Pragmatic language difficulties in children with hyperactivity and attention problems: an integrated review.

BACKGROUND: Diagnostic criteria for attention deficit hyperactivity disorder (ADHD) suggest a range of difficulties in the pragmatic aspects of language, including excessive talking and interrupting others. Such difficulties have been periodically reported over several decades in studies on the language abilities of children with features of ADHD, yet a comprehensive review of the literature has been lacking. AIMS: This review aims to integrate evidence from several lines of research from 1979 to the present on pragmatic language difficulties in children with ADHD or symptoms of ADHD. METHODS & PROCEDURES: A comprehensive search of empirical literature on pragmatic language in children with ADHD or symptoms of ADHD was conducted using PsycINFO and PubMed databases and through following up relevant references cited in articles. Literature was reviewed with respect to the nature and extent of pragmatic language difficulties in ADHD. OUTCOMES & RESULTS: Thirty studies met the review inclusion criteria, including recent questionnaire studies, observational studies of children's communication patterns, and studies of higher-level language comprehension and production. The studies indicate a consistent profile of pragmatic language impairments in children with features of ADHD, particularly in the areas of excessive talking, poor conversational turn-taking, and lack of coherence and organization in elicited speech. CONCLUSIONS & IMPLICATIONS: Pragmatic language difficulties are common in children with features of ADHD. These difficulties are consistent with deficits in executive function that are thought to characterize ADHD, thus providing some support for the theory that executive function contributes to pragmatic language competency. As yet there is very little empirical evidence of specific relationships between particular aspects of pragmatic language and particular domains of executive function. Given the importance of pragmatic language competency for children's social and academic functioning, pragmatic language abilities should be considered during clinical assessment for ADHD and targeted for intervention.

Which Measures From a Sustained Attention Task Best Predict ADHD Group Membership?

Difficulty with sustaining attention to a task is a hallmark of ADHD. It would be useful to know which measures of sustained attention best predict a diagnosis of ADHD. Participants were 129 children with a diagnosis of ADHD and 129 matched controls who completed the fixed Sustained Attention to Response Task (SART). The number of commission and omission errors, standard deviation of response time (SDRT), tau, fast and slow frequency variability, d-prime, and mu were able to successfully classify children with and without ADHD. The mean response time, criterion, and sigma were not able to classify participants. The best classifiers were d-prime (0.75 Area Under the Receiver Operated Characteristic), tau (.74), SDRT (0.74), omission errors (0.72), commission errors (0.71), and SFAUS (0.70). This list of the best classifier measures derived from the SART may prove useful for the planning of future studies.