Pragmatic language and theory of mind in children with symptoms of ADHD: relationships with executive functions

© 2018 Dr. Benita Christine GreenChildren’s social, academic and interpersonal functioning is sustained by language in use, yet a moderate body of research indicates that children with ADHD, and children with ADHD symptoms, have problems with pragmatic language. They can be prone to excessive talking, poor conversational turn-taking and lack of clarity and coherence in their utterances. Pragmatic language is thought to depend in part on theory of mind (ToM) and on executive functions such as sustained attention and response inhibition. This research first investigates the nature and extent of pragmatic language problems in children with symptoms of ADHD, and any co-occurring problems with ToM. In view of neurocognitive heterogeneity in children with ADHD and in the general population, the research then examines whether pragmatic language problems are related to specific subgroups of executive function, and whether any ToM difficulties are similarly related. A community sample of 148 children aged 8 to 10 years participated (76 boys). ADHD symptoms and pragmatic language ability were assessed by parent questionnaire. Most of the children (n = 110, 57 boys) then completed the Sustained Attention to Response Task (SART; Robertson, Manly, Andrade, Baddeley, & Yiend, 1997) and a digit span task, while conversational pragmatics was assessed using observational ratings from a semi-structured conversation and ToM was assessed from children’s responses to an animated triangles task. Children with ADHD symptoms (n = 29) showed substantially poorer pragmatic language than children without such symptoms (n = 81), in terms of both parent report of communications skills and conversational pragmatics. They evinced subtle problems with ToM. Cluster analysis revealed three distinct profiles of performance on the SART, with one subgroup characterised by poor sustained attention (n = 13), one subgroup with poor response inhibition (n = 16) and the remainder with no particular weakness (n = 81). Children with ADHD symptoms were distributed across all three subgroups. Nonetheless, the subgroup with poor sustained attention had a higher level of ADHD symptoms and a consistent pattern of poorer conversational pragmatics and ToM than the subgroup that performed well on the SART. Surprisingly, the subgroup with poor response inhibition did not show poorer pragmatic language or ToM, nor higher level of ADHD symptoms, than the subgroup that performed well on the SART. The results indicate that neurocognitive heterogeneity amongst children with ADHD symptoms is nested within heterogeneity in the general population. Moreover, specific weakness in sustained attention may contribute to behavioural symptoms of ADHD and to problems with pragmatic language and ToM amongst a subgroup of school-aged children. Sustained attention may be required to monitor the communicative intentions of conversational partners and the content, timing and relevance of conversational turns. Executive weakness, however, does not appear to underlie ADHD symptoms or pragmatic language and ToM problems in all children, posing a challenge to causal models of ADHD. Results are discussed in terms of whether behavioural symptoms of ADHD might disrupt both interpersonal engagement and the application of executive functions in communicative contexts