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

Abstract 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). SPSS 23.0 was used for statistical processing. Between-group comparisons employed independent samples t-tests (for normally distributed data), Mann-Whitney U tests (for non-normal distributions), and χ² tests (for categorical variables). Within-group pre-post intervention changes were analyzed using paired-samples t-tests or Wilcoxon signed-rank tests, depending on data normality. Results: 1.Efficacy of Mood Regulation: After three months of treatment, the experimental group exhibited significantly greater improvement than the control group (P < 0.05) in anxiety and depression subscales of the CBCL, SDQ parent/teacher emotional symptom ratings, Conners depression scores, Vanderbilt ADHD parent/teacher anxiety/depression items, and the BRIEF Emotion Regulation Index. 2. Core Symptom Severity: The experimental group demonstrated significantly greater reductions (P < 0.05) in inattention and hyperactivity/impulsivity symptoms compared to controls, as measured by the Vanderbilt ADHD parent/teacher subscales, CBCL hyperactivity scores, SDQ hyperactivity ratings, Conners hyperactivity/impulsivity factor, and impulse control indices. 3.Executive Functioning Improvements: The experimental group showed significantly greater enhancements (P < 0.05) across all BRIEF executive function domains. 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. Trial registration: ChiCTR2200062513. Clinical Trial Registry:the Chinese Clinical Trial Registry (ChiCTR) Trial Registration Number:2200062513 Date of Registration:10 August 2022