P RAGMATIC L AN G U AG E D EFICITS IN A TTEN TION -D EFICIT H YPERACTIVITY D ISORD ER (AD H D ) Stephen M. Camarata* and Terrie Gibson Department of Hearing and Speech Sciences, Vanderbilt University School of Medicine, Nashville, Tennessee Thenatureof Attention Deficit-HyperactivityDisorder (ADHD) asdescribed in the Fourth Edition of the Diagnostic and Statistical Manual [DSM-IV, American Psychiatric Association, 1994] indicates a potential association with language disorder, particularly in the area of social language skills (pragmatics). However, to date there have been relatively few studies examining this language-behavior rela- tionship in children with ADHD. The purpose of this paper is to provide a description of social/pragmatic language deficits and to present a theoretical model of potential associations between pragmaticlanguagedeficitsand ADHD.Previousstudiesof language skills in children with ADHD are examined within this theoretical framework and the clinical implicationsof the proposed association are discussed.  1999 Wiley-Liss, Inc. MRDD Research Reviews1999;5:207–214. Key Words: pragmatics; language disorders; ADHD social skills; ADHD language skills PRAGMATIC LANGUAGE DEFICITS IN ATTENTION-DEFICIT HYPERACTIVITY DISORDER (ADHD) A lthough there have been a number of studies describing the relationship between language disorders and behavior disorders in children [see Baker and Cantwell, 1992; Beitchman et al., 1996; Camarata et al, 1988; Cantwell et al., 1981; Prizant et al., 1990], there have been relatively few data available that directly examine the language skills of children with a particular subtype of behavior disorder: Attention Deficit-Hyperactivity Disorder (ADHD) [DSM-IV, American Psychiatric Association, 1994]. Trautman and others [1990] provide an example of the behavior disorders-ADHD-language association. A review of a special education program for children with severe behavior disorders revealed that 33% (22 of 66) children enrolled in the program had an ADHD diagnosis. Fifteen of the 22 (68.2%) with an ADHD diagnosis also were identified with a speech or language disorder as well. More recently, Tirosh and Cohen [1998] reported a high (45%) comorbidity between language deficits and attention deficit disorder (ADD) in a sample of 3,208 children six to 11 years old. Finally, Cohen et al. [1998] indicated that children who had been previously identified with language disorders were more likely subsequently to be identified as ADHD than children without language disorders. Children with language disorders were also rated by teachers and parents as having more severe attention problems than the children without language disorders. A contrasting result was reported by Benasich et al. [1993], who reported no significant comorbid relationship between language impairments and ADHD. The purpose of this paper is to provide a rationale for examining the pragmatic aspects of language as they relate to ADHD and to examine the DSM-IV descriptions of language disorder and ADHD to determine how these widely used criteria relate to pragmatic language skills. Currently, a direct association between ADHD and language disorders has not been established, and although Tirosh and Cohen [1998] argue that the neurocognition of children with comorbid language disorders and ADD should be viewed differently than ADD without language disorder, a well articulated account of potential relationships between language disorders and ADHD is currently unavailable [see Benasich et al., 1993; Westby and Cutler, 1994]. Given the theoretical overlap in the behavioral characteristics of ADHD and other types of disruptive behavior [see DSM-IV pp. 78–94], this relative lack of data on direct associations language disorders is perhaps a bit surprising. Cohen et al. [1998] indicated that systematic clinical assessment of language is rarely completed on children with ADHD. One possible explanation for this apparent paradox is that the nature of the potential language deficits may be primarily focused in the social language domain rather than in the structural (grammatical) aspects of language often assessed on standardized tests. Moreover, the social skills disabilities associated with ADHD have been viewed in terms of peer relationships and social ratings rather than communication skills [Greene et al., 1996; Frederick and Olmi, 1994]. For example, Camarata et al. [1988] examined the morphological, semantic, and syntactic skills of children with behavior disorders but did not include an assessment of social language skills in their test battery. This omission was due, in part, to the lack of norm referenced, standardized measures of social language/ pragmatic skills available at that time. Because the construct of pragmatic language from a clinical perspective has only recently been developed [Camarata, in press; Mueller, in press; Prutting and Kirchner, 1987], the lack of data may relate to the difficulty in assessing accurately the pragmatic skills of children with ADHD. *Correspondence to: Stephen M. Camarata, Vanderbilt University School of Medicine, Bill Wilkenson Center, 1114 19 Avenue South, Nashville, TN 37212. M ENTAL RETARDATION AND DEVELOPM ENTAL DISABILITIES RESEARCH REVIEW S 5: 207–214 (1999)  1999 Wiley-Liss, Inc.