Eur Child Adolesc Psychiatry (2015) 24:185–198

DOI 10.1007/s00787-014-0560-9

ORIGINAL CONTRIBUTION

Justice and rejection sensitivity in children and adolescents

with ADHD symptoms
Rebecca Bondü • Günter Esser

Received: 24 January 2014 / Accepted: 5 May 2014 / Published online: 31 May 2014
 Springer-Verlag Berlin Heidelberg 2014

Abstract Justice sensitivity captures individual differ- Introduction

ences in the frequency with which injustice is perceived
and the intensity of emotional, cognitive, and behavioral Research has linked ADHD to erratic, defiant, disruptive,
reactions to it. Persons with ADHD have been reported to or socially withdrawn behavior as well as a lack of social
show high justice sensitivity, and a recent study provided competencies throughout the life span (e.g., [23, 26]). The
evidence for this notion in an adult sample. In 1,235 Ger- constructs of justice sensitivity and rejection sensitivity
man 10-to 19-year olds, we measured ADHD symptoms, may add to our understanding of the emergence and
justice sensitivity from the victim, observer, and perpetra- maintenance of these behavior patterns in persons with
tor perspective, the frequency of perceptions of injustice, ADHD, as they may make ADHD patients particularly
anxious and angry rejection sensitivity, depressive symp- vulnerable to negative cues in social interactions and––
toms, conduct problems, and self-esteem. Participants with with regard to victim justice sensitivity and rejection sen-
ADHD symptoms reported significantly higher victim sitivity––promote negative responses to these cues. Indeed,
justice sensitivity, more perceptions of injustice, and higher reports both from practitioners and persons affected point
anxious and angry rejection sensitivity, but significantly to a high sensitivity to injustice in persons with ADHD
lower perpetrator justice sensitivity than controls. In latent [31].
path analyses, justice sensitivity as well as rejection sen- Justice sensitivity captures individual differences in the
sitivity partially mediated the link between ADHD symp- perception of and response to injustice from the perspec-
toms and comorbid problems when considered tives of a victim, an uninvolved observer, a passive bene-
simultaneously. Thus, both justice sensitivity and rejection ficiary, or an active perpetrator [40]. Individuals high in
sensitivity may contribute to explaining the emergence and justice sensitivity generally perceive injustice more fre-
maintenance of problems typically associated with ADHD quently and intensely, and show stronger cognitive, emo-
symptoms, and should therefore be considered in ADHD tional, and behavioral responses to injustice [25, 43].
therapy. Victim sensitivity has been linked to antisocial behavior
tendencies, but observer, beneficiary, and perpetrator sen-
Keywords ADHD
Justice sensitivity
Rejection sitivity are related to prosocial behavior (e.g., [14, 19]).
sensitivity
Conduct problems
Depressive symptoms Rejection sensitivity, as a similar sensitivity construct,
refers to individual differences in the tendency to expect,
perceive, and react to alleged or actual cues of rejection in
the social environment [11].
Findings from a recent study by Schäfer and Kraneburg
[39] supported the notion of higher justice sensitivity in
adults: participants with ADHD showed higher observer
R. Bondü (&)
G. Esser
and beneficiary justice sensitivity than controls, visible in
Department of Psychology, University of Potsdam,
Karl-Liebknecht-Str. 24-25, 14476 Potsdam, Germany behavioral reactions in an experimental game. In addition,
e-mail: [email protected] participants with the inattentive ADHD subtype showed

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higher justice sensitivity across all four subscales of the and unjust, they are in turn likely to promote aggressive or
justice sensitivity inventory [40] than participants with the defiant behavior. This interaction pattern presumably
hyperactive/combined ADHD subtype and controls. In results in a spiral of negative interactions, with research
contrast, one previous study investigating male adults pointing to ADHD as the source of this vicious circle [24].
failed to show the expected higher rejection sensitivity in Consequently, it can be assumed that persons with ADHD
persons with ADHD than in controls [8]. experience injustice and rejection more often than others,
We examined (1) the associations between justice sen- not only subjectively but also objectively.
sitivity as well as anxious and angry rejection sensitivity Therefore, ADHD not only shows high comorbidities
and ADHD symptoms in children and adolescents, and (2) with oppositional defiant or conduct disorder in childhood
whether findings from previous research in adults can be and adolescence [9, 13, 32], but also shows high comor-
transferred to this age range. Furthermore, (3) we examined bidities with depression, anxiety, substance abuse, and
the potential mediating role of justice and rejection sensi- eating disorders in children as well as in adults [16, 44]. As
tivity on the link between ADHD symptoms and associated in the general population, females with ADHD show more
problems such as conduct problems, depressive symptoms, internalizing problems and males with ADHD show more
or low self-esteem. Thus, our research combines person- externalizing problems [15]. Safren et al. [38] introduced
ality psychology and clinical psychology with the aim of the Cognitive-Behavioral Model of (Adult) ADHD to
not only describing, but also explaining ADHD and its explain the link between ADHD and these related prob-
relationships with other problem behaviors. In this respect, lems: ADHD symptoms lead to failure, underachievement,
the study strives to contribute to the understanding of the and problems in relationships. These negative experiences
link between ADHD symptoms and interpersonal sensi- promote negative thoughts and beliefs such as low self-
tivities as well as the link between ADHD symptoms and esteem or negative self-statements, which ultimately result
related problems in children and adolescents. The insights in negative feelings such as depression, guilt, anxiety, or
from our study can be useful for the development of anger.
therapeutic intervention strategies to prevent or alleviate Apparently, persons with ADHD suffer from their lack
comorbid problems in children and adolescents with of social competencies and the resulting negative social
ADHD symptoms. Furthermore, the study helps to extend experiences, and struggle to understand social cues and
the knowledge regarding (victim) justice and rejection behave appropriately. Under these circumstances, Schäfer
sensitivity as potential risk factors for emotional and and Kraneburg [39] argue that justice sensitivity may be a
behavioral problems in children and adolescents. useful disposition, because it may work to compensate for
inadequate social skills: High victim sensitivity, which
ADHD symptoms and subtypes focuses on self-related interests, may protect the indi-
vidual from disadvantages and exploitation in social
ADHD is characterized by patterns of inattentiveness as interactions. People who are high in victim sensitivity are
manifested by obliviousness, a lack of continuous atten- sensitive to only slight or ambiguous cues of untrust-
tion, or distractibility, as well as patterns of hyperactivity worthiness, meanness, and injustice and interpret these
and impulsiveness as manifested by agitation, excessive cues negatively due to a suspicious mindset. This results
talking, or uncontrolled, impatient, emotionally unstable, in the early withdrawal of cooperation if there appears to
or erratic behavior [1]. It is two to three times more fre- be any danger of the individual being exploited [3, 18]. In
quent in boys than in girls. Inattentive symptoms (inat- contrast, high observer, beneficiary, and perpetrator sen-
tentive subtype) have been linked in particular to timidity sitivity, which focus on moral concerns, may demonstrate
and anxiousness in social interactions, whereas hyperactive an understanding of social norms when shown in social
symptoms (hyperactive/combined subtype; [23]) have been interactions.
linked in particular to verbal and physical aggression, rule-
breaking, or defiance. A lack of social competencies is ADHD and justice sensitivity
considered as the underlying cause of both of these mal-
adjusted behavior patterns, preventing persons with ADHD Individuals consistently and persistently differ in terms of
from adequately encoding, processing, and reacting to the frequency and intensity of their perceptions of and
relevant social cues [33]. reactions to injustice [25, 43]. Justice sensitivity disposes
Given these social skill deficits, persons with ADHD the individual to a cognitive preoccupation with injustice
frequently encounter negative reactions themselves: diffi- (rumination). The pattern of emotional and behavioral
culties in school, in the workplace, as well as in parent, reactions depends on the perspective from which injustice
peer, partner, and child relationships are prevalent [26, 32, is perceived: victim-sensitive persons readily perceive
37]. As these reactions can often be interpreted as rejecting injustice to their own disadvantage, react with anger, and

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strive for retaliation. Observer-sensitive persons readily of the justice sensitivity inventory than 13 persons with the
perceive disadvantages of others, react with indignation, hyperactive ADHD subtype and 15 controls. The hyper-
and strive to retaliate against the perpetrator or to com- active group only differed from controls in terms of higher
pensate the victim. Beneficiary-sensitive persons disap- ratings of observer sensitivity. Thus, although correlations
prove of injustice to their own advantage and to the between measures were small, both the experimental and
disadvantage of others, react with feelings of guilt, and questionnaire data pointed to a vulnerability to injustice in
strive to compensate the victim. Finally, perpetrator-sen- persons with ADHD, especially in those with the inatten-
sitive persons readily perceive themselves as causing tive subtype.
disadvantages, react with guilt, and strive to punish However, previous research on ADHD on the one hand
themselves or to compensate the victim [40, 42]. and justice sensitivity on the other hand, as well as theo-
All justice sensitivity perspectives are positively corre- retical considerations, would suggest somewhat different
lated due to a conjoint concern for justice. Victim sensitivity, correlation patterns between ADHD symptoms and the
however, also comprises a concern for self-related interests different perspectives of justice sensitivity than previously
[2, 40]. Consequently, victim sensitivity has been positively reported: given the positive relations of ADHD symptoms
related to negative, egoistic traits such as jealousy, Machi- as well as of victim sensitivity with aggressive behavior
avellism, negative reciprocity, or vengeance as well as to and conduct problems, positive correlations between
aggression or emotional and conduct problems. In contrast, ADHD symptoms and victim sensitivity can be expected.
in questionnaire and experimental studies conducted in dif- Furthermore, persons with high impulsiveness, as ascribed
ferent age groups, observer, beneficiary, and perpetrator to individuals with ADHD, may find it more difficult to
sensitivity were positively linked to positive, altruistic traits control the need to retaliate against a perpetrator of injus-
such as role-taking, empathy, or tender-mindedness as well tice and the accompanying feelings of anger that have been
as to prosocial behavior [2, 6, 14, 17, 19, 42]. linked to high victim sensitivity [6]. Thus, high victim
Reports on high sensitivity to injustice in people with sensitivity might enhance the risk of impulsive disruptive
ADHD point to correlations of individual difference vari- behavior in persons with ADHD symptoms. Negative
ables with clinically relevant conditions. Thus, our research reactions associated with victim sensitivity may also work
strives to highlight the links between personality disposi- to impair social relations in the long term, promoting a
tions reflecting sensitivity to negative social cues and vicious circle of disruptive behavior and negative reactions
ADHD symptoms. This should add to the understanding and in the social environment, as has been related to ADHD.
explanation of ADHD and its association with other problem Furthermore, victim sensitivity in particular has been
behaviors (e.g., by showing how these dispositions influence linked to other emotional and behavioral problems such as
thoughts and feelings as well as the perception and inter- high levels of neuroticism, insomnia, depressive symp-
pretation of social cues). This appears to be important, toms, anxiety, or psychosomatic discomfort in different age
because our study may highlight that effective intervention groups [6, 21, 22, 40, 42]. Therefore, it has been considered
strategies for treating ADHD and related problems need to as a potential risk factor for different kinds of problem
take into account not only external social influences and behavior [6, 36]. In line with this rationale, victim sensi-
symptoms of ADHD, but also individual difference vari- tivity may promote dysfunctional thoughts and beliefs,
ables which may shape these problems further. which may enhance comorbid problems in persons with
In line with reports on high justice sensitivity in persons ADHD, as described in the Cognitive-Behavioral Model of
with ADHD, Schäfer and Kraneburg [39] found signifi- ADHD by Safren et al. [38].
cantly higher observer and beneficiary sensitivity in 29 The link between ADHD symptoms and victim sensi-
adults with ADHD symptoms recruited via ADHD internet tivity also requires further examination for two other rea-
forums and screened for ADHD symptoms than in 14 sons: first, so far, this link has only been investigated via
controls in an experimental game: participants with ADHD questionnaire data in a comparatively small sample of adult
showed a lower acceptance of unjust allocations of lottery participants with ADHD and controls. The findings from
tickets to their own benefit (beneficiary) and higher will- this study therefore require replication in a larger sample.
ingness to restore justice after unjust allocations of tickets Second, previous research has found that victim sensitivity
(observer; victim sensitivity not assessed, no differences in increases throughout childhood and adolescence [6].
just allocations of lottery tickets as an indicator of perpe- Accordingly, in the age range investigated in the present
trator sensitivity). In a second step, 37 participants rated study, victim sensitivity is still developing, and correlations
their justice sensitivity regarding all four facets using the between ADHD and victim sensitivity in child and ado-
justice sensitivity inventory [40]. Nine persons classified as lescent samples may differ from those in adult samples.
having the inattentive ADHD subtype averaged signifi- Hence, we expected to find higher victim sensitivity in
cantly higher justice sensitivity ratings on all four subscales children and adolescents with ADHD symptoms than in

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controls. Moreover, we assumed that victim sensitivity resilient to its effects. Because persons with ADHD are
would positively mediate the link between ADHD symp- prone to experiencing rejection [26, 32, 37], they may also
toms and comorbid problems in line with the theoretical be prone to rejection sensitivity. However, contrary to
assumptions outlined above. expectation, a previous study using questionnaire data did
In contrast to victim sensitivity, observer, beneficiary, not find higher rejection sensitivity in 53 adult men with
and perpetrator sensitivity have been shown to be nega- ADHD than in 25 controls [8]. In line with the expecta-
tively related to antisocial behavior and positively related tions, rejection sensitivity was linked to more positive
to prosocial behavior [14, 17, 19]. This is most probably outcomes in persons with the inattentive ADHD subtype
due to the moral motivation underlying these justice sen- and controls, but in persons with the hyperactive ADHD
sitivity facets, which reflects a genuine concern for others subtype higher rejection sensitivity predicted better social
and works to inhibit antisocial impulses. Thus, high outcomes cross-sectional. The failure to find higher rejec-
observer and perpetrator sensitivity may enhance positive tion sensitivity in men with ADHD as compared to controls
social interactions and relationships, and buffer the sug- was interpreted as an adult expression of the positive
gested adverse effects of ADHD symptoms in terms of illusory bias. This has been observed in children with
protective factors. However, high impulsiveness, low ADHD and leads to an overestimation of social skills and
inhibitory control, and conduct problems often associated seemingly also prevents the perception of the impairment
with ADHD may undermine these prosocial tendencies or of peer relations (p. 270).
impede the individual from acting on them appropriately. Nevertheless, this explanation cannot account for the
Moreover, given the antithetic links of ADHD symptoms frequent erratic and disruptive behavior or withdrawal in
and observer, beneficiary, and perpetrator justice sensitiv- persons with ADHD. Furthermore, child and adolescent
ity with antisocial behavior and aggression, we expected to samples may differ from adult samples in terms of the link
find lower observer and perpetrator sensitivity in children between rejection sensitivity and ADHD (e.g., the adult
and adolescents with ADHD symptoms than in controls. version of the rejection sensitivity measure only captures
Persons who are high in justice sensitivity are consid- anxious rejection sensitivity, whereas the child version
ered to perceive injustice frequently. If our assumption of covers anxious and angry rejection sensitivity). In line with
higher victim sensitivity and more unjust experiences in our theoretical assumptions, we therefore expected to find
participants with ADHD symptoms as compared to con- higher anxious and angry rejection sensitivity in children
trols is valid, they should also report more frequent per- and adolescents with ADHD symptoms than in controls.
ceptions of injustice from the victim perspective. Like justice sensitivity, rejection sensitivity might also
Accordingly, if participants with ADHD symptoms indeed explain the link between ADHD symptoms and comorbid
show lower observer and perpetrator sensitivity, they problems, because it has already been connected to a
should also report perceptions of injustice from the variety of problem behaviors such as aggression, depres-
observer and the perpetrator perspective less frequently. sion, and eating disorders in different age groups and is
considered a risk factor for psychological problems in
ADHD and rejection sensitivity adolescence [12, 29, 30]. Thus, we expected rejection
sensitivity to positively mediate the link between ADHD
Rejection sensitivity resembles justice sensitivity and is symptoms and related problems.
defined as the tendency to ‘‘expect, readily perceive, and
overact to rejection’’ [11]. It serves self-protective goals, The present study
and persons who are high in rejection sensitivity tend to
react unfavorably to perceived threats of rejection either The present study examined the link between ADHD
through aggression (particularly in persons who angrily symptoms and justice and rejection sensitivity in a large
expect rejection) or through social withdrawal (particu- sample of 10- to 19-year-old children and adolescents in
larly in persons who anxiously expect rejection) [28]. Germany and tested whether previous findings in adult
Both of these behavior patterns are often observed in samples could be replicated in this age range. In addition,
relation to ADHD as well and are likely to result in a self- using structural equation models, we examined the role of
fulfilling prophecy of expected and real rejection in par- justice and rejection sensitivity as potential mediators of
ent, peer, and partner relationships [12]. Again, this is a the link between ADHD symptoms and related problems.
pattern which has been frequently observed in persons Thus, our research adds to the understanding and expla-
with ADHD. nation of ADHD symptoms and their associations with
Rejection sensitivity is assumed to be acquired through other problem behaviors by taking an individual difference
previous rejection by parents and peers [12], implying that perspective and linking it to clinical psychology. Based on
repeated rejection makes the individual vulnerable and not the theoretical considerations outlined above and on

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findings from previous research, we expected to find: (1) does not get recognition he/she deserves’’), and perpetrator
higher victim sensitivity and lower observer and perpetra- (e.g., ‘‘I feel guilty when I deny someone the recognition
tor sensitivity in participants with ADHD symptoms than in he/she deserves’’) perspective with five congruently wor-
controls; (2) more frequent perceptions of injustice as a ded items per scale of the Justice Sensitivity Inventory for
victim and less frequent perceptions of injustice as an Children and Adolescents [6]. Response options ranged
observer and a perpetrator in participants with ADHD from 0 = completely disagree to 5 = completely agree.
symptoms than in controls; and (3) higher anxious and The number of items was reduced to five and the benefi-
angry rejection sensitivity in participants with ADHD ciary subscale was not assessed to avoid overstraining the
symptoms than in controls. Moreover, we assumed that (4) younger participants and due to time restrictions. In addi-
justice and rejection sensitivity would independently tion, 2 out of the 15 items were reworded somewhat to
mediate the link between ADHD symptoms and comorbid make them more comprehensible for children. Research
problems such as conduct problems as an example of has established the reliability and validity of the original
externalizing problem behavior, depressive symptoms as 10-item version of the Justice Sensitivity Inventory [40, 42,
an example of internalizing problem behavior, and low 43] and of the adapted 5-item version for children and
self-esteem from a cross-sectional perspective. adolescents [6]. Participants rated the frequency of per-
ceived injustice as a victim, an observer, and a perpetrator
during the past year on a four-point scale (0 = never to
Method 3 = often; e.g., ‘‘How often have you been treated unfairly
during the last year?’’) with three additional items. We also
Sample used these three items to compute a mean score of the total
perceived injustice.
The sample consisted of N = 1,235 German children
and adolescents aged between 10 and 19 years Rejection sensitivity
(M = 13.91 years, ± 1.78). Gender was almost equally
distributed (50.2 % girls). Of the participants, 21.1 % We measured rejection sensitivity with a translated (initial
attended a public primary school, 52 % grammar school, translation by the first author and translation checked by a
23.9 % comprehensive school, and 3 % other school types. bilingual speaker) and shortened version of the Child
Rejection Sensitivity Questionnaire (the original measure
Material comprises 12 items; [12]). Participants were presented with
six ambiguous situations which might or might not be
ADHD symptoms interpreted as resulting in rejection and were asked to rate
how anxious and how angry they would feel prior to the
We assessed AHDH symptoms using the five-item hyper- outcome (1 = not anxious/angry to 6 = very, very anx-
activity subscale of the German version of the Strengths ious/angry) and how likely rejection would be (1 = very
and Difficulties Questionnaire (SDQ; [20]). Three items unlikely to 6 = very likely, e.g., ‘‘Imagine that a famous
cover hyperactivity (SDQ-HA; ‘‘I am restless. I cannot stay person is coming to visit your school. Your teacher is going
still for long’’), and two items cover inattentiveness to pick five kids to meet this person. You wonder whether
symptoms (SDQ-IN; ‘‘I am easily distracted’’). Response she will choose you…’’). We computed anxious and angry
options ranged from 0 = not true to 2 = certainly true. rejection sensitivity in line with Downey and Feldman [12]
The SDQ is an established, economical measure to assess by multiplying the degree of anxiety and anger by the
various problems in children and adolescents. It has been perceived likelihood of rejection for each situation and
normalized to distinguish a normal, a borderline, and an dividing the resulting sum by the number of situations. The
abnormal group (www.sdqinfo.com) and is frequently used authors provided evidence for acceptable to good internal
in research both in Germany and internationally. Previous consistencies (0.79 and 0.82) for the two subscales and for
research established the construct validity and acceptable the factorial validity of the original 12-item scale (http://
internal consistencies of the German version of the SDQ [4, socialrelations.psych.columbia.edu/measures/children-rs-
27]. questionnaire).

Justice sensitivity Conduct problems

We measured justice sensitivity from the victim (e.g., ‘‘It Conduct problems were measured using the five-item
makes me angry when others get recognition that I subscale of the Strengths and Difficulties Questionnaire
deserve’’), observer (e.g., ‘‘I am indignant when someone (SDQ; [20]; ‘‘I fight a lot’’).

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Depressive symptoms confirmatory factor analyses, including conduct problems

and self-esteem (see below for more details). We therefore
Depressive symptoms were measured using 39 items proceeded using all of the scales in the structural equation
(1 = yes, 0 = no) of the dysphoria (‘‘Do you cry often?’’) models.
and the psychosomatic complaints (‘‘Do you often feel
ill?’’) subscales of the Deutscher Depressionstest für Kin-
der (German depression test for children; [35]). Results

Self-esteem Descriptive statistics and correlations

We measured self-esteem with a subscale of the kid- In line with the German SDQ norms (www.sdqinfo.com),
KINDL (e.g., ‘‘During the last week I was proud of we considered participants to have severe (abnormal)
myself’’; [34]). Response options ranged from 1 = never to ADHD symptoms and assigned them to the ADHD
5 = always. We deleted one item due to low item-total symptoms group if they scored at least 7 out of 10 points on
correlations and low factor loadings in the structural the SDQ hyperactivity subscale. Of the 1,235 participants
equation models. The three remaining items were summed in our sample, 87 (7 %) reported severe ADHD symptoms.
up to form a total score. The measure has shown acceptable We assigned the remaining 1148 participants to the control
internal consistencies and factorial, convergent, and dis- group. Groups did not differ in terms of age
criminant validity [34]. (t(105.86) = 1.21, p = 0.230), but age was related to most
dependent variables (see Table 2). Boys were overrepre-
Procedure sented in the ADHD symptoms group (Fisher’s Exact Test:
p = 0.019, OR = 1.71). Table 1 shows scale internal
We collected data in standardized 1.5-to 2-h sessions as consistencies as well as scale characteristics and mean
part of a large-scale study on risk factors for frequent values of dependent and independent measures for all
psychological problems in children and adolescents. All participants and separately for boys and girls. Due to sig-
participants were guaranteed privacy and completed the nificant correlations between dependent measures
questionnaires either via paper and pencil or via computer. (Table 2), we employed MANOVA to test for gender dif-
Instructions were read aloud to the participants. Items were ferences and controlled for age to test whether gender
only read aloud if low reading skills impaired under- should be used as a control variable in subsequent analyses.
standing or took up too much time. Participants marked Results indicated a significant effect of gender, F(12,
their answers alone. Interviews followed a standardized 1221) = 20.24, p \ 0.001, g2p = 0.17). On the subscale
sequence (measures of the present study: self-esteem, SDQ, level, girls showed significantly higher observer and per-
rejection sensitivity, justice sensitivity, depression). Par- petrator sensitivity (p \ 0.001 each), anxious rejection
ticipants were offered breaks and were told that they could sensitivity (p = 0.001), and depressive symptoms
request breaks if necessary. Written consent to participate (p \ 0.001), whereas boys showed significantly higher
in the study was obtained from the parents or the partici- ratings of perceived injustice as a perpetrator (p = 0.047),
pants themselves if they were of age. The procedure and conduct problems (p \ 0.001), and self-esteem
instruments applied in the study were approved by the (p \ 0.001). There were no gender differences within the
Ethics Committee of the University of Potsdam and the ADHD symptoms group in any of the justice or rejection
Ministry of Education of the German Federal state of sensitivity measures [MANOVA: F(8, 77) = 1.25,
Brandenburg. For all variables, the percentage of missing p = 0.281], but a separate MANOVA revealed gender
data was B0.2 %. Given the low percentage of missing differences in related problems [F(3, 82) = 7.24,
data, they were replaced by single imputation via SPSS 22. p \ 0.001, g2p = 0.21]: boys from the ADHD symptoms
Low internal consistencies of the conduct problems and group showed significantly higher conduct problems than
the self-esteem scales (Table 1) could not be improved by girls (p = 0.006), whereas girls reported significantly
deleting further items. With regard to the conduct problem higher depression scores (p = 0.007) and marginally lower
scale, the SDQ captures different forms of these problems self-esteem (p = 0.069).
in terms of clinical symptoms, which can be, but are not Victim sensitivity and both rejection sensitivity sub-
necessarily, associated with one another. The items are scales were significantly positively correlated with ADHD
therefore not required to form an internally consistent symptoms, and perpetrator sensitivity was significantly
scale. Furthermore, we were able to replicate the intended negatively correlated with ADHD symptoms (Table 2). No
factor structure of the measures as used in our study via correlation was found between ADHD symptoms and

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Table 1 Descriptive statistics for the total sample and separately for boys and girls
Scale a Total M Boys M Girls M ADHD M Control M F pd g2p
(SD) (SD) (SD) (SD) (SD)

SDQ-hyperactivity 0.72 3.46 (2.06) 3.54 (2.15) 3.37 (1.98)

JS-victim 0.79 2.77 (1.10) 2.75 (1.18) 2.80 (1.07) 3.12 (1.18)a 2.75 (1.09)d 11.04 0.001 0.009
a c
JS-observer 0.86 2.92 (1.15) 2.68 (1.20) 3.15 (1.04) 2.88 (1.27) 2.92 (1.14) 0.06 0.802
JS-perpetrator 0.88 3.35 (1.26) 3.04 (1.30)a 3.66 (1.14)c 2.88 (1.40)a 3.38 (1.25)c 10.10 0.002 0.008
a
JS-frequency victim 1.33 (0.75) 1.34 (0.76) 1.33 (0.74) 1.60 (0.90) 1.31 (0.73) 12.24 \0.001 0.010
JS-frequency observer 1.86 (0.77) 1.86 (0.78) 1.86 (0.76) 2.06 (0.78) 1.85 (0.77) 6.39 0.012 0.005
a c
JS-frequency perpetrator 0.82 (0.63) 0.85 (0.66) 0.78 (0.61) 1.10 (0.72) 0.80 (0.62) 19.06 0.000 0.015
JS-mean frequency injustice 0.60 1.34 (0.53) 1.35 (0.55) 1.32 (0.55) 1.59 (0.60) 1.32 (0.52) 21.02 \0.001 0.017
RS-anxious 0.65 7.44 (3.24) 7.15 (3.20)a 7.74 (3.24)b 9.11 (3.58) 7.32 (3.17) 27.11 \0.001 0.022
RS-angry 0.65 4.53 (2.53) 4.67 (2.59) 4.39 (2.47) 6.01 (2.75) 4.42 (2.48) 30.73 \0.001 0.024
SDQ-conduct problems 0.44 1.51 (1.25) 1.67 (1.34)a 1.35 (1.13)c 2.90 (1.47) 1.41 (1.17) 120.78 \0.001 0.089
Depressive symptoms (total) 0.89 8.02 (6.49) 6.73 (5.63)a 9.30 (7.02)c 12.38 (7.30) 7.69 (6.31) 54.91 \0.001 0.043
a
Self-esteem 0.55 11.30 (1.76) 11.64 (1.68) 10.98 (1.78)c 11.34 (1.75) 10.84 (1.76) 9.77 0.002 0.008
n boys = 615, n girls = 620, n ADHD = 87, n control = 1,148
a,b a,c d
p \ 0.05, p \ 0.001, two-tailed

observer sensitivity. When controlling for rejection sensi- indicated by hypothesis 3, participants from the ADHD
tivity, the partial correlation between victim sensitivity and symptoms group also expressed significantly higher anxious
ADHD symptoms was reduced to 0.05 (p = 0.08), whereas and angry rejection sensitivity than controls (p \ 0.001,
the correlation between perpetrator sensitivity and ADHD respectively). Due to considerable differences in sample sizes,
symptoms remained stable at -0.13 (p \ 0.001). When we repeated our analyses with separate U tests, which yielded
controlling for the justice sensitivity scales in terms of the identical results. A separate MANOVA also revealed signif-
relationship between ADHD symptoms and anxious and icant differences in related problems [F(3, 1229) = 46.48,
angry rejection sensitivity, correlations remained stable at p \ 0.001, g2p = 0.10], with significantly higher ratings of
0.24 and 0.22, respectively (both p’s \0.001). conduct problems (p \ 0.001) and depressive symptoms
(p \ 0.001) as well as lower ratings of self-esteem
Differences between participants with ADHD (p = 0.002) in participants with ADHD symptoms than in
symptoms and controls controls.
The group effect for the sensitivity measures remained
To test hypotheses 1–3, we computed a MANOVA with even after controlling for conduct problems [F(8,
ADHD group status as the independent variable, justice and 1221) = 2.66, p = 0.007, g2p = 0.02]. On the subscale
rejection sensitivity subscales and frequencies of perceived level, there were significant differences in anxious and
injustice as dependent variables, and gender and age as control angry rejection sensitivity (p \ 0.001 and p = 0.001) and
variables. There was a significant group effect [F(8,1224) = marginally significant differences with regard to victim
7.76, p \ 0.001, g2p = 0.048; see Table 1 for details on the sensitivity (p = 0.055) and total perceptions of injustice
subscale level]. In line with hypothesis 1, participants from the (p = 0.061). Thus, differences between participants with
ADHD symptoms group rated their victim sensitivity signif- ADHD symptoms and controls could not be accounted for
icantly higher (p = 0.001) and their perpetrator sensitivity by comorbid conduct problems alone. In line with our
significantly lower (p = 0.002) than controls. However, there reasoning, however, there were no longer any differences
were no differences in observer sensitivity. In line with between the ADHD symptoms group and controls in terms
hypothesis 2, participants from the ADHD symptoms group of perpetrator sensitivity (p = 0.177) and perceptions of
reported significantly more frequent perceptions of injustice injustice as a perpetrator (p = 0.205) when conduct prob-
from the victim’s perspective, but contrary to hypothesis 2, lems were controlled for. Thus, aggressive and disruptive
also from the observer’s and perpetrator’s perspective behavior, as is often shown by children and adolescents
(p ranging from\0.001 to 0.012). It should be noted that this with ADHD and as reflected in conduct problems,
includes significantly higher ratings of perceived injustice as explained the lower perpetrator sensitivity in the ADHD
a perpetrator, although perpetrator sensitivity ratings were symptoms group as well as the more frequent perceptions
significantly lower in persons with ADHD symptoms. As of injustice from the perpetrator perspective.

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192 Eur Child Adolesc Psychiatry (2015) 24:185–198

-0.10***
0.18***

-0.10***
-0.15***

0.10***
We repeated our analyses with a control group matched

0.08**

0.08**
0.07*
by age, gender, and school type. When using this smaller

-0.03
0.04
0.05

-0.03

-0.05
–
control group, differences between groups were even more
14

pronounced and effect sizes were larger. In particular,

-0.18***
-0.13***

-0.22***

-0.16***
-0.21***
-0.16***
-0.15***
-0.39***
when controlling for the influence of conduct problems

-11***
-0.03
-0.01

-0.03
[F(8, 164) = 3.68, p = 0.001, g2p = 0.152], there were
13

–
still significant differences with regard to victim sensitivity
(p = 0.013), perceptions of injustice as a victim
0.30***
0.26***
0.16***

0.38***
0.20***
0.19***
0.34***
0.36***
0.28***
0.30***
0.07*

(p = 0.007), total perceptions of injustice (p = 0.009), and

12

–
anxious and angry rejection sensitivity (p = 0.005 and
0.033, respectively). Because testing with the large control
0.43***
0.13***

-0.20***
0.20***
0.11***
0.30***
0.27***
0.15***
0.25*** group seemed more conservative, and to meet the
-0.03

– requirements of structural equation models in terms of

11

sample size, we continued using the larger comparison

0.24***
0.18***

0.21***

0.16***
0.19***
0.64***

sample in the subsequent latent analyses.

-0.06*
0.02

0.05

–
10

Justice and rejection sensitivity as mediating factors

0.25***
0.20***
0.10***

0.26***

0.14***
0.21***
0.08**

0.06*

In line with our expectations, the results from our study did
9

not yield evidence for generally higher justice sensitivity in

persons with ADHD symptoms, but did indicate positive
0.18***
0.32***
0.18***

0.75***
0.78***
0.71***

links between victim sensitivity, rejection sensitivity,

-0.02

ADHD symptoms, and comorbid problems, as well as

8

negative correlations with perpetrator sensitivity. We

0.20***
0.23***

-0.19***
0.30***
0.35***

therefore tested the assumption that justice and rejection

0.01

sensitivity mediate the link between ADHD symptoms and

–

conduct problems, depressive symptoms, and low self-

7

esteem via three separate latent path analyses in the total

0.21***
0.22***

0.34***
0.07**

sample (N = 1,235) using Mplus7. We used single items

0.05

as indicators for all constructs (i.e., five items each for the
6

justice sensitivity and SDQ subscale, six items for the

0.14***
0.28***
0.16***

rejection sensitivity scales, four items for the self-esteem

0.07*

scale) apart from depressive symptoms, which were indi-

5

cated by the two subscales of the depression questionnaire.

-0.12***
0.23***
0.58***

To account for similarities in item wordings within and

between justice sensitivity scales, we modeled two addi-
–
4

tional wording factors when more than one justice sensi-

tivity subscale was used in a model (Fig. 1a, b). As
0.49***

inspections of modification indices suggested correlations

-0.02

between error terms, we allowed for correlations of two

–
3

items in the ADHD subscale with similar contents. We also

* p \ 0.05, ** p \ 0.01, *** p \ 0.001
0.11***

allowed for correlations between two victim sensitivity

items if only one justice sensitivity subscale was used in a
2

model. We were able to replicate the intended factor

structure of our measures as used in the mediation models
Depressive symptoms
Table 2 Intercorrelations

Conduct problems

in separate confirmatory factor analyses [hyperactivity:

Mean f injustice

v2(df = 4) = 14.22, p = 0.007, RMSEA = 0.045,

JS-perpetrator

f Perpetrator

Self-esteem
JS-observer

RS-anxious

SRMR = 0.017; justice sensitivity, victim and perpetrator:

f Observer
JS-victim

RS-angry
SDQ-HY

f Victim

v2(df = 27) = 181.90, p = 0.000, RMSEA = 0.068,

SRMR = 0.058; victim sensitivity: v2(df = 3) = 6.20,
Age

p = 0.103, RMSEA = 0.029, SRMR = 0.008; anxious

rejection sensitivity: v2(df = 9) = 21.68, p = 0.010,
10
11
12
13
14
1
2
3
4
5
6
7
8
9

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Eur Child Adolesc Psychiatry (2015) 24:185–198 193

Fig. 1 Direct and indirect

effects of ADHD symptoms on
conduct problems, depressive
symptoms, and self-esteem. All
models controlled for age and
gender (*p B 0.05; **p B 0.01;
***p B 0.001). a v2 = 794.84,
df = 329, p B 0.001,
N = 1,235, RMSEA = 0.032,
SRMR = 0.036, R2 = 0.622
total direct: b = 0.608***; total
indirect: b = 0.103***, JS-
victim: b = 0.025**, JS-
perpetrator: b = 0.033***, rs-
angry: b = 0.045**.
b v2 = 749.60, df = 253,
p B 0.001, N = 1,235,
RMSEA = 0.038,
SRMR = 0.039, R2 = 0.424
total direct: b = 0.269***; total
indirect: b = 0.163***, JS-
victim: b = 0.025**, JS-
perpetrator: b = 0.000, rs-
anxious: b = 0.138***
(measurement model as
displayed in Fig. 1a, factor
loadings rs-anxious as in
Fig. 1c). c v2 = 509.56,
df = 175, p B 0.001,
N = 1,235, RMSEA = 0.039,
SRMR = 0.040, R2 = 0.214
total direct: b = -0.249***;
total indirect: b = -0.081***,
JS-victim: b = -0.008, rs-
anxious: b = -0.073***

RMSEA = 0.034, SRMR = 0.020; angry rejection sensi- [v2(df = 767) = 1,545.77, p = 0.000, RMSEA = 0.029,
tivity: v2(df = 9) = 19.44, p = 0.022, RMSEA = 0.031, SRMR = 0.042], compared to the baseline model,
SRMR = 0.017; conduct problems: v2(df = 5) = 11.68, respectively. In each case, all indicators showed significant
p = 0.040, RMSEA = 0.033, SRMR = 0.018; self- loadings on their latent factors. We included gender and
esteem: v2(df = 1) = 0.74, p = 0.388, RMSEA = 0.000, age as intercorrelated control variables in the mediation
SRMR = 0.010; depression: not estimated in a separate models, regressed on mediators and outcomes, and allowed
model because the model is not identified due to only two for correlations with ADHD symptoms (not displayed in
indicators] and in a single CFA including all dependent and Fig. 1). We used a robust MLM estimator to account for
independent measures with correlated latent factors non-normally distributed data.

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194 Eur Child Adolesc Psychiatry (2015) 24:185–198

First, we investigated indirect effects in terms of the In line with hypothesis 4, victim sensitivity, perpetrator
association between ADHD symptoms and conduct prob- sensitivity, and rejection sensitivity had indirect effects on
lems. In separate latent path analyses, victim (b = 0.019*), the link between ADHD symptoms and conduct problems
perpetrator (b = 0.019**), and angry rejection sensitivity and depressive symptoms. Contrary to the hypothesis, the
(b = 0.058***) each had significant indirect effects on link between ADHD symptoms and low self-esteem was
conduct problems. We therefore included all three media- only mediated by rejection sensitivity.
tor variables into one model, allowing for correlations
between victim and perpetrator sensitivity and victim and
angry rejection sensitivity. The model explained 62.2 % of
the variance in conduct problems. There was a significant Discussion
direct effect of ADHD symptoms on conduct problems
(b = 0.608***) and a significant total indirect effect The present study examined the links between ADHD
(b = 0.103***). All three mediator variables significantly symptoms and justice sensitivity subscales and rejection
contributed to the total indirect effect (victim sensitivity: sensitivity in a large sample of children and adolescents.
b = 0.025**, perpetrator sensitivity: b = 0.033***, angry Previous research concentrated on adult samples and pro-
rejection sensitivity: b = 0.045**; v2(df = 329) = 794.84, duced somewhat unexpected findings. Therefore, the
p = 0.000, RMSEA = 0.034, SRMR = 0.038). present study investigated whether these previous findings
Second, we investigated indirect effects on the link could be transferred to children and adolescents. Beyond
between ADHD symptoms and depressive symptoms. In examining group differences between participants with
separate latent path analyses, victim (b = 0.042***), per- severe ADHD symptoms and controls, we also investigated
petrator (b = -0.013*), anxious (b = 0.156***) and angry the mediating role of the sensitivity constructs in a series of
rejection sensitivity (b = 0.089***) each had significant latent path analyses and considered their joint mediating
indirect effects on depressive symptoms. Due to high cor- influences on related internal and external problems. Thus,
relations between latent rejection sensitivity scales our study sought to contribute to the understanding of the
(r = 0.90), we only included anxious rejection sensitivity, emergence and maintenance of negative behavior patterns
victim sensitivity, and perpetrator sensitivity in a single path and related problems in children and adolescents with
analysis, allowing for correlations between all three media- ADHD symptoms from the perspective of personality
tor variables. The model explained 42.4 % of the variance in dispositions, thereby linking personality and clinical
depressive symptoms. There was a significant direct effect of psychology.
ADHD symptoms on depressive symptoms (b = 0.269***)
and a significant total indirect effect (b = 0.163***). Justice and rejection sensitivity in children
However, when all three mediator variables were included in and adolescents with ADHD symptoms
the model, only victim sensitivity (b = 0.025**) and anx-
ious rejection sensitivity (b = 0.138***) significantly con- In line with our predictions and partly contrary to previous
tributed to the indirect effect [v2(df = 253) = 749.60, research, children and adolescents with ADHD symptoms
p = 0.000, RMSEA = 0.040, SRMR = 0.040]. reported significantly higher victim sensitivity, more per-
Finally, we tested indirect effects on the link between ceptions of injustice as a victim, and higher anxious and
ADHD symptoms and low self-esteem. In separate latent angry rejection sensitivity, but significantly lower perpe-
path analyses, victim (b = -0.019*), angry rejection trator sensitivity than controls. No differences were found
(b = -0.064*), and anxious rejection sensitivity (b = in terms of observer sensitivity. Contrary to our expecta-
-0.093***) each showed significant indirect effects on self- tions, participants with ADHD symptoms also perceived
esteem. We included anxious rejection and victim sensitivity injustice as an observer and as a perpetrator more fre-
in one path analysis, allowing for correlations between the quently than controls.
two mediator variables. The model explained 23.5 % of the Our findings indicate that children and adolescents with
variance in self-esteem. There was a significant direct effect ADHD symptoms are particularly sensitive to experiences
of ADHD symptoms on self-esteem (b = -0.222***) and a of injustice and rejection as a victim. This is also demon-
significant total indirect effect (b = -0.093***). However, strated by lower thresholds of perceiving unjust situations
when both mediators were included in the model, only or of perceiving situations as unjust, as reflected by higher
anxious rejection sensitivity contributed significantly to ratings of perceptions of injustice from the victim’s per-
the indirect effect [b = -0.086***, victim sensitivity: spective. Higher victim sensitivity as well as higher anx-
b = -0.007; v2(df = 194) = 582.21, p = 0.000, RMSEA = ious and angry rejection sensitivity in these children and
0.040, SRMR = 0.040]. adolescents indicates that they show more intense reactions

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Eur Child Adolesc Psychiatry (2015) 24:185–198 195

to these unjust events by ruminating or by experiencing This suggests that the adverse effects of high victim and
negative emotions such as anger or anxiety. These negative rejection sensitivity are additive. In the present study,
cognitions and emotions are likely to cause additional rejection sensitivity generally showed stronger indirect
strain in children and adolescents with ADHD symptoms, effects than justice sensitivity. Anxious rejection sensitivity
thereby presumably further increasing their vulnerability. was evidently a better predictor of emotional or internal-
They should also show increased tendencies to retaliate izing problems, whereas angry rejection sensitivity
against perpetrators of injustice. Considering impulsive- appeared to be a better predictor of externalizing problems.
ness and difficulties in social behavior associated with Among the justice sensitivity scales, victim sensitivity
ADHD symptoms, our findings may help to explain the showed the most consistent and strongest indirect effects
link between ADHD and related problems. Indeed, both even when controlling for the effects of rejection sensi-
victim sensitivity and rejection sensitivity independently tivity on latent level, but perpetrator sensitivity indepen-
mediated the link between ADHD symptoms and related dently added to the indirect effect on conduct problems.
problems from a cross-sectional perspective, adding to the In contrast to previous research, but in line with our
negative effects of ADHD symptoms. Both higher victim assumptions, children and adolescents with ADHD symp-
sensitivity and higher rejection sensitivity predicted higher toms reported significantly lower perpetrator sensitivity
ratings of conduct problems and depression as well as than controls. These findings imply that these children and
lower ratings of self-esteem. adolescents generally perceive themselves to be the per-
Our findings are therefore in line with previous research petrator of injustice less frequently, and have lower ten-
linking ADHD to prevalent experiences of rejection, dis- dencies to respond to self-perpetrated injustice with
ruptive behavior, and emotional problems [9, 13, 16, 32, feelings of guilt and a cognitive preoccupation. They
44] and linking high victim sensitivity, low perpetrator should also show less prosocial behavior (e.g., compensate
sensitivity, and high rejection sensitivity to aggression, the victim) and less inhibition of antisocial behavior. When
conduct problems, and emotional problems [6, 7, 12, 29, considered in conjunction with victim sensitivity and
30, 40–42]. Furthermore, our results support the cognitive- anxious rejection sensitivity, perpetrator sensitivity did not
behavioral model of ADHD by Safren and colleagues [38], add to the prediction of depressive symptoms. It did,
which suggests that the link between ADHD and sub- however, show a negative indirect effect on conduct
sequent emotional problems is mediated by relationship problems over and above victim sensitivity and angry
problems and negative thoughts and beliefs. Our findings rejection sensitivity. In other words, high perpetrator sen-
suggest that victim sensitivity and rejection sensitivity may sitivity predicted low levels of conduct problems. Thus,
work to promote dysfunctional thoughts and beliefs and given its underlying prosocial motivation, high perpetrator
may further burden social relationships. This reasoning is sensitivity may work to buffer the adverse effects of high
also in line with assumptions of the social information victim and rejection sensitivity on conduct problems even
processing model, which explains the genesis and main- in persons with high levels of ADHD symptoms.
tenance of maladaptive, aggressive behavior [10]. The
authors postulate that individual characteristics, such as the Comparison with previous research
hostile attribution bias, promote aggressive behavior by
leading to negative (mis)interpretations of the situation and Although the findings of the present study are in line with our
negative attributions of others’ intentions. Our results theoretical considerations, they contradict previous research,
indicate that victim sensitivity and rejection sensitivity may which found higher justice sensitivity [39] and–––unex-
be accompanied by a hostile attribution bias, which has pectedly––did not find higher rejection sensitivity [8] in
also been described as a part of the suspicious mindset adults with ADHD as compared to controls. There are sev-
associated with victim sensitivity [18]. eral potential explanations for these differences:
Correlations between justice and rejection sensitivity First, they can be attributed to differences in sample
suggest a general vulnerability and disposition to intense ages. Although a variety of studies have yielded evidence
reactions to negative social experiences. In line with our of ADHD in adults, the diagnosis and relevant symptoms
hypothesis, however, justice and rejection sensitivity of ADHD in this age range remains controversial. Conse-
independently mediated the link between ADHD symp- quently, it might be difficult to compare adult ADHD
toms and related problems even when considered simul- samples with child and adolescent samples. Furthermore,
taneously. When testing our measurement model, we were the ability or the insight to apply heightened justice sen-
unable to create one single sensitivity measure from victim sitivity to compensate for a lack of social competencies as
and rejection sensitivity. Thus, the two measures appar- proposed by Schäfer and Kraneburg [39] may only be
ently account for distinct negative social cues and cannot acquired in adulthood. In this case, however, the question
be reduced to one single factor of interpersonal sensitivity. remains to be answered of whether this can be considered

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196 Eur Child Adolesc Psychiatry (2015) 24:185–198

to be a conscious process. Conceptualizing justice sensi- combination with self-reports on low perpetrator sensitivity,
tivity as an acquired strategy, that is, a mere consequence however, instead of merely reflecting a high sensitivity for
of ADHD symptoms, contradicts research findings that one’s own actions, these perceptions apparently reflect an
consider justice sensitivity to be a trait. Although research actually higher prevalence of self-perpetrated unjust
has provided evidence for changes in justice sensitivity behavior as compared to controls. These behaviors can be
with age and as a consequence of serious experiences of explained by comorbid conduct problems in participants
injustice, it is generally considered as a trait which is only with ADHD. Finally, reports of frequent perceptions of
prone to gradual change [2, 40] and which is formed early injustice or rejection by persons with ADHD symptoms may
in life [6]. It therefore seems more likely that existing also not only reflect a particularly high sensitivity to these
differences in justice sensitivity become somewhat more cues, but an actually higher frequency of such events in the
pronounced due to experiences of injustice and rejection lives of persons with ADHD symptoms due to their prob-
following from ADHD symptoms. Moreover, findings by lems in social relationships.
Schäfer and Kraneburg [39] indicate that heightened justice Fourth, differences between the findings in adult sam-
sensitivity is primarily shown by adults who predominantly ples and in the present sample may be explained by other
or only show attention-deficit symptoms. These persons, variables. For example, even if justice sensitivity serves to
however, are not primarily characterized by social prob- compensate for a lack of social competencies, it may not
lems (not even in childhood). Thus, high justice sensitivity necessarily lead to prosocial behavior due to further
in adults with attention-deficit symptoms may not consti- problems in persons with ADHD (e.g., lack of impulse
tute a compensation strategy, but rather reflect a strong control). Instead, it might constitute a verbal strategy that
distractibility by social cues in general. only signals the understanding of social norms on a theo-
Second, differences between our results and previous retical level. This strategy may be more pronounced in
findings may be explained by methodological differences: adults than in children and adolescents due to higher verbal
Schäfer and Kraneburg [39] reported low correlations competencies. The finding that participants with ADHD
between questionnaire and experimental measures of jus- symptoms in our sample did perceive injustice more fre-
tice sensitivity, whereas the present study only employed quently than controls, also from the observer perspective,
questionnaire data. Thus, experimental data might yield may support this interpretation.
different results regarding the link between justice sensi-
tivity and ADHD symptoms in children and adolescents. Practical implications
In addition, Canu and Carlsson [8] had also expected to
find higher rejection sensitivity in an adult sample. Indeed, Therapy in children and adolescents with ADHD often
they also found that persons with ADHD showed some- concentrates on behavioral interventions primarily designed
what higher rejection sensitivity ratings than controls, but to strengthen impulse control and attention. The findings of
the differences were not significant. Thus, the present study the present study imply that persons with ADHD may also
may merely have had higher power to identify significant benefit from cognitive interventions and cognitive restruc-
differences, also given small effect sizes. turing. For example, these interventions may train persons
Third, differences between present findings and anecdotal with ADHD symptoms to think of alternative explanations
evidence of high justice sensitivity in persons with ADHD for people’s alleged negative behavior other than their being
may be attributed to amateurish definitions of justice sen- unjust, rejecting, or even mean. They should also be taught
sitivity. In daily life, people are likely to be considered about how their own behavior might contribute to others’
justice-sensitive if they frequently perceive injustice and are unfavorable reactions. These two steps may work together to
sensitive to injustice to their own disadvantage, that is, if reduce the number of occasions that promote impulsive or
they are victim-sensitive. Indeed, children and adolescents even disruptive reactions in such individuals. Safren et al.
with ADHD symptoms in our sample showed high victim [38] pointed out that negative thoughts and beliefs may
sensitivity and reported more frequent perceptions of promote comorbid problems in adults with ADHD. Our
injustice from different perspectives. Furthermore, high results indicate that these assumptions can also be trans-
victim sensitivity was positively correlated with frequent ferred to younger age groups. According to the present
perceptions of injustice from all perspectives. Taken toge- findings, cognitive interventions should be particularly use-
ther, laypersons may consider persons with ADHD symp- ful in children and adolescents with comorbid conduct
toms to be highly justice-sensitive because they are highly problems, because these problems accounted for group dif-
victim-sensitive. This assumption is supported by a further ferences in perpetrator justice sensitivity as well as in the
finding of the present study: High ratings of perceptions of frequency of the perception of self-perpetrated injustice.
injustice as a perpetrator may generally be interpreted as Comorbid conduct problems, however, did not account for
reflecting a high sensitivity to causing injustice to others. In differences in victim sensitivity, the perceived frequency of

123
Eur Child Adolesc Psychiatry (2015) 24:185–198 197

injustice, and rejection sensitivity. Therefore, a stronger primary interest of the present article was to investigate the
consideration of cognitive factors and cognitive restructur- potential role of justice and rejection sensitivity as risk factors
ing also seems important in children and adolescents with for emotional or behavioral problems in persons with ADHD
mere ADHD symptoms. symptoms. Nevertheless, future longitudinal studies might be
interested in the two sensitivity constructs as consequences of
Limitations and outlook these problems or mutual influences.
Despite these limitations, the present study provides first
Our study has several strengths, including the large sample information on the link between justice and rejection sen-
size as well as the simultaneous consideration of justice and sitivity and ADHD symptoms in a large sample of children
rejection sensitivity and of several additional problems fre- and adolescents, thereby linking personality psychology
quently associated with ADHD. Nevertheless, there are some and clinical psychology. Our findings help to explain some
limitations to our study that require discussion. These include symptoms that are often associated with ADHD symptoms
the marginally acceptable internal consistencies of some of as well as their relation with subsequent problems. Because
our measures, although these are less serious in latent anal- our findings pertain to latent variables, they allow for
yses, which do not require item correlations. Due to time estimates of direct and indirect effects that are free from
constraints, we did not employ the beneficiary justice sensi- measurement error. Our findings thus add to explaining the
tivity subscale in our study. Due to the unexpected divergent link between ADHD symptoms and comorbid emotional
correlation patterns in observer and perpetrator sensitivity in and behavior problems. They may also provide some
the present study, the scale might be of particular interest for starting points for future interventions in persons with
future studies in children and adolescents. Although the large ADHD. Finally, the findings of the present study further
sample size is an advantage of our study, it also works to support the notion that justice and rejection sensitivity
detect statistical significance more easily. Thus, it should be might constitute risk factors for different emotional and
taken into account that some of the effects were small when behavioral problems in childhood and adolescence.
interpreting the study results.
The prevalence of ADHD in our study was similar to Acknowledgments This research was funded by a German
Research Foundation (Deutsche Forschungsgemeinschaft) Grant (No.
previous studies. However, we were only able to screen for GRK 1668/1-583855).
ADHD symptoms. Future studies should use more detailed
measures of ADHD symptoms, which would also allow for a Conflict of interest There are no conflicts of interest.
clearer distinction between participants with mere attention-
deficit and additional hyperactivity symptoms. This would
enable differences in justice sensitivity in the two ADHD References
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