Abstract
Behavioral inconsistencies and disorders in adulthood and youth are often caused by neglecting children's emotional-behavioral issues. Therefore, the present study was performed to fit the causal model based on externalized behavioral disorders according to executive functions of the brain: the mediating role of social skills in students with attention-deficit/hyperactivity disorder. This study in terms of purpose is the applied one and is considered descriptive-correlational research. The statistical population of the present study included all the elementary school students of Mashhad in the academic year of 2021-2022, and 209 students were selected as the sample group using the purposeful sampling method. To collect data, the Connors Attention Deficit/Hyperactivity Disorder Assessment Questionnaire, Teacher's Form (1969), Achenbach's Child Behavior Checklist (CBCL) - Parent Version, Behavior Rating Inventory of Executive Function, and Social Skills Questionnaire (Parent Version) were used. The results showed that the causal model of the relationship between executive functions, social skills, and externalized behavioral disorders in students with attention-deficit/hyperactivity disorder was confirmed based on different fit indices. Executive functions of the brain and social skills have a direct effect on behavioral disorders. In addition, executive functions have an indirect effect on externalized behavioral disorders through social skills. Therefore executive functions and social skills play an important role in externalized behavioral disorders in students with attention deficit/hyperactivity disorder, and targeting these two components in psychological treatments can be effective in reducing behavioral disorders.
Keywords: Externalized Behavioral Disorders, Executive Functions, Social Skills, Attention Deficit / Hyperactivity Disorder.
 
 
 
Extended Abstract

Introduction

One of the most complex childhood disorders that are often not diagnosed, is the neurodevelopmental disorder attention deficit/hyperactivity disorder (ADHD), which appears with inattention and hyperactivity in the age range of six months to seven years. It may continue in adulthood as well (Shahwan, Suliman, Jairoun, Alkhoujah, Mohammed, & Abdullah, 2020). ADHD children have problems with communication and social behaviors; it is one of the most common behavioral and social disorders in childhood and adolescence, which affects about 5-7% of people (American Psychiatric Association, 2013). The problems caused by this disorder include wide areas of a person's life, including health, communication problems, academic progress, employment, financial management (Barkley, Murphy, & Fischer, 2015), and family problems (Almadani, Askary, & Bavi 2022). Externalized behavior disorders that include a range of aggression, bullying, delinquent behaviors, theft, lying, disobedience, and fighting (Cramer, 2015) are observed in these people. Studies have shown that executive function deficits include a set of cognitive and metacognitive processes that help us create goals, monitor thoughts, control emotions and actions, and choose appropriate behaviors to curb undesirable behaviors (Lassander, Hintsanen, Suominen, Mullola, Fagerlund, Vahlberg, et al., 2020), it is common in these individuals (Wang and Liu, 2020). Another factor that can affect the amount of externalized behavioral disorders in children is social skills. Compared to normal children, children with ADHD have weaker social interaction and have difficulty communicating with others (Parke, Becker, Graves, Baily, Paul, Freeman et al., 2018). In other words; Attention-deficit/hyperactivity disorder not only causes a decrease in concentration and attention, but it is also problematic in social relationships, the type of interaction and the way to react to others (Arumugam & Parasher, 2018). Therefore, the current research will be conducted with the aim of fitting the causal model based on externalized behavioral disorders based on the executive functions of the brain: the mediating role of social skills in students with attention deficit/hyperactivity disorder.

Research Question

Is the fit of the causal model based on externalized behavioral disorders based on the executive functions of the brain with the mediation of social skills in students with attention deficit/hyperactivity disorder confirmed?

Literature Review

Studies show that externalizing problems in childhood are predictors of delinquent behaviors in adolescence and crime and violence in adulthood (Zhu, Olsen, Liew, Niclasen, & Obel, 2014). Executive functions include sets of cognitive and metacognitive processes that help us set goals, monitor thoughts, control emotions and actions, and choose appropriate behaviors for undesirable behaviors (Lassander et al., 2020). Executive functions are much related to social and educational functions and daily activities of people. These functions become the individual's self-regulation and also enable him to behave with different responses, self-direction (Lima, Rzezak, Guimarães, Montenegro, Guerreiro, & Valente, 2017). The review goes under these subheadings. The findings indicate that poor skill in executive functions causes antisocial behavior, inability to solve problems, distraction and aggression in children (Romero-López, Quesada-Conde, Bernardo, & Justicia-Arráez, 2017). The results of Al-Khatib's research (2021) indicated a positive and significant correlation between social problems and behavioral problems. In a research, Ajarlou, Moghadsin, and Hosni (2021) showed that maladaptive emotion regulation and cognitive deficits of attention also play a mediating role in the relationship between depression and anxiety variables with symptoms of attention deficit hyperactivity disorder.

Methodology

The method of this study was descriptive-correlation. The statistical population of the current research was all the students and their parents in the school year 2021-2022 in the elementary school of Mashhad. 209 students were selected using the purposeful sampling method. Thus, in order to collect the sample, the education departments were referred to Mashhad City. Then 15 elementary schools were selected from different areas of Mashhad city and then they were referred to the schools and after screening the students for attention deficit hyperactivity disorder through a questionnaire by the teacher, after identification with the help of the school principal, the questionnaires were given to the parents. Students were placed. To collect data from questionnaires of Conners' teacher rating scale--revised short form, achenbach's child behavior checklist (CBCL) - parent version, behavioral rating scale of executive functions (BRIEF), social skills rating system (SSRS) parent version used. In order to test the research hypotheses, the path analysis method was used using SPSS23 and Lisrel 8.8 software.

Results

A total of 209 students with attention deficit/hyperactivity disorder with an age of 9.62 in the age range of 7 to 12 years participated in this study. 91 of them were girls and 118 were boys. The results of the path analysis showed that executive functions have a direct and significant effect on both externalized behavioral problems and social skills. Also, the direct effect of social skills on externalized behavioral problems is significant. In general, the results showed that the proposed model of this research has a good fit and all the fit indices indicate the approval of this model, the results of which are shown in Table 1.
Table 1. Structural Equation Models Fit Indices




Fit index


Perfect Fit


Acceptable Fit


value


Result






χ²/sd


0 ≤ χ²/sd0 ≤ 2


2 ≤ χ²/sd0 ≤ 5


2.28


Acceptable




RMSEA


0 ≤ RMSEA ≤.05


.05 ≤ RMSEA ≤.08


.071


Acceptable




GFI


0.95≤ GFI< 1.00


0.90≤ GFI< 0.95


.91


Acceptable




NFI


0.95≤ NFI< 1.00


0.90≤ NFI< 0.95


.94


Acceptable




CFI


0.95≤CFI<1.00


0.90≤CFI<0.95


.92


Acceptable





Discussion

 The obtained results showed that the effect of brain executive function disorder on externalized behavioral disorders was positive and significant. The results obtained with the research findings of Yang et al. (2022), and Fraser et al. (2022); the research conducted on executive functions in people with behavioral problems shows that there are deficits such as problems in inhibition, which are related to disorders in the frontal region of the brain. In other words, response inhibition provides stopping and controlling inappropriate behaviors as well as producing appropriate behaviors in different situations, and this is essential in preventing behavioral problems (AbdulRahimpour et al., 2021).
It showed that social skills have an effect on externalized behavioral problems. The results obtained with the research findings of Al-Khatib (2021), Fuchs et al. (2020), and Trigors et al. (2020) are consistent. High levels of participation and sociability are generally associated with growth. From another angle, it is possible to explain this finding, when students have social skills and can adjust the level of their response to the people around them depending on the situation, they are less prone to externalizing behaviors such as aggression, violence, and impulsiveness.
The indirect effect of brain executive function disorder on externalizing behavioral problems through social skills was significant. Therefore, social skills were accepted as mediators of the relationship between brain executive functions and externalized behavioral problems. This means that executive functions can indirectly influence externalized behaviors through social skills in addition to direct influence. People who have significant skills in executive functions, i.e., reasoning, organization, and working memory, can analyze social situations correctly and reduce externalized behavioral disorders, i.e., impulsivity and violence in students.

Conclusion

Therefore executive functions and social skills play an important role in externalized behavioral disorders in students with attention deficit/hyperactivity disorder, and targeting these two components in psychological treatments can be effective in reducing behavioral disorders.

Acknowledgments

We are grateful to all the people who have collaborated in this research.