Kids With ADHD Have Trouble Expressing Themselves in Writing

Aug. 22, 2011 -- Children with attention deficit hyperactivity disorder (ADHD) are more likely to have trouble expressing themselves in writing than children who do not have the disorder, a new study finds.

As many as 9% of children aged 5 to 19 have ADHD, according to the most recent estimates from the CDC. ADHD is characterized by impulsiveness, hyperactivity, and inattention. Children with ADHD are also at greater risk for alcohol or substance abuse, poor academic performance, and mood disorders such as depression and anxiety.

The study, which appears in Pediatrics, adds written-language disorder to this list, says study author Slavica K. Katusic, MD, an associate professor of epidemiology and pediatrics at the Mayo Clinic in Rochester, Minn.

Written-language disorder is an umbrella term that refers to difficulty with written language expression, including punctuation, spelling, grammar, and handwriting. “Teachers, psychologists, and parents are more intrigued by reading problems and ADHD, and no one is paying attention to writing problems,” she says.

Researchers analyzed medical, school, and private tutoring records for 5,718 children who were born from 1976 to 1982 and remained in Rochester, Minn., at least until their fifth birthday. Of these, 379 were diagnosed with ADHD. They found that 64.5% of boys with ADHD showed signs of written-language disorder by the time they were 19, compared with 16.5% of boys without ADHD. Among girls, 57% of those with ADHD had issues expressing themselves in writing by age 19. By contrast, just 9.4% of girls without ADHD experienced difficulty with punctuation, grammar, spelling, and written language expression, the study shows.

Dyslexia More Common Among Girls With ADHD, Writing Issues

Written-language disorder often comes with reading disability. Girls with ADHD and written-language disorder were much more likely to also have a reading disability than boys with ADHD, the study shows.

The ability to express oneself clearly in writing is an important skill, Katusic says. Handwriting has become somewhat obsolete as more people rely on computers to type, but “you can still make grammatical errors and poor paragraph organization on a computer,” she says. Issues associated with written-language disorder can occur alone or in tandem, but poor penmanship on its own does not constitute written-language disorder.

Mark Batshaw, MD, chief academic officer at Children's National Medical Center in Washington, D.C., agrees and says these issues become more and more important as students enter high school and college.

“At age 6 or 7, you are not expected to do a whole lot of writing, but when you start getting into high school and have to write papers, these skills become very important,” he says.

Fully 30% of children with ADHD will have some type of learning disability, he says. “Reading disability is so common that no one has really focused on the writing side,” he says.

“Many kids with ADHD do well verbally, but when asked to write a paragraph or logically put a story down on paper, they just can’t do it,” he says. These skills involve a different area of the brain than reading skills, he says.

“Previously we were only focusing on reading, and what this study does is to look beyond reading to the possibility that ADHD may also be affecting spelling and the students’ ability to express themselves in writing,” he says.

The earlier these issues are recognized, the earlier they can be addressed, he says.