Understanding the participation outcomes for persons with disability when partnered with assistance dogs: A scoping review.

INTRODUCTION: Assistance dogs are trained to support persons living with disability and mitigate limitations that hinder their participation in everyday activities. Despite participation being a frequent challenge for people with disabilities, evidence linking assistance dog provision to improved participation outcomes is underdeveloped. This scoping review aimed to improve understanding by mapping the participation outcomes claimed in research on assistance dogs using the International Classification of Functioning (ICF), Disability and Health framework. METHODS: Using the Arksey and O'Malley's six-step framework, this scoping review searched six databases. Data were collected, mapped and summarised in accordance with the domains outlined in the ICF. RESULTS: In total, 38 studies across 41 papers met the inclusion criteria. Included studies investigated assistance dogs who were partnered with people living with physical disabilities, mental illness, autism and chronic conditions that require alerting (e.g., epilepsy and diabetes). Mapping of participation outcomes suggested that assistance dogs can have a positive impact on participation in many areas of daily life. CONCLUSION: Findings can assist practitioners, funders and policymakers to recognise the value of assistance dogs as a support for people with disability. However, further research is needed to address limitations regarding study designs, for example, the outcome measures used.

A systematic review of video-modelling interventions for children and adolescents with attention-deficit hyperactivity disorder.

OBJECTIVE: To identify, appraise, and synthesise the evidence for video-modelling interventions for individuals with attention-deficit hyperactivity disorder (ADHD). METHOD: We searched four electronic databases. Two independent researchers screened abstracts and methodologically assessed data using the Kmet appraisal checklist. RESULTS: A total of 15 studies met the inclusion criteria (11 original studies and four follow-up studies). Of the 11 original studies, one was a randomised controlled trial, one was a controlled between-group comparative design, two were one group pre-test post-test studies, one was an experimental 2 × 2 factorial design, and six were single-case experimental design studies. Studies included 1-35 participants with ADHD aged 5-16 years. Three studies targeted behaviour, three targeted social play skills, two targeted social behaviour, one targeted social skills, one targeted goal orientation and friendship quality, targeted and one attention/comprehension of social behaviour. In four studies video-modelling was the whole intervention, with no other intervention components reported. Nine studies reported positive outcomes immediately after intervention, two studies reported mixed findings. All studies were found to have good or strong methodological quality. CONCLUSION: There is preliminary evidence to suggest video-modelling may be a promising intervention approach for targeting the social skills and behaviours of individuals with ADHD when used in conjunction with other intervention components. Future studies need to lower the risk of bias and use larger sample sizes before the efficacy of video-modelling interventions can be fully investigated.

Can I join in? Multiple case study investigation of play performance generalisation for children with autism spectrum disorder from dyad to triad.

INTRODUCTION: Children with autism spectrum disorder (ASD) have difficulties with play, social interaction with peers and generalisation of intervention outcomes. The Ultimate Guide to Play, Language and Friendship (PLF) has demonstrated effectiveness in improving play performance of children with ASD and their typically developing (TD) peers. The aim of this investigation was to examine the changes in play performance when an additional TD child is added to an existing dyad of a child with ASD and a TD playmate to inform future delivery and adaptations of the intervention. METHODS: Participants in this multiple case study design were five children with ASD and their TD peer who completed a dyad intervention as part of a randomised control trial investigation of the PLF and an additional TD peer who joined the play dyad. A trained occupational therapist delivered an adapted version of the PLF to the triad over four clinic sessions. An independent rater scored each child (N = 15) on The Test of Playfulness at pre- and post-triad intervention. Line graphs were used to examine case data and compare to dyad play performance and patterns of interaction. RESULTS: Four of the five children with ASD generalised their play performance from the dyad to the triad social environment. However, the triad intervention did not demonstrate improvements in play performance. The play performance scores for the children with ASD and their TD peers were variable and demonstrated changes in their play pattern from the dyad to the triad. CONCLUSION: This investigation delivered preliminary evidence of play performance generalisation from a dyad to a triad with TD peers for children with ASD. Careful consideration of characteristics of all playmates is recommended for delivering the intervention to support play performance of children with ASD.

Prevalence of drooling, swallowing, and feeding problems in cerebral palsy across the lifespan: a systematic review and meta-analyses.

AIM: To determine the prevalence of drooling, swallowing, and feeding problems in persons with cerebral palsy (CP) across the lifespan. METHOD: A systematic review was conducted using five different databases (AMED, CINAHL, Embase, MEDLINE, and PubMed). The selection process was completed by two independent researchers and the methodological quality of included studies was assessed using the STROBE and AXIS guidelines. Meta-analyses were conducted to determine pooled prevalence estimates of drooling, swallowing, and feeding problems with stratified group analyses by type of assessment and Gross Motor Function Classification System level. RESULTS: A total of 42 studies were included. Substantial variations in selected outcome measures and variables were observed, and data on adults were limited. Pooled prevalence estimates determined by meta-analyses were as high as 44.0% (95% confidence interval [CI] 35.6-52.7) for drooling, 50.4% (95% CI 36.0-64.8) for swallowing problems, and 53.5% (95% CI 40.7-65.9) for feeding problems. Group analyses for type of assessments were non-significant; however, more severely impaired functioning in CP was associated with concomitant problems of increased drooling, swallowing, and feeding. INTERPRETATION: Drooling, swallowing, and feeding problems are very common in people with CP. Consequently, they experience increased risks of malnutrition and dehydration, aspiration pneumonia, and poor quality of life. WHAT THIS PAPER ADDS: Drooling, swallowing, and feeding problems are very common in persons with cerebral palsy (CP). The prevalence of drooling, swallowing, and feeding problems is 44.0%, 50.4%, and 53.5% respectively. There are limited data on the prevalence of drooling, swallowing, and feeding problems in adults. Higher Gross Motor Function Classification System levels are associated with higher prevalence of drooling, swallowing, and feeding problems. There is increased risk for malnutrition, dehydration, aspiration pneumonia, and poor quality of life in CP.

PREVALENCIA DE PROBLEMAS DE SIALORREA, DEGLUCIÓN Y ALIMENTACIÓN EN PARÁLISIS CEREBRAL A LO LARGO DE LA VIDA: UNA REVISIÓN SISTEMÁTICA Y METAANÁLISIS: OBJETIVO: Determinar la prevalencia de problemas de sialorrea/babeo, deglución y alimentación en personas con parálisis cerebral (PC) a lo largo de la vida MÉTODO: Se llevó a cabo una revisión sistemática utilizando cinco bases de datos diferentes (AMED, CINAHL, Embase, MEDLINE y PubMed). El proceso de selección fue completado por dos investigadores independientes y la calidad metodológica de los estudios incluidos se evaluó utilizando las directrices STROBE y AXIS. Se realizó un metaanálisis para determinar las estimaciones de prevalencia agrupadas en problemas de babeo, deglución y alimentación con análisis de grupos estratificados por tipo de evaluación y nivel del Sistema de Clasificación de la Función Motora Gruesa. RESULTADOS: Se incluyeron un total de 42 estudios. Se observaron variaciones sustanciales en las medidas y variables de resultados seleccionadas, y los datos sobre adultos fueron limitados. Las estimaciones de prevalencia agrupadas determinadas por metaanálisis fueron tan altas como 44,0% (intervalo de confianza [IC] del 95% 35,6-52,7) para babeo, 50,4% (IC 95% 36,0-64,8) para problemas de deglución y 53,5 % (IC 95% 40,7-65,9) para problemas de alimentación. Los análisis de grupo para el tipo de evaluaciones no fueron significativos; sin embargo, el funcionamiento más severo en PC se asoció con problemas concomitantes de aumento de sialorrea, deglución y de la alimentación. INTERPRETACIÓN: Problemas relacionados con sialorrea, tragar, y de alimentación son muy comunes en personas con PC. En consecuencia, ellos experimentan mayores riesgos de desnutrición y deshidratación, neumonía por aspiración y mala calidad de vida.

PREVALÊNCIA DE PROBLEMAS COM SIALORRÉIA, DEGLUTIÇÃO E ALIMENTAÇÃO EM PARALISIA CEREBRAL AO LONGO DA VIDA: UMA REVISÃO SISTEMÁTICA E METANÁLISE: OBJETIVO: Determinar a prevalência de problemas com sialorréia, deglutição e alimentação em pessoas com paralisia cerebral (PC) ao longo da vida. MÉTODO: Uma revisão sistemática foi realizada utilizando cinco bases de dados diferentes (AMED, CINAHL, Embase, MEDLINE, e PubMed). O processo de seleção foi realizado por dois pesquisadores independentes e a qualidade metodológica dos estudos incluídos foi avaliada usando as diretrizes STROBE e AXIS. Metanálises foram realizadas para determinar as estimativas de prevalência agrupada de problemas de sialorréia, deglutição e alimentação, com análises estratificadas por tipo de avaliação e nível do Sistema de Classificação da Função Motora Grossa. RESULTADOS: Um total de 42 estudos foram incluídos. Variações substanciais nas medidas de resultado e variáveis selecionadas foram observadas, e dados em adultos são limitados. As estimativas de prevalência agrupada determiadas pela metanálise chegaram a 44,0% (intervalo de confiança [IC] 95% 35,6-52,7) para sialorréia, 50,4% (IC 95% 36,0-64,8) para problemas com deglutição, e 53,5% (IC 95% 40,7-65,9) para problemas de alimentação. Análises agrupadas por tipo de avaliação não foram significativas; no entanto, comprometimento funcional mais severo em PC foi associado com mais problemas concomitantes de salivação deglutição e alimentação. INTERPRETAÇÃO: Problemas de sialorréia, deglutição e alimentação são muito comuns em pessoas com PC. Consequentemente, elas apresentam risco aumentado de malnutrição e desidratação, pneumonia por aspiração e pior qualidade de vida.

The play skills of children with high-functioning autism spectrum disorder in peer-to-peer interactions with their classmates: A multiple case study design.

BACKGROUND/AIM: Children with ASD are known to have lower play skills than their typically developing peers. However, the play skills of children with ASD are rarely investigated using observational measures in the context of their everyday peer-to-peer play interactions. To explore the play skills of children with ASD and their aged matched classmates during a peer-to-peer play interaction. METHODS: Using convenience sampling, four children with ASD (5-11 years) attending mainstream schools were recruited for this multiple case design study. Each child with ASD was paired with one of their aged matched typically developing classmates. Children's play skills were measured using the Test of Playfulness (ToP). Additional case data were collected through teacher-reported social skills and behaviours. Rasch analysis was utilised to convert raw ToP scores into an interval level overall score for each child. Children's individual ToP item scores, social skills and behaviours are presented by case. RESULTS: The two children with ASD who had the highest ToP scores, also had the highest teacher-reported social skills. All children with ASD had greatest difficulty on ToP items reflecting suspension of reality and framing. Two children with ASD had higher ToP scores than their classmate. In these two cases, the classmates had similar play skills of children with ASD. CONCLUSION: The play skills of children with ASD varied by case. Across the cases, teacher-reported social skills, classmate age and existence of friendship between children were all factors observed to influence play. These findings require replication and investigation in larger scale studies.

Peer-mediated intervention to improve play skills in children with autism spectrum disorder: A feasibility study.

BACKGROUND/AIM: Children with autism spectrum disorder (ASD) frequently demonstrate impaired play skills and poor quality social interactions compared to typically developing peers. Complex interventions to improve play skills should be investigated with randomised control trials (RCT) where possible to support evidence-based practice for occupational therapists. Prior to a RCT, multiple feasibility studies are recommended to identify barriers to the trial. The aim of this study is to adapt a complex intervention to improve play skills in children with ASD and investigate the feasibility of conducting a RCT. METHODS: Participants were 10 children with ASD paired with typically developing playmates chosen by their families. Pairs attended 10 intervention sessions involving video modelling, therapist- and peer-mediation and free play. Participant numbers needed for future investigation of effectiveness were calculated and time and cost considerations were reviewed. The Test of Playfulness (ToP) was the primary outcome measure; both parent- and child-report outcome measures were evaluated for appropriateness. RESULTS: To determine effectiveness of the intervention 34 pairs in both control and intervention groups will be needed to conduct a RCT over an 18-month timeframe. ToP scores showed a positive, but not statistically significant trend from pre- to post-intervention. These improvements were maintained at follow-up in both clinic and home environments. The Piers-Harris 2 and the Parent Relationship Questionnaire were identified as appropriate secondary outcome measures; additional parent- and teacher-report outcome measures are recommended for the RCT. CONCLUSION: A RCT to investigate effectiveness of this intervention for improving play skills of children with ASD and their playmates are feasible.

Parents' perceptions of the long-term appropriateness of a psychosocial intervention for children with attention deficit hyperactivity disorder.

BACKGROUND/AIM: Designing psychosocial interventions that parents perceive as appropriate is essential to enhancing their engagement with the intervention and their long-term use of the intervention strategies. The aim of this study was to explore the long-term appropriateness of a play-based psychosocial intervention for children with Attention Deficit Hyperactivity Disorder (ADHD) from the perspectives of parents. METHODS: Semi-structured phone interviews were conducted with 14 parents of children with ADHD who participated in a randomised controlled trial of the play-based intervention 1 year earlier. RESULTS: Thematic analysis led to the development of three core-themes: (i) Everybody needs a parenting handbook, (ii) No one thing you are dealing with, and (iii) A different approach: Reframing. DISCUSSION: The core-themes related back to a definition of intervention appropriateness that acknowledges the intervention as important/relevant, beneficial, socially and ecologically valid and promotes sustainable change, indicating parents perceived the intervention as appropriate. The core-themes also resembled aspects of the process of family adaptation. Findings highlight the importance of designing interventions that are appropriate from parents' perspectives to enhance their long-term engagement and use of the intervention strategies as well as outcomes for their child in the long term.

Pragmatic Language Outcomes of Children With Attention Deficit Hyperactivity Disorder After Therapist- and Parent-Delivered Play-Based Interventions: Two One-Group Pretest-Posttest Studies With a Longitudinal Component.

OBJECTIVE: The pragmatic language outcomes of children with attention deficit hyperactivity disorder (ADHD) were explored across two feasibility studies. METHOD: Five children with ADHD (ages 6-11 yr), their parents, and 5 typically developing peers completed an assessment 18 mo after a therapist-delivered intervention (Study 1). Participants then completed a parent-delivered intervention (Study 2). Blinded ratings of peer-to-peer play interactions documented changes in children's pragmatic language 18 mo after the Study 1 intervention and before, immediately after, and 1 mo after the Study 2 intervention. Nonparametric statistics and Cohen's d were used to measure change. RESULTS: Children's pragmatic language outcomes were maintained 18 mo after the therapist-delivered intervention and significantly improved from before to 1 mo after the parent-delivered intervention. CONCLUSION: Interventions involving occupational therapist and speech-language pathologist collaboration, play, and parent and peer involvement may facilitate children's pragmatic language skills.

The social play, social skills and parent-child relationships of children with ADHD 12 months following a RCT of a play-based intervention.

BACKGROUND/AIM: There is an urgent need to investigate the long-term impact of social skill interventions for children with attention deficit hyperactivity disorder (ADHD). Interventions targeting the social skills of children with ADHD have limited short-term effectiveness and rarely investigate the long-term impact. Furthermore, these interventions are most frequently conducted in the clinic setting, without including the child's natural settings and interactants, such as their regular playmates and parents. METHODS: The present study investigated the social play, social skills and parent-child relationships of children with ADHD and their playmates (n = 13/group) aged 5-13 years. A two-group before and after design with a longitudinal component was applied. Participant data compared over two time points, immediately following a randomised, controlled trial (RCT) of a play-based intervention and 12 months post-RCT. RESULTS: From immediately following the RCT to the 12-month follow-up, children with ADHD maintained social play skill gains in the home environment. Playmates maintained social play skill gains across the home and clinic environments. Children scored within a developmentally appropriate range, falling within 1 standard deviation of the mean for social skills and most parent-child relationship scales using norm-based assessments. CONCLUSION: Results support the long-term effectiveness of the intervention.

Validity of the Assistance to Participate Scale with Parents of typically developing Australian children aged three to eight years.

BACKGROUND/AIM: The Assistance to Participate Scale (APS) measures the assistance parents provide to children with disability to participate in play and leisure. The primary aim of this study was to extend the psychometric development of the APS through application to a typically developing sample. METHODS: Parents (N = 125) of typically developing Australian children aged three to eight years completed an online questionnaire comprising the APS, Pediatric Evaluation of Disability Inventory (PEDI), Pediatric Quality of Life Scale (PedsQL) (caregiver scales) and demographic questions. Guided by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN), structural validity of the APS was investigated using principal components analysis; internal consistency reliability through calculation of Cronbach's α; construct validity through convergence with previously validated measures of paediatric occupational performance and quality of life (PEDI, PedsQL) and investigation of five research hypotheses developed a priori. RESULTS: Structural validity of the APS was confirmed. Internal consistency (Cronbach's α = 0.76) was good for this unidimensional scale. Construct validity was substantiated by moderate correlations with the PEDI and PedsQL (physical), and data that supported all research hypotheses. Statistically significant differences were found in APS scores based on sex (P = 0.018), age (P < 0.001), school attendance (P < 0.001) and elder sibling (P = 0.006). CONCLUSIONS: Results of this study indicate the APS is a valid and reliable measure of the parental role in a typically developing child's play. Validation upon a typically developing sample offers preliminary guidelines regarding the normative pattern of assistance provided to children during play. Further research in line with the COSMIN is required.

Evaluating the pragmatic language skills of children with ADHD and typically developing playmates following a pilot parent-delivered play-based intervention.

BACKGROUND/AIM: Children with attention deficit hyperactivity disorder (ADHD) often present with pragmatic language deficits and difficulties with peer-peer friendships. Parents and typically developing peers (TDPs) may be able to assist via parent and peer-mediated intervention approaches when adequately supported by trained adult facilitators. This study investigated whether a parent-delivered play-based intervention supported by occupational therapists and speech language pathologists was feasible and improved the pragmatic language skills of children with ADHD and their TDPs. METHODS: Nine children with ADHD paired with nine TDPs (mean age = 8.2 years) participated. The seven-week intervention was delivered by parents of children with ADHD at their home and consisted of weekly assigned home-based modules, supported play-dates between the pairs of children and supplemented by three clinic visits. Parent adherence to intervention activity was monitored on a weekly basis. Blinded ratings of observed peer-peer play interactions were used to detect changes in pragmatic language from pre-post intervention and one month follow-up using the Pragmatic Observation Measure (POM). RESULTS: All parents reported completing the seven weekly home-based modules and attended all clinic visits. Significant improvements in observed pragmatic language skills were found from pre-follow-up for both the ADHD and TDP children and pre-post for the ADHD children. CONCLUSION: The preliminary findings suggest that using parents to facilitate their child's pragmatic language skills was a feasible intervention approach with parents acting as agents of change to improve the pragmatic language of their children. This exploratory study identifies the need for further large-scale research to address the pragmatic language skills of children with ADHD using parent-delivery in a play-based, peer-peer context.

Measurement of visual ability in children with cerebral palsy: a systematic review.

AIM: To identify and evaluate measures of visual ability used with children with cerebral palsy (CP). METHOD: Eight databases were searched for measures of visual ability. Key selection criteria for measures were: use with children with CP; focus of visual ability measurement at the Activities and Participation domain of the International Classification of Functioning, Disability and Health (ICF). The Consensus-based Standards for the Selection of Measurement Instruments (COSMIN) Checklist was used to assess psychometric properties. RESULTS: From 6763 papers retrieved, 25 were relevant and 19 measures of visual ability were identified. Only 10 measures were supported with evidence of validity or reliability. No discriminative measure analogous to existing CP functional classification systems was found. No outcome measure valid for evaluation of visual abilities of children with CP was found. INTERPRETATION: Vision impairment is recognized as relevant to the functioning of children with CP; however, measurement of vision is most often focused at 'Body Function' levels, for example visual acuity. Measuring visual abilities in the Activities and Participation domain is important in considering how a child with CP functions in vision-related activities. The lack of psychometrically strong measures for visual ability is a gap in current clinical practices and research.

A pilot play-based intervention to improve the social play interactions of children with autism spectrum disorder and their typically developing playmates.

BACKGROUND/AIM: Occupational therapists play a key role in addressing the social difficulties of children with ASD. However, interventions are often time intensive, without outcomes generalising beyond the clinic setting. To examine the feasibility and preliminary effectiveness of an intervention to address the social play skills of children with ASD. METHODS: Participants in this multiple case study design were five children with autism spectrum disorder (ASD), five typically developing playmates and five parents of children with ASD. Two therapists and parents delivered the intervention involving clinic play sessions and home modules. Parents' treatment adherence was recorded. The Test of Playfulness was scored by a blinded rater to examine child outcomes following the intervention. Line graphs were used to examine case data. Percentage of non-overlapping data (PND) was used to calculate the single-case effect size for each child. RESULTS: Parents completed 92.2% of the intervention. Children's case data showed an upwards trend from pre- to post-intervention in four of the five pairs (child with ASD and playmate). However, there was a decrease in scores from post-intervention to the two-month home follow-up for all but one pair. PND indicated the intervention was effective for two children with ASD and three of their playmates, had a questionable effect on three children with ASD and no observable effect on two playmates. CONCLUSION: The intervention demonstrated preliminary feasibility and effectiveness for improving the social play skills of some children with ASD. Careful consideration is needed to identify which children with ASD and which playmates would be best suited for this intervention approach.

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.

BACKGROUND: Children with attention deficit hyperactivity disorder (ADHD) experience significant ongoing social difficulties which occur in multiple contexts. Interventions designed to improve these social difficulties have demonstrated minimal effectiveness. Thus, there is a clear need to establish interventions that are effective in addressing the social difficulties of children with ADHD across contexts and in the long term. AIM: To examine the long-term effectiveness and appropriateness of a pilot parent-delivered intervention designed to improve the social play skills of children with ADHD and their playmates. METHOD: Participants included five children with ADHD who had completed the intervention 18-months prior, their typically developing playmates and mothers of children with ADHD. Blinded ratings from the Test of Playfulness were used to measure children's social play: post-intervention and 18-months following the intervention in the home and clinic. Wilcoxon signed-ranks and Cohen's-d calculations were used to measure effectiveness. Parents' perspectives of the appropriateness of the intervention were explored through semi-structured interviews and data were analysed thematically. RESULTS: The social play skills of children with ADHD and their playmates were maintained following the intervention in the home and clinic. Thematic analysis revealed four core-themes against an intervention appropriateness framework: new parenting tools, a social shift, adapting strategies over time and the next developmental challenge. CONCLUSION: The parent-delivered intervention demonstrated long-term effectiveness and appropriateness for improving children's social play skills. SIGNIFICANCE: These preliminary results are promising as maintaining treatment effects and achieving generalisation across contexts has remained an unachieved goal for most psycho-social interventions.

Evaluation of a pilot parent-delivered play-based intervention for children with attention deficit hyperactivity disorder.

OBJECTIVE. This study evaluated a parent-delivered intervention aiming to address the social difficulties of children with attention deficit hyperactivity disorder (ADHD). The intervention was evaluated from three perspectives: effectiveness, feasibility, and appropriateness. METHOD. This one-group pretest-posttest study included 5 children with ADHD and their parents, who had previously participated in a therapist-delivered play-based intervention. The 7-wk parent-delivered intervention involved home modules (including a DVD, manual, and play dates with a typically developing playmate) and three therapist-led clinic-based play sessions. The Test of Playfulness was used as a pre- and postintervention and follow-up measure. Parents were interviewed 1 mo following the intervention, and data were analyzed for recurring themes. RESULTS. Children's social play outcomes improved significantly from pretest to 1-mo follow-up (Z = 2.02, p = .04, d = 1.0). Three themes emerged: the clinic play environment as a sanctuary, parental barriers to intervention delivery, and tools for repeating learned lessons. CONCLUSION. The parent-delivered intervention demonstrated preliminary evidence for feasibility and effectiveness. Further research is warranted regarding appropriateness.

Eighteen-month follow-up of a play-based intervention to improve the social play skills of children with attention deficit hyperactivity disorder.

BACKGROUND/AIM: There is a well-documented need for interventions to successfully address the social difficulties of children with attention deficit hyperactivity disorder. This study aimed to further the development of a previously conducted pilot of a play-based intervention. To achieve this, children's social play outcomes pre-post and 18-month following the intervention were examined by raters unaware of the study's purpose. Additionally, parents' experiences of the intervention were explored. METHODS: Participants included five children with attention deficit hyperactivity disorder who had participated in a play-based intervention and their typically developing playmates; parents of children with attention deficit hyperactivity disorder also participated. Children and their playmates attended an 18-month follow-up play session and parents participated in semi-structured interviews. The Test of Playfulness was used to measure children's play outcomes in the context of social play with a peer, pre-post and 18-months following the intervention. Wilcoxon signed-ranks (Z) and Cohen's-d were used to measure effect. Thematic analysis was used to analyse reoccurring themes from parents' interviews. RESULTS: Children's social play outcomes improved pre-post intervention (Z = 2.02; P = 0.04; d = 1.6) and were maintained 18-month post intervention (Z = 0.14; P = 0.89; d = -0.4). Core themes included: the intervention as an enjoyable experience, a common language for talking about play/social interactions, an observable change in children's skills, transference of skills and the need for support to refresh learnt lessons over time. CONCLUSIONS: The intervention demonstrated preliminary and long-term efficacy in developing the social play skills of children with attention deficit hyperactivity disorder. Further research is required to optimise intervention feasibility and parent involvement prior to conducting a large-scale research.

The friendships of children and youth with attention-deficit hyperactivity disorder: A systematic review.

BACKGROUND: Children with attention-deficit hyperactivity disorder (ADHD) experience substantial difficulty maintaining meaningful friendships, which has implications for social functioning and mental health. No systematic review has investigated their friendship difficulties. OBJECTIVES: To systematically review and methodologically appraise the quality of existing studies reporting on friendships of children with ADHD. To compare their friendships to typically-developing children, and examine associations between friendship and children's social-emotional wellbeing and mental health. METHOD: Six databases were searched. The methodological quality of studies was assessed using the QualSyst appraisal tool and the Appraisal tool for Cross-Sectional Studies. Aspects of friendships measured were charted, along with comparisons between children with ADHD and typically-developing children and the associations between friendships and social-emotional wellbeing and mental health. RESULTS: Twenty-three cross-sectional studies and one longitudinal follow-up study were included. Studies included 1509 participants with ADHD, with 1197 typically-developing participants used as a companion in 19 of the 24 studies. Friendship quantity was the most investigated aspect of friendship. Children and youth with ADHD had significantly fewer friends, lower quality friendships and poorer friendship interactions. There were mixed findings from studies investigating the role or impact of friendship on social-emotional wellbeing and mental health. Twenty-two had strong methodological quality. CONCLUSION: Limited longitudinal studies, small sample sizes and variability in measurement restrict the interpretations of friendship over time and the causal impact of friendship on social and emotional outcomes. Further research should investigate the role and impact of friendships on the social-emotional wellbeing of children and youth with ADHD.