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

The effect of Ecological Executive Skills training on emotional problems in children with attention-deficit hyperactivity disorder | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The effect of Ecological Executive Skills training on emotional problems in children with attention-deficit hyperactivity disorder Lili Wang, Xinyue Peng, Hanyu Dong, Chi Ma, Guangyu Liang, Weiyan Zhao, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7380036/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 02 Jan, 2026 Read the published version in BMC Psychiatry → Version 1 posted 10 You are reading this latest preprint version 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 ecological executive skills training attention deficit and hyperactivity disorder anxiety depression executive function Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 02 Jan, 2026 Read the published version in BMC Psychiatry → Version 1 posted Editorial decision: Revision requested 15 Oct, 2025 Reviews received at journal 12 Oct, 2025 Reviews received at journal 11 Oct, 2025 Reviewers agreed at journal 16 Sep, 2025 Reviewers agreed at journal 14 Sep, 2025 Reviewers invited by journal 13 Sep, 2025 Editor assigned by journal 13 Sep, 2025 Editor invited by journal 11 Sep, 2025 Submission checks completed at journal 10 Sep, 2025 First submitted to journal 10 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7380036","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":515667347,"identity":"d80335ef-c79e-4fb4-936c-f1dc202c2d9d","order_by":0,"name":"Lili Wang","email":"","orcid":"","institution":"The First Hospital of Jilin University","correspondingAuthor":false,"prefix":"","firstName":"Lili","middleName":"","lastName":"Wang","suffix":""},{"id":515667348,"identity":"5048be4a-97aa-42e8-9a0b-102ab162de4d","order_by":1,"name":"Xinyue Peng","email":"","orcid":"","institution":"The First Hospital of Jilin 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problems in children with attention-deficit hyperactivity disorder","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"ecological executive skills training, attention deficit and hyperactivity disorder, anxiety, depression, executive function","lastPublishedDoi":"10.21203/rs.3.rs-7380036/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7380036/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: 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.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMethods:\u0026nbsp; 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\u0026nbsp;(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.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults:\u0026nbsp;1.Efficacy of Mood Regulation: After three months of treatment, the experimental group exhibited significantly greater improvement than the control group (P \u0026lt; 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 \u0026lt; 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 \u0026lt; 0.05) across all BRIEF executive function domains. 4. EEST can improve Social Functioning Outcomes.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusions:\u0026nbsp;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.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTrial registration:\u0026nbsp;ChiCTR2200062513.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eClinical Trial Registry:the Chinese Clinical Trial Registry (ChiCTR)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTrial Registration Number:2200062513\u003cbr\u003e\nDate of Registration:10 \u0026nbsp;August 2022\u003c/p\u003e","manuscriptTitle":"The effect of Ecological Executive Skills training on emotional problems in children with attention-deficit hyperactivity disorder","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-22 03:47:56","doi":"10.21203/rs.3.rs-7380036/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-15T18:34:37+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-12T13:59:38+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-11T04:59:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"161185526897549857399877215380414910679","date":"2025-09-16T04:51:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"216779345109018696273510563383048030799","date":"2025-09-14T19:34:12+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-13T16:23:23+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-13T16:15:19+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-11T17:19:08+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-10T09:35:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychiatry","date":"2025-09-10T09:33:57+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ce94d058-99d9-45fd-ad0b-a7a4db0bc6fd","owner":[],"postedDate":"September 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-05T16:05:06+00:00","versionOfRecord":{"articleIdentity":"rs-7380036","link":"https://doi.org/10.1186/s12888-025-07748-6","journal":{"identity":"bmc-psychiatry","isVorOnly":false,"title":"BMC Psychiatry"},"publishedOn":"2026-01-02 15:57:37","publishedOnDateReadable":"January 2nd, 2026"},"versionCreatedAt":"2025-09-22 03:47:56","video":"","vorDoi":"10.1186/s12888-025-07748-6","vorDoiUrl":"https://doi.org/10.1186/s12888-025-07748-6","workflowStages":[]},"version":"v1","identity":"rs-7380036","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7380036","identity":"rs-7380036","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}