Social Skills Training

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Key points

  • Social impairment among youth with attention-deficit/hyperactivity disorder (ADHD) is common, and often persists after administration of interventions documented to reduce the core symptoms of the disorder (eg, medication, behavioral contingency management).

  • Traditional SST is an intervention intended to target social impairment, which focuses on increasing children’s knowledge of skilled behaviors and in-session practice. However, traditional SST approaches may have difficulty with encouraging

Introduction/Background

Although social problems are not part of the diagnostic criteria of attention-deficit/hyperactivity disorder (ADHD), impairment in social functioning is a prominent associated feature of this condition.1 Social impairment can be displayed in multiple ways,2 but a common manifestation is the poor, unskilled behaviors that children with ADHD display in social situations.3, 4 Specifically, children with ADHD are likely to engage in aggressive and disruptive behaviors with peers, such as intruding

Social skills training interventions

Social skills training (SST) has proliferated in the past 2 decades to address the prevalent social impairment among children with ADHD,15, 16 although it also has been used to treat children who have social problems but do not have ADHD.17 The traditional form of SST is based on the logic that children lack the core skills to enact prosocial, positive behaviors, and therefore they resort to displaying disruptive, offensive behaviors in peer situations. According to the theory behind SST, the

Most Likely Responders

SST, even as traditionally provided in clinics, may be more efficacious for populations of children with internalizing problems or social withdrawal relative to those with disruptive behavior problems, such as ADHD.17, 47, 48 Among children with ADHD, it is possible that those who have socially withdrawn behaviors and/or comorbid anxiety may be more responsive than children with ADHD alone to psychosocial treatment in general, which would potentially include SST.49, 50, 51

As well, children with

Summary and future directions

Social problems are a persistent and treatment-refractory area of impairment for children with ADHD. Currently there is no SST intervention that normalizes the social functioning of children with ADHD, even if the intervention is associated with improvement. As such, there remains a clear and persistent need for better interventions for social problems in this population. Because nearly all existing SST approaches focus on changing the problem behaviors of children with ADHD, an exciting future

Recommendations for clinicians

  • Clinicians working with ADHD populations should be certain to assess social impairment. Even though parents may not bring it directly to clinicians’ attention, particularly when children are young, social impairment is important to ask about (and treat) because it tends to persist and augment emotional/behavioral maladjustment over time.

  • Clinicians should not assume that treating the core symptoms of ADHD will naturally be sufficient to remediate social impairment. Rather, if clinicians adopt a

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    None of the authors has any conflict of interest to disclose.

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