Social Skills and Self-esteem in Iranian Children with Attention-Deficit/Hyperactivity Disorder and Healthy Peers: A Cross-Sectional Study

Abstract

Background: Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental condition associated with deficits in attention, hyperactivity, and impulsivity, often accompanied by social and emotional difficulties. Although international studies have examined these aspects, limited data exist on the social and self-esteem profiles of children with ADHD in Iran. Objectives: To compare social skills and self-esteem between children and adolescents with ADHD and healthy peers, and to examine the association between these domains. Methods: In this cross-sectional study conducted from March 2024 to September 2025 at Isfahan University of Medical Sciences, 50 children diagnosed with ADHD (DSM-5-TR criteria) and 50 controls aged 6 - 18 years were evaluated. Social skills were assessed using the Matson Evaluation of Social Skills with Youngsters (MESSY), and self-esteem was assessed using the Coopersmith self-esteem Inventory. Group differences were analyzed using Mann-Whitney U and χ² tests, and correlations were examined with Spearman’s ρ. Results: Children with ADHD showed significantly lower total social skills scores (178 ± 23.9 vs 199 ± 36.7; P < 0.001) and reduced performance in appropriate social behavior (P = 0.016), antisocial behavior (P = 0.001), and aggressive/impulsive behavior (P = 0.001). They also exhibited lower total self-esteem (27.1 ± 7.1 vs 31.8 ± 7.4; P = 0.004), particularly in social (P = 0.001) and family (P = 0.001) dimensions. A positive correlation between social skills and self-esteem was observed in the total sample (ρ = 0.50, P = 0.001) and controls (ρ = 0.59, P = 0.001) but not in the ADHD group (ρ = 0.22, P = 0.12). Conclusions: Children with ADHD demonstrate significant impairments in social functioning and self-esteem relative to healthy peers. The absence of a strong correlation between these domains within the ADHD group suggests complex psychosocial mechanisms that warrant targeted behavioral and family-based interventions.