Impaired social functioning in individuals with ADHD has been well-documented as early as the preschool years and often persists into adulthood. Existing treatments for ADHD are effective for improving the inattention, impulsivity and overactivity characteristic of the disorder, but they have limited effectiveness at improving social skills. This suggests that social deficits in ADHD may be secondary to a separate phenomenon rather than the core symptoms of the disorder. Language problems are also common in ADHD, with accumulating evidence of pragmatic language difficulties. Pragmatic deficits have been associated with social impairment in several developmental and neurological disorders; however, the degree to which pragmatic deficits affect social skills in individuals with ADHD is unclear. The present study examined the relation between pragmatic deficits and social impairment in children with ADHD. To this end, 63 children, ages 7-11 years, were recruited and assigned to an ADHD or typically developing group based on parent and teacher ratings of ADHD symptoms and a semi-structured interview with a parent. A comprehensive assessment of pragmatic language was conducted using parent ratings of pragmatic skills, standardized tests of pragmatic language, and a narrative task. Parents also completed a rating scale of children's social skills. Results indicated that compared to their peers, children with ADHD have poorer pragmatic language skills across measures. Pragmatic deficits were present over and above receptive language problems. Furthermore, pragmatic language skills as measured by parent ratings mediated the effect of ADHD on social skills. These findings have implications for the treatment and possible prevention of social problems in children with ADHD.
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