A cross-etiology comparison of the socio-emotional behavioral profiles associated with attention-deficit/hyperactivity disorder and specific language impairment

Figures & data

Table 1. Characteristics of children rated: Group means (M), standard deviations (SD), and ranges.

	ADHD (n = 20)			SLI (n = 20)			TD (n = 20)
	M	SD	Range	M	SD	Range	M	SD	Range	F(2, 57)	Contrasts
Age (months)	94.30	7.4	85–107	94.20	7.9	84–107	93.95	6.4	85–107	0.01	ADHD = SLI = TD
Maternal education^a	3.55	0.9	2–5	3.35	0.9	2–5	3.85	1.20	1–5	1.20	ADHD = SLI = TD
Nonverbal^b	101.50	10.3	83–120	97.75	8.2	88–120	110.35	10.4	91–126	9.22***	TD > ADHD = SLI
Verbal^c	20.90	2.7	17–25	12.50	2.7	8–17	22.60	2.8	17–27	77.24***	ADHD = TD > SLI
DSM-ADHD^d	72.75	5.2	67–80	56.80	7.7	50–73	53.30	4.6	50–63	61.81***	ADHD > SLI = TD

^aScale of 1 = some high school and 5 = some graduate school/graduate degree.

^bNaglieri Nonverbal Ability Test, standard score (M = 100; SD = 15).

^cClinical Evaluation of Language Fundamentals, 4th Ed. – Screening Test (range for 5- to 8-year olds = 0–28; criterion scores: 7 years = 16; 8 years = 18).

^dChild Behavior Checklist, DSM-IV ADHD syndrome scale, T score (higher values indicate elevate levels of attention/impulsivity difficulties).

*p < 0.05, **p < 0.01, ***p < 0.001.

Table 2. Child Behavior Checklist T scores: group means (M), standard deviations (SD), and ranges.

	ADHD (n = 20)			SLI (n = 20)			TD (n = 20)
CBCL scale	M	SD	Range	M	SD	Range	M	SD	Range	F (2,57)	Contrasts
Anxious/depressed	62.6	11.1	50–88	55.7	8.0	50–74	53.3	5.8	50–72	5.33**^a	ADHD > SLI = TD
Withdrawn	56.3	6.8	50–76	55.5	5.5	50–66	52.3	3.1	50–60	4.41*^a	ADHD > TD
Somatic complaints	57.8	8.5	50–78	56.3	8.1	50–76	51.5	2.0	50–57	7.89**^a	ADHD > TD
Social problems	61.7	9.6	50–93	60.8	8.7	50–82	52.7	4.4	50–68	11.55***^a	ADHD = SLI > TD
Thought problems	65.0	9.5	51–84	56.3	8.1	50–77	52.9	4.0	50–62	13.98***^a	ADHD > SLI, TD
Attention problems	73.8	7.2	61–88	59.8	8.0	50–73	54.1	5.8	50–69	41.18***	ADHD > SLI > TD
Rule-breaking	62.0	7.7	51–78	55.6	7.6	50–70	53.0	4.5	50–67	10.12***^a	ADHD > SLI = TD
Aggressive behavior	65.9	11.5	50–91	57.1	9.1	50–76	52.9	5.5	50–72	10.45***^a	ADHD > SLI = TD
Internalizing	58.9	11.7	39–78	53.6	10.5	39–73	46.7	8.5	33–67	7.03**	ADHD > TD
Externalizing	64.4	9.3	44–79	51.9	14.4	33–73	45.7	10.7	33–67	13.37***	ADHD > SLI = TD
DSM-affective	63.5	9.4	52–86	57.8	7.5	50–70	53.9	6.3	50–70	7.13**^a	ADHD > TD
DSM-anxiety	60.2	8.9	50–77	55.3	7.9	50–77	53.6	6.5	50–72	3.82*	ADHD > TD
DSM-oppositional	63.1	10.0	51–80	55.4	7.4	50–73	52.7	4.3	50–63	8.94**^a	ADHD > SLI = TD
DSM-conduct	63.5	9.3	51–82	56.1	8.5	50–72	52.7	1.1	50–69	10.38***^a	ADHD > SLI > TD

^aWelch’s robust test of equality of means (asymptotically F distributed).

*p < 0.05, **p < 0.01, ***p < 0.001.

Table 3. Conners’ Parent Rating Scales-Revised Long version T scores: group means (M), standard deviations (SD), and ranges.

	ADHD (n = 20)			SLI (n = 20)			TD (n = 20)
CPRS-R:L scale	M	SD	Range	M	SD	Range	M	SD	Range	F (2,57)	Contrasts
Oppositional	67.5	12.9	49–87	52.3	11.3	40–79	48.7	8.6	29–67	16.27***	ADHD > SLI = TD
Cog probs/inattention	75.0	8.7	60–90	64.6	12.7	48–87	52.6	11.0	40–79	21.13***	ADHD > SLI > TD
Hyperactivity	79.2	8.0	67–90	54.20	9.6	42–77	50.1	7.2	41–68	71.31***	ADHD > SLI = TD
Anxious-shy	57.8	13.5	42–90	53.5	12.9	40–81	50.5	10.1	40–76	1.79	ADHD = SLI = TD
Perfectionism	56.9	13.5	40–85	50.8	9.1	40–71	46.1	7.8	40–71	4.94*^a	ADHD > TD
Social problems	69.9	13.6	45–90	57.9	14.0	43–88	48.2	5.0	45–64	24.19***^a	ADHD > SLI > TD
Psychosomatic	56.0	11.6	43–82	52.8	10.8	43–82	46.15	1.1	43–56	7.79**^a	ADHD > TD
Restless impulsive	79.9	5.7	70–89	56.1	10.4	43–80	50.6	7.5	39–63	106.63***^a	ADHD > SLI = TD
Emotional liability	63.2	11.2	41–79	56.15	13.2	41–89	46.6	8.4	39–73	14.54***	ADHD > SLI > TD
ADHD Index	77.5	6.3	65–87	59.6	11.8	45–83	50.4	9.2	40–67	43.21***	ADHD > SLI > TD
DSM-inattentive	75.3	7.8	64–88	60.2	12.2	45–86	52.0	10.9	40–80	25.64***	ADHD > SLI > TD
DSM-hyperactive	79.6	7.5	69–90	56.9	10.4	45–78	49.5	6.9	41–67	70.12***	ADHD > SLI = TD
DSM total	79.1	6.1	70–90	59.1	8.5	45–82	50.7	8.5	41–68	57.52***	ADHD > SLI > TD

^aWelch’s robust test of equality of means (asymptotically F distributed).

*p < 0.05, **p < 0.01, ***p < 0.001.

Table 4. Child Behavior Checklist: number of children above recommended cutoffs for likely clinical status.

CBCL scale^a	ADHD (n = 20)	SLI (n = 20)	TD (n = 20)	χ^2	Contrasts
Withdrawn: # above cutoff	2	2	0	2.14	ADHD = SLI = TD
# below cutoff	18	18	20
Social problems: # above cutoff	8	5	1	6.89*	ADHD > TD
# below cutoff	12	15	19
Thought problems: # above cutoff	10	3	0	15.52***	ADHD > SLI = TD
# below cutoff	10	17	20
Attention problems: # above cutoff	19	6	1	35.19***	ADHD > SLI > TD
# below cutoff	1	14	19
Rule breaking: # above cutoff	6	4	1	4.23	ADHD = SLI = TD
# below cutoff	14	16	19
Aggressive behavior: # above cutoff	10	5	1	10.39**	ADHD > TD
# below cutoff	10	15	19
Internalizing: # above cutoff	12	5	2	12.17**	ADHD > TD = SLI
# below cutoff	8	15	18
Externalizing: # above cutoff	13	6	3	11.34**	ADHD > SLI = TD
# below cutoff	7	14	17
DSM-conduct: # above cutoff	8	4	1	7.28*	ADHD > TD
# below cutoff	12	16	19

^aT scores at/above 65 for syndrome scales and at/above 60 for composite scales considered clinically significant.

*p < 0.05, **p < 0.01, ***p < 0.001.

Table 5. Conners’ Parent Rating Scale-Revised Long version: number of children above recommended cutoffs for likely clinical status.

CPRS-R:L^a	ADHD (n = 20)	SLI (n = 20)	TD (n = 20)	χ^2	Contrasts
Oppositional: # above cutoff	11	3	2	12.43**	ADHD > SLI, TD
# below cutoff	9	17	18
Cog Probs/Inattention: # above cutoff	17	11	3	19.76***	ADHD > SLI > TD
# below cutoff	3	9	17
Hyperactivity: # above cutoff	20	3	1	45.42***	ADHD > SLI = TD
# below cutoff	0	17	19
Social Problems: # above cutoff	13	6	0	19.56***	ADHD > SLI > TD
# below cutoff	7	14	20
Restless Impulsive: # above cutoff	20	5	0	44.57***	ADHD > SLI > TD
# below cutoff	0	15	20
Emotional Liability: # above cutoff	9	6	1	8.35*	ADHD = SLI > TD
# below cutoff	11	14	19
ADHD Index: # above cutoff	20	4	3	36.77***	ADHD > SLI = TD
# below cutoff	0	16	17
DSM-Inattentive: # above cutoff	17	7	2	23.76***	ADHD > SLI = TD
# below cutoff	3	13	18
DSM-Hyperactive: # above cutoff	20	16	19	42.93***	ADHD > SLI = TD
# below cutoff	0	4	1
DSM-Total: # above cutoff	20	5	2	37.58***	ADHD > SLI = TD
# below cutoff	0	15	18

^aT scores at/above 65 for syndrome and composite scales considered clinically significant.

*p < 0.05, **p < 0.01, ***p < 0.001.

Table 6. Child Behavior Checklist and Conners’ Parent Rating Scales adjusted for language and academic items: number of children above recommended cutoffs for likely clinical status.

	ADHD (n = 20)	SLI (n-20)	TD (n = 20)	χ^2	Contrasts
CBCL^a
Withdrawn: # above cutoff	2	1	0	2.11	ADHD = SLI = TD
# below cutoff	18	19	20
Social Problems: # above cutoff	7	4	1	5.63*	ADHD > TD
# below cutoff	13	16	19
Attention Problems: # above cutoff	16	5	1	25.98***	ADHD > SLI = TD
# below cutoff	4	15	19
Internalizing: # above cutoff	12	5	2	12.17***	ADHD > SLI = TD
# below cutoff	8	15	18
CPRS-R:L^b
Cog Probs/Inattention: # above cutoff	12	4	2	13.33***	ADHD > SLI = TD
# below cutoff	8	16	18
DSM-Inattentive: # above cutoff	15	6	2	18.75***	ADHD > SLI = TD
# below cutoff	5	14	18
DSM-Total: # above cutoff	20	3	2	42.03***	ADHD > SLI = TD
# below cutoff	0	17	18

^aT scores at/above 65 for syndrome scales and at/above 60 for composite scales considered clinically significant.

^bT scores at/above 65 for syndrome and composite scales considered clinically significant.

*p < 0.05, **p < 0.01, ***p < 0.001.

Figure 1. ROC curves associated with discrimination of ADHD and SLI cases for parent ADHD symptom scales adjusted for the presence of language and academic items (reference line indicates test accuracy at “chance”).

Table 7. Diagnostic accuracy associated with parent ADHD scales including those adjusted for language and academic items.

Measure	Area under curve	Optimal cutoff^a	Sensitivity	Specificity	Positive likelihood ratio^b	Negative likelihood ratio^c
Subscale
Discrimination
CBCL
Attention problems
ADHD versus TD	0.976***	64.5	0.95	0.95	19.00	0.0526
ADHD versus SLI	0.889***	63.5	0.95	0.70	3.16	0.0714
Attention problems (adjusted)
ADHD versus TD	0.979***	63.0	0.95	0.95	19.00	0.0526
ADHD versus SLI	0.906***	62.5	0.80	0.75	5.33	0.2667
CPRS-R:L
Cog probs/inattention
ADHD versus TD	0.920***	58.0	1.00	0.85	6.67	<0.0117
ADHD versus SLI	0.740**	69.0	0.80	0.70	2.67	0.2857
Cog probs inattention (adjusted)
ADHD versus TD	0.909***	55.0	1.00	0.85	6.67	<0.0117
ADHD versus SLI	0.792**	62.5	0.75	0.75	3.00	0.3333
Restless impulsive
ADHD versus TD	1.00***	66.5	1.00	1.00	>99.00	<0.0101
ADHD versus SLI	0.971***	69.0	1.00	0.90	10.00	<0.0111
DSM-hyperactive
ADHD versus TD	1.00***	68.0	1.00	1.00	>99.00	<0.0101
ADHD versus SLI	0.943***	68.0	1.00	0.85	6.67	<0.0117
DSM-inattentive
ADHD versus TD	0.944***	63.5	1.00	0.90	10.00	<0.0111
ADHD versus SLI	0.842***	70.0	0.75	0.80	3.75	0.3125
DSM-inattentive (adjusted)
ADHD versus TD	0.825***	58.5	1.00	0.85	6.67	<0.0117
ADHD versus SLI	0.822***	67.5	0.75	0.85	5.00	0.2941
DSM-total
ADHD versus TD	1.00***	69.0	1.00	1.00	>99.00	<0.0101
ADHD versus SLI	0.935***	68.0	1.00	0.85	6.67	<0.0117
DSM-total (adjusted)
ADHD versus TD	1.00***	67.0	1.00	1.00	>99.00	<0.0101
ADHD versus SLI	0.929***	66.5	1.00	0.85	6.67	<0.0117

^aDetermined using Youden index (J) where J = maximum {sensitivity + specificity –1}.

^bPositive likelihood ratio = sensitivity/(1 − specificity): values of 1 = “neutral”; 3 = “moderately positive”; ≥10 = “very positive.”

^cNegative likelihood ratio = (1 − sensitivity)/specificity: values of 1 = “neutral”; ≤0.30 = “moderately negative”; ≤0.10 = “extremely negative.”

*p < 0.05, **p < 0.01, ***p < 0.001.