The Characteristics Of Social Functioning And Their Intervention On Children With Attention Deficit Hyperactivity Disorder

Part 1 The Characteristics and Influencing Factors ofSocial Functioning in Children with ADHDObjectives: To explore the characteristics of social function in children with attention deficit hyperactivity disorder(ADHD)with different age gender and subtypes,finding out the factors influencing the social function of children with ADHD.Methods: Children were selected in the pediatric department of Shanghai mental health center and met the diagnostic criteria for ADHD in DSM-5 from August 2018 to August 2019.Children from a primary school in Pudong district of Shanghai were randomly selected as healthy control group.The demographic information of the ADHD children was collected after informed consent.Weiss Functional Impairment Scale-Parent form(WFIRS-P),Strengths and Difficulties Questionnaire(SDQ),Friendship Quality Questionnaire(FQQ)and Social Skills Rating of Pupils(SSRP)were used to evaluate the social function,peer problems,friendship quality and social skills of the two groups respectively.The data of ADHD children also compared and analyzed with the healthy control group to explore the characteristics of social function of the ADHD children as well as the differences of social function between ADHD children with different age,gender and subtypes.This study used SNAP-Ⅳ,Piers-Harris Children’s Self-consciousness Scale(PHCSS)and some tests,including Stroop Color Word Association test(SCWT),the Wisconsin card sorting test(WCST),the Behavior Rating Inventory of Executive Function(BRIEF),and memorizing numbers and decoding to assess the severity of clinical symptoms,selfawareness and executive function in children with ADHD respectively.Correlation analysis and regression analysis were used to explore the relationship between all these factors and social function.Results: ADHD children scored significantly higher on social activities in WFIRS-P,peer problems in SDQ,conflict and betrayal in FQQ than healthy children(P<0.05).Other factors and total score of FQQ as well as all dimensions and total score of the SSRP were significantly lower than those of healthy children(P<0.05).There were significant differences in the quality of friendship among ADHD children of different ages(P<0.05).Children aged 11～12 had more problems with their peers and poorer quality of friendship.There were statistically significant differences in score of emotion control and presentation skills in SSRP among ADHD children with different gender(P<0.05),and the score of ADHD boys were significantly lower than those of ADHD girls.There were significant differences in the score of group prestige in SSRP among different subtypes(P<0.05),and the attention deficit type was significantly lower than the hyperactive type(P<0.05).The results of regression analysis showed that the communicative intention factor in SSRP was a protective factor for children’s social function,while the oppositional defiant behavior and poor ability of shifting,monitoring as well as inhibition were the risk factors for social function.Factors with significant positive correlation with social activities include:inattention(r=0.50,P<0.01),hyperactivity and impulsivity(r=0.23,P<0.01)and oppositional defiant behavior in SNAP-Ⅳ.The number of persistent errors in WCST(r=0.39,P<0.01).Inhibition(r=0.53,P<0.01),shifting(r=0.46,P<0.01),emotional control(r=0.48,P<0.01),initiative(r =0.35,P<0.01),working memory(r=0.20,P<0.05),planning/organizing(r = 0.28,P< 0.05)organization of materials(r=0.24,P<0.01)monitoring(r =0.47,P<0.01)in BRIEF.Significantly negative correlation with social activity factors are: the communicative intention(r=-0.39,P<0.01),presentation skills(r=-0.17,P<0.05),emotional sensitivity(r=-0.25,P< 0.01),emotional control(r=-0.26,P<0.01)communication skills(r=-0.28,P<0.01)in SSRP and the total score of SSRP(r=-0.27,P<0.01).Intelligence and school situation(r=-0.17,P<0.05),gregariousness in PHSCC(r=-0.17,P<0.05)and the total score of PHSCC(r=-0.17,P<0.05).Conceptualization level(r =-0.21,P< 0.05)and the number of persistent response of WCST(r=-0.17,P<0.05),total time of Stroop b(r=-0.22,P<0.05).Conclusions: ADHD children have social dysfunction,as children with ADHD get older,their have more peers problems and poorer friendship quality.Different gender and subtypes have similar levels of impaired social function,but there are differences in the performance of social skills.The deficiency of social function of ADHD children is influenced by their communicative intention,oppositional defiant behavior as well as the ability of shifting,monitoring,inhibition.Part 2 Effect of Social Functioning Intervention on Children with ADHDObjectives: To verify the effect of PEERS(Program for the Education & Enrichment of Relational Skills)social skills training on social function intervention of ADHD children.Methods: The content of PEERS social skills training has been adjusted according to the characteristics of Chinese culture,experience of clinical work for ADHD and feedback of pre-experiment.The program was firstly discussed and preliminarily modified at the research group meeting,and then the framework of training program was determined after experts discussion.The PEERS Social Skills Training Manual in ADHD was finally formed.Children with ADHD were randomly divided into PEERS social skills training group and drug group.The children and their parents of PEERS group receive 60~90 minutes social skills training at the same time every week for 10 times.The topics of PEERS include exchange of information,two-way communication,how to use electronic devices to make friends,select appropriate friends,and use humor appropriately,strategies for exiting social conversations,good sportsmanship in games or sports,organize and attend parties,deal with peer conflicts,bad reputations and rumors.Children in the drug group receive medication for 10 weeks.Both groups were assessed at baseline and after 10 weeks of intervention.The assessment included demographic information,SNAP-IV,Weiss Functional Impairment Scale-Parent form(WFIRS-P),Strengths and Difficulties Questionnaire(SDQ),Friendship Quality Questionnaire(FQQ),Social Skills Rating of Pupils(SSRP)and Wechsler Intelligence Scale for Children-Fourth Edition(WISC-IV).Results: A total of 23 ADHD were enrolled in the PEERS group and 23 in the drug group.Compared with baseline,the score of children in PEERS on family function,self-concept and risk-taking behavior in WFIRS-P significantly decreased after training(P<0.05).The score of help and guidance,conflict and resolution strategy,and total score of FQQ of children in PEERS group were significantly improved after training as well as the score of communication intention and emotion control in SSRP(P<0.05).After 10 weeks of intervention,there was significant interaction effect between time and group on help and guidance(F=4.695,P<0.05)and conflict resolution strategy in FQQ(F=5.940,P<0.05),the total score of FQQ(F=5.806,P<0.05)and communication intention in SSRP(F=9.165,P<0.01).Through simple effect analysis,no significant difference was found in the drug group before and after study time,but PEERS group had significant differences(P<0.01).Conclusions: PEERS social skills training has a certain improvement effect on the social function of children with ADHD,and can be applied to the intervention of children with ADHD,which has clinical significance.