1 Esther Parigger The relation between Attention Deficit Hyperactivity Disorder (ADHD) and (Specific) Language Impairment ((S)LI) Esther Parigger LEXEF 2007

2 Esther Parigger Overview Diagnoses ADHD and SLI Discussion (part 1) Comorbidity: ADHD and (S)LI / (S)LI and ADHD Discussion (part 2) Possible relationships Discussion (part 3)

3 Esther Parigger 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 inattention Symptoms 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.

4 Esther Parigger ADHD Hoffmann, 1845 ‘Filip de Schommelaar’  Hyperactivity  Impulsivity ‘Hans Kijk-in-de-Lucht’ Inattention

5 Esther Parigger SLI Diagnosis  Exclusion  Severity Impaired hearing Emotional and behavioral problems PIQ < 85 Neurological deficits/ lesions Speech motor skill deficiencies Low 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 SLI Video of Jan  7;11.21 Frog-story Mayer, 1969

7 Esther Parigger Discussion (part 1) What do you think about the ADHD and SLI diagnoses?

8 Esther Parigger 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 Comorbidity with ADHD Conduct disorder, oppositional defiant disorder Mood disorders, anxiety disorders Tourette’s syndrome, chronic tics Language problems, learning disorders Prevalence rates vary! Cantwell, 1996; Jónsdottír, 2006; Cohen et al., 1998; Blankenstijn en Scheper, 2003

10 Esther Parigger 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 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

12 Esther Parigger 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 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)

14 Esther Parigger Discussion (part 2) Are ADHD en (S)LI comorbid disorders or is (S)LI secondary to ADHD (or vice versa)?

15 Esther Parigger Possible relationships between 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

16 Esther Parigger 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 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 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 More information: W: T: I’ll upload a hand-out for you! Thanks for this discussion!