The Relationship Between Executive Function and Social Functioning in Children With ADHD: A Meta-Analytic Study

Abstract

Social functioning difficulties are among the most persistent and impairing features of Attention-Deficit/Hyperactivity Disorder (ADHD), with lasting consequences for academic, emotional, and psychosocial outcomes. Theoretical models of ADHD suggest that these difficulties may arise, in part, from impairments in executive functioning (EF), delay aversion, and cognitive-energetic processes. Among these mechanisms, EF has received considerable research attention due to its robust and malleable role in development, making it a promising target for intervention. From this perspective, understanding the association between EF and social functioning is important, yet empirical findings have been inconsistent, with some studies showing positive associations and others reporting null results. The present thesis addresses this gap by conducting a meta-analysis to quantify the association between EF and social functioning in children with ADHD and to examine whether this association varies across mean age, gender composition, publication year, EF group, social functioning domain, social functioning measurement type, diagnostic rigour, and methodological transparency. A systematic search was conducted to identify empirical studies reporting zero-order correlations between EF and social functioning in children with ADHD. Effect sizes were extracted and synthesised using multilevel random-effects meta-analytic models with robust variance estimation (RVE), and moderator analyses were conducted to examine potential sources of heterogeneity. Across 11 studies comprising 69 effect sizes, EF showed a small but statistically significant positive association with social functioning in children with ADHD (r = .08, 95% CI [.024, .128], p = .012). None of the moderator tests provided evidence that the association varied across the examined child, measurement, or study characteristics. Sensitivity analyses indicated that the overall effect was stable across leave-one-study-out re-estimation and across alternative assumptions about the within-study correlation. An Egger-style precision regression did not indicate a statistically significant small-study effect. These findings indicate that performance-based EF and social functioning share only a small amount of variance in ADHD samples. Practically, interventions that target social impairment in children with ADHD may therefore need to focus less on improving EF in isolation and more on supporting social performance during real-world social interactions. Future research should prioritise clearer reporting of extractable EF and social functioning correlations, test EF and social functioning associations within EF-impaired subgroups, and compare estimates from models with and without RVE where appropriate.