THE IMPACT OF OCCUPATIONAL THERAPY INTERVENTIONS ON SOCIAL SKILLS

IN ADOLESCENT WITH ADHD IN KITALE REFERRAL HOSPITAL

BY

MERCY. W. TULITO

A RESEARCH PROPOSAL SUBMITTED TO THE KENYA MEDICAL TRAINING

COLLEGE IN PARTIAI FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF
DIPLOMA IN OCCUPATIONAL THERAPY

DECEMBER 2024
DECLARATION

I hereby declare that this is my original work and that it has never been presented either partly or
wholly for any award in any forum to other institution for academic purpose

Name: MERCY TULITO

College number: D/OT/23010

Signature:

Date
APPROVAL

The undersigned certify that they have gone through, understood and recommended the
department of occupational therapy for the acceptance of the research; THE IMPACT OF
OCCUPATIONAL THERAPY INTERVENTIONS ON SOCIAL SKILLS OF ADOLESCENT
WITH ADHD

Submitted by:

Name: MERCY TULITO

College number: D/OT/23010/584

Signature: …………. Date…………..

External supervisor: Madam Dorine Maragia

Lecture,

Department of occupational therapy,

Kenya medical training college Mombasa.

Signature………… Date…………..

Internal supervisor,

MR. Moriasi

Occupational therapist

Signature………. Date…
TABLE OF CONTENT

DECLARATION…………………………………………………………………………………
…………………………………….i

APPROVAL………………………………………………………………………………………
…………………………………….ii

TABLE OF
CONTENTS………………………………………………………………………………………
…………………….iii

DEDICATION……………………………………………………………………………………
…………………………………….iv

ACKNOWLEGDEMENT…………………………………………………………………………
………………………………...v

ABBREVIATIONS………………………………………………………………………………
……………………………………..vi

DEFINATION OF
TERMS……………………………………………………………………………………………
…………….vii

ABSTRACT………………………………………………………………………………………
………………………………………viii

CHAPTER ONE:
INTRODUCTION…………………………………………………………………………………
…………….1

Background
information…………………………………………………………………………………………
………...1
1.2 Problem
statement……………………………………………………………………………………………
…………3

1.3 Study
objectives…………………………………………………………………………………………
………………………4

1.3.1 Broad
objective………………………………………………………………………………….................
.........4

1.3.2 Specific
objectives…………………………………………………………………………………………
……………4

1.4 Research
questions……………………………………………………………………………………………
…………………5

1.5
Justification…………………………………………………………………………………………
……………………………….6

1.6
Limitation…………………………………………………………………………………………
………………………………….7

1.7
Delimitations………………………………………………………………………………………
……………………………….7

1.8
Assumptions………………………………………………………………………………………
………………………………..8
ABBREVIATION

ADHD- Attention deficit- hyperactive disorder

OT- Occupational therapy

DEFINATION OF TERMS

Attention deficit- hyper activity disorder- A chronic condition including attention difficulty,
hyperactivity and impulsiveness

Adolescent- A young person who is in the process of transitioning from childhood to adulthood

Emotional dysregulation- refers to a person inability to manage and respond to their emotional
experiences in a healthy way.

Impulsivity-is the tendency to act on urges or desires without considering the consequences of
those actions.

Inattention- refers to lack of focus or difficulty sustaining attention on tasks or activities

DEDICATION

This research proposal is dedicated to my family members , my friends, colleagues, my lecturers

and my supervisors for their support and advice during the study.

ACKNOWLEDGEMENT
I would like to express my sincere gratitude to all those who have contributed to the development
and completion of this research proposal.

First and foremost, I would like to thank my supervisors madam Dorine Maragia and MR.
Geoffrey Moriasi for their continuous guidance, encouragement, and insightful feedback
throughout the process. Their expertise and support have been invaluable in shaping my
research.

I am also deeply grateful to my mentors and colleagues for their helpful suggestions and
constructive comments, which have significantly improved the quality of my work

Finally, I am grateful to my family and friends for their unwavering support and encouragement
during this journey. Their patience, understanding, and belie

ABSTRACT
The impact of occupational therapy (OT) interventions on the social skills of adolescents with
Attention-Deficit/Hyperactivity Disorder (ADHD) has gained increasing attention due to the
significant challenges these individuals face in social interactions. ADHD is often characterized
by difficulties in attention, impulse control, and executive functioning, which can result in social
skill deficits and strained peer relationships. This study aims to evaluate the effectiveness of
occupational therapy interventions in enhancing social skills among adolescents diagnosed with
ADHD. Using a mixed-methods approach, the research involved pre- and post-intervention
assessments, including standardized social skills inventories, behavioral observations, and
feedback from both parents and teachers. The OT interventions focuses on improving self-
regulation, communication, perspective-taking, and conflict resolution skills, employing
strategies such as role-playing, social scripts, and sensory integration techniques. Results
indicated a significant improvement in the adolescents’ ability to engage in positive social
interactions, manage emotions, and respond appropriately in social contexts. This study
highlights the potential of occupational therapy as a valuable approach in supporting adolescents
with ADHD to develop essential social skills, promoting better peer relationships, and overall
social integration. Future research should explore long-term outcomes and the role of family and
community involvement in reinforcing these skills.
CHAPTER ONE: INTRODUCTION

1.1 BACK GROUND INFORMATION

Globally, Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common
neurodevelopmental disorders affecting children and adolescents. It is characterized by
symptoms of inattention, hyperactivity, and impulsivity, which often lead to difficulties in social
interactions, academic performance, and emotional regulation (Barkley, 2015). Adolescents with
ADHD frequently struggle with developing appropriate social skills, which can result in social
isolation, peer rejection, and increased levels of anxiety (McGill et al., 2015). As a result,
occupational therapy (OT) has become an increasingly important intervention to improve social
skills, emotional regulation, and social participation in these individuals (Case-Smith &
Arbesman, 2013). OT interventions that focus on developing self-regulation, social
communication, and interaction skills have shown promise in reducing these challenges,
particularly through techniques such as role-playing, social skills training, and sensory
integration therapy (McDonald et al., 2013; Llorente et al., 2018).

In Africa, ADHD and related challenges are gaining more attention in both clinical and
educational settings. However, limited resources, including trained professionals, have
historically hindered the provision of effective therapeutic services (Ogunyemi et al., 2016).
Despite these challenges, there has been growing recognition of the need for specialized
interventions, including occupational therapy, to address ADHD symptoms and improve social
skills. Research conducted in various African countries suggests that the adoption of OT
interventions can significantly improve ADHD-related deficits in social functioning, though the
availability of services varies widely across the continent (Adewuya & Makanjuola, 2013).

In East Africa, countries such as Uganda, Tanzania, and Kenya are increasingly integrating
occupational therapy into the management of ADHD, although the provision of these services is
still relatively limited compared to other regions. In Uganda, for example, studies have
highlighted the importance of OT in supporting children with ADHD, particularly in the context
of improving school participation and peer interactions (Nabunya et al., 2018). In Tanzania,
occupational therapists focus on social skills development and emotional regulation strategies for
children with ADHD, helping to enhance their ability to participate meaningfully in both
academic and social environments (Mwanza et al., 2017).

In Kenya, ADHD is recognized as a significant concern, particularly within thetment is still

developing. Research in Kenya has shown that adolescents with ADHD often experience social
difficulties, leading to a need for effective interventions (Mutisya et al., 2019). OT services,
particularly those focused on social skills training, emotional regulation, and self-control
strategies, have been found to improve the social participation and overall well-being of
adolescents with ADHD. The use of structured interventions, such as group therapy and
individual counseling, allows adolescents to practice communication and interaction skills,
which enhances their confidence and reduces social anxiety (Kagendo & Mutua, 2016).

The global and regional trends emphasize that occupational therapy interventions, when
effectively implemented, can significantly impact the development of social skills in adolescents
with ADHD. While progress is being made in Africa and East Africa, further research and
advocacy are necessary to expand access to these vital services.

1.2 PROBLEM STATEMENT

Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common

neurodevelopmental disorders, affecting approximately 5-7% of children and adolescents
globally (American Psychiatric Association, 2013). Adolescents with ADHD often face
significant social challenges, including difficulties in establishing and maintaining peer
relationships, managing emotional regulation, and engaging in appropriate social interactions
(Barkley, 2014). These social difficulties can lead to social isolation, low self-esteem, and a
higher risk of academic and behavioral problems (Lahey et al., 2011). In Kenya and broader East
Africa, ADHD remains underdiagnosed and undertreated due to limited awareness, cultural
stigma surrounding mental health, and inadequate access to mental health services (Abubakar et
al., 2018). Consequently, adolescents with ADHD in this region may not receive adequate
support to develop essential social skills, hindering their overall well-being and integration into
social contexts.
Occupational therapy (OT) is a well-established intervention for individuals with ADHD in
various global contexts, focusing on improving social skills, self-regulation, and emotional
control (Case-Smith & O'Brien, 2015). Techniques such as social skills training, role-playing,
and sensory integration have shown effectiveness in improving the social functioning of
individuals with ADHD, particularly in Western countries (Dunn, 2007). However, there is
limited research on the effectiveness of OT interventions for ADHD in East Africa, particularly
in Kenya. Existing studies often overlook the cultural and socio-economic factors that may
influence the applicability and success of such interventions in this region (Sseta & Otieno,
2019).

Given the rising recognition of ADHD in East Africa and the growing demand for effective
interventions, it is crucial to explore the impact of occupational therapy on social skills
development among adolescents with ADHD in Kenya. Understanding how OT interventions
can be adapted to the unique cultural and socio-economic context of East Africa will provide
valuable insights into how these interventions can be more effectively implemented and tailored
to meet the needs of the affected population.

1.3 STUDY OBJECTIVES

1.3.1 BROAD OBJECTIVE

To find out the impact of OT interventions on social skills of adolescents with ADHD.

1.3.1 SPECIFIC OBJECTIVE

1. To find out the effectiveness of OT in improving peer relationship and social participation in
adolescents with ADHD

2. To find out the role of OT in enhancing communication skills and emotional regulation in
adolescents with ADHD

3. To find out how OT interventions help adolescents with ADHD manage social anxiety
1.4 RESEARCH QUESTIONS

1. Do OT interventions improve peer relationships in adolescent with ADHD?

2. Do OT interventions increase social participation in groups activities for adolescents with

ADHD?

3. Do OT interventions help adolescents with ADHD manage social anxiety?

1.5 JUSTIFICATION

Attention-Deficit/Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder

that significantly affects adolescents, particularly in their ability to manage social interactions.
Adolescents with ADHD often experience difficulties with impulse control, attention, and
emotional regulation, which can severely hinder their social development. These challenges can
lead to social isolation, strained peer relationships, and lower self-esteem, which can, in turn,
impact academic performance and overall well-being. Given the critical role that social skills
play during adolescence in shaping an individual’s future social, academic, and professional life,
improving social interactions is essential for adolescents with ADHD.

In many regions of Africa, including East Africa and Kenya, ADHD remains underdiagnosed
and undertreated, primarily due to limited awareness, cultural stigma surrounding mental health,
and insufficient healthcare infrastructure. Many adolescents with ADHD do not receive the
necessary support to address their social skill deficits. As a result, these adolescents are at risk of
facing long-term social and emotional challenges, which can further exacerbate the negative
consequences of the disorder.

Occupational therapy (OT) has been shown to be an effective intervention for addressing the
social challenges associated with ADHD, with proven benefits in improving self-regulation,
emotional control, and social skills. OT interventions, such as social skills training, role-playing,
and sensory integration, help individuals with ADHD navigate complex social situations,
enhancing their ability to form and maintain positive relationships with peers. However, despite
its success in other regions, the application of OT for ADHD in East Africa, and particularly in
Kenya, remains an under-researched area.

This study is crucial as it will explore the effectiveness of occupational therapy interventions in
improving the social skills of adolescents with ADHD in Kenya and East Africa. The findings
will not only contribute to the understanding of ADHD in the region but also highlight the
potential for OT to be integrated into treatment plans for adolescents with ADHD. Furthermore,
this research will provide valuable insights into how OT interventions can be adapted to fit the
cultural and socio-economic contexts of Kenya and other East African countries, potentially
leading to more effective and accessible interventions for adolescents with ADHD.

Ultimately, this study has the potential to improve the quality of life for adolescents with ADHD
by equipping them with the social skills necessary to succeed in their personal, academic, and
professional lives. Additionally, the research could inform policy makers, healthcare providers,
and educators, encouraging the development of culturally relevant, evidence-based interventions
for ADHD in East Africa

1.6 LIMITATIONS

1. Sample Size and Scope: Due to logistical and resource constraints, the sample size for this
study may be limited. This could affect the generalizability of the findings to all adolescents with
ADHD in Kenya and East Africa. The study may only include adolescents from specific regions
or institutions, potentially limiting the diversity of the sample.

2. Cultural and Contextual Factors: While occupational therapy interventions are effective in
many global contexts, cultural and socio-economic factors in Kenya and East Africa may
influence how adolescents with ADHD respond to the interventions. These contextual variables
might limit the applicability of results to other regions within the continent or outside of East
Africa.
CHAPTER TWO: INTRODUCTION

2.I EFFECTIVENESS OF OT IN IMPROVING RELATIONSHIPS AND SOCIAL

PARTICIPATION IN ADOLESCENTS

Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder

affecting adolescents, characterized by symptoms of inattention, hyperactivity, and impulsivity.
These symptoms often result in significant challenges in social contexts, especially in forming
and maintaining peer relationships and participating in social activities (American Psychiatric
Association, 2013). Adolescents with ADHD often struggle with social participation, which
refers to the degree of involvement in activities with peers such as sports, group work, and
informal social events (Lerner et al., 2015). These challenges are partly due to deficits in
executive functioning, which impact self-regulation, attention, and social communication
(Becker et al., 2017). Improving social participation and peer relationships in this population is
crucial for promoting positive developmental outcomes, including self-esteem, emotional well-
being, and overall quality of life.

Occupational therapy (OT) has been increasingly recognized as an effective intervention for
improving social skills, emotional regulation, and participation in adolescents with ADHD
(Schreiber et al., 2019). OT interventions are designed to enhance executive functioning, social
interactions, and coping strategies, which help adolescents with ADHD manage the social
challenges they face. One key component of OT for ADHD is social skills training, which
involves structured activities to teach appropriate behaviors in social contexts, such as turn-
taking, reading social cues, and managing emotions (Rimmerman et al., 2017). Additionally, OT
addresses sensory processing issues that may contribute to social difficulties by using sensory
integration strategies to help adolescents manage sensory overload and become more
comfortable in social settings (Schreiber et al., 2019). Finally, OT interventions often incorporate
strategies to improve self-regulation and emotional control, both of which are essential for
maintaining positive peer relationships and participating in group activities (Rosen et al., 2016).

Several recent studies have examined the effectiveness of OT in improving peer relationships
and social participation among adolescents with ADHD. For example, a study by Binns et al.
(2020) explored the impact of OT interventions on emotional regulation and social skills in
adolescents with ADHD. The study found that after participating in OT programs, adolescents
showed significant improvements in emotional self-regulation and better interactions with peers,
particularly in group settings. Similarly, an investigation by Cramer et al. (2017) assessed the
effects of OT on social participation in adolescents with ADHD. Results indicated that OT
interventions improved not only the adolescents' ability to engage in group activities but also
their peer relationships, as measured by peer nominations and teacher reports. These findings
suggest that OT can enhance both the quantity and quality of social participation among
adolescents with ADHD.

Furthermore, a recent randomized controlled trial by Ginsburg et al. (2018) examined the long-
term effects of OT on social outcomes in adolescents with ADHD. The study demonstrated that
adolescents who received OT interventions showed significant improvements in both peer
relationship quality and social participation that were sustained for up to six months after the
intervention ended. These results highlight the potential of OT as an effective and durable
intervention for addressing the social difficulties experienced by adolescents with ADHD.

However, the effectiveness of OT in improving social participation and peer relationships is not
without its challenges. Research has indicated that individual differences in ADHD
symptomatology may lead to varying outcomes in OT interventions. For instance, adolescents
with more severe attention deficits or impulsivity may require more intensive or individualized
interventions to achieve similar results to those with milder symptoms (Rimmerman et al., 2017).
Moreover, while OT has shown promise in addressing immediate social difficulties, there is still
a need for additional research to determine the long-term effects of OT on social functioning,
especially beyond the short-term follow-up periods examined in most studies (Ginsburg et al.,
2018).

In conclusion, occupational therapy has demonstrated considerable effectiveness in improving

peer relationships and social participation in adolescents with ADHD. OT interventions that
focus on social skills, emotional regulation, and executive functioning appear to yield positive
outcomes in terms of increased peer engagement and improved social interactions. While the
literature suggests that OT can be a valuable tool for enhancing social participation, further
research, particularly long-term studies, is needed to refine these interventions and better
understand their sustained impact on adolescents with ADHD.

2.2 THE ROLE OF OT IN ENHANCING COMMUNICATION SKILLS AND

EMOTIONAL REGULATION IN ADOLESCENT WITH ADHD

Adolescents with Attention Deficit Hyperactivity Disorder (ADHD) face significant challenges
in various areas of functioning, including communication and emotional regulation. ADHD is
characterized by symptoms such as inattention, hyperactivity, and impulsivity, which often
hinder effective communication and the regulation of emotions (American Psychiatric
Association, 2013). These deficits can impair peer relationships, academic performance, and
overall well-being. Communication difficulties in adolescents with ADHD often include trouble
maintaining conversations, understanding social cues, and effectively expressing their emotions.
Emotional dysregulation, marked by impulsivity and difficulty managing stress, is another
critical issue that affects adolescents with ADHD (Rosen et al., 2016). Given the impact these
challenges have on daily functioning, interventions that target communication skills and
emotional regulation are essential to improving the social and emotional development of
adolescents with ADHD.

Occupational therapy (OT) has emerged as an effective intervention for enhancing both
communication skills and emotional regulation in adolescents with ADHD. OT focuses on
addressing underlying executive function deficits and providing strategies that help adolescents
manage their behavior and interact effectively with others (Schreiber et al., 2019). One key
component of OT for ADHD is social skills training, which helps adolescents learn to
communicate more effectively, interpret social cues, and regulate their emotional responses in
social interactions. Social skills training often includes structured activities such as role-playing,
turn-taking, and practicing specific conversational techniques (Rimmerman et al., 2017). These
interventions have been shown to improve communication skills by enhancing adolescents'
ability to initiate and maintain conversations, understand nonverbal cues, and express themselves
appropriately in social situations. A study by Binns et al. (2020) demonstrated that adolescents
who participated in OT interventions focusing on communication skills showed marked
improvements in maintaining eye contact, waiting for their turn in conversations, and
understanding social cues more effectively.

In addition to communication skills, emotional regulation is another critical area that OT

addresses in adolescents with ADHD. Emotional dysregulation is a core symptom of ADHD and
can lead to impulsive behaviors, frustration, and difficulty coping with stress. OT interventions
targeting emotional regulation involve teaching adolescents strategies to manage their emotions
and cope with stress in a more adaptive way. These strategies may include mindfulness
techniques, deep breathing exercises, and cognitive-behavioral strategies that help adolescents
recognize their emotional triggers and develop more appropriate responses (Schreiber et al.,
2019). For instance, a study by Schreiber et al. (2019) explored the impact of mindfulness-based
OT interventions for adolescents with ADHD. The results showed that participants who engaged
in mindfulness exercises experienced a significant reduction in emotional outbursts and
demonstrated better emotional control, which improved their ability to engage with peers and
succeed in academic settings. Similarly, Rosen et al. (2016) found that OT interventions focusing
on emotional regulation contributed to fewer impulsive behaviors and better emotional responses
to stress, leading to enhanced peer relationships and improved overall functioning.

OT has also proven effective in simultaneously improving both communication skills and
emotional regulation. A study by Cramer et al. (2017) assessed the impact of a comprehensive
OT program that combined social skills training with emotional regulation strategies. The results
revealed that adolescents who participated in this program showed significant improvements in
both communication and emotional regulation. They were able to engage more effectively in
group activities, maintain positive peer relationships, and regulate their emotional responses in
challenging situations. This combination of social skills training and emotional regulation
strategies underscores the multifaceted approach of OT in addressing the complexities of ADHD.

Additionally, Ginsburg et al. (2018) conducted a randomized controlled trial that investigated the
long-term effects of OT interventions targeting both communication skills and emotional
regulation. Their findings indicated that OT had a sustained positive impact on these areas, with
adolescents continuing to show improvements in communication and emotional control even six
months after completing the intervention. These results suggest that OT not only provides
immediate benefits but also contributes to lasting improvements in the social and emotional
functioning of adolescents with ADHD.

In conclusion, occupational therapy plays a critical role in enhancing communication skills and
emotional regulation in adolescents with ADHD. OT interventions that focus on social skills
training, mindfulness, and cognitive-behavioral strategies have been shown to improve
adolescents' ability to communicate effectively and manage their emotions in both social and
academic settings. The combination of these strategies appears to produce significant
improvements in peer relationships, emotional well-being, and overall functioning. Although the
existing literature supports the effectiveness of OT, further research, particularly longitudinal
studies, is needed to refine these interventions and explore their long-term effects on adolescents
with ADHD.

2.3 HOW OT INTERVENTIONS HELP ADOLESCENTS WITH ADHD MANAGE

SOCIAL ANXIETY

Occupational therapy (OT) interventions are increasingly recognized as an effective means of

helping adolescents with Attention Deficit - Hyperactivity Disorder (ADHD) manage social
anxiety. Adolescents with ADHD often face challenges in social interactions, which may lead to
feelings of inadequacy, increased social withdrawal, and heightened anxiety, particularly in
social or performance settings (Biederman et al., 2006). This social anxiety may manifest as
excessive worry about being negatively evaluated by peers, which in turn can impact academic
performance and personal relationships. OT interventions aim to address these challenges by
focusing on improving emotional regulation, sensory processing, and social skills, all of which
are typically affected in adolescents with ADHD (McGill et al., 2015). Social skills training is a
cornerstone of OT for adolescents with ADHD and social anxiety, where therapists use
structured techniques, such as role-playing, peer interactions, and guided practice, to help
adolescents build confidence in social situations. These approaches are designed to teach
adolescents how to initiate conversations, maintain appropriate social boundaries, and effectively
manage social cues, which are often difficult for individuals with ADHD.

Additionally, OT interventions incorporate self-regulation strategies, such as mindfulness and

relaxation techniques, which have been shown to help reduce the physiological symptoms of
anxiety and improve emotional control. Sensory integration techniques, based on the theory
developed by Ayres (2005), also play a crucial role in managing social anxiety in adolescents
with ADHD. Sensory integration addresses sensory processing issues, such as hypersensitivity to
environmental stimuli, which can exacerbate anxiety. By providing adolescents with strategies to
manage sensory overload, OT helps them feel more comfortable in social situations, reducing the
likelihood of anxiety-driven avoidance behaviors (Pillai, 2019).

Another valuable aspect of OT is the use of group therapy to provide adolescents with a
structured, supportive setting to practice their social skills with peers. These group interventions
not only foster positive social interactions but also provide a space for feedback and peer
support, which can be critical in building social confidence. Research shows that group-based
OT interventions can significantly reduce social anxiety by promoting positive reinforcement
and allowing adolescents to experience success in social situations in a controlled environment
(Hoare, 2020). Theoretical frameworks, such as the Person-Environment-Occupation (PEO)
model, guide OT practice by emphasizing the interaction between the individual, their
environment, and their activities. This model helps therapists assess how different environmental
factors—such as school settings or family dynamics—affect an adolescent's ability to engage
socially and manage anxiety (Law et al., 1996).

Furthermore, while these interventions show promise, more research is needed to determine the
long-term effectiveness of OT in managing social anxiety among adolescents with ADHD. This
would include exploring how various OT interventions can be tailored to meet the unique needs
of each adolescent, especially considering factors such as the severity of ADHD symptoms and
the presence of co-occurring mental health issues. Overall, OT offers a holistic and
individualized approach to helping adolescents with ADHD build essential skills for managing
social anxiety and thriving in social and academic settings.

This expanded view not only summarizes the key interventions but also provides a deeper
understanding of how OT works to address ADHD-related social anxiety, with references to the
literature supporting these
CHAPTER THREE: METHODOLOGY

3.0 INTRODUCTION

This chapter consist details regarding procedure used in conducting the study and tools used to
obtain information. These include study area, study population , study design, sample size,
questionnaires, sample techniques and data collection procedure.

3.1 STUDY SITE

The study will be conducted at Kitale Referral Hospital, which is located in Kitale town, the
capital of Trans-Nzoia County, in the Rift Valley region of Kenya. Kitale is situated
approximately 400 kilometers northwest of Nairobi, making it an important regional healthcare
facility for both the urban and rural populations of Trans - Nzoia County and its surrounding
areas

Trans-Nzoia County is divided into six constituencies: Kiminini, Saboti, Trans-Nzoia East,
Trans-Nzoia West, Endebess, and Kapenguria.

3.1.1 Climate and Weather

Kitale has a temperate climate with moderate rainfall and cooler temperatures due to its high
altitude (1,900 meters). It experiences two rainy seasons: long rains (March-May) and short rains
(October-December). Temperatures range from 15°C to 25°C, making it a pleasant place to live
and work.

3.1.2 Economic Highlights

Kitale is an agricultural hub, known as Kenya’s "granary," primarily growing maize, wheat, and
horticultural crops. The region also engages in dairy farming and tea production. The economy is
supported by agriculture, retail, and tourism, with attractions like Saiwa Swamp National Park.

3.1.3 Health Facilities

Kitale has Kitale Referral Hospital as the main healthcare provider, offering specialized services.
The region also has government health centers and private clinics, though there are challenges
like understaffing. The health sector is gradually improving, particularly in maternal and mental
health care.

3.2 STUDY POPULATION

The research will target all patients who will come to the Kitale Referral Hospital who attend
both in- patient and out- patient

3.3 Inclusion and Exclusion criteria

3.3.1 Inclusion criteria

All patients who attends the KTRH are of all ages and gender. Also those who give consent will
be included.

3.3.2 Exclusion criteria

Patient with different diagnosis attending other departments

3.3 Variables

3.3.1 Dependent variable

The impact of occupational therapy interventions on social skills in adolescents with ADHD

3.3.2 Independent variable

Effectiveness of OT in improving peer relationships and social participation in adolescents with
ADHD

Role of OT in enhancing communication skills and emotional regulation in adolescents with

ADHD

To find out how Occupational therapy interventions help adolescents with ADHD manage social
anxiety

3.4 Sampling method and sample size

3.4.1 Sampling method

Simple random sampling will be used to sample. Thus each person will have the probability to
be included in the sample .

8 study

N=Z 2PQD

d2

Where;

N= desired sample size

Z= standard normal deviate at the standard level

In the case of this study the required confidence level is 50% therefore

The standard normal deviate is 1.96

P= the proportion in the target population estimated to have the characteristic being measured.
Since there will be no estimate available, a value of 50% will be used as recommended by
Fishers et. Al

Q= 1-p

D= 0.05
Hence : N= (1.96)2 (0.5) (0.5)

N= 384.16

If the population is less than 10,000 the required sample size will be similar

N f= n

1+(n/N)

N f= desired sample size when population is less than 10,000

N= desired sample size when population is more than 10,000

N f= 1+384/100= 4.84

N f= 79.33

Time and resources will be limited thus 217 respondents with ideal sample might not be covered
but 30% of the sample will be covered to represent the sample size

30/100x 79.33

N f=23.801

N f = 24respondents

Therefore approximately 24 respondents will be used to collect data.

3.5 Piloting/ pre-testing

The pre- testing of this study will be carried out in KTRH where by patients with ADHD will be
given questionnaire as a method of collecting data, thus will help the research to know if the tool
is more efficient and convenient to the respondent targeted.

3.6 Validity

A preliminary data collected during pre- testing will determine the validity of the questionnaire
developed
3.7 Reliability

Reliability will be given by the pilot study that will be carried out to both inpatient and outpatient
department where about 20 respondents will be given a questionnaire to fill.

3.8 Data collection

The study area and study site will be accessed during the fieldwork placement period . in this the
respondents will be available. The research will question the respondent in relation to research
question and objectives.

3.9 Data analysis and presentation

The data will be processed and analyzed manually and electronically by calculators and use of
computers software package, Microsoft word, MS excel. The result will be presented in form of
figures and tables.

3.10 Ethical consideration

The permission to carry out the study will be obtained from National Council of Science and
Technology Innovation (NACOSTI), through the department of rehabilitation; Kenya Medical
Training College. Further authority will be obtained at the KTRH. research will ensure there is
no unreasonable, unsafe or thoughtless demands made to the respondent and ensure sufficient
knowledge will be shared by all concerned.
References

Adewuya, A. O., & Makanjuola, V. A. (2013). ADHD and its management in African countries.
World Psychiatry, 12(1), 41-42. https://doi.org/10.1002/j.2051-5545.2013.tb00125.x

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.). American Psychiatric Publishing.

Ayres, A. J. (2005). Sensory integration and the child. Western Psychological Services.

Barkley, R. A. (2014). Attention-deficit hyperactivity disorder: A handbook for diagnosis and

treatment (4th ed.). Guilford Press.

Becker, S. P., Sidol, C. A., & Fite, P. J. (2017). ADHD and peer relationships: A meta-analytic
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APPENDIX I: QUESTIONNAIRE

Title: The impact of OT interventions on social skills of adolescents with ADHD

Introduction

My name is Mercy Tulito a student at KMTC Mombasa. This questionnaire aims to understand
the impact of OT interventions on social skills of adolescent with ADHD. Your responses will
remain confidential and will only be used for research purposes.

SECTION A: Demographic Information:

1. Age of the adolescent:

A. 12-14 years

B. 15-17 years

C. 18-20 years

2. Gender:

A. Male

B. Female

C. Other
3. How long has the adolescent been receiving occupational therapy services?

A. Less than 6 months

B. 6 months - 1 year

C. More than 1 year

SECTION B: Relationship and Social Participation

1. Has the adolescent’s ability to interact with peers improved since starting occupational
therapy?

A. Yes

B. No

C Not sure

2. To what extent has the adolescent’s social participation (e.g., engaging in group activities,
school events) changed since beginning occupational therapy?

A Significantly improved

B. Slightly improved

C. No change

D. Worse
3. Please rate the adolescent's willingness to engage in social situations (e.g., group activities,
family gatherings):

A. Much more willing

B. Slightly more willing

C. No change

D. Less willing

4. What specific activities or strategies have been most helpful in improving the adolescent's
social participation? (e.g., role-playing, peer interactions)

SECTION C: Communication Skills

1. How has the adolescent’s ability to communicate with others (both peers and adults) improved
after receiving occupational therapy?

A. Significantly improved

B. Slightly improved

C. No change

D. Worse

2. Does the adolescent now express themselves more clearly in social situations (e.g., asking for
help, initiating conversations)?
A. Yes, much more clearly

B. Sometimes

C. No, still struggles

3. To what extent has the adolescent shown improvement in non-verbal communication (e.g.,
body language, facial expressions)?

A. Significant improvement

B. Some improvement

C. No improvement

D. Worse

4. What specific occupational therapy techniques have contributed to improvements in

communication? (e.g., social skills training, role-playing, communication strategies)

SECTION D: Emotional Regulation

1. Has the adolescent become better at managing emotions in challenging situations (e.g.,
frustration, anger, excitement)?

A. Yes, significantly better

B. Somehow better
C. No change

D. Worse

2. How often does the adolescent use strategies taught in occupational therapy (e.g., deep
breathing, mindfulness) to manage emotional responses?

A. Very frequently

B. Occasionally

C. Rarely

D. Never

3. Has the adolescent demonstrated improved self-control in stressful or social situations (e.g.,
staying calm in group activities)?

A. Yes, always

B. Sometimes

C. Rarely

D. Never

4. Which occupational therapy interventions have been most helpful in regulating emotions?
(e.g., relaxation techniques, mindfulness exercises)
SECTION E: Managing Social Anxiety

1. Has the adolescent's social anxiety improved since starting occupational therapy?

A. Yes, significantly

B. Somewhat

C. No improvement

D. Worsened

2. How often does the adolescent feel anxious in social situations (e.g., talking to peers,
participating in class)?

A. Never

B. Occasionally

C. Frequently

D. Always

3. To what extent has occupational therapy helped the adolescent feel more confident in social
interactions?

A. Significantly more confident

B. Somewhat more confident

C. No change

D. Less confident

4. Which specific occupational therapy interventions have helped the adolescent manage social
anxiety? (e.g., exposure therapy, relaxation techniques, cognitive-behavioral strategies)

SECTION F: Overall Impact of Occupational Therapy

1. In your opinion, how effective has occupational therapy been in improving the adolescent's
overall social skills, emotional regulation, and management of anxiety?

A. Very effective

B. Somewhat effective

C. Not effective

D. Not sure

2. What additional support or strategies could further help the adolescent in managing ADHD
symptoms, social anxiety, and improving social participation?

3. Any other comments or suggestions regarding the impact of occupational therapy on the
adolescent’s well-being?

Closing Statement
Thank you for your valuable input. If you have any questions or need further assistance, please
contact [insert contact information

APPENDIX II: RESEARCH BUGDET

Item Quantity Cost per unit Total cost

Stationary Assorted - 500
Printing papers 1 ream 550 1050
Typing 2000 2000
Binding 2 50 100
Total 3650
 APPENDIX III: RESEARCH WORK PLAN

Activity March April May June July August Septembe October November
r

Topic

Approval

Proposal
writing

Proposal
submission

Data
collection

Data
analysis

Report
writing

Presentation
and
submission