Skip to main content
SpringerLink
Log in

A Systematic Review and Meta-analysis of Narrative Language Abilities in Children with Attention-Deficit/Hyperactivity Disorder

  • Published:
Research on Child and Adolescent Psychopathology Aims and scope Submit manuscript

Abstract

While children with ADHD are reported to have language problems, it is less clear if their ability to use language to tell a story (i.e., form a narrative) is impaired. Therefore, a systematic review and meta-analysis of studies examining the oral production of fictional stories in children with ADHD was conducted. Databases were systematically searched in January 2019 and December 2020 (follow-up). Studies comparing children (≤ 18 years) with ADHD to a control group of typically developing children were included. The meta-analysis adhered to PRISMA guidelines and was preregistered with PROSPERO [CRD42019122040]. Sixteen studies were retained. Results indicated that compared to typically developing children, children with ADHD produced less coherent narratives (Hedges’ g = 0.58 p < .001), gave more ambiguous references (Hedges’ g = 0.52, p < .001), made more disruptive errors (Hedges’ g = 0.41, p < .001), and produced language that was less syntactically complex (Hedges’ g = 0.39, p < .05). Children with ADHD also produced less language overall (Hedges’ g = 0.27, p < .05), although this result appeared to be an artefact of publication bias. Two studies investigated internal state language and both found children with ADHD to produce narratives with less internal state language. Children with ADHD did not produce less fluent narratives (Hedges’ g = 0.23, p = .47), although a scarcity of studies [K = 4] preclude firm conclusions. In conclusion, children with ADHD were impaired in several areas of oral narrative production and screening for narrative language problems should be considered when assessing language and communicative abilities in children with ADHD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Availability of Data and Material

Not applicable.

Code Availability

Not applicable.

Notes

  1. VIQ from Houghton et al. (2008) used in calculation of mean. The mean for the NC group was based on six studies, as the seventh study (13) only provided a mean IQ for the ADHD group.

References

  • APA, A. P. A. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. (A. P. Association, Ed.). American Psychiatric Association. https://doi.org/10.1176/9780890425596

  • Astington, J., & Baird, J. (2015). Why language matters for theory of mind. : Oxford University Press.

  • *Baixauli Fortea, I., Berenguer Forner, C., Colomer, C., Casas, A. M., & Miranda, B. R. (2018). “Communicative skills in Spanish children with Autism Spectrum Disorder and children with Attention Deficit Hyperactivity Disorder. Analysis through parents’ perceptions and narrative production” [Article]. Research in Autism Spectrum Disorders, 50, 22–31. https://doi.org/10.1016/j.rasd.2018.02.006

    Article  Google Scholar 

  • Baixauli, I., Colomer, C., Rosello, B., & Miranda, A. (2016). Narratives of children with high-functioning autism spectrum disorder: A meta-analysis. Research in Developmental Disabilities, 59, 234–254. https://doi.org/10.1016/j.ridd.2016.09.007

    Article  PubMed  Google Scholar 

  • Baker, A. E., Hengeveld, K., Appel, R., Muysken, P., Hengeveld, K., & Kuiken, F. (2012). Linguistics. John Wiley & Sons, Incorporated. http://ebookcentral.proquest.com/lib/asb/detail.action?docID=835550

  • Bamberg, M., & Damrad-Frye, R. (1991). On the ability to provide evaluative comments: Further explorations of children’s narrative competencies. Journal of Child Language, 18(3), 689–710. https://doi.org/10.1017/S0305000900011314

  • Barkley, R. A. (1997). Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD. Psychological Bulletin, 121(1), 65–94.

    Article  Google Scholar 

  • Barkley, R. A. (2015). Executive Functioning and Self-Regulation Viewed as an Extended Phenotype. In R. A. Barkley (Ed.), Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment, 4th ed. (4 ed., pp. 405–434). The Guilford Press.

  • Bergman, A., & Hallin, A. E. (2021). The effect of picture support on narrative retells in Swedish adolescents with ADHD. Clinical Linguistics & Phonetics, 35(7), 690–705. https://doi.org/10.1080/02699206.2020.1825816

    Article  Google Scholar 

  • Borenstein, M., Hedges, L., Higgins, J., & Rothstein, H. (2013). Comprehensive Meta-Analysis Version 3. Biostat, Englewood, NJ.

  • Borenstein, M., Hedges, L. V., Higgins, J. P., & Rothstein, H. R. (2010). A basic introduction to fixed-effect and random-effects models for meta-analysis. Research Synthesis Methods, 1(2), 97–111. https://doi.org/10.1002/jrsm.12

    Article  PubMed  Google Scholar 

  • Borenstein, M., Hedges, L. V., Higgins, P. T., & Rothstein, H. R. (2009). Introduction to Meta-Analysis (Vol. 77). https://doi.org/10.1111/j.1751-5823.2009.00095_15.x

  • Borenstein, M., Higgins, J. P., Hedges, L. V., & Rothstein, H. R. (2017). Basics of meta-analysis: I(2) is not an absolute measure of heterogeneity. Research Synthesis Methods, 8(1), 5–18. https://doi.org/10.1002/jrsm.1230

    Article  PubMed  Google Scholar 

  • Botting, N. (2002). Narrative as a tool for the assessment of linguistic and pragmatic impairments. Child Language Teaching and Therapy, 18(1), 1–21. https://doi.org/10.1191/0265659002ct224oa

    Article  Google Scholar 

  • Boudreau, D. (2008). Narrative abilities: Advances in research and implications for clinical practice. Topics in Language Disorders, 28(2), 99–114. https://doi.org/10.1097/01.TLD.0000318932.08807.da

  • Capps, L., Losh, M., & Thurber, C. (2000). “The frog ate the bug and made his mouth sad”: Narrative competence in children with autism. Journal of Abnormal Child Psychology, 28(2), 193–204. https://doi.org/10.1023/A:1005126915631

  • Coghill, D., Toplak, M. E., Rhodes, S., & Adamo, N. (2018). Cognitive functioning in ADHD: Inhibition, memory, temporal discounting, decision making, timing, and reaction time variability. In T. Banaschewski, D. Coghill, & A. Zuddas (Eds.), Oxford Textbook of Attention Deficit Hyperactivity Disorder (pp. 94–102). University Press. https://doi.org/10.1093/med/9780198739258.003.0010

  • Curenton, S. M. (2011). Understanding the landscapes of stories: The association between preschoolers’ narrative comprehension and production skills and cognitive abilities. Early Child Development and Care, 181(6), 791–808. https://doi.org/10.1080/03004430.2010.490946

  • *Derefinko, K. J., Bailey, U. L., Milich, R., Lorch, E. P., & Riley, E. (2009). The effects of stimulant medication on the online story narrations of children with ADHD. School Mental Health, 1(4), 171–182. https://doi.org/10.1007/s12310-009-9017-6

  • *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(6), 853–865. https://doi.org/10.1007/s10802-006-9070-7

  • Francis, S., Fine, J., & Tannock, R. (2001). Methylphenidate Selectively Improves Story Retelling in Children with Attention Deficit Hyperactivity Disorder. Journal of Child and Adolescent Psychopharmacology, 11(3), 217–228. https://doi.org/10.1089/10445460152595540

    Article  PubMed  Google Scholar 

  • Freer, B. D., Hayden, A., Lorch, E. P., & Milich, R. (2011). The Stories They Tell: Story Production Difficulties of Children With ADHD. School Psychology Review, 40(3), 352–366.

    Article  Google Scholar 

  • Graziano, P. A., & Garcia. (2016). Attention-deficit hyperactivity disorder and children’s emotion dysregulation: A meta-analysis. Clinical Psychology Review, 46, 106–123. https://doi.org/10.1016/j.cpr.2016.04.011

    Article  PubMed  Google Scholar 

  • Green, B. C., Johnson, K. A., & Bretherton, L. (2014). Pragmatic language difficulties in children with hyperactivity and attention problems: An integrated review. International Journal of Language & Communication Disorders, 49(1), 15–29. https://doi.org/10.1111/1460-6984.12056

  • Guo, L. Y., Tomblin, J. B., & Samelson, V. (2008). Speech disruptions in the narratives of English-speaking children with specific language impairment. Journal of Speech, Language, and Hearing Research, 51(3), 722–738. https://doi.org/10.1044/1092-4388(2008/051)

    Article  PubMed  Google Scholar 

  • Hart, B., & Risley, T. R. (1995). Meaningful differences in the everyday experience of young American children. Paul H Brookes Publishing, Baltimore, MD. http://search.proquest.com/docview/618768959?accountid=14468http://wx7cf7zp2h.search.serialssolutions.com/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/PsycINFO&rft_val_fmt=info:ofi/fmt:kev:mtx:book&rft.genre=book&rft.jtitle=&rft.atitle=&rft.au=Hart%2C+Betty%3BRisley%2C+Todd+R.&rft.aulast=Hart&rft.aufirst=Betty&rft.date=1995-01-01&rft.volume=&rft.issue=&rft.spage=268&rft.isbn=1557661979&rft.btitle=Meaningful+differences+in+the+everyday+experience+of+young+American+children.&rft.title=Meaningful+differences+in+the+everyday+experience+of+young+American+children.&rft.issn=&rft_id=info:doi/

  • Hedges, L., & Olkin, I. (1985). Statistical Methods in Meta-Analysis. In (Vol. 20). https://doi.org/10.2307/1164953

  • *Houghton, S., Cordin, R., Durkin, K., & Whiting, K. (2008). Salience and temporal sequencing of time-related actions in boys with attention deficit/hyperactivity disorder. Child Neuropsychology, 14(1), 60–70. https://doi.org/10.1080/09297040601160582

  • Karalunas, S. L., & Nigg, J. T. (2020). Heterogeneity and Subtyping in Attention-Deficit/Hyperactivity Disorder-Considerations for Emerging Research Using Person-Centered Computational Approaches. Biological Psychiatry, 88(1), 103–110. https://doi.org/10.1016/j.biopsych.2019.11.002

    Article  PubMed  Google Scholar 

  • Karmiloff-Smith, A. (1985). Language and cognitive processes from a developmental perspective. Language and Cognitive Processes, 1(1), 61–85. https://doi.org/10.1080/01690968508402071

    Article  Google Scholar 

  • Klecan-Aker, J. S., & Swank, P. R. (1987). The narrative styles of normal first and third grade children. Language and Speech, 30(3), 251–262.

    Article  Google Scholar 

  • *Koltun, H. S. (2004). Narrative comprehension and production abilities of children with attention-deficit/hyperactivity disorder University of Toronto]. National Library of Canada.

  • 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, 58(6), 640–654. https://doi.org/10.1111/jcpp.12688

    Article  PubMed  Google Scholar 

  • *Kuijper, S. J. M., Hartman, C. A., Bogaerds-Hazenberg, S. T. M., & Hendriks, P. (2017). Narrative production in children with autism spectrum disorder (ASD) and children with attention-deficit/hyperactivity disorder (ADHD): Similarities and differences. Journal of abnormal psychology (1965), 126(1), 63–75. https://doi.org/10.1037/abn0000231

  • *Lee, H., Sim, H., Lee, E., & Choi, D. (2017). Disfluency characteristics of children with attention-deficit/hyperactivity disorder symptoms. Journal of Communication Disorders, 65, 54–64. https://doi.org/10.1016/j.jcomdis.2016.12.001

  • Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., Clarke, M., Devereaux, P. J., Kleijnen, J., Moher, D. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: Explanation and elaboration BMJ 339. https://doi.org/10.1136/bmj.b2700

  • Liles, B. Z., Coelho, C., Duffy, R., & Zalagens, M. (1989). Effects of elicitation procedures on the narratives of normal and closed head-injured adults. Journal of Speech and Hearing Disorders, 54, 356–366.

    Article  Google Scholar 

  • Liles, B. Z., & Purcell, S. (1987). Departures in the spoken narratives of normal and language-disordered children. Applied Psycholinguistics, 8(2), 185–202. https://doi.org/10.1017/S0142716400000205

    Article  Google Scholar 

  • Lorch, E. P., Milich, R., Flake, R. A., Ohlendorf, J., & Little, S. (2010). A developmental examination of story recall and coherence among children with ADHD. Journal of Abnormal Child Psychology, 38(3), 291–301. https://doi.org/10.1007/s10802-009-9377-2

    Article  PubMed  PubMed Central  Google Scholar 

  • Losh, M., & Gordon, P. C. (2014). Quantifying narrative ability in autism spectrum disorder: A computational linguistic analysis of narrative coherence. Journal of Autism and Developmental Disorders, 44(12), 3016–3025. https://doi.org/10.1007/s10803-014-2158-y

  • Loveland, K., & Tunali, B. (1994). Narrative language in autism and the theory of mind hypothesis: A wider perspective. In Understanding other minds: Perspectives from autism. (pp. 247–266). Oxford University Press, New York, NY.

  • Martinussen, R., & Tannock, R. (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(7), 1073–1094. https://doi.org/10.1080/13803390500205700

    Article  PubMed  Google Scholar 

  • Marx, I., Hacker, T., Yu, X., Cortese, S., & Sonuga-Barke, E. (2021). ADHD and the Choice of Small Immediate Over Larger Delayed Rewards: A Comparative Meta-Analysis of Performance on Simple Choice-Delay and Temporal Discounting Paradigms. Journal of Attention Disorders, 25(2), 171–187. https://doi.org/10.1177/1087054718772138

    Article  PubMed  Google Scholar 

  • *Miniscalco, C., Hagberg, B., Kadesjö, B., Westerlund, M., & Gillberg, C. (2007). Narrative skills, cognitive profiles and neuropsychiatric disorders in 7–8-year-old children with late developing language. International Journal of Language & Communication Disorders, 42(6), 665–681. https://doi.org/10.1080/13682820601084428

  • Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLOS Medicine, 6(7), e1000097. https://doi.org/10.1371/journal.pmed.1000097

    Article  PubMed  PubMed Central  Google Scholar 

  • Nigg, J. T., Willcutt, E. G., Doyle, A. E., & Sonuga-Barke, E. J. (2005). Causal heterogeneity in attention-deficit/hyperactivity disorder: Do we need neuropsychologically impaired subtypes? Biological Psychiatry, 57(11), 1224–1230. https://doi.org/10.1016/j.biopsych.2004.08.025

    Article  PubMed  Google Scholar 

  • Norbury, C. F., & Bishop, D. V. M. (2003). Narrative skills of children with communication impairments. International Journal of Language & Communication Disorders, 38(3), 287–313. https://doi.org/10.1080/136820310000108133

  • Oram, J., Fine, J., Okamoto, C., & Tannock, R. (1999). Asessing the Language of Children with Attention Deficit Hyperactivity Disorder. American Journal of Speech-Language Pathology, 8(1), 72.

    Article  Google Scholar 

  • Orsolini, M. (1990). Episodic structure in children’s fantasy narratives: “Breakthrough” to decontextualized discourse. Language and Cognitive Processes, 5(1), 53–79. https://doi.org/10.1080/01690969008402097

  • Parigger, E. (2012). Language and executive functioning in children with ADHD University of Amsterdam.

    Google Scholar 

  • Pievsky, M. A., & McGrath, R. E. (2017). The Neurocognitive Profile of Attention-Deficit/Hyperactivity Disorder: A Review of Meta-Analyses. Archives of Clinical Neuropsychology, 33(2), 143–157. https://doi.org/10.1093/arclin/acx055

    Article  Google Scholar 

  • *Purvis, K. L., & Tannock, R. (1997). Language abilities in children with attention deficit hyperactivity disorder, reading disabilities, and normal controls. Journal of Abnormal Child Psychology, 25(2), 133–144. https://doi.org/10.1023/A:1025731529006

  • *Renz, K., Lorch, E. P., Milich, R., Lemberger, C., Bodner, A., & Welsh, R. (2003). On-Line Story Representation in Boys with Attention Deficit Hyperactivity Disorder. Journal of Abnormal Child Psychology, 31(1), 93–104. https://doi.org/10.1023/A:1021777417160

  • Rohrer-Baumgartner, N., & Zeiner. (2014). Does IQ influence Associations between ADHD Symptoms and other Cognitive Functions in young Preschoolers? Behavioral and Brain Functions, 10(1), 16. https://doi.org/10.1186/1744-9081-10-16

    Article  PubMed  PubMed Central  Google Scholar 

  • Ros, R., & Graziano, P. A. (2018). Social Functioning in Children With or At Risk for Attention Deficit/Hyperactivity Disorder: A Meta-Analytic Review. Journal of Clinical Child & Adolescent Psychology, 47(2), 213–235. https://doi.org/10.1080/15374416.2016.1266644

    Article  Google Scholar 

  • *Rumpf, A. L., Kamp-Becker, I., Becker, K., & Kauschke, C. (2012). Narrative competence and internal state language of children with Asperger Syndrome and ADHD. Research in Developmental Disabilities, 33(5), 1395–1407. https://doi.org/10.1016/j.ridd.2012.03.007

  • Sciberras, E., Mueller, K. L., Efron, D., Bisset, M., Anderson, V., Schilpzand, E. J., Jongeling, B., & Nicholson, J. M. (2014). Language problems in children with ADHD: A community-based study. Pediatrics, 133(5), 793–800. https://doi.org/10.1542/peds.2013-3355

  • Siller, M., Swanson, M. R., Serlin, G., & Teachworth, A. G. (2014). Internal state language in the storybook narratives of children with and without autism spectrum disorder: Investigating relations to theory of mind abilities. Research in Autism Spectrum Disorders, 8(5), 589–596. https://doi.org/10.1016/j.rasd.2014.02.002

  • Sjöwall, D., & Thorell, L. B. (2014). Functional Impairments in Attention Deficit Hyperactivity Disorder: The Mediating Role of Neuropsychological Functioning. Developmental Neuropsychology, 39(3), 187–204. https://doi.org/10.1080/87565641.2014.886691

    Article  PubMed  PubMed Central  Google Scholar 

  • Sonuga-Barke, E. J. S., Taylor, E., Sembi, S., & Smith, J. (1992). Hyperactivity and Delay Aversion—I. The Effect of Delay on Choice. Journal of Child Psychology and Psychiatry, 33(2), 387–398. https://doi.org/10.1111/j.1469-7610.1992.tb00874.x

  • Staikova, E., Gomes, H., Tartter, V., McCabe, A., & Halperin, J. M. (2013). Pragmatic deficits and social impairment in children with ADHD. Journal of Child Psychology and Psychiatry, 54(12), 1275–1283. https://doi.org/10.1111/jcpp.12082

  • Stroup, D. F., Berlin, J. A., Morton, S. C., Olkin, I., Williamson, G. D., Rennie, D., Moher, D., Becker, B. J., Sipe, T. A., & Thacker, S. B. (2000). Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA, 283(15), 2008–2012.

  • Tannock, R. (2018). ADHD and Communication Disorders. In T. Banaschewsk, D. Coghill, & A. Zuddas (Eds.), Oxford Textbook of Attention Deficit Hyperactivity Disorder (First Edition ed., pp. 261–272). Oxford University Press.

  • *Tannock, R., Purvis, K. L., & Schachar, R. J. (1993). Narrative abilities in children with attention deficit hyperactivity disorder and normal peers. Journal of Abnormal Child Psychology, 21(1), 103–117. https://doi.org/10.1007/BF00910492

  • Tannock, R., & Schachar, R. J. (1996). Executive dysfunction as an underlying mechanism of behavior and language problems in attention deficit hyperactivity disorder. In Language, learning, and behavior disorders: Developmental, biological, and clinical perspectives. (pp. 128–155). Cambridge University Press.

  • Wells, G., Shea, B., O’Connell, D., Peterson, j., Welch, V., Losos, M., & Tugwell, P. (2000). The Newcastle–Ottawa Scale (NOS) for Assessing the Quality of Non-Randomized Studies in Meta-Analysis.

  • WHO. (2018). International classification of diseases for mortality and morbidity statistics (11th revision).

  • Wigglesworth, G. (1990). Children’s narrative acquisition: A study of some aspects of reference and anaphora. First Language, 10(29, Pt 2), 105–125. https://doi.org/10.1177/014272379001002902

Download references

Acknowledgements

The authors would like to thank Dr. Michael Borenstein for his statistical advice.

Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. Department of Psychology and Behavioural Sciences, Aarhus University, Bartholins Allé 9, 8000, Aarhus, Denmark

    Ida Bonnerup Jepsen, Esben Hougaard, Susan Tomczak Matthiesen & Rikke Lambek

Authors
  1. Ida Bonnerup Jepsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Esben Hougaard
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Susan Tomczak Matthiesen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rikke Lambek
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ida Bonnerup Jepsen.

Ethics declarations

Ethics Approval

Not applicable.

Consent to Participate

Not applicable.

Consent for Publication

Not applicable.

Conflicts of Interests

The authors have no relevant financial or non-financial interests to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 147 KB)

Supplementary file2 (PDF 359 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jepsen, I.B., Hougaard, E., Matthiesen, S.T. et al. A Systematic Review and Meta-analysis of Narrative Language Abilities in Children with Attention-Deficit/Hyperactivity Disorder. Res Child Adolesc Psychopathol 50, 737–751 (2022). https://doi.org/10.1007/s10802-021-00871-4

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10802-021-00871-4

Keywords

Search

Navigation