Comparison of the play of children with attention deficit hyperactivity disorder by subtypes

Studies have found differences in the nature and severity of social problems experienced by children with different subtypes of attention deficit hyperactivity disorder (ADHD). Given that play is often the context for acquiring social skills, there is surprisingly limited research examining whether these differences distinguish the play of children within the groups. Using the Test of Playfulness (ToP), we examined the similarities and differences in play between children (aged 5-11 years) diagnosed with the three DSM-IV ADHD subtypes: inattentive (I-subtype; n=46), hyperactive-impulsive (HI-subtype; n=28) and combined subtypes (C-subtype; n=31). Bias interaction, an item-by-item analysis, revealed that the hierarchy of ToP items was similar for children with the HI- and C-subtypes, but differed for children with the I-subtype. Specifically, children with the I-subtype found it more difficult to become intensely engaged in play and to take on playful mischief and clowning; however, they found social play items to be easier. Conversely, whereas mischief and clowning were relatively easier for children with the HI- and C-subtypes, many items reflecting social interaction were more difficult. These findings suggest that interventions can be tailored to these differing presentations. However, further research is needed to confirm the findings.