, G. (2008). Theory and Practice of Group Counseling (7th ed.). Belmont, CA: Thomson Brooks/Cole.Erikson, E. H. (1950). Childhood and Society . New York: Norton.
Papalia, D.E., Olds, S.W. & Feldman, R.D. (2007). Human Development , (10th ed.). New York: McGraw-Hill.
Patrice B.F. Garver, PhD, is a developmental psychologist who specializes in the assessment and treatment of children with learning and behavioral problems. She has worked as a special educator, learning disabilities specialist, psychometrician, and school psychologist, and is presently in private practice. She specializes in working with children and adults with ADHD and with gifted students who have learning disabilities. She also runs therapeutic groups for adolescents in middle school. CHADD honored Dr. Garver with its Outstanding Professional Award her untiring work with children and adults with ADHD.
This article originally appeared in the December 2012 issue of Attention magazine. Copyright © 2012 by Children and Adults with Attention Deficit Hyperactivity Disorder (CHADD). All rights reserved. No portion of this article may be reproduced without written permission from CHADD.