ORIGINAL RESEARCH article
Front. Psychiatry
Sec. ADHD
This article is part of the Research TopicAssessment and Intervention for Children and Adolescents Affected by Neurodevelopmental DisordersView all 4 articles
The mechanism of social interaction deficits in attention-deficit/hyperactivity disorder children: The role of cognitive flexibility
Provisionally accepted
- 1Sun Yat-Sen University, Guangzhou, China
- 2Guangzhou Medical University, Guangzhou, China
- 3Lingnan Normal University, Zhanjiang, China
- 4Tohoku Daigaku, Sendai, Japan
- 5Southern Medical University, Guangzhou, China
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Abstract Background: Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent mental disorders among children in China. Although the relationship between ADHD symptoms and social interaction deficits has been empirically examined, cognitive flexibility (CF), as a core factor theoretically contributing to ADHD, has still been less studied. Aim: This study aims to explore how CF influences social interaction deficits using both tradition method (questionnaire surveys) and novel paradigms (Reinforcement learning). Method: In study 1, we recruited 20 clinically urban Chinese children diagnosed with ADHD (M = 9.50, SD = 1.82) and 23 control group children (M = 9.80, SD = 1.86). Questionnaires were used to assess ADHD symptoms, CF, and social interaction deficits (including social self-efficacy and emotion problems). Furthermore, a mediation analysis was conducted. In study 2, 21 urban Chinese children diagnosed with ADHD (M = 10.00, SD = 2.53) and 21 control children (M = 9.19, SD = 1.44) completed a two-stage Markov Decision Task to measure their CF. Results: Study1 showed that CF mediated the relationship between ADHD symptoms and social interaction deficits in children with ADHD. Study 2 demonstrated that the control group employed both model-based and model-free cognitive strategies; however, the ADHD group did no demonstrate either strategy. These findings indicate a significant difference in CF between ADHD and control groups, particularly in their selection of cognitive strategies. Conclusion: To sum up, the findings suggest that a low level or deficiency in CF may be a key factor contributing to social problems in children with ADHD. Future research directions are further discussed.
Keywords: ADHD children, cognitive flexibility, Model-based strategy, model-free strategy, social interaction deficits
Received: 23 Aug 2025; Accepted: 03 Nov 2025.
Copyright: © 2025 Liu, Yin, Chen, He, Sun and Yu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Meng Yu, yumengbnu@163.com
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