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Are Children with ADHD at Risk for Developing Language Impairments?

presented by Sean Redmond

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Financial: Sean Redmond receives compensation from MedBridge for this course. There is no financial interest beyond the production of this course.

Non-Financial: Sean Redmond has no non-financial interests or relationships with MedBridge.

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What are the links between Attention-Deficit/Hyperactivity Disorder (ADHD) and language impairment? Are children with ADHD at increased risk for developing language impairments (LI)? Do children with both ADHD and LI have more severe/different symptoms than children with specific language impairment (SLI)? ADHD represents a ubiquitous neurodevelopmental disorder and children with both communication disorders and ADHD appear with regularity on practitioner caseloads. This course presents current evidence regarding the clinical phenomenology of comorbid ADHD+LI and offers practical guidelines for the differential diagnosis of ADHD and LI.

Meet Your Instructor

Sean Redmond, PhD, CCC-SLP

Sean Redmond received his B.A. in Speech and Hearing Sciences from the University of California, Santa Barbara in 1990, his M.A. in Speech Language Pathology from the University of Kansas in 1993, and his Ph.D. in Child Language from the University of Kansas in 1997. He teaches and conducts research in the Department of Communication…

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Chapters & Learning Objectives

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1. Cross Signals of Comorbidity in the Literature

This chapter starts by trying to answer the questions “are children with ADHD at increased risk for developing language impairments?” and shows that we cannot answer this question because the evidence has been inconclusive. Reports of ADHD+LI comorbidity have been highly unstable (7 % to 90%). Variability in this case cannot easily be attributed to the common culprits of noisy signals within comorbidity research. Measurement error is a likely contributor to the lack of clarity on this issue. In both the language and behavior domains, there are assessment instruments with very weak psychometric properties. These instruments are presented along with stronger alternatives.

2. Differential Diagnosis of ADHD and Language Impairment

This chapter divides up clinical symptoms into those that are diagnostically ambiguous, those that are supportive of an LI diagnosis, and those that are supportive of an ADHD diagnosis. Several difficulties are clinically ambiguous because they have been shown to be common in both ADHD and SLI: poor reading/academics, teacher rated behavior problems, peer difficulties, pragmatic deficits, poor performance on executive function and continuous performance tasks Some difficulties are specific to SLI and have not been found in samples of ADHD where comorbid LI has been ruled out: tense-marking, nonword repetition, sentence recall, verbal memory, narratives Some difficulties are specific to ADHD and have not been found in SLI when comorbid ADHD has been ruled out: parent rated behavior problems, visuospatial memory deficits, fast speaking rate, vocal abuse, and elevated levels of mazes in conversation.

3. Consequences of ADHD+LI Comorbidity

This chapter takes up the issue of the effects of ADHD comorbidity on children’s language development. Different kinds of comorbidity affect language impairments in different ways. For example, when LI is comorbid with low nonverbal IQ, there are more severe language symptoms and slower rates of growth. Relative to children with SLI, individuals with comorbid low nonverbal IQ are at increased risk for reading and behavioral problems – including ADHD. They also might be less responsive to interventions. In contrast, children with LI and co-occurring reading disabilities (LI+RD) have not presented with either more severe linguistic or severe reading difficulties. Comorbidity of ADHD+ LI appears to be similar to LI+RD based on the available evidence. There is some evidence that individuals with ADHD+LI might be getting preferential access to speech-language services. Additional research is needed to determine the impact of ADHD+LI comorbidity on children’s response to different treatments and how best to integrate linguistic and behavioral interventions. We also need clarity on the mechanisms behind ADHD+LI comorbidity that can only be achieved by longitudinal investigations. Understanding how comorbidity between these two common disorders arises introduces the possibility of eventually reducing rates of comorbidity.

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How to Address Specific Language Impairments in Children

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How to Address Specific Language Impairments in Children

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How should we address those children on our caseloads who seem to be struggling with language development for no good reason? Specific language impairment (SLI) is the term currently used to refer to cases of disrupted language development in the absence of any clear causal mechanism (e.g. intellectual disability, environmental deprivation, hearing impairment, socioemotional disorder). Although SLI has been widely recognized by researchers as a common communication disorder that affects more individuals than autism, Down syndrome, stuttering, and traumatic brain injury combined most people have never heard of SLI. This course presents current evidence regarding the epidemiology, clinical features, associated academic and socioemotional consequences, and theoretical explanations of SLI. Ongoing disagreements among researchers and clinicians on how best to refer to and manage children affected by idiopathic language impairments call into question the future of SLI as a clinical designation.

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