The association between attention-deficit/hyperactivity disorder and narrative language: What is the role of executive function?

Background: Research suggests that Attention-Deficit/Hyperactivity Disorder (ADHD) may be associated with narrative language (or storytelling) difficulties, and executive functioning is hypothesized to underlie this association. However, the contribution of executive function to the narrative language production of children with ADHD is unclear and understudied. Accordingly, this study examined the association between ADHD and narrative language and whether it was mediated by executive function. Methods: Children with a clinical diagnosis of ADHD (n = 46) and a comparison group of neurotypical children (n = 40) aged 7-11 years completed a narrative language task, as well as laboratory measures of executive function (i.e., working memory updating and response inhibition) and core language. Results: Children with ADHD produced narratives with more ambiguous references (β = 0.72, p < 0.001), less overall coherency (β = -0.59, p = 0.001), and more morpho-syntactic errors (β = 0.47, p < 0.05). There was a significant indirect effect of core language on the association between ADHD and morpho-syntactic errors (β = 0.25, p < 0.05). No other indirect effects were statistically significant. Conclusions: While ADHD was associated with several central aspects of narrative language production, executive function did not mediate this association. Clinicians working with children with ADHD should be aware of the potential presence of co-occurring narrative language difficulties and that narrative language support may need to target language (e.g., grammar).