Exploring the association between social skills, social intelligence, and executive dysfunction in adolescents with attention deficit hyperactivity disorder: a mediational analysis

Individuals with attention deficit hyperactivity disorder (ADHD) frequently experience difficulties in social information processing, social awareness, and exhibit inappropriate social behaviors, which adversely affect their relationships, particularly in adolescence period. This study explores the role of social skills, social intelligence, and executive dysfunction in shaping peer relations in adolescents with ADHD. The study included 151 adolescents with ADHD, receiving medical treatment and 70 healthy controls (HC). Participants completed the Matson Evaluation of Social Skills with Youngsters (MESSY), the Social Support Appraisals Scale (SSAS), the Peer Relations Scale (PRS), and the Tromsø Social Intelligence Scale (TSIS); parents completed the Conners Parent Rating Scale (CPRS) and the Behavior Rating Inventory of Executive Function (BRIEF). Adolescents with ADHD scored significantly higher on MESSY- Inappropriate Assertiveness/Impulsiveness, whereas lower scores on MESSY-appropriate social skills, SSAS friend and teacher subscales, total score, TSIS, and PRS subscales except closeness compared to HC. Lower social information processing and higher inappropriate Assertiveness/Impulsiveness scores were significantly associated with a comorbid externalizing disorder. ADHD symptom severity and level of executive dysfunction were negatively correlated with social skills, appropriate social behaviors, and social support. Social intelligence mediated the relationship between social skills and peer relationships. Mediational analyses have revealed that, each one-unit increase in the TSIS score was associated with a 0.375-point increase in the PRS score. Social impairment may be a key mechanism linking ADHD symptoms to peer relationships, even in adolescents receiving medical treatment. Targeted interventions could enhance peer interactions and social support in adolescents with ADHD.