Language and School Problems Linked in ADHD

Laurie Barclay, MD

April 21, 2014

Children with attention-deficit/hyperactivity disorder (ADHD) are more likely than children without ADHD to have language problems, which contribute to dramatically poorer academic functioning.

The results of the community-based study were published online April 21 and in the May print issue of Pediatrics.

"Children with [ADHD] have poorer academic and social functioning and more language problems than typically developing peers," write Emma Sciberras, DPsych, from Murdoch Childrens Research Institute and The Royal Children's Hospital in Parkville, Victoria, Australia, and colleagues. "However, it is unknown how language problems impact the academic and social functioning of these children."

Therefore, the authors assessed the prevalence of language problems in children with or without ADHD, as well as the effect of language problems on social and academic performance in children with ADHD The researchers enrolled 179 children aged 6 to 8 years with ADHD and 212 control participants of the same age from 43 schools in Melbourne, Australia.

To evaluate spoken language, the investigators used the fourth edition Clinical Evaluation of Language Fundamentals screener. Other outcomes were academic performance based on direct assessment with the Wide Range Achievement Test 4 and teacher report using the Social Skills Improvement System. The Strengths and Difficulties Questionnaire and Social Skills Improvement System measured social function on the basis of parent and teacher report.

Children with ADHD were nearly 3 times as likely to have language problems as those without ADHD (odds ratio, 2.8; 95% confidence interval [CI], 1.5 - 5.1), after adjustments for sociodemographic characteristics and child comorbidities, including autism spectrum disorder. Despite this, fewer than half of children with ADHD and language problems had been seen by a speech pathologist, and only one quarter were currently seeing a speech pathologist.

Language Problems Linked to Poorer School Performance

Among children with ADHD, those with language problems had worse academic performance than those without language problems. However, language problems were not linked to poorer social functioning.

The mean difference (MD) for word reading was −11.6 (95% CI, −16.4 to −26.9; effect size, −0.7) for children with ADHD and language problems compared with children with ADHD and no language problems. For math computation, the mean difference was −11.4 (95% CI, −15.0 to −7.7; effect size, −0.8), and for academic competence, it was −10.1 (95% CI, −14.0 to −6.1; effect size, −0.7).

"[G]iven the strong association between language and academic underachievement found in this study, if children with ADHD are falling significantly behind academically, they should be referred for a language assessment," the study authors write.

"[F]uture research should examine whether language-based interventions are effective in improving academic functioning for this vulnerable group of children."

Limitations of this study include use of a screening measure for language, which did not differentiate receptive from expressive language problems, and lower participation rate for the control group than for the ADHD group.

"Language problems are common in children with ADHD and are associated with markedly poorer academic functioning independent of ADHD symptom severity and comorbidities," the study authors conclude. "There was little evidence that language problems were associated with poorer social functioning for children with ADHD."

Funded by the Australian National Health and Medical Research Council (NHMRC), the Collier Foundation, and the Murdoch Childrens Research Institute. Dr Sciberras’ position is funded by an NHMRC Early Career Fellowship in Population Health. One coauthor is funded by an NHMRC Practitioner Fellowship. This work was supported by NHMRC Centre for Research Excellence, the Victorian Government’s Operational Infrastructure Support Program to the Murdoch Childrens Research Institute, and the Victorian Government funding to the Parenting Research Centre. The authors have disclosed no other relevant financial relationships.

Pediatrics. Published online April 21, 2014. Full text

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