Evaluation of social skills of children with attention deficit hyperactivity disorder in the context of theory of mind and executive functions

Aim: In this study, it was aimed to evaluate the social adaptation and skills of girls and boys aged 6-12 years with Attention Deficit Hyperactivity Disorder (ADHD) in the context of theory of mind, executive functions and emotion recognition and compare them with a healthy control group. Materials and Methods: In our study, 59 children aged 6-12 years with ADHD who applied to the outpatient clinics of Ankara University, Department of Child and Adolescent Psychiatry were included. As a control group, 49 children without any psychiatric disorder who were age and gender matched with the ADHD group were included. Participants were informed about the study, invited to the study and written informed consent was obtained from those who agreed. In the first interview, a sociodemographic data form was filled in and a psychiatric diagnostic interview (K-SADS-PL) was conducted. At the end of this interview, the DSM-IV Based Screening and Assessment Scale for Conduct Disorders in Children and Adolescents, the Revised Conners Parent Rating Scale and the SASS-T were given to the families to complete. The DSM-IV Based Screening and Assessment Scale for Conduct Disorders in Children and Adolescents and the Revised Conners Teacher Rating Scale were given for the children's teachers to complete. In the second interview, the children were administered the WISC-IV to assess intelligence; the Chocolate Bar Test, the Ice Cream Truck Test and the Faux Pas Test to assess ToM skills; the WCST, the Stroop Test and the Trail Making Test (computerized with PEBL Launcher Version 2.1) to assess executive functioning skills; and finally the TPANC to assess nonverbal cue understanding and emotion recognition skills. All analyses were performed with IBM SPSS 25.0 and the significance level is accepted as 0.05. Results: The ADHD group had higher scores in all subscale scores and total score in the SASS-T compared to the control group. Theory of mind test performances of ADHD and control groups were similar. The ADHD group performed worse than the control group in all three executive function tests. The control group scored higher than the ADHD group in the three TPANC scores and recognized the feeling of disgust in a shorter time. The control group scored significantly higher in most of the score types of the WISC-IV. A correlation was found between the ToM and executive function test performances of the groups and the scores of the SASS-T. There was a correlation between TPANC total duration score and introversion subscale of the SASS-T. There was a correlation between the groups' FSIQ and SASS-T scores. There was also a correlation between inattention and hyperactivity-impulsivity symptoms in the parent and teacher forms of the groups and SASS-T scores. Conclusions: The ADHD group scored higher in all SASS-T subscale scores and total score. Contrary to our hypotheses, the ToM test performances of the groups were similar. The ADHD group performed worse in executive function tests. Significant differences were found between the groups in terms of TPANC scores and duration scores. Significant correlations were found between the groups' theory of mind skills, executive function test performances, TPANC scores, FSIQ, ADHD symptoms in the parent-teacher forms and SASS-T scores. To the best of our knowledge, our study is the first study in the literature that evaluates and correlates the social skills of children with ADHD in the context of theory of mind, executive functions and emotion recognition. In this respect, it is thought that our study will contribute to the literature. However, future follow-up studies with larger sample groups may reveal these relationships more clearly. Understanding the factors that cause social adaptation and skill deficits in ADHD and developing intervention methods are important for improving functionality.