Summary of findings for the main comparison. Social skills training compared to no intervention.
| Social skills training compared to no intervention | ||||||
| Patient or population: children aged five to 18 years with ADHD Settings: outpatient clinic; inpatient hospital wards; elementary schools; community mental health centre Intervention: social skills training Comparison: no intervention | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | Number of participants (studies) | Certainity of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| No intervention | Social skills training | |||||
|
Teacher‐rated social skills Measured by: Conners Behavior Rating Scale: Social Problems Index; Strength and Difficulties Questionnaire: Prosocial Behaviour Subscale (teacher‐rated); Social Skills Improvement System; Social Skills Rating Scale: Coorperation Subscale Follow‐up: at end of treatment |
‐ | The mean score for teacher‐rated social skills at end of treatment in the intervention groups was 0.11 standard deviations higher (0.00 lower to 0.22 higher)e | ‐ | 1271 (11 studies) | ⊕⊝⊝⊝
Very low a,b,c |
Social skills training may have no effect on teacher‐rated social skills |
|
Parent‐rated social skills Measured by: Social Skills Rating Scale; Weiss Functional Impairment Scale: Social Acitivities Domain (parent‐rated); Strength and Difficulties Questionnaire: Prosocial Behavior Subscale; Social Skills Improvement System Follow‐up: at end of treatment |
‐ | The mean score for parent‐rated social skills at end of treatment in the intervention groups was 0.19 standard deviations higher (0.06 higher to 0.32 higher) | ‐ | 1609 (15 studies) | ⊕⊝⊝⊝
Very low a,b,c |
Social skills training may have no effect on parent‐rated social skills |
|
Teacher‐rated emotional competencies Measured by: Strengths and Difficulties Questionnaire: Emotional Symptoms Subscale; Conners Behavior Rating Scale: Emotional Index Score Follow‐up: at end of treatment |
‐ | The mean score for teacher‐rated emotional competencies at end of treatment in the intervention groups was 0.02 standard deviations lower (0.72 lower to 0.68 higher) | ‐ | 129 (two studies) | ⊕⊝⊝⊝
Very low a,b,c |
Social skills training may have no effect on teacher‐rated emotional competencies |
|
Teacher‐rated general behaviour Measured by: Self‐Control Rating Scale; Conners Behavior Rating Scale: Aggressiveness Index; Disruptive Behavior Disorders Rating Scale; Conners Teacher Rating Scale: Conduct Problems Index; Strengths and Difficulties Questionnaire: Conduct Problems Subscale (teacher‐rated); Child Symptom Inventory: ODD Scale (teacher‐rated); Child Behavior Checklist Follow‐up: at end of treatment |
‐ | The mean score for teacher‐rated general behaviour at end of treatment in the intervention groups was 0.06 standard deviations lower (0.19 lower to 0.06 higher) | ‐ | 1002 (eight studies) | ⊕⊕⊝⊝
Low a,d |
Social skills training may have no effect on teacher‐rated general behaviour |
|
Parent‐rated general behaviour Measured by: Strengths and Difficulties Questionnaire (parent‐rated; total scores); Conners Behavior Rating Scale: Aggressiveness Index; Disruptive Behavior Disorders Rating Scale; Behavior Rating Inventory of Executive Function; SDQ: Conduct Problems Subscale (parent‐rated); Child Symptom Inventory; Child Behavior Checklist Follow‐up: at end of treatment |
‐ | The mean score for parent‐rated general behaviour at end of treatment in the intervention groups was 0.38 standard deviations lower (0.61 lower to 0.14 lower) | 995 (eight studies) | ⊕⊝⊝⊝
Very low a,b,c,d |
Social skills training may slightly improve parent‐rated general behaviour | |
|
Teacher‐rated ADHD symptoms Measured by: Disruptive Behavior Disorders Rating Scale; ADHD Rating Scales: Hyperactivity and Impulsivity Subscales (total scores); Conner Teacher Rating Scale: Hyperactivity Index; Strengths and Weaknesses of ADHD Symptoms and Normal Behaviors; ADHD Symptom Checklist; Child Symptom Inventory (ADHD (inattention) scale score); SNAP‐IV (teacher rating scale) Follow‐up: at end of treatment |
‐ | The mean score for teacher‐rated ADHD symptoms at end of treatment in the intervention groups was 0.26 standard deviations lower (0.47 lower to 0.05 lower) | ‐ | 1379 (14 studies) | ⊕⊝⊝⊝ Very lowa,b,c | Social skills training may slightly improve teacher‐rated ADHD symptoms |
|
Parent‐rated ADHD symptoms Measured by: Conners Parent Rating Scale: Hyperkinesis Index; Disruptive Behavior Disorders Rating Scale; Strengths and Weaknesses of ADHD Symptoms and Normal Behaviors; Sluggish Cognitive Tempo; ADHD Symptom Checklist; ADHD Rating Scales; Child Symptom Inventory: Inattention; SNAP‐IV (teacher rating scale); Child Attention Profile Follow‐up: at end of treatment |
‐ | The mean score for parent‐rated ADHD symptoms at end of treatment in the intervention groups was 0.54 standard deviations lower (0.81 lower to 0.26 lower) | ‐ | 1206 (11 studies) | ⊕⊝⊝⊝ Very lowa,b,c | Social skills training may slightly improve parent‐rated ADHD symptoms |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% Cl). | ||||||
| ADHD: Attention deficit hyperactivity disorder; CI: Confidence interval; ODD: Oppositional defiant disorder; SNAP‐IV: Swanson, Nolan and Pelham rating scale ‐ Fourth Version. | ||||||
| GRADE Working Group grades of evidence High quality: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate quality: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low quality: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low quality: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect. | ||||||
aDowngraded one level due to high risk of bias (systematic errors leading to overestimation of benefits and underestimation of harms) in several 'Risk of bias' domains, including lack of sufficient blinding and selective outcome reporting (many of the included studies did not report on this outcome) bDowngraded one level due to inconsistency: moderate statistical heterogeneity (I2 = 30% to 50%) c Downgraded one level due to imprecision: wide CI dDowngraded one level due to indirectness (children's general behaviour was assessed by different types of rating scales, each with a different focus on behaviour)
eThe effect on the primary outcome, teacher‐rated social skills at end of treatment, corresponds to a MD of 1.22 points on the social skills rating system (SSRS) scale (95% CI 0.09 to 2.36). The minimal clinical relevant difference (10%) on the SSRS is 10.0 points (range 0 to 102 points on SSRS).