Psychosocial functioning of adolescents with ADHD in the family, school and peer group: A scoping review protocol.

OBJECTIVE: The objective of this scoping review is to investigate what is known about the psychosocial functioning of adolescents with ADHD. All basic life environments (family, school and peer group) will be considered.
INTRODUCTION: Adolescence is especially critical for people with ADHD-natural maturation may be accompanied by changing symptoms of ADHD. A number of childhood difficulties transform during adolescence and contribute to problems in various areas that comprise psychosocial functioning. The available studies focus on selected domains of psychosocial functioning of adolescents with ADHD, however, to the authors' best knowledge, there is no comprehensive description of this issue. The lack of such a description is the main rationale for conducting this scoping review. INCLUSION CRITERIA: Pointing to the PCC elements (population, concept, context), the scoping review will include primary studies on the concept of psychosocial functioning (including functioning in the family, school and peer group). In the included studies, the term "psychosocial functioning" (or related) had to be used explicitly. The population will be adolescents (10 to 19 years old) with a formal diagnosis of ADHD (DSM classification) or Hyperkinetic Syndrome (ICD-9) or Hyperkinetic Disorders (ICD-10). There will be no restrictions on the research context.
METHODS: The methodology of scoping reviews will be applied in accordance with the guidelines of the Joanna Briggs Institute (JBI). The following databases: Academic Search Ultimate, ERIC, MEDLINE, ProQuest Central, PsycInfo, Scopus, and databases under the Web of Science will be searched for primary studies in peer-reviewed journals, written in English and published since 1987. The analyses will be based mainly on frequency counts of the components of psychosocial functioning and population characteristics. The results will be presented in tabular form and supplemented with a descriptive summary. The protocol has been registered on the Open Science Framework: https://doi.org/10.17605/OSF.IO/MS82H [registration DOI].

Introduction

At the very beginning of diagnosing what is known today as ADHD, it was considered a childhood disorder [1, 2]. Therefore, the vast majority of research on it has focused on children. Moreover, one of the first reviews [3] suggested a 50% decrease in the prevalence of ADHD every 5 years. This has led to the widespread belief that most people outgrow ADHD by young adulthood [4, 5]. The early findings are not reflected in subsequent reports. More recent studies have found that 60–85% of children diagnosed with ADHD continue to show symptoms during adolescence [6]. Based on the results of one of the latest systematic reviews [7], the prevalence of persistent ADHD in adulthood reported in studies published after 2011 is 55%. Thus, ADHD in many cases does not remit. These findings indicate the need to pay attention to the situation of adolescents with ADHD.

During adolescence, the process of sexual maturation and intense emotional and social development take place. This is a time to free oneself from parental influence, determine one’s own identity and place within a peer group [8]. Young people with ADHD, like all teenagers, experience such changes. However, their natural development takes place in the presence of symptoms of the disorder. Additionally, this period of life may also involve substantial changes in the symptoms of the disorder [9-11]. Compared to childhood, in adolescence, signs of hyperactivity are less common and may be reported as feelings of restlessness, jitteriness, or impatience [12-15]. Research indicates that an increase in symptoms, including difficulties with attention, may be the consequence of the changes in the hormonal milieu during puberty [16]. Adolescents with ADHD are also more likely than their peers without ADHD to develop comorbidities such as conduct disorder or substance use disorders [12]. Additionally, anxiety disorders are common among teenagers suffering from ADHD [17]. The combination of ADHD and anxiety is associated with a very high risk of bipolar disorder in adulthood [18].

Emotional dysregulation and low frustration tolerance are also common in ADHD [13]. Adolescents with ADHD, compared to their peers, have significant difficulties coping with positive and negative emotions. They display stronger reactions to frustration or stress, emotional impulsivity, and rapid changes between emotions [19-21]. Poor emotion regulation may contribute to many negative outcomes, such as engagement in risky behaviour, including substance use, verbal and physical aggression, traffic accidents, and peer or family conflicts [19, 22, 23]. Adolescents with ADHD take more risk in daily life than their peers without ADHD [24]. This observation is supported by evidence on laboratory risk-taking tasks [25].

Therefore, childhood ADHD is associated with negative developmental outcomes in adolescence and adulthood [26] in various areas of life [27]. The studies revealed that children with ADHD have lower self-esteem than their peers [28] and are impaired within the peer functioning domain [29]. They are often unpopular with other children and may become isolated [30]. About 80% of them experience high rates of peer rejection and tend to have fewer friends [31, 32]. It should be noted that social problems, including lower peer acceptance, are associated with depressive symptoms in late childhood and adolescence [33, 34]. Moreover, girls with ADHD have a higher rate of mood disorders than girls without ADHD [35]. In the school environment, children with ADHD experience greater difficulties than their typically developing peers [36], including academic problems [27, 35, 37], higher dropout rates or low academic achievement [38]. The relationship between a parent and an adolescent diagnosed with ADHD may also be impaired [39, 40]. Parents and teenagers with ADHD reported more conflict problems in their family, higher levels of anger intensity during conflicts, and more aggressive conflict tactics compared to a community control group [41]. Additionally, parent-child problems significantly mediate the relationship between attention problems and depression [42].

Summarising, the above description shows that teenagers with a childhood history of ADHD may encounter complex problems. These difficulties may have a negative impact on their psychosocial functioning. Hence, the concept of this scoping review is psychosocial functioning. This concept is considered an important construct in the conceptualisation of mental disorders. Accordingly, in the process of diagnosing ADHD, there must be clear evidence that the symptoms of the disorder have a direct negative impact on social, academic, or occupational functioning [12, 13].

There is no concrete definition of psychosocial functioning in the theoretical literature [43]. This concept usually refers to an individual’s ability to achieve developmental tasks [44], interact with others and with society, and perform daily tasks [45]. The definition also takes into account an individual’s satisfaction with this ability and their social interactions [45, 46]. With regard to children, their psychosocial functioning consists of their psychological development and interaction with the social environment [47]. Psychosocial functioning can also be narrowly defined by a specific domain (e.g. marital, school or occupational functioning) [45] or equate to social functioning [48] and described as the ability of an individual to function in various social roles, such as a student, family member, friend [46].

According to the literature on the subject [47, 49–55], researchers focus on different aspects of psychosocial functioning, including emotional health, self-esteem, social competences, social network, social adjustment, alienation, support, coping skills. By focusing on the particular life environments of adolescents, other components can be mentioned such as: family communication, child-parent relationship, learning motivation, academic performance, peer problems, peer rejection. Thus, the term psychosocial functioning is a very complex concept that includes a variety of constructs and covers a wide spectrum of variables. However, in order not to limit the scope of the review, this study does not adopt any definition of psychosocial functioning. The only definition-related requirement for this concept is that the authors of primary research articles had to use the term psychosocial functioning (or functioning in a family, school or peer group) explicitly. Further details are explained in the Concept subsection.

The first step in this scoping review was to verify the innovative character of the project. A preliminary search for ongoing or existing scoping reviews and systematic reviews on the psychosocial functioning of adolescents with ADHD has been conducted. At the end of August 2021, the following databases were searched: Cochrane Database of Systematic Reviews (CDSF), The Campbell Collaboration Database, The International Prospective Register of Systematic Reviews (PROSPERO), The Joanna Briggs Institute (JBI) EBP Database of Systematic Reviews and Implementation Reports, PubMed, The Open Science Framework (OSF) and figshare.com. The exemplary search strings for the PubMed and CDSF are presented in the S1 Appendix.

The preliminary searches have shown that still relatively little is known about the psychosocial functioning of adolescents with ADHD [56]. Among systematic or scoping reviews that in some way address the issue of psychosocial functioning in the ADHD population, almost all of them combined children and adolescents into one group. Only two systematic reviews concerned adolescents with ADHD only, and both focused on assessing the effectiveness of interventions. One of the studies [52] was related to the peer functioning. The other [57] focused on the academic domain and limited the research design to randomised controlled trials. Therefore, both reviews were limited to selected areas of psychosocial functioning, which narrowed the spectrum of this concept. Moreover, none of them was intended to describe psychosocial functioning comprehensively, as is the case in the proposed review.

In conclusion, it is rational to conduct this scoping review. According to the preliminary search and to the best knowledge of the authors, this is the first scoping review exploring the concept of psychosocial functioning of adolescents with ADHD in three basic life environments simultaneously. This holistic description argues for an innovative character of the present project. Another argument for the innovative nature of the project is that it focuses on adolescence. The facts presented previously clearly show that the situation of adolescents with ADHD is difficult and complicated. The increased risk of negative effects in all basic life environments is reflected in the psychosocial functioning of teenagers with ADHD. As mentioned, the importance of assessing psychosocial functioning in ADHD is acknowledged in the DSM and ICD classification systems. Socialization, understood as a process of continuous interactions between a maturing person and their family, school and peer environment, stimulates the development, adaptation and functioning of the individual. Deterioration in psychosocial functioning has adverse consequences for the development of an individual in various areas, including cognition, body image, mental and physical health [58-60]. Therefore, it seems justified to broadly explore the issue of psychosocial functioning of adolescents with ADHD. The scoping review is one of the newest research approaches that makes it possible in a structured manner.

Objectives of the study

The main goal of the scoping review is to describe comprehensively the concept of psychosocial functioning of adolescents with ADHD. This description will contain information both on psychosocial functioning in general and in particular life environments (family, school, peer group). Gathering the information will help to organise the existing evidence and identify gaps in the knowledge of the concept. Evidence-based detailed knowledge collected is needed as a starting point for effective profiling of educational and therapeutic activities.

The first stage of achieving the main goal will be to find the main components and methods of measuring the concept of "psychosocial functioning of adolescents with ADHD". The results of the scoping review will show how researchers operationalise the concept, what aspects they focus on, and what indicators dominate.

Additionally, conducting the scoping review will help to verify the feasibility of systematic reviews (and possibly meta-analyses): (1) on the effects of non-medical interventions on psychosocial functioning of adolescents with ADHD and (2) on potential differences in psychosocial functioning from their peers without ADHD.

Review questions

This scoping review will answer the following primary question: What is known about the psychosocial functioning of adolescents with ADHD? The research sub-questions are as follows:

What are the constitutive components of the psychosocial functioning of adolescents with ADHD? (In other words: How is "psychosocial functioning of adolescents with ADHD" operationalised?)

What characterises the psychosocial functioning of adolescents with ADHD in general?

What characterises the psychosocial functioning of adolescents with ADHD in the family?

What characterises the psychosocial functioning of adolescents with ADHD at school?

What characterises the psychosocial functioning of adolescents with ADHD in the peer group?

Materials and methods

The proposed scoping review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews [61]. All data will be presented in accordance with The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) [62]. The PRISMA-ScR checklist is attached as S2 Appendix. The protocol has been registered on the Open Science Framework: https://doi.org/10.17605/OSF.IO/MS82H [registration DOI]. The scoping review will be based only on the results already published in peer-reviewed articles. Therefore, no primary data will be collected, and ethical approval was not required.

Eligibility criteria

The studies included in the scoping review must meet all of the criteria described below.

Participants

The population covered by this scoping review is adolescents with a formal diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD; based on DSM criteria) or Hyperkinetic Syndrome (HKS; based on ICD-9 criteria) or Hyperkinetic Disorders (HKD; based on ICD-10 criteria).

Research will be included regardless of participants’ completed or ongoing therapies, ADHD subtypes (presentations), comorbidities or medications. However, all these circumstances will be noted. Studies that focused on a different disorder (e.g. autism spectrum disorders, oppositional defiant disorder, conduct disorder), but included participants with comorbid ADHD, will only be eligible for inclusion if results were presented for the subgroup diagnosed with ADHD.

According to definitions of adolescence of the World Health Organization (WHO) and the American Psychological Association (APA), an age range of 10 to 19 will be used. Studies where the age of the participants exceeds this range will only be included if the results have been reported separately for age groups. Therefore, it will be possible to extract the data for the group of interest (aged from 10 to 19).

Concept

The scoping review will focus on psychosocial functioning of adolescents with ADHD, taking into account the three most important life environments–family, school and peer group.

Studies will be included if psychosocial functioning has been measured and reported results. The only definition-related inclusion criterion for the concept is that the authors of the primary studies had to explicitly use one of the following terms for the variables of interest: psychosocial functioning, social functioning, family functioning, school functioning, academic functioning, peer functioning, peer group functioning, or adequate grammatical forms. All the considered phrases were included in the search strings (see S3 Appendix). It should be emphasized that, in order not to narrow the scope, this review does not adopt a specific definition of psychosocial functioning. The authors of the review are aware that psychosocial functioning is a very complex concept with no concrete semantic boundaries. Consequently, they will not decide on the definition of the concept and will focus on finding the main components and methods of measuring psychosocial functioning in the included studies.

Context

There will be no restrictions regarding the context of the studies. All geographic locations, cultural/sub-cultural, sociodemographic or economic contexts will be included.

Types of sources

All study designs will be eligible for the scoping review, including self-report data as well as data obtained from parents, teachers, therapists. However, searches will be limited to full text articles on primary research in peer-reviewed journals. Therefore, systematic reviews and meta-analyses will be excluded, as well as commentaries, posters, opinion papers or "grey literature".

Exclusion criteria

The basis for excluding studies from the scoping review will be if any of the following criteria are met:

only informal diagnosis of ADHD (e.g. from a parent’s or teacher’s report or any ADHD rating scale other than the DSM or ICD criteria);

only participants under 10 or over 19 years old, or no possibility for extracting data for the age group of interest;

no possibility to extract data only for the ADHD subgroup (in studies with comorbid ADHD);

no use of any of the following terms for the variables of interest: psychosocial functioning, social functioning, family functioning, school functioning, academic functioning, peer functioning, peer group functioning, or adequate grammatical forms;

paper in a language other than English (see the Search strategy section for details);

non-peer reviewed journal;

research published before 1987 (see the Search strategy section for details);

no possibility to access the full version of the text or the data being searched.

Search strategy

The search strategy will aim to locate only primary studies in peer-reviewed journals, written in English and published since 1987.

▶ In order to ensure methodological correctness and high quality of the researches, it was assumed that only peer-reviewed articles would be taken into account. Therefore, the search for "grey literature" will not be carried out.

▶ Systematic reviews and meta-analyses will be excluded for practical reasons in order to limit the volume of material to be retrieved and reviewed. Moreover, the inclusion of this type of articles would likely give very similar (or even identical) results to an electronic search limited to primary studies only.

▶ Due to the linguistic capabilities of the team and common practice, only English language papers will be considered.

▶ The name ADHD has been used since 1987, when the DSM-III-R was published. Additionally, it was noticed at that time that the disorder does not pass with childhood. This change in approach was reflected in the book with a meaningful title: "The hyperactive child, adolescent, and adult: Attention deficit disorder through the lifespan" [63]. Accordingly, publishing since 1987 is a limitation for the scoping review.

An initial limited search of MEDLINE and ERIC was undertaken to identify articles about adolescents with ADHD and/or psychosocial functioning. The text words contained in the titles and abstracts of relevant articles, and the index terms used to describe these papers, all combined on the basis of Boolean logic, were used to develop a full search strategy for databases under EBSCO and Scopus (included in the S3 Appendix).

The titles, abstracts and keywords will be searched in the following databases: Academic Search Ultimate (via EBSCO), ERIC (via EBSCO), MEDLINE (via EBSCO), ProQuest Central, PsycInfo, Scopus, and all databases under the Web of Science (excluding MEDLINE).

The search strategy, including all identified keywords and index terms, will be adapted for each included database. The reference list of all sources of evidence included in the review will be screened for additional studies. A re-run search will also be conducted prior to final analyses to capture the latest articles.

Source of evidence selection

Following the search, all identified citations will be collated and uploaded into Zotero 5.0 [64] and duplicates will be removed. Pilot tests will be conducted to increase consistency among reviewers. In the first one, 10% of all included citations (specifically, titles and abstracts) will be independently screened by all three reviewers against the review inclusion criteria. They will then discuss the results, amend the screening and modify the eligibility criteria as necessary. After the first pilot test, the titles and abstracts of the remaining 90% of citations included will be independently screened by two reviewers against the inclusion criteria. Potentially relevant sources will be retrieved in full and their citation details imported into the new collection in Zotero.

The second pilot test will cover 10% of the full text articles. All three reviewers will independently screen this portion of the resources to determine if the inclusion criteria are met. Then, the remaining 90% of the full texts of the selected citations will be assessed in detail by two independent reviewers against the inclusion criteria. Reasons for the exclusion of the sources of evidence in full text that do not meet the inclusion criteria will be recorded and reported in the scoping review. Any doubts or disagreements between reviewers at any stage of the selection process will be resolved through discussion and consensus of the research team.

The results of the search and the study inclusion process will be reported in full in the final scoping review and presented in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review (PRISMA-ScR) flow diagram [62], supplemented with the number of sources collected for each review sub-question.

Data extraction

Data will be extracted from papers finally included in the scoping review by three reviewers using their data extraction tool (Excel spreadsheet). The data extracted will include specific details about the participants, concept, context, study methods and key findings relevant to the review questions.

The pilot of the draft extraction form will be carried out on a randomly selected 10% of the articles included in the review. All three reviewers will independently extract data from this portion of the resources. In case of any doubts, the whole team will make a decision through discussion and the data extraction form will be improved. Then the remaining 90% of the articles will be divided among the three reviewers and each of them will extract the data from their part.

A draft extraction form is provided (see S4 Appendix). The draft data extraction tool will be modified and revised as necessary during the process of extracting data from each included evidence source. Modifications will be detailed in the scoping review. If appropriate, authors of papers will be contacted to obtain missing or additional data, where required.

Data analysis and presentation

First, the extracted results will be divided into overall psychosocial functioning and functioning in particular life environments (family, school and peer group). The sorted research evidence will be summarised and descriptively mapped to characterise components of psychosocial functioning. This will be based on the occurrence of the variables measured. The following frequency counts will also be used: components of psychosocial functioning, variables or measurement tools assessing psychosocial functioning, available population characteristics (including country, age, gender, adolescence stage, ADHD presentation/subtype, comorbidities), pharmacological or other treatments/interventions, study designs, or other important data fields (unknown at protocol stage).

Summarising the research evidence on the topic, an attempt will be made to broadly describe psychosocial functioning of adolescents with ADHD in general. However, this will not be an in-depth type of analysis because this would be beyond the scope of the scoping review. Analyses will be based on examining the similarities and differences between the research evidence, the occurrence of variables or measurement tools commonly used to assess psychosocial functioning, the identification of research gaps and any key findings that would be useful to answer the question of what is known about the scoping review topic.

The data will be presented in tabular form and, if necessary, graphically. A preliminary tabular presentation of individual PCC elements is included in S5 Appendix. The tabular mapping technique will be used to present how psychosocial functioning was operationalised in included evidence sources (see S6 Appendix). A narrative summary will accompany the tabulated or charted results and will describe how the results relate to the review objectives and questions.

Overlaps and/or gaps in the literature will be identified. Implications for future studies will be suggested, mainly based on research gaps. A discussion on the need and feasibility of future research in the context of psychosocial functioning, in particular systematic reviews (and possibly meta-analyses) of the treatment effectiveness in adolescents with ADHD and potential differences from peers without ADHD, will also be carried out.

Discussion

The protocol presented in this paper describes a detailed plan for conducting the scoping review on psychosocial functioning of adolescents with ADHD. Publishing the protocol at the beginning of the study ensures that information about it reaches a wide range of researchers, and will enable the reproduction of this scoping review in the future.

Necessary changes to the study protocol will be presented in the final scoping review report, which is planned to be published in a peer-reviewed journal. The article will include full results of the search: a description of the study inclusion and data extraction process as well as the findings for scoping review questions. At this time all available data will be made public. It should also be mentioned that any disagreements or uncertainties that will arise between the team members at any stage of the research process will be resolved through discussion. As needed, amendments to the study will be updated on the OSF project page https://doi.org/10.17605/OSF.IO/6WX5C [page DOI].

Pointing to the strengths of the study, applying a scoping review methodology, the latest research approach, enables the study of a wide spectrum of psychosocial functioning. Thus, the family, school and peer environment are taken into account at the same time, which gives a comprehensive description. Moreover, focusing on adolescence attests to the innovative character of the study. Additionally, the time span of the search is very wide (since 1987) and there are no restrictions on the context of the research included. It is also worth emphasizing that conducting the scoping review will help to verify the feasibility of (future) systematic reviews (and possibly meta-analysis): (1) on the effects of non-medical interventions on psychosocial functioning of adolescents with ADHD and (2) on potential differences in psychosocial functioning from their peers without ADHD. These reviews will contribute to an even deeper knowledge of the subject.

However, the authors are aware that the planned study is not free of limitations. One of the issues that may be debatable is including only participants with a formal diagnosis of ADHD. This will result in the rejection of some studies, but the authors are convinced that this approach will contribute to collecting the most homogeneous sample possible. Another potentially questionable decision is not to search "grey literature". The argument for such a solution was the desire to include only highly reliable, well-designed research. Moreover, by balancing the breadth of the review with the reasonable time frame and research project resources, unpublished studies were excluded. A decision like this was also made in other scoping reviews [65-69]. The exclusion of systematic reviews and meta-analyses in this scoping review may also be considered a limitation. A search including this type of articles would likely give corresponding (or even identical) datasets of primary studies to the search excluding systematic reviews and meta-analyses–assuming, of course, that both searches would have a similar strategy and inclusion criteria. If the search strategies and inclusion criteria were different–it is possible that dataset from the search including systematic reviews and meta-analyses would contain additional primary studies. However, these differences in search approaches would make the scoping review procedure less precise and less replicable. And the authors wanted to avoid it. There are also other scoping reviews that exclude systematic reviews and meta-analyses, focusing searches solely on primary studies [65–67, 70]. The review may also be limited by excluding non-English articles. The language criterion was based on the capabilities of the team members. Moreover, it is a common practice in reviews.

Despite the indicated limitations, the proposed scoping review, to the authors’ best knowledge, will be the first to investigate the concept of psychosocial functioning of adolescents with ADHD simultaneously in three basic life environments, assuming precise methodological criteria.

The exemplary search strings for a preliminary search.

(PDF)

Click here for additional data file.

The PRISMA-ScR checklist.

(PDF)

Click here for additional data file.

Search strings for Scopus and EBSCO databases.

(PDF)

Click here for additional data file.

Data extraction instrument (preliminary table).

(PDF)

Click here for additional data file.

Draft tabular presentation of the PCC components.

(PDF)

Click here for additional data file.

Components of psychosocial functioning in evidence sources (draft table).

(PDF)

Click here for additional data file.

22 Mar 2022

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Reviewer #1: Thank you for the opportunity to review this manuscript of a scoping review protocol. I would recommend this manuscript undergo some major revisions in order to be published. My major areas of concern are:

1. Some sentences/paragraphs are difficult to understand or quite vague, which I assume are language issues. It would be good to get a native speaker to review the manuscript if possible and help to improve it

2. I’m not entirely sure what the rationale is for this scoping review and what the authors are hypothesising – this may be a language issue but it’s really important that the authors make it clearer why they are conducting this review and what they want to find out.

3. There is not definition of the main concept “Psychosocial functioning”. The manuscript centres around this concept but it is unclear to me how exactly this is conceptualised for this review.

4. The introduction reads very vague on a lot of aspects. There are quite a few blanket statements made without evidence which could, potentially be quite harmful for children and adolescents with ADHD. I have highlighted a few issues further down.

Some more detailed comments below:

Abstract

P1,l20: hyperkinetic disorder is commonly differentiated from ADHD. I would suggest sticking with one of the terms. I would recommend ADHD, as hyperkinetic disorder is, to my knowledge, a bit outdated.

P1, l20-23, Introduction: seems a bit vague. It would be good to have a definition of “psychosocial functioning” in there.

P2,l25-28: in the text you mention that you will only include studies in English and from 1987 onwards but here you state that all primary studies are included. The abstract should align with the rest of the manuscript.

P2, l27/28. “The concept is derived from the social sciences.” – which concept and why is this information important here?

P2, l28: “There will be no restrictions on the research context” – again, in the text you mention certain exclusions (medical, neurobiological, neurocognitive) which don’t seem to be reflected here.

p2, l31-32: no need for brackets around the databases, the way it’s phrased they should be listed after a colon.

P2,l34: “frequency counts” of what though? Can you explain the method of analysis a bit better?

Introduction

I could not find your review question and/or aim stated explicitly in the introduction section. It would be very helpful to include a research question or hypothesis in the introduction. What is it that you are actually wanting to find out and why?

P2, l43/44: Consider changing this sentence to “may involve changes in the symptoms”, it is very general and may not be the case for everyone. I recommend deleting the next sentence (“Therefore, all natural processes are affected…”) as this is not correct and no evidence is provided for this.

P2/3,l46/47: citation needed.

P2/3,l47/48: “ADHD does not pass in most cases…” This would be highly contested. There are various studies that show a large percentage of children who outgrow their ADHD-related behaviours throughout adolescence. A proportion of children struggle with ADHD behaviours throughout adulthood, but this is not the case for many. Also, ADHD is defined by the displayed symptoms/behaviours, so if those are no longer present, the person has, by definition, no ADHD. Thus, I suggest amending this statement.

P2,l48-50: “Moreover, children with hyperkinetic disorder have limited contact with their peers, isolate themselves and due to their behaviour or the problems they cause, they have no close friends outside the family.” This sentence needs deleting or a complete rewrite. 1. Hyperkinetic disorder is no longer a diagnosis used and I would recommend only referring to it in your inclusion criteria to capture older studies that use ICD-10 or before definitions. Commonly, hyperkinetic disorder is often distinguished as a more severe form of ADHD, I think it may lead to confusion, especially amongst non-European readers, if you switch between the two terms throughout the text. 2. I think it is very dangerous (and wrong) to state that children (or anyone else) with ADHD have no friends and have limited contact because of the behaviours and that they cause problems. Please think about what you are implying with this. There are many children with ADHD that lead pretty happy lives and are socially completely integrated.

P3,l53: “The above facts clearly show…” I don’t think you have shown this above. Please consider re-writing your introduction to detail how ADHD impacts adolescents.

P3,l65-71: This whole paragraph should be moved into the methods section, it is not relevant to the introduction. Consider including more information on the actual concept of “psychosocial functioning” – a definition of how you utilised this concept for this study would be very helpful. It is not quite clear to me what you mean by this exactly.

P4/5,l80-101: I would suggest shortening this a bit and summarising more concisely what has been done and what has not been done. It is not quite clear to me what the new aspect of your work is for this. It reads as if there has already been a lot of studies and reviews of psychosocial functioning done. I would contest your last sentence in this paragraph: there is a lot of research out there on ADHD and we know a lot about it already. Arguably, what we still do not know (or what is still contested) is what sort of interventions help adolescents with ADHD.

Objectives of the study and review questions

Consider moving both of these into the introduction. I was looking for this information earlier on. According to JBI these should be in the introduction of a protocol.

P5,l105/6: “this study assumes taking into account..” this sentence doesn’t really make sense – I would recommend deleting it.

The objectives section still does not make very clear what the actual main aim of this study is apart from gathering information on psychosocial functioning in adolescents with ADHD. Why do you want to gather this information?

Eligibility criteria

Concept, p7,l158: There really needs to be some explanation of “psychosocial functioning” – this is your main concept. There needs to be a definition (see also line163 in which you say “as defined in this review” but you haven’t defined it).

The mentioning of the three environments could be moved to the context section – this is the context in which you are looking at the concept.

P7, l160-166: This is all not relevant to the concept. This can go into exclusion criteria.

P8, l175/176: why are you excluding systematic reviews and meta-analyses?

P8,l188/193: for these exclusion criteria it is, again, really important that you have a solid definition of psychosocial functioning somewhere. Just presenting some examples and then writing “etc”., does not seem a full list of exclusions or inclusion. Also, if you are excluding all studies without clinical diagnosis and also those that do not fully conceptualise psychosocial functioning in a “holistic” way (however you want to define that) -my guess is you will be left with very few or no studies.

Source of evidence selection

P10 – according to JBI methodology the title/abstract screening and full text selection should be done by 2 reviewers independently.

Data analysis and presentation

P12,l 272: “Although the synthesis of the results is not the goal of the scoping review,..”: what is your goal then? You may need to re-phrase this. The goal of any review should be the synthesis of evidence in some form!

Reviewer #2: 1. Summary of the research and your overall impression

The authors describe a planned scoping review that explores an important area in the field of adolescent mental health and wellbeing. They clearly outline the methodological steps that will be undertaken to identify and synthesise studies that discuss the topic of psychosocial difficulties among adolescents with ADHD. Bringing together the literature on 3 key areas of adolescents’ life (i.e. family, school and peer group) would be a valuable contribution to knowledge that could inform future research. However, there are a few minor issues that could be addressed at this proposal stage which could benefit the study process and outcomes.

2. Minor issues to be considered

• The authors stated that other/similar review have been conducted “relatively long ago”. Would it be possible for the authors to explicitly state a timeframe? For example, “more than 5 years ago”.

• The authors used “etc” a number of times in the manuscript. Can the authors rephrase these sentences to avoid using “etc” as this is less common for academic submissions?

• The authors describe the propose study as innovative. However, the argument that “ADHD is still being researched and we still know relatively little about it in youth” is a bit unclear. The authors may wish to further develop this point possibly narrowing it to focus on psychosocial difficulties in adolescents. This is important as there is a wealth of evidence on ADHD and youth as it relates to other fields like medicine and nutrition.

• The authors may wish to provide a citation to support their justification for excluding information not published in peer reviewed journals. This is important as one of the advantages of the scoping review methodology is that is gives researchers the opportunities to search more broadly using grey literature sources to identify information that is usually missed in traditional systematic reviews. It is possible that grey literature searches were conducted in the preliminary searches as the authors mentioned Figshare and OSF.

• The authors described piloting 10% of the studies during screening and data extraction before independently working on the remaining 90%. However, it is not clear if any verification or cross-checking or comparisons will be done to ensure further accuracy, reliability and consistency. Although not explicitly stated in the JBI guidance would the authors consider this as a limitation?

• Similarly, the authors may wish to acknowledge that not including the “optional consultation phase” proposed by other scoping review methodologist (Arksey and O’Malley framework) could be a limitation or a consideration for future research? Owing to the research questions proposed there might be an opportunity here for valuable input from lived experience experts.

**********

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Reviewer #1: No

Reviewer #2: Yes: Shaun Liverpool

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Submitted filename: PLOS scoping review comments.docx

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5 May 2022

RESPONSE TO REVIEWERS

Dear Academic Editor and Reviewers,

We would like to thank you for the opportunity to revise our manuscript and for the helpful comments and constructive suggestions. After careful consideration, we have responded to each comment and heeded your feedback. It is our belief that the manuscript has gained in quality after making the edits suggested.

The descriptions of the changes made are included below. This content is also available in a more accessible form in the attached file "Response to Reviewers.pdf".

The line numbering refers to the version of the text subjected to review (first submission).

ACADEMIC EDITOR:

Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

Answer: We have checked and corrected the manuscript according to PLOS ONE's style requirements.

REVIEWER #1:

1. Some sentences/paragraphs are difficult to understand or quite vague, which I assume are language issues. It would be good to get a native speaker to review the manuscript if possible and help to improve it

Answer: Thank you for the suggestion, our paper has been checked and corrected by an experienced native British English proofreader.

2. I’m not entirely sure what the rationale is for this scoping review and what the authors are hypothesising – this may be a language issue but it’s really important that the authors make it clearer why they are conducting this review and what they want to find out.

Answer: Thank you for drawing attention to this issue. We have expanded the last paragraph before the Objectives of the study subsection to emphasize the rationale for conducting our scoping review. According to the JBI methodology, we do not pose any hypotheses, instead there are review questions. The Objectives of the study subsection was modified to describe in detail what we want to achieve.

We hope that the changes have clarified this issue.

3. There is not definition of the main concept “Psychosocial functioning”. The manuscript centres around this concept but it is unclear to me how exactly this is conceptualised for this review.

Answer: Thank you for pointing out this deficiency. We have changed two paragraphs in the Introduction to briefly outline possible ways of defining psychosocial functioning present in the literature. However, we also emphasized that:

“(…) in order not to limit the scope of the review, this study does not adopt any definition of psychosocial functioning. The only definition-related requirement for this concept is that the authors of primary research articles had to use the term psychosocial functioning (or functioning in a family, school or peer group) explicitly. Further details are explained in the Concept subsection.”

We have also expanded the Concept subsection to better explain our research assumptions. We hope that the changes made are sufficient.

4. The introduction reads very vague on a lot of aspects. There are quite a few blanket statements made without evidence which could, potentially be quite harmful for children and adolescents with ADHD. I have highlighted a few issues further down. Some more detailed comments below.

Answer: Thank you very much for drawing attention to this issue. In response to this comment, we have almost completely rewritten the Introduction and supported it with evidence based on research. Detailed answers to the highlighted issues are provided below. In our opinion, all the changes made have streamlined and cleared the Introduction.

4.1. Abstract

A. P1,l20: hyperkinetic disorder is commonly differentiated from ADHD. I would suggest sticking with one of the terms. I would recommend ADHD, as hyperkinetic disorder is, to my knowledge, a bit outdated.

Answer: Thank you for the suggestion. Wherever possible, “hyperkinetic disorders” has been replaced with “ADHD”. The term “hyperkinetic disorders” remained in the inclusion criteria. This is necessary because this term was the official name for ADHD in the ICD-10, and the ICD is a widely used classification system in many places around the world (including European countries, Australia, Canada, Brazil, China, Korea, South Africa). Only since January 1, 2022, when the ICD-11 came info effect, “ADHD” has replaced “hyperkinetic disorders”. Moreover, for precision, we have also added the term “hyperkinetic syndrome” (to reflect the ICD-9 classification in the inclusion criteria).

B. P1, l20-23, Introduction: seems a bit vague. It would be good to have a definition of “psychosocial functioning” in there.

Answer: We have made a few changes to make this paragraph more precise. Moreover, we have provided additional information on the concept in the Inclusion criteria paragraph. However, as required by PLOS ONE, the Abstract cannot exceed 300 words. Therefore, no more information could be added.

C. P2,l25-28: in the text you mention that you will only include studies in English and from 1987 onwards but here you state that all primary studies are included. The abstract should align with the rest of the manuscript.

Answer: Thank you for pointing out this lack of precision. This confusing information and the entire paragraph have been corrected. In addition, we have emphasized that (in this paragraph) there are only criteria related to the PCC elements (population, concept, context).

D. P2, l27/28. “The concept is derived from the social sciences.” – which concept and why is this information important here?

Answer: The “concept” was about psychosocial functioning. This information was related to the PCC elements (which should be listed in the Inclusion criteria paragraph). This sentence was just additional information. However, it was unnecessary and imprecise and has been removed.

E. P2, l28: “There will be no restrictions on the research context” – again, in the text you mention certain exclusions (medical, neurobiological, neurocognitive) which don’t seem to be reflected here.

Answer: This sentence is correct – there will be no restrictions on the research context. However, the issue of the context of the scoping review was indeed described unclear in our protocol. This problem has been corrected throughout the manuscript, mainly by removing sentences related to medical, neurobiological or neurocognitive studies from the Introduction, Concept and Exclusion criteria subsections.

F. p2, l31-32: no need for brackets around the databases, the way it’s phrased they should be listed after a colon.

Answer: Thank you for this comment. The suggested change has been made.

G. P2,l34: “frequency counts” of what though? Can you explain the method of analysis a bit better?

Answer: Thank you for drawing attention to this understatement. We have added some general information (in a way that the limited length of the Abstract allowed). A detailed description is provided in the Data analysis and presentation subsection of the manuscript.

4.2. Introduction

A. I could not find your review question and/or aim stated explicitly in the introduction section. It would be very helpful to include a research question or hypothesis in the introduction. What is it that you are actually wanting to find out and why?

Answer: The Objectives of the study and the Review questions are subsections of the Introduction section (which is in line with the JBI manual). Indeed, it is hard to remark this in the submitted manuscript file. According to PLOS ONE's style requirements, the main section (Introduction) has the headline Times New Roman 18 and the subsections have the headings Times New Roman 16. Additionally, the entire Objectives of the study subsection has been corrected (see Answer #4.3.C), and we hope that after these changes our goals are clearly defined.

B. P2, l43/44: Consider changing this sentence to “may involve changes in the symptoms”, it is very general and may not be the case for everyone. I recommend deleting the next sentence (“Therefore, all natural processes are affected…”) as this is not correct and no evidence is provided for this.

Answer: Thank you for this comment. As suggested, the first sentence has been changed (additionally, more citations were provided). The second sentence has not been deleted but replaced by the following:

“However, their natural development takes place in the presence of symptoms of the disorder.”

C. P2/3,l46/47: citation needed.

Answer: As a consequence of the changes made throughout the Introduction, this sentence has been rewritten, supported by citations and moved to the beginning of the Introduction.

D. P2/3,l47/48: “ADHD does not pass in most cases…” This would be highly contested. There are various studies that show a large percentage of children who outgrow their ADHD-related behaviours throughout adolescence. A proportion of children struggle with ADHD behaviours throughout adulthood, but this is not the case for many. Also, ADHD is defined by the displayed symptoms/behaviours, so if those are no longer present, the person has, by definition, no ADHD. Thus, I suggest amending this statement.

Answer: Thank you for focusing attention on this issue. This statement has been amended, expanded and supported by citations from research results. As a consequence of these changes, the entire paragraph has been created, which has been placed at the beginning of the Introduction.

E. P2,l48-50: “Moreover, children with hyperkinetic disorder have limited contact with their peers, isolate themselves and due to their behaviour or the problems they cause, they have no close friends outside the family.” This sentence needs deleting or a complete rewrite.

1. Hyperkinetic disorder is no longer a diagnosis used and I would recommend only referring to it in your inclusion criteria to capture older studies that use ICD-10 or before definitions. Commonly, hyperkinetic disorder is often distinguished as a more severe form of ADHD, I think it may lead to confusion, especially amongst non-European readers, if you switch between the two terms throughout the text.

2. I think it is very dangerous (and wrong) to state that children (or anyone else) with ADHD have no friends and have limited contact because of the behaviours and that they cause problems. Please think about what you are implying with this. There are many children with ADHD that lead pretty happy lives and are socially completely integrated.

Answer: 1. Thank you for the suggestion. The term “hyperkinetic disorders” has been replaced by “ADHD” (see Answer #4.1.A for details).

2. Thank you for highlighting the careless wording that we have used which may actually be harmful. This sentence has been completely rewritten (using research results only) and supported by citations.

F. P3,l53: “The above facts clearly show…” I don’t think you have shown this above. Please consider re-writing your introduction to detail how ADHD impacts adolescents.

Answer: This part of the Introduction has also been rewritten and expanded to highlight how ADHD impacts adolescents. We hope that the changes made have improved this issue.

G. P3,l65-71: This whole paragraph should be moved into the methods section, it is not relevant to the introduction. Consider including more information on the actual concept of “psychosocial functioning” – a definition of how you utilised this concept for this study would be very helpful. It is not quite clear to me what you mean by this exactly.

Answer: Thank you for the comment. To clarify this part of the Introduction, this paragraph has been deleted. Moreover, we have added information about possible ways of defining psychosocial functioning present in the literature and that our study does not adopt any definition of psychosocial functioning (see Answer #3).

H. P4/5,l80-101: I would suggest shortening this a bit and summarising more concisely what has been done and what has not been done. It is not quite clear to me what the new aspect of your work is for this. It reads as if there has already been a lot of studies and reviews of psychosocial functioning done. I would contest your last sentence in this paragraph: there is a lot of research out there on ADHD and we know a lot about it already. Arguably, what we still do not know (or what is still contested) is what sort of interventions help adolescents with ADHD.

Answer: Thank you for your suggestion. This paragraph has been shortened according to your comment. Most of the studies previously cited were based on data from children and adolescents combined into one group, so it was our overstatement to discuss them. The last sentence in this paragraph was imprecise and has also been changed in the following way:

“The preliminary searches have shown that still relatively little is known about the psychosocial functioning of adolescents with ADHD.”

4.3. Objectives of the study and review questions

A. Consider moving both of these into the introduction. I was looking for this information earlier on. According to JBI these should be in the introduction of a protocol.

Answer: As explained previously (see Answer #4.2.A) these parts are the subsections of the Introduction.

B. P5,l105/6: “this study assumes taking into account..” this sentence doesn’t really make sense – I would recommend deleting it.

Answer: Thank you for the suggestion. As the objectives of the study were described in more detail, we have decided not to delete this sentence, but to change it in the following way:

“This description will contain information both on psychosocial functioning in general and in particular life environments (family, school, peer group).”

C. The objectives section still does not make very clear what the actual main aim of this study is apart from gathering information on psychosocial functioning in adolescents with ADHD. Why do you want to gather this information?

Answer: Thank you for your comment, the objectives section has been expanded and clarified. The introduced changes have emphasized that our goal is descriptive – to identify, characterise and summarise research evidence on a given topic, including the identification of research gaps. Such a goal, according to the scoping review of scoping reviews (Pham et al., 2014), is the main objective of most scoping reviews and it is sufficient for this method.

4.4. Eligibility criteria

A. Concept, p7,l158: There really needs to be some explanation of “psychosocial functioning” – this is your main concept. There needs to be a definition (see also line163 in which you say “as defined in this review” but you haven’t defined it).

Answer: Thanks for the suggestion. The Concept subsection has been rewritten and clarified.

B. The mentioning of the three environments could be moved to the context section – this is the context in which you are looking at the concept.

Answer: After careful consideration of this comment, we have decided not to move environments issue to the Context section. According to the definitions mentioned in the Introduction, psychosocial functioning is described as the ability of an individual to function in various social roles (Priebe, 2007). Functioning in a school, family or peer group are therefore situated within the semantic limits of psychosocial functioning and – for some researchers – may be components of this concept. Our conclusion is in line with JBI's explanation of the context, which is rather related to cultural factors such as geographic location (e.g. country) or specific social or gender-based interests. In some cases, the context may also encompass details of a specific setting (e.g., healthcare system). However, none of the above factors apply to our scoping review, for which each contextual setting will be eligible for inclusion.

C. P7, l160-166: This is all not relevant to the concept. This can go into exclusion criteria.

Answer: Thank you for the comment. This paragraph was originally intended to clarify various questionable situations. However, in light of your comment, we have realised that this could lead to confusion and misunderstandings. Therefore, the paragraph has been deleted. There was also no need to move it to the Exclusion criteria as it described the specific circumstances of inclusion. Such details were unnecessary and more confusing, and did not change anything about the actual inclusion criteria. See also Answer #4.1.E.

D. P8, l175/176: why are you excluding systematic reviews and meta-analyses?

Answer: Thank you for drawing attention to this issue. Indeed, there was no justification for excluding systematic reviews and meta-analyses. This deficiency has been corrected by adding an explanation in the Search strategy and Discussion sections (as another limitation of the study).

E. P8,l188/193: for these exclusion criteria it is, again, really important that you have a solid definition of psychosocial functioning somewhere. Just presenting some examples and then writing “etc”., does not seem a full list of exclusions or inclusion. Also, if you are excluding all studies without clinical diagnosis and also those that do not fully conceptualise psychosocial functioning in a “holistic” way (however you want to define that) -my guess is you will be left with very few or no studies.

Answer: Thank you for the comment. The definition issue has been corrected (see Answer #3). The comment concerns the 4th and 5th criteria from the Exclusion criteria subsection, which have been replaced by one criterion:

“(…) 4. no use of any of the following terms for the variables of interest: psychosocial functioning, social functioning, family functioning, school functioning, academic functioning, peer functioning, peer group functioning, or adequate grammatical forms;”

We hope that these changes have clarified this issue.

4.5. Source of evidence selection

P10 – according to JBI methodology the title/abstract screening and full text selection should be done by 2 reviewers independently.

Answer: Thank you for focusing attention on this oversight. This was noticed during the course of the project (but after the submission of the manuscript) and the procedure has been corrected. Therefore, the description of the procedure in the article has been modified accordingly.

4.6. Data analysis and presentation

P12,l 272: “Although the synthesis of the results is not the goal of the scoping review,..”: what is your goal then? You may need to re-phrase this. The goal of any review should be the synthesis of evidence in some form!

Answer: Thank you for the comment, this part of the sentence has been deleted. We understand that our sentence may not have been clear to the reader. However, it seems to us that this is a disagreement resulting from a different understanding of the word synthesis. The JBI manual explicitly states that: “formal synthesis is not normally conducted in a scoping review” (Peters et al., 2020, p.411), and further: “It is important to point out that scoping reviews do not synthesize the results/outcomes of included sources of evidence as this is more appropriately done within the conduct of a systematic review” (p.421).

REVIEWER #2:

1. The authors stated that other/similar review have been conducted “relatively long ago”. Would it be possible for the authors to explicitly state a timeframe? For example, “more than 5 years ago”.

Answer: Thank you for the comment. According to the changes suggested by Reviewer #1 (see Answer #4.2.H) this sentence has been deleted. After the reviews, we concluded that most of the studies previously cited based on data from children and adolescents combined into one group . Therefore, it was not entirely appropriate to mention them in the protocol referring only to research on the adolescent population.

2. The authors used “etc” a number of times in the manuscript. Can the authors rephrase these sentences to avoid using “etc” as this is less common for academic submissions?

Answer: Thank you for drawing attention to this issue. Sentences containing “etc” have been rephrased or deleted (due to changes resulting from other comments).

3. The authors describe the propose study as innovative. However, the argument that “ADHD is still being researched and we still know relatively little about it in youth” is a bit unclear. The authors may wish to further develop this point possibly narrowing it to focus on psychosocial difficulties in adolescents. This is important as there is a wealth of evidence on ADHD and youth as it relates to other fields like medicine and nutrition.

Answer: Than you for your comment. Indeed, this sentence was vague and has been clarified in the following way:

“The preliminary searches have shown that still relatively little is known about the psychosocial functioning of adolescents with ADHD.”

4. The authors may wish to provide a citation to support their justification for excluding information not published in peer reviewed journals. This is important as one of the advantages of the scoping review methodology is that is gives researchers the opportunities to search more broadly using grey literature sources to identify information that is usually missed in traditional systematic reviews. It is possible that grey literature searches were conducted in the preliminary searches as the authors mentioned Figshare and OSF.

Answer: Thank you for the suggestion. After the changes made, the Discussion section cites studies in which grey literature was excluded. Balancing our desire for a broad review (seven large databases, articles since 1987, and three basic living environments) with a reasonable time frame and research project resources, we decided to include only highly reliable, well-designed studies. We are aware that this is a limitation of our study and this issue is emphasized in the Discussion section.

Indeed, grey literature was included in the preliminary search (PROSPERO, OSF and figshare.com checked). However, this only served to determine if there are ongoing or existing scoping reviews and/or systematic reviews on psychosocial functioning of adolescents with ADHD (to avoid duplication of the research).

5. The authors described piloting 10% of the studies during screening and data extraction before independently working on the remaining 90%. However, it is not clear if any verification or cross-checking or comparisons will be done to ensure further accuracy, reliability and consistency. Although not explicitly stated in the JBI guidance would the authors consider this as a limitation?

Answer: Thank you for focusing attention on this issue. According to the comment of the Reviewer #1 (see Answer #4.5.), the description of the procedure has been modified in the article. In line with the JBI methodology, the title/abstract screening and full text selection should be done by 2 (or more) reviewers independently. This oversight in the procedure was noticed during the course of the project (but after the submission of the manuscript) and the procedure has been corrected. 90% of the studies will be assessed in detail by two independent reviewers against inclusion criteria. The results will be compared and disagreements between reviewers will be resolved through discussion and consensus of the research team. The JBI methodology does not assume any verification/comparison of the data extraction process results. Therefore, we have decided not to consider this as a limitation of this scoping review. Of course, any doubts during the data extraction process will be discussed by team members.

6. Similarly, the authors may wish to acknowledge that not including the “optional consultation phase” proposed by other scoping review methodologist (Arksey and O’Malley framework) could be a limitation or a consideration for future research? Owing to the research questions proposed there might be an opportunity here for valuable input from lived experience experts.

Answer: Thank you for this valuable information on the possible benefits of consulting experienced experts. This will come in handy in our future research. However, in this scoping review, we would like to consistently apply the JBI methodology. Therefore, we did not include the proposed phase (to avoid combining methodological approaches), and we have decided not to consider this as a limitation of this scoping review. It seems to us that suggesting an “optional consultation phase” as consideration for future research will be more relevant and useful in the final scoping review report (when the results of the review are known) than in this protocol.

Submitted filename: Response to Reviewers.pdf

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23 May 2022

Psychosocial functioning of adolescents with ADHD in the family, school and peer group: A scoping review protocol

PONE-D-21-37767R1

Dear Dr.Swietek ,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Additional Editor Comments (optional):

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.

Reviewer #1: Yes

Reviewer #2: Yes

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3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Have the authors described where all data underlying the findings will be made available when the study is complete?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

(Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Thank you for revising the manuscript and resubmitting it. Overall, I think it is now much better, clearer and easier to follow. I got a much better understanding of what the authors are suggesting. I have a few minor suggestions to add, mainly I tend to think that the manuscript could be shortened a little by avoiding repetition here and there. Please take these as suggestions, if the editors are happy with the length this does not need to be changed on my account.

Abstract, L37: Suggest you reword the sentence to have the databases searched after the colon at the end: “The following databases will be searched for primary studies in peer-reviewed journals, written in English and published since 1987: Academic Search…”

Introduction:

I think this is much better now both in content and in wording, even though quite long (might be possible to shorten it a bit?). I would take out lines 148-153 – I don’t think you need to explain this in the introduction. You provided a good overview of what psychosocial functioning is and have explained that there are different ways to conceptualise it – I would leave this detail for the methods – but just a suggestion.

The revised section about rationale (l185-212) is also much improved. I feel this could also be shortened a bit, you have a few sentences in there like “As mentioned,..”, which indicates that there is a bit of repetition in here. Overall, it is now much clearer what gap you are trying to fill with your research and why!

Concept/Context:

I still think your life environments of family, school and peer group could be the context in which you are looking at the concept – but as you have given this some thought and have decided against this suggestion, I am sure you can make it work this way as well.

Reviewer #2: The authors have sufficiently addressed all previous comments within the text and provided appropriate justifications for methodological decisions.

**********

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Reviewer #1: No

Reviewer #2: Yes: Shaun Liverpool

10 Jun 2022

PONE-D-21-37767R1

Psychosocial functioning of adolescents with ADHD in the family, school and peer group: A scoping review protocol

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