Assessing speech,language and communication difficulties in children referred for ADHD: A qualitative evaluation of a UK child and adolescent mental health service
Restricted accessResearch articleFirst published online July, 2018
Assessing speech,language and communication difficulties in children referred for ADHD: A qualitative evaluation of a UK child and adolescent mental health service
Attention-deficit hyperactivity disorder (ADHD) is one of the most common childhood neuropsychiatric disorders and is highly comorbid with speech, language and communication difficulties (SLCDs). However, it is unclear how often SLCDs are identified in ADHD referrals in routine practice and whether there are unidentified SLCDs within this population.
Method:
A thematic analysis was conducted on a random sample of case notes from 18 referrals for ADHD made to a child and adolescent mental health service (CAMHS) in London, United Kingdom. Analyses aimed to identify (a) the types of SLCDs detected during assessment, (b) at which point of the episode of care these SLCDs were suspected and (c) whether a referral or consultation was made to a speech and language therapist (SLT) for further evaluation.
Results:
Out of 18 cases investigated, 15 were found to have possible SLCDs based on case notes and reports provided by external agencies. However, only four were referred by CAMHS for further assessment. It is unclear what, if any, steps other external agencies took. Themes describing types of SLCDs, comorbidities and the process of identification are discussed.
Conclusion:
The analysis of this service’s case notes revealed a range of different routes to the identification of SLCDs, and it was unclear what steps were taken as a result of assessment. A limitation is that this is just one service and the results may not generalise. However, given the similarity in practitioner training received across the country and that practitioners move from service to service, there are grounds for repeating the study in other services. We recommend a more structured approach to identifying SLCDs and recording assessment and treatment decisions made.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
2.
BakerL.CantwellD. (1992). Attention deficit disorder and speech/language disorders. Comprehensive Mental Health Care, 2, 3–16.
3.
BarkleyR. A. (1990). Attention deficit hyperactivity disorder: A handbook for diagnosis and treatment. New York, NY: Guilford Press.
4.
BarkleyR. A. (1997). Behavioural inhibition, sustained attention, and executive function: Constructing a unified theory of ADHD. Psychology Bulletin, 121, 65–94.
5.
BarkleyR. A. (1998). Attention-deficit hyperactivity disorder. Scientific American, 179, 44–49.
6.
BarkleyR. A.DuPaulG. J.McMurrayM. B. (1990). Comprehensive evaluation of attention deficit disorder with and without hyperactivity as defined by research criteria. Journal of Consulting and Clinical Psychology, 58, 775–789.
7.
BarkleyR. A.FischerM.EdelbrockC. S.SmallishL. (1990). The adolescent outcome of hyperactive children diagnosed by research criteria: I. An 8-year prospective follow-up study. Journal of the American Academy of Child & Adolescent Psychiatry, 29, 546–557.
8.
BeitchmanJ. H.NairR.CleggM.FergusonB.PatelP. G. (1985). Prevalence of psychiatric disorders in children with speech and language disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 25, 528–535.
9.
BeitchmanJ. H.TuckettM.BatthS. (1987). Language delay and hyperactivity in preschoolers: Evidence for a distinct subgroup of hyperactives. Canadian Journal of Psychiatry, 32, 683–687.
10.
BiedermanJ.NewcornJ.SprichS. (1991). Comorbidity of attention deficit hyperactivity disorder. American Journal of Psychiatry, 148, 564–577.
11.
BishopD. V. M. (1998). Development of the Children’s Communication Checklist (CCC): A method for assessing qualitative aspects of communicative impairment in children. Journal of Child Psychology and Psychiatry, 39, 879–891.
12.
BishopD. V. M. (2003). The Children’s Communication Checklist version 2 (CCC-2). London, England: Psychological Corporation.
13.
BishopD. V. M.SnowlingM. (2004). Developmental dyslexia and specific language impairment: Same or different?Psychological Bulletin, 130, 858–886.
14.
BraunV.ClakeV. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101.
15.
BruceB.TherlundG.NettelbladtU. (2006). ADHD and language impairment: A study of the parent questionnaire FTF (Five to Fifteen). European Child & Adolescent Psychiatry, 15(1), 52–60.
16.
CannonT. D.KellerM. C. (2006). Endophenotypes in the genetic analyses of mental disorders. Annual Review of Clinical Psychology, 2, 267–290.
17.
CohenN. J.DavineM.HorodezkyN.LipsettL.IsaacsonL. (1993). Unsuspected language impairment in psychiatrically disturbed children: Prevalence and language and behavioral characteristics. Journal of the American Academy of Child & Adolescent Psychiatry, 32, 595–603.
18.
CohenN. J.VallanceD. D.BarwickM.ImN.MennaR.HorosezkyN. B.IsaacsonL. (2000). The interface between ADHD and language impairment: An examination of language, achievement, and cognitive processing. Journal of Child Psychology and Psychiatry, 41, 353–362.
19.
DencklaM. B. (1996). A theory and model of executive function: A neuropsychological perspective. In LyonG. R.KrasnegorN. A. (Eds.), Attention, memory, and executive function (pp. 263–278). Baltimore, MD: Paul H Brookes Publishing.
20.
DockrellJ.MesserD. J. (1999). Children’s language and communication difficulties. London, England: Bloomsbury Publishing.
21.
ElliottC. D.SmithP.McCullochK. (1996). British Ability Scales: Second edition (BAS II): Administration and scoring manual. London, England: NFER-Nelson.
22.
ForresterA.OwensD. G. C.JohnstoneE. C. (2001). Diagnostic stability in subjects with multiple dimensions for psychotic illness. Psychological Medicine, 31, 151–158.
23.
FugardA. J. B.PottsH. W. W. (2015). Supporting thinking on sample sizes for thematic analyses: A quantitative tool. International Journal of Social Research Methodology, 18, 669–684.
24.
GargaroB. A.RinehartN. J.BradshawJ. L.TongeB. J.SheppardD. M. (2011). Autism and ADHD: How far have we come in the comorbidity debate?Neuroscience & Biobehavioral Reviews, 35, 1081–1088.
25.
HumphriesT.KoltunH.MaloneM.RobertsW. (1994). Teacher-identified oral language difficulties among boys with attention problems. Journal of Developmental and Behavioral Pediatrics, 15(2), 92–98.
26.
KadesjoB.GillbergC. (2001). The comorbidity of ADHD in the general population of Swedish school-age children. Journal of Child Psychology and Psychiatry, 42, 487–492.
27.
KesslerR. C.ChiuW. T.DemlerO.WaltersE. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62, 631–636.
28.
KimO. H.KaiserA. P. (2000). Language characteristics of children with ADHD. Communication Disorders Quarterly, 21, 154–165.
29.
LindsayG.DockrellJ. (2000). The behavior and self-esteem of children with specific speech and language difficulties. British Journal of Educational Psychology, 70, 583–601.
30.
LordC.RutterM.DiLavoreP. D.RisiS. (2001). Autism diagnostic observation schedule. Los Angeles, CA: Western Psychological Services.
31.
LordC.RutterM.Le CouteurA. (1994). Autism diagnostic interview – Revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24, 659–685.
32.
LoveA. J.ThompsonM. G. (1988). Language disorders and attention deficit disorders in young children referred for psychiatric services: Analysis of prevalence and a conceptual synthesis. American Journal of Orthopsychiatry, 58(1), 52–64.
33.
MansellW.HarveyA.WatkinsE.ShafranR. (2009). Conceptual foundations of the transdiagnostic approach to CBT. Journal of Cognitive Psychotherapy, 23, 6–19.
34.
MartinussenR.TannockR. (2006). Working memory impairments in children with attention-deficit hyperactivity disorder with and without comorbid language learning disorders. Journal of Clinical and Experimental Neuropsychology, 28, 1073–1094.
35.
National Collaborating Centre for Mental Health. (2009). The NICE guideline on diagnosis and management of ADHD in children, young people and adults. London, England: The British Psychological Society and The Royal College of Psychiatrists.
36.
Nolen-HoeksemaS.WatkinsE. R. (2011). A heuristic for developing transdiagnostic models of psychopathology: Explaining multifinality and divergent trajectories. Perspectives on Psychological Science, 6, 589–609.
37.
RapinI.AllenD. (1983). Developmental language disorders: Nosologic considerations. In KirkU. (Ed.), Neuropsychology of language, reading and spelling (pp. 155–184). New York, NY: Academic Press.
38.
RyanG. W.BernardH. R. (2003). Techniques to identify themes. Field Methods, 15, 85–109.
39.
SalmonG. (2004). Multi-agency collaboration: The challenges for CAMHS. Child and Adolescent Mental Health, 9, 156–161.
40.
StringerH.LozanoS. (2007). Under identification of speech and language impairment in children attending a special school for children with emotional and behavioural disorders. Educational and Child Psychology, 24(4), 9–19.
41.
TannockR. (2002). Language, reading, and motor control problems in ADHD. A potential behavioral phenotype. In GreenhillL. L. (Ed.), Learning disabilities, implications for psychiatric treatment (pp. 129–167). Washington, DC: American Psychiatric Press.
42.
TannockR.SchacharR. (1996). Executive dysfunction as an underlying mechanism of behaviour and language problems in attention deficit hyperactivity disorder. Language, Learning, and Behaviour Disorders: Developmental, Biological and Clinical Perspectives, 38, 128–155.
43.
TiroshE.CohenA. (1998). Language deficit with attention-deficit disorder: A prevalent comorbidity. Journal of Child Neurology, 13, 493–497.
44.
TomblinJ. B.MuellerK. (2012). Foreword: Exploring the comorbidity of attention-deficit/hyperactivity disorder and language, speech and reading disorders. Topics in Language Disorders, 32, 195–197.
45.
ToppelbergC. O.ShapiroT. (2000). Language disorders: A 10-year research update review. Journal of the American Academy of Child & Adolescent Psychiatry, 39, 143–152.
46.
TrautmanR. C.GiddanJ. J.JursS. G. (1990). Language risk factor in emotionally disturbed children within a school and day treatment program. Journal of Children Communication Disorders, 13, 123–133.
47.
WatsonD. (2009). Differentiating the mood and anxiety disorders: A quadripartite model. Annual Review of Clinical Psychology, 5, 221–247.
48.
WechslerD. (1991). Manual for the Wechsler Intelligence Scale for Children–third edition (WISC-III). San Antonio, TX: Psychological Corporation.
