1 Esther Parigger. 13-04-07.

The relation between Attention Deficit Hyperactivity Disorder (ADHD) and

(Specific) Language Impairment ((S)LI)

Esther Parigger

LEXEF 2007

2 Esther Parigger. 13-04-07.

Overview Diagnoses ADHD and SLIDiscussion (part 1)

Comorbidity: ADHD and (S)LI / (S)LI and ADHDDiscussion (part 2)

Possible relationships Discussion (part 3)

3 Esther Parigger. 13-04-07.

ADHD Diagnosis

Symptoms (division in subtypes)

-present before 7 years of age

-present in two or more settings

-significant impairment in functioning

-not accounted for by another disorder

APA, 2000

Symptoms of inattentionSymptoms of hyperactivity/impulsivity Predominantly inattentive subtype

Predominantly hyperactive/impulsive subtype Combined subtype

Problem: diagnosed on the basis of clinical evaluation.

Problem (?): language items are included in the symptom list.

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ADHD

Hoffmann, 1845

‘Filip de Schommelaar’

Hyperactivity

Impulsivity

‘Hans Kijk-in-de-Lucht’

•Inattention

5 Esther Parigger. 13-04-07.

SLI Diagnosis

Exclusion

Severity

Impaired hearingEmotional and behavioral problemsPIQ < 85Neurological deficits/ lesionsSpeech motor skill deficienciesLow reading age

LA Receptive < MAP/CA (6 mo.) LA Expressive < MAP/CA (12 mo.)LA Overall < MAP/CA (6 mo.)

Problem: diagnosed on the basis of exclusion.

Stark and Tallal, 1981

Bishop, 1994; Botting, 2005

Problem: no behavioral problems allowed..

6 Esther Parigger. 13-04-07.

SLI Video of Jan

7;11.21

Frog-story

Mayer, 1969

7 Esther Parigger. 13-04-07.

Discussion (part 1)

What do you think about the ADHD and SLI diagnoses?

8 Esther Parigger. 13-04-07.

Comorbidity Problems

Used descriptively

(A)symptomatic overlap

Assessment

Definition (for now): “the presence of more than one specific disorder in a person in a defined period of time”

Wittchen, 1996;

Burke et al., 1990

9 Esther Parigger. 13-04-07.

Comorbidity with ADHD Conduct disorder, oppositional defiant disorder Mood disorders, anxiety disordersTourette’s syndrome, chronic tics Language problems, learning disorders

Prevalence rates vary!

Cantwell, 1996; Jónsdottír, 2006;

Cohen et al., 1998; Blankenstijn en Scheper, 2003

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Comorbidity with ADHD: ADHD and language problems

Subtle problems in language comprehension

More robust problems in language production

Syntax

Pragmatics

Parigger and Baker, 2005

11 Esther Parigger. 13-04-07.

Comorbidity with ADHD: ADHD and language problems Percentage of worded plot elements in Frog-stories

Total score

-effect of diagnosis: ADHD<N

-effect of age: 7<8<9

Parigger, in prep (a); Blankenstijn and Scheper, 2003; Tannock; 1993;

Trabasso and Rodkin (in Berman and Slobin), 1994

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Comorbidity with SLI E.g. motor abnormalities, reading disabilities, nonverbal IQ’s at the lower end of the normal range, social problems, attention deficit disorders etc.

”SLI is thus rarely specific, and for this reason, it has been argued that there is a need for a change in terminology”

Webster 2004: 473

13 Esther Parigger. 13-04-07.

Comorbidity with SLI:SLI and ADHD symptoms

23% of 200 children with SLI (11 years old) scored in the atypical range of the ADHD scale of the SDQ

SLI group without and SLI group with ADHD symptoms differed, mainly in expressive language tasks with semantic (pragmatic?) content

Botting, 2006 (poster)

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Discussion (part 2)

Are ADHD en (S)LI comorbid disorders or is (S)LI secondary to ADHD (or vice versa)?

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Possible relationshipsbetween PI and LI

Unicausal comorbidity:

(third risk factors) PI LI

(third risk factors) LI PI

Dependent causal comorbidity:

(third risk factors) LI/PI LI/PI

Blankenstijn en Scheper, 2003: 20

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Possible relationship between ADHD and language problems

Executive Dysfunction Theory

“We theorize that the core behavioral symptoms of ADHD (…) and the pragmatic difficulties that these children exhibit (…) are related to deficits in executive function (i.e. higher-order cognitive processes).”

Tannock and Schachar, 1996: 147

17 Esther Parigger. 13-04-07.

Main study

Comparison of language profiles and cognitive profiles of children with ADHD, SLI and normally developing children (7 and 8 years of age)

Parigger, in prep (b).

18 Esther Parigger. 13-04-07.

Discussion (part 3)

Is it plausible to think that a specific executive functioning profile can be related to a specific language profile in ADHD?

19 Esther Parigger. 13-04-07.

More information:

E: e.m.parigger@uva.nl

W: http://home.medewerker.uva.nl/e.m.parigger

T: 0031-20-5253811

I’ll upload a hand-out for you!

Thanks for this discussion!