Purpose of Review
Many children and adolescents with attention-deficit/hyperactivity disorder (ADHD) have difficulties in their social skills and peer relationships. Because social problems exacerbate later maladjustment in ADHD populations, it is important to address this serious impairment. Although social skills training (SST) is a common intervention approach, evidence to date suggests that SST has limited efficacy, at least when provided in traditional, clinic-based settings. The current review summarizes recent advances to traditional SST approaches that may potentially enhance their efficacy.
We identify two promising directions in which SST may be modified to make it more efficacious for ADHD populations. The first direction involves providing increased reinforcement and reminders of appropriate social behavior at the point of performance to youth with ADHD (e.g., in vivo, in real life peer situations as opposed to in the clinic). We note the importance of ensuring that youth with ADHD are receptive to such reminders. The second direction involves encouraging peers to be more socially accepting and inclusive of youth with ADHD. This avenue has been understudied in the literature to date.
SST for children and adolescents with ADHD may be enhanced by providing more in vivo reminders and feedback at the point of performance and by making efforts to alter peers’ impressions about youth with ADHD.
This is a preview of subscription content,to check access.
Access this article
Similar content being viewed by others
Papers of particular interest, published recently, have been highlighted as: • Of importance
Hoza B, Mrug S, Gerdes AC, Hinshaw SP, Bukowski WM, Gold JA, et al. What aspects of peer relationships are impaired in children with attention-deficit/hyperactivity disorder? J Consult Clin Psychol. 2005;73(3):411–23. https://doi.org/10.1037/0022-006x.73.3.411.
Gardner DM, Gerdes AC. A review of peer relationships and friendships in youth with ADHD. J Atten Disord. 2015;19(10):844–55. https://doi.org/10.1177/1087054713501552.
Normand S, Schneider BH, Lee MD, Maisonneuve M-F, Chupetlovska-Anastasova A, Kuehn SM, et al. Continuities and changes in the friendships of children with and without ADHD: a longitudinal, observational study. J Abnorm Child Psychol. 2013;41(7):1161–75. https://doi.org/10.1007/s10802-013-9753-9.
Canu WH, Tabor LS, Michael KD, Bazzini DG, Elmore AL. Young adult romantic couples’ conflict resolution and satisfaction varies with partner’s attention–deficit/hyperactivity disorder type. J Marital Fam Ther. 2014;40(4):509–24. https://doi.org/10.1111/jmft.12018.
Mikami AY, Hinshaw SP, Patterson KA, Lee JC. Eating pathology among adolescent girls with attention-deficit/hyperactivity disorder. J Abnorm Psychol. 2008;117(1):225–35. https://doi.org/10.1037/0021-843x.117.1.225.
Greene RW, Biederman J, Faraone SV, Sienna M, Garcia-Jetton J. Adolescent outcome of boys with attention-deficit/hyperactivity disorder and social disability: results from a 4-year longitudinal follow-up study. J Consult Clin Psychol. 1997;65(5):758–67. https://doi.org/10.1037/0022-006x.65.5.758.
• Evans SW, Owens JS, Bunford N. Evidence-based psychosocial treatments for children and adolescents with attention-deficit/hyperactivity disorder. J Clin Child Adolesc Psychol. 2014;43(4):527–51. https://doi.org/10.1080/15374416.2013.850700. This paper provides a review of evidence-based psychosocial treatments for youth with ADHD and highlights limitations of current approaches for peer-related issues
Becker KD, Chorpita BF, Daleiden EL. Improvement in symptoms versus functioning: how do our best treatments measure up? Adm Policy Ment Health Ment Health Serv Res. 2011;38(6):440–58.
Ronk MJ, Hund AM, Landau S. Assessment of social competence of boys with attention-deficit/hyperactivity disorder: problematic peer entry, host responses, and evaluations. J Abnorm Child Psychol. 2011;39(6):829–40. https://doi.org/10.1007/s10802-011-9497-3.
Mikami AY, Jia M, Na JJ. Social skills training. Child Adolesc Psychiatr Clin N Am. 2014;23(4):775–88.
Gresham FM, Cook CR, Crews SD, Kern L. Social skills training for children and youth with emotional and behavioral disorders: validity considerations and future directions. Behav Disord. 2004;30(1):32–46.
Gresham FM, Elliott SN. Social skills improvement system-rating scales. Minneapolis: Pearson Assessments; 2008.
Antshel KM, Polacek C, McMahon M, Dygert K, Spenceley L, Dygert L, et al. Comorbid ADHD and anxiety affect social skills group intervention treatment efficacy in children with autism spectrum disorders. J Dev Behav Pediatr. 2011;32(6):439–46.
Pelham WE, Fabiano GA. Evidence-based psychosocial treatments for attention-deficit/hyperactivity disorder. J Clin Child Adolesc Psychol. 2008;37(1):184–214. https://doi.org/10.1080/15374410701818681.
de Boo GM, Prins PJM. Social incompetence in children with ADHD: possible moderators and mediators in social-skills training. Clin Psychol Rev. 2007;27(1):78–97. https://doi.org/10.1016/j.cpr.2006.03.006.
• Mikami AY, Normand S. The importance of social contextual factors in peer relationships of children with ADHD. Curr Dev Disord Rep. 2015;2(1):30–7. This paper emphasizes the importance of social contextual factors that contribute to the peer difficulties children with ADHD experience and suggests that interventions consider this context in order to increase efficacy
Barkley RA. Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychol Bull. 1997;121(1):65–94. https://doi.org/10.1037/0033-2909.121.1.65.
Abikoff HB. ADHD psychosocial treatments: generalization reconsidered. J Atten Disord. 2009;13(3):207–10. https://doi.org/10.1177/1087054709333385.
Mikami AY, Lerner MD, Lun J. Social context influences on children’s rejection by their peers. Child Dev Perspect. 2010;4(2):123–30. https://doi.org/10.1111/j.1750-8606.2010.00130.x.
Mrug S, Hoza B. Impression formation and modifiability: testing a theoretical model. Merrill-Palmer Q: J Dev Psychol;Merrill-Palmer Q: J Dev Psychol. 2007;53(4):631–59. https://doi.org/10.1353/mpq.2008.0004.
Harris MJ, Milich R, McAninch CB. When stigma becomes self-fulfilling prophecy: expectancy effects and the causes, consequences, and treatment of peer rejection. In: Brophy J, editor. Advances in research on teaching. Greenwich: JAI Press; 1998. p. 243–72.
Fabiano GA, Schatz NK, Pelham WE Jr. Summer treatment programs for youth with ADHD. Child Adolesc Psychiatr Clin N Am. 2014;23(4):757–73. https://doi.org/10.1016/j.chc.2014.05.012.
Mikami AY, Griggs MS, Lerner MD, Emeh CC, Reuland MM, Jack A, et al. A randomized trial of a classroom intervention to increase peers’ social inclusion of children with attention-deficit/hyperactivity disorder. J Consult Clin Psychol. 2013;81(1):100–12. https://doi.org/10.1037/a0029654.
Gregus SJ, Craig JT, Rodriguez JH, Pastrana FA, Cavell TA. Lunch buddy mentoring for children victimized by peers: two pilot studies. J Appl Sch Psychol. 2015;31(2):167–97.
Pfiffner LJ, Hinshaw SP, Owens E, Zalecki C, Kaiser NM, Villodas M, et al. A two-site randomized clinical trial of integrated psychosocial treatment for ADHD-inattentive type. J Consult Clin Psychol. 2014;82(6):1115.
Frankel F, Whitham C. Parent-assisted group treatment for friendship problems of children with autism spectrum disorders. Brain Res. 2011;1380:240–5.
Mikami AY, Lerner MD, Griggs MS, McGrath A, Calhoun CD. Parental influence on children with attention-deficit/hyperactivity disorder: II. Results of a pilot intervention training parents as friendship coaches for children. J Abnorm Child Psychol. 2010;38(6):737–49. https://doi.org/10.1007/s10802-010-9403-4.
Vilardo BA, DuPaul GJ, Kern L, Hojnoski RL. Cross-age peer coaching: enhancing the peer interactions of children exhibiting symptoms of ADHD. Child Fam Behav Ther. 2013;35(1):63–81.
Plumer PJ, Stoner G. The relative effects of classwide peer tutoring and peer coaching on the positive social behaviors of children with ADHD. J Atten Disord. 2005;9(1):290–300.
• Pelham WE, Burrows-MacLean L, Gnagy EM, Fabiano GA, Coles EK, Wymbs BT, et al. A dose-ranging study of behavioral and pharmacological treatment in social settings for children with ADHD. J Abnorm Child Psychol. 2014;42(6):1019–31. Although the Summer Treatment Program has existed for a long time, this study affirms the importance of providing treatment in the child’s social environment and the inclusion of point of performance reminders
Pelham WE, Wheeler T, Chronis A. Empirically supported psychosocial treatments for attention deficit hyperactivity disorder. J Clin Child Psychol. 1998;27(2):190–205. https://doi.org/10.1207/s15374424jccp2702_6.
O’Connor BC, Fabiano GA, Waschbusch DA, Belin PJ, Gnagy EM, Pelham WE, et al. Effects of a summer treatment program on functional sports outcomes in young children with ADHD. J Abnorm Child Psychol. 2014;42(6):1005–17.
Sibley MH, Pelham WE Jr, Mazur A, Gnagy EM, Ross JM, Kuriyan AB. The effect of video feedback on the social behavior of an adolescent with ADHD. J Atten Disord. 2012;16(7):579–88.
Graziano PA, Slavec J, Hart K, Garcia A, Pelham WE Jr. Improving school readiness in preschoolers with behavior problems: results from a summer treatment program. J Psychopathol Behav Assess. 2014;36(4):555–69.
Sibley MH, Pelham WE, Evans SW, Gnagy EM, Ross JM, Greiner AR. An evaluation of a summer treatment program for adolescents with ADHD. Cogn Behav Pract. 2011;18(4):530–44. https://doi.org/10.1016/j.cbpra.2010.09.002.
Carlson CL, Mann M. Attention-deficit/hyperactivity disorder, predominately inattentive subtype. Child Adolesc Psychiatr Clin North Am;Child Adolesc Psychiatr Clin N Am. 2000;9(3):499–510.
• Pfiffner LJ, Rooney M, Haack L, Villodas M, Delucchi K, McBurnett K. A randomized controlled trial of a school-implemented school–home intervention for attention-deficit/hyperactivity disorder symptoms and impairment. J Am Acad Child Adolesc Psychiatry. 2016;55(9):762–70. This study provides an example of how an integrated program that involves teachers and parents to ensure a constant presence for children with ADHD during peer interactions can lead to improvements in social skills
Frankel F, Myatt R, Feinberg D. Parent-assisted friendship training for children with autism spectrum disorders: effects of psychotropic medication. Child Psychiatry Hum Dev. 2007;37(4):337–46.
Frankel F, Myatt R, Cantwell DP, Feinberg DT. Parent-assisted transfer of children’s social skills training: effects on children with and without attention-deficit hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 1997;36(8):1056–64. https://doi.org/10.1097/00004583-199708000-00013.
Gardner DM, Gerdes AC, Weinberger K. Examination of a parent-assisted, friendship-building program for adolescents with ADHD. J Atten Disord. 2015:1087054715588188. doi:https://doi.org/10.1177/1087054715588188.
Mikami AY. The importance of friendship for youth with attention-deficit/hyperactivity disorder. Clin Child Fam Psychol Rev. 2010;13(2):181–98. https://doi.org/10.1007/s10567-010-0067-y.
Mikami AY, Jack A, Emeh CC, Stephens HF. Parental influence on children with attention-deficit/hyperactivity disorder: I. Relationships between parent behaviors and child peer status. J Abnorm Child Psychol. 2010;38(6):721–36. https://doi.org/10.1007/s10802-010-9393-2.
Wiener J, Mak M. Peer victimization in children with attention-deficit/hyperactivity disorder. Psychol Sch. 2009;46(2):116–31. https://doi.org/10.1002/pits.20358.
Craig JT, Gregus SJ, Burton A, Rodriguez JH, Blue M, Faith MA, et al. Exploring change processes in school-based mentoring for bullied children. J Prim Prev. 2016;37(1):1–9.
Kaya C, Blake J, Chan F. Peer-mediated interventions with elementary and secondary school students with emotional and behavioural disorders: a literature review. J Res Spec Educ Needs. 2015;15(2):120–9.
Watkins L, O’Reilly M, Kuhn M, Gevarter C, Lancioni GE, Sigafoos J, et al. A review of peer-mediated social interaction interventions for students with autism in inclusive settings. J Autism Dev Disord. 2015;45(4):1070–83.
Owens J, Goldfine M, Evangelista N, Hoza B, Kaiser N. A critical review of self-perceptions and the positive illusory bias in children with ADHD. Clin Child Fam Psychol Rev. 2007;10(4):335–51. https://doi.org/10.1007/s10567-007-0027-3.
Mikami AY, Calhoun CD, Abikoff HB. Positive illusory bias and response to behavioral treatment among children with attention-deficit/hyperactivity disorder. J Clin Child Adolesc Psychol. 2010;39(3):373–85. https://doi.org/10.1080/15374411003691735.
Jia M, Jiang Y, Mikami AY. Positively biased self-perceptions in children with ADHD: unique predictor of future maladjustment. J Abnorm Child Psychol. 2016;44(3):575–86. https://doi.org/10.1007/s10802-015-0056-1.
Gregson KD, Erath SA, Pettit GS, Tu KM. Are they listening? Parental social coaching and parenting emotional climate predict adolescent receptivity. J Res Adolesc. 2016;26(4):738–52. https://doi.org/10.1111/jora.12222.
De Laet S, Doumen S, Vervoort E, Colpin H, Van Leeuwen K, Goossens L, et al. Transactional links between teacher–child relationship quality and perceived versus sociometric popularity: a three wave longitudinal study. Child Dev. 2014;85(4):1647–62.
Mikami AY, Griggs MS, Reuland MM, Gregory A. Teacher practices as predictors of children’s classroom social preference. J Sch Psychol. 2012;50(1):95–111. https://doi.org/10.1016/j.jsp.2011.08.002.
Mikami AY, Reuland MM, Griggs MS, Jia M. Collateral effects of a peer relationship intervention for children with ADHD on typically developing classmates. Sch Psychol Rev. 2013;42(4):458–76.
• Mikami AY, Mercer SH. Teacher behaviors toward children with attention-deficit/hyperactivity disorder predict peers’ initial liking and disliking impressions in a summer camp setting. J Soc Clin Psychol. 2017;36(6):506–34. In this study of a classroom intervention, teacher practices that address peers’ reputational bias of children with ADHD are highlighted as beneficial for peer relationships
• Pryce J, Giovannetti S, Spencer R, Elledge LC, Gowdy G, Whitley ML, et al. Mentoring in the social context: mentors’ experiences with mentees’ peers in a site-based program. Child Youth Serv Rev. 2015;56:185–92. This study illustrates that mentoring programs may not only allow for in vivo reminders of social skills for children with ADHD, but also be a way to address peers’ reputational bias
Conflict of Interest
Amori Yee Mikami reports grants from Michael Smith Foundation for Health Research, Canadian Institutes of Health Research, and Institute of Education Sciences. Sophie Smit and Adri Khalis each declare no potential conflicts of interest.
Human and Animal Rights and Informed Consent
All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines.
This article is part of the Topical Collection on Attention-Deficit Disorder
About this article
Cite this article
Mikami, A.Y., Smit, S. & Khalis, A. Social Skills Training and ADHD—What Works?. Curr Psychiatry Rep 19, 93 (2017). https://doi.org/10.1007/s11920-017-0850-2