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Understanding Language Impairments in Children with ADHD Carol Westby, PhD (mocha@unm.edu) Lee Robinson, MS (lee_robinson@byu.edu Brigham Young University ASHA 2007 Body function&structure (Impairment ) Activities (capacity) (Limitation) Participation (performance) (Restriction)

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understanding language impairments in children with adhd

Understanding Language Impairments in Children with ADHD

Carol Westby, PhD (mocha@unm.edu)

Lee Robinson, MS (lee_robinson@byu.edu

Brigham Young University

ASHA 2007

slide2

Body function&structure(Impairment)

Activities

(capacity)

(Limitation)

Participation

(performance)

(Restriction)

Environmental Factors

Personal Factors

International Classification

of Functioning

Condition (disorder/disease)

slide3

DSM-IV Criteria for ADHD

  • I. Either A or B:
  • A. Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is disruptive and inappropriate for developmental level:
  • Inattention
  • Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
  • Often has trouble keeping attention on tasks or play activities.
  • Often does not seem to listen when spoken to directly.
  • Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
  • Often has trouble organizing activities.
  • Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
  • Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
  • Is often easily distracted.
  • Is often forgetful in daily activities.
slide4

B. Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to a point that is disruptive and inappropriate for developmental level:

  • Hyperactivity
  • Often fidgets with hands or feet or squirms in seat.
  • Often gets up from seat when remaining in seat is expected.
  • Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
  • Often has trouble playing or enjoying leisure activities quietly.
  • Is often "on the go" or often acts as if "driven by a motor".
  • Often talks excessively.
  • Impulsivity
  • Often blurts out answers before questions have been finished.
  • Often has trouble waiting one's turn.
  • Often interrupts or intrudes on others (e.g., butts into conversations or games).
  • C. Some symptoms that cause impairment were present before age 7 years.
  • D. Some impairment from the symptoms is present in two or more settings (e.g. at school/work and at home).
  • E. There must be clear evidence of significant impairment in social, school, or work functioning.
slide5

Based on these criteria, three types of ADHD are identified:

ADHD, Predominantly Hyperactive-Impulsive Type: if Criterion 1B is met but Criterion 1A is not met for the past six months.

ADHD, Predominantly Inattentive Type: if criterion 1A is met but criterion 1B is not met for the past six months

ADHD, Combined Type: if both criteria 1A and 1B are met for the past 6 months

NOTE: Predominantly hyperactivity/impulsivity and combined types have particularly be associated with deficits in executive functioning and working memory.

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.

children
Children

Ryan, age 6, on medication

ADHD – predominantly hyperactive-impulsive

?comorbid Asperger’s

Jason, 8, on medication

ADHD – predominantly hyperactive/

Impulsive (may be moving to combined type)

Zach, age 15

ADHD – predominantly inattentive;

Sluggish cognitive tempo;

Comorbid language/learning disability

parent concerns for zach
Parent Concernsfor Zach

Talks really loud a lot of time,

I think he is a little obnoxious.

Doesn’t really have hardly any friends at all.

He tries really hard.

Doesn’t understand doesn’t realize that he not acting the same way as other kids at school.

Talks about Zach is cool.

Zach is always in the story.

It is getting better

It might be that he’s really consumed with himself still cause that’s a younger child.

E: Is he aware of not having friends

Yeh, Said that he doesn’t have any friends.

parent concerns for ryan
Parent Concernsfor Ryan

Biggest concern we have for him in school is his social acceptance and his ability to interact socially.

Anything that would give him skills in being able to when a friend expresses a different opionion than his, being able to say, “well, that’s OK, but this is my opinion.”

When somebody has a toy he wants or isn’t sharing a turn, being able to approach that and in a socially acceptable manner, say, “I’ve waited 5 minutes; can I have a turn now.”

Give him tools that he can apply in situations when usually the alternative would be to lash out, or kinda spit, or take the toy.

hyperactivity song by mark lowry
Hyperactivity song by Mark Lowry

They might tame the wind,

They might calm the sea,

But they’re never harness my energy.

I’m the poster boy for hyperactivity!

It’s not my fault!

The world’s not keeping up with me.

sluggish cognitive tempo
Sluggish Cognitive Tempo

Qualitatively different problems with attention

Spacey, daydreamy, easily confused, stares a lot

Under- rather than over-active

Lethargic, sluggish, slow moving

Slow information processing

Social withdrawal

Greater risk for anxiety

Reduced response to stimulants

research evidence on effectiveness of adhd treatments
Research Evidence on Effectiveness of ADHD Treatments
  • Medication more effective than psychosocial treatments in the short-term
  • Medication combined with psychosocial treatments the most effective
  • Best supported psychosocial treatments involve:
    • Contingency management/reinforcement approaches
    • Parent training
    • Integration of home and school-based approaches

Multimodal Cooperative Group (2004). National Institute of Mental Health Multimodal Treatment Study of ADHD follow-up: changes in effectiveness and growth after the end of treatment. Pediatrics, 113, 762-769.

research evidence on effectiveness of adhd treatments12
Research Evidence on Effectiveness of ADHD Treatments
  • Limitations of medication treatments
    • Problems with compliance to medication regimens
  • Limitations of psychosocial treatments
    • Failure to maintain post-treatment benefits
    • Failure to generalize to broader areas of life functioning
    • Failure to achieve long-term gains in academic achievement
    • Persistent deficits in executive functions, motivational deficits, and impairments in self-regulation

70-80% of adolescents with ADHD have significantly impairing symptoms

slide13
Need

Revised diagnostic criteria

Outcome measures that capture real-world functioning

Improving long-term efficacy and effectiveness outcomes in ADHD:

A treatment development workshop. March 12-13, 2007, Rockville, MD.

evidence based practice
Evidence-Based Practice

Professional

Expertise

Clinical

Decision

Making

Research

Evidence

Client

Evidence

barkley s definition of adhd
Barkley’s Definition of ADHD

ADHD consists of developmental deficiencies in the regulation and maintenance of behavior by rules and consequences. These deficiencies give rise to problems with inhibiting, initiating, or sustaining responses to tasks or stimuli and adhering to rules of instructions, particularly in situations where consequences for such behavior are delayed, weak, or nonexistent.

Barkley, R. (1990). Attention-deficit hyperactivity disorder: A Handbook for diagnosis and treatment. New York: Guilford, p.71.

slide16

Aspects of

Executive Functioning

Deficits in

Behavioral Inhibition

Result in deficits in

Deficits in

Nonverbal

Working Memory

Sense of time

Schema formation

Anticipatory set/hindsight

forethought

Complex imitations

Deficits in Verbal Working Memory/

Internalization of Speech

Rule-governed behavior

Reading comprehension

Moral reasoning

Deficits in

regulation of affect.

arousal, motivation

Emotional control

Perspective taking

Motivation/ persistence

Analysis and synthesis

Creativity

Deficits in

Problem-Solving

Barkley, R.A. (2005). ADHD and the nature of self-control. New York: Guilford.

Deficits in Goal-Directed

Behavior

other disorders
Other Disorders
  • Associated disorders: disorders that are a direct result of the ADHD
    • A result of the deficits in executive function; which may include deficits in theory of mind
  • Comorbid disorders: disorders that exist in addition to the ADHD
adhd and associated disorders
ADHD and Associated Disorders
  • Types of communication problems
    • Pragmatic deficits
      • As evaluated by the DSM-IV
        • Difficulty taking turns
        • Interrupt
        • Don’t listen to what is said
        • Excessive talking
      • Difficulties in introducing, maintaining, changing topics; failure to adjust language to listener
      • Scores on CCC-2 scales, Inappropriate Initiation and Social Relationships, differentiated children with ADHD from controls
        • No difference between children with ADHD and controls on speech, syntax
    • Discourse organization

Bruce, Thernlund, & Nettelbladt, 2006;Cameratia & Gibson, 1999; Geurts, et al, 2004; Nixon, 2001)

adhd and associated disorders19
ADHD and Associated Disorders
  • Reading problems
    • Failure to monitor comprehension
    • Failure to understand main ideas
    • Difficulty with inferencing
  • Failure to use language to regulate behavior and plan
  • Motor development and motor planning

(Barkley, 2005; McInnes, Humphries, Hogg-Johnson, & Tannock, Purvis & Tannock, 1997)

deficits in identifying emotions
Deficits in Identifying Emotions
  • Children with ADHD (7-13 years with no comorbid disorders)
    • less accurate than typical children in identifying the emotions of happiness, sadness, anger, and fear in pictures and in the tone of voice of an adult reading a sentence (Cadesky, Mota, & Schachar, 2000)
    • When shown photographs depicting joy, anger, disgust, and sadness in varying intensities, exhibited particular difficulty in identifying anger and sadness( Pelc, Kornreich, Foisy, & Dan, 2006).
    • Significant correlation between interpersonal problems and impairment in decoding emotional facial expressions.
  • Adults with ADHD had more difficulty identifying emotions compared to those adults without ADHD (Rapport, Friedman, Tzelepis, & Van Voorhis, 2002).
narrative comprehension in children with adhd
Narrative Comprehension in Children with ADHD
  • Fewer causal connections in stories
  • Difficulty establishing a goal (less frequent mention of initiating event)
  • Difficulty using causal, goal-based story structures to guide ongoing comprehension and later recall
  • Use more ambiguous reference
  • Include more extraneous information
  • Children with ADHD-only answer fewer inferential questions than children without ADHD
    • Children with ADHD +LI answer fewer literal and inferential questions

(Flory, et al, 2006; Lorch, et al, 2006; McInnes, Humphries, Hogg-Johnson and Tannock, 2003; Renz, et al, 2003)

adhd and comorbid disorders
ADHD and Comorbid Disorders
  • Externalizing disorders identified more with predominantly hyperactive-impulsive and combined types
    • Conduct disorder
    • Oppositional defiant disorder
  • Internalizing disorders identified more with predominantly inattentive type
    • Anxiety/depression
    • Speech/language disorders affecting phonology, syntax, semantics
    • Dyslexia (deficits in decoding and syntax)
stroop task
Stroop Task

Black

Blue

Red

Yellow

Green

Orange

persuasive writing
Persuasive Writing

Should Animals be used in a Circus

I think that animals at the circus should be able to do tricks because it is fun to see it and it looks very dangerous. Other people might not think that is a good idea, because the people are doing dangerous things. But they are triand to do that.

It is fun to see it. Becuase people are doing dangerous things like, makking lions jump through hoops.

It is dangerous and scary to see it, but people are trained to do it. It looks cool.

People have a lot of fun. People always cheer after ever trick. They are so happy to come.

In conclusion I think it is cool to have animals do tricks. Because it is fun to see it, and it has dangerous actors in it. People have a lot of fun there.

types of answers to qri questions
Types of Answers to QRI Questions
  • Failure to link ideas across a passage – making relational inferences
  • Failure to make causal inferences
  • Failure to parse syntax
  • Excessive elaboration or overreliance on prior knowledge
  • Failure to know a key vocabulary word
  • No response – did not answer

Dewitz, P., & Dewitz, P.K. (2003). They can read the words, but they can’t

understand: Refining comprehension assessment. The Reading Teacher,

56:5, 422-435.

the octopus 5 th grade concept questions
The Octopus – 5th gradeConcept Questions
  • What is an octopus?
    • A big creature with 8 legs
  • Why does an animal attack another animal?
    • Wants to eat it
  • What are animal defenses?
    • Pine needles, claws
  • What is animal camouflage?
    • So things can’t see it
  • Prediction
    • Octopus attacking humans
the octopus 5 th grade
The Octopus – 5th grade
  • Explicit questions
    • What is the favorite food of the octopus? (crabs)
    • How does the octopus move forward very rapidly when it is frightened? Pushes water from its body
    • What does the ink-like fluid do to the water? Makes it dark (not specific enough)
    • What is one color that an octopus can change to? Pink and blue
the octopus 5 th grade34
The Octopus – 5th grade
  • Implicit
    • What is this passage mainly about? An octopus and what it does when it’s scared or excited (relational inference across text)
    • Why doesn’t an octopus completely change color when it sees a crab? Don’t know (causal inference across text)
    • What color does an octopus probably become when it sees an enemy? Dark(relational inference from text)
    • Why might the shy octopus attack another creature? If hurt (over reliance on prior knowledge)
theory of mind emotion understanding
Theory of Mind & Emotion Understanding

Belief understanding does not guarantee emotion understanding; emotion understanding does not guarantee empathy; and empathy does not guarantee sympathy as manifested by kindness to people who are sad.

Davis, M., & Stone, T., (2003). Synthesis: Psycholgical understanding and social skills. In B. Repacholi & V. Slaugher (Eds.), Individual differentes in theory of mind: Implications for typical and atypical development (pp. 306-352). New York: Psychology Press.

slide36

Pons,R. Harris, P., & M. de Rosnay (2004). Emotion comprehension between 3-11 years : Developmental periods and hierarchical organization. European Journal of Developmental, 1, 127-152

Wellman, H.M. & Liu, D. (2004). Scaling of theory-of-mind tasks. Child Development, 75, 523-541.

slide37
Sad

Mind Reading: The Interactive Guide for Emotions

perceptual language distance
Perceptual-language distance

I

II

III

IV

perceptual

Matching

Perception

Selective

Analysis of

Perception

Reordering

Perception

Reasoning

about

Perception

language

distance

Blank, M., Rose, S.A., Berlin, L.J. (1978). The language of learning:

The preschool years. New York: Grune & Stratton.

early childhood alternative thinking
Johnny has been playing with this truck for a long time, all morning, and now Jimmy wants a chance to play with it. What can Jimmy do or say so he can have a chance to play with the truck?

Peter broke his mom’s favorite flower pot and his mom might be mad at him. What could Peter say or do so that his mom will not be mad?

Early Childhood (Alternative Thinking)

Spivack, G., Platt, J.J., & Shure, M.. (1976). The problem-solving approach to adjustment. San Francisco: Jossey-Bass.

middle childhood means end thinking
Middle Childhood (Means-End Thinking)

Child is told the beginning and end of a story and is asked to fill in the middle, tell what happens in between, or tell how the ending got to be that way.

Al (Joyce) moved into the neighborhood. He (she) didn’t know anyone and felt very lonely. The story ends with Al (Joyce) having many good friends and feeling at home in the neighborhood. What happens in between Al’s (Joyce’s) moving in and feeling lonely, and when he (she) ends up with many good friends.

Spivack, G., Platt, J.J., & Shure, M.. (1976). The problem-solving approach to adjustment. San Francisco: Jossey-Bass.

adolescence consequential thinking
Adolescence(Consequential Thinking)

George is in training. The football coach has a rule that all members of the team get to bed early during the week. George gets invited to a Tuesday night social in the next town by a girl he likes a lot. If he goes, he’ll end up getting to bed rather late. He would really like to go.

Tell everything that goes on in George’s mind and then tell what happens.

Spivack, G., Platt, J.J., & Shure, M.. (1976). The problem-solving approach to adjustment. San Francisco: Jossey-Bass.

conflict resolution
Conflict Resolution
  • John’s teacher assigned him to work with three other boys on a project for the science fair. The boy’s decided to build a model airplane that could actually fly. All of the boys, except one, a boy named Bob, worked hard on the project. Bob refused to do anything and just let the others do all the work. This bothered John very much. Now I’d like you to tell the story back to me.
  • Now I’d like to ask you some questions about the story.
  • What is the main problem?
  • Why is that a problem?
  • What is a good way for John to deal with Bob?
  • Why is that a good way for John to deal with Bob?
  • What do you think will happen if John does that?
  • How do you think they both will feel if John does that?

Nippold, M.A., Mansfield, T.C., Billow, J.L. (2007). Peer conflict explanations in children, adolescents, and adults: Examining the development of complex syntax. American Journal of Speech-Language Pathology, 1, 1798-188.

ways social skills affect academics
Ways social skills affect academics
  • Teacher-student relationships
    • Teacher may spend more time addressing child’s behavioral issues then teaching child academic concepts
  • Peer relationships
    • Child not selected for peer work groups
    • Child does not fully participate in learning groups
  • Ability to make inferences from texts
    • If child does not understand emotionality and temporal-cause/effect relationships in social situations, cannot use this information to build mental models for texts
specific targets outcomes
Specific targets/outcomes

Emotional Understanding

Problem

Solving

Temporal sequence & cause and effect

Non-verbal

cues

underlying principles explicit teaching
Underlying Principles:Explicit teaching
  • Repeated exposures
  • Variety of contexts
  • Practice in safety
developing episodic memory
Semantic memory: memory for words and concepts

Procedural memory: memory for how to do something

Episodic memory: memory for subjective experiences throughout time; ability to perceive the present moment as both a continuation of the past and as a prelude to the future.

Plan, Do, Review = Episodic Memory

Journal writing

Facilitates episodic memory

Take it home and share with the family

Culturally appropriate

Developing episodic memory

McGuigan, F., & Salmon, K. (2004). The time to talk: The influence of the timing of adult-child talk on children’s event memory. Child Development, 75, 669-686.

Tulving, E. (1993). What is episodic memory? Current Directions in Psychological Science, 2, 67-70.

outcomes focus on participation
Outcomes focus on participation
  • Capacity goal
    • Zach will identify when his clinician is indicating boredom.
  • Participation goal
    • Zach will make and keep a friend
    • Zach will invite a friend to a movie, arranging time, place and transportation
slide50

Emotional understanding

Problem

Solving

Temporal, cause/effect relationships

Noverbal cues

scripts and role plays
Scripts and role-plays
  • Teach the script to improve temporal sequencing
  • Cause/effect relationships that exist in that event (what to do when things change)
  • Must focus on emotionality as well
  • Non-verbal
thomas profile
Thomas profile
  • DX: Asperger’s/ High functioning ASD
  • High capacity
    • Introduces and maintains conversation topics
    • Appropriate eye contact
    • Appropriate questions
  • Can participate appropriately
  • Emotional understanding is an issue
    • Can choose to be appropriate but …”Mom, I’m done. I have to go home.”’
    • Believes everyone is against him
    • Can’t forgive others, ever!
  • Parent concerns
    • Differentiating between annoying and teasing
    • Okay to disagree with a friend but still be friends
k profile
K profile
  • Asperger’s
  • Normal language scores
  • Emotional understanding and script examples
    • “I want a snack and a friend”
    • “Ms. Robinson embarrassed me”
  • Parent concerns
    • Play in peace with her siblings
    • Listen and pay attention to others
value of scripts and role plays
Value of Scripts and Role-plays
  • Write out the script beforehand
  • Props act as cues and supports
  • Practice variations
  • Focus on emotions
  • Slow down the interaction
  • Problem solve solutions when things go wrong
  • Confederates both as role models and as troublemakers
  • Explicit teaching, debriefing is critical, more critical in establishing the episodic memory than the prep work
ryan s profile
Ryan’s profile
  • ADHD, possible Asperger’s
  • Low capacity
    • Poor narratives, comprehension, inference
    • Highly verbal
    • Not responsive
    • Appropriate social interactions very “scripted”
  • Parent concerns
    • Social interactions at school
    • Sharing
    • Accepting others’ ideas
    • Stay in own space
value of story enactment
Value of Story Enactment
  • Sequence of events, emotions, narrative
  • Range of language from immediate/concrete to remote/abstract
  • Story becomes the child’s experience, so promotes child’s episodic memory
cd profile
CD profile
  • Classic SLI
  • Highly motivated to participate
  • Lacks sophisticated emotional understanding
  • Takes over the conversation
  • Parent concerns
    • Let others talk about what they want to talk about
    • Let others talk!
value of videos
Value of Videos
  • Visual
  • Slow things down
  • Turn the sound off
  • Focus on the non-verbal cues
  • Watch it over and over again
  • Too subtle=too hard to figure out/start with the obvious and work towards subtle
  • Target what the child is actually doing in a non-threatening way
  • Funny/OTT or more subtle, depending on the needs of the client
conversation game
Conversation game
  • Brinton, B., Robinson, L., & Fujiki, M. (2004). Description of a program for social language intervention: "If you can have a conversation, you can have a relationship." Language, Speech and Hearing Research in the Schools, 35, 283-290.
cd again
CD, again
  • Classic SLI
  • Highly motivated to participate
  • Lacks sophisticated emotional understanding
  • Takes over the conversation
  • Parent concerns
    • Let others talk about what they want to talk about
    • Let others talk!
value of the conversation game
Value of the Conversation Game
  • Practice
  • Cause and effect
    • Pre-teaching
  • Conversational responsiveness
    • Checking in with the other person
    • Adjusting to the partner, changing
  • Balanced turn taking
  • Not static but dynamic, changing, flexible
measuring progress
Measuring progress:
  • 1-5 scale
    • Emotions
    • Content
    • Appropriate turn taking/responsiveness
    • Non-verbal cues
    • Amount of support needed from the clinician
  • Parent report
zach profile
Zach profile
  • Narratives
  • Content
  • On IEP for LD but no speech services
  • Parent concerns
    • Doesn’t have friends
    • Doesn’t understand that he isn’t acting like others
    • Loud and obnoxious
    • Acts like a younger child
jason profile
Jason profile
  • ADHD only
  • Academics
  • Social
    • Nice kid
    • No clue how long he talks
  • Parent concerns
    • Starting to run into academic problems
    • Behavior!
bibliography
Bibliography
  • American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.
  • Baker, L., & Cantwell, D.P. (1992). Attention deficit disorder and speech/language disorders. Comprehensive Mental Health Care, 2, 3-16.
  • Barkley, R.A. (2006). A theory of ADHD. In R.A. Barkley (Ed.), Attention-deficit hyperactivity disorder (pp.297-334). New York: Guilford.
  • Barkley, R.A. (2005). ADHD and the nature of self-control. New York: Guilford.
  • Beitchman, J.H., Brownlie, E.B., & Wilson, B. (1996). Linguistic impairment and psychiatric disorder: Pathways to outcomes. In J.H. Beitchman, N.J. Cohen, M. Konstantareas, & R. Tannock (Eds.), Language, learning and behavior disorders (pp. 493-514). Cambridge: Cambridge University Press.
  • Berk, L.E., Potts, M.K. (1991). Development and functional significance of private speech among attention-deficit hyperactivity disorder and normal boys. Journal of Abnormal Child Psychology, 19, 357-377.
  • Beitchman, J., Tuckett, M., & Bath, S. (1987). Language delay and hyperactivity in preschoolers: evidence for a distinct group of hyperactives. Canadian Journal of Psychiatry, 32, 683-687.
  • Brock, S.W., & Knapp, P.K. (1996). Reading comprehension abilities of children with attention-deficit/hyperactivity disorder. Journal of Attention Disorders, 1, 173-186.
  • Brown, T.E. (2006). Executive functions and attention deficit hyperactivity disorder: Implications of two conflicting views. International Journal of Disability, Development and Education, 53(1), 35-46.
  • Bruce, B., Thernlund, G., & Nettelbladt (2006). ADHD and language impairment. European Child and Adolescent Psychiatry, 15, 52-60.
slide66

Cadesky, E.B., Mota, V.L., & Schachar, R., (2000). Beyond words: How do children with ADHD and/or conduct disorder process nonverbal information about affect? Journal of the American Academy of Child & Adolescent Psychiatry, 39(9), 1160-1167.

  • Camarata, S.M., & Gibson, T. (1999). Pragmatic language deficits in attention-deficit hyperactivity disorder (ADHD). Mental Retardation and Developmental Disabilities Research Reviews, 5, 202-214.
  • Cantwell, D., & Baker, L. (1991). Psychiatric and developmental disorders in children with communication disorder. Washington, DC: American Psychiatric Press.
  • Cherkes-Julkowski, M. & Stolzenberg, J. (1991). Reading comprehension, extended processing and attention dysfunction. ERIC EJ427050.
  • Cohen, N., Menna, R., Vallance, D. (1998). Language, social cognitive processing, and behavioral characteristics of psychiatrically disturbed children with previously identified and unsuspected language impairments. Journal of Child Psychology and Psychiatry, 39, 853-864.
  • Denkla, M.B. (1994). Measurement of executive function. In G.R. Lyon (Ed.), Frames of reference for the assessment of learning disabilities: New views on measure issues (pp. 117-142). Baltimore: Brookes.
  • Flory, K., Milich, R., Lorch, E.P., Hayden, A.N., Strange, C., & Welsh, R. (2006). Online story comprehension among children with ADHD: Which core deficits are involved? Journal of Abnormal Child Psychology, 34, 850-862.
  • Gillam, R.B., & Pearson, N.A. (2004). Test of narrative language. Austin, TX: Pro-Ed.
  • Grodzinsky, G.M., & Diamond, E. (1992). Frontal lobe functioning in boys with attention-deficit hyperactivity disorder. Developmental Neuropsychology, 8, 427-445.
slide67

Hamlett, K.W., Pelligrini, D.S., & Conners, C.K. (1987). An investigation of executive processes in the problem-solving of attention deficit disorder-hyperactivity children. Journal of Pediatric Psychology, 12, 227-240.

  • Humphries, T., Koltun, H., Malone, M., & Roberts, W. (1994). Teacher-identified oral language difficulties among boys with attention problems. Journal of Developmental and Behavioral Pediatrics, 15, 92-98.
  • Kim, O.H., & Kaiser, A.P. (2000). Language characteristics of children with ADHD. Communication Disorders Quarterly, 21(3), 154-16.
  • Leslie, L., & Caldwell, J. (2005). Qualitative reading inventory—4. Boston: Allyn & Bacon.
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