The Relationship of Receptive and Expressive Social Skills to Social Outcomes in Children with Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorders

Background: Significant overlap between symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorders (ASD) has been demonstrated in previous research.  While both groups demonstrate social impairments, evidence from previous research may imply a distinction in the pattern of social deficits between the two groups.  Examination of receptive and expressive social cognitive skills in each group may identify factors that predict social outcomes and potentially offer insight into the underlying pathophysiology of the social impairments characteristic of these two neuropsychiatric disorders. 

Objectives: To identify factors predictive of social outcomes in groups with known social skill deficits. 

Methods: Participants were 88 children diagnosed with an ASD (4 females, 82 males ages 4-19 years; mean age = 9.16; SD = 4.22) and 105 children diagnosed with ADHD (42 females, 63 males ages 4-18; mean age = 9.64, SD = 3.02) undergoing assessment in a pediatric neuropsychology clinic.  Receptive social skills were measured through a facial and vocal affect comprehension task, Diagnostic Analysis of Nonverbal Accuracy (DANVA-2).  Expressive social skills were measured by the Pragmatic Judgment subtest of the Comprehensive Assessment of Spoken Language (CASL).  Social outcomes were assessed through the teacher report Behavior Assessment Scale for Children, 2^nd Edition (BASC-2) Social Skills subtest.  

Analyses were planned to examine group differences relative to the standardization sample and to each other.  One-sample and independent samples t-tests against the normative means were performed on the DANVA-2, CASL, and BASC-2 measures.  Regression analyses were performed to examine the relative contribution of receptive and expressive social skills to the prediction of teacher rated social competence in each group.

Results: Independent samples t-tests indicated that the performance of the ASD group was significantly less accurate than the ADHD group on the child facial [t(191) = 2.911, p = .004)] and vocal [t(149) = 2.899, p = .004)] affect recognition tasks and on the CASL pragmatic judgment subtest [t(159) = 4.505, p < .001)].  One-sample t-tests against the mean of the normative sample indicated that both groups performed significantly lower on all tasks, with the exception of the adult vocal affect task, for which the mean score of ADHD group did not differ from the normative mean.  Finally, regression analyses indicated that the linear combination of predictors accounted for a significant amount of variability in teacher report of social competence in the ADHD group (R² = .13, R²_adj = .086, F(5,99) = 2.965, p=.015), but not in the ASD group.  Only partial correlations between CASL pragmatic judgment and social competence rating were significant in the ADHD regression model. 

Conclusions: The significant contribution of performance on the pragmatic judgment subtest of the CASL to the prediction of social outcome may suggest that social difficulties in ADHD result from difficulties in social decision making and responding rather than misinterpretation of affective cues.  This pattern was not identified in the ASD group, suggesting that social difficulties may result from different processes in ASD.