Attention deficit hyperactivity disorder (ADHD) is a common behavioral disorder that typically develops in childhood (Cordier et al., 2017). Inappropriate levels of hyperactivity, impulsivity, and inattention characterize ADHD (American Psychological Association [APA], 2000) and reports indicate that between 5% and 11% of children are affected by it (Cordier et al., 2017). Though ADHD is not considered a language disorder (APA, 2017) some of its symptoms can put children with the disorder at a higher risk of language problems compared to typically developing individuals (Korrel, Mueller, Silk, Anderson, & Sciberras, 2017). Many studies have been conducted to examine types of language difficulties that children with ADHD experience, from pragmatic (social) language issues to problems with producing and understanding language (Korrel et al., 2017). While some of these language issues and are not very severe, they can often cause children to suffer within aspects of their academic and social lives (Sciberras et al., 2014), therefore a lot of current research focuses on techniques that school professionals can use to help children with ADHD overcome their language difficulties (Cordier et al., 2017).

ADHD is a neurobehavioral disorder that makes aspects of daily life, such as paying attention and controlling impulses, very difficult for people (National Institute of Mental Health [NIH], 2016). Symptoms of ADHD, which include being easily distracted, hyperactivity, trouble with staying organized, acting without thinking etc., usually develops in childhood, but can continue affecting people as they grow into adolescence and adulthood as well (NIH, 2016). According to recent research, ADHD can be caused by a number of factors, like genetics, mothers smoking or consuming alcohol while pregnant, brain injuries, low birth weight, etc. (NIH, 2016). The symptoms that children with ADHD experience often affect their language and communication abilities. Their impulsivity and distractibility, for example, could prompt them to speak at inappropriate times, struggle with finding the words they want to say, talk too loudly, or get easily distracted by background noise or activity (NIH, 2016). In addition, according to recent studies, ADHD often co-occurs with language and communication disorders (Kim & Kaiser, 2000). This can make it difficult for children with the disorder to be successful academically and socially.

 Children with ADHD can develop multiple types of language issues, but research has demonstrated that their most common problems revolve around expressive (expressing thoughts), receptive (understanding what others say), and pragmatic (social) language (Korrel et al., 2017). It is still not completely clear whether ADHD has more of an impact on expressive or receptive language abilities because different research studies have produced different findings. One study by Okmi H. Kim and Ann P. Kaiser (2000), for example, studied the language characteristics of 11 children with ADHD and 11 typically developing (TD) children, and found that children with ADHD were more likely to have issues with expressive language than receptive language. During the researcher-child conversation procedure, the children with ADHD often did not respond to the questions the speaker asked, interrupted others, and spoke less overall than the typically developing children (O.H. Kim & Kaiser, 2000). They also scored worse than their TD peers on sentence imitation and word articulation tasks. No differences were found between ADHD and TD groups when it came to receptive language tasks, like comprehending sentences spoken to them, however (Kim & Kaiser, 2000). While this suggests that children with ADHD struggle more with expressive than receptive language, the study’s sample size (11 children in each group) is very small, so the results may not be as reliable or generalizable as other studies with larger samples.

Another study by Hellend and colleagues (2016) found that receptive and pragmatic language difficulties were most prominent in children with ADHD. The main aim of this study was to examine language impairments (LI) in children with ADHD and RD compared to typically developing controls. They derived their groups from a population based sample of 5,672 children, and a screening questionnaire with questions regarding 4 different types of LI was given to their parents and teachers (Helland, Posserud, Helland, Heimann, & Lundervold, 2016). The items related to LI aimed at assessing children’s phonological abilities–whether or not they could pronounce certain words or sounds, and expressive language abilities–whether or not they could elaborate on or explain things. The assessment also tested receptive language abilities, which focused on whether or not they have trouble understanding things that are said to them, and pragmatics, which looked at whether or not they have difficulties holding conversations with others (Helland et al., 2016). The results indicated that each of these LIs were more prominent in both ADHD and LD groups than control groups, but receptive and pragmatic language issues were most noticeable in children with ADHD, while more expressive and phonological problems were found in children with RD (Helland et al., 2016). These results contrast those of Kim and Kaiser’s (2000) study in relation to receptive vs. expressive language difficulties, but Hellend and colleagues’ (2016) significantly larger sample size indicates that their results may be more reliable. With that said, each study has its own limitations, and there are more studies besides these two that also have contrasting results (Korrel et al., 2017), so it still is not clear which language issue is most commonly associated with ADHD. It is clear, however, that both of these language issues, as well as others, are more prevalent in individuals with ADHD than those without the disorder (Helland et al., 2016; Kim & Kaiser, 2000; Korrel et al., 2017).

While both Helland and colleagues (2016) and Kim and Kaiser (2000) studies indicate that pragmatic language problems are common for children with ADHD, a study by Ekaterina Staikova, Hilary Gomes, Vivien Tartter, Alyssa McCabe, and Jeffery M. Halperin (2013) further emphasizes the prevalence of that specific issue. As humans, we use pragmatic language skills in our every-day interactions with other people. These skills, which refer to what we say, how we say things, our body language, etc., are extremely important for communicating with others (Staikova et al., 2013). The goal of this study was to examine the pragmatic language functioning of children with ADHD, and additionally, to assess whether or not pragmatic language issues are positively correlated with poor social skills in children with the disorder. To test this, Staikova and colleagues (2013) recruited 63 children (26 with ADHD and 35 TD) between the ages of 7 and 11 years old, to complete a comprehensive pragmatic language assessment. The assessment included parent ratings, standardized tests and narrative tasks that involved listening to passages involving social interactions and communication and then answering questions that required participants to provide appropriate responses. For example, some participants were given the phrase, “Cassie spilled her milk” and were then asked, “what does she say to her mother?” The children were instructed to make inferences about the story and characters as well (Staikova, Gomes, Tartter, McCabe, & Halperin, 2013). Parents were also asked to rate their children’s social skills using the Social Skills Improvement System rating scale that measures social behaviors like cooperation, empathy, self-control, and problematic behaviors (Staikova et al., 2013). Results indicated that, across all measures, children with ADHD had poorer pragmatic language skills than their typically developing peers, and that these pragmatic language issues often coincided with poorer social skills (Staikova et al., 2013).

The pragmatic and social issues illustrated in Saikova and colleagues’ article, as well as all of the other language issues that children with ADHD often develop, can lead to poor academic performance. A study by Emma Sciberras and colleagues (2014) illustrates this. The main aim of their research was to analyze the prevalence of language issues in children with ADHD compared to TD controls, as well as examine the impact of these problems on the participants’ academic functioning (Sciberras et al., 2014). 179 children with ADHD and 212 controls were assessed for oral language problems and academic functioning through screenings, academic achievement tests, and teacher reports (Sciberras et al., 2014). Results showed that children with ADHD were more likely to have language problems than controls, and that the children with both ADHD and language problems had poorer reading, math, and overall academic competence scores than those with ADHD alone (Sciberras et al., 2014). Unlike Staikova and colleagues’ (2013) study, Sciberras and colleagues (2014) did not find a relationship between language issues and poor social functioning, which could be due to the fact that they did not assess participants’ pragmatic (social) language skills. Regardless, the results of this study suggest that language problems in children with ADHD do often hinder their success in school.

Due to the academic and social deficits that language problems in children with ADHD can cause, a lot of current research focuses on interventions that parents and trained professionals can use to help children overcome these difficulties. A study by Reinie Cordier, Natalie Munro, Sarah Wilkes-Gillan, Lydia Ling, Kimberly Docking, and Wendy Pearce (2017), for example, aimed to examine whether a parent-delivered play based intervention, with the help of occupational therapists (OTs) and speech language pathologists (SLPs), could improve the pragmatic language skills of children with ADHD when interacting with typically developing peers. In order to test this, 9 children with ADHD were paired with 9 typically developing children, and each pair participated in weekly play-dates supported by OTs and SLPs (Cordier et al., 2017). Each child with ADHD also completed weekly home-based, parent facilitated activities, like discussions of readings and videos, as well as 3 clinic visits with a trained therapist (Cordier et al., 2017). Results of the study indicated that the weekly play-dates, home-based activities, and clinic visits significantly improved the pragmatic language skills of children with ADHD as well as their typically developing peers (Cordier et al., 2017). The outcome of this research suggests that parents have the ability to help their children with ADHD improve their pragmatic language skills within just a couple of months. These findings are promising for children with ADHD that suffer within their social relationships, and highlight the need for more research on this topic, as well as ways to improve expressive and receptive language issues. Hopefully, as more studies are conducted, more helpful techniques will be discovered, and more children with language issues that result from their ADHD will have greater success in school and their social lives.

References

American Psychiatric Association. (2000). Diagnostic and statisti- cal manual of mental disorders (4th ed., text rev.). Washing- ton, DC: Author.

Attention-Deficit/Hyperactivity Disorder (ADHD): The Basics. (n.d.). Retrieved December 11, 2017, from https://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder-adhd-the-basics/index.shtml

Cordier, R., Munro, N., Wilkes‐Gillan, S., Ling, L., Docking, K., & Pearce, W. (2017). Evaluating the pragmatic language skills of children with ADHD and typically developing playmates following a pilot parent‐delivered play‐based intervention. Australian Occupational Therapy Journal, 64(1), 11–23.

Helland, W. A., Posserud, M.-B., Helland, T., Heimann, M., & Lundervold, A. J. (2016). Language impairments in children with ADHD and in children with reading disorder. Journal of Attention Disorders, 20(7), 581–589.

Kim, O. H., & Kaiser, A. P. (2000). Language Characteristics of Children with ADHD. Communication Disorders Quarterly, 21(3), 154–165.

Konicarova, J. (2014). Psychological principles of learning language in children with ADHD and dyslexia. Activitas Nervosa Superior, 56(3), 62–68.

Korrel, H., Mueller, K. L., Silk, T., Anderson, V., & Sciberras, E. (2017). Research Review: Language problems in children with Attention-Deficit Hyperactivity Disorder—A systematic meta‐analytic review. Journal of Child Psychology and Psychiatry, 58(6), 640–654.

Sciberras, E., Mueller, K. L., Efron, D., Bisset, M., Anderson, V., Schilpzand, E. J., … Nicholson, J. M. (2014). Language problems in children with ADHD: A community-based study. Pediatrics, 133(5), 793–800.

Staikova, E., Gomes, H., Tartter, V., McCabe, A., & Halperin, J. M. (2013). Pragmatic deficits and social impairment in children with ADHD. Journal of Child Psychology and Psychiatry, 54(12), 1275–1283.