Performance-Based Social Skills Training Improves Treatment Outcomes for Youth with Comorbid ADHD or Anxiety
Objectives: We examined the impact of psychiatric comorbidity on treatment response to a community-based GSSI that provides an enriched, in vivo social learning and practice opportunities for ASD youth (Lerner et al., 2011).
Methods: Seventy-five children and adolescents, ages 9 to 17 years (M=12.86 years, SD=2.19; 59 male) participated in a 6-week community-based summer GSSI. The majority of parents reported a diagnosis of ASD for their child (86.7%). Parents completed measures of broad psychopathology (BASC-2; Reynolds & Kamphaus, 2004) and ASD symptomatology (SRS; Constantino & Gruber, 2007) at baseline and endpoint.
Results: Using ANCOVA-of-change, presence of any comorbid psychiatric diagnosis was associated with improvements on the BASC-2 behavioral symptom index and externalizing problems, specifically in aggression and conduct problems (all β<=-.21, p<=.05). In addition, the presence of a comorbid ADHD diagnosis was associated with reduced BASC-2 behavioral symptoms and externalizing problems (all β<-.28, p<.049), and improved adaptive skills, notably in social skills and daily living activities (all β>.29, p<.01). Finally, presence of a comorbid anxiety diagnosis was associated with greater improvements on the SRS, driven by improvements in social awareness and cognition (all β<-.23, p<.04).
Conclusions: As hypothesized, the presence of a comorbid psychiatric disorder moderated the treatment outcomes for youths participating in a GSSI. Consistent with previous research, participants with anxiety made larger gains on the SRS compared to other participants (Antshel et al., 2011). Unlike previous studies, youth with comorbid ADHD showed augmented improvements in externalizing problems and improved their adaptive skills. This suggests that GSSIs employing social-performance approaches can be particularly beneficial for youth with ADHD. This is supported by recent research indicating that impaired social decision-making mediated the relationship between ADHD symptoms and social skills deficits for youth with ADHD (Humphreys, Galan, Tottenham, & Lee, 2016). Future research should examine the mechanisms of change for performance training GSSIs, which may further elucidate unique benefits for those with comorbid ADHD.