Language Deficit With Attention Deficit Disorder: A Prevalent Comorbidity

The aim of this Study was to delineate the prevalence and behavioral patterns of' children with attention deficit and language problems as compared to children with attention-deficit hyperactivity disorder (ADHD) only. Out of a cohort of 3208 children 6 to 11 years old, 5.2% were identified as having a primary ADHD. A teacher's behavioral questionnaire, pediatric interview and assessment, IQ, attention tests and language were employed. A 45% rate of language problems was identified. This comorbidity is more prevalent among girls (P = .02). Sequencing and short term memory were significantly related to attention deficit and language problems, but the attention scores were not. Language performance was the best predictor of group assignment and was superior to IQ in that regard. Correlation analysis revealed a different behavioral pattern for the two groups. It appears that a significant proportion of children with ADHD have a language comorbidity not reflected by IQ assessments; therefore, language tests should be considered as part of their routine assessment. Children with attention-deficit and language problems appear to have a different neurocognitive pattern underlying their problems as compared with their peers with ADHD only. (J Child Neurol 1998; 13:493 497).

Attention-deficit hyperactivity disorder (ADHD) is the most prevalent behavioral disorder in childhood.1 Comorbidities such as conduct disorder, oppositional-defiant disorder, anxiety and depressive and mood disorders as well as learning disabilities are well acknowledged.2,3 The association of attention deficit and language deficits also has been documented. Psychiatric problems among children with a primary language disorder1-11 and, conversely, language deficits among children with psychiatric disorders12-16 were repeatedly reported. However, as previously suggested, most of the literature concerns biased clinical samples and fails to control for intervening factors such as intelligence.17 The scope of the present study was therefore to investigate children with ADHD and no other behavioral comorbidities.

It has been suggested that in intellectually normal individuals, inferior language abilities may relate more to neurocognitive functions other than language (e.g., short-term memory and processing speed).18 However, when children with attention deficit were compare with children with attention deficit and reading disability, IQ was not found to have a main effect.19 It was suggested that memory was related both to attention14, 20-22 and language functions. 22, 23-26

The hypotheses for the present research were the following:

1. Children with ADHD (with no other behavioral comorbidity) have a high prevalence of attention-deficit and language problems.
2. This association is not necessarily mediated by IQ.
3. Children with attention-deficit and language difficulties present a different behavioral pattern than children with attention deficit and no language difficulty.
4. Short-term memory is less optimal among children with both attention-deficit and language difficulty, as compared to children with attention deficit only.

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