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

Sean M Redmond

doi:10.1044/2020_jslhr-20-00050

Abstract

PurposeEstimates 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.MethodEighty-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.ResultsThe 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%.ConclusionsCo-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

Highlights

Children affected by language disorders represent a heterogeneous group
We have considered whether signs and symptoms of idiopathic language disorder could be mischaracterized during routine clinical assessments as supportive of a diagnosis of attention-deficit/ hyperactivity disorder (ADHD) or another socioemotional behavioral disorder (Ash et al, 2017; Redmond, 2002; Redmond & Ash, 2014; Redmond & Rice, 1998, 2002; Redmond, Hannig, & Wilder, 2019)
Shifting enthusiasm for new terms and new criteria for idiopathic language disorder places the field of child language disorders in an interesting and potentially vulnerable place

Summary

Introduction

Children affected by language disorders represent a heterogeneous group. For some children, their acquisition of linguistic proficiency is complicated by either injury or concomitant neurodevelopmental disruption or both. Even more puzzling is that many more children with language disorders appear to have them in the absence of identifiable injury or any clinically significant deficits in other areas of development (Beitchman et al, 1986; Norbury et al, 2016; Tomblin et al, 1997). The existence of idiopathic cases as the prototypical presentation of language disorders within the pediatric population suggests that nonverbal deficits of the sort that lead to significant disruptions in other areas of development are neither necessary nor sufficient preconditions.

Methods

Results

Conclusion