Discipline Based Literature Review
Everleigh
childrenwithADHDpart2.pdf
Effectiveness of Social Skills Interventions Incorporating Peer Interactions for Children With Attention Deficit Hyperactivity Disorder: A Systematic Review Ashley Fox, Stephanie Dishman, Mary Valicek, Karen Ratcliff, Claudia Hilton
Importance: Few studies examining the use of peers during interventions have been published, and no systematic review has been conducted to evaluate the available literature.
Objective: To examine the effectiveness of social skills interventions incorporating peers for children with attention deficit hyperactivity disorder (ADHD) to improve social interactions.
Data Sources: A search of five databases (CINAHL, PubMed, Web of Science, Google Scholar, and PsycINFO) produced 697 articles. Sixty-one were retrieved for full-text review, and 15 articles met inclusion criteria.
Study Selection and Data Collection: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to abstract data. Inclusion criteria: Participants younger than age 18 yr with any ADHD pattern, social skills interventions with peer involvement, outcome measures within the domain of occupational therapy, written in English, and involved a peer as the sole or primary component at some point in the social skills intervention. Exclusion criteria: Studies older than 20 yr or that used participants with comorbidities or multiple conditions.
Findings: Interventions incorporating both peer categories were effective for increasing play skills, reducing undesirable social behaviors (e.g., inappropriate verbalizations, dominant behaviors, aggression), and improving communication (e.g., pragmatic language, collaboration, joint participation) and social participation. Improvements were maintained over time, as evidenced by follow-up studies.
Conclusions and Relevance: Outcomes of these studies demonstrate moderate evidence that supports the use of social skills interventions incorporating peers for children with ADHD to improve social interactions, supporting their use by occupational therapists and the need for more studies.
What This Article Adds: This article provides guidance to occupational therapy practitioners on social skills intervention options for children with ADHD.
For many people with attention deficit hyperactivity disorder (ADHD), interactions with peers can be challenging.Approximately 6.1 million children ages 2–17 yr in the United States have a diagnosis of ADHD (Centers for Disease Control and Prevention, 2018). According to the Diagnostic and Statistical Manual of Mental Disorders (5th
ed.; American Psychiatric Association [APA], 2013), ADHD is defined as a pattern of inattention, hyperactivity, or both
(i.e., combined). Inattention can lead to difficulty with maintaining attention to tasks, difficulty organizing and planning
activities, and ease of becoming distracted (APA, 2013). Hyperactivity is evident in problems such as fidgeting, leaving
the classroom at inappropriate times, having difficulty waiting for one’s turn, and interrupting others. Because of these
issues with attention and hyperactivity, children with ADHD are aversive to peers and have lower social skills necessary
for engagement in social participation than do typically developing (TD) peers (Mikami, 2010; Mrug et al., 2012;
Waschbusch, 2002; Young & Amarasinghe, 2010).
Citation: Fox, A., Dishman, S., Valicek, M., Ratcliff, K., & Hilton, C. (2020). Effectiveness of social skills interventions incorporating peer interactions for children with attention deficit hyperactivity disorder: A systematic review. American Journal of Occupational Therapy, 74, 7402180070. https://doi.org/ 10.5014/ajot.2020.040212
The American Journal of Occupational Therapy, March/April 2020, Vol. 74, No. 2 7402180070p1
Research Article
Social Skills Deficits in Children With Attention Deficit Hyperactivity Disorder Social skills are the competencies people use to communicate, learn, get needs met in appropriate ways, get along with
others, make friends, develop healthy relationships, protect themselves, and interact with society (Dowd & Tierney,
2017). Social dysfunction is a common characteristic among children with ADHD (Hoza et al., 2005). Hodgens et al.
(2000) found that children with hyperactive or inattentive forms of ADHD can experience peer rejection in as little as a
few hours after meeting a new peer. Negative social behaviors can vary depending on the subtype of ADHD. Children
with hyperactive or combined ADHD more frequently demonstrate impulsive actions and aggressive characteristics
that are sources of annoyance to their peers. Children with the inattentive type of ADHD display socially withdrawn
behaviors and often make inappropriate social statements because of lack of awareness of the feelings of others or
difficulty managing their own emotions (Hodgens et al., 2000).
Impact of Social Skills Deficits The symptoms and social characteristics associated with ADHD often result in social dysfunction and lead to peer
rejection and less meaningful friendships (Mrug et al., 2012). Children with ADHD were found to be twice as likely as TD
children to have no friends (Hoza et al., 2005); of those who reported having friends, 56% of those friends did not
consider these children to be their friends. Even when children with ADHD have friends, the friendships tend to be of
lower quality and less stable than those of their TD peers (Hoza et al., 2005) and to last a shorter time than friendships of
TD children (Normand et al., 2011).
Social dysfunction, peer rejection, and poor friendship quality can persist over time if not resolved. Constant social
difficulties and peer rejection have been associated with adverse outcomes later in life (Mrug et al., 2012). In an 8-yr
follow-up of children with ADHD, Mrug et al. (2012) found that symptoms of ADHD were correlated with higher levels of
substance abuse and depressive symptoms. Peer rejection was positively associated with delinquency, smoking,
anxiety, and social impairment, whereas friendship was associated with lower delinquency and lower depressive
symptoms.
Need for Peer Involvement Because problems with peer relationships are likely a causal factor in persistent long-term impairments, approaches
that address peer relationships are important (Mrug et al., 2012). Of the currently accepted interventions targeted at
social skills improvement, those involving TD peers in treatment have been shown to result in improved generalization
(Ang & Hughes, 2002; DuPaul & Weyandt, 2006). This outcome was especially true when the same peers engaged in
social interactions outside of treatment sessions in an environment where practice, corrections, and reinforcement could
occur organically (Ang & Hughes, 2002; DuPaul & Weyandt, 2006). Incorporation of peers in parent training inter-
ventions also has demonstrated the potential to improve positive social behaviors and friendship development
(Antshel, 2015).
Few studies examining the use of peers during interventions have been published, and no systematic review has
been conducted to evaluate the available literature. A systematic review is warranted to clarify the effectiveness of peer
inclusion during social interventions for children with ADHD. The objective of this systematic review, therefore, was to
evaluate whether social skills interventions incorporating peers are effective in improving social skills in children with
ADHD. The knowledge gained from the studies included in this review can be implemented in practice to improve social
participation in children with ADHD while reducing peer rejection and the negative long-term outcomes resulting from
social dysfunction.
The American Journal of Occupational Therapy, March/April 2020, Vol. 74, No. 2 7402180070p2
Research Article
Method Search Strategy Intervention studies from peer-reviewed journals were selected for this systematic review on the basis of a topic and
search protocol agreed on by members of the research team (the authors). Databases searched were CINAHL,
PubMed, Web of Science, Google Scholar, and PsycINFO. Other sources included to ensure a comprehensive search
of the literature were reference lists from published literature and hand searches of electronic journals. The aim of our
review was to examine the effects of social skills interventions for children with ADHD that included some type of
interaction with peers and outcome measures within the domain of occupational therapy.
Selection Criteria To meet inclusion criteria, studies had to have participants younger than age 18 yr with any ADHD pattern, provide a
social skills training intervention with peer involvement, use outcome measures within the domain of occupational
therapy, and be published in English. Studies needed to use a peer as the sole or primary component at some point in
the social skills intervention (search terms are listed in Table 1). Peers were defined as TD children, children with
ADHD, playmates, schoolmates, or siblings who were similar in age to the children with ADHD. Initially, only publications
in the past 10 yr were included, yielding 10 articles, so search criteria were expanded to the past 20 yr to provide more
comprehensive coverage of the available literature, yielding 15 articles. All review databases, including the Cochrane
database, were screened for systematic reviews on social skills interventions for children with ADHD that included peers
to ensure that the systematic review had not already been completed.
Studies that addressed adults with ADHD and articles written in a language other than English were excluded.
Additionally, studies that used participants with comorbidities or multiple conditions, such as autism spectrum disorder
and conduct disorder, were excluded to prevent characteristics that were not consistent with ADHD diagnoses from
affecting the results of the interventions.
Procedure Each member of the research team performed comprehensive searches and screened the results on the basis of the
inclusion criteria. From there, the team, with the guidance of additional experienced researchers, discussed and
analyzed the full-text articles to determine which studies to include in this systematic review. Each article was reviewed
by at least two team members to ensure accuracy of data. Disagreements were addressed by involving the rest of
the research team and outside researchers until a consensus was reached (for a diagram of the flow of articles through
the selection process, see Figure 1). Finally, the data were compiled into an evidence table (Table A.1 in Appendix A)
and classified by level of evidence on the basis of the American Occupational Therapy Association’s (2017) Guidelines
for Systematic Reviews, which are based on Sackett (1989).
Results Fifteen studies met the inclusion criteria (1 Level I study, 1
Level II study, 10 Level III studies, and 3 Level IV studies).
Intervention methods were categorized as incorporating ei-
ther peers with ADHD or peers without ADHD. The methods
incorporating peers without ADHD were subcategorized as
play-based and school-based interventions. Study partici-
pants ranged in age from 5 to 16 yr, with most being between
ages 5 and 11 yr. The participants with ADHD were pre-
dominantly male, which is reflective of the population of
Table 1. Key Search Terms
Category Key Search Terms
Population children with ADHD, peers, school- aged children, similar-aged peers, similar-aged playmates, typically developed peers
Intervention occupational therapy, pediatric occupational therapy, peer coaching, peer-mediated approaches, peer modeling, play- based interventions, playmates, social interventions, social play, social skills interventions, social skills training
Note. ADHD = attention deficit hyperactivity disorder.
The American Journal of Occupational Therapy, March/April 2020, Vol. 74, No. 2 7402180070p3
Research Article
children with an ADHD diagnosis. In the
case of peers, more equal numbers of male
and female peers were common, and
some samples had more girls. Dosage for
the interventions ranged from one to five
times per week, for 20 min to 9 hr in each
session, over 12 days to 15 wk.
Interventions were evaluated individu-
ally to see how they affected social skills in
children with ADHD. Eleven studies pro-
duced statistically significant improvement
in social skills with peer involvement,
whereas four studies did not. Table 2 lists
the methods, peer roles, and settings used
for the interventions.
Risk of Bias We used Higgins et al.’s (2011) methods to
assess for risk of five types of bias: selection
bias, performance bias, detection bias,
attrition bias, and reporting bias (Table
A.2). Blinding of outcome assessment for
objective outcomes occurred in 7 of the 15
studies reviewed. Six studies had high risk
for attrition bias because of incomplete
outcome data. None of the studies had
high risk of selective reporting bias.
Avoiding most of these types of bias is often
impractical and problematic in studies with
Level II–IV designs. In spite of these risks,
we deemed the findings useful and valuable
to inform the use of interventions to sup-
port the social skills development of children with ADHD. Several researchers participated in multiple studies included
in this systematic review, although different participants were included in each of the studies.
Interventions Incorporating Peers Without Attention Deficit Hyperactivity Disorder Of the 15 articles, 11 involved interventions incorporating peers without ADHD. We classified these studies into two
subcategories: play-based interventions and school-based interventions.
Play-Based Interventions
Evidence from eight studies supports play-based interventions incorporating peers without ADHD. In a Level I study,
Wilkes-Gillan, Bundy, Cordier, Lincoln, and Chen (2016) used an intervention-first group and a control-first group to
evaluate a 10-wk play-based program. Children with ADHD were paired with a TD peer playmate and participated in
sessions involving video feedback, discussion of social skills, cooperative play, and therapist modeling. Parents joined
Figure 1. Flow diagram for inclusion and exclusion of peer-reviewed studies in the systematic review.
Id en
tif ic
at io
n Sc
re en
in g
In cl
ud ed
El ig
ib ili
ty
Remaining records after screening by title (n = 84)
Remaining records after duplicates removed
(n = 697)
Records identified through database search
(N = 1,546)
Additional records identified through other sources
(n = 288)
Remaining records after screening by abstract
(n = 61)
Remaining records before full-text articles assessed
(n = 61)
Studies found to be relevant to research question for qualitative synthesis
(n = 15)
Records excluded (n = 613)
Full-text articles excluded (n = 46)
Records excluded (n = 23)
Note. Figure format from “Preferred Reporting Items for Systematic Reviews and Meta- Analyses: The PRISMA Statement,” by D. Moher, A. Liberati, J. Tetzlaff, and D. G. Altman; PRISMA Group, 2009, PLoS Medicine, 6(7), e1000097. https://doi.org/10. 1371/journal.pmed.1000097
The American Journal of Occupational Therapy, March/April 2020, Vol. 74, No. 2 7402180070p4
Research Article
video feedback sessions, participated in discussions with
their children, observed play sessions, received training,
and delivered home modules weekly. Parents also facili-
tated four 40-min play sessions in their homes between a TD
playmate and their child with ADHD. The change in the
overall play skills of the intervention-first group after the
intervention phase was significantly greater than the change
in the overall play skills of the control-first group, t(14) =
8.02, p < .001. Test of Playfulness (Bundy, 2004) scores on
play skills items improved significantly from pre- to post-
intervention and from preintervention to 1-mo follow-up in
the intervention-first group (p < .001). Social items scores
revealed significant improvement from pre- to post-
intervention and from preintervention to 1-mo follow-up
(p < .001) but no significant difference from postintervention
to 1-mo follow-up (p > .05).
Barnes et al. (2017) conducted a Level III study using a
play-based intervention involving both home and clinic
settings for children with ADHD, TD peer playmates, and
the children’s parents. Video recordings, parent surveys
(Parenting Relationship Questionnaire, Kamphaus &
Reynolds, 2006; Social Skills Improvement System,
Gresham & Elliott, 2008), and direct observation were used
to evaluate play. Improvement in social play skills was
sustained in the home environment but not in the clinical
environment, as demonstrated by an increasing trend with a
medium effect size (d = 0.68, p = .36). Parents reported
continued use of the activities after the initial intervention,
which may have influenced maintenance of improvement demonstrated by the follow-up scores.
Wilkes-Gillan, Bundy, Cordier, and Lincoln (2016) conducted a Level III study of a 7-wk, parent-delivered, play-
based intervention for children with ADHD and TD peer playmates. Parents received 1 hr of training, administered home
modules to promote social interactions, and provided feedback to their children before, during, and after facilitated
playdates. Parents observed and discussed three clinic sessions of therapist-supported free play and promotion of
prosocial behaviors. Social play skills of children with ADHD significantly improved from pre- to postintervention (p = .03)
and 1-mo follow-up (p = .02). Additionally, social play skills of TD playmates significantly improved from pre- to
postintervention (p = .02). The long-term effectiveness of the study was evaluated in a Level III 18-mo follow-up study
by Cantrill et al. (2015). Semistructured interviews with parents and play observations revealed that play skills for both
children with ADHD and TD playmates improved, but not significantly, from postintervention to 18-mo follow-up,
demonstrating maintenance of skills (p = .07).
Three Level III studies used a 7-wk, play-based intervention program in which a TD peer playmate of similar age was
paired with a child with ADHD (Cordier et al., 2013; Docking et al., 2013; Wilkes et al., 2011). The intervention occurred
in 40-min sessions once a week in a playroom and included video feedback–feedforward and modeled play by the
therapist, peer, and child, while parents received training and education on social skills through play. Significant
improvements in play were found for both children with ADHD and their TD playmates (p < .01), and all children with
Table 2. Components of the Interventions Used in the 15 Studies in This Systematic Review
Category Intervention Components
Intervention methods
Parent ratings and surveys Home modules Parent training programs Parent-directed sessions Peer monitoring Group contingency Classwide Peer Tutoring Peer coaching Peer collaboration Video footage Play-based Video feedback–feedforward Modeled play (by therapist, child, and peer) Role-play Self-management Rehearsal Coached play Socialization homework Therapeutic and recreational activities and games Cooperative tasks Problem-solving training Anger management Behavioral point system
Roles of peers Typically developing playmate Peer in group therapy Peer monitor Class member Buddy during activities Tutor and coach Trained collaborative partner
Settings Home Outpatient clinic Playroom in clinic Classroom School, outside of classroom (e.g., conference room) Community-based setting (e.g., local YMCA)
The American Journal of Occupational Therapy, March/April 2020, Vol. 74, No. 2 7402180070p5
Research Article
ADHD significantly improved their play skills (p < .01), whether they had language difficulty (p = .002) or not (p = .007;
Docking et al., 2013; Wilkes et al., 2011). Cordier et al. (2013) discovered significantly improved mean overall posttest
scores for pragmatic language on two outcome measures (Pragmatic Protocol, p = .006; Structured Multidimensional
Assessment Profiles, p = .001). However, Docking et al. (2013) reported that communication and pragmatic language
abilities of children with ADHD did not significantly improve over the course of the intervention (p = .528).
A Level III study by Wilkes-Gillan et al. (2014) investigated the effects of the 7-wk, play-based intervention performed
by Wilkes et al. (2011) at 18-mo follow-up through parent interviews and a 30-min clinic play session with a TD peer
playmate. The children with ADHD maintained their gains 18 mo after the intervention.
School-Based Interventions
Evidence from 3 Level IV studies supports school-based interventions incorporating peers without ADHD. Davies and
Witte (2000) examined the effect of a self-monitoring and group contingency approach to address inappropriate
verbalizations in the classroom. Peers played the roles of collaborative partner, class member, and behavior monitor.
The intervention was implemented in a third-grade classroom for 30-min sessions in two intervention periods. Ten
students were removed from the group, and the children with ADHD were rematched with TD students. Baseline
assessments were completed before each intervention period. At the initial baseline assessment, the children with
ADHD made significantly more inappropriate verbalizations (p < .05) than their TD peers. At the second baseline
assessment, the difference was no longer significant, indicating that the peer intervention had equalized the number of
inappropriate verbalizations by both groups.
Plumer and Stoner (2005) used the Classwide Peer Tutoring (CWPT) approach and peer coaching to improve
positive social behaviors of 2 fourth-grade children and 1 third-grade child with ADHD. CWPT is a teaching strategy that
may be applied with an entire class of students. In this study, CWPT was implemented using student pairs who
alternated between the roles of tutor and tutee during spelling practice. A point-reward system of reinforcement was
used to reward good performance, and in-the-moment error correction was provided. For the children with ADHD, peers
played the roles of tutor, behavior coach, and behavior monitor. An intervention stage that used only CWPT was
implemented for 20–25 min 3 days/wk for approximately 10 wk. Students reviewed goals each day and assigned
performance ratings for each. The Peer Social Behavior Code of the Systematic Screening for Behavior Disorders
(Walker & Severson, 1992) was used to measure positive social behaviors. In the academic setting, the 3 participants
increased positive social behaviors by 84%, 84%, and 87%. Generalized effects of CWPT were not found for social-
setting behaviors. In the social setting, 2 children increased positive social behaviors by 28% and 21%; 1 student’s result
was an outlier. Once peer coaching was added to the CWPT in later phases, the 3 students’ mean positive social
behaviors increased from 32% to 62%, 47% to 75%, and 69% to 90%, respectively. Comparing performance when peer
coaching was added to the CWPT-only phase suggests that peer coaching improved student outcomes in social
settings relative to CWPT alone. When using the Attention Scale of the Behavior Assessment System for Children
(Reynolds & Kamphaus, 1992) to address behavior and emotional qualities, the teacher reported improvements of
varying amounts in all 3 students.
Watkins and Wentzel (2008) examined the difference that involvement of a peer partner as a facilitator during a
planning task would make regarding social participation dynamics and problem-solving methods of children with ADHD.
Each child was provided with a shopping list and asked to plan possible routes through an imaginary town to the stores
needed to obtain the items in 25 min. Several days after the pretest, the children repeated the same task with a trained
peer partner without a time limit. Systematic observational coding of eight target behaviors during the collaborative
sessions indicated that the participants significantly increased joint participation (p < .01, d = 0.70) and collaborative
(p < .01, d = 0.60) behaviors and decreased dominance behaviors (p < .01, d = 0.83).
The American Journal of Occupational Therapy, March/April 2020, Vol. 74, No. 2 7402180070p6
Research Article
Interventions Incorporating Peers With Attention Deficit Hyperactivity Disorder Four studies assessed the influence of social skills interventions involving interactions with peers with ADHD in a group
therapy setting. In a Level II study, Frankel et al. (1997) explored the efficacy of a social skills training intervention that
involved role-play and coached play with a peer. Compared with the wait-list control group, the intervention group had
significantly better scores on the teacher-reported Aggression scale of the Pupil Evaluation Inventory (PEI; p < .05;
Pekarik et al., 1976) and the parent-reported Assertion and Self-Control subscales of the Social Skills Rating System
(SSRS; p < .05; Gresham & Elliott, 1990). No significant difference was found between groups in performance on the
Hyperactivity and Inattention scales of the PEI (p > .25).
In a Level III study, Corkum et al. (2010) examined the effectiveness of the Working Together Program, which
focuses on a range of social skills including making conversation, giving introductions, making positive statements to
others, speaking assertively, using courtesy words, asking for help, offering and giving help, giving and accepting
criticism, joining a play activity, and negotiating conflict. The intervention included role-play and group activities with
peers that targeted the social skills. Parent and teacher ratings of overall social skills on the SSRS improved significantly
(ps = .05 and .04, respectively). Student self-ratings at posttreatment were slightly higher than at pretreatment but did
not reach statistical significance.
Hoza et al. (2003) conducted a Level III study of the effects of a summer treatment program that consisted of a
behavioral point system, peer-oriented interventions, dyadic peer interventions, sports skills training, academic re-
mediation, participation in recreational activities, and weekly parent trainings. Each child was paired with a buddy to
promote friendship skills while participating in program activities. The buddy’s antisocial behavior was significantly
predictive of the children’s academic improvement and normalization. Children paired with a less antisocial buddy were
viewed as more normalized (p < .001), showed more improvement in academic performance, and had higher quality
friendships (p < .001). Parental compliance with the buddy system was predictive of the children’s perception of
companionship (p < .001) and was marginally predictive of positive adaptation (p < .10).
In a Level III study, Hansen et al. (2000) examined the Kids Together program, which uses play therapy, role-playing,
board games, and expressive arts to enhance social skills in a group therapy setting. Children practiced emotion
identification, nonverbal communication, self-image and others’ perceptions of them, self-monitoring and organization,
impulse control, conflict resolution, and responsibility with their peers. After the intervention, the children demonstrated
significant improvements in internalizing behavior problems (p = .008) and total behavior problems (p = .011). Ex-
ternalizing behaviors decreased, but not significantly (p = .051).
Discussion The purpose of this systematic review was to investigate existing evidence for the benefits of incorporating peer
interactions into interventions promoting social skills attainment in children with ADHD. Fifteen articles explored social
skills interventions incorporating TD peers or peers with ADHD. The children with ADHD who were paired with TD
peers showed more consistent and significant improvement in social play skills, pragmatic language, and problem
solving postintervention. Follow-up performance assessments in 5 studies indicated that children maintained im-
provements in social skills but did not demonstrate further improvement (Barnes et al., 2017; Cantrill et al., 2015;
Wilkes-Gillan et al., 2014; Wilkes-Gillan, Bundy, Cordier, & Lincoln, 2016; Wilkes-Gillan, Bundy, Cordier, Lincoln, &
Chen, 2016). However, none of the studies incorporating peers without ADHD included a follow-up assessment past
18 mo, so the long-term impact of the interventions cannot be generalized. Interventions involving peers with ADHD
focused on improving a variety of social skills in addition to reducing negative behaviors.
The considerable adult (e.g., parent, teacher, therapist) involvement in the social skills interventions of these studies
requires further discussion. The extent to which the social skills improvements can be attributed to the incorporation of
peers when adults were also part of the intervention (albeit in a different role from that of peers) is unknown. However, a
The American Journal of Occupational Therapy, March/April 2020, Vol. 74, No. 2 7402180070p7
Research Article
systematic review by Storebø et al. (2019) of 25 randomized clinical trials on social skills training for children with ADHD
found no significant differences between groups that participated in social skills training and groups that received no
intervention. In that review, social skills training focused on teaching the children how to read subtle cues in social
interactions, typically with parents and teachers. Storebø et al. found that interventions primarily using parents and
teachers, rather than peers, had no significant effects on outcomes, unlike the results from studies in our review, in
which incorporating peers in the interventions produced significant improvements in most cases.
Overall, study outcomes provide moderate evidence supporting the use of social skills interventions for children with
ADHD that incorporate peers both with and without ADHD to increase play skills, reduce undesirable social behaviors,
and improve communication and social participation. The findings of this systematic review can be used in practice to
improve social skills development and ultimately social participation by children with ADHD. Occupational therapy
practitioners can use these findings to support inclusion of peers in the intervention process across multiple settings and
in a variety of roles. Regardless of intervention modalities used, studies incorporating peers were effective at improving
social skills of the children with ADHD. Targeting behaviors in the natural environment can help efforts made in therapy
generalize beyond the intervention and promote further improvements in play skills with repetition after intervention has
ceased. Improved outcomes and generalizability of skills across environments resulting from teaching and involving
parents during the intervention process were an additional practical implication of this review. However, it is important to
note that the lack of high-level studies addressing this topic limits understanding of the role that peer inclusion plays in
occupational therapy practice and how it can be used to promote generalization of social skills learned in therapy.
Strengths and Limitations Strengths of the 15 studies include statistically significant improvements after implementation of a social skills in-
tervention and promotion of interactions with peers. In addition, a majority of the studies (9 of 15) used multiple outcome
measures, providing more data to qualify results. Involvement of parents during the intervention process demonstrated
a positive influence on outcomes and increased generalizability of skills across environments. Finally, 5 studies
reported maintenance of improvements at follow-ups of previously conducted intervention studies, suggesting that
children with ADHD were able to maintain improved skills over time, even though outcomes were not always sig-
nificantly different between postintervention and follow-up assessments.
Limitations across the 15 studies included the lack of a control group (13 studies), participant dropout (6 studies),
lack of blinding of researchers scoring assessments (7 studies), small sample sizes and limited generalizability to
pediatric populations (5 studies), and insufficient evidence regarding generalizability of skills across environments and
long-term outcomes. In addition, discussion was limited regarding medication use and its effects on children’s social
interactions during interventions. Only 1 study demonstrated Level I evidence; the remaining 14 studies provided lower
evidence because randomized groups were not used, indicating that groups were not blinded to intervention, which
may have influenced performance outcomes. Finally, many studies had small sample sizes (<20 total participants).
The primary limitation of this review is that the studies did not always use peers as the primary intervention. Many
modalities were used in addition to peer involvement, making it difficult to clearly identify the incorporation of peers as
the reason for improvements in social skills. Additionally, peers were often siblings or of the opposite gender, possibly
resulting in different social expectations for the interactions. Inclusion only of studies available in English and published
in peer-reviewed journals was a limitation of the study selection process.
Future Research Further research is needed to provide additional support for incorporating peers in social skills interventions for children
with ADHD. Higher level studies are needed that strive to create specific intervention guidelines and that include control
groups, blinding of researchers, randomization of participants, and larger sample sizes. Future research should also
include longitudinal studies to track long-term outcomes.
The American Journal of Occupational Therapy, March/April 2020, Vol. 74, No. 2 7402180070p8
Research Article
Implications for Occupational Therapy Practice Our findings from the 15 studies indicate that social skills interventions incorporating the use of peers are beneficial for
children with ADHD, and in some cases their TD peers as well. The findings suggest the following implications for
occupational therapy practice:
• Social skills interventions incorporating the use of peers with or without ADHD are feasible and have the potential to
be an effective method for improving social interactions for children with ADHD.
• Play-based and school-based interventions that incorporate TD peers can help improve social skills of children with
ADHD.
• Social skills interventions combining multiple modalities—for example, parent involvement, video feedback, and
play—in addition to incorporating peers have the potential to result in greater improvements in social behaviors for
children with ADHD than one intervention method alone.
Conclusion Research has demonstrated that social skills interventions incorporating peers for children with ADHD can contribute to
improved social interactions and participation across multiple environments. Social skills interventions involving multiple
modalities that incorporate peers in various roles can result in improvements in social behaviors for children with
ADHD. It is important to practice social skills in natural environments to generalize skills across different contexts.
Educating parents and caregivers about supportive strategies and appropriate play can help children generalize skills to
the home environment. More research is needed to demonstrate the long-term effectiveness of interventions in-
corporating peers and generalization across environments.
References American Occupational Therapy Association. (2017). Guidelines for systematic reviews. Retrieved from http://ajot.submit2aota.org/journals/ajot/forms/
systematic_reviews.pdf
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Ang, R. P., & Hughes, J. N. (2002). Differential benefits of skills training with antisocial youth based on group composition: A meta-analytic investigation.
School Psychology Review, 31, 164–185.
Antshel, K. M. (2015). Psychosocial interventions in attention-deficit/hyperactivity disorder: Update. Child and Adolescent Psychiatric Clinics of North
America, 24, 79–97. https://doi.org/10.1016/j.chc.2014.08.002
*Barnes, G., Wilkes-Gillan, S., Bundy, A., & Cordier, R. (2017). The social play, social skills and parent–child relationships of children with ADHD 12 months
following a RCT of a play-based intervention. Australian Occupational Therapy Journal, 64, 457–465. https://doi.org/10.1111/1440-1630.12417
Bundy, A. (2004). Test of Playfulness, Version 4.0. Sydney: University of Sydney.
*Cantrill, A., Wilkes-Gillan, S., Bundy, A., Cordier, R., & Wilson, N. J. (2015). An eighteen-month follow-up of a pilot parent-delivered play-based intervention to
improve the social play skills of children with attention deficit hyperactivity disorder and their playmates. Australian Occupational Therapy Journal, 62,
197–207. https://doi.org/10.1111/1440-1630.12203
Centers for Disease Control and Prevention. (2018). Attention-deficit/hyperactivity disorder (ADHD). Retrieved from https://www.cdc.gov/ncbddd/adhd/data.
html
*Cordier, R., Munro, N., Wilkes-Gillan, S., & Docking, K. (2013). The pragmatic language abilities of children with ADHD following a play-based intervention
involving peer-to-peer interactions. International Journal of Speech-Language Pathology, 15, 416–428. https://doi.org/10.3109/17549507.2012.713395
*Corkum, P., Corbin, N., & Pike, M. (2010). Evaluation of a school-based social skills program for children with attention-deficit/hyperactivity disorder. Child
and Family Behavior Therapy, 32, 139–151. https://doi.org/10.1080/07317101003776472
*Davies, S., & Witte, R. (2000). Self-management and peer-monitoring within a group contingency to decrease uncontrolled verbalizations of children
with attention-deficit/hyperactivity disorder. Psychology in the Schools, 37, 135–147. https://doi.org/10.1002/(SICI)1520-6807(200003)37:2<135::AID-
PITS5>3.0.CO;2-U
*Docking, K., Munro, N., Cordier, R., & Ellis, P. (2013). Examining the language skills of children with ADHD following a play-based intervention. Child
Language Teaching and Therapy, 29, 291–304. https://doi.org/10.1177/0265659012469042
Dowd, T. P., & Tierney, J. (2017). Teaching social skills to youth: A step-by-step guide to 182 basic to complex skills plus helpful teaching techniques. Boys
Town, NE: Boys Town Press.
*Indicates studies that were systematically reviewed for this article.
The American Journal of Occupational Therapy, March/April 2020, Vol. 74, No. 2 7402180070p9
Research Article
DuPaul, G. J., & Weyandt, L. L. (2006). School-based intervention for children with attention deficit hyperactivity disorder: Effects on academic, social, and
behavioural functioning. International Journal of Disability, Development and Education, 53, 161–176. https://doi.org/10.1080/10349120600716141
*Frankel, F., Myatt, R., Cantwell, D. P., & Feinberg, D. T. (1997). Parent-assisted transfer of children’s social skills training: Effects on children with and without
attention-deficit hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1056–1064. https://doi.org/10.1097/
00004583-199708000-00013
Gresham, F. M., & Elliott, S. N. (1990). Social Skills Rating System: Manual. Circle Pines, MN: American Guidance Service.
Gresham, F. M., & Elliott, S. N. (2008). Social Skills Improvement System: Rating scales manual. Minneapolis: NCS Pearson.
*Hansen, S., Meissler, K., & Ovens, R. (2000). Kids Together: A group play therapy model for children with ADHD symptomatology. Journal of Child and
Adolescent Group Therapy, 10, 191–211. https://doi.org/10.1023/A:1016631228545
Higgins, J. P. T., Altman, D. G., & Sterne, J. A. C. (2011). Assessing risk of bias in included studies. In J. P. T. Higgins & S. Green (Eds.), Cochrane handbook for
systematic reviews of interventions (Version 5.1.0). London: Cochrane Collaboration. Retrieved from http://handbook-5-1.cochrane.org
Hodgens, J. B., Cole, J., & Boldizar, J. (2000). Peer-based differences among boys with ADHD. Journal of Clinical Child Psychology, 29, 443–452. https://doi.
org/10.1207/S15374424JCCP2903_15
Hoza, B., Mrug, S., Gerdes, A. C., Hinshaw, S. P., Bukowski, W. M., Gold, J. A., . . . Arnold, L. E. (2005). What aspects of peer relationships are impaired in
children with attention-deficit/hyperactivity disorder? Journal of Consulting and Clinical Psychology, 73, 411–423. https://doi.org/10.1037/0022-006X.73.
3.411
*Hoza, B., Mrug, S., Pelham, W. E., Jr., Greiner, A. R., & Gnagy, E. M. (2003). A friendship intervention for children with attention-deficit/hyperactivity disorder:
Preliminary findings. Journal of Attention Disorders, 6, 87–98. https://doi.org/10.1177/108705470300600301
Kamphaus, R. W., & Reynolds, C. R. (2006). Parenting Relationship Questionnaire. Minneapolis: NCS Pearson.
Mikami, A. Y. (2010). The importance of friendship for youth with attention-deficit/hyperactivity disorder. Clinical Child and Family Psychology Review, 13,
181–198. https://doi.org/10.1007/s10567-010-0067-y
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G.; PRISMA Group. (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA
statement. PLoS Medicine, 6(7), e1000097. https://doi.org/10.1371/journal.pmed.1000097
Mrug, S., Molina, B. S. G., Hoza, B., Gerdes, A. C., Hinshaw, S. P., Hechtman, L., & Arnold, L. E. (2012). Peer rejection and friendships in children with
attention-deficit/hyperactivity disorder: Contributions to long-term outcomes. Journal of Abnormal Child Psychology, 40, 1013–1026. https://doi.org/10.
1007/s10802-012-9610-2
Normand, S., Schneider, B. H., Lee, M. D., Maisonneuve, M. F., Kuehn, S. M., & Robaey, P. (2011). How do children with ADHD (mis)manage their real-life
dyadic friendships? A multi-method investigation. Journal of Abnormal Child Psychology, 39, 293–305. https://doi.org/10.1007/s10802-010-9450-x
Pekarik, E. G., Prinz, R. J., Liebert, D. E., Weintraub, S., & Neale, J. M. (1976). The Pupil Evaluation Inventory: A sociometric technique for assessing
children’s social behavior. Journal of Abnormal Child Psychology, 4, 83–97. https://doi.org/10.1007/BF00917607
*Plumer, P. J., & Stoner, G. (2005). The relative effects of Classwide Peer Tutoring and peer coaching on the positive social behaviors of children with ADHD.
Journal of Attention Disorders, 9, 290–300. https://doi.org/10.1177/1087054705280796
Reynolds, C. R., & Kamphaus, R. W. (1992). Behavior Assessment System for Children: Manual. Circle Pines, MN: American Guidance Service.
Sackett, D. L. (1989). Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest, 95, 2s–4s
Storebø, O. J., Elmose Andersen, M., Skoog, M., Joost Hansen, S., Simonsen, E., Pedersen, N., . . . Gluud, C. (2019). Social skills training for attention deficit
hyperactivity disorder (ADHD) in children aged 5 to 18 years. Cochrane Database of Systematic Reviews, 6, CD008223. https://doi.org/10.1002/
14651858.CD008223.pub3
Walker, H. M., & Severson, H. H. (1992). Systematic Screening for Behavior Disorders (SSBD): User’s guide and administration manual (2nd ed.). Longmont,
CO: Sopris West.
Waschbusch, D. A. (2002). A meta-analytic examination of comorbid hyperactive-impulsive-attention problems and conduct problems. Psychological
Bulletin, 128, 118–150. https://doi.org/10.1037/0033-2909.128.1.118
*Watkins, D. E., & Wentzel, K. R. (2008). Training boys with ADHD to work collaboratively: Social and learning outcomes. Contemporary Educational
Psychology, 33, 625–646. https://doi.org/10.1016/j.cedpsych.2008.01.004
*Wilkes, S., Cordier, R., Bundy, A., Docking, K., & Munro, N. (2011). A play-based intervention for children with ADHD: A pilot study. Australian Occupational
Therapy Journal, 58, 231–240. https://doi.org/10.1111/j.1440-1630.2011.00928.x
*Wilkes-Gillan, S., Bundy, A., Cordier, R., & Lincoln, M. (2014). Eighteen-month follow-up of a play-based intervention to improve the social play skills of
children with attention deficit hyperactivity disorder. Australian Occupational Therapy Journal, 61, 299–307. https://doi.org/10.1111/1440-1630.12124
*Wilkes-Gillan, S., Bundy, A., Cordier, R., & Lincoln, M. (2016). Child outcomes of a pilot parent-delivered intervention for improving the social play skills of
children with ADHD and their playmates. Developmental Neurorehabilitation, 19, 238–245. https://doi.org/10.3109/17518423.2014.948639
*Wilkes-Gillan, S., Bundy, A., Cordier, R., Lincoln, M., & Chen, Y. W. (2016). A randomised controlled trial of a play-based intervention to improve the social
play skills of children with attention deficit hyperactivity disorder (ADHD). PLoS One, 11, e0160558. https://doi.org/10.1371/journal.pone.0160558
Young, S., & Amarasinghe, J. M. (2010). Practitioner review: Non-pharmacological treatments for ADHD: A lifespan approach. Journal of Child Psychology and
Psychiatry, and Allied Disciplines, 51, 116–133. https://doi.org/10.1111/j.1469-7610.2009.02191.x
The American Journal of Occupational Therapy, March/April 2020, Vol. 74, No. 2 7402180070p10
Research Article
Ashley Fox, MOT, OTR, is Occupational Therapist, Northside Independent School District, San Antonio, TX.
Stephanie Dishman, MOT, OTR, is Occupational Therapist, ATI Physical Therapy, San Antonio, TX.
Mary Valicek, MOT, OTR, is Graduate, Department of Occupational Therapy, University of Texas Medical Branch, Galveston.
Karen Ratcliff, PhD, OTR, is Assistant Professor, Department of Occupational Therapy, University of Texas Medical Branch, Galveston.
Claudia Hilton, PhD, MBA, OTR, FAOTA, is Associate Professor, Department of Occupational Therapy, University of Texas Medical Branch, Galveston; [email protected]
Acknowledgments This study was completed at the University of Texas Medical Branch, Galveston. We thank Chelsea Jordan for assistance with establishing a research topic and initial article searching.
The American Journal of Occupational Therapy, March/April 2020, Vol. 74, No. 2 7402180070p11
Research Article
Ap pe
nd ix
A
Ev id en ce
an d R is k- of -B ia s Ta bl es
Ta bl e A. 1.
Ev id en
ce Ta
bl e fo r So
ci al
Sk ill s In te rv en
tio ns
In co rp or at in g Pe
er In te ra ct io ns
fo r Ch
ild re n W ith
AD H D
Au th or /Y ea
r Le
ve l of
Ev id en
ce /S tu dy
D es ig n/
Pa rt ic ip an
ts /In
cl us io n Cr ite
ri a
In te rv en
tio n an
d Co
nt ro l
O ut co m e M ea
su re s
R es ul ts
Pl ay -B as ed
In te rv en tio
ns In co rp or at in g Pe
er s W ith
ou t AD
H D
Ba rn es
et al . (2 01
7) Le ve lI II
O ne
gr ou
p, no
nr an do
m iz ed ,
pr et es t– po
st te st
N = 26
n = 13
ch ild re n w ith
AD H D (8 4. 6%
m al e;
M ag e = 10
.0 yr )
n = 13
TD pl ay m at es
(4 6. 2%
m al e;
M ag e = 9. 3 yr )
H om
e vi si t, n = 13 ;c lin ic vi si t, n = 12
(1 ch ild
di sc on tin ue d pa rt ic ip at io n af te rc ol le ct io n of
ho m e vi si t da ta )
In cl us io n Cr ite ria
Ch ild re n w ith
AD H D : Cl in ic al ly si gn
ifi ca nt
le ve lo
f sy m pt om
s on
th e CC
BR S
Si m ila r- ag e TD
pl ay m at es :S
pe nt
si gn
ifi ca nt
am ou nt
of tim
e w ith
th e ch ild
w ith
AD H D ,
di d no t re pr es en t AD
H D on
th e CC
BR S,
no de ve lo pm
en ta ld
is or de rs , no
in di ca tio n of
de ve lo pm
en ta li ss ue s
In te rv en tio n
6 1- hr
cl in ic se ss io ns
an d w ee kl y ho m e
m od ul es
of an
in te rv en tio n to
im pr ov e
so ci al pl ay
sk ill s in vo lv in g vi de o
re co rd in g,
pa re nt
su rv ey s,
an d
ob se rv at io n
Co nt ro l
N o co nt ro l
• To
P • PR
Q • SS
IS
N o si gn
ifi ca nt
di ffe re nc e w as
fo un d
be tw ee n m ea n To
P sc or es
fr om
th e
or ig in al st ud
y an d sc or es
fr om
a fo llo w -u p
ho m e vi si t (d
= 0. 68 , p = .3 6) .
Im pr ov em
en ts
in so ci al pl ay
sk ill s w er e
su st ai ne d in
th e ho m e en vi ro nm
en t bu t
no ti n th e cl in ic al en vi ro nm
en t( d = 0. 68 ).
Ca nt ril le t al . (2 01
5) Le ve lI II
Fo llo w -u p st ud y
N = 10
ch ild re n an d th ei r m ot he rs
n = 5 ch ild re n w ith
AD H D (8 0%
m al e,
M ag e = 10
.0 yr ) an d th ei r m ot he rs
(M ag e = 42
.4 yr )
n = 5 TD
pl ay m at es
(4 0%
m al e,
M ag e =
10 .8 yr )a nd
th ei rm
ot he rs (M
ag e = 41
.5 yr )
In cl us io n Cr ite ria
Ag es
6– 11 , co m pl et ed
th e pa re nt -d el iv er ed
in te rv en tio n 18
m o pr io r, fo rm
al di ag no si s
of AD
H D ,c on tin ue d m ed ic at io n th ro ug ho ut
st ud y
In te rv en tio n
18 -m
o fo llo w -u p of
W ilk es -G ill an ,B
un dy ,
Co rd ie r, & Li nc ol n (2 01
6) th at
us ed
To P
an d se m is tr uc tu re d in te rv ie w s to
as se ss
m ai nt en an ce
of pl ay
sk ill s af te r a 7- w k,
pa re nt -d el iv er ed , pl ay -b as ed
in te rv en tio n
to pr om
ot e pr os oc ia lb
eh av io rs
Co nt ro l
N o co nt ro l
• To
P • PR
Q • Se m is tr uc tu re d in te rv ie w s
Pl ay
sk ill s fo r bo
th ch ild re n w ith
AD H D
an d TD
ch ild re n di d no
t im pr ov e
si gn
ifi ca nt ly bu tw
er e m ai nt ai ne d (p
= .0 7)
18 m o af te r in te rv en tio n.
Pa re nt s re po
rt ed
th at th e pr og ra m
he lp ed
th ei r ch ild re n de ve lo p so ci al sk ill s an d
aw ar en es s.
(C on tin ue d )
The American Journal of Occupational Therapy, March/April 2020, Vol. 74, No. 2 7402180070p12
Research Article
Ta bl e A. 1.
Ev id en
ce Ta
bl e fo r So
ci al
Sk ill s In te rv en
tio ns
In co rp or at in g Pe
er In te ra ct io ns
fo r Ch
ild re n W ith
AD H D
(C on
t. )
Au th or /Y ea
r Le
ve l of
Ev id en
ce /S tu dy
D es ig n/
Pa rt ic ip an
ts /In
cl us io n Cr ite
ri a
In te rv en
tio n an
d Co
nt ro l
O ut co m e M ea
su re s
R es ul ts
Co rd ie r et
al . (2 01 3)
Le ve lI II
O ne
gr ou
p, no
nr an do
m iz ed ,
pr et es t– po
st te st
N = 14
(7 1. 4%
m al e;
M ag e = 7. 6 yr )
In cl us io n Cr ite ria
AD H D di ag no
si s,
co ul d ha ve
co m or bi d
co nd iti on s,
on m ed ic at io ns , LD
s pr es en t
In te rv en tio n
7- w k, pl ay -b as ed
in te rv en tio n to
im pr ov e
so ci al sk ill s th at
pa ire d ch ild re n w ith
AD H D w ith
a TD
pl ay m at e an d in cl ud ed
vi de o fe ed ba ck ,m
od el ed
pl ay ,a nd
pa re nt
tr ai ni ng
Co nt ro l
N o co nt ro l
• PP
• S- M AP
s Bo
th ou tc om
e m ea su re s re ve al ed
si gn
ifi ca nt
im pr ov em
en t in
pr ag m at ic
la ng
ua ge
(P P,
p = .0 06 ; S- M AP
s, p = .0 01 ).
D oc ki ng
et al . (2 01 3)
Le ve lI II
O ne
gr ou
p, no
nr an do
m iz ed ,
pr et es t– po
st te st
N = 28
n = 14
ch ild re n w ith
AD H D (7 1. 4%
m al e;
M ag e = 7. 6 yr )
n = 14
TD pl ay m at es
(5 7. 1%
m al e; M
ag e =
7. 3 yr )
In cl us io n Cr ite ria
Fo rm
al di ag no si s of
AD H D , co ul d be
on m ed ic at io ns , co ul d ha ve
co m or bi d
co nd
iti on
s
In te rv en tio n
7- w k, pl ay -b as ed
in te rv en tio n to
im pr ov e
co m m un ic at io n an d pl ay
sk ill s th at pa ire d
ch ild re n w ith
AD H D w ith
a TD
pl ay m at e
an d in cl ud
ed vi de o fe ed ba ck , m od
el ed
pl ay , an d pa re nt
tr ai ni ng
Co nt ro l
N o co nt ro l
• To
P • CC
C– 2
• TO
PS – 3
Si gn
ifi ca nt
im pr ov em
en ts
in pl ay
sk ill s
oc cu rr ed
in ch ild re n w ith
AD H D w ho
di d
(p = .0 02 )a nd
di d no
th av e LD
s (p
= .0 07 ).
Co m m un
ic at io n an d pr ag m at ic la ng
ua ge
ab ili tie s of
th e ch ild re n w ith
AD H D di d no t
si gn
ifi ca nt ly im pr ov e (p
= .5 28
).
W ilk es
et al . (2 01
1) Le ve lI II
O ne
gr ou
p, no
nr an do
m iz ed ,
pr et es t– po
st te st
N = 28
n = 14
ch ild re n w ith
AD H D (7 1. 4%
m al e;
M ag e = 7. 6 yr )
n = 14
TD pl ay m at es
(5 7. 1%
m al e; M
ag e =
7. 3 yr )
In cl us io n Cr ite ria
Bo th
gr ou
ps :P
ro fi ci en t in
En gl is h,
pa re nt al
pa rt ic ip at io n
Ch ild re n w ith
AD H D : Fo rm
al AD
H D
di ag no si s,
co ul d ha ve
co m or bi d co nd
iti on
, no
m aj or
ne ur od
ev el op
m en ta lo rp
sy ch ia tr ic
di so rd er
TD pl ay m at es : Si m ila r ag e as
ch ild
w ith
AD H D , kn ew
ch ild
be fo re , no
di ag no si s of
AD H D , co ul d be
si bl in g,
no de ve lo pm
en ta l
or be ha vi or
co nc er ns
In te rv en tio n
7- w k, pl ay -b as ed
in te rv en tio n to
im pr ov e
so ci al sk ill s th at
pa ire d ch ild re n w ith
AD H D w ith
a TD
pl ay m at e an d in cl ud ed
vi de o fe ed ba ck ,m
od el ed
pl ay ,a nd
pa re nt
tr ai ni ng
Co nt ro l
N o co nt ro l
• To P
Pl ay
sk ill s im pr ov ed
si gn ifi ca nt ly fo r bo
th th e ch ild re n w ith
AD H D an d th ei r TD
pl ay m at es
(p < .0 1) .
TD pl ay m at es
sh ow
ed si gn
ifi ca nt
im pr ov em
en ts
in so ci al pl ay
(p < .0 1) .
(C on tin ue d )
The American Journal of Occupational Therapy, March/April 2020, Vol. 74, No. 2 7402180070p13
Research Article
Ta bl e A. 1.
Ev id en
ce Ta
bl e fo r So
ci al
Sk ill s In te rv en
tio ns
In co rp or at in g Pe
er In te ra ct io ns
fo r Ch
ild re n W ith
AD H D
(C on
t. )
Au th or /Y ea
r Le
ve l of
Ev id en
ce /S tu dy
D es ig n/
Pa rt ic ip an
ts /In
cl us io n Cr ite
ri a
In te rv en
tio n an
d Co
nt ro l
O ut co m e M ea
su re s
R es ul ts
W ilk es -G ill an
et al . (2 01 4)
Le ve lI II
D es cr ip tiv e st ud y w ith
an al ys is of
ou tc om
es
N = 10
n = 5 ch ild re n w ith
AD H D (1 00 %
m al e;
M ag e = 8. 9 yr )
n = 5 TD
pl ay m at es
(8 0%
m al e;
M ag e =
8. 7 yr )
In cl us io n Cr ite ria
Ch ild re n w ith
AD H D : Pr im ar y di ag no si s of
AD H D co nfi rm
ed by
D SM
– IV
an d CC
BR S,
no m aj or
ne ur ol og ic al or
ps yc hi at ric
di so rd er , ag es
6 to
11 , co ul d be
on m ed ic at io ns
TD pl ay m at es : Fa m ili ar
w ith
an d re gu la rly
en ga ge d w ith
ch ild
w ith
AD H D ;a ge s 6 to 11
; co ul d be
pe er , co m m un
ity fr ie nd
, or
fa m ily
m em
be r; no
di ag no si s of
AD H D ; no
de ve lo pm
en ta lo
r be ha vi or
co nc er ns
In te rv en tio n
18 -m
o fo llo w -u p of
W ilk es
et al . (2 01
1) us in g pl ay
ob se rv at io ns
an d pa re nt
in te rv ie w s to
as se ss
m ai nt en an ce
of pl ay
sk ill s af te r a 7- w k,
pl ay -b as ed
in te rv en tio n to
im pr ov e so ci al pl ay
sk ill s
Co nt ro l
N o co nt ro l
• To
P • Se m is tr uc tu re d in te rv ie w s
Ch ild re n w ith
AD H D m ai nt ai ne d ga in s 18
m o af te r th e in te rv en tio n;
no si gn ifi ca nt
re gr es si on
in so ci al pl ay
sk ill s w as
re po rt ed
be tw ee n po
st te st
an d 18
-m o
fo llo w -u p (p
= .8 9) .
W ilk es -G ill an , Bu
nd y,
Co rd ie r, &
Li nc ol n (2 01 6)
Le ve lI II
O ne
gr ou
p, no
nr an do
m iz ed ,
pr et es t– po
st te st
N = 18
ch ild re n
n = 9 ch ild re n w ith
AD H D (8 8. 9%
m al e;
M ag e = 8. 2 yr )
n = 9 TD
pl ay m at es
(4 4. 4%
m al e; M
ag e =
8. 9 yr )
N = 16
pa re nt s of
th e ch ild re n w ith
AD H D
(5 6. 3%
m al e;
M ag e = 41
.7 yr )
In cl us io n Cr ite ria
Ch ild re n w ith
AD H D : Fo rm
al di ag no si s of
AD H D , no
ne ur od ev el op
m en ta lo
r ps yc hi at ric
di so rd er s,
m ai nt ai ne d
m ed ic at io n st at us , pa rt ic ip at io n of
at le as t
1 pa re nt
TD pl ay m at es : N o di ag no
si s of
AD H D , no
co nc er ns
ab ou
td ev el op m en t, co ul d be
pe er
or si bl in g, re gu la rly
in te ra ct ed
w ith
th e ch ild
w ith
AD H D
In te rv en tio n
7- w k,
pa re nt -d el iv er ed , pl ay -b as ed
in te rv en tio n to
pr om
ot e pr os oc ia l
be ha vi or s th at
us ed
fe ed ba ck
an d
ob se rv ed
th er ap is t- su pp or te d pl ay
Co nt ro l
N o co nt ro l
• To P
So ci al pl ay
sk ill s im pr ov ed
si gn ifi ca nt ly in
th e ch ild re n w ith
AD H D fr om
pr e-
to po st in te rv en tio n (p
= .0 3) ,w
ith co nt in ue d
im pr ov em
en ta t1
-m o fo llo w -u p (p
= .0 2) .
So ci al pl ay
sk ill s of
pl ay m at es
im pr ov ed
si gn
ifi ca nt ly fr om
pr e-
to po st in te rv en tio n
(p = .0 2) .
(C on tin ue d )
The American Journal of Occupational Therapy, March/April 2020, Vol. 74, No. 2 7402180070p14
Research Article
Ta bl e A. 1.
Ev id en
ce Ta
bl e fo r So
ci al
Sk ill s In te rv en
tio ns
In co rp or at in g Pe
er In te ra ct io ns
fo r Ch
ild re n W ith
AD H D
(C on
t. )
Au th or /Y ea
r Le
ve l of
Ev id en
ce /S tu dy
D es ig n/
Pa rt ic ip an
ts /In
cl us io n Cr ite
ri a
In te rv en
tio n an
d Co
nt ro l
O ut co m e M ea
su re s
R es ul ts
W ilk es -G ill an , Bu
nd y,
Co rd ie r,
Li nc ol n,
& Ch
en (2 01
6) Le ve lI
R CT
N = 58
ch ild re n
N = 37
ad ul ts
In te rv en tio n- fi rs tg ro up :n
= 15
ch ild re n w ith
AD H D (8 6. 7%
m al e; M
ag e = 8. 2 yr ), n = 15
TD pl ay m at es
(6 6. 7%
m al e; M ag e = 8. 5 yr ),
n = 24
pa re nt s of ch ild re n w ith
AD H D (M
ag e =
41 .9
yr )
Co nt ro l-fi
rs t gr ou
p: n = 14
ch ild re n w ith
AD H D (8 5. 7%
m al e; M
ag e = 8. 5 yr ), n = 14
TD pl ay m at es
(2 1. 4%
m al e; M ag e = 7. 9 yr ),
n = 13
pa re nt s of ch ild re n w ith
AD H D (M
ag e =
42 .3
yr )
In cl us io n Cr ite ria
Ch ild re n w ith
AD H D : Fo rm
al di ag no si s of
AD H D , ag es
5 to
11 , no
co m or bi di tie s,
no di ag no si s of
m aj or
de ve lo pm
en ta ld is or de r,
co ul d be
on m ed ic at io n
TD pl ay m at es : Ch
os en
by ch ild re n w ith
AD H D , no
t di ag no
se d w ith
an y
de ve lo pm
en ta ld
is or de r, no
co nc er ns
re ga rd in g de ve lo pm
en t, w ee kl y in te ra ct io ns
w ith
ch ild
w ith
AD H D , co ul d be
si bl in g
Pa re nt s of
ch ild re n w ith
AD H D : At
le as t 1
pa re nt pr es en ta ts es si on s he ld in th e cl in ic ,
pe rf or m
as si gn
ed ho
m e ac tiv iti es , re po
rt an y m ed ic at io n ch an ge s
In te rv en tio n
10 -w k pl ay -b as ed
in te rv en tio n to
im pr ov e
pl ay fu ln es s an d so ci al sk ill s w ith
a TD
pl ay m at e an d pa re nt
in vo lv em
en t
Pa re nt s: R ec ei ve d 1 hr
of tr ai ni ng
th e fi rs t
w ee k,
jo in ed
a fe ed ba ck
se ss io n,
pa rt ic ip at ed
in di sc us si on s w ith
ch ild ,
or ga ni ze d pl ay da te s,
an d de liv er ed
m od
ul es
w ee kl y
Co nt ro l
N o tr ea tm
en t fo r 10
w k,
th en
th e sa m e
in te rv en tio n as
th e in te rv en tio n- fi rs t
gr ou
p
• To P
Th e in te rv en tio n- fi rs tg
ro up
de m on
st ra te d
si gn
ifi ca nt ly gr ea te r im pr ov em
en ts
in ov er al lp
la y sk ill s th an
th e co nt ro l-fi
rs t
gr ou p,
t( 14
) = 8. 02 , p < .0 01 .
Si gn
ifi ca nt im pr ov em
en ts oc cu rr ed
in To
P so ci al ite m s fr om
pr e-
to po st in te rv en tio n
an d fr om
pr ei nt er ve nt io n to
1- m o fo llo w -
up (p
< .0 01 ).
N o si gn
ifi ca nt
di ffe re nc e in
so ci al sk ill s
oc cu rr ed
fr om
po st in te rv en tio n to
1- m o
fo llo w -u p,
de m on st ra tin g m ai nt en an ce
of sk ill s ( p
> .0 5) .
Sc ho ol -B as ed
In te rv en tio
ns In co rp or at in g Pe
er s W ith
ou t AD
H D
D av ie s & W itt e (2 00
0) Le ve lI V
Si ng le -c as e ex pe rim
en ta l( AB
AB re ve rs al )
N = 50
n = 8 ch ild re n w ith
AD H D (5 0%
m al e;
M ag e = 9 yr )
n = 42
TD pe er s
In cl us io n Cr ite ria
Ch ild re n in
3r d- gr ad e cl as sr oo m
to ge th er
In te rv en tio n
Se lf- m an ag em
en ta nd
gr ou p co nt in ge nc y
in te rv en tio n us in g pe er pa rt ne rs ,a
re w ar d
sy st em
, an d gr ou p fe ed ba ck
in th e
cl as sr oo m
to re du ce
th e fr eq ue nc y of
ta rg et ed
in ap pr op
ria te
be ha vi or s,
30 -m
in se ss io ns
ea ch
m or ni ng
fo r 12
da ys ,
fo llo w ed
by a se co nd
10 -d ay
in te rv en tio n
pe rio
d
Co nt ro l
N o co nt ro l
• In ap pr op ria te
ve rb al iz at io n fr eq ue nc y
co un
ts Th
e ch ild re n w ith
AD H D m ad e
si gn
ifi ca nt ly m or e in ap pr op
ria te
ve rb al iz at io ns
th an
th e TD
pe er s at th e fi rs t
ba se lin e (p
< .0 5) , bu
t no
si gn
ifi ca nt
di ffe re nc e w as
fo un
d at
th e se co nd
ba se lin e.
(C on tin ue d )
The American Journal of Occupational Therapy, March/April 2020, Vol. 74, No. 2 7402180070p15
Research Article
Ta bl e A. 1.
Ev id en
ce Ta
bl e fo r So
ci al
Sk ill s In te rv en
tio ns
In co rp or at in g Pe
er In te ra ct io ns
fo r Ch
ild re n W ith
AD H D
(C on
t. )
Au th or /Y ea
r Le
ve l of
Ev id en
ce /S tu dy
D es ig n/
Pa rt ic ip an
ts /In
cl us io n Cr ite
ri a
In te rv en
tio n an
d Co
nt ro l
O ut co m e M ea
su re s
R es ul ts
Pl um
er & St on
er (2 00
5) Le ve lI V
Si ng
le -s ub
je ct
de si gn
N = 3 (3 3. 3%
m al e;
M ag e = 9. 67
yr )
In cl us io n Cr ite ria
M et
di ag no st ic cr ite ria
fo r AD
H D , pa re nt -
an d te ac he r- re po rt ed
AD H D sy m pt om
s an d
pr ob le m s w ith
pe er
so ci al re la tio ns
In te rv en tio n
CW PT
an d co ac hi ng
by a te ac he r- se le ct ed
pe er
w ith
at le as t av er ag e ac ad em
ic ac hi ev em
en t an d go od
be ha vi or
in cl as s;
in te rv en tio n in cl ud ed
po in t- re w ar d
sy st em
, go al se tti ng
an d re m in de rs , an d
pe er
pe rf or m an ce
fe ed ba ck , 20 – 25
m in /
da y,
3 da ys /w k fo r ap pr ox . 10
w k
Co nt ro l
N o co nt ro l
• SS
R S
• SS
BD • BA
SC
O n th e SS
BD , al l3
ch ild re n sh ow
ed im pr ov em
en ts
in po
si tiv e so ci al be ha vi or
of 84
% , 84
% , an d 87
% in
th e ac ad em
ic se tti ng
;2 st ud en ts sh ow
ed im pr ov em
en ts
of 28
% an d 21
% in
th e so ci al se tti ng .
O nc e pe er
co ac hi ng
w as
ad de d to
th e
CW PT
in la te r ph as es , th e 3 st ud en ts ’
m ea n po
si tiv e so ci al be ha vi or s in cr ea se d
fr om
32 %
to 62
% ,4 7%
to 75
% ,a nd
69 %
to 90
% .
O n th e BA
SC , 1 ch ild
im pr ov ed
in be ha vi or al an d em
ot io na lq
ua lit ie s fr om
th e cl in ic al to
th e at -r is k ra ng e,
an d th e
ot he r 2 im pr ov ed
fr om
th e at -r is k to
th e
av er ag e ra ng e.
In te rp re ta tio n of th es e re su lts
is lim
ite d by
th e la ck
of si gn
ifi ca nc e da ta .
W at ki ns
& W en tz el (2 00
8) Le ve lI V
W ith in -s ub je ct
de si gn
N = 27
n = 24
ch ild re n w ith
AD H D (1 00 %
m al e;
M ag e = 11
.1 yr )
n = 3 pe er
pa rt ne rs
(0 %
m al e;
M ag e no
t re po
rt ed )
In cl us io n Cr ite ria
Ch ild re n w ith
AD H D :T
ea ch er -, pa re nt -, an d
ot he r- re po rt ed
cl in ic al ly si gn ifi ca nt
sy m pt om
s (C CB
R S te ac he r ra tin g sc al e) ,
lo w to
av er ag e ac ad em
ic ac hi ev em
en t
sc or es
(M et ro po
lit an
Ac hi ev em
en t Te st ),
cu rr en t st im ul an t tr ea tm
en t as
pr es cr ib ed
Pe er
pa rt ne rs : Ac ad em
ic ac hi ev em
en t
sc or es
in 10 th
pe rc en til e (M
et ro po lit an
Ac hi ev em
en t Te st ), gr ea te r th an
av er ag e
in te lli ge nc e (W
IS C–
III ), G PA
≥ 3. 5,
pa rt of
gi fte d pr og
ra m , no
m in at ed
by te ac he r or
ot he r fo r go
od so ci al sk ill s,
no AD
H D
sy m pt om
s (C CB
R S te ac he r ra tin g sc al e)
In te rv en tio n
Si ng le se ss io n (n o tim
e lim
it) of
an er ra nd -p la nn in g ta sk
in w hi ch
pe er
pa rt ne rs
tr ai ne d to
im pr ov e in te ra ct io ns
w ith
th e ch ild re n w ith
AD H D pr ov id ed
su pp
or t in
pl an ni ng
th e m os t ef fi ci en t
ro ut e
Co nt ro l
N o co nt ro l
• Sy st em
at ic ob se rv at io na lc od in g sy st em
of 8 ta rg et
be ha vi or s
Co m pa re d w ith
pr et es t re su lts , th e
ch ild re n w ith
AD H D sh ow
ed in cr ea se d
jo in t pa rt ic ip at io n be ha vi or s (p
< .0 1,
d = 0. 70 ), de cr ea se d do
m in an ce
be ha vi or s
(p < .0 1,
d = 0. 83 ), an d im pr ov ed
co lla bo ra tio n be ha vi or s (p
< .0 1, d = 0. 60 ).
(C on tin ue d )
The American Journal of Occupational Therapy, March/April 2020, Vol. 74, No. 2 7402180070p16
Research Article
Ta bl e A. 1.
Ev id en
ce Ta
bl e fo r So
ci al
Sk ill s In te rv en
tio ns
In co rp or at in g Pe
er In te ra ct io ns
fo r Ch
ild re n W ith
AD H D
(C on
t. )
Au th or /Y ea
r Le
ve l of
Ev id en
ce /S tu dy
D es ig n/
Pa rt ic ip an
ts /In
cl us io n Cr ite
ri a
In te rv en
tio n an
d Co
nt ro l
O ut co m e M ea
su re s
R es ul ts
In te rv en tio
ns In co rp or at in g Pe
er s W ith
AD H D
Co rk um
et al . (2 01 0)
Le ve lI II
O ne
gr ou
p, no
nr an do
m iz ed ,
pr et es t– po
st te st
N = 16
ch ild re n w ith
AD H D (6 2. 5%
m al e;
M ag e = 9. 96
yr )
In cl us io n Cr ite ria
D ia gn
os is of
AD H D , so ci al di ffi cu lti es
In te rv en tio n
10 w ee kl y 1- hr
gr ou
p se ss io ns
of th e
W or ki ng
To ge th er
Pr og
ra m
co ns is tin g of
pr es en ta tio n of a fo lk ta le ,d is cu ss io n of its
re la tio n to
a so ci al sk ill ,r ol e- pl ay in g,
an d
m ai nt en an ce
ac tiv iti es
Co nt ro l
N o co nt ro l
• SS
R S
Bo th
pa re nt s (p
= .0 5)
an d te ac he rs
(p =
.0 4)
ra te d th e ch ild re n’ s ov er al ls oc ia l
sk ill s si gn
ifi ca nt ly hi gh er
at po st tr ea tm
en t
co m pa re d w ith
pr et re at m en t.
Th e ch ild re n’ s po st tr ea tm
en t se lf- ra tin gs
w er e sl ig ht ly bu
t no
t si gn
ifi ca nt ly hi gh
er th an
th ei r pr et re at m en t ra tin gs
(p = .0 8) .
Fr an ke le t al . (1 99 7)
Le ve lI I
Tw o gr ou ps , no
nr an do
m iz ed
N = 73
n = 47
ch ild re n w ith
AD H D (7 7%
m al e;
M ag e = 9. 1 yr )
n = 26
ch ild re n w ith ou
t AD
H D
In te rv en tio n gr ou
p, n = 49
(3 5 w ith
AD H D ,
14 w ith ou t AD
H D )
Co nt ro lg
ro up
, n = 24
(1 2 w ith
AD H D , 12
w ith ou t AD
H D )
In cl us io n Cr ite ria
Ch ild re n w ith
AD H D : AD
H D di ag no si s w ith
no se co nd ar y di ag no si s,
pr es cr ib ed
st im ul an t m ed ic at io n,
en ro lle d in
ge ne ra l
ed uc at io n
In te rv en tio n
12 w ee kl y 1- hr
se ss io ns
of so ci al sk ill s
tr ai ni ng
ad dr es si ng
gr ou p en tr y
te ch ni qu es
an d co nv er sa tio na ls ki lls ,
co ac he d pl ay , an d ho
m ew
or k
as si gn
m en ts to
be co m pl et ed
by ch ild re n
an d pa re nt s
Co nt ro l
W ai t lis t
• PE
I • SS
R S
Th e in te rv en tio n gr ou p ha d si gn ifi ca nt ly
be tte r ou
tc om
es th an
th e co nt ro lg
ro up
(p < .0 5) .
Ch ild re n w ith
AD H D de m on st ra te d
im pr ov ed
pe rf or m an ce
on al lm
ea su re s of
th e PE
I (p
< .0 5)
ex ce pt
w ith dr aw
al (p
> .0 5) .
N o si gn
ifi ca nt
gr ou p di ffe re nc es
w er e
fo un
d on
th e PE
I H yp er ac tiv ity
an d
In at te nt io n sc al es
(p > .2 5) .
H an se n et
al . (2 00
0) Le ve lI II
O ne
gr ou
p, no
nr an do
m iz ed
N = 30
(8 0%
m al e;
M ag e = 10
.5 yr )
In cl us io n Cr ite ria
AD H D di ag no
si s,
ag es
5– 17
, an y ra ce ,
co m pl et io n of
pr e– po
st m ea su re s by
pa re nt
or ca re gi ve r, re ce iv in g in di vi du al th er ap y,
ta ki ng
st im ul an t m ed ic at io n
In te rv en tio n
15 -w k Ki ds
To ge th er pr og ra m co m pr is in g
2- hr
bi w ee kl y se ss io ns
in w hi ch
pl ay
th er ap y,
ex pr es si ve
ar ts , di sc us si on s,
th er ap eu tic
ac tiv iti es , ga m es , an d
re cr ea tio na la ct iv iti es
w er e us ed
to en ha nc e so ci al sk ill s in
a gr ou p th er ap y
se tti ng
Co nt ro l
N o co nt ro l
• CB
CL Th
e ch ild re n de m on
st ra te d si gn
ifi ca nt
im pr ov em
en t in
in te rn al iz in g be ha vi or
pr ob le m s (p
= .0 08 ) an d to ta lb
eh av io r
pr ob le m s (p
= .0 11 ).
Ex te rn al iz in g be ha vi or s de cr ea se d, bu tn ot
si gn
ifi ca nt ly (p
= .0 51
).
(C on tin ue d )
The American Journal of Occupational Therapy, March/April 2020, Vol. 74, No. 2 7402180070p17
Research Article
Ta bl e A. 1.
Ev id en
ce Ta
bl e fo r So
ci al
Sk ill s In te rv en
tio ns
In co rp or at in g Pe
er In te ra ct io ns
fo r Ch
ild re n W ith
AD H D
(C on
t. )
Au th or /Y ea
r Le
ve l of
Ev id en
ce /S tu dy
D es ig n/
Pa rt ic ip an
ts /In
cl us io n Cr ite
ri a
In te rv en
tio n an
d Co
nt ro l
O ut co m e M ea
su re s
R es ul ts
H oz a et
al . (2 00
3) Le ve lI II
O ne
gr ou
p, no
nr an do
m iz ed
N = 20
9 (9 0%
m al e;
M ag e = 8. 98
yr )
In cl us io n Cr ite ria
AD H D di ag no
si s,
ag es
5– 12
In te rv en tio n
8- w k su m m er
be ha vi or al tr ea tm
en t
pr og ra m , 9 hr /d ay , 5 da ys /w k,
th at
in cl ud
ed a be ha vi or al po
in t sy st em
, pe er -o rie nt ed
in te rv en tio ns , sp or ts
sk ill s tr ai ni ng , ac ad em
ic re m ed ia tio n,
re cr ea tio na la ct iv iti es , so ci al sk ill s
tr ai ni ng , co op er at iv e ta sk s,
pr ob le m -
so lv in g tr ai ni ng ,a ng er
m an ag em
en t, an d
pa re nt
tr ai ni ng s
Co nt ro l
N o co nt ro l
• Pa re nt al co m pl ia nc e as si gn
m en ts
• Im
pr ov em
en t an d no rm
al iz at io n ra tin g
sc al e
• Q ua lit y of
bu dd y re la tio ns hi p ra tin gs
• FQ
S
Ch ild re n pa ire d w ith
a le ss
an tis oc ia l
bu dd y w er e vi ew
ed as
m or e no
rm al iz ed
(p < .0 01 ), sh ow
ed m or e im pr ov em
en ti n
ac ad em
ic pe rf or m an ce
(p < .0 01 ), an d ha d
hi gh er
qu al ity
fr ie nd sh ip s (p
< .0 01 ).
Pa re nt
co m pl ia nc e w ith
th e bu
dd y sy st em
w as
pr ed ic tiv e of
th ei r ch ild ’s pe rc ep tio n
of co m pa ni on sh ip
(p < .0 01 ) an d w as
m ar gi na lly
pr ed ic tiv e of
po si tiv e
ad ap ta tio n (p
< .1 0) .
N ot e. AD
H D = at te nt io n de fi ci th
yp er ac tiv ity
di so rd er ;B
AS C = Be ha vi or
As se ss m en tS
ys te m
fo r Ch
ild re n;
CB CL
= Ch
ild Be ha vi or
Ch ec kl is t; CC
BR S = Co
nn er s Co
m pr eh en si ve
Be ha vi or
R at in g Sc al es ;C
CC – 2 =
Ch ild re n’ s Co
m m un
ic at io n Ch
ec kl is t, 2n
d ed iti on
;C W PT
= Cl as sw
id e Pe er
Tu to rin
g; D SM
– IV
= D ia gn os tic
an d St at is tic al M an ua lo fM
en ta lD
is or de rs ,4 th
ed iti on
;F Q S = Fr ie nd
sh ip Q ua lit ie s Sc al e; G PA
= gr ad e
po in t av er ag e; LD
s = la ng
ua ge
di ffi cu lti es ;M
= m ea n;
PE I = Pu
pi lE
va lu at io n In ve nt or y; PP
= Pr ag m at ic Pr ot oc ol ;P
R Q = Pa re nt in g R el at io ns hi p Q ue st io nn ai re ;R
CT = ra nd om
iz ed
co nt ro lle d tr ia l; S- M AP
s =
St ru ct ur ed
M ul tid im en si on
al As se ss m en tP
ro fi le s; SS
BD = Sy st em
at ic Sc re en in g fo rB
eh av io rD
is or de rs ;S
SI S = So
ci al Sk ill s Im
pr ov em
en tS
ys te m ;S SR
S = So
ci al Sk ill s R at in g Sy st em
;T D = ty pi ca lly
de ve lo pi ng
; To
P = Te st
of Pl ay fu ln es s;
TO PS
– 3 = Te st
of Pr ob
le m
So lv in g,
3r d ed iti on
; W IS C–
III = W ec hs le r In te lli ge nc e Sc al e fo r Ch
ild re n,
3r d ed iti on
.
The American Journal of Occupational Therapy, March/April 2020, Vol. 74, No. 2 7402180070p18
Research Article
Table A.2. Risk-of-Bias Table
Citation
Selection Bias
Performance Bias: Blinding of
Participants and Personnel
Detection Bias
Attrition Bias: Incomplete
Outcome Data
Reporting Bias:
Selective Reporting
Random Sequence Generation
Allocation Concealment
Blinding of Outcome
Assessment: Self- Reported Outcomes
Blinding of Outcome
Assessment: Objective Outcomes
Barnes et al. (2017)
– – – – + – +
Cantrill et al. (2015)
– – – – + + +
Cordier et al. (2013)
– – – NA + + +
Corkum et al. (2010)
– – – – – + +
Davies & Witte (2000)
– – – – – ? +
Docking et al. (2013)
– – – – ? – +
Frankel et al. (1997)
– – – – – – +
Hansen et al. (2000)
– – – – – – +
Hoza et al. (2003)
– – – – + + +
Plumer & Stoner (2005)
– – – – – + +
Watkins & Wentzel (2008)
– – – – – + +
Wilkes et al. (2011)
– – – NA – – +
Wilkes-Gillan et al. (2014)
– – – – + + +
Wilkes-Gillan, Bundy, Cordier, & Lincoln (2016
– – – – + – +
Wilkes-Gillan, Bundy, Cordier, Lincoln, & Chen (2016)
+ + – NA + + +
Note. Categories for risk of bias are as follows: + = low risk of bias; ? = unclear risk of bias; − = high risk of bias. NA = not applicable because of study design. Risk- of-bias table format adapted from “Assessing Risk of Bias in Included Studies,” by J. P. T. Higgins, D. G. Altman, and J. A. C. Sterne, in Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0), by J. P. T. Higgins and S. Green (Eds.), 2011, London: Cochrane Collaboration. Retrieved from http:// handbook-5-1.cochrane.org. Copyright © 2011 by The Cochrane Collaboration.
The American Journal of Occupational Therapy, March/April 2020, Vol. 74, No. 2 7402180070p19
Research Article
Copyright of American Journal of Occupational Therapy is the property of American Occupational Therapy Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
