A preliminary study of the effects of stimulant medications on estimates of psycholinguistic abilities for children with attention-deficit/hyperactivity disorder.

Underlying deficits in inattention, hyperactivity, and/or impulsivity might contribute to suboptimal test-taking behaviours during language assessments that can lead to diagnostic errors. Considerations of potential medication effects on estimates of children's nonword repetition, sentence recall, tense-marking, and narrative abilities are warranted given long-standing enthusiasm for these indices to serve as clinical markers for developmental language disorder (DLD). A battery consisting of 1 nonverbal, 1 reading, and 6 verbal measures was administered twice to 26 children (6-9 years) with independently diagnosed combined-type attention-deficit/hyperactivity disorder (ADHD). All participants had been prescribed stimulant medications for the management of their ADHD symptoms and were assessed off- and on-medication, with order counter-balanced across participants. Half of the participants had concomitant DLD. Examiners were unaware of children's clinical status during assessments or when they were testing children who had received medication. Effect sizes were calculated for each measure. Significant score differences indicating a beneficial impact of stimulant medications on children's performances were observed on the recalling sentences subtest of the Clinical Evaluation of Language Fundamentals and the Picture Peabody Vocabulary Test. Adjustments may be needed when speech language pathologists use sentence recall or receptive vocabulary measures to make diagnostic decisions with children who have ADHD.

Factors Impacting Implementation of Universal Screening of Developmental Language Disorder in Public Schools.

PURPOSE: Developmental language disorder (DLD) is an underidentified neurodevelopmental disorder that affects, on average, one out of 11 kindergarten-age children (ages 4-6 years). Children with DLD can face academic, behavioral, psychiatric, emotional, and social challenges. Universal screening is seen as an effective way for public school districts to increase DLD identification rates. However, little is known about factors impacting implementation of school-based universal screenings for DLD. We partnered with a large suburban school district in the Intermountain West region of the United States to gather detailed perspectives from school personnel regarding the barriers and facilitators to the implementation of universal screening in their district. METHOD: Using a two-phase mixed-methods design, we first conducted focus groups to identify potential barriers and facilitators to universal screening. We then used the qualitative data from the first phase to develop a 20-item survey to assess agreement with the focus group results among a wider group of district speech-language pathologists and kindergarten teachers from the school district. RESULTS: Our survey showed moderate levels of agreement with our focus group results. In particular, school personnel showed high levels of support for universal screening for DLD, with interesting interplay across various factors: (a) the negative impact of unmanageable workload on personnel under both referral- and universal-based identification formats, (b) the preference for paraprofessionals to administer screenings, (c) the role that Response to Intervention programs may play in offsetting workloads associated with universal screenings, and (d) the need for increased awareness and education about child language development and impairment among general education teachers and the public. CONCLUSION: Recommendations for incorporating these factors into more useful and applicable collaborative research-based efforts are presented. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.23661876.

Positive Predictive Values Associated With Adapting the Redmond Sentence Recall Measure Into a Kindergarten Screener for Developmental Language Disorder.

PURPOSE: Researchers estimate the prevalence of developmental language disorder (DLD) in 5-year-olds to be between 7% and 12%. Current identification systems in public schools typically favor referral identification formats over targeted or universal screenings. Public schools face unique challenges when assessing the value of screening measures for DLD that include real-world considerations such as administration, time, and resource constraints. This study used the positive predictive value (PPV) of the Redmond Sentence Recall (RSR) to assess its fidelity when administered by special education paraprofessionals. Our obtained PPV was compared across three areas: (a) previous studies that have utilized the RSR, (b) rates extrapolated from the participating school district's preexisting referral system from a previous study, and (c) expectations based on DLD prevalence. METHOD: Language screenings were conducted in two elementary schools using the RSR administered by school-based paraprofessionals trained on the screener protocol. One hundred sixty-four kindergarten students (age range: 5-6 years) were screened. Confirmatory testing was completed on all students who failed the screener. RESULTS: Of the 164 students screened, 19 failed the RSR (11.5%), and 14 met criteria (8.5%) for DLD (PPV = .74). Our PPV was similar to previously published studies that utilized the RSR using research assistants and was higher than the PPV associated with teacher-based referrals from the participating school district. CONCLUSION: The RSR represents a potentially useful screener for identifying children at risk for previously unidentified language disorders in public schools. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.22044479.

Psycholinguistic profiling of children with sluggish cognitive tempo.

Language disorders are frequently comorbid with attention deficit/hyperactivity disorder (ADHD). Sluggish cognitive tempo (SCT), a second attention disorder, may potentially explain some of the links between language disorders and ADHD. In this study we examined the psycholinguistic abilities of 207 children (mean age 7;10) with and without clinically significant levels of SCT symptoms to determine the degree to which symptoms of language disorder co-occur in cases of SCT. Analyses of children's tense-marking, nonword repetition, and sentence recall indicated that deficits in these areas were not associated with SCT. Instead, SCT appears to be more closely aligned with features of social (pragmatic) communication disorder.

The Reliability of Short Conversational Language Sample Measures in Children With and Without Developmental Language Disorder.

PURPOSE: Language sample analysis (LSA) represents an ecologically valid method for diagnosing, identifying goals, and measuring progress in children with developmental language disorder (DLD). LSA is, however, time consuming. The purpose of this study was to determine the length of sample needed to obtain reliable LSA measures for children in kindergarten and first grade with typical language (TL) and DLD using automated analyses from the Systematic Analysis of Language Transcripts software. METHOD: Play-based conversational language samples collected on kindergarten to first-grade children with TL (n = 21) and DLD (n = 21) from a community-based sample were analyzed. Eight LSA measures were calculated from 1-, 3-, 5-, 7-, and 10-min sample cuts and compared to 20-min samples for reliability. RESULTS: Reliability estimates were similar for the TL and DLD groups except for errors and omissions, which showed overall higher levels of reliability in the DLD group and reached acceptable levels at 3 min. Percent grammatical utterances were reliable at 7 min in the DLD group and not reliable in shorter samples in the TL group. The subordination index was reliable at 10 min for both groups. Number of different words reached acceptable reliability at the 3-min length for the DLD group and at the 10-min length for the TL group. Utterances and words per minute were reliable at 3 min and mean length of utterance at 7 min in both groups. CONCLUSIONS: Speech-language pathologists can obtain reliable LSA measures from shorter, 7-min conversational language samples from kindergarten to first-grade children with DLD. Shorter language samples may encourage increased use of LSA. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.19529287.

Self-regulation in children with vocal fold nodules: A multilevel analysis.

INTRODUCTION: Vocal fold nodules (VNs) represent the most common cause of voice disorders in children. Phonotrauma related to chronic, repetitive, intense vocal activity is often cited as the proximate cause of VNs. However, diminished self-regulation (SR) may predispose some children toward extreme phonotraumatic voice use, thereby contributing secondarily to their development. This case-control study examined the association between features of SR and VNs in children. METHOD: Parents of children with VNs (N = 40, Age Mean = 7.5, SD = 2.03 years) and vocally normal, medical controls (VNCs; N = 40, Age Mean = 7.6, SD = 1.54 years) completed the Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2; Gioia, Isquith, Guy & Kenworthy, 2015), an inventory that evaluates components of SR in children. RESULTS: Children with VNs, as compared with the vocally normal control group, were described as (i) impulsive (i.e., scoring significantly worse on the Behavior Regulation Index, BRI; P < 0.001, Cohen's d = 0.86), and (ii) emotionally dysregulated (i.e., scoring significantly worse on the Emotional Regulation Index, ERI; P < 0.001, Cohen's d = 0.81). CONCLUSIONS: Diminished SR in some children with VNs may contribute to phonotraumatic vocal behaviors and potentially attenuate the effectiveness of voice therapy.

Clinical Intersections Among Idiopathic Language Disorder, Social (Pragmatic) Communication Disorder, and Attention-Deficit/Hyperactivity Disorder.

Purpose Estimates of the expected co-occurrence rates of idiopathic language disorder and attention-deficit/hyperactivity disorder (ADHD) provide a confusing and inconsistent picture. Potential sources for discrepancies considered so far include measurement and ascertainment biases (Redmond, 2016a, 2016b). In this research symposium forum article, the potential impact of applying different criteria to the observed co-occurrence rate is examined through an appraisal of the literature and an empirical demonstration. Method Eighty-five cases were selected from the Redmond, Ash, et al. (2019) study sample. Standard scores from clinical measures collected on K-3rd grade students were used to assign language impairment status, nonverbal impairment status, social (pragmatic) communication disorder status, and ADHD status. Criteria extrapolated from the specific language impairment (Stark & Tallal, 1981), developmental language disorder (Bishop et al., 2017), and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition language disorder (American Psychiatric Association, 2013) designations were applied. Results The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition language disorder designation and its separation of language disorder from the social (pragmatic) communication disorder designation provided the clearest segregation of idiopathic language deficits from elevated ADHD symptoms, showing only a 2% co-occurrence rate. In contrast, applying the broader developmental language disorder designation raised the observed co-occurrence rate to 22.3%. The specific language impairment designation yielded an intermediate value of 16.9%. Conclusions Co-occurrence rates varied as a function of designation adopted. The presence of pragmatic symptoms exerted a stronger influence on observed co-occurrence rates than low nonverbal abilities. Impacts on clinical management and research priorities are discussed. Presentation Video https://doi.org/10.23641/asha.13063751.

"Tell Me About Your Child": A Grounded Theory Study of Mothers' Understanding of Language Disorder.

Purpose The purpose of this study was to generate a theory grounded in data explaining caregivers' understanding of their child's language disorder and the perceived role of speech-language pathologists in facilitating this knowledge. Method This study employed grounded theory as a conceptual framework. Qualitative data were generated based on semistructured interviews conducted with 12 mothers of children who had received speech-language pathology services. Results The following themes emerged from the data analysis: (a) Many mothers reported receiving confusing or irrelevant diagnostic terms for language disorder, (b) mothers of children with language disorders were distressed about their children's language problems, (c) mothers did not always trust or understand their children's speech-language pathologist, and (d) mothers were satisfied with the interventions their child had been receiving. Mothers described their children's language disorder using a total of 23 labels, most of which were not useful for accessing meaningful information about the nature of their child's communication problem. Generally, mothers reported they did not receive language-related diagnostic labels from speech-language pathologists for their child's language disorder. Conclusions Two theories were generated from the results: (a) Lack of information provided to mothers about their child's language disorder causes mothers psychological harm that appears to be long lasting. (b) Difficulties in successfully relaying information about language disorders to parents result in negative perceptions of speech-language pathology. Implications and future directions are discussed. Supplemental Material https://doi.org/10.23641/asha.12177390.

Redmond (2002) Revisited: Have Standardized Behavioral Rating Scales Gotten Better at Accommodating for Overlapping Symptoms with Language Impairment?

Seventeen years ago, Redmond reviewed five standardized behavioral rating scales and identified several aspects of their design that made them prone to mischaracterize language impairments as socioemotional behavioral disorders. The purpose of this report is to provide an update and extension of the original audit. We consulted test manuals to evaluate: (1) representation of children with language impairments in their standardization samples; (2) presence of language, or academic items within their inventories; (3) accommodations for administering the measure to children with language impairments; and (4) procedures for identifying inordinately punitive ratings. Overlapping language and academic symptoms continued to be a problem across current behavioral rating scales. Improvements since Redmond occurred in the representation of children with language impairments in standardization samples and in procedures for identifying inordinately punitive ratings. We discuss implications for clinical assessment, research programs, and instrument development.

Diagnostic Accuracy of Sentence Recall and Past Tense Measures for Identifying Children's Language Impairments.

Purpose Measures of linguistic processing and grammatical proficiency represent strong candidates for adaptation into language screeners for early elementary students. One key barrier, however, has been the lack of consensus around the preferred reference standard for assigning affected status. Diagnostic accuracies associated with sentence recall and past tense marking index measures were examined relative to 5 different reference standards of language impairment: receipt of language services, clinically significant levels of parental concern, low performance on language measures, a composite requiring at least 2 of these indicators, and a composite requiring convergence across all indicators. Method One thousand sixty grade K-3 students participated in school-based language screenings. All students who failed the screenings and a random sampling of those who passed were invited to participate in confirmatory assessments. The community-based sample was supplemented by a clinical sample of 58 students receiving services for language impairment. Two hundred fifty-four students participated in confirmatory testing. Examiners were naive to participants' status. Results Diagnostic accuracies for the sentence recall and past tense marking index measures varied across the different reference standards (areas under receiver operating characteristic curves: .67-.95). Higher levels of convergence occurred with reference standards based on behavioral measures. When affected status was defined by receipt of services and/or parental ratings, cases presented with higher levels of performance on the language measures than when affected status was based on behavioral criteria. Conclusion These results provide additional support for the adaptation of sentence recall and past tense marking to screen for language impairments in early elementary students. Supplemental Material https://doi.org/10.23641/asha.8285786.

Risk for Speech and Language Impairments in Preschool Age HIV-exposed Uninfected Children With In Utero Combination Antiretroviral Exposure.

BACKGROUND: Perinatally HIV-exposed but uninfected (HEU) children have elevated risk of late language emergence at 1 year of age, with possible links to in utero antiretroviral (ARV) exposure. We investigated possible risks for speech impairments (SIs) and language impairments (LI) in preschool monolingual HEU children in the United States. METHODS: Speech and language assessments were conducted as part of the Pediatric HIV/AIDS Cohort Study Surveillance Monitoring of ART Toxicities study at ages 3 (N = 208) and 5 (N = 429) years. Domains of speech, overall language, vocabulary and grammar were assessed. SI and LI were defined by standardized scores <15th percentile and categorized as primary (normal nonverbal IQ ≥ 85 without hearing loss) and concomitant (low nonverbal IQ and/or presence of hearing loss). Logistic regression models were used to estimate odds of SI and LI for different ARV exposures, adjusted for confounding variables. RESULTS: The risk for language impairments in HEU children was higher than population norms; risk for SIs was not elevated. Risk factors for impairments included male sex, black race and other socioeconomic measures, although these varied by age, primary (P) versus concomitant (C) impairment and by speech or language measure. Adjusted logistic regression models revealed lower and increased risk for specific ARVs. Tenofovir exposure was associated with increased risk for SI at 3 years of age but was associated with decreased risk for concomitant language impairment at 5 years of age. CONCLUSIONS: Further investigation of combination ARV exposure and speech/language impairment among preschool children is needed to confirm associations.

Associations Between the 2D:4D Proxy Biomarker for Prenatal Hormone Exposures and Symptoms of Developmental Language Disorder.

Purpose: Relative lengths of the index (2D) and ring (4D) fingers in humans represent a retrospective biomarker of prenatal hormonal exposures. For this reason, the 2D:4D digit ratio can be used to investigate potential hormonal contributions to the etiology of neurodevelopmental disorders. This study tested potential group differences in 2D:4D digit ratios in a sample of boys with and without developmental language disorder (DLD) and examined the strength of associations between 2D:4D digit ratio and a battery of verbal and nonverbal measures. Method: A group of 29 boys affected by DLD and a group of 76 boys with typical language abilities participated (age range = 5;6-11;0 years). Scanned images were used to measure finger lengths. Language measures included the core language subtests from the Clinical Evaluation of Language Fundamentals-Fourth Edition (Semel, Wiig, & Secord, 2003), a nonword repetition task, a sentence recall task, and the Test of Early Grammatical Impairment (Rice & Wexler, 2001). Results: Significant group differences indicated lower 2D:4D digit ratios in the group with DLD. Modest associations were found between 2D:4D digit ratios and some Clinical Evaluation of Language Fundamentals-Fourth Edition subtests. Conclusions: Prenatal hormone exposures may play a role in the etiology of some language symptoms.

The influence of scale structure and sex on parental reports of children's social (pragmatic) communication symptoms.

The addition of social (pragmatic) communication disorder [S(P)CD] to the DSM-5 taxonomy has left clinicians and researchers searching for appropriate diagnostic measures. Factor analysis procedures examined the extent to which S(P)CD symptoms presented within the Children's Communication Checklist-Second Edition (CCC-2) represented a unique construct and whether these factors were influenced by children's sex. Parents of 208 children (males = 125 and females = 83) from a community-based sample completed the CCC-2. Two pragmatic scores from the CCC-2 were analysed as follows: the social interaction difference index (SIDI) and a pragmatic composite from the original CCC (PC-5). Factor analysis failed to find a unique factor structure for either pragmatic composite. Analyses uncovered different factor structures for the CCC-2 SIDI and PC-5 composites and for boys and girls. S(P)CD represents a complex combination of symptoms that are poorly differentiated from other language and socioemotional behavioural difficulties.

Longitudinal Evaluation of Language Impairment in Youth With Perinatally Acquired Human Immunodeficiency Virus (HIV) and Youth With Perinatal HIV Exposure.

BACKGROUND: Language impairment (LI) risk is increased for perinatally acquired human immunodeficiency virus-infected (PHIV) and perinatally exposed to HIV but uninfected (PHEU) youth. This study evaluates the persistence of LI in these groups. METHODS: The Clinical Evaluation of Language Fundamentals was repeated on participants of the Pediatric HIV/AIDS Cohort Study Adolescent Master Protocol 18 months postbaseline. Regression models identified factors associated with change in standardized score (SC) and the resolution or development of LI. RESULTS: Of 319 participants, 112 had LI at baseline. Upon re-evaluation, SCs were highly stable and changes were similar in PHIV (n = 212) and PHEU (n = 107) participants. Those with family history of language delays had a 2.39 point lower mean increase in SCs than those without, after controlling for demographic and socioeconomic factors and baseline LI status. Among PHIV participants, CD4 count <350 cells/mm3 was associated with lower mean SC change (4.32 points), and exposure to combination antiretroviral therapy (cART) or protease inhibitors (PIs) was associated with a higher mean SC change (5.93 and 4.19 points, respectively). Initial LI was persistent in most cases (78%); 20 new cases occurred (10%). Female sex was associated with higher odds of LI resolution. Among PHIV, duration and baseline cART and history of PI use were associated with LI resolution; higher percentage of detectable viral loads before baseline was associated with lower odds of resolution. CONCLUSIONS: The PHIV and PHEU youth are at risk for persistent LI, and family history of language delays was a risk factor for persistence of problems. Measures of successful HIV treatment predicted more favorable outcomes among PHIV youth.

Markers, Models, and Measurement Error: Exploring the Links Between Attention Deficits and Language Impairments.

PURPOSE: The empirical record regarding the expected co-occurrence of attention-deficit/hyperactivity disorder (ADHD) and specific language impairment is confusing and contradictory. A research plan is presented that has the potential to untangle links between these 2 common neurodevelopmental disorders. METHOD: Data from completed and ongoing research projects examining the relative value of different clinical markers for separating cases of specific language impairment from ADHD are presented. RESULTS: The best option for measuring core language impairments in a manner that does not potentially penalize individuals with ADHD is to focus assessment on key grammatical and verbal memory skills. Likewise, assessment of ADHD symptoms through standardized informant rating scales is optimized when they are adjusted for overlapping language and academic symptoms. CONCLUSION: As a collection, these clinical metrics set the stage for further examination of potential linkages between attention deficits and language impairments.

Language Impairment in the Attention-Deficit/Hyperactivity Disorder Context.

PURPOSE: Attention-deficit/hyperactivity disorder (ADHD) is a ubiquitous designation that affects the identification, assessment, treatment, and study of pediatric language impairments (LIs). METHOD: Current literature is reviewed in 4 areas: (a) the capacity of psycholinguistic, neuropsychological, and socioemotional behavioral indices to differentiate cases of LI from ADHD; (b) the impact of co-occurring ADHD on children's LI; (c) cross-etiology comparisons of the nonlinguistic abilities of children with ADHD and specific LI (SLI); and (d) the extent to which ADHD contributes to educational and health disparities among individuals with LI. RESULTS: Evidence is presented demonstrating the value of using adjusted parent ratings of ADHD symptoms and targeted assessments of children's tense marking, nonword repetition, and sentence recall for differential diagnosis and the identification of comorbidity. Reports suggest that the presence of ADHD does not aggravate children's LI. The potential value of cross-etiology comparisons testing the necessity and sufficiency of proposed nonlinguistic contributors to the etiology of SLI is demonstrated through key studies. Reports suggest that children with comorbid ADHD+LI receive speech-language services at a higher rate than children with SLI. CONCLUSION: The ADHD context is multifaceted and provides the management and study of LI with both opportunities and obstacles.

Consequences of co-occurring attention-deficit/hyperactivity disorder on children's language impairments.

PURPOSE: Co-occurring attention-deficit/hyperactivity disorder (ADHD) and communication disorders represent a frequently encountered challenge for school-based practitioners. The purpose of the present study was to examine in more detail the clinical phenomenology of co-occurring ADHD and language impairments (LIs). METHOD: Measures of nonword repetition, sentence recall, and tense marking were collected from 57 seven- to nine-year-old children. The performances of children with ADHD+LI status were compared with those of children with specific language impairment (SLI) and children with typical development (TD). RESULTS: ADHD status had no independent detrimental impact on the affected children's LIs (SLI = ADHD+LI < TD). A modest positive correlation was found between the severity of children's ADHD symptoms and their sentence recall performance, suggesting a tendency for affected children who had higher levels of ADHD symptoms to perform better than those children with lower levels. CONCLUSION: These outcomes are difficult to reconcile with attention-deficit/information-processing accounts of the core deficits associated with SLI. Potential protective mechanisms associated with ADHD status are discussed.

Contributions of children's linguistic and working memory proficiencies to their judgments of grammaticality.

PURPOSE: The authors explored the cognitive mechanisms involved in language processing by systematically examining the performance of children with deficits in the domains of working memory and language. METHOD: From a database of 370 school-age children who had completed a grammaticality judgment task, groups were identified with a co-occurring language and working memory impairment (LI-WMI; n = 18) or specific language impairment (SLI) with typical working memory skills ( n = 60) and matched control groups. Correct and incorrect use of grammatical markers occurred either early or late in sentence stimuli, imposing a greater working memory load for late-marker sentences. RESULTS: Children with SLI showed a lower preference for grammatical items than typically developing controls, regardless of error marker position. Children with LI-WMI demonstrated a performance pattern modulated by error marker position: Their preference for grammatical items was lower than typically developing controls for late but not early marker sentences. CONCLUSION: This pattern of results suggests that there are distinct and dissociable impacts of working memory and linguistic skills on metalinguistic functioning through a grammatical judgment task.

Effect of language context on ratings of shy and unsociable behaviors in English language learner children.

PURPOSE: The primary goal of this study was to explore the effect of language context on the socially withdrawn behaviors of school-age-children who are English language learners (ELLs) from middle- to high-socioeconomic status (SES) backgrounds. This is one of the 1st studies to address the frequently confused concepts of shyness and unsociability as independent constructs within the ELL population. The authors of this study also investigated the feasibility of an experimental parent and child questionnaire that examines shyness and unsociability across native-language and English-speaking contexts. METHOD: Children and mothers (34 of whom were ELLs and 37 of whom were native English speakers) were administered an experimental questionnaire examining the children's shy and unsociable behavior in native-language and English-speaking contexts. RESULTS: Children and mothers in the ELL group reported significantly higher ratings of shy behavior in English-speaking versus native-language contexts, whereas unsociable ratings did not differ across language contexts. CONCLUSIONS: Shyness and unsociability are distinguishable behaviors in ELL children, and researchers should consider these constructs when examining withdrawal. In addition, examining ELL children's behavior across language contexts provides a valuable method for investigating language-influenced behavioral problems. This study demonstrates the need for service providers to evaluate behavior across subtype and language context before pathologizing withdrawal in ELL children.

A cross-etiology comparison of the socio-emotional behavioral profiles associated with attention-deficit/hyperactivity disorder and specific language impairment.

Cross-etiology comparisons provide important information that can help practitioners establish criteria for differential diagnosis and tailor interventions towards the source of children's difficulties. This study examined the extent to which parent rating scales of socioemotional behavioral difficulties differentiate cases of attention-deficit/hyperactivity disorder (ADHD) from cases of specific language impairment (SLI), and typical development (TD). Parents of 60 children (7-8 years) completed the Child Behavior Checklist (Achenbach & Rescorla, 2001) and the Conners Parent Rating Scale-Revised (Conners, 2004). Significant differences were observed between ratings provided for the children with ADHD and the children with SLI and TD across several scales which assessed behavioral and emotional difficulties. Most of the observed differences between ratings provided for the SLI and TD groups were not significant when nonverbal IQ was treated as a covariate or when syndrome scales were adjusted for the presence of language and academic items. In contrast, these adjustments had little impact on observed differences between the children with ADHD and the other groups. These results highlight important and clinically useful differences between the scope and the scale of socioemotional behavior difficulties associated with ADHD and SLI.