Dennis Cantwell and Lorian Baker (1991) studied the overlap between language disorders and ADHD in preschoolers referred to a clinic for speech or language problems. Almost all had serious problems relative to others of their age in being able to understand what was said to them or in being able to use verbal language to express themselves. Nineteen percent of these children with speech or language impairments also met diagnostic criteria for ADD, almost fourfold the baseline incidence of ADD reported at that time in the general population.
Joseph Beitchman and others (1996) did a longer-term study of preschool children with language disorders. In that sample, too, ADHD was found to be the most common psychiatric disorder, occurring in 30 percent of the preschoolers who had speech or language disorders. Findings from Beitchman's long-term study showed that children with impaired language function at age five were much more likely than others to have a psychiatric disorder at age twelve. Children with severe difficulty in using language and in understanding what others say to them are more likely to have significant behavioral problems; they are also likely to have poorer social skills. Communication difficulties may thus contribute eventually to failure in school or employment.
Because psychologists and psychiatrists generally have little training in speech and language impairments, the important role of these functions in academic, social, and vocational difficulties may often be overlooked. Many mental health workers assume that interpersonal problems are always caused by unrecognized emotional conflicts. For some individuals, however, interpersonal difficulties are more fundamentally rooted in an inability clearly to say what one is thinking or to understand correctly what others are trying to say.
Most physicians and mental health clinicians are similarly not educated to understand specific learning disorders (LD) that often overlap with ADHD. There are three major types of learning disorders: reading disorder, mathematics disorder, and disorder of written expression.
At age twelve, George was in fifth grade. He was a well-behaved boy who wanted very much to do well in school. His grades in math were always high, but he generally did poorly in reading and in any other classwork that involved reading. He was bright. On IQ tests he scored in the high average range. He had a strong vocabulary for listening and for speaking, but his reading vocabulary was very small. He could not read many words that were familiar when spoken to him. He could memorize a short list of words for weekly spelling tests, but he could not remember to spell those words correctly after the test and he was generally a very poor speller.
When called on to read aloud, George often mispronounced easy words and was tediously slow and halting. Despite getting extra help for reading since first grade, George could not sound out unfamiliar words. His mind seemed unable to retain what he had been taught about what sounds are associated with specific combinations of letters. He could not grasp the basics of phonics and had an intense dislike for reading because he found it so tedious and embarrassing.
Sally Shaywitz (2003) has described how most children, unlike George, learn to "break the code" in order to learn to read.
The very first discovery a child makes on his way to reading is the realization that spoken words have parts. Suddenly a child appreciates that the word he hears comes apart into smaller pieces of sound; he has developed phonemic awareness .. . the ability to notice, identify and manipulate the individual sounds—phonemes—in spoken words. (p. 51)
Shaywitz noted that 70 to 80 percent of American children learn how to translate the code of written letters into spoken sounds without much difficulty. The remaining 20 to 30 percent have varying levels of persisting difficulty in learning to convert combinations of letters into spoken words. It is this impairment in learning to process phonemes, not the tendency to reverse letters and numbers, that is the major ingredient in dyslexia, another name for reading disorder.
There is strong evidence to suggest that dyslexia is associated with specific impairments in brain function. Sally Shaywitz and Bennett Shaywitz (2002) used functional MRI imaging to study the brains of dyslexic children compared to nonimpaired readers. In the brains of the dyslexic boys and girls, they found evidence of disrupted functioning in specific left hemisphere circuits that have been shown to be crucial for reading.
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