Language problems more common in children with ADHD

A study found that children with ADHD are more likely to have language problems.

Children who have attention-deficit/hyperactivity disorder are nearly three times more likely to have language problems than kids without ADHD, according to new research.

And those language difficulties can have far-reaching academic consequences, the study found.

The study, published online April 21 in Pediatrics, looked at 6- to 8-year-olds with and without ADHD in Australia.

"We found that 40 percent of children in the ADHD group had language problems, compared to 17 percent of children in the 'control' group," said Emma Sciberras, a clinical psychologist and post-doctoral research fellow at the Murdoch Children's Research Institute in Victoria, Australia. "Rates of language problems were similar in boys and girls with ADHD," she added.

Children with ADHD commonly have trouble with school performance and social functioning. The impact that language problems might have on these factors hasn't been well-studied, the study authors noted.

"The differences in academic functioning between children with ADHD and language problems, compared to those with ADHD alone, were quite large and clinically meaningful," said Sciberras.

Language problems refer to spoken language -- both receptive and expressive language. Receptive language is the ability to listen and understand what's being said; expressive is the ability to speak and be understood.

In a separate study in the same issue of the journal, Sciberras and her colleagues looked at almost 400 children with ADHD, aged 5 to 13, and found almost two-thirds had one or more anxiety disorders.

When children with ADHD had two or more anxiety disorders -- this was true for one-third of the kids -- their quality of life, behavior and daily functioning suffered, the researchers said.

"It is very common for children with ADHD to experience additional difficulties," said Sciberras. "Both of these studies demonstrate that the additional difficulties that go along with ADHD, in this case anxiety and language problems, can make daily functioning even harder for children with ADHD."

The language study included 179 children diagnosed with ADHD and 212 without the attention disorder. Fewer than half of the children with ADHD were taking medications to help control their symptoms.

After adjusting for sociodemographic factors and other conditions, such as autism spectrum disorders, the researchers found that the risk of language problems was 2.8 times higher in children with ADHD.

When the researchers looked at how those language problems affected school work, they found lower math, reading and academic scores.

However, the researchers didn't find that language problems had an impact on social functioning.

"We were surprised that language problems were not associated with poorer social functioning for children with ADHD," Sciberras said. "It could be that children with ADHD are already experiencing poorer social functioning due to other factors including their ADHD symptoms or other associated difficulties."

However, Sciberras cautioned that language troubles might become more problematic as these kids get older because social relationships get more complex with age.

One outside expert said the study is a good reminder for parents and physicians.

"If a child has ADHD and they're struggling in school, even though their ADHD symptoms are well-controlled, in addition to getting tested for learning disabilities, they should also be looked at for language difficulties as well. And that's not something we always think of," said Dr. Bradley Berg, medical director of McLane Children's Pediatrics at Baylor Scott & White Healthcare in Round Rock, Texas.

Whether speech-language interventions will help the youngsters with ADHD isn't clear, however.

Berg also pointed out that this issue is a "chicken-and-egg" problem. "Do these kids have a language disorder that's causing them to not understand what's going on at school and that's making them restless and fidgety because they're bored. Or do they have ADHD and that's causing difficulty understanding the language. Or is there something going on in an area of the brain that creates both of these problems?" he said. "We don't know."

It's possible that the findings from this Australian study might not translate to a U.S. population. For one thing, medication trends might differ, Berg said.

For children with ADHD who also suffer anxiety, Sciberras said medications might help, and a type of psychotherapy called cognitive behavioral therapy could also be useful. The researchers are currently conducting a study to treat anxiety in children with ADHD.

"If parents are concerned that their child with ADHD has anxiety, language or any other additional difficulties that are not currently being managed, we encourage them to discuss their concerns with their child's treating clinician," she said.

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Genetic link between autism and language impairment

Scientists have found a genetic link between autism and language impairment showing these two conditions may result from a common genetic factor.

In the first molecular genetic study of families with a history of both language impairment and autism, scientists may have uncovered a shared origin for the two conditions, an important step toward explaining why some cases of autism are accompanied by language difficulties and others are not. The study, a collaboration of The Research Institute at Nationwide Children's Hospital with experts at Rutgers University, indicates that a disorder called specific language impairment -- one of the most common developmental delays in children -- may be caused by the same genetic variants that lead to language difficulties in some children with autism. The findings are published Oct. 30 in the American Journal of Psychiatry.

As many as two-thirds of individuals with an Autism Spectrum Disorder (ASD) also have language impairments, which can range from mild limitations to complete non-verbal behavior. However, the remaining third may have normal or even above average language abilities. To investigate whether specific language impairment and language-impaired autism cases are caused by the same genetic variants, researchers examined the genetic code of 79 families with a history of both conditions.

Using a genome-wide scan and a series of language tests, the researchers identified two new genetic links for language impairment in these families: 15q23¬-26 and 16p12. Each of these new links is jointly related to language-impaired ASD and non-ASD related specific language impairment, suggesting a single cause for both issues.

"A genetic cause of language impairment may help explain why some kids with ASD have language impairments and others don't, as well as why some members of a family have language impairment only and others have ASD as well," says Christopher W. Bartlett, PhD, principal investigator in the Battelle Center for Mathematical Medicine at Nationwide Children's and lead author of the study. The research is part of a long-term collaboration between scientists at Nationwide Children's and Rutgers, initiated by a grant from the National Institute of Mental Health to Linda M. Brzustowicz, MD, professor of the Department of Genetics at Rutgers and senior investigator on the project.

Language impairment is not part of the diagnostic definition of ASD. And according to Dr. Bartlett, this study raises the question of whether language impairment is actually a dissociable trait in at least some forms of ASD.

"There is nothing about autism that dictates that language impairment has to occur," says Dr. Bartlett, who also is an assistant professor of pediatrics at The Ohio State University School of Medicine. "In this study, we demonstrated a shared mechanism between the two disorders. Language problems and ASD are complicated and have numerous genetic factors, but we think that many genetic factors related to communication could be the same for specific language impairment and language-impaired autism."

The genetic variations appear to be relevant to both disorders and may indicate a greater level of genetic predisposition for impairments in language ability among individuals with and without ASD in those families.

In an earlier study, the researchers found similarities in language deficit type and severity between language-impaired non-ASD and language-impaired ASD individuals in the same family. The behavioral genetics study, published in Biological Psychiatry, found that the same genes active in specific language impairment appear in ASD, but their effect is amplified in ASD. That finding, coupled with this new research, suggests that the two disorders may be on an etiological continuum.

"If further research confirms a genetic link between language impairment and ASD, then we may be able to find out why some family members only develop language impairment while others develop autism," says Dr. Bartlett. "But most of all, we want to know why there is such a range in communication abilities in children with autism -- why so many children have language difficulties when it's not required for the diagnosis."

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