Examination of Peer Interactions During Cooperative and Competitive Board Games Among Children with Attention-Deficit/Hyperactivity Disorder on and off Methylphenidate

Children with ADHD have significant difficulties with social skill application (e.g., waiting turn, interpreting social cues). Behavioral treatments to promote social skills, such as the Summer Treatment Program (STP), incorporate daily social skills training with systematic opportunities to apply skills as part of peer group interactions. Recreational periods are particularly well-suited for examining these behaviors, as social skills are essential during game play. The current study examined undesirable behaviors during board games and explored underlying factors (e.g., inhibitory control, sensitivity to reinforcement) that may contribute to undesirable behaviors during play. Twenty-eight children with ADHD participated in the current cross-over design study. At baseline, children completed a task of inhibitory control and their parents rated their child's sensitivity to reinforcement. During the STP, children played competitive or cooperative board games, when taking either stimulant medication or placebo, in small groups of 3-4 children across 20 days. Undesirable behaviors were recorded during game play. Overall, medication use reduced rule violations, poor sportsmanship, and other behaviors. Only cooperative board games decreased teasing behavior. There was a reward x game interaction, such that those with higher reward sensitivity exhibited more poor sportsmanship during competitive games. Collectively, these findings suggest that stimulant medication attenuates undesirable peer interactions during board game play, cooperative board games may decrease teasing relative to competitive games, and the board game setting may be a potential avenue to better understand and address peer interactions in children with ADHD.