Social Skills Training for ADHD in Children

Summary

A Cochrane review [Abstract] 1 included 25 studies with a total of 2690 children with ADHD (between 5 and 17 years of age). Most of the trials compared child social skills training and parent training plus medication versus medication alone. The duration of the interventions ranged from 8 to 10 weeks (8 studies) up to 2 years. The types of social skills interventions were named 1) social skills training, 2) cognitive behavioural therapy, 3) multimodal behavioural/psychosocial therapy, 4) child life and attention skills treatment, 5) life skills training, 6) the "challenging horizon programme", 7) verbal self-instruction, 8)meta-cognitive training, 9) behavioural therapy, 10) behavioural and social skills treatment, and 11) psychosocial treatment.

The duration of the interventions ranged from 5 weeks to 2 years. Most of the trials compared child social skills training or parent training combined with medication vs. medication alone. Some of the experimental interventions also included teacher consultations. There was no clinically relevant treatment effect of social skills interventions on the primary outcome measures: teacher-rated social skills at end of treatment (SMD 0.11, 95% CI 0.00 to 0.22; 11 trials, n=1271); teacher-rated emotional competencies at end of treatment (SMD −0.02, 95% CI −0.72 to 0.68; two trials, n=129); or on teacher‐rated general behaviour (SMD −0.06 (negative value better), 95% CI −0.19 to 0.06; 8 trials, n=1002). The effect on the primary outcome, teacher-rated social skills at end of treatment, corresponds to a MD of 1.22 points on the social skills rating system (SSRS) scale (95% CI 0.09 to 2.36). The minimal clinical relevant difference (10%) on the SSRS is 10.0 points (range 0 to 102 points on SSRS). There was evidence in favour of social skills training on teacher-rated core ADHD symptoms at end of treatment for all eligible trials (SMD −0.26, 95% CI −0.47 to −0.05; 14 trials, n=1379 participants).

Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment and lack of blinding), by inconsistency (heterogeneity in interventions, measurements and controls), and by imprecise results (few patients in trials).