ارزیابی روانسنجی مهارت های سیستم امتیاز اجتماعی در کودکان مبتلا به اختلال نقص توجه و بیش فعالی

The social skills rating system (SSRS) was developed to assess social skills of children, as observed by multiple raters (teacher, parent, child). Studies of the SSRS have been conducted with handicapped, mentally retarded and learning disabled children. No studies have reported the psychometric properties of the SSRS in a clinical ADHD sample. This is important, because deficient social functioning is associated with ADHD. The present study assesses the psychometric properties of the teacher, parent and child versions of the SSRS in children with ADHD (n=123), and normal controls (n=239). Also, the social skills of children with ADHD, as rated on the SSRS were examined. Results support the factor structure and internal consistency of the original SSRS-teacher version. Moreover, support was found for 3 out of 4 scales of the SSRS-parent version. The factor structure of the SSRS-child version could not be replicated. An explanatory factor analysis on the SSRS-child version yielded two factors. Evidence was found for discriminative ability of the SSRS between normal controls and children with ADHD. Finally, informant agreement between raters was found to be poor.

Social skills such as cooperation with peers, initiating relationships, sharing and receiving compliments enable a child to interact effectively with others and to avoid socially unacceptable responses (Gresham, 1988). Unfortunately not all children develop adequate social skills in their childhood (Gresham & Elliot, 1990). Especially, children with ADHD (Attention deficit hyperactivity disorder) are at risk for experiencing difficulties in their social functioning compared to normal controls (e.g. Gentschel & MacLaughlin, 2000; Greene et al., 1996; Biederman, Faraone, & Chen, 1993). Social impairment was found to be a significant predictor of an adverse long-term outcome of ADHD in adolescence (Greene, Biederman, Faraone, Sienna, & Garcia-Jetton, 1997; Greene et al., 1999). Therefore, identifying children with ADHD and social disabilities at an early stage is important for preventive purposes (Greene et al., 1997). Several instruments have been developed to help identify social problems in children. The social skills rating system (SSRS), developed by Gresham and Elliot (1990), is a multi-rater instrument with a child, parent and teacher version, for the assessment of social skills dimensions in children. The SSRS has been used in several studies as a screening device (e.g. Frankel & Feinberg, 2002; Gresham, MacMillan, Bocian, Ward, & Forness, 1998) and as a measure to assess treatment outcome (e.g., Antshel & Remer, 2003; Pfiffner & McBurnett, 1997; Sheridan, Dee, Morgan, McCormick, & Walker, 1996). Children's social behavior has been found to vary across different settings (Achenbach, McConaughy, & Howell, 1987; Kazdin, 1979). The SSRS takes this situational specificity into account and assumes that parents, children and teachers often contribute unique information to ascertain social behaviors (Gresham & Elliot, 1990). Consequently, Gresham and Elliot (1990) analyzed the parent, teacher and child versions of the SSRS separately, resulting in different factor structures for each version. These factor analyses showed that all three versions contained three factors: “Cooperation”, “Assertion” and “Self-control”. The parent version consisted of an additional factor, “Responsibility”. The child version contained an additional factor, labeled “Empathy”. The internal consistency of the SSRS subscales ranged from .51 to .91, with a mean internal consistency of .75 (Gresham & Elliot, 1990). A number of recent studies have examined the psychometric qualities of the SSRS in further detail (Albertus, Birkinbine, Lyon, & Naibi, 1996; Bramlett, Smith, & Edmonds, 1994; Flanagan, Alfonso, Primavera, Povall, & Higgins, 1996; Gresham, Elliot, & Black, 1987; Merrell & Popinga, 1994; Shahim, 1999). Shahim (1999), for example, using a sample of 89 special education students, found a moderate correlation (r=.30) between the teacher and parent ratings of social skills on the SSRS. Bramlett et al. (1994) found a moderate relationship (r=.46) between teacher and parent ratings of a mixed group of learning disabled, mentally retarded and non-referred children. These studies suggest that social skills are perceived as somewhat consistent across raters. Other studies examining convergent validity have found moderate to high correlations between the SSRS and other social competence measures, including the Woodcock–Johnson Scales of Independent Behavior (Merrell & Popinga, 1994), the Vineland Adaptive Behavior Scales (Albertus et al., 1996) and the Behavior Assessment System for Children (BASC; Flanagan et al., 1996). Flanagan et al. (1996) found a high positive correlation (r =.58) between parent ratings on the BASC and the SSRS. However, teacher ratings showed a low correlation between the BASC and the SSRS (r=.23). Also, internal consistencies for the SSRS seem satisfactory. Shahim (1999) has found high alpha coefficients (Cronbach's alpha) for the parent (.89) and the teacher versions (.92) of the SSRS, comparable to the alpha coefficients of the parent and teacher SSRS reported by Gresham and Elliot (1990). Although some studies have found the SSRS to discriminate between the broad categories of handicapped and non-handicapped children (Albertus et al., 1996; Gresham et al., 1987) and mentally retarded, learning disabled students and non-referred children (Bramlett et al., 1994), to our knowledge, no studies have yet addressed the discriminative power of the SSRS with more narrowly defined groups of children, such as children with ADHD and their normally developing peers. In spite of this, some researchers (e.g., Antshel & Remer, 2003; Pfiffner & McBurnett, 1997) have used the SSRS in studies with children with ADHD. Socially inappropriate behaviors and difficulties in social problem solving seem directly related to the core features of ADHD (Greene et al., 1996) and may be expressed as frequent shifts in conversation, not listening to others, initiating conversations at inappropriate times, frequently interrupting or intruding on others, and clowning around (DSM-IV, American Psychiatric Association, 1994). Also, it has been estimated that a large proportion of children with ADHD experience social rejection from their peer group (Barkley, 1998; Hinshaw & Melnick, 1995; Erhardt & Hinshaw, 1994) or are rated as less popular than their peers (Wheeler & Carlson, 1994). Consequently, social problems are seen by some as central to the psychopathology of ADHD (Gentschel & MacLaughlin, 2000; Whalen & Henker, 1985). Also, the DSM-IV (American Psychiatric Association, 1994) describes as a criterion for ADHD, next to a persistent pattern of inattention and/or hyperactivity/impulsivity, clear evidence of interference with developmentally appropriate social functioning. The present study was undertaken to evaluate the psychometric properties of a Dutch translation of the three different versions of the SSRS in a clinically referred sample of school age children with ADHD, and a sample of normal controls. Three issues were examined. First, Gresham and Elliot (1990)'s factor structure of the original American teacher, parent, and child versions of the SSRS was evaluated for the ADHD sample and a sample of normal controls separately. Also, internal consistencies for each subscale were examined. If the original factor structure of Gresham and Elliot was not found to be satisfactory for our samples, alternative factor structures were explored. Second, psychometric properties of the SSRS were addressed. Children with ADHD were compared to normal controls on the SSRS and the discriminative power of the SSRS was examined. Third, informant agreement on the teacher, parent and child versions of the SSRS was examined. With respect to the first research question, it was expected that the original structure of Gresham and Elliot (1990) would be confirmed in the Dutch ADHD and normal control samples. Further, it was expected that children with ADHD would show lower levels of social skilled behaviors than normal controls (Gentschel & MacLaughlin, 2000; Greene et al., 1996; Biederman et al., 1993) and the SSRS would be able to differentiate between children with ADHD and normal controls. With respect to the third research question, informant agreement was expected to be low, because behavior ratings are evaluative judgments affected by the specific environment and by the raters’ standards for behavior or because of the possible situational specificity of social behaviors (Achenbach et al., 1987).