Psychology
2012. Vol.3, No.8, 616-620
Published Online A 2012 in SciRes (http://www.SciRP.org/journal/psych) http://dx.doi.org/10.4236/psych.2012.38094
616
The Impact of a Self-Control Training Program on
Enhancement of Social Skills in Students with ADHD
Ahmad Beh-Pajooh1*, Sayyed Mohsen Fatemi2, Bagher Ghobari Bonab1,
Hamid Alizadeh3, Ghorban Hemmat i4
1Faculty of Psychology & Education, Univer sit y of Tehran, Tehran, Iran
2Department of Psych o logy, Harvard Universit y , Cambridge, USA
3Faculty of Psychology & Educ at io n , Allameh Tabataba’i University, Tehran, Iran
4Faculty of Psychology & Educ at io n , Shiraz University, Shiraz, Iran
[e-mail], [e-mail]. ir
Received February 15th, 2012 ; revised April 7th, 201 2; accept ed June 10 th, 2012
Objective: The study examined the effect of a self-control training program on enhancing social skills in
students with ADHD. Method: The study selected a pre-test-posttest control group design for a sample of
twenty male students in an elementary school in Tehran, Iran. The sample was divided into experimental
and control groups with the implementation of the treatment for the random assignment of the experi-
mental group for the period of one month. A repeated measure method was performed to analyze the data.
Results: The results indicated that the self-control training procedure was significantly effective in im-
proving the social skills of students with ADHD. The follow-up data indicated the effectiveness of the
treatment after the lapse of one month. Conclusion: The results suggested that teaching self-control tech-
niques to students with ADHD would enhance their social skills.
Keywords: Self-Control Procedure; Social Skills; Attention Deficit Hyperactivity Disorder
Introduction
Attention Deficit Hyperactivity Disorder (ADHD) appears to
be one of the most common and prevalent psychological and
neurodevelopmental disorders among children characterized by
more inattention, hyperactivity and impulsivity difficulties
(DSM-IV-TR, American Psychiatric Association [APA], 2000).
ADHD has been reported to be the main reason behind the
referrals of 30% to 40% of school-age children to mental health
counseling centers (Cantwell, 1996; Goldstein, 1995). It is es-
timated that 3% - 7% of school-age children suffer from ADHD
in the United States (APA, 2000; Conners & Jett, 1999). The
prevalence rate of ADHD symptoms in other countries also
indicates nearly the same. For example, Khoushabi and Poure-
temad (2002) have reported that 3% - 5% of Iranian high school
students suffer from ADHD. More specifically, Ghanizadeh
(2008) has declared that 10.1% of primary students have
ADHD symptoms. The existing evidence also reveals gender
differences of children with ADHD in Iran, whereas boys are
reported to be 3 to 10 times more susceptible to this disorder
than girls (Khoushabi & Pouretemad, 2002).
Core difficulties in children with ADHD include problems in
sustaining attention, poor impulsive and hyperactivity control.
Since children with ADHD are more likely to display problems
such as, emotional and behavioral disorders and to be impaired
in social behaviors, a timely intervention program may be nec-
essary to treat for them. The accurate diagnosis of the disorder
and effective administration of prevention programs would play
a significant role on preventing behavioral disorders and learn-
ing problems in such chil dren. As Braswell (1998) and Br aswe ll
and Bloomquist (1991) have reviewed the main aim of most
intervention programs are teaching self-control and self regula-
tion techniques to children with ADHD. Teaching self-control
and self-regulation techniques may serve as an effective strat-
egy to reduce the problems of these children (Austin, 2003;
Murray, 2002; Pierangelo & Giuliani, 2008; Whittenberg, 1995).
Self-control is defined as the response of choosing a delayed
larger reinforcer over an immediate smaller reinforcer (Dixon et
al., 1998; Gilmore, Cuskelly, & Hayes, 2003). The term self-
control suggests the ability to manage and control impulsivity
and ephemeral desires (Barkley, 1997). According to Russell
Barkley (1990, 1997), understanding ADHD is inextricably tied
to understanding of the nature of self-control.
Historically, cognitive-behavioral intervention programs have
been developed and widely used for treatment of children with
ADHD over 40 years. For example, Meichenbaum and Good-
man (1971) examined the effect of self-directed speech in im-
proving sustained attention and behavioral inhibitions in a
group of impulsive children. Many children with ADHD have
poor social skills as well as weak interpersonal relationships.
According to Landau, Milich and Diener (1998), approximately
fifty percent of children with ADHD experience peer rejection
and for many of them, relationship with adults are problematic.
Gresham and Elliot (1984) have defined social skills as so-
cially acceptable behaviors that enable a person to interact ef-
fectively with others to avoid socially rejection. Similarly, in
their study of the personality of children with ADHD, Lufi and
Parish-Plass (1995) found that these children were more de-
pendent on an external source of control, had less emotional
stability and suffered from more social anxiety. Children with
ADHD, therefore, may need assistance to notice the effects of
*Corresponding author.

A. BEH-PAJOOH ET AL.
their social behaviors on other people.
Children with ADHD often encounter problems in social in-
teractions with their teachers and peers and may seem to be
excluded on behalf of other children. Children with ADHD may
not often know the reason of getting rejected by other children
and may not see the connection between their behaviors and
other children’s lack of receptiveness. The typical behaviors of
children with ADHD seem to be associated with inattention to
other’s feelings, irresponsibility, impulsivity, impatience and
lack of cooperation in participatory tasks. Patience, therefore, is
a skill that such children need to learn (Friedman & Doyal,
1992).
Children with ADHD, thus, may need to realize the possible
adverse consequences of their behaviors. This may also require
learning appropriate and effective ways to meet the right needs.
The wrong evaluation and lack of control may possibly ge nera te
faulty actions for children with ADHD. Self-control techniques
that would contribute to the implementation of self-monitoring,
self-evaluation and self-reinforcement may help these children
make right choices and become aware of the consequences of
their behaviors (Matson & Ollendick, 1988).
Whittenberg (1995) studied the effects of training social
skills and self-control techniques on a group of socially handi-
capped children. Fourteen boys and twenty-two girls at the
fourth grade of ordinary schools participated in this pretest and
post-test experimental research which lasted for 12 weeks. The
experimental group with self-control training included eight
participants and the one receiving social skills training had nine
subjects. The control group with no intervention program con-
sisted of 19 participants. The participants in the experimental
groups received one hour treatment per week for a period of ten
weeks. The findings indicated that both training methods had
reduced social anxiety in participants. However, the self-control
training program indicated a higher impact in comparison with
the social skills training program.
Austin (2003) studied the effect of self-management tech-
niques on the treatment of ADHD in school children. His study
was an experimental pre-test post-test design including four
primary school children. The intervention program consisted of
a series of behavioral goals for children self-management and
availability of a set of self-reinforcement alternatives. The
findings indicated that in-class inappropriate behaviors espe-
cially academically irrelevant behaviors and hyperactivity sig-
nificantly decreased in all participants due to the effect of the
self-management techniques training. A follow-up study con-
firmed the maintenance of the results after one month.
Murray (2002) used cognitive-behavioral methods for teaching
self-control techniques to pre-school children with impulsive
behaviors. The study included 31 four-year-old children who
were randomly assigned to experimental and control groups.
The experimental group received self-control training tech-
niques for five weeks using cognitive-behavioral techniques.
The findings indicated that self-control ability had increased in
children which lead to the reduction of the rates of impulsive
behaviors.
In a similar study, Heinrich and colleagues (2004) examined
the effect of training self-control techniques on elementary
students with ADHD. The participants included thirteen 7 to 13
year-old children who received self-control training and relaxa-
tion exercises for 25 sessions in three weeks. The findings in-
dicated behavioral improvement in ADHD children. Further-
more, the severity of ADHD had also decreased among the
participants.
However, some findings have reported that self-control
training has not been effective with high incidence populations,
including children with ADHD (Abikoff, 1991). Yet, few stud-
ies have examined the effectiveness of such training over time
and especially little research has been conducted in Iran.
Therefore, it seems there is a need for more investigation and it
was hoped that such knowledge would help teachers and school
psychologists to maximize the effectiveness of self-control
programs. In the present study it was hypothesized that students
who had participated in self-control training programs, their
prosocial behaviors would enhance more than those who had no
experience of such training.
Method
Participants
The researchers used a pretest-posttest experimental research
design with a control group. The population included all ele-
mentary school boys in Tehran who enrolled and attended in
mainstream schools at the time of study. The independent vari-
able was defined as the self-control training program with the
dependent variable as the social skills.
The convenient sample included twenty male elementary
school children with an average IQ scores (95 - 108) and the
age range of 7 - 11 years (M = 8.5; SD = 1.8). They had been
diagnosed by a psychiatrist as having the symptoms of ADHD
based on the criteria of the DSM-IV (APA, 2000). The partici-
pants were not under any medication or therapy and were ran-
domly assigned to the experimental and control groups. The
experimental group received the self-control training intervention
program while the control group received no treatment. All the
participants’ parents signed the consent forms to agree with
participation of t h ei r ch il dren in this study.
Instruments
The study administered three instruments:
1) The 18-Item ADHD Checklist: The teachers were asked
to rate each student on the 18-item ADHD checklist. The
18-item ADHD checklist was developed by Ghanizadeh (2010)
on the basis of diagnostic criteria of the DSM 4th (APA, 2000)
to detect ADHD symptoms among potential students. The
checklist has sufficient validity and reliability and uses a
4-point Likert-type (Likert, 1932) rating scale including often
or always (3), sometimes (2), seldom (1), and never or not ob-
served (0).
2) Raven’s Progressive Matrices: Raven’s Progressive Ma-
trices measure was used to control the intelligence quotient of
the students. The researchers used the 36-item color form of
this measure for 6 - 9-year-old children and the 60-item form
for children of 9 - 11. The reliability coefficient of this test for
various age groups ranges between .70 and .90. In addition, this
measure has a correlation coefficient of .40 - .75 with other
intelligence tests, including Stanford Binnet and Wechsler In-
telligence Scale for Children (Anastasi & Urbina, 2009).
3) The Social Skills Rating System: The Social Skills Rat-
ing System (SSRS) was developed by Gresham and Elliott in
1990. The SSRS is a norm-referenced rating scale and provides
a broad assessment of students’ social behavior that can affect
teacher-student relations. The SSRS includes three behavior
rating forms for parents, teachers and students. The elementary

A. BEH-PAJOOH ET AL.
school teacher form (grades K-6) was used in this study. This
measure is based on a 30-item questionnaire rated on a
three-point Likert type scale (Likert, 1932). Numerical scores 0,
1, and 2 were assigned for the answers Never, Sometimes, and
Very Often, respectively. Therefore, a score of 60 would be
used potentially for the maximum score and zero for the mini-
mum.
Internal consistency coefficient range from .83 to .94 was
reported for the SSRS using test re-test method and Cronbach’s
alpha (Gresham & Elliott, 1990). Furthermore, in a study in
Iran, Cronbach’s alpha and split-half methods estimated a reli-
ability of .90 and .88 respectively by Shahim (1999). In addi-
tion, in the present study the researchers measured the reliabil-
ity of the SSRS on a 100 sample of elementary students in Te-
hran obtaining a Cronbach’s alpha of .87. Thus, the scale indi-
cates a high degree of internal reliability. The content validity
of the SSRS also was verified by five professors of psychology.
The SSRS questionnaire booklet was filled out by the teacher
of each student. The questionnaire was administered three times.
The first time, it was administered to both experimental and
control groups as a pretest before the introduction of the inter-
vention program. For the second time, it was re-administered at
the end of the intervention program as the post-test to both
groups. The third time of administration of the test was per-
formed (on both groups) as a follow-up measurement one
month after the second administration in order to measure the
maintenance of the behavior changes.
Intervention Program
The self-control training program was consisted of teaching
and reinforcing appropriate social behaviors of students and
administered in four phases.
First Phase: At the beginning, the participants of the expe-
rimental group received instructions and were given a notebook
with 15 pages in every page contained fifteen appropriate social
skills, such as, “I should stay in my seat”, “I should follow my
teacher’s instructions”, and “I should drop the garbage in the
dustbin”. Then, during two successive sessions these social
skills were introduced to the students and contingencies of per-
forming these behaviors were described. The students were
taught the appropriate social skills and their contingencies. The
students also became acquainted of the token economy system
and backup reinforcers.
Second Phase: In the second phase, a 45-minute orientation
meeting was held with the teachers by the researcher regarding
how to use token economy. Tokens were given to the teachers
in order to use them in reinforcing students’ appropriate behav-
iors. The teachers were given points to students’ prosocial be-
haviors every day and adding them up to their cards each day in
order to accumulate their points. For example, if a student was
attentive, the teacher gives one point. However, if during the
administration of the intervention program the student listened
to the teacher more than one hour, he would be awarded one
point for the listening skill. The teachers were trained to meas-
ure each student's social behavior in a similar manner (before
and after the intervention program). Furthermore, teachers were
asked to collect the notebooks at the end of each school day.
The teachers would then give points the social skills according
to the student’s social performance on that day. At the end of
each week, students were reminded of the accumulated rein-
forcers they had gotten. The students were instructed that in
case of spending their tokens they can buy different desired
objects. However, they were prompted to save their tokens and
accumulate their marks to get a better and more precious object.
This token economy program was lasted for a month. In this
period of intervention students accumulated their reinforcers in
order to buy a precious object they deserved. T he students were
also given reinforcement cards on the basis of their cumulative
points. On the first day, the teacher added up scores and gave a
reinforcement card immediately to the students. The points for
the second and third days were aggregated and a reinforcement
card was given accordingly. In a similar vein, points for the
fourth, fifth and sixth days were aggregated and a cumulative
reinforcement card was given on the last day. Therefore, the
students were realizing to wait for the new reinforcement card
with a time gap in which one more day was added to the last
day they received those cards.
Third Phase: In the third phase, the students received two
separate 45-minute orientation sessions in two groups divided
on the basis of their age ranges. The first group included
first-and second-grade elementary students (7 & 8 years old)
and the second group consisted of third- fourth- and fifth-grade
elementary students (ages 9, 10 & 11). Students were briefed on
the listed social skills. The target behaviors were clearly and
operationally defined for them. As an example, the "listening
skill" was defined as sitting on the chair, looking at the teacher
as well as at the blackboard, focusing on what the teacher was
saying, avoiding any other activities while listening and taking
notes. Two graduate clinical psychology students assisted the
researchers in teaching those social skills.
Students were also given instructions how to earn score cards
from their teachers. To receive a point card, students had to
point at minimum 50%, increasing progressively. The students
also learned on how to exchange their point cards with rein-
forcement cards. They were reminded that higher points were
needed for bigger prizes.
Fourth Phase: At the end of each week, students’ points
were to taled and t hey were give n the optio n for diffe rent priz es
according to their obtained total points. The students, however,
were urged to forego the smaller prizes for the bigger ones.
Therefore, they were reminded that they needed to save their
points to earn the bigger prize. Since prizes increased hierar-
chically in value, the points had to increase cumulatively too.
Therefore, students tried to follow the specified target behav-
iors and to earn their desired prizes. This program was run for
one month and points were totaled for each student at the end of
the program. Students were awarded different prizes for their
total points (including toy cars, balls in different sizes, toy re-
volver, water paint palette, story books, etc.).
Results
The findings revealed that students in the experimental group
performed socially better than those in the control group. As
noted earlier the main research question of this study was,
“What is the effect of training self-control procedure on en-
hancement of the social skills of students with ADHD?” To
answer this question, the means of the two groups (experimen-
tal and control) were compared at three times (pretest, post-test
and follow-up). Since the differences among the means at three
times were statistically significant, the null hypothesis was
rejected. Table 1 shows the descriptive statistics for both
groups.
618

A. BEH-PAJOOH ET AL.
Table 1.
Mean and SD for social skills of groups measured at three different
times.
Test Group N Mean SD
Control 10 24.2 3.67
Pretest Experimental 10 23.5 3.92
Control 10 23.3 4.08
Post-test Experimental 10 29.4 3.2
Control 10 23.8 4.05
Follow-up Experimental 10 29 2.98
As Table 1 shows, the means of experimental and control
groups did not differ significantly at pretest. However, the
means of the experimental groups were significantly different at
the post-test and maintained through at the follow-up measure-
ment. A repeated measure of MANOVA was performed to
examine the statistical significance of the difference between
the means (See Table 2).
As Table 2 shows, the F ratio of 6.86 is statistically signifi-
cant (F1,19 = 6.86, p > .05, DF = 1) indicating a significant dif-
ference between the means of experimental and control groups.
In addition, the F ratio for the effect of times produced a sig-
nificant result of 6.42 (p > .01, DF = 2). Therefore, there was a
significant difference between times of measurement. The time
group interaction effect produced a significant F ratio of 10.29
(p > .001, DF = 2). Since the interaction effect was statistically
significant, one may conclude that the effect of time on group
was different.
A post hoc Tukey HSD test was performed in order to find
which means differed significantly from others in the cells
produced by the time group interaction effect. Table 3 shows
the results of the Tukey HSD analysis. As it can be seen in
Table 3, there is a significant difference between experimental
group pretest and post-test and follow-up measurement (p
< .01). Furthermore, there were significant differences between
the pretest and post-test in the experimental group, and between
the pretest and follow-up measurement in the experimental
group (p < .05). Moreover, the means differences between fol-
low-up measurement in the experimental group and the post-
test mean in the experimental group and between the post-test
and the follow-up measurement in the control group were sta-
tistically significant (p < .05). As a result, one may conclude
that training self-control techniques had significantly improved
the social skills of the participants.
Table 2.
Results of repeated-measures MANOVA examining self-control by
ADHD.
Source Sum of
squares Mean square DF F Sig
Between-gro up va ri a nc e 678.94 214.59 19
Group 187.27 187.27 1 6.86 .017
Error 491.67 27.32 18
Within-group variance 459.99 117.43 40
Time 85.03 42.58 2 6.42 .004
Time × Group 136.43 68.22 2 10.29.001
Error 238.53 6.63 36
Total 1138.93 332.02 59
Table 3.
Results of Tuckey HSD post-hoc test comparing mean diffrences of
group × time.
Group Comparison group Mean difference Sig
Experimental post-test –5.9 .009
Experimental
pretest Experimental follow-up –5.5 .018
Control pre t est 5.2 .029
Control post-test 6.1 .006
Experimental
post-test
Control follow-up 5.6 .015
Control pre t est 4.8 .045
Control post-test 5.7 .013
Experimental
follow-up
Control follow-up 5.2 .029
Discussion
As discussed earlier, children with ADHD have difficulties
in social functioning in school setting. Hence, in the present
study, the social skills of students with ADHD compared with
students without ADHD. The subjects in both experimental and
control groups were pretested on their social skills. Afterward,
the experimental group received self-control training intervention
program (as the independent variable) for one month. The so-
cial skills test was readminstered as the post-test at the end of
the program and as follow-up measurement within one month
of the post-test. The results of a repeated measure of MANOVA
revealed statistically significant differences between the ex-
perimental and control groups. Furthermore, the results of the
follow-up measurement indicated that the results were main-
tained across time. The time group interaction showed that the
results of the post-test and the follow-up measurement were not
significant for both groups; rather, the post-test scores of the
experimental group had significantly changed from the pretest
and maintained by the time of the follow-up measurement. The
analysis of the results implied that participants’ social skills in
the experimental group receiving the intervention program had
improved.
The findings of this study are consistent with those of Hen-
imrich and colleagues (2004) indi cating that teaching self-control
techniques would improve the behavior of individuals with
ADHD. The results are also in agreement with those of Austin
(2003), Murray (2002) and Whittenberg (2004) to the effect
that teaching self-control techniques had a significant effect on
decreasing problematic behaviors and impulsivity in individu-
als with ADHD.
Inability to self-control is one of the major problems in chil-
dren with ADHD. In other words, one may state that children
with ADHD are similar to normal ones, except for the fact that
typically developing children can control their behaviors in
different contexts and occasions. However, individuals suffer-
ing from ADHD may be unable to control their behaviors and
predict the ensuing consequences. Therefore, teaching self-control
techniques to children with ADHD may help them improve
their self-control ability and minimize their problems in com-
munication and problematic behaviors and consequently en-
hance their social skills. The results of the present study support
the argument that teaching self-control techniques may be one
of the best methods to help students with ADHD improve their
behaviors through internal monitoring of their behaviors and

A. BEH-PAJOOH ET AL.
620
evaluating the consequences of their behaviors. Si nce self-cont rol
may allow children to manage their behaviors in the absence of
watching adults, it may teaches them to take responsibility for
their own actions.
Teaching self-control techniques to children may also enable
them to provide self-directed feedback on their behaviors. They
may learn to evaluate and monitor their behaviors and system-
atically treat themselves with appropriate rewards for their ac-
ceptable behaviors. They may also learn to perform effectively
and productively even in the absence of an external agent (e.g.
parent, teacher, p ri n ci pal).
Generally speaking, childre n with ADHD may have p robl ems
in their self-control. The results of the present research indicate
that teaching self-control techniques may minimize quite a
number of the problems of children with ADHD.
Limitations and Suggestions: Like many other studies, the
present study was limited in a number of ways. The participants
in this study included boys only. Therefore, one must take cau-
tion in generalizing the results to the female population. An-
other limitation is that, the students in the control group might
meet and interact with those in the experimental group possibly
allowing them to exchange ideas. Additionally, in this study we
could not differentiate the participants based on subtypes of
ADHD (inattentive, hyperactive-impulsive or combined).
For further research, researchers are encouraged to examine
the effect of self-control training on other behavioral-emotional
disorders in children and on different age groups. Examining
the effect of self-control techniques training on a mild, moder-
ate and severe attention deficit and hyperactivity disorder is
also strongly encouraged.
Finally, the researchers encourage teachers and parents to
teach self-management and self-control techniques to children
with ADHD to explore further implications. As Hughes and
Cooper (2008) have mentioned to us in their book: “Changing
the child’s behavior will take time and medication alone will
not provide the child with sufficient support to modify his or
her behavior” (p. 90).
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