New findings of a randomized controlled trial indicate that play-based intervention designed to improve the social play skills is effective among children diagnosed with attention deficit hyperactivity disorder (ADHD). Investigators affiliated with The University of Sydney, the Curtin University in Perth, and Australian Catholic University published their findings in the journal PLoS One.
ADHD is one of the most prevalent developmental disorders. According to CDC, as of 2011, approximately 11% of children 4-17 years of age (6.4 million) have been diagnosed with ADHD, compared with 8% of children in 2003 and 10% in 2007. In this age group, approximately 5% of children were taking ADHD medication, compared with 6% in 2011. The average age of ADHD diagnosis is 7 years of age, and boys are more likely than girls (13% vs. 6%) to receive the diagnosis.
“Many children with ADHD have social difficulties,” and “one core area of social difficulty is peer interactions, particularly within the context of play,” investigators wrote in their publication.
With regard to the trial design, researchers randomly assigned children to an intervention-first group (a 10-week play-based intervention) or control-first group (no treatment for 10 weeks, followed by the 10-week play-based intervention). Children diagnosed with autism spectrum disorder (ASD) or with intellectual disability were excluded, but children with comorbidity such as language difficulties or conduct disorder were included in the trial. Investigators confirmed the ADHD diagnosis by using the parent-rated Conners Comprehensive Behavior Rating Scales (CCBRS). All children who were diagnosed with ADHD between ages 5 and 11 by a pediatrician or psychiatrist were included, and they all continued to take any medication that was previously prescribed for ADHD for the duration of the study.
Investigators involved with the current study have previously compared the peer-to-peer play interactions of children diagnosed with ADHD to those of typically developing children. Based on these observations, they developed a test [The Test of Playfulness (ToP)] in order to examine children’s play skills in peer-to-peer play interactions.
According to the authors, the ToP has 9 items that reflect social skills: initiating interactions, negotiating, sharing, supporting another, duration of engaging in social interactions, the intensity of involvement with another in social interactions, social skills when interacting with another, giving verbal and non-verbal clues, and responding to others’ verbal and non-verbal clues.
Investigators then addressed the social difficulties by designing an intervention in order to improve the overall play skills of children with ADHD. One of the main aims of the intervention was for the improvements in social skills to generalize to the home environment.
During the 10-week intervention, the therapist conducted 5 sessions with children and their parents where s/he provided video-feedback on a 3-minute, edited footage of children playing during a previous week. During the sessions, the therapist supported the children (and parents) by engaging in cooperative play for 25 minutes, and by modeling the desired pro-social skills such as sharing, problem solving, and negotiating. The therapist also directed parents to follow an individualized home intervention program during weeks 8 and 9.
Although the relatively small sample size is one of the limitations, and these findings cannot be generalized to the broader population of children with ADHD, “When evaluating the effect once all children had received the intervention, the intervention yielded a large treatment effect (d=1.5 and d=1.6, respectively) for improving the play skills of all children with ADHD in peer-to-peer interactions,” the authors wrote.
More specifically, results indicate that children diagnosed with ADHD who were assigned to the intervention-first group showed significant improvements following 10 weeks of intervention with regard to the overall play skills (pre=46.65 (SD=11.0), post=67.79 (SD=8.4), P=0.001, 95% CI=16.27-26.00, d=1.5).
Similarly, at the 1-month follow up, the overall ToP measure scores for children with ADHD significantly improved from pre to post intervention (pre=46.65 (SD=11.0), post=69.68 (SD=7.5), P=0.001, 95% CI=16.98-29.08, d=1.6).
“Lower baseline ToP scores predicted greater intervention change,” and “ this is a promising finding as it demonstrates that children with severe social skills deficits benefited most from the intervention,” investigators concluded.
Wilkes-Gillan S, Bundy A, Cordier R, et al. A randomized controlled trial of a play-based intervention to improve the social play skills of children with attention deficit hyperactivity disorder (ADHD). PLoS One. 2016;11(8):e0160558.