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Children with attention deficit hyperactivity disorder (ADHD) are at significant risk for a variety of comorbid conditions, including social skills deficits. Although interventions addressing various aspects of social difficulties with these children have been developed, few researchers have integrated new The authors would like to acknowledge the numerous individuals who participated in the development and implementation of this project, The Children’s Center and the University of Utah Psychoeducational Clinic for the use of its facilities, and the peer confederates and research participants for their time and effort throughout the study. This article represents the results of a study awarded the Outstanding Dissertation of the Year Award for 2002 by Division 16 (School Psychology) of the American Psychological Association. Opinions expressed herein are those of the authors and do not reflect the opinions of the awarding agencies. Address correspondence to the second author: Daniel Olympia, Department of Educational Psychology, 1705 Campus Center Drive, MBH 327, University of Utah, Salt Lake City, UT 84112; Email: olympia@ed.utah.edu. 198 Fenstermacher, Olympia, & Sheridan in School Psychology Quarterly 21 (2006) technology with existing so cial skills intervention literature and investigated such approaches empirically. The purpose of this study was to investigate the effectiveness of a computer-mediated social skills training program for children diagnosed with ADHD. The program pre sented specific social skill sequences to four children with ADHD in a variety of computer–facilitated formats with video peer modeling, social problem–solving, and reinforcement components. Participants’ abilities to demonstrate specific so cial problem–solving skills effectively in a behavioral analogue environment were evaluated. The study used a multiple-probe variation of the multiple-baseline de sign (MBD) across participants. All participants demonstrated improvements in ability to demonstrate effective social problem–solving skills in analogue role–play assessments with live peers. Follow–up data at 3 and 6 week intervals indicated that participants maintained their gains over time. Att ention–defi cit/hyperactivity disorder (ADHD) is a complex and chronic disorder aff ecting 3 to 5% of school–aged children (American Psychiatric Association, 1994). ADHD is believed to originate in early childhood (Barkley, Fischer, Newby, & Breen, 1988), deemed to be chronic throughout childhood and adolescence (Klein & Manuzza, 1991), and oft en associated with comorbid conditions such as oppositional–defi ant disorder, learning disabilities, conduct disorder, academic underachievement, and social skills defi cits (Barkley, 1998). The social diffi culties of children with ADHD are well established and clearly linked to key symptoms of the disorder (e.g., DuPaul, McGoey, Eckert, & VanBrakle, 2001; Hoza, Owens, & Pelham, 1999; Sheridan, 1998). Children with ADHD/I (predominantly inatt entive) are more so cially withdrawn (Edelbrock, Costello, & Kessler, 1984), more likely to demonstrate defi cits in sustaining att ention (Barkley, 1990), and oft en dis play symptoms of anxiety and depression (Lahey, Schaughency, Hynd, Carlson, & Nieves, 1987). Diagnostic features for ADHD/HI (predomi nantly hyperactive/impulsive) and ADHD/COM (combined) subtypes include impulsivity, aggression, overactivity, noncompliance, and anti social tendencies. Behaviors associated with either of these subtypes can directly or indirectly interfere with daily opportunities for prosocial inter actions and, over time inhibit the development of meaningful relation ships with others (Sheridan, 1995a) and lead to active social rejection ex periences (Barkley, 1998). Additionally, children with ADHD frequently exhibit less positive social behaviors, initiate fewer positive peer interac tions, experience lower rates of peer reinforcement, and demonstrate fewer cooperative social behaviors (Elliott & Gresham, 1993). Indeed, the social performanceofchildrenwithADHDinkey areassuchassocialen try skills, problem–solving skills, and observance of participatory and conversational rules is Computer–facilitated, Interactive Social Skills Training for Boys with ADHD 199 regarded as highly problematic (DuPaul & Stoner, 2003) and oft en precedes serious problems during adolescence and adulthood (Rubin, Bukowski, & Parker, 1998). INTERVENTIONS FOR CHILDREN WITH ADHD Over the past two decades, it has been demonstrated that no single inter vention for children with ADHD is eff ective, due to the myriad symptoms associated with the disorder (Muscott & Guilford, 1994). In fact, the cre ation of a “prosthetic environment” using multiple interventions across multiple sett ings over longer time durations may be necessary for many children with the disorder (Barkley, 1998). While the singular impact of stimulant medication in treating symptoms of ADHD is strong (Greene & Ablon, 2001), intervention is most eff ective when pharmacological treat ment is paired with psychosocial, behavioral, and cognitive behavioral treatment strategies (Hoza, 2001; Pelham & Gnagy, 1999). This may be particularly true for children with ADHD and social skills diffi culties (Anastopoulos, DuPaul, & Barkley, 1991; MTA Cooperative Group, 1999; Sheridan, Dee, Morgan, McCormick, & Walker, 1996; Wells et al., 2000). Since the use of multimodal strategies represents the optimal treatment package when treating children with ADHD, the need for a wide range of adjunctive treatments to address symptom severity and the presence of specifi c behavioral diffi culties, including social performance diffi culties, across a range of sett ings and situations is apparent. Consequently, the empirical validation of a variety of behavior or cog nitive–behavior based treatment strategies to address social skill needs for students with ADHD is vital. A thorough review of research investi gating the full range of these strategies is beyond the scope of this article. Interested readers are referred to Elliott , Gresham, and Heff er (1987); Sheridan and Walker (1999); and others. However, the limited empirical support for social skills interventions with this population has been a source of concern for many school psychologists, particularly when chil dren with ADHD and social skills defi cits are asked to demonstrate or generalize skills to other sett ings (DuPaul & Stoner, 2003). APPROACHES TO SOCIAL SKILLS INTERVENTION Practitioners working with children having social skills defi cits and ADHD have relied on a variety of cognitive behavioral and behavioral intervention techniques, including modeling, behavioral rehearsal, reinforced practice, peer coaching, and direct instruction (DuPaul & Stoner, 2003). Oft en, these interventions are proscribed in a group for200 Fenstermacher, Olympia, & Sheridan in School Psychology Quarterly 21 (2006) mat, with students exhibiting similar characteristics meeting together with a psychologist for a specifi ed duration of time. Group–facilitated Social Skills Training The interactive and performance aspects of social skills defi cits and the fact that they regularly occur in a group context initially appeared well suited to group–facilitated approaches. However, recent evidence sug gests that the current practice of grouping children for the purpose of teaching and practicing social skills may lead to unanticipated outcomes such as unintended changes in att itude toward antisocial behavior, identifi cation with deviant peers, and assimilation of deviant values (Ang & Hughes, 2002; Arnold & Hughes, 1999; Dishion, McCord, & Poulin, 1999). In fact, when peer aggregations in a group format are used to deliver interventions for at–risk youth, such practices “. . . may make shopping for a deviant interpersonal environment much easier” (Arnold & Hughes, 1999, p.110). Group–facilitated social skills instruction has also served as an impor tant aspect of strategies to promote generalization. The importance of generalizing newly acquired social skills has created interest in more comprehensive interventions that incorporate various levels of training (individual, group, class, school–wide), more systematic involvement of parents and teachers, homework assignments, and use of booster sessions and other enhancements to off set any negative effects of grouping these children and produce maximum gains across sett ings. Social skills inter ventions also frequently include a problem– solving component to pro mote generalization to other sett ings (Sheridan, 1995b). Some approaches have also att empted to teach and support specifi c social skills using im bedded instruction and positive behavior plans to teach and reinforce skills in naturally occurring contexts (Sheridan, Hungelmann, & Maughn, 1999; Sugai & Lewis, 1996). For example, the Tough Kid Social Skills Program (Sheridan, 1995a; Sheridan et al., 1996) provides such a comprehensive treatment modality. Initial results of group–based inter ventions, which included didactic training in conversation skills, problemsolving, and anger/impulse control strategies, have in fact pro duced impressive gains in the sessions themselves, but generalization to other sett ings and situations continues to be problematic (Gresham, 2002). Computer–mediated Social Skills Training Along with traditional strategies for social skills assessment and instruction, novel techniques are also emerging, including the use of computer technology and the integration of video and computer–based soComputer–facilitated, Interactive Social Skills Training for Boys with ADHD 201 cial sim ulations with instructional content (Muscott & Guilford, 1994; Smokowski, 2003). The potential advantages are numerous. Computer programs can present stimulus events using video content that maintains close fi delity with the actual phenomenon of social interaction. The content of these stimuli can be constructed to re

Effectiveness of a computer-facilitated interactive social skills training program for boys with attention deficit hyperactivity disorder.