1 Esther Parigger. 14-07-07.

1
Exploring the overlap
between children with SLI and children
with ADHD
Esther Parigger EUCLDIS 2007
2
Overview

• Overlap between SLI and ADHD
• Executive functions in SLI with(out) ADHD
  symptoms
• Semantics/pragmatics in SLI with(out) ADHD
  symptoms
• Conclusion and discussion

3
SLI

• Stark and Tallal, 1981
• Bishop, 1994

Impaired hearing Emotional and behavioral
problems PIQ lt 85 Neurological deficits/
lesions Speech motor skill deficiencies Low
reading age

• Diagnosis
• ?Exclusion
• ?Severity

LA Receptive lt MAP/CA (6 mo.) LA Expressive lt
MAP/CA (12 mo.) LA Overall lt MAP/CA (6 mo.)
Diagnosed on the basis of exclusion!
No behavioral problems allowed!
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ADHD

• APA, 2000

Language items are included in the symptom list!
Diagnosed on the basis of clinical evaluation!

• Diagnosis
• ?Symptoms (division in subtypes)
• -present before 7 years of age
• -present in 2 or more settings
• -significant impairment in functioning
• -not accounted for by another disorder

Symptoms of inattention Symptoms of
hyperactivity/impulsivity
Predominantly inattentive subtype Predominantly
hyperactive/impulsive subtype Combined subtype
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SLI and ADHD

• Not just two different worlds..
• ? overlapping symptoms

6
SLI and behavioural problems

• Botting, 2006 (poster)

• 23 of 200 children with (S)LI
• scored in the atypical range of
• the ADHD scale of the SDQ
• These children performed worse
• in expressive language tasks with
• semantic content
• ? underlying problems with inhibition?

Expected2-6!
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ADHD and language problems
Parigger and Baker, 2005 Parigger, in prep. (a)

• Subtle problems in language comprehension
• More robust problems in language production
• ? mainly pragmatics

• E.g. percentage of worded plot elements in
  Frog-stories
• -effect of diagnosis ADHDltTD
• -effect of age 7lt8lt9

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Possible explanation
Tannock and Schachar, 1996 147

• Executive Dysfunction Theory
• We theorize that the core behavioural
  symptoms of ADHD () and the pragmatic
  difficulties that these children exhibit ()
  are related to deficits in executive function
  (i.e. higher-order cognitive processes).

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This study
Parigger, in prep (b)

• Is it possible, within a SLI group, to
  distinguish a group of children with ADHD
  symptoms and a group of children without ADHD
  symptoms?
• If so, is it possible to differentiate these
  groups with respect to
• 1 Executive functions?
• 2 Semantics/pragmatics?

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Subjects

• 15 children diagnosed with SLI
• -13 boys, 2 girls
• -mean age 82

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Groups

• Dutch checklist for behavioural problems VvGK
• 33 of 15 children with SLI
• scored in the (sub)clinical range of
• the inattention and/or hyperactivity
• scales of the VvGK

Expected2-6!
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1a Inhibition

• CANTAB Stop Signal Task

Table 1 stop signal reaction time (SSRT) Table 1 stop signal reaction time (SSRT)
Group Mean (sd)
SLI-ADHD (n10) 303,80 (115,24)
SLIADHD (n5) 284,05 (109,02)
Total (n15) 297,22 (109,66)

ANOVA SLIADHD SLI-ADHD
Comparison with typically developing norm group
not yet possible
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1b Attention

• CANTAB Rapid Visual Information Processing

Table 2 A prime (A) Table 2 A prime (A)
Group Mean (sd)
SLI-ADHD (n10) 0,16 (0,51)
SLIADHD (n5) 0,08 (0,82)
Total (n15) 0,13 (0,60)
ANOVA SLIADHD SLI-ADHD
Norm group comparison SLI-ADHD TD
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1c Working memory

• CANTAB Spatial Working Memory

Table 3 between errors (BE) Table 3 between errors (BE)
Group Mean (sd)
SLI-ADHD (n10) 0,16 (0,98)
SLIADHDADHD (n5) 0,12 (0,44)
Total (n15) 0,15 (0,82)
ANOVA SLIADHD SLI-ADHD
Norm group comparison SLI-ADHD TD
15
1d Shifting

• CANTAB Intra/extradimensional Shift

Table 4 total errors (adjusted) (TE) Table 4 total errors (adjusted) (TE)
Group Mean (sd)
SLI-ADHD (n10) 0,45 (1,37)
SLIADHD (n5) 0,34 (0,88)
Total (n15) 0,41 (1,19)
ANOVA SLIADHD SLI-ADHD
Norm group comparison SLI-ADHD TD
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Summary executive functions

• No differentiation between SLI group with and SLI
  group without ADHD symptoms on measures of
• -inhibition
• -attention
• -working memory
• -shifting

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2a Semantics

• Dutch childrens communication checklist
  CCC-2-NL

Table 1 semantic subscale (SEM) Table 1 semantic subscale (SEM)
Group Mean (sd)
SLI (n10) 13,3 (2,06)
SLI/ADHD (n5) 14,4 (1,82)
Total (n15) 13,67 (1,99)
Table 5 semantic subscale (SEM) Table 5 semantic subscale (SEM)
Group Mean (sd)
SLI-ADHD (n10) 13,3 (2,06)
SLIADHD (n5) 14,4 (1,82)
Total (n15) 13,67 (1,99)

ANOVA SLIADHD SLI-ADHD
Norm group comparison SLIADHD lt TD SLI-ADHD lt TD
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2b Pragmatics

• Dutch childrens communication checklist
  CCC-2-NL

Table 1 semantic subscale (SEM) Table 1 semantic subscale (SEM)
Group Mean (sd)
SLI (n10) 13,3 (2,06)
SLI/ADHD (n5) 14,4 (1,82)
Total (n15) 13,67 (1,99)
Table 6 pragmatic composite (PC) Table 6 pragmatic composite (PC)
Group Mean (sd)
SLI-ADHD (n10) 48,5 (4,79)
SLIADHD (n5) 62,6 (13,35)
Total (n15) 53,2 (10,63)

ANOVA SLIADHD lt SLI-ADHD
Norm group comparison SLIADHD lt TD SLI-ADHD TD
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2c Coherence

• Dutch childrens communication checklist
  CCC-2-NL

Table 1 semantic subscale (SEM) Table 1 semantic subscale (SEM)
Group Mean (sd)
SLI (n10) 13,3 (2,06)
SLI/ADHD (n5) 14,4 (1,82)
Total (n15) 13,67 (1,99)
Table 4 coherence (COH) Table 4 coherence (COH)
Group Mean (sd)
SLI-ADHD (n10) 13,3 (2,05)
SLIADHD (n5) 15,6 (1,67)
Total (n15) 14,07 (2,18)

ANOVA SLIADHD lt SLI-ADHD
Norm group comparison SLIADHD lt TD SLI-ADHD lt TD
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Summary semantics/pragmatics

• Differentiation between SLI group with and SLI
  group without ADHD symptoms on
• -pragmatic composite
• -coherence subscale

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Conclusion

• It is possible, within a SLI group, to
  distinguish a group of children with ADHD
  symptoms and a group of children without ADHD
  symptoms.
• These groups dont differ with respect to
  executive functioning. But they do differ with
  respect to pragmatics and coherence.

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Discussion

• An overlapping subgroup?

ADHD
LI SLI (prag.)
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Further research
Parigger, in prep (c)

• Main study
• Comparison of language profiles and cognitive
  profiles of children with ADHD, children with
  SLI, and normally developing children

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Information

• E e.m.parigger_at_uva.nl
• W http//home.medewerker.uva.nl/e.m.parigger
• T 0031-20-5253811

Ill upload a hand-out!
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Theory of constructive operators (TCO)

• Im-Bolter, 2006
• Pascual-Leone, 1970, 1987

M- capacity
Recentration (updating)
Language competence
Interruption (inhibition)
Decentration (shifting)