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Background <p>Emotional problems represents a prevalent clinical manifestation in pediatric populations with attention-deficit/hyperactivity disorder (ADHD), exacerbating functional impairments and complicating treatment outcomes. While pharmacological and behavioral interventions target core ADHD symptoms, structured approaches addressing emotional dysregulation through executive function training remain underexplored. Ecological executive skills training (EEST) has emerged as a promising intervention. This study systematically evaluates the multidimensional impact of EEST by integrating behavioral, cognitive, and emotional metrics to establish an evidence-based framework.</p> Methods <p>A total of 65 primary school children diagnosed with ADHD for the first time were recruited for this study. Children with ADHD were evaluated by Achenbach Child Behavior Checklist (CBCL), Strengths and Difficulties Questionnaire(SDQ), Conner’s Parent Symptom Questionnaire (PSQ), Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS), Behavior Rating Inventory of Executive Function(BRIEF) and Weiss Functional Impairment Rating Scales-Parent Report (WFIRSP). Statistical analysis was conducted using SPSS software (version 19.0). Categorical variables were presented as counts (n) and percentages (%). Improvements in Inattention were analyzed using Generalized Estimating Equations (GEE) with robust standard error estimators.</p> Results <p>1.Efficacy of Mood Regulation: After three months of treatment, the experimental group exhibited significantly greater improvement than the control group in anxiety and depression subscales of the CBCL, SDQ teacher emotional symptom ratings, PSQ (Anxiety), VADPRS and VADTRS anxiety/depression items, and the BRIEF Emotion Regulation Index. 2. Core Symptom Severity: The experimental group demonstrated significantly greater reductions in inattention and hyperactivity/impulsivity symptoms compared to controls, as measured by the VADPRS and VADTRS. 3.Executive Functioning Improvements: The experimental group showed significantly greater enhancements (<i>P</i> &lt; 0.05) across all BRIEF executive function domains, with particularly significant improvements observed in working memory. 4. EEST can improve Social Functioning Outcomes.</p> Conclusions <p>EEST significantly alleviates emotional probloms in children with ADHD, including symptoms of anxiety, depression, and impaired emotional control. Furthermore, this intervention demonstrates measurable improvements in core ADHD symptoms, executive functioning, and social competency. </p> Clinical trial registry <p>The Chinese Clinical Trial Registry (ChiCTR). Trial Registration Number:2,200,062,513​.</p>

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The effect of Ecological Executive Skills training on emotional problems in children with attention-deficit hyperactivity disorder

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月2日

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  • Lili Wang,
  • Xinyue Peng,
  • Hanyu Dong,
  • Chi Ma,
  • Guangyu Liang,
  • Weiyan Zhao,
  • Feiyong Jia,
  • Lin Du

摘要

Background

Emotional problems represents a prevalent clinical manifestation in pediatric populations with attention-deficit/hyperactivity disorder (ADHD), exacerbating functional impairments and complicating treatment outcomes. While pharmacological and behavioral interventions target core ADHD symptoms, structured approaches addressing emotional dysregulation through executive function training remain underexplored. Ecological executive skills training (EEST) has emerged as a promising intervention. This study systematically evaluates the multidimensional impact of EEST by integrating behavioral, cognitive, and emotional metrics to establish an evidence-based framework.

Methods

A total of 65 primary school children diagnosed with ADHD for the first time were recruited for this study. Children with ADHD were evaluated by Achenbach Child Behavior Checklist (CBCL), Strengths and Difficulties Questionnaire(SDQ), Conner’s Parent Symptom Questionnaire (PSQ), Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS), Behavior Rating Inventory of Executive Function(BRIEF) and Weiss Functional Impairment Rating Scales-Parent Report (WFIRSP). Statistical analysis was conducted using SPSS software (version 19.0). Categorical variables were presented as counts (n) and percentages (%). Improvements in Inattention were analyzed using Generalized Estimating Equations (GEE) with robust standard error estimators.

Results

1.Efficacy of Mood Regulation: After three months of treatment, the experimental group exhibited significantly greater improvement than the control group in anxiety and depression subscales of the CBCL, SDQ teacher emotional symptom ratings, PSQ (Anxiety), VADPRS and VADTRS anxiety/depression items, and the BRIEF Emotion Regulation Index. 2. Core Symptom Severity: The experimental group demonstrated significantly greater reductions in inattention and hyperactivity/impulsivity symptoms compared to controls, as measured by the VADPRS and VADTRS. 3.Executive Functioning Improvements: The experimental group showed significantly greater enhancements (P < 0.05) across all BRIEF executive function domains, with particularly significant improvements observed in working memory. 4. EEST can improve Social Functioning Outcomes.

Conclusions

EEST significantly alleviates emotional probloms in children with ADHD, including symptoms of anxiety, depression, and impaired emotional control. Furthermore, this intervention demonstrates measurable improvements in core ADHD symptoms, executive functioning, and social competency.

Clinical trial registry

The Chinese Clinical Trial Registry (ChiCTR). Trial Registration Number:2,200,062,513​.