Social skills and associated factors of late elementary school children with attention deficit hyperactivity disorder (ADHD) at child and adolescent psychiatric unit, King Chulalongkorn Memorial Hospital

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Ananya Chaiwattanapong
Wasin Laohavinij
Jirada Prasartpornsirichoke
Sasithorn Preechawuttidech


Objective: This study aimed to determine the associations between parenting practices, sociodemographic factors, and social skills in children with ADHD. 

Method: A cross-sectional study was conducted at the Child and Adolescent Outpatient Clinic, Department of Psychiatry, King Chulalongkorn Memorial Hospital, from December 1, 2022, to April 30, 2023. This study recruited parents and children with ADHD who were enrolled in late elementary schools. The sociodemographic status of both children and parents was collected using questionnaires. In addition, child interviews and Thai version standardized tests such as the Screening for Child Anxiety Related Disorders (SCARED), the Swanson, Nolan, and Pelham IV scale (SNAP-IV), the Alabama Parenting Questionnaire (APQ), and the Social Skill Questionnaire (SSQ) were utilized in this study. Associations between factors and social skills were analyzed using multiple linear regression with a 0.05 significance threshold.

Results: One hundred and twelve ADHD patients and their parents were included in the study. 83.0 percent of the patients were male, and 41.1 percent had at least one comorbidity. Positive factors associated with social skills were positive parenting scores (β=0.2, p=0.04), a good child-teacher relationship (β=4.5, p=0.006 and β=6.51, p<0.001 for children with moderate and satisfactory relationships compared to the poor group, respectively), and receiving behavioral modifications in the past 3 months (β=2.8, p=0.05). Social skills were negatively associated with negative parenting scores (β=-0.3, p=0.009), male gender (β=-6.9, p=0.002), physical illness (β=-11.6, p<0.001), predominant inattentiveness (β=-8.8, p<0.001), combine type (β=-7.3, p<0.001), and symptoms of oppositional defiant disorder (β=-5.9, p<0.001).

Conclusion: It is crucial to combine clinical treatments for ADHD using medication and improving environmental factors. This includes offering positive parenting guidance, which consists of involving parents in child-rearing and fostering effective parental roles, along with promoting a healthy parent-child relationship and cultivating a positive teacher-student relationship. These efforts, combined with behavior modification interventions, are likely to yield favorable outcomes for social skills development in children with ADHD.

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Chaiwattanapong, A., Laohavinij, W., Prasartpornsirichoke, J., & Preechawuttidech, S. (2024). Social skills and associated factors of late elementary school children with attention deficit hyperactivity disorder (ADHD) at child and adolescent psychiatric unit, King Chulalongkorn Memorial Hospital. Journal of the Psychiatric Association of Thailand, 69(1), 16–31. Retrieved from
Original Articles


Thomas R, Sanders S, Doust J, Beller E, Glasziou P. Prevalence of attention-deficit/hyperactivity disorder: A systematic review and meta-analysis. Pediatrics 2015;135(4):e994–1001.

Visanuyothin T, Pavasuthipaisit C, Wachiradilok P, Arunruang P, Buranasuksakul T. The prevalence of attention deficit/hyperactivity disorder in Thailand. J Ment Health Thail 2013;21(2):66–75.

Greene RW, Biederman J, Faraone SV, Ouellette CA, Penn C, Griffin SM. Toward a new psychometric definition of social disability in children with attention-deficit hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 1996;35(5):571–8.

Shaw-Zirt B, Popali-Lehane L, Chaplin W, Bergman A. Adjustment, social skills, and self-esteem in college students with symptoms of ADHD. J Atten Disord 2005;8(3):109–20.

Abrahão ALB, Elias LCDS. Students with ADHD: Social skills, behavioral problems, academic performance, and family resources. Psico-USF 2021;26(3):545–57.

Mary A, Slama H, Mousty P, Massat I, Capiau T, Drabs V, et al. Executive and attentional contributions to theory of mind deficit in attention deficit/hyperactivity disorder (ADHD). Child Neuropsychol 2016;22(3):345–65.

Al-Yagon M, Forte D, Avrahami L. Executive functions and attachment relationships in children with ADHD: Links to externalizing/internalizing problems, social skills, and negative mood regulation. J Atten Disord 2020;24(13):1876–90.

Gnanavel S, Sharma P, Kaushal P, Hussain S. Attention deficit hyperactivity disorder and comorbidity: A review of literature. World J Clin Cases 2019;7(17):2420–6.

Pliszka SR. Patterns of psychiatric comorbidity with attention-deficit/hyperactivity disorder. Child Adolesc Psychiatr Clin N Am 2000;9(3):525–40.

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.

Young S, Chadwick O, Heptinstall E, Taylor E, Sonuga-Barke EJS. The adolescent outcome of hyperactive girls. Eur Child Adolesc Psychiatry 2005;14(5):245–53.

Ragnarsdottir B, Hannesdottir DKr, Halldorsson F, Njardvik U. Gender and age differences in social skills among children with ADHD: Peer problems and prosocial behavior. Child Fam Behav Ther 2018;40(4):263–78.

Booster GD, DuPaul GJ, Eiraldi R, Power TJ. Functional impairments in children with ADHD: Unique effects of age and comorbid status. J Atten Disord 2012;16(3):179–89.

Kaiser NM, McBurnett K, Pfiffner LJ. Child ADHD severity and positive and negative parenting as predictors of child social functioning: Evaluation of three theoretical models. J Atten Disord 2011;15(3):193–203.

Solanto MV, Pope-Boyd SA, Tryon WW, Stepak B. Social functioning in predominantly inattentive and combined subtypes of children with ADHD. J Atten Disord 2009;13(1):27–35.

Mikami AY, Huang-Pollock CL, Pfiffner LJ, McBurnett K, Hangai D. Social skills differences among attention-deficit/hyperactivity disorder types in a chat room assessment task. J Abnorm Child Psychol 2007;35(4):509–21.

Graziano PA, Geffken GR, McNamara JP. Atypical behaviors and comorbid externalizing symptoms equally predict children with attention-deficit/hyperactivity disorder’s social functioning. Child Psychiatry Hum Dev 2011;42(4):377–89.

Abikoff H, Hechtman L, Klein RG, Gallagher R, Fleiss K, Etcovitch J, et al. Social functioning in children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment. J Am Acad Child Adolesc Psychiatry 2004;43(7):820–9.

Alkalay, S., Dan, O. Effect of short-term methylphenidate on social impairment in children with attention deficit/hyperactivity disorder: systematic review. Child Adolesc Psychiatry Ment Health 2022;16(1):93.

Storebø OJ, Elmose Andersen M, Skoog M, Joost Hansen S, Simonsen E, Pedersen N, et al. Social skills training for attention deficit hyperactivity disorder (ADHD) in children aged 5 to 18 years. Cochrane Database Syst Rev 2019;6(6):1–146.

Jia RM, Mikami AY, Normand S. Social resilience in children with ADHD: parent and teacher factors. J Child Fam Stud 2021;30(4):839–54.

Bishop C, Mulraney M, Rinehart N, Sciberras E. An examination of the association between anxiety and social functioning in youth with ADHD: A systematic review. Psychiatry Res 2019;273:402–21.

Becker SP, Langberg JM, Evans SW, Girio-Herrera E, Vaughn AJ. Differentiating anxiety and depression in relation to the social functioning of young adolescents with ADHD. J Clin Child Adolesc Psychol 2015;44(6):1015–29.

Johnston C, Chronis-Tuscano A. families and ADHD. In: Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment, 4th ed. New York, NY, US: The Guilford Press; 2015. p. 191–209.

Pliszka S, AACAP work group on quality issues. Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 2007;46(7):894–921.

Ollendick TH, Weist MD, Borden MC, Greene RW. Sociometric status and academic, behavioral, and psychological adjustment: A five-year longitudinal study. J Consult Clin Psychol 1992;60:80–7.

Tangjittiporn T, Sottimanon A, Ularntinon S. Psychometric properties of the screen for child anxiety related disorders Thai version. Pediatr Int 2022;64(1).

Pityaratstian N, Booranasuksakul T, Juengsiragulwit D, Benyakorn S. ADHD screening properties of the Thai version of Swanson, Nolan, and Pelham IV scale (SNAP-IV) and strengths and difficulties questionnaire. J Psychiatr Assoc Thail 2014;59(2):97–110.

Khamon A, Charnsil C, Srisurapanont M, Suradom C. Development and validation of the Thai version of the Alabama parenting questionnaire (APQ). J Ment Health Thail 2019;27(2):107–20.

Susan H. Spence. Social skills training: Enhancing social competence with children and adolescents. Berkshire, UK: NFER-Nelson; 1995. 7–9.

Bursac Z, Gauss CH, Williams DK, Hosmer DW. Purposeful selection of variables in logistic regression. Source Code Biol Med 2008;3(1):17.

Van der Oord S, Van der Meulen EM, Prins PJM, Oosterlaan J, Buitelaar JK, Emmelkamp PMG. A psychometric evaluation of the social skills rating system in children with attention deficit hyperactivity disorder. Behav Res Ther 2005;43(6):733–46.

Achenbach TM, McConaughy SH, Howell CT. Child/adolescent behavioral and emotional problems: Implications of cross-informant correlations for situational specificity. Psychol Bull 1987;101(2):213–32.

Hughes JN, Chen Q. Reciprocal effects of student–teacher and student–peer relatedness: Effects on academic self-efficacy. J Appl Dev Psychol 2011;32(5):278–87.

Bergin C, Bergin D. Attachment in the Classroom. Educ Psychol Rev 2009;21(2):141–70.

Wang Y, Tao Y, Zhu L, Li Y, Huang D. Preschool children's negative affect and social skills in China: The moderating effect of the teacher-child relationship. Front Psychol 2022;13:e991039

Meijer SA, Sinnema G, Bijstra JO, Mellenbergh GJ, Wolters WHG. Social functioning in children with a chronic illness. J Child Psychol Psychiatry 2000;41(3):309–17.

van Rijn S, Barendse M, van Goozen S, Swaab H. Social attention, affective arousal and empathy in men with Klinefelter syndrome (47,XXY): Evidence from eye tracking and skin conductance. PLoS ONE 2014;9(1):e84721.

Beebe DW, Gozal D. Obstructive sleep apnea and the prefrontal cortex: towards a comprehensive model linking nocturnal upper airway obstruction to daytime cognitive and behavioral deficits. J Sleep Res 2002;11(1):1–16.

Hinshaw SP. Impulsivity, emotion regulation, and developmental psychopathology: specificity versus generality of linkages. Ann N Y Acad Sci 2003;1008(1):149–59.

Hodgens JB, Cole J, Boldizar J. Peer-based differences among boys with ADHD. J Clin Child Psychol 2000;29(3):443–52.

The MTA Cooperative Group. A 14-Month Randomized Clinical Trial of Treatment Strategies for Attention-Deficit/Hyperactivity Disorder. Arch Gen Psychiatry 1999;56(12):1073–86.