Industry leaders in improving attention. |
|
For more information call (800) 788 - 6786 or request
a |
ADHD and Language Difficulties
One of the key aspects of ADHD for parents and clinicians to be aware of is that there are a number of other difficulties that often co-occur in children with ADHD. For example, children with ADHD are more likely to be diagnosed with other externalizing behavior problems such as Oppositional Defiant Disorder and Conduct Disorder. (For more information on other disorders that tend to occur with ADHD, please click here.
Children with ADHD also are more likely to experience difficulties with depression and anxiety, and to have specific learning difficulties. Such co-occurring problems are not evident in all children with ADHD, and a variety of factors contribute to why some children with ADHD experience one or more of these additional difficulties while others do not. Correctly identifying these additional problems is essential to providing effective treatment as they often play an important role in the long-term success experienced by children with ADHD, and may not be substantially helped by interventions that are typically prescribed for ADHD alone.
Another reasonably common, but often overlooked, problem that can go along with ADHD is language impairment. Language difficulties (significant problems in either the production or understanding of language) are more common in children with a wide variety of psychiatric disorders, and this is also the case in children with ADHD. In addition, both ADHD and language difficulties are likely to play a role in the academic struggles that many children with ADHD experience. Therefore, it is important to know which difficulties that are typically experienced by children with ADHD are specific to ADHD alone, and which reflect language impairment. Such knowledge could prove helpful in ensuring that a child receives treatments that are most likely to meet his or her needs.
Examining the academic and cognitive functioning in ADHD children with and without a co-occurring language deficit was a fundamental issue addressed in a paper published in the Journal of Child Psychology and Psychiatry (Cohen N.J., et al., 41, 353-362, 2000). Participants in this study included 166 children between the ages of 7 and 14 (approximately 75% boys) who had been brought by their parents to a mental health center. Of these children, 105 were diagnosed with ADHD, and the remaining 61 were diagnosed with some other psychiatric disorder. As part of the evaluation process, participants were also administered a number of standardized tests of language functioning to determine whether or not they also met criteria for a co-occurring language impairment. Of the 105 children with ADHD, 36 were diagnosed with a language impairment as well. Among the 61 children with a psychiatric diagnosis besides ADHD, approximately 50% had a co-occurring language disorder. The specific nature of the language deficits was not described, but problems in both expressive and receptive language were included.
Following this battery of language tests, participants were given a series of tests designed to evaluate their academic and cognitive functioning. These included tests of reading, spelling, math achievement, IQ, and working memory. The authors then compared the performance of children in 4 different groups: those with ADHD and no language impairment; those with ADHD and a language impairment; those with a psychiatric diagnosis besides ADHD with no language impairment, and those with a psychiatric diagnosis besides ADHD and a language impairment. These comparisons enabled the authors to determine which academic and cognitive difficulties may be specific to ADHD, which may be specific to language difficulties, and which are specific to neither ADHD nor language impairments, but which are likely to occur in children with any type of psychiatric problem.
Results
For the academic achievement measures, ADHD and language difficulties were both significantly associated with lower achievement scores. Thus, children with ADHD did worse than children with a psychiatric diagnosis besides ADHD, and children with ADHD and a language impairment did worse than children with another psychiatric diagnosis as well as a language impairment.
Of particular interest, however, are comparisons between the ADHD groups with and without a language impairment. For each academic achievement area, ADHD children with a language impairment did substantially worse than those without. The figures are shown below. (Note: On the tests administered, a score of 100 is average, and any score between 90 and 109 is considered to fall within the average range. In the table below, LI stands for language impairment. Basic reading refers to the ability to sight read single words. Word attack refers to the ability to correctly sound out nonsense words such as "glurp".)
For children with ADHD alone, the average achievement scores for each area fell within the normal range. In contrast, scores for children with ADHD who also had a language disorder were substantially below average. In all cases, the magnitude of the difference between the groups is significant.
Similar results were found for intellectual ability. Children with ADHD alone had significantly higher IQ scores than those with ADHD and a language impairment (108 vs. 96). This was largely because the ADHD + LI children received poor results on the verbal portions of the IQ test. Children with ADHD + LI also performed worse on the various memory tests that were administered.
Summary And Implications
The results of this study highlight the importance of screening for language difficulties among children who are being evaluated or treated for ADHD. Compared to ADHD children who did not have language difficulties, children with ADHD + LI performed significantly worse on measures of academic achievement, intellectual functioning, and working memory. Although not directly tested in this study, it is reasonable to hypothesize that successfully addressing the academic difficulties of children with ADHD + LI requires interventions that focus directly on their language impairment in addition to difficulties attributed to their primary symptoms of ADHD. Thus, for these children, bringing their ADHD symptoms under control is not expected to be a sufficient intervention. For some children with ADHD alone, in contrast, interventions that focus more exclusively on the core ADHD symptoms of inattention, hyperactivity, and impulsivity could be quite adequate.
Screening for associated language difficulties is not a frequent component in ADHD evaluations, and is most often excluded when primary care physicians conduct the evaluation. Should parents have any concerns about their child’s expressive or receptive language functioning, a thorough screening for language difficulties is worth pursuing. In addition, for children already being treated for ADHD but who continue to struggle academically, results from this study suggest that language difficulties may be a contributor to this problem. A speech and language evaluation may be worth considering in such instances.
Note: This article originally appeared in Attention Research Update, an online newsletter written by Dr. David Rabiner, a Duke University psychologist and former member of CHADD's Professional Advisory Board. You can learn more about Attention Research Update and sign up for a free subscription at www.helpforadd.com.