If your child has ADHD, or you've wondered whether they might, you may have noticed that some of the hardest moments involve language: following multi-step directions, telling a story in order, or getting their ideas onto paper. That's not a coincidence. Attention, executive function, and language work closely together. Here's how they connect, what the research says, and why it can help to look at language skills too.
What is executive function?
Harvard's Center on the Developing Child describes executive function and self-regulation as "a set of skills that relies on three types of brain function: working memory, mental flexibility, and self-control." It compares these skills to an airport's air traffic control system, helping us hold onto and work with information, focus thinking, filter distractions, and switch gears.[1]
These skills take a long time to mature. According to the Center, "children aren't born with these skills—they are born with the potential to develop them," and the full range of abilities keeps growing through the teen years and into early adulthood.[1]
CHADD, a national ADHD organization, defines executive function as "brain functions that activate, organize, integrate and manage other functions." One model CHADD describes, from researcher Russell Barkley, lists "internalization of speech (verbal working memory)" as one of four areas of executive function.[2]
How are ADHD and executive function related?
CHADD notes that "deficits in executive functions are highly interrelated to symptoms associated with ADHD" and can affect a person's ability "to begin, work on and complete tasks."[2]
The Centers for Disease Control and Prevention (CDC) describes the predominantly inattentive presentation of ADHD this way: "It is hard for the individual to organize or finish a task, to pay attention to details, or to follow instructions or conversations." In the hyperactive-impulsive presentation, the person "fidgets and talks a lot."[3] Notice how many of these descriptions involve communication: following instructions, following conversations, and talking.
Do children with ADHD have more language difficulties?
Research suggests that, as a group, they often do. A 2017 systematic meta-analytic review by Korrel and colleagues looked at 21 studies comparing children with ADHD to children without ADHD. It concluded that "children with ADHD have poorer performance on measures of overall, expressive, receptive, and pragmatic language compared with controls."[5] In plain terms, the differences showed up in using language, understanding it, and using it socially.
That's a group finding, not a prediction for any individual child; every child's profile is different. If these terms are new to you, our posts on receptive vs. expressive language and pragmatic language explain them.
ADHD also overlaps with reading and writing. ASHA's professional guidance reports that children with ADHD have shown a greater risk for written language disorder and/or reading disability.[7] It adds that attention deficits and reading difficulties "appear to be distinct developmental disorders with different causes," but that when they co-occur, "inattention may contribute to reading comprehension difficulties."[7]
Where parents often notice the overlap
Because executive function and language are intertwined, the same everyday task can draw on both. Some common places this shows up:
- Following directions. The CDC lists trouble following instructions or conversations as part of the inattentive presentation.[3] Holding a multi-step direction in mind also depends on working memory, one of the three executive function skills.[1]
- Storytelling. Harvard's activity guide explains that as children's storytelling becomes more complex, they "practice holding and manipulating information in working memory."[8] ASHA notes that an SLP evaluating a child with ADHD may see how well the child "can retell a story or talk about an event."[4]
- Organizing ideas and schoolwork. ASHA lists "problems planning, organizing, and finishing tasks on time" among the signs of ADHD.[4]
- Conversation. ASHA notes that some children with ADHD need help with social skills and may need to learn "how to take turns and pay attention when talking to others."[4]
Is it ADHD, a language difficulty, or both?
This can be genuinely hard to sort out, even for professionals. In a 2016 review, researcher Sean Redmond wrote that ADHD frequently co-occurs with other conditions, and that "the symptoms of other disorders can mimic the symptoms of ADHD," which makes careful diagnosis and the identification of co-occurring conditions essential.[6] He also noted that reported rates of ADHD and language impairment occurring together "have been remarkably unstable" across studies.[6]
For example, when a child doesn't follow a spoken direction, it may not be obvious whether attention, understanding of the language, or both played a part. Redmond's review highlights specific language measures, such as tense marking, nonword repetition, and sentence recall, as useful for telling the two apart and for identifying when both are present.[6] Korrel and colleagues concluded that "a screening of language functioning may be a valuable addition to the assessment of ADHD."[5]
Who does what: ASHA explains that a child's doctor tests for ADHD, gathering information from parents and teachers. An SLP may test a child "to see if they have speech, language, or social problems," including how well they can "plan, organize, and pay attention to details."[4]
How can a speech-language pathologist help?
According to ASHA, "an SLP can work with your child on speech, language, and social problems," and can help a child "learn how to plan and organize to get tasks done." ASHA adds that the SLP will work with the child's teacher, and that supports in class may include sitting near the front or using checklists or planners to stay organized.[4] You can read more about language therapy and social communication support.
Ideas to try at home
Harvard's executive function activity guide suggests playful ways to practice these skills together:[8]
- Tell stories and write them down. Encourage your child to tell you stories, write them down, and read them together. The guide says revisiting a story "supports more intentional organization and greater elaboration."[8]
- Make play plans. Before playing, children decide who they'll be and what they'll do, then draw the plan. The guide notes that planning play "encourages social problem solving, as well as oral language."[8]
- Tell group stories. Each person adds to the story in turn, which the guide says challenges "attention, working memory, and self-control."[8]
The bottom line
Executive function, attention, and language are closely linked, and research shows that children with ADHD, as a group, are more likely to have language differences as well. Some behaviors that look like inattention can also involve language, and the reverse. If your child struggles with directions, storytelling, conversation, or organizing their ideas, a speech-language pathologist can look at their language skills alongside the rest of the picture, so you and their care team understand what's really behind the challenges.
Sources
- Center on the Developing Child at Harvard University (2012). InBrief: Executive Function. Harvard University.
- CHADD (n.d.). Executive Function Skills. Children and Adults with Attention-Deficit/Hyperactivity Disorder.
- Centers for Disease Control and Prevention (n.d.). Symptoms of ADHD. CDC.
- American Speech-Language-Hearing Association (n.d.). Attention-Deficit/Hyperactivity Disorder (ADHD). ASHA.
- Korrel, H., Mueller, K. L., Silk, T., Anderson, V., & Sciberras, E. (2017). Research Review: Language problems in children with Attention-Deficit Hyperactivity Disorder – a systematic meta-analytic review. Journal of Child Psychology and Psychiatry.
- Redmond, S. M. (2016). Language Impairment in the Attention-Deficit/Hyperactivity Disorder Context. Journal of Speech, Language, and Hearing Research.
- American Speech-Language-Hearing Association (n.d.). Written Language Disorders (Practice Portal). ASHA.
- Center on the Developing Child at Harvard University (n.d.). Enhancing and Practicing Executive Function Skills with Children from Infancy to Adolescence. Harvard University.
Articles from Speech Me Therapy, a pediatric speech-language therapy practice in North Phoenix serving Scottsdale, Paradise Valley, and families across Arizona by telehealth. Our posts summarize published guidance from professional and public health organizations; sources are listed at the end of every article.