ADHD and Children Language Impairments

As school-based SLPs, we often serve children with language impairments who also have a diagnosis of ADHD. But is there a link between the two? Do students with ADHD tend to perform lower on language assessments? Or better?

When I assess students with ADHD, I can't help but wonder if their performance is impacted by their compromised ability to attend and focus on testing items. Why do they seem to do poorly on Repeating Sentences on the CELF? Is it because of attention difficulties or because they have a language impairment? Or both? This article, published in November 2014 in Language, Speech, and Hearing Services in Schools, attempts to examine the link between the two disorders.

The Details

Sean M. Redmond; Andrea C. Ash; Tiffany P. Hogan; Consequences of co-occurring attention-deficit/hyperactivity disorder on children's language impairments. Language, Speech, and Hearing Services in Schools, 2014, Vol. doi:10.1044/2014_LSHSS-14-0045. Retrieved 1/13/15 from https://pubs.asha.org/doi/10.1044/2014_LSHSS-14-0045

The Question

The authors of this article sought to examine whether the presence of ADHD in children further impacted their linguistic skills beyond what could be attributed to their primary language impairment.

The Method

Data was collected from a sample of 57 seven- to nine-year-old children. Measures of nonword repetition, sentence recall, and tense marking were collected, and the performances of children with ADHD+LI status were compared to children with specific language impairment (SLI) and children with typical development (TD).

The Results

Results from this study found overall that ADHD status had little noticeable impact. Performances of children with ADHD+LI were similar to the performances of a matched group of children with SLI. In fact, the group means for the ADHD+LI group were, in most cases, higher than the observed group means for the children with SLI. Also, symptoms associated with the SLI group were much more severe than the ADHD+LI group when both affected groups were compared to the control group.

The Take-Away

Frankly, I was surprised by these results, and it called to attention my own personal biases when evaluating children with ADHD. Children with co-morbid diagnoses of ADHD and SLI actually perform better on some language tasks than children with SLI alone - really?!

This is an eye-opener for me and makes me wonder if I've been more dismissive of low scores for this population than necessary. If children with ADHD and SLI actually perform higher on standardized language assessments than their SLI peers, perhaps a low score should be a red flag that language services are warranted.

This study focused mostly on syntax and working memory, however. I would be interested in learning more about how children with ADHD+SLI perform in story comprehension and vocabulary compared to children with SLI. Would they fair just as well in that area?

Also, I'd love to know why children with ADHD+SLI performed better on these tasks. The authors propose that children with ADHD may be more likely to be referred for language disabilities, although their language difficulties may not be as severe as children who are referred for SLI alone. Additionally, this study was only conducted on seven to nine-year-olds. The DSM 5 now states that behaviors can manifest prior to age 12, instead of age 7 as stated in the DSM IV. How would ten-year-olds with ADHD+SLI do on these tasks compared to children with SLI only? How about high schoolers?

But alas, that will have to be for another day. How about you? Have you seen a difference in students you work with who have ADHD? Leave a comment below and keep the conversation going.