The moderating role of co-occurring attention-deficit hyperactivity disorder in social skills group training for autistic children and adolescents.
Anna Fridell, Nora Choque Olsson, Christina Coco and 2 others
PMID 40265462WHAT IT FOUND
KONTAKT social skills training helped most autistic adolescents and children without ADHD, but not children with co-occurring ADHD.
In that subgroup, standard care alone produced higher response rates than the training.
Key findings
01Children with co-occurring ADHD showed no benefit from KONTAKT over standard care, with standard care producing higher response rates in the reliable improvement analysis.
02Adolescents with and without ADHD, and children without ADHD, all showed significant improvements from KONTAKT compared to standard care alone.
03Overall, KONTAKT was effective compared to standard care, with a number needed to treat of 8 for reliable improvement and 6 for clinically relevant improvement.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The original trials were not designed for moderation analysis, and the three-way interaction test lacked statistical power. The sample was imbalanced, with 74% of participants having co-occurring ADHD, which affects the precision of estimates for the smaller non-ADHD group. ADHD diagnoses were taken from medical records and not re-verified by the research team, and the trials began when autism and ADHD could not formally be diagnosed together, suggesting possible underdiagnosis. The study only used parent-rated social responsiveness as an outcome, potentially missing gains in other areas such as teacher-rated behavior or self-reported well-being. Standard care varied among participants and included multiple concurrent treatments (e.g., medication, CBT), making it impossible to isolate the specific effect of KONTAKT from the background of usual services.
Declared interests
One author receives royalties for the KONTAKT manuals and is a partner in a company associated with the intervention. Other authors are co-authors of the manuals but do not receive royalties. The study was funded by public health and research foundations, including Region Stockholm and the Swedish Research Council.
The easy way to misread this
Do not conclude that social skills training is ineffective for children with ADHD. The null finding applies specifically to the KONTAKT protocol as delivered in this study, where children with ADHD may have been hindered by the group format. It does not mean no intervention works, but that this specific group-based approach did not outperform standard care for this subgroup.