Does Social Skills Training Benefit Children with ADHD?

00:00 Introduction and Brief History of Social Skills Training Research
00:42 Discussion of 2018 meta-analysis of research on social skills
01:50 Review of results of a subsequent 2019 meta-analysis
02:42 Results of a 2020 meta-analysis of social sills interventions for ADHD children and teens
06:05 Results of a 2018 meta-analysis focusing on interventions that used peers as part of the social skills training programs
09:08 Why don’t social skills training programs for ADHD children and youth work very well, if at all - Results of a study showing that the social difficulties do not arise from a skill deficit but from performance problems
10:54 Brief discussion of Amori Mikima’s new approach to social interventions for ADHD - Parent Friendship Coaching - it is based on the premise that ADHD is a performance disorder not a knowledge or skill disorder
12:32 Conclusion
This video addresses the important question of how effective social skills training is for improving the social relationship problems so commonly seen in children and teens with ADHD. It discusses the results of 4 different and recent meta-analyses of the research which yield rather discouraging results for this domain of impairment in ADHD. I then discuss the relatively more recent social intervention program by Amori Mikami that is based on the executive functioning theory of ADHD and that it is more of a performance than skill acquisition problem for those with ADHD. That approach, known as Parent Friendship Coaching, does seem to have some evidence for effectiveness.
References
Storebo, O. J. et al. (2018). Social skills training for attention deficit hyperactivity disorder (ADHD) in children aged 5 to 18 years. Cochrane Database of Systematic Reviews, doi.org/10.1002/14651858.CD00...
Morris, S. et al. (2019). Interventions for Adolescents With ADHD to Improve Peer Social Functioning: A Systematic Review and Meta-Analysis. Journal of Attention Disorders, 25(10). doi.org/10.1177/1087054720906514
Powell, L. A. et al. (2020). Psychoeducation Intervention Effectiveness to Improve Social Skills in Young People with ADHD: A Meta-Analysis. Journal of Attention Disorders, 26(3). doi.org/10.1177/1087054721997553
Cordler, R. et al. (2018). Peer Inclusion in Interventions for Children with ADHD: A Systematic Review and Meta-Analysis. Biomed Research International. doi.org/10.1155/2018/7693479
Aduen, P. et al. (2018). Social Problems in ADHD: Is it a Skills Acquisition or Performance Problem? Journal of Psychopathology and Behavioral Assessment, 40, pp. 440-451. link.springer.com/article/10....

[@llareia]

You are 100% right at least in the case of my daughter. She knows all the zones of regulation and her toolkit by heart but she just can't apply that knowledge in the moment because she gets so peaked in the moment that she doesn't even want to use it. Her OT is working toward a performance-based approach, but I'll be ordering this book for at home because it sounds perfect!

[@IntricateRhetoric]

I think that sentiment is related to a broader idea Dr Barkley has discussed, about changing the 'moments of execution' of many difficult skills. It can have much greater effects than focusing on training those skills in an environment that doesn't feature the challenges that are preventing proper skill execution. I've used this idea on myself a great deal (ADHD diagnosed) - but also found myself, unthinkingly, using this in my parenting. It's been very helpful, letting me give the *right guidance* when it's most helpful. I hope you and your daughter have a lot of success with the approach!

[@aybikeanacali8414]

Can you please make a video about how to protect ADHD children from bullying and how to deal with it when it happened? Many adhd children are victims of bullying and teachers and parents dont know how to deal with it. When you tell it to your parents, they talk to parents of the bully and they punish their kid but it only makes it worse because now there is revenge.

[@Queenread82]

i wasn't expecting to tear up watching one of your videos but I did. I was so lonely. So heartbreakingly lonely. I couldn't understand why I didn't fit in. I didn't understand why I couldn't keep friends. I did have friends in high school but we were all probably undiagnosed neurodiverse drama and art freaks. We all wandered off after HS and didn't keep in touch so there I was again, trying to fit in all over again. I think I finally gave up. (I do have friends but they are like me. We forget about each other until we remember and say "hey fren!") BTW, I'm 60 and diagnosed just this month.

[@AmandaJuneHagarty]

I've been doing one on one therapy every 2 weeks for about a year and a half now and that has been helping me by a tiny fraction on my social life. But not because I have learned social skills. It's a combination of things. First of all simple awareness and mindfulness. And then not beating myself up for it. If I I do the wrong thing, I don't have to go down a shame spiral. I can actually say out loud "whoops sorry ...that was my ADHD." And that lets me forgive myself and move on, let's the other person know that I didn't mean to be that way and offers them a window of empathy. Most of my life I have felt like I was "performing" in social groups. Like I have a role and I have lines that I am supposed to say and I keep forgetting lines or going off script or saying other people's lines. I never felt like I was actually just being myself..for myself. I was always trying to do the things others wanted me to do, but never getting it right and maybe not really having that deeper connection to what was right in the first place. They are just lines in a play that someone else gave to me. But now I have started to figure out that it's ok to just be me, to let people know that I might act a little different sometimes and help them understand me. I don't always feel like I am doing something wrong. I can also spot some of my impulsive behaviors now before I do them. Or as I do them. LOL The only "social skills training" I remember getting as a kid was that my mom sat me down in front of that sesame Street video about the kid who wants to pop the balloon and then the chain of consequences. And I remember her really drilling home that I have to think about every way in which popping the balloon could hurt others. But I'm an over thinker and I don't think this has helped me in life. It more paralyzed me or made me focus too hard on the other people and whether something I did hurt them. It gave me this tremendous burden of guilt and shame and blame in social interaction. I think social training is more likely to screw kids up emotionally than help them. I'm not sure why people keep trying. Just be understanding and compassionate and tell kids with ADHD that it's not their fault. Teach them how to explain themselves after they have done the faux pas. Teach them how to accept their flaws and be themselves.

[@sparkle74HvH]

God, that makes so much sense. I always wonder why people tell me I am acting like an ahole, even though I don't mean it and I just want to be friendly

[@edwardmitchell6581]

I can understand that consequence anxiety. I can't spend time with more that one person at a time because I get burnt out calculating maximum utility. In our personal lives deontological framework works much better. Attending a 12-step program has shown me that. Now to actually retrain my brain...

[@OrafuDa]

Yes, I also think that social skills training can end up being bad for mental health, just as you described it. In a way, I believe it can have similar effects as ABA therapy has for autism. Just trying to always act according to some trained routine means the self gets lost, and is a driver for anxiety, depression and other negative mental health effects (and ultimately physical health as well). I believe that practicing the performance of social skills can be beneficial to some extent, if the self doesn’t get suppressed to the extent that it gets lost. Forming of positive, sustainable habits that do not defy my self or others would be the target, as well as positively reinforcing social mindfulness and analysis skills. What I believe has helped me most in the past are mindfulness and kindness, of course on top of learning social skills (which I did mostly in my youth). Being mindful of others and their thoughts and needs, how interactions work, and doing as much as I reasonably can without beating myself up too much about problems and failures. Also, accepting that others are not perfect as well and being kind and helpful about it, by trying to the right things from my side. I also believe that what I want the most is to get my brain functioning better, so that my pre-frontal cortex is more in control. Better planning and better execution of plans, less impulsivity and more emotional control in myself would mean that I do not need to work so hard to compensate with mindfulness and kindness. The starting conditions would be better. I am not officially diagnosed, so far, waiting times in my region are about 6 years now … and that is why I have no personal experience with medication, so far. But I hope that medication will help improve my pre-frontal controls, as described above.

[@brendalg4]

Wow that was amazing... I just posted a comment about whether I should get the training or not. I already second guess myself all the time. Such as when I said this, did they think I meant this thing or the other thing? Did I hurt their feelings? Do they think I am a jerk? Etc I didn't have friends growing up but not for a typical reason... I originally had friends. Then I played with another kid that other kids wouldn't play with. That made them not play with me either. So then after that, I didn't have friends. I went to school with the same kids from elementary through junior high. So any social skills that I should have learned I didn't get a chance to learn

[@nursekellyjane]

What about social training for later in life diagnosed adults? 🤔 I am curious about that as I am 32, recently diagnosed and have struggled with communicating my thoughts to words / social situations, etc.

[@amypeggs9606]

Try self-reg training instead. Stuart Shanker and Zones of Regulation are good here.

[@sauliluolajan-mikkola620]

I was diagnosed at 37. Reading three books many times over has seemed to help me avoid feeling attacked and avoid making others feel I’m attacking them. Leadership and Self-Deception The Anatomy of Peace Extreme Ownership In a nutshell, you don’t assume the worst of others, and look only at things you could do better. Don’t try to be a referee in your own game. Anything along the lines of ”it takes two to tango” in a conflict will appear as avoiding responsibility and shifting blame, no matter how objectively you think you are looking at it. Look for things that you could have done better even if none of it is your fault. This principle has eliminated or quickly resolved the vast, vast majority of social problems I used to have at work, with my spouse, and my kids.

[@adhd_coach_katherine]

Have you looked at the PEERS program? Although it is designed for autistic teens & adults it would still be beneficial to many w ADhD.

[@IntricateRhetoric]

Really interesting - helped me make a few conceptual connections between 'social skills training' for ADHD and some aspects of 'applied behaviour analysis' for Autism (diagnosed with both). Specifically, both of these approaches are often harmful and distressing because they focus on the affected person's behaviour. Instead, a successful approach likely involves tailoring their environment to help avoid unnecessary conflict (and unlearn maladaptive behaviours). Your talks and videos have helped me radically shift my perspective on ADHD since being diagnosed. For most of my life (pre- and post-diagnosis), I often tried to "learn better skills" to solve my dysfunctions. Over the last several years, approaching my life with the mindset that I should be working to skew the *moments that require skill execution* in my favour has let me make more progress (becoming stable, sustainably productive, and emotionally regulated) than I had made during the last entire decade. Thank you for your work - past and ongoing! Sections from your talk on "30 essential ideas" are my go-to resource for politely but effectively discouraging pervasive ADHD myths.

[@publius9350]

I think the most important thing would just be making sure everyone knows when they have ADHD, or are subclinical, but have traits that it can affect social skills. I had no idea (and to some degree, still do not) why I had so so many social difficulties.

[@ilkerxyz8505]

Me too

[@binghobson7122]

This makes absolute sense doc, thank you.

[@Plasmafox]

So the methodology defines benefit without attempting to measure improvement in social outcomes using a tool like Interpersonal Support Evaluation or the Social Support Questionnaire. Instead, they asked parents and teachers whether they subjectively approve of the child's behavior? How can a conclusion be made based on something that wasn't measured?

[@robbooth8062]

Thanks Prof Barkley for this wonderful channel. It is profoundly useful to me, both as a sufferer and as a psychological researcher. Also, does anyone know if there's anyone out there, on KZbin or elsewhere, doing this kind of thing for depression or anxiety disorders? Thanks in advance!

[@grummelameise]

thats why telling me "don't interrupt and don't be so loud" won't work at all.

[@Plasmafox]

People interrupting me to shame me about volume and then talking over me when I spoke at a normal volume taught me to stutter and struggle to participate in conversations at all. Which one is worse for social performance long term? It was never about that. They just wanted a quiet, passive child. They got it, and I'll be fixing that damage for the rest of my life.

[@hannahbaker2561]

Curious about how social slills training perform for those with adhd and asd combined? And medicated adhd vs unmedicated participation in social skills?

[@ButterflyonStone]

I think it depends on what 'social skills' training means as it means different things to different people and can be very different between programs. Traditional skills training sucks - you can't learn performance skills by rote memory - you need to be able to action it in the situation in real time. However, as an adult education around understanding how and why people react and interact in certain ways, how my interaction style is different and how to negotiate shared spaces and relationship difficulties - for example, expressing having different tendencies or being more effective in explaining my thought processes, action or intents has been helpful. Another area is role play for specific situations - for example, practising a job interview to reduce anxiety and work out what to say is helpful or peer coaching in real-time conversation with a trusted person.

[@adhd_coach_katherine]

Ah - this sounds quite like “why will no one play with me” by Caroline Maguire. Thank you for the Mikami link - I will get it this week. It sounds useful for adults too. Do executive function training programs “work” to improve them - I suspect some limited awareness benefit but medication/external structure is more beneficial.

[@russellbarkleyphd2023]

The CBT programs targeting EF deficits may help here though that is far from clear but the game based apps for EF training do not. Be well.

[@brendalg4]

I grew up with no friends... But I don't think it was ADHD related. My mom says I told her when I was very young that I was going to play with a child that others wouldn't play with. Then they wouldn't play with me either. That meant I grew up with no friends. I have not been tested but my doctor thinks I have ADHD at 59. Do I need social skills training?

[@s.m.4948]

Dad! Plaid!

[@diannaannette6956]

Have you seen ADHD Dude? Do you think him type of intervention is beneficial?

[@doubletrouble687]

His videos are beneficial for kids with adhd and his approach is different than traditional social skills training.