Can prosocial behavior buffer symptom severity and impairment in children and adolescents with ADHD symptoms in a clinical setting?

Background: Most research in children with ADHD has focused on risk factors and their outcomes, such as symptom severity as a risk factor for functional impairment. Yet, a small group of studies show that some children function well despite their symptom severity. Preliminary evidence suggests that social protective factors may protect children with ADHD against its negative impact across different domains. The purpose of this study was to evaluate whether prosocial behavior, as a protective factor, buffers the effects of symptoms on impairment in children and adolescents with ADHD symptoms.

Methods: In this cross-sectional study, we used routinely collected data from the Development and Well-Being Assessment (DAWBA). Reports were included from 822 mothers, 581 fathers, and 1109 teachers, who provided information on the children's symptoms, impairment and prosocial behavior (aged 5-18). To examine the effects of prosocial behavior on the relationship between symptoms and functional impairment, multiple regression analyses were conducted using data from these three perspectives.

Results: Although we did not find buffering effects, regression analyses revealed that parent- and teacher-reported prosocial behavior demonstrated promotive effects on functional impairment, indicating that prosocial behavior may be beneficial in reducing impairment on daily life of children with ADHD. These results were consistent across raters and age-groups, except the mother-rated model for adolescents. Additionally, when investigating these effects by gender, we found that higher prosocial behavior, as observed by fathers, was related to lower impairment for girls.

Conclusion: Our results suggest that prosocial behavior should be considered in clinical practice when evaluating impairment scores for ADHD. Finally, our findings plead for more in-depth measures of social protective factors and across different levels, including individual, family, and community levels. This approach will help identify factors that, independently of risks, may positively impact the functioning of these children.