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Arabic Speech Sound Disorder in Children with ADHD

It is well known that children with Attention Deficit Hyperactivity Disorder (ADHD) often have co-morbid learning disabilities, including those affecting reading and writing (dyslexia), or numbers and mathematics (dyscalculia). Another area where young children with ADHD may exhibit developmental weaknesses compared to typically developing (TD) children is in the area of speech and language development. Worryingly, recent literature has indicated that children with articulation and phonological disorders who are not identified and treated early may encounter academic, social and psychological difficulties. One such disorder, Speech Sound Disorder (SSD), is an expressive language disorder that has frequently been observed among children with ADHD.

According to the American Speech-Language Hearing Association (ASHA), “while most children make some mistakes as they learn to say new words. A speech sound disorder occurs when mistakes continue past a certain age. Every sound has a different range of ages when the child should make the sound correctly. Speech sound disorders include problems with articulation (making sounds) and phonological processes (sound patterns).”

A recent study conducted by Ruaa Hariri at King Abdulaziz University in Jeddah, Saudi Arabia, attempted to identify both articulation and phonological disorders amongst Arabic speaking children with ADHD in order to measure the influence of ADHD on speech sounds, through identifying which types of Arabic SSD are particular to children with ADHD in comparison to children of Typical Development (TD).

According to Hariri, the majority of studies tackling the correlation between ADHD and language disorders have been conducted in relation to the English language. Through this study, she aimed to fill this gap through identifying Arabic Speech Sound Disorder (SSD) amongst children with ADHD symptoms, and answering the following questions: 1. Do children with ADHD acquire their Arabic consonants in the same way and following the same developmental stages as TD children? 2. How are the articulation errors and phonological processes amongst the ADHD group and TD group both similar and different? and 3. Which of the three subtypes of ADHD are related to Arabic Speech Sound Disorder (SSD)?

The ADHD sample group included 10 children aged 5–7 years, with 8 boys and 2 girls, from different Arab nationalities (5 Egyptians, 1 Jordanian, 3 Saudis, and 1 Yemeni), all of whom had been referred to an institute for speech and hearing for articulation assessment and speech therapy. Of the 10 children with ADHD, five of them had the combined type of ADHD (ADHD-C), two had the predominantly hyperactive/impulsive type (ADHD-HI), and three had the predominantly inattentive type (ADHD-PI). In addition, 8 out of the 10 ADHD patients were taking ADHD medication before and during the study.

Although the participants spoke different colloquial forms of Arabic, the version of the language used in the articulation test was Educated Spoken Arabic (ESA), which is the form that is taught in schools. The articulation test used 38 pictures in a book to elicit 50 words for all 28 Arabic consonants occurring in all three positions (initial, medial, and final).

Among the findings of this study, it was reported that children with ADHD have articulation difficulties with most of the Arabic consonants, and produce almost three times the number of phonological errors as Typically Developing (TD) children. It was noticed that the glottal stop /ʔ/ was frequently pronounced and used as a replacement for most of the difficult sounds. Other common errors included letters being devoiced, de-emphasized, de-affricated, deleted, de-nazalized, inserted, substituted, backed, fronted, or stopped. Importantly, it was discovered that the developmental stages of Arabic consonant acquisition for children with ADHD are different from those of TD. Also, the study confirms that all three types of ADHD can affect a child’s speech intelligibility.

The study concludes that early intervention for these deficits should be a priority. Because of the comorbidity between ADHD and Speech Sound Disorder, speech-language pathologists (SLP) and audiologists must be aware of current perspectives on ADHD to facilitate effectively when working with patients with ADHD.

The author also stresses that in order for a child with intelligibility problems (such as one with ADHD) to receive appropriate treatment for SSD at a clinic or speech institute, they will need to be compared with children who speak similar dialects. Accordingly, children of a similar background and age were included in this study in order to provide an adequate comparison in terms of Arabic speech sound acquisition among the two groups of children (TD and ADHD).

The Comorbidity between Attention-Deficit/Hyperactivity Disorder (ADHD) in Children and Arabic 
Speech Sound Disorder