Research Article

Peer Inclusion in Interventions for Children with ADHD: A Systematic Review and Meta-Analysis

Table 3

Peer included studies for children with ADHD.

DesignTreatment conditionParticipants NAge Years (mean ± SD)Inclusion criteriaOutcome measureTreatment outcome

Abikoff et al. [53]
RCT: random assignment
ADHD peer intervention
1 year weekly, 2nd year monthly
(1) mph only
(2) mph + MPT + SST
(3) mph + ACT
mph: 34 (ADHD)
mph + MPT: 34 (ADHD)
mph + ACT: 35 (ADHD)
8.2 ± 0.8ADHD diagnosis
Positive response to mph
Social skills outcomes:
SSRS: parent + child form
Others:
TOPS: teacher form
Observations in gym
SSRS: significant improvement
TOPS: significant improvement
Significantly fewer positive and negative behaviours

Choi and Lee [54]
RCT: random assignment
ADHD peer intervention
Weekly EMT and SST treatment for 16 weeks
(1) EMT group
(2) SST group
(3) Waitlist control
EMT: 25
SST: 25
Control: 24
EMT:
11.0 ± 0.9
SST:
11.1 ± 0.9
Control:
10.8 ± 0.8
ADHD diagnosis
Total WISC-Revised Korean Version IQ > 90
Behaviour Problem Scale score in clinical range on CBCL
Social skills outcomes:
Peer Relational Skills Scale
Others
Emotion Expression Scale for Children
Child Depression Inventory
State-Trait Anxiety Inventory for Children
No differences between SST and control groups. EMT group improved significantly more than control
EMT group improved significantly more than SST and control groups
SST group improved significantly more than control group, but no differences between EMT and control groups

Frankel et al. [55]
QES: child and parent manually assigned
Non-ADHD peer intervention
SST weekly for 12 weeks
(1) Treatment
(2) Waitlist control
Treatment
35: ADHD/14: no ADHD
Waitlist control
12: ADHD/12 no ADHD
9.05 ± 3.06Peer problems
ADHD (using mph)
ODD based on DSM-III-R
Social skills outcomes:
SSRS: parent form; attention and self-control subscales
Others:
PEI: teacher form
SSRS: significantly greater improvement
PEI: nonsignificant improvement on the withdrawal scale. Significant improvement on the aggression scale

Guli et al. [56]
QES: children manually assigned
ADHD and other diagnosis peer interventions
SST weekly for 12 weeks or twice weekly for 8 weeks
(1) SCIP group
(2) Clinical control
SCIP: 18 (5 ADHD/2 NLD/11 ASD)
Control: 16 (3 ADHD/6 NLD/7 ASD)
10.97 ± 1.98ADHD diagnosis
Overall intelligence > 80 on WISC-III
Social skills outcomes:
BASC: parent form; withdrawal and social skills subscales
DANVA2
Observed social interaction
SSRS: parent form
Others:
Parent and child interviews
BASC: no significant effects found
DANVA2: no significant effects found
Observations: medium effects for increases in positive interactions and decreases in solitary play for treatment group
Baseline measure for presence of clinically significant social skills deficits
75% reported one or more specific positive changes

Haas et al. [57]
QES: children manually assigned
Non-ADHD peer intervention
Behavioural treatment for 8 weeks in the context of a STP
(1) Treatment
(2) Control
Treatment
54: ODD or CP/ADHD
Control
16: no ODD or CP/ADHD
9.48 ± 1.58ADHD diagnosis
Nonmedicated
Social skills outcomes:
SIRF: staff observations
Peer sociometric interviews
Others:
Time-out measures
SIRF: significant improvement in social skills and problem solving
Peer sociometrics: significant improvement in Likert and Dislike nominations
Time-out: significant improvements

Hannesdottir et al. [58]
RCT: random assignment
ADHD peer intervention
Behavioural and SST treatment with working memory training
(1) Treatment
(2) Waitlist control
(3) Parent training
Treatment: 16
Control: 14
Parent training: 11
9.2 ± 0.62ADHD diagnosisSocial skills outcomes:
SSRS: parent form
Others:
ADHD Rating Scale-IV
ERC
SDQ
Icelandic WISC-IV
Significant group × time interactions favouring treatment group over waitlist control
Significant group × time interactions favouring treatment group over waitlist control for inattention, but not hyperactivity/impulsivity
No significant main effect of time
No significant main effect of time
Significant main effects on two subscales (Coding and Letter-Number Sequencing), but no significant group × time interactions

Hantson et al. [59]
QES: child and parent manually assigned
ADHD peer intervention
SST daily for 2 weeks in the context of an intensive therapeutic summer day camp
(1) Treatment
(2) Treatment as usual control
Treatment
33: ADHD
Treatment as usual control
15: ADHD
8.6 ± 1.6ADHD diagnosis
IQ > 70 on WISC-III
Social skills outcomes:
IPR: child form
WFIRS-P: parent form
Others:
CGI-P: parent form
IPR: significant improvement
WFIRS-P: Significant improvements except for WFIRS Risky Activities subscale
CGI-P: significant improvement

Huang et al. [60]
QES: child and parent manually assigned
ADHD peer intervention
Weekly SST treatment for 8 weeks consisting of 80-minute sessions
(1) SST group
(2) No treatment control
SST: 45
Control: 52
SST:
8.2 ± 0.9
Control:
8.5 ± 0.9
ADHD diagnosisSocial skills outcomes:
SSRS: child + teacher form
Others
SNAP: parent + teacher
CBCL: child form
SSRS-C: significant improvement in Self-Control in favour of SST group; SSRS-T: significant improvement in active participation in favour of SST group
SNAP-P: main effect of group on Oppositional subscale; SNAP –T: Main effect of group on Active Participation subscale
CBCL-C: main effect of group on Anxious/Depressed subscale

Jensen et al. [61]
RCT: random assignment
3-year follow-up
ADHD peer intervention
Treatment over 14 months
(1) Medication only
(2) Behavioural treatment incl. parent training + STP + school-based treatment
(3) Combined incl. medication + behavioural treatment
(4) Community care control
Medication management
115: (ADHD)
Behavioural treatment
127: (ADHD)
Combined treatment
127: (ADHD)
Community care control
116: (ADHD)
11.8 ± 0.95Children who participated in the 1999 MTA studySocial skills outcomes:
SSRS: parent + teacher forms
Others:
SNAP: parent + teacher forms
WIAT: reading score
CIS
SSRS: effect size for improvement from baseline to 36 months across all treatment groups was 0.8–0.9
SNAP: effect size for improvement from baseline to 36 months across all treatment groups was 1.6–1.7 for ADHD and 0.7 for ODD
WIAT: effect size for improvement from baseline to 36 months across all treatment groups was 0.1–0.2
CIS: effect size for improvement from baseline to 36 months across all treatment groups was 0.9–1.0

Kolko et al. [62]
QES: children manually assigned
ADHD and other diagnosis peer interventions
3 weekly sessions for 5 weeks
(1) SCST group
(2) SA group
SCST: 36 (10 ADHD/11 CD/15 OD)
SA: 20 (4 ADHD/12 CD/4 OD)
10.4 ± 2.1Score of at least 7 on a four-item social problems screen, with at least one maximum ratingSocial skills outcomes:
CAI-M: Self-report
LNS-M: Self-report
SPS: Staff report
Sociometric Ratings: Staff
Peer Nomination
Behavioural Role-Play
In vivo behavioural observations
CAI-M: significant improvement in post-training scores
LNS-M: SCST group showed significant reduction in post-training scores
SPS: SCST group showed significant reduction in posttraining scores
Both groups improved significant
SCST group showed greater pre-post reduction nominations
SCST group showed significant improvement
SCST group exhibited significant improvement

Mikami et al. [63]
RCT: random assignment
Typically developing peer intervention
Weekdays for four weeks total
Weekdays for 2 weeks per treatment allocation
(1) MOSAIC then COMET
(2) COMET then MOSAIC
MOSAIC: 12 ADHD/58 TD
COMET: 12 ADHD/55 TD
8.15 ± 0.79ADHD diagnosis after screening
IQ >80 on WASIl
Social skills outcomes:
Peer sociometric nominations
Peer interaction observations
Messages from peers
Others:
Teacher-Child Rating Scale subscales of
problem behaviours
Main effect on positive nominations for treatment was not significant. Received fewer negative nominations and more reciprocated friendship nominations when in MOSAIC relative to COMET group
No main effect for treatment condition
Received a significantly greater proportion of positive messages when in MOSAIC relative to COMET group
No main effects for treatment condition

MTA Cooperative Group [64]
RCT: random assignment
ADHD peer intervention
Treatment over 14 months
(1) Medication only
(2) Behavioural treatment incl. parent training + STP + school-based treatment
(3) Combined incl. medication + behavioural treatment
(4) Community care control
Medication management
144: (ADHD)
Behavioural treatment
144: (ADHD)
Combined treatment
145: (ADHD)
Community care control
146: (ADHD)
8.5 ± 0.8ADHD combined type diagnosis
In residence with the same primary caretaker(s) for last 6 months or longer
Social skills outcomes:
SSRS: parent + teacher
Others:
SNAP: parent + teacher
MASC: child form
Parent-child relationship questionnaire
WIAT: (reading, math + spelling)
SSRS: significant improvement for parent-reported internalizing problems for combined treatment over behavioural treatment
SNAP: combined + medication management were clinically and statistically superior to behavioural treatment + community care
MASC: improvements of small magnitude
Improvements of small magnitude
Significant improvement for reading achievement score for combined treatment over behavioural treatment

MTA Cooperative Group [65]
RCT: random assignment
24-month follow-up
ADHD peer intervention
Treatment over 14 months
(1) Medication only
(2) Behavioural treatment incl. parent training + STP + school-based treatment
(3) Combined incl. medication + behavioural treatment
(4) Community care control
Medication management
128: (ADHD)
Behavioural treatment
139: (ADHD)
Combined treatment
138: (ADHD)
Community care control
135: (ADHD)
8.4 ± 0.8Children who participated in the 1999 MTA studySocial skills outcomes:
SSRS: parent + teacher
Others:
SNAP: parent + teacher
Negative/ineffective discipline factor
WIAT: (reading, math + spelling)
SSRS: nonsignificant overall treatment effect
SNAP: significant overall treatment effect
Nonsignificant overall treatment effect
WIAT: nonsignificant overall treatment effect

Pfiffner et al. [66]
RCT: random assignment
ADHD and other diagnosis peer interventions
Treatment over 12 weeks
First cohort:
(1) CLAS program
(2) Waitlist control
Second-Fifth cohort:
(1) CLAS program
(2) Treatment as usual control
Five cohorts of children randomized to either CLAS program or control
25: ADHD, 2: Undifferentiated Attention Deficit Disorder; 19: Oppositional Defiant Disorder, 3: Conduct Disorder, 4: Separation Anxiety Disorder, 5: Overanxious Disorder, 2: Dysthymic Disorder.
8.7 ± 1.2ADHD diagnosis
IQ > 80 on the WASI
Attending school full time with school consenting to participate in school-based treatment
Social skills outcomes:
SSRS: parent + teacher
Others:
Child Symptom Inventory
SCT Scale
COSS: parent + teacher
Test of Life Skill Knowledge
Clinical Global Impressions: parent + teacher
SSRS: significant improvements
Significant reductions in number of DSM-IV inattention symptoms
SCT: significant treatment effects
COSS: significant improvements of organisational skills
Significantly improvements
Significantly greater improvement

Shechtman and Katz [67]
RCT: random assignment
ADHD and other diagnosis peer interventions
Weekly for 15 weeks
(1) Group therapy
(2) Waitlist control
Group Therapy: 42 (20: ADD or ADHD/22 LD)
Waitlist control: 45 (14 ADD or ADHD/31 LD)
13.26 ± 0.77ADD/ADHD or LD diagnosisSocial skills outcomes:
Adolescent Interpersonal Competence Questionnaire
Intimate Friendship Scale
Working Alliance Inventory
Significant treatment condition by time effect
Nonsignificant treatment condition by time effect
High association between bonding with group members and gains on social competence

Storebø et al. [68]
RCT: random assignment
ADHD peer intervention
Weekly for 8 weeks
(1) Experimental treatment incl. SST + parent training + standard treatment
(2) Standard treatment alone
Experimental treatment
28: ADHD
Standard treatment alone
27: ADHD
10.4 ± 1.31ADHD diagnosis
IQ > 80
Not previously medicated
Indexes from Conners 3 and Connors CBRS:
Social skills outcomes:
Social Problems score
Peer Relations score
Others:
Executive Functions score
Academic score
Aggressiveness score
Emotional score
Hyperactivity score
No statistically significant difference when comparing groups
Neutral result between groups
Neutral result between groups
Neutral result between groups
Highly significant changes towards fewer symptoms
No statistically significant difference when comparing groups

Waxmonsky et al. [69]
RCT: random assignment
ADHD peer intervention
Weekly for 8 weeks
(1) Atomoxetine + BT
(2) Atomoxetine alone
Atomoxetine + BT
29: ADHD
Atomoxetine alone
27: ADHD
8.59 ± 1.58ADHD diagnosis
IQ > 75
Positive response to atomoxetine
Social skills outcomes:
SSRS: parent + teacher
Others:
Student Behaviour Teacher Response Observation Code
DBD: parent + teacher
APRS: teacher
PSERS: parent + teacher
CDRS-R: child + parent
interview
DRC/ITBE
Clinical Global Impressions Scale: clinician
SSRS: significantly lower parent-rated problem behaviours
No difference between groups post-treatment
DBD: marginally significant improvement of ADHD and ODD symptoms
APRS: significantly higher teacher-rated impulse control
PSERS: mean scores well within the mild range.
Marginally lower depression scores post-treatment. Suicidal thoughts decreased significantly over time but with no difference between groups
DRC/ITBE: Significant main effect of medication/time
51.9% of subjects in Atomoxetine-only and 55.2% of Atomoxetine + BT subjects were rated as much or very much improved

Notes. RCT = randomized controlled trial, QES = quasi-experimental study, mph = methylphenidate, MPT = Multipsychosocial Treatment, SST = social skills training, ACT = attention control treatment, ADHD = Attention-Deficit Hyperactivity Disorder, SSRS =Social Skills Rating Scale [70], TOPS =Taxonomy of Problem Situations [71], EMT = emotional management training, WISC-Revised Korean Version = Wechsler Intelligence Scale for Children-Revised Korean Version [72], CBCL = Child Behaviour Checklist [73, 74], ODD = oppositional defiant disorder, DSM-III-R = Diagnostic and Statistical Manual of Mental Disorders 3rd Edition, PEI = Pupil Evaluation Inventory [75], SCIP = Social Competence Intervention Program, NLD = nonverbal learning disorder, ASD = autism spectrum disorder, WISC-III (Weschler Intelligence Scale for Children-III [76]), BASC = Behaviour Assessment System for Children [77], DANVA2 = Diagnostic Analysis of Nonverbal Accuracy 2 Nowicki, 2004, CP = conduct problems, SIRF = Staff Improvement Rating Form [78], ERC = Emotion Regulation Checklist [79]; SDQ = Strengths and Difficulties Questionnaire [80], Icelandic WISC-IV = Wechsler Intelligence Scale for Children-Icelandic version [81], IPR = Index of Peer Relations [82], WFIRS-P = Weiss Functional Impairment Rating Scale-Parent Version [83], CGI-P = Conners’ Global Index-Parent Version [84], SNAP = (Swanson, Nolan, and Pelham Rating Scale [85], STP = summer treatment program, MTA = Multimodal Treatment Study of Children with ADHD, WIAT = Wechsler Individual Achievement Test [86], CIS = Columbia Impairment Scale [87], SCST = social-cognitive skills training, SA = social activity group, CD = conduct disorder, OD = other disorders, CAI-M = Children’s Assertiveness Inventory-Modified [88], LNS-M = Loneliness Scale for Children-Modified [89], SPS = Social Problems Screen, MOSAIC = Making Socially Accepting Inclusive Classrooms, COMET = contingency management training, TD = typically developing, WASI = Wechsler Abbreviated Scale of Intelligence [90], MASC = Multidimensional Anxiety Scale for Children [91], CLAS = Child Life and Attention Skills program, SCT Scale = Sluggish Cognitive Tempo Scale [92], COSS = Children’s Organizational Scale [93], DSM-IV = Diagnostic and Statistical Manual of Mental Disorders 4th Edition, LD = learning disabilities, Conners 3 [94], Conners CBRS = Conners Behaviour Rating Scales [94], BT = behaviour therapy, DBD = Disruptive Behaviour Disorders Rating Scale [95], APRS = Academic Performance Rating Scale [96], PSERS = Pittsburgh Side Effects Rating Scale [97], CDRS-R = Children’s Depression Rating Scale-Revised [98], and DRC/ITBE = Daily Report Card/Individual Target Behaviour Evaluation. When handling studies with multiple social skills outcome measures, one singular outcome measure was chosen that most comprehensively reflected the construct social skills. This singular outcome measure was then used for the calculation of an effect size. No measures were aggregated within the study to obtain one effect size.