Journal of Abnormal Child Psychology, Vol .25, No. 2, 1997, pp.

133-144

Language Abilities in Children with Attention Deficit

Hyperactivity Disorder, Reading Disabilities, and
Normal Controls

Karen L. Purvis1 and Rosemary Tannock2'3

Received August 22, 1995; revision received December 20, 1995;
accepted March 4, 1996

Research has demonstrated a high prevalence of language impairments (LI) and reading
disabilities (RD) in children with attention deficit hyperactivity disorder (ADHD). Since RD
is also associated with LI, it is unclear whether the language impairments are specific to
ADHD or associated with comorbid RD. The language abilities of ADHD children with and
without RD were investigated in a task requiring recall of a lengthy narrative, and in tests
assessing knowledge of the semantic aspects of language. The study was conducted with 50
boys—14 ADHD, 14 ADHD + RD, 8 RD, and 14 normal controls, aged 7 to 11. Children
with ADHD (ADHD-only, ADHD + RD) exhibited difficulties in organizing and monitoring
their story retelling. Children with RD (RD-only, ADHD + RD) demonstrated deficits in
receptive and expressive semantic language abilities on the language processing tests. The
comorbid group (ADHD + RD) exhibited the deficits of both ADHD and RD children.
The deficiencies of ADHD children are consistent with higher-order executive function defi-
cits while the deficits of RD children are consistent with deficits in the basic semantics of
language processing.
KEY WORDS: Attention deficit hyperactivity disorder; reading disorder; language abilities; narratives.

Attention deficit hyperactivity disorder (ADHD) communication/language disorders (Baker &

is characterized by persistent and developmentally in-
appropriate levels of inattention, impulsivity, and hy-
peractivity (American Psychiatric Association, 1994).
However, ADHD is a heterogeneous disorder which
exhibits marked overlap with other disorders (see Bied-
erman, Newcorn, & Sprich, 1991 for review). One class
of disorders for which children with ADHD appear to
be at risk, yet which often remains unrecognized, is
1Doctoral candidate, University of Toronto, Toronto, Ontario,
Canada.
2Department of Psychiatry Research, Hospital for Sick Children,
Toronto, Ontario, Canada M5G 1X8.
3Address all correspondence to Rosemary Tannock, Ph.D., De-
partment of Psychiatry Research, Hospital for Sick Children, 555
University Avenue, Toronto, Ontario M5G 1X8 Canada.
Cantwell, 1992; Beitchman, Tuckett, & Batth, 1987;
Cohen, Davine, Horodezky, Lipsett, & Isaacson,
1993; Love & Thompson, 1988; Tannock & Schachar,
1996).
Many of the studies of the language abilities of
children with ADHD have not distinguished between
children with ADHD alone (ADHD-only) and those
with comorbid disorders (e.g., Beitchman et al., 1987;
Love & Thompson, 1988), making it difficult to de-
termine whether the language impairments are spe-
cific to ADHD or whether they are more a function
of the comorbid disorder. In particular, a substantial
proportion of ADHD children also meet criteria for
a diagnosis of reading disability (August & Garfinkel,
1989; Dykman & Ackennan, 1991; Faraone et al.,
1993; Lambert & Sandoval, 1980; Semrud-Oikeman

133
<X»l-0627/97A>4aH>13»113<VO C 1997 Plenum Publishing Corporation
134
et al., 1992) which are also associated with language
impainnents (Hallahan & Kaufman, 1976; Lapadat,
1991).
The purpose of the present study was to examine
the pragmatic and semantic language abilities of chil-
dren with ADHD and to examine the impact of con-
current reading disabilities on their performance. The
inclusion of reading-disabled (RD) control groups
(ADHD + RD, RD-only) permits an examination of
the deficits due to ADHD and/or comorbidity with
RD. As well, the separate language measures should
permit us to examine the pragmatic communication
versus semantic language difficulties of ADHD chil-
dren. The task of story retelling was chosen because
it requires attention to the incoming information, ex-
traction of meaning and relevance, encoding of the
input into memory, and reconstruction from memory
using effort and judgment so that the information is
organized, coherent, and sensitive to the needs of the
listener. The ability to fulfil and coordinate the on-
going requirements while performing the task re-
quires, in addition to linguistic abilities, effortful
organization, planning, and self-monitoring, which in-
volve higher-order cognitive skills, referred to as "ex-
ecutive functions" (Douglas, 1988; Shallice, 1982).
The two tests of receptive and expressive semantic
language abilities were chosen as language measures
which do not have the additional executive function
requirements of planning and organization.
METHOD
Subjects
A total of 50 boys, aged 7 to 11 years, partici-
pated in the study. Of these, 14 boys had a confirmed
diagnosis of ADHD, 14 met the diagnosis of ADHD
and reading disability (ADHD + RD), eight had a
diagnosis of RD alone, and 14 children had no di-
agnosis (normal comparison). The children were part
of a larger study investigating the cognitive abilities
of children with ADHD (Schachar, Tannock, Mar-
riot, & Logan, 1995). The present study included
70% of the sample from the larger study. Subjects
were selected for the current study based upon age,
IQ, and diagnosis. Children with ADHD and/or RD
were recruited from children referred for behavior
problems to the psychiatric or pediatric outpatient
clinics at a children's hospital in a large metropolitan
urban area. The normal comparison group (NC) con-
Purvis and Tannock
sisted of children recruited from other medical out-
patient clinics at the same hospital for minor medical
problems or routine health checks. Only those chil-
dren without any history of behavioral or attentional
problems, nor any current medical, behavioral, or at-
tentional problems were eligible for the comparison
group. Any child whose estimated full-scale IQ was
less than 80 or who showed evidence of a neurologi-
cal disorder, poor physical health, uncorrected sen-
sory impairments, or a history of psychosis was
excluded. Four of the ADHD boys were receiving
psychostimulant medication. The remaining children
were being considered for an evaluation of stimulant
treatment. Medications were discontinued 48 hours
before the day of testing.
Measures
Diagnostic Measures
The diagnosis of ADHD was based on informa-
tion obtained from semi-structured interviews con-
ducted with the child's parents [Parent Interview for
Child Symptoms—Revised (PICS-R); Schachar &
Wachsmuth, 1989] and teacher [Teacher Telephone
Interview (TTI); Schachar & Tannock, 1990]. In both
the PICS-R and TTT, informants provided descrip-
tions of the child's behavior in various situations
specified by the interview (e.g., playing out of doors,
while watching television). The interviewer, rather
than the informant, made decisions about the pres-
ence of absence of symptoms by referring to specific
criteria regarding severity, frequency, age-appropri-
ateness, and level of disability resulting from the be-
havior. Interrater reliability for the PICS is high, with
agreement for diagnoses at 100%. Substantial inter-
rater agreement has also been obtained for diagnoses
based on the TTI: ADHD (K = .76), oppositional de-
fiant disorder (ODD) (K = .76), and conduct disorder
(CD) (K = .83) (Schachar et al., 1995). To be classi-
fied as ADHD, children had to meet the severity and
age-of-onset criteria in the Diagnostic and statistical
manual of mental disorders (3rd ed., rev.) (DSM-III-R;
American Psychiatric Association, 1987). ADHD was
diagnosed if eight or more ADHD symptoms were
reported by either parents (PICS) or teacher (TTI)
with onset before 7 years of age and with persistence
of more than 6 months.
The diagnosis of reading disability was based on
a combined formula approach recommended by
Language Abilities in ADHD and RD
Barkley (1990), which requires an achievement score
of at least 1.5 SD below the mean for age, plus a
discrepancy of at least 1.0 SD between that achieve-
ment score and the child's full scale IQ score. All
subjects were administered the Vocabulary and Block
Design subtest of the Wechsler Intelligence Scale for
Children—Revised (WISC-R; Wechsler, 1974) as an
estimate of verbal and nonverbal intelligence (Sat-
tler, 1988) as well as all three subtests of the Wide
Range Achievement Test—Revised (WRAT-R; Jastak
& Wilkinson, 1987). In this study, the Reading sub-
test of the WRAT-R was used to define reading dis-
ability.
Language Measures
Three measures of language ability were se-
lected. The first was a story retelling task which re-
quired the comprehension and use of extended
stretches of language. The other two measures were
standardized measures of receptive and expressive
abilities involved in the semantic aspects of language.
Story Retelling Task. One folk tale was selected
as stimulus material for this task. This story was un-
familiar to the children in the study but had been
used in prior studies on story recall in normal chil-
dren (Brown, Day, & Jones, 1983; Brown & Smiley,
1977; Smiley, Oakley, Worthen, Campione, & Brown,
1977) and ADHD children (Tannock, Purvis, &
Schachar, 1993). The folk tale, "The Father, His Son
and Their Donkey," originated from an oral tradition
and was intended to be read aloud to children. The
story was audiotaped at a normal rate for speaking
or reading aloud, at approximately 100 words/minute
and narrated by a female voice. The story was 2 min,
56 s, in length and involved multiple characters and
sequences of events which made it too long and de-
tailed to be recalled verbatim. Thus retelling re-
quired the selection and organization of relevant
information.
The story had been divided into individual units.
A unit was defined as one which contained an idea
and/or represented a pausal unit. Each unit was rated
(using a 4-point scale) for its importance to the struc-
ture and theme of the story as a whole by Brown
and colleagues in a previous study (Brown et al.,
1983), following a procedure used by Brown and
Smiley (1977), developed by Johnson (1970).
The story contained 427 words, and 63 pausal
units, and scored 5.2 on the Dale-Chall Readability In-
135
dex (Dale & Chall, 1948). The number of units at each
of the four levels, from most to least important were
16,16,16, and 15, respectively, and occurred approxi-
mately equally often in each quarter section of the
story. Recall of important units would therefore not
be contaminated by primacy or recency effects (Brown
& Smiley, 1977).
Story Measures. Retelling a story involves two ba-
sic steps. First the child must attend and comprehend
the story. Second, he or she must try and reproduce
the narrative. For this reason, the children's perform-
ances were assessed along these two basic dimen-
sions, comprehension and production.
• Comprehension. Two measures were used to as-
sess children's comprehension of the story. The
first was selective recall as a function of the pre-
judged thematic importance of the story units.
The second was a comprehension score based
on children's responses to a series of factual and
inferential questions which were derived from
units of information central to the theme of the
story.
Selective recall was defined as the num-
ber of idea units correctly recalled at each of
the four levels of importance. This was con-
verted to a proportion of the total number of
units at each level, to remain consistent with
previous research. The ability to focus on im-
portant aspects of the story rather than non-
essential material is an essential cognitive
process for comprehension of written or audi-
torily presented information (Smiley et al.,
1977). Thus it is the pattern of recall (rather
than the absolute amount) which indicates
comprehension.
Responses to the comprehension ques-
tions were rated as correct (score 2),partially
correct (score 1), or incorrect (score 0), yield-
ing a maximum score of 10. The questions
were included as a supplement to the selec-
tive recall measure because it was considered
possible that the children could exhibit com-
prehension by answering when prompted with
a question but not spontaneously produce the
information during free recall of the story.
Production. Two aspects of children's produc-
tion of narratives were assessed. The first was
overall productivity (total amount recalled) and
the second was the adequacy of the children's
organization and self-monitoring of their output.
136
Organization and self-monitoring were assessed
in terms of unrepaired errors made by children
during their story reconstructions. Errors left un-
repaired reflect a lack of ongoing self-monitor-
ing of the accuracy of the child's own output.
Four types of errors were analyzed: (a) errors
in sequencing story events, (b) ambiguous ref-
erences, (c) misinterpretations, and (d) inappro-
priate word substitutions. The number of errors
of a specific type were computed as a proportion
of the total number of story units recalled by
the child to control for differences in total out-
put. Definitions and examples of each of these
coding categories are provided in the appendix.
Retelling story events out of sequence re-
flects a breakdown in the global organization
of the story theme. Referring back to prior
events via the use of pronominal references
requires a complex organization of ideas to
maintain the distinction between characters,
events, and their relationships, for the clari-
fication of the listener (Liles & Purcell, 1987).
Ambiguous references thus reflect cohesion
problems with the local organization of infor-
mation across sentences (Fine, 1985; Liles &
Purcell, 1987). Misinterpretations are seman-
tic departures from the original text that vio-
late text veracity (i.e., inaccurate information
that alters the text's primary meaning). These
reflect a breakdown in the process of self-
monitoring the accuracy of the information.
However, they must be interpreted in light of
the child's comprehension of the story. That
is, if comprehension is poor, misinterpreta-
tions may in fact be due to poor comprehen-
sion. However, if comprehension is adequate,
misinterpretations may be viewed as deficits
in self-monitoring of the output at the propo-
sition level. Inappropriate word substitutions
(e.g., nuns substituted for maidens) also re-
flect a breakdown in self-monitoring of the
accuracy of information but is at the word
level rather than the proposition level. Leav-
ing unrepaired these inaccuracies that violate
text veracity reflects a failure to actively
monitor meanings within and across sen-
tences (Liles & Purcell, 1987).
The Word Test. The Word Test (WT, Jorgeson,
Barrett, Huisingh, & Zachman, 1981) is a stand-
ardized measure of children's expressive vocabulary
Purvis and Tannock
and semantic abilities. Five of the six available sub-
tests were administered to the children. These in-
cluded (1) Associations, where the subject must
choose the one word from four that does not belong
and then explain his/her choice in relation to the
category of the other three words; (2) Synonyms,
where the subject must express a one-word synonym
for each stimulus item; (3) Semantic Absurdities,
which measures the ability to identify and express
what is wrong with an absurd statement; (4) Anto-
nyms, where the child must give a one-word opposite
for each stimulus item; and (5) Multiple Definitions,
where the child must give two meanings for each test
word.
Language Processing Test. The Language Process-
ing Test (LPT, Richard & Hanner, 1985) is a stand-
ardized measure of the semantic aspects of language
which taps the ability to analyze, organize, and asso-
ciate linguistic units. Three of the six available sub-
tests were chosen, including (1) Similarities, where the
subject must compare the properties of two items,
identity the primary common aspects, and describe
how they are alike; (2) Differences, which taps the
ability to contrast two items by identifying the primary
aspects of item variance and tell how the two objects
are not alike; and (3) Multiple Meanings, which re-
quires the child to recognize and define a word in
varying contexts using language strategies to select ap-
propriate synonyms or definitions by giving up to four
definitions for each stimulus word.
Procedure
Children were tested individually in one session
in a small quiet room. The instructions for the story
retelling task were to listen carefully to the story so
that each child could retell it in his or her own words
for the next child coming to the study. The children
were also told that their stories would be recorded
and that afterwards they would be asked questions
about the story. Details of the procedure and data
preparation including transcription and coding can be
found in Tannock et al. (1993). Interrater agreement
for the story units, based on point-to-point correspon-
dence and averaged across importance levels, was .91.
Interrater reliability for story errors was .95. All dis-
agreements were resolved through discussion prior to
data entry and analysis. The children were then ad-
ministered the subtests of The Word Test and Lan-
guage Processing Test. Diagnostic interviews with
Language Abilities in ADHD and RD 137

Table I. Selection Criteria and Clinical Characteristics of the Sample0

F-values and significance
(df = 1,46)"
Controls RD ADHD ADHD + RD ADHDx
(14) (8) (14) (14) ADHD RD RD

Age 9.2 (1.4) 9.3 (1.9) 8.7 (1.4) 8.7 (1.3)

WISC-R
Estimated IQ 109.0 (8.1) 102.8 (11.4) 104.9 (9.4) 101.6 (12.2)
Vocabulary 11.6 (1.8) 8.1 (2.8) 10.6 (2.2) 9.2 (2.6) 12.5d
Block Design 11.6 (Zl) 12.9 (3.3) 11.1 (2.1) 11.4 (2.7)
WRAT-R
Reading 100.9 (9.8) 71.0 (7.1) 101.1 (9.5) 68.9 (9.4) 129.5*
Spelling 91.1 (11.9) 74.2 (6.5) 92.6 (14.3) 68.6 (9.3) 40.0"
Arithmetic 95.3 (13.9) 87.2 (7.3) 93.3 (7.6) 81.6 (15.7) 7.T1
Parent and Teacher Diagnostic Variables and Cutoff Scores

Parent
Hyperactivity 0.6 (0.7) 1.8 (2.5) 11.0 (2.4) 9.1 (4.2) 92.4'
Oppositional defiant 0.7 (1.1) 0.6 (1.5) 4.7 (2.O) 32 (Z8) 25.5*
Conduct disorder 0.1 (0.3) 0.1 (0.4) 1.6(1.4) 1.8(1.7) 16.4B
Teacher
Hyperactivity 0.7 (1.0) 3.7 (1.7) 11.4 (2.2) 9.4 (Z8) 130.8* ViSf-"
Oppositional defiant 0.8 (1.9) 0.5 (1.2) 3.6 (2.3) 3.1 (3.4) 14.6'
Conduct disorder 0.0 (0.0) 0.0 (0.0) 1.4 (1.6) 1.5 (1.9) 8.&
'Values given as means and standard deviations (in parentheses). ADHD = attention deficit hyperactivity disorder, RD = reading
disability.
6Missing data for some subjects; for parent ratings (df = 1,40), controls, n = 9, RD, n = 7, ADHD, n = 14, ADHD + RD, « = 14;
for teacher ratings; (df = 1,38), controls, n = 9,, RD, n = 6, ADHD, n = 14, ADHD + RD, n = 13.
cPost hoc comparison of RD and contro groups, and post hoc comparison of ADHD and ADHD + RD groups not significant.
dp < .01.
'p < .001.

last factor. Story errors were analyzed using a 2

parents were conducted on the same day as the chil-
(ADHD) x 2 (RD) multivariate analysis of variance
dren's testing. Telephone interviews with teachers
(MANOYA) on the four error types. Scores on the
were conducted within 1 to 2 weeks before or after
two standardized language tests were analyzed sepa-
the testing session. Testing was conducted blind to
rately in 2 (ADHD) x 2 (RD) x 5 (WT subtests) and
each child's diagnosis.
2 (ADHD) x 2 (RD) x 3 (LPT subtests) MANOVAS.
Univariate analyses and post-hoc comparisons of
Analysis pairs of group means (Tukey Honestly Significant
Difference Test; Keppel, 1982) were conducted to
Diagnostic and sample characteristics were ana- clarify any main effects and interactions.
lyzed using the analysis of variance (ANOVA) pro-
gram in the windows version of the Statistical
Package for the Social Sciences with two between- RESULTS
subjects factors: 2 (ADHD) x 2 (RD). Analysis of
comprehension (proportion of idea units recalled as Age and IQ
a function of their structural level of importance) was
analyzed using a 2 (ADHD) x 2 (RD) x 4 (Impor- The four groups did not differ in age, estimated
tance Level) ANOVA with repeated measures on the IQ, or Block Design scores of the WISC-R. A sig-
 138
Fig. 1. Mean proportion of story units recalled by normal control, RD, ADHD, ADHD +
RD groups as a function of prejudged level of thematic importance. RD = reading disability,
ADHD = attention deficit hyperactivity disorder.
nificant main effect of RD was found on the Vocabu-
lary scores of the WISC-R, indicating that the RD
groups (RD and ADHD + RD) scored lower on this
subtest than the non-RD groups (NC and ADHD).
Means, standard deviations, F-values, and signifi-
cance for these data and diagnostic measures are
presented in Table I.
Diagnostic Measures
As expected, children who were selected to be
in the ADHD groups (ADHD, ADHD + RD) had
significantly higher ADHD scores on both the parent
and teacher measures than children in the non-
ADHD groups (RD and normal controls) (Table I).
The average number of positive symptoms (out of a
total of 14) for the ADHD group was 11 on both
parent and teacher interviews. The average number
of positive symptoms for the ADHD + RD group
were nine on both interviews. No interaction between
ADHD and RD status was found for parent meas-
ures; however, an interaction was found for teacher
scores of ADHD symptoms. Post-hoc Tukey analysis
did not reach significance, but an examination of the
means revealed that the pure-RD children had
slightly more teacher-identified symptoms of ADHD
than normal controls. Thus the ADHD and ADHD
+ RD groups did not differ significantly in severity
Purvis and Tannock
of ADHD symptomatology. Similarly, the RD and
NC groups did not differ significantly from each
other. These findings validate our diagnostic proce-
dures and indicate that comorbidity was not con-
founded with severity.
Similar main effects of ADHD diagnosis were
found for severity of ODD and CD symptomatology
(Table I). Thus the ADHD groups differed from the
non-ADHD groups in the severity of ODD/CD
symptomatology. In the pure-ADHD group, three
children met criteria for a diagnosis of ODD, and six
met criteria for a diagnosis of CD. In the ADHD +
RD group, one child met the diagnosis for ODD and
eight children met criteria for CD. A chi-square test
for the difference in the distribution of ODD/CD di-
agnoses between the ADHD and ADHD + RD
groups revealed no significant differences. No child
in either the normal controls or the pure-RD group
met criteria for a further diagnosis.
With respect to academic achievement, signifi-
cant main effects of RD were found for the three
subtests of the WRAT-R (Reading, Spelling, and
Arithmetic), indicating the RD groups (RD and
ADHD + RD) scored significantly lower than the
non-RD groups (ADHD and normal controls) on all
three subtests. No significant interactions were
found. These results again validate the diagnostic
procedures by indicating that academic achievement,
 Language Abilities in ADHD and RD
fig. 2. Mean proportion of errors produced by all groups during story recall. RD =
reading disability; ADHD = attention deficit hyperactivity disorder.
particularly reading, was equated within the RD and
non-RD groups.
Story Retelling—Comprehension
The primary measure of comprehension was se-
lective recall. The mean proportion of units recalled
by the four groups of children at each level of im-
portance are illustrated in Fig. 1. This figure shows
that the control, ADHD, and ADHD + RD groups
exhibited a similar pattern of recall, although the
normal children tended to recall more at each level
of importance. Thus these three groups recalled
more of the theman'calry important information than
the minor details. The pure-RD group, as shown in
Fig. 1, appeared to have a different pattern of recall
from the other three groups, recalling fewer of the
most important units of information (level 4). They
did not recall increasingly more information units as
importance level increased.
Statistical analysis of these results revealed no
significant interactions or main effects for group. As
expected, a significant effect of level [F(3, 138) =
29.00, p < .001] was found. Post-hoc Tukey compari-
sons among the means for importance levels revealed
that children recalled proportionately more of the
most important units (levels 4 and 3) than the least
important (levels 2 and 1) but there was no signifi-
139
cant difference in the recall of levels 4 and 3, or be-
tween levels 2 and 1.
The mean comprehension question scores (out
of a possible 10) for the ADHD, ADHD + RD, RD,
and control groups were 5.4,5.8, 4.9, and 6.4, respec-
tively. Although the RD-only children obtained the
lowest scores, the analysis revealed no significant dif-
ferences between the groups.
Story Retelling—Production
Verbal Productivity. As illustrated in Fig. 1, the
normal controls appeared to recall proportionately
more total idea units than the other three groups.
The proportion of idea units for the ADHD, ADHD
+ RD, RD, and NC groups were .27, .28, .24, and
.36, respectively. This trend was indicated by a non-
significant interaction between the ADHD and RD
groups [F(l, 46) = 3.40, p = .072].
Organization and Monitoring. The mean propor-
tion of error types as a function of diagnostic group
are illustrated in Fig. 2. The overall MANOVA indi-
cated a three-way interaction between ADHD, RD,
and error type [F(3,138) = 4.69, p < .01]. Therefore
errors were analyzed separately in 2 (ADHD) x 2
(RD) ANOVAs. Significant main effects of ADHD
diagnosis were found for sequence errors [F(l, 46)
= 5.7, p < .05], misinterpretations [F(l, 46) = 4.5,
 140 Purvis and Tannock

Table II. Mean Scores on the Word Test (WT) and Language Processing Testa
F-values and significance (WT, df
= 1,37; LPT, df = 1,36)
ADHDx
Controls RD ADHD ADHD + RD ADHD RD RD
The Word Test
Associations 51.9 (63) 44.2 (8.8) 50.1 (2.8) 47.8 (7.6)
Synonyms 50.8 (6.0) 43.8 (45) 50.6 (4.0) 47.9 (4.0)
Semantic Absurdities 51.6 (4.6) 42.7 (6.1) 49.8 (5.2) 47.8 (3.4)
Antonyms 48.6 (4.3) 44.0 (4.3) 51.4 (4.4) 47.4 (2.8)
Multiple Definitions 50.4 (4.6) 41.0 (5.4) 48.4 (4.6) 46.6 (4.3)
Mean score 605 (3.9) 43.2 (5.0) 50.0 (22) 47.6 (3.2) 18.6e 45C
Language Processing Test
Similarities 52.7 (65) 45.0 (9.9) 51.8 (6.8) 49.5 (9.9)
Differences 50.9 (5.3) 43.8 (9.4) 50.8 (8.1) 46.5 (8.9)
Multiple Meanings* 48.9 (10.3) 40.5 (85) 46.3 (5.2) 425 (3.6)
Mean score 50.8 (5.4) 43.1 (8.6) 49.6 (5.0) 46.2 (6.1) 7.3d
"Values given as cans and standard deviations (in parentheses) T-scores, mean = 50, SD = 10 (WT); 15 (LPT. Missing data for some
subjects; the Word Test controls, n = 9., RD, n = 4, ADHD, n = 14, ADHD, n = 14; Language Processing Test ADHD + RD, n
= 13. RD = reading disability; ADHD = attention deficit hyperactivity disorder.
^Scores on this test significantly lower than the combined scores of Similarities and Differences.
cp < .05.
*p < .01.
'p < .001.

with the pure-RD children scoring lower than the

p < .05], and substitutions [F(l, 46) = 5.2, p < .05],
normal controls. A significant main effect for RD
indicating that the ADHD groups (ADHD, ADHD
\F(1, 37) = 18.65, p < .001] was also found, indicat-
+ RD) made more of these errors than the non-
ing that the RD groups (RD and ADHD + RD)
ADHD groups. A significant ADHD x RD interac-
scored significantly lower than the non-RD groups
tion was found for ambiguous references [F(l, 46) -
(normal controls and ADHD). No other main effects
7.6, p < .01]. Post-hoc analyses of the four groups
or interactions were found.
revealed that the pure-ADHD and pure-RD groups
Language Processing Test. Again, a significant
made significantly more ambiguous references than
main effect for reading disability [F(l, 36) = 7.3, p
normal controls. No differences in ambiguous refer-
< .05] was found, indicating that the RD groups (RD
ences were found between the two ADHD groups
and ADHD + RD) scored significantly lower than
(ADHD and ADHD + RD) or between the two RD
the non-RD groups (normal controls and ADHD).
groups (ADHD + RD and RD).
No interactions between ADHD and RD diagnostic
status or subtests were found. A significant main ef-
The Word Test and Language Processing Test fect of subtest was found [F(2, 72) = 6.0, p < .01].
Post-hoc tests found that all children scored lower on
Word Test. Means and standard deviations for the Multiple Meanings subtest than on the Similari-
The Word Test and Language Processing lest are ties and Differences subtests.
presented in Table II. The overall MANOVA for The
Word lest revealed a significant ADHD x RD inter-
action [F(l, 37) = 4.5, p < .05]. Although post-hoc DISCUSSION AND CONCLUSIONS
Tukey tests for this interaction did not reach signifi-
cance, an examination of the means suggests that the The results revealed two central findings con-
interaction occurred within the non-ADHD groups, cerning the language abilities of ADHD children
 Language Abilities in ADHD and RD
with and without reading disabilities. First, children
with ADHD, regardless of RD status, exhibited dif-
ficulties in organizing and monitoring their verbal
productions. Second, children with RD, regardless of
ADHD status, demonstrated deficits in receptive and
expressive semantic language abilities. In other
words, difficulties in story organization and self-
monitoring of the accuracy of the information as re-
flected in story errors were affected by ADHD status,
whereas deficits in semantic aspects of language were
affected by RD status. The comorbid group (ADHD
+ RD) generally exhibited the deficits of both pure
groups (ADHD-only and RD-onty).
The difficulties of ADHD children in organizing
their productions as reflected in story errors are con-
sistent with previous research (Tannock et al., 1993).
The ADHD groups exhibited a higher frequency of
sequence errors, which reflects a breakdown in the
global organization of story theme. The pure-ADHD
group had difficulties in local organization, reflected
in ambiguous references. These are failures in cohe-
sion which make it difficult for the listener to follow
the speaker's train of thought Ambiguous references
can result from a failure to organize and monitor the
cohesion between sentences, as well as from a failure
to take into account the needs of the listener. Both
the pure-ADHD and ADHD + RD groups were
more likely to misinterpret information and to use
inappropriate word substitutions. These two error
types occurred in the absence of comprehension
problems; therefore they are interpreted to reflect a
failure to monitor the accuracy of the information.
These errors reflect pragmatic difficulties with lan-
guage use. The inability to relate ideas specifically
and accurately in a logical sequence results in dis-
unity in discourse and makes comprehension by the
listener difficult (Prutting & Kirchner, 1987).
In contrast to the RD groups (RD and ADHD
+ RD), the ADHD-only group did not show deficits
in the receptive or expressive, semantic aspects of
language. Unlike the narrative task, The Word lest
and the Language Processing lest did not require
lengthy responses with demands for self-organization.
Thus the language deficits of ADHD children with-
out RD seem to reflect difficulties with language use
(i.e., pragmatics) rather than deficits in the basic sub-
systems of language (i.e., phonology, semantics and
syntax). A wide range of pragmatic difficulties, such
as difficulties in maintaining a conversation or turn
taking during conversations (Humphries, Koltun,
141
Malone, & Roberts, 1994; Zentall, Gohs, & Culatta,
1983) have been demonstrated in ADHD children.
The pragmatic difficulties of ADHD children
may be related to the higher-order cognitive deficits
referred to as "executive functions" (Barkley, 1994;
Benson, 1991; Douglas, 1988; Hamlett, Pellegrini, &
Connors, 1987; Mattes, 1980; Pennington, Groissser,
& Welsh, 1993; Schachar, Tannock, & Logan, 1993;
Shue & Douglas, 1992). Executive functions are self-
regulatory processes which are responsible for the or-
ganization and monitoring of information processing,
mobilizing attention, and inhibiting responding
Douglas, 1988; (Goldman-Rakic, 1987; Luria, 1966).
The problems in self-regulation are not problems of
knowing what to do, but rather in doing what is known
(Kinsbourne, 1989). The story used in this study was
complex (many characters and events) and was not
logically sequenced. This increases the demands on
the child's executive processes, requiring self-directed
effort, planning, and organization. Thus it may be
deficits in executive function rather than deficits in
the fundamental subsystems of language (i.e., pho-
nology, semantics, and syntax) that accounted for the
pragmatic difficulties of the ADHD children (Tan-
nock & Schachar, 1996).
Impairments in these basic language subsystems
are more closely associated with RD than with
ADHD (Ackerman, Dykman, & Gardner, 1990; Au-
gust, 1987; August & Garkinkel, 1989; Felton, Wood,
Brown, Campbell, & Harter, 1987; Tannock, Corkum,
Schachar, & Purvis, 1994; Tannock et al., 1993;). The
findings of deficits on the language processing tests
supported this general conclusion, since children with
a diagnosis of RD (ADHD + RD, RD-onty), scored
significantly lower than children with adequate read-
ing skills (normal controls, ADHD).
In this study, no differences were found between
groups in comprehension of the story as reflected in
the selective recall of levels of importance or in the
comprehension questions scores. Previous narrative
studies have found a lack of sensitivity to the impor-
tance of information in children with learning dis-
abilities (Hansen, 1978; Smiley et al., 1977; Worden
& Nakamura, 1982), but not in ADHD children
(O'Neill & Douglas, 1991; Tannock et al., 1993; Zen-
tall, 1988). The present findings are consistent with
previous research, with the pure-RD children recall-
ing fewer of the most important units of information;
however, the sample size may have been too small
to permit detection of differences.
 142
In contrast to the language deficits on the lan-
guage processing tests, the children with RD did not
exhibit difficulties organizing their story retelling in
an accurate, logical sequence. However, the pure-RD
children did have particular difficulties with referen-
tial cohesion as reflected in the number of ambigu-
ous references. Previous research has supported the
finding that children with RD and language-disor-
dered children have particular difficulties with refer-
ential cohesion even in the absence of
comprehension difficulties (Lapadat, 1991), but no
difficulties with sequencing story information when
the story is meaningfully structured (Feagans &
Short, 1984; Graybeal, 1981; Montague, Maddus, &
Dereshivksy, 1990; Worden & Nakamura, 1982).
The deficits of the comorbid group (ADHD +
RD) relative to the two pure groups allows for an
examination of the basis for comorbidity. There is
considerable debate in the literature as to whether
this group has the core cognitive deficits of RD-onty
children, ADHD-only children, or both (i.e., Fergus-
son & Horwood, 1992; Pennington et al., 1993; Shay-
witz et al., 1995). In this study, the ADHD + RD
children were found to have the most of the deficits
of both pure groups. However, there was some indi-
cation that this group was less impaired on the lan-
guage measures than pure-RD children. The ADHD
+ RD group did not differ from normal controls in
ambiguous references and the pure-RD children
seemed to be the most impaired on The Word lest.
In addition, the RD group tended (albeit nonsignifi-
cantly) to be the least sensitive to importance levels
in the story retelling task. It is possible that the basis
for the reading disability in ADHD + RD children
is somewhat different than for its presence in pure-
RD children. One limitation of this study was that it
could not measure phonological processing.
Phonological abilities are widely recognized as the
core deficit in reading disabilities (e.g., Stanovich,
1988) and may have differentiated between the
ADHD + RD and pure-RD groups.
A recent study which addressed issues relating
to classification and definition with a large cohort of
RD, ADHD, and ADHD + RD children found that
children with both ADHD and RD did indeed ex-
hibit difficulties within the language system (includ-
ing phonological awareness) characteristic of
children with RD only. Thus it appears that many
children with comorbid ADHD and RD diagnoses
exhibit the characteristics of both pure disorders.
This issue is also being addressed by the authors in
Purvis and Tannock
a current study with a similar design and comparable
populations.
From a clinical perspective, these results suggest
a need to emphasize different aspects of language in
the instruction and remediation of children in the
different diagnostic categories. In particular, pure-
ADHD children would benefit from instruction in
self-monitoring and awareness of language use in
language contexts which are beyond the sentence
level. Children with RD would benefit from instruc-
tion in the semantic aspects of language, including
the ability to analyze, categorize, and associate the
meanings of words in a language. The finding that
children with both ADHD and RD exhibited the
deficits of both pure groups suggests that remedia-
tion should be directed to both types of difficulties.
APPENDIK
Error code Explanation
Sequence error Idea unit is retold in a different order than
in the original story,
so that the story theme is affected (e.g.,
"The father gets off the
donkey and then hoists his son up behind
him"). It is not scored
if an item is simply omitted and the story
continues in order.
Misinterpretation Meaning of an action or event is
incorrectly interpreted, (e.g., in
the original story the father hoists his son
up behind him on the
donkey, whereas the child interprets the
event as the father gets
off and then the son gets on).
Substitution A word for an object, character, or event
in the original story is
replaced with an inappropriate word (i.e.,
not a synonym). For
example, nuns is substituted for maidens, pond
is substituted for aver.
Ambiguous A pronoun is not linked to a specific
reference character or event so that its
referent is ambiguous. For example, in the
sentence "The father
and son were on the donkey and then he
got off," it is not
known whether the pronoun "he" refers to
the father or the son.
 Language Abilities in ADHD and RD
ACKNOWLEDGMENTS
This research was supported by grants from
Health and Welfare Canada (NHRDP) awarded to
Drs. Schachar, Tannock, and Logan, and from the
Medical Research Council of Canada awarded to
Drs. lannock, Schachar, and Logan. The study is
based in part on a Master's thesis completed by
Karen Purvis at the University of Toronto. The
authors gratefully acknowledge Michael Marriott and
Patricia Fulford for their assistance with data collec-
tion.
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