ADHD and language disorders

Yes.

And here’s why.

We’ve written before about the complex relationship between Attention-Deficit Hyperactivity Disorder (ADHD) and language development, based, in part, on some terrific research published back in 2015. But there is growing, higher quality evidence that children with ADHD have a higher prevalence of language difficulties than their typically developing peers. 

A systematic “meta-analytic” review was published in 2017 by Dr Hannah Korrel and colleagues. The researchers painstakingly reviewed peer-reviewed, published research on children with ADHD that included standardised language testing measures. The research team concluded that:

• children with ADHD had significantly poorer language functioning compared with other children, including overall, with expressive language, receptive language, and pragmatic language, also known as the social use of language; and
• although the evidence is a bit mixed, in general, there was a pattern of larger deficits in children with ADHD as the processing/narrative requirements became more demanding (e.g. Luo & Timler, 2008).

Taken together, these results provide strong evidence that:

• ADHD is associated with weaknesses in several language areas; and
• difficulties with expressive, receptive and pragmatic language should perhaps be considered “core” elements of ADHD deficits.

Why are language problems so common in children with ADHD?

We don’t know!

• Some researchers think that ADHD and language disorders – although different things – often co-occur, and have some common symptoms. Interestingly, some of the diagnostic criteria for different kinds of ADHD include things we often seen in children with developmental language disorders, e.g.:
  • “Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction).”
  • “Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked).”
  • “Often talks excessively.”
  • “Often blurts out an answer before a question has been completed (e.g., completes people’s sentences; cannot wait for turn in conversation).”
  • “Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities).”   
• Some researchers think that ADHD symptoms – (e.g. poor concentration and attention, or working memory deficits) – may affect language performance on tests (e.g. Barkley, 2014), which is why we find the research identifying some tests we can use to help distinguish issues so useful, clinically.
• Some researchers look at the fact that ADHD affects children with low socio-economic status and/or learning disorders disproportionately, and observe that both low socio-economic status and learning disorders are known to have a secondary impact on language skills (e.g. Neville et al., 2013).
• There is some interesting research looking at developmental brain differences in children with ADHD and children without ADHD, which may be associated with language issues – though this research is still in its infancy (e.g. Kibby et al., 2009, Miller et al., 2006).

Why is this an issue?

Three main reasons:

• Language problems are not currently included as a core diagnostic criteria of ADHD in current clinical classification systems like the DSM-5 (although, as noted above, language-related symptoms are certainly included).
• Past research indicates that language deficits are not currently being appropriately identified or treated in many children with ADHD. One study showed that less than half of children diagnosed with ADHD and language problems had accessed speech pathology services, with only a quarter accessing language therapy at the time of the study (e.g. Sciberras et al., 2014).
• Lots of studies that did not include standardised testing (and were therefore not included in the systematic study) suggest that many children with ADHD have marked language impairments that continue into adolescence and may even persist into adulthood – even if they don’t warrant the label of “language disorder” (e.g. Englehardt et al., 2012). So we might be underestimating the size of the problem.

Clinical bottom line

Children with ADHD should have their language assessed, including their receptive, expressive and social use of language. At the very least, children with ADHD should be screened by a speech-language pathologist so that potential language issues can be identified, then investigated and treated, as early as possible. 

Related articles:

• “She doesn’t really have a language problem. She just wasn’t paying attention to your tests”. FAQ: ADHD and language disorders
• Language disorders
• Speaking for themselves: why I choose ambitious goals to help young children put words together
• “Huh?!” The many benefits of using Blank’s Language Levels framework to help your kids to understand language for school

Principal source: Korrel H., Mueller, K.L., Silk, T., Anderson, V., and 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.

Special thanks to Associate Professor Natalie Munro from the University of Sydney for bringing this important research to our attention.