Theory of mind failure and emotion dysregulation as contributors to peer bullying among adolescents with attention-deficit/hyperactivity disorder

This study investigated whether poor performance in the Reading the Mind in the Eyes Test (RMET) and emotion dysregulation (ED) contributes to involvement in bullying among adolescents with attention-deficit/hyperactivity disorder (ADHD). Altogether, 105 adolescents with ADHD aged 10–18 years (mean: 13.9±1.8 years, 77% boys) were recruited. RMET was applied to evaluate the ToM abilities. Participants completed the Difficulties in Emotion Regulation Scale (DERS) and the Olweus Bully/Victim Questionnaire to measure ED and evaluate involvement in bullying, respectively. Among the subjects, 24.8% were victims, 23.8% were perpetrators. The perpetrators and victims exhibited significantly lower RMET scores and higher DERS awareness scores than non-victims/nonperpetrators. The perpetrators also exhibited significantly higher DERS impulse scores and DERS total scores than nonvictims/non-perpetrators. Binary logistic regression analysis revealed that a 1-point decrease in the RMET score increased the odds of bullying victimization by 53% and bullying perpetration by 21.6%, while a 1-point increase in DERS impulse scores increased the risk of bullying perpetration by 14.9%. This study is the first to show an association between poor ToM ability and involvement in bullying as victims/perpetrators among children with ADHD. Both victims and perpetrators had problems with emotional awareness, while only perpetrators had difficulties controlling their impulses.