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Maryland Coalition for Inclusive Education

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The 5 Ps of Inclusive Education with Dr. Shelley Moore ~ 1101

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"Neurodiversity may be every bit as crucial for the human race as biodiversity is for life in general. Who can say what form of wiring will prove best at any given moment?"

- Harvey Blume, The Atlantic, 1998

Although there is broad diversity across the population, some individuals have neurological variations that make it particularly challenging for their communication, self-expression and interactions with others. Neurodivergence is a broad umbrella and is not just autism. Neurological variations can include autism, ADHD, dyslexia, dyspraxia, dyscalculia, dysgraphia and tics. (However, Judy Singer, who coined the term, proposes that we are ALL neurodiverse because no two humans on the planet are exactly the same.)

The environments within which individuals with these neurovariations learn, work and live can either facilitate or inhibit their growth and development.

The purpose of this initiative is to create environments that will maximally facilitate these individuals to grow and achieve their full potential. It is about facilitating a community of practice for universities, colleges, employers and service providers to work together to create these environments and opportunities for neurodivergent young adults.

The Resources section includes a vast array of resources that have been created or curated for use by neurodivergent students, their parents and carers, employers and universities.

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Neurodiversity Hub - Resources for Students, Employers & More

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Neurodiversity Hub promotes a community of practice for universities, colleges and employers to support neurodivergent students become work-ready and build connections with organisations that value their talents. It also promotes a community of practice for architects and building designers to prom

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Share your videos with friends, family, and the world

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The Neuro-Inclusion Revolution  | Theresa Haskins | TEDxBGSU

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Frontiers | Development of inclusive education in the Republic of Kazakhstan: an inside view (case of the Karaganda region)

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In Kazakhstan, in the process of inclusive education, which ensures equal access to education for all children, taking into account their particular educatio…

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LEGAL REGULATION OF INCLUSIVE EDUCATION IN KAZAKHSTAN: FEATURES AND TOOLS

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Law of the Republic of Kazakhstan “About education”

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Law of the Republic of Kazakhstan of July 27, 2007 No. 319-III ZRK “About Education”

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Guides: Special education and inclusion: Recent e-books

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This guide is for those interested in special education, both research and practice. This includes programs for those with learning differences and social differences, plus programs to promote inclusion.

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ABSTRACT

ABSTRACT
This paper focuses on a major challenge facing education systems around the world, that of finding ways of including all children in schools. In economically poorer countries this is mainly about the millions of children who are not able to attend formal education (UNESCO, 2015). Meanwhile, in wealthier countries many young people leave school with no worthwhile qualifications, whilst others are placed in special provision away from mainstream education and some choose to drop out since the lessons seem irrelevant (OECD, 2012). Faced with these challenges, there is evidence of an increased interest in the idea of making education more inclusive and equitable. However, the field remains confused as to the actions needed in order to move policy and practice forward.

Introduction

This paper focuses on a major challenge facing education systems around the world, that of finding ways of including all children in schools. In economically poorer countries this is mainly about the millions of children who are not able to attend formal education (UNESCO, 2015). Meanwhile, in wealthier countries many young people leave school with no worthwhile qualifications, whilst others are placed in special provision away from mainstream education and some choose to drop out since the lessons seem irrelevant (OECD, 2012). Faced with these challenges, there is evidence of an increased interest in the idea of making education more inclusive and equitable. However, the field remains confused as to the actions needed in order to move policy and practice forward.

In the paper I draw on research carried out with colleagues in various parts of the world that points to some promising possibilities (for more detailed accounts see Ainscow, 2016a). In so doing, I provide frameworks that may be helpful to readers as they consider the other contributions to this journal. I begin, however, by summarizing relevant international developments.

The international policy context

Over the last 30 years there have been major international efforts to encourage inclusive educational developments. In particular, the United Nation's Education for All (EFA) movement has worked to make quality basic education available to all learners. Agreed in 1990, the EFA Declaration sets out an overall vision, which is about being proactive in identifying the barriers some learners encounter in attempting to access educational opportunities. It also involves the identification of resources available at national and community level, and bringing them to bear on overcoming those barriers. This vision was reaffirmed by the World Education Forum meeting in Dakar, 2000, held to review the progress made in the previous decade. The Forum declared that EFA must take particular account of the needs of the poor and the disadvantaged, including working children, remote rural dwellers and nomads, and ethnic and linguistic minorities, children, young people affected by conflict, HIV/AIDS, hunger and poor health, and those with special learning needs.

A major impetus for inclusive education was given by the World Conference on Special Needs Education in 1994. More than 300 participants representing 92 governments and 25 international organizations met in Salamanca, Spain to further the objective of Education for All by considering the fundamental policy shifts required to promote the approach of inclusive education, namely enabling schools to serve all children, particularly those defined as having special educational needs (UNESCO, 1994). Although the immediate focus of the Salamanca conference was on what was termed special needs education, its conclusion was that:

Special needs education - an issue of equal concern to countries of the North and of the South - cannot advance in isolation. It has to form part of an overall educational strategy and, indeed, of new social and economic policies. It calls for major reform of the ordinary school. (p. iii-iv)

The aim, then, is to reform education systems. This can only happen, it is argued, if mainstream schools become capable of educating all children in their local communities. The Salamanca Statement concluded that:

Regular schools with [an] inclusive orientation are the most effective means of combating discriminatory attitudes, creating welcoming communities, building an inclusive society and achieving education for all; moreover, they provide an effective education to the majority of children and improve the efficiency and ultimately the cost-effectiveness of the entire education system. (p.ix)

As this key passage indicates, the move towards inclusive schools can be justified on a number of grounds. There is an educational justification: the requirement for inclusive schools to educate all children together means that they have to develop ways of teaching that respond to individual differences and that therefore benefit all children; a social justification: inclusive schools are able to change attitudes to difference by educating all children together, and form the basis for a just and non-discriminatory society; and an economic justification: it is likely to be less costly to establish and maintain schools which educate all children together than to set up a complex system of different types of school specializing in particular groups of children.

Further impetus to this movement was provided by the 48th session of the IBE-UNESCO International Conference on Education, with its theme 'Inclusive Education: The Way of the Future'. The long-term objective of this event was to support UNESCO member states in providing the social and political conditions which every person needs in order to exercise their human right to access, take an active part in, and learn from educational opportunities (Opertti, Walker, & Zhang, 2014). During the conference, ministers, government officials and representatives of voluntary organizations discussed the importance of broadening the concept of inclusion to reach all children, under the assumption that every learner matters equally and has the right to receive effective educational opportunities.

Moving forward, the year 2016 was particularly important in relation to the future of the EFA movement and, indeed, the legacy of Salamanca. Building on the Incheon Declaration agreed at the World Forum on Education in May 2015 (UNESCO, 2015), it saw the publication by UNESCO of the Education 2030 Framework for Action. This emphasizes inclusion and equity as laying the foundations for quality education. It also stresses the need to address all forms of exclusion and marginalization, disparities and inequalities in access, participation, and learning processes and outcomes. In this way, it is made clear that the international EFA agenda really has to be about 'all'.

The importance of including disabled children is an essential strand within this new international policy agenda. This was stressed in the United Nations' Convention on the Rights of Persons with Disabilities (United Nations, 2008), which states: 'The right to inclusive education encompasses a transformation in culture, policy and practice in all educational environments to accommodate the differing requirements and identities of individual students, together with a commitment to remove the barriers that impede that possibility.'(General Comment No 4) The Convention defines non-inclusion, or segregation, as the education of students with disabilities in separate environments (i.e. in separate special schools, or in special education units located with regular schools). It commits to ending segregation within educational settings by ensuring inclusive classroom teaching in accessible learning environments with appropriate support. This means that education systems must provide a personalized educational response, rather than expecting the student to fit the system.

A new commitment reinforcing inclusion and equity in education was expressed at an International Forum, co-organized by UNESCO and the Ministry of Education of Colombia in September 2019 to celebrate the 25 th anniversary of the Salamanca Declaration. As underlined by the theme 'Every learner matters', the Forum was an opportunity to revive the broadened notion of inclusion as a general guiding principle to strengthen equal access to quality learning opportunities for all learners.

Like all major policy changes, progress in relation to inclusion and equity requires an effective strategy for implementation. In particular, it requires new thinking which focuses attention on the barriers experienced by some children that lead them to become marginalized as a result of contextual factors. The implication is that overcoming such barriers is the most important means of development forms of education that are effective for all children. In this way, inclusion becomes a way of achieving the overall improvement of education systems.

A whole-system approach

International experience has led me to formulate a framework for thinking about how to promote inclusion and equity within education systems (see Figure 1). Amended from an earlier version (Ainscow, 2005), it focuses attention on five interrelated factors, summarized in the diagram below. Together, they can help in determining 'levers for change' (Senge, 1989).

The framework places schools at the centre of the analysis. This reinforces the point that moves towards inclusion must be focussed on increasing the capacity of local neighbourhood mainstream schools to support the participation and learning of an increasingly diverse range of learners. This is the paradigm shift implied by the Salamanca Statement, which I have described as an 'inclusive turn' (Ainscow, 2007). It argues that moves towards inclusion are about the development of schools, rather simply involving attempts to integrate vulnerable groups of students into existing arrangements.

At the same time, the framework draws attention to a range of contextual influences that bear on the way schools carry out their work. As explained below, these influences may provide support and encouragement to those in schools who are wishing to move in an inclusive direction. However, the same factors can act as obstacles to progress. These influences relate to: the principles that guide policy priorities within an education system; the views and actions of others within the local context, including members of the wider community that the schools serve and the staff of the departments that have responsibility for the administration of the school system; and the criteria that are used to evaluate the performance of schools. In what follows each of the five factors are explained, leading to a series of key ideas that need to be considered in developing future policies.

Inclusion and equity as principles

Terms such as 'equity' and 'inclusion' can be confusing since they may mean different things to different people. This is a particular problem when trying to move forward with other people - not least in schools, where everybody is so busy. Put simply, if there is not a shared understanding of the intended direction, progress will be difficult. There is, therefore, a need for agreed definitions of these concepts. Recent international policy documents argue that they should be seen as principles that inform all aspects of educational policy (e.g. UNESCO, 2017).

In some countries, inclusive education is still thought of as an approach to serving children with disabilities within general education settings. Internationally, however, it is increasingly seen more broadly as a principle that supports and welcomes diversity amongst all learners. It presumes that the aim of is to eliminate social exclusion that is a consequence of attitudes and responses to diversity in race, social class, ethnicity, religion, gender and ability. As such, it starts from the belief that education is a basic human right and the foundation for a more just society. Hence, the emphasis on equity, which implies a concern with fairness.

Our research suggests that it is helpful to use a definition of inclusive education that involves a process that is concerned with the identification and removal of barriers to the presence, participation and achievement of all students (Ainscow et al., 2006). At the same time, it involves a particular emphasis on those groups of learners who may be at risk of marginalization, exclusion or underachievement.

We have found that a well-orchestrated debate about these elements can lead to a wider understanding of the principle of inclusion. Furthermore, such a debate, though by its nature slow and, possibly, never ending, can have leverage in respect to fostering the conditions within which schools can feel encouraged to move in a more inclusive direction. These debates must involve all stakeholders within communities, including families, political and religious leaders, and the media. They should also involve those within national and local district education offices. Recently, in countries such as Colombia, Ecuador, Mexico, Oman and Uruguay, I have used the indicators provided by The Guide for Ensuring Inclusion and Equity in Education (UNESCO, 2017) to facilitate such discussions.

Use of evidence

Previously I have argued that evidence is the life-blood of inclusive development (Ainscow et al., 2006, 2012). Therefore, deciding what kinds of evidence to collect and how to use it requires care, since, within education systems, ' what gets measured gets done'. This is widely recognized as a double-edged sword precisely because it is such a potent lever for change. On the one hand, data are required in order to monitor the progress of children, evaluate the impact of interventions, review the effectiveness of policies and processes, plan new initiatives, and so on. On the other hand, if effectiveness is evaluated on the basis of narrow, even inappropriate, performance indicators, then the impact can be deeply damaging. Whilst appearing to promote the causes of accountability and transparency, the use of data can, in practice: conceal more than they reveal; invite misinterpretation; and, worse of all, have a perverse effect on the behaviour of professionals. The challenge is, therefore, to harness the potential of evidence as a lever for change, whilst avoiding these potential problems.

The starting point for making decisions about the evidence to collect at the system level should be with an agreed definition of inclusion. In other words, we must 'measure what we value', rather than is often the case, 'valuing what we can measure'. In line with the suggestions made earlier, then, evidence collected within an education system needs to relate to the presence, participation and achievement of all students, with an emphasis placed on those groups of learners regarded to be 'at risk of marginalisation, exclusion or underachievement'.

An engagement with evidence is also crucial at the level of the school, where it can provide the stimulus for professional learning. The starting point for developing inclusive practices is with the sharing of existing approaches through collaboration amongst staff, leading to experimentation with new practices that will reach out to all students (Ainscow, 2016b). This requires the development of a common language with which colleagues can talk to one another and, indeed, to themselves, about detailed aspects of their practice. Without such a language, teachers find it very difficult to experiment with new possibilities (Huberman, 1993). A framework that can help in the promotion of an inclusive dialogue within a school is provided by the Index for Inclusion, a review instrument developed originally for use in England but now available in many countries (Booth & Ainscow, 2002)

The use of evidence to study teaching within a school can help in generating a language of practice (Ainscow et al., 2006). This, in turn, can foster the development of practices that are more effective in reaching hard to reach learners. Specifically, it can create space for rethinking by interrupting existing discourses. Particularly powerful techniques for generating evidence involve the use of mutual lesson observation, sometimes through video recordings, and comments collected from students about teaching and learning arrangements within a school (Ainscow & Messiou, 2017). Under certain conditions, such approaches provide interruptions that stimulate self-questioning, creativity and action. In so doing they can lead to a reframing of perceived problems that, in turn, draws the teacher's attention to overlooked possibilities for addressing barriers to participation and learning. In this way, differences amongst students, staff and schools become a catalyst for improvement.

Our current research is exploring teacher/student dialogue as a means of making this happen. This was stimulated by a study carried out between 2011 and 2014 that had a major impact on our thinking (see Messiou et al., 2016, for more details). It involved collaborative action research carried out by teams of teachers in eight secondary schools in three countries (i.e. England, Portugal and Spain), with support from locally based university researchers. The schools were chosen because of the diversity of their student populations. Each team experimented with ways of collecting and engaging with the views of students in order to foster the development of more inclusive classroom practices. Typically, teachers worked in trios following an approach based on lesson study, a systematic procedure for the development of teaching that is well established in Japan and some other Asian countries (Lewis, Perry, & Murata, 2006). Meanwhile, members of the university teams monitored the process and outcomes of these activities.

So, for example, in planning a joint lesson they would each teach, one trio of teachers identified students within each of their classes who they saw as being particularly vulnerable. They felt that by thinking about the lesson with these individuals in mind they might create new and different ways of facilitating the learning of all of their students. One teacher talked about a student who would not speak, even when invited. Another teacher focused on one of his students who had severe dyslexia. This led the teachers to discuss how they might plan their lessons differently; they talked, for example, about getting the students to write on the whiteboard, and getting students to rehearse verbally what they wanted to say, rather than writing arguments down.

The trio decided that they needed to involve some of their students before teaching the lesson to get an idea of how they preferred to learn. They also wanted to consider how best to plan the lesson to support the many differences amongst the students. They therefore selected seven students, each from a different ethnic background, six of who were born outside the country. The teachers got these students together at lunchtime and asked them to rank their preferences regarding different classroom activities that might be used when studying poetry. One of the teachers explained:

Initially, they were quite reluctant to perhaps voice an opinion that they thought we wouldn't like ... . We stepped back for a bit and just left the recording device on the table and let them talk about what they liked and what they didn't like, because if we're not imposing our views on them, they were more likely to be honest.

The overall aim of the lesson was to develop awareness of and confidence in a variety of dramatic techniques. Each teacher taught the lesson with their two colleagues observing, making changes in the light of the regular discussions that took place as they proceeded. It was noticeable that these conversations became increasingly focused on matters of detail and, as a result, led to a greater emphasis on mutual challenge and personal reflection. By the end of the process the three teachers all commented that they had been challenged to rethink their lesson planning and facilitation. Through this, they realized that new approaches gave members of the class the opportunities to learn out of their 'comfort zones' and, in so doing, this moved the teachers' expectations about the capabilities of their students.

Drawing on the lessons from this research in secondary schools, a current study is using a new model for developing learning and teaching that we call 'Inclusive Inquiry' (Messiou, 2019; Messiou & Ainscow, 2020). This uses dialogue involving teachers and students in order to explore possibilities for making lessons more inclusive. Central to the model is the idea of engaging with the views of students, a process that permeates all the processes involved.

The Inclusive Inquiry approach is currently being trialled in 30 primary schools in five countries (i.e. Austria, Denmark, England, Spain and Portugal).¹ It involves a series of interconnected processes, as shown in Figure 2. Central to these are discussions amongst teachers and their students about how to make lessons more inclusive. This involves students learning how to use research techniques to gather the views of their classmates.

The dialogues that this encourages are focused on learning and teaching. More specifically, differences amongst students and teachers are used to challenge existing thinking and practices in ways that are intended to encourage experimentation in order to foster more inclusive ways of working. This, in turn, sets out to break down barriers that are limiting the engagement of some learners.

The evidence from this study supports our earlier research which suggested that classroom-based research of this kind can be a powerful way of moving practice forward within a school. What is distinctive, however, is the added value that comes from engaging students themselves in the process. It is also clear that the use of the approach can present various organizational challenges. In particular, it has sometimes proved to be challenging of the status quo within schools. Consequently, greater collaboration is needed amongst teachers in order to support the introduction of new practices. This requires organizational flexibility and the active support of senior staff, prepared to encourage and support processes of experimentation. Indeed, it implies the need for cultural change within a school, a theme I return to below.

School development

There is not one single model of what an inclusive school looks like. What is common to highly inclusive schools, however, is that they are welcoming and supportive places for all of their students, not least for those with disabilities and others who experience difficulties (Dyson, Howes, & Roberts, 2004). This does not prevent these schools from also being committed to improving the achievements of all of their students. Indeed, they tend to have a range of strategies for strengthening achievement that are typical of those employed by all effective schools, and the emphasis on supporting vulnerable students does not appear to inhibit these strategies. A key factor is the emphasis placed on tracking and supporting the progress of all of the students.

A problem reported from a number of countries, is that despite national policies emphasizing the equal rights of children with disabilities to attend mainstream settings, there has been evidence over many years of significant increases in the proportions of students being categorized in order that their schools can earn additional resources (Fulcher, 1989; Meijer & Watkins, 2019). This has led to dissatisfaction with progress towards integration and brought demands for more radical changes. One of the concerns of those who adopt this view is with the way in which students come to be designated as having special needs (e.g. Slee, 2010). They see this as a social process that needs to be continually challenged. More specifically, they argue that the continued use of what is sometimes referred to as a 'medical model' of assessment - within which educational difficulties are explained solely in terms of a child's deficits - prevents progress in the field, not least because it distracts attention from questions about why schools fail to teach so many children successfully.

The implication is that schools need to be reformed and practices need to be improved in ways that will lead them to respond positively to student diversity - seeing individual differences not as problems to be fixed, but as opportunities for enriching learning. Within such a conceptualization, a consideration of difficulties experienced by students can provide an agenda for change and insights as to how such changes might be brought about. Moreover, this kind of approach is more likely to be successful in contexts where there is a culture of collaboration that encourages and supports problem-solving (Ainscow, 2016a; Skrtic, 1991).

According to this view, the development of inclusive practices is seen as involving those within a particular context in working together to address barriers to education experienced by some learners. These themes are further supported by a review of international research literature that examines the effectiveness of school actions in promoting inclusion (Dyson et al., 2004). In summary, this suggests that some schools are characterized by an 'inclusive culture'. Within such schools, there is a degree of consensus among adults around values of respect for difference and a commitment to offering all students access to learning opportunities.

The extent to which such inclusive cultures lead directly and unproblematically to enhanced student participation is not clear. Some aspects of these cultures, however, can be seen as participatory by definition. For instance, respect for diversity from teachers may itself be understood as a form of participation by children within a school community. Moreover, schools with such cultures are also likely to be characterized by forms of organization (such as specialist support being made within the ordinary classroom, rather than by withdrawal for separate attention) and practices (such as cooperative group work) which could be regarded as participatory by definition.

All of this means that attempts to develop inclusive schools should pay attention to the building of consensus around inclusive values within school communities. This implies that school leaders should be selected in the light of their commitment to inclusive values and their capacity to lead in a participatory manner (Riehl, 2000). Finally, the external policy environment should be compatible with inclusive developments in order to support rather than undermine the efforts of schools.

Involving the wider community

In order to foster inclusion and equity in education, governments need to mobilize human and financial resources, some of which may not be under their direct control. Forming partnerships among key stakeholders who can support and own the process of change is therefore essential. These stakeholders include: parents/caregivers; teachers and other education professionals; teacher trainers and researchers; national, local and school-level administrators and managers; policy-makers and service providers in other sectors (e.g. health, child protection and social services); civic groups in the community; and members of minority groups that are at risk of exclusion.

Family involvement is particularly crucial. In some countries, parents and education authorities already cooperate closely in developing community-based programmes for certain groups of learners, such as those who are excluded because of their gender, social status or impairments (Miles, 2002). A logical next step is for these parents to become involved in supporting change for developing inclusion in schools.

Where parents lack the confidence and skills to participate in such developments, it might be necessary to engage and build capacity and networks. This could include the creation of parent support groups, training parents to work with their children, or building the advocacy skills of parents to negotiate with schools and authorities. Here, it is worth adding that there is evidence that the views of families, including children themselves, can be helpful in bringing new thinking to the efforts of schools to develop more inclusive ways of working.

All of this means changing how families and communities work, and enriching what they offer to children. In this respect there are many encouraging examples of what can happen when what schools do is aligned in a coherent strategy with the efforts of other local players - employers, community groups, universities and public services (Kerr, Dyson, & Raffo, 2014). This does not necessarily mean schools doing more, but it does imply partnerships beyond the school, where partners multiply the impacts of each other's efforts.

This has implications for the various key stakeholders within education systems. In particular, teachers, especially those in senior positions, have to see themselves as having a wider responsibility for all children, not just those that attend their own schools. They also have to develop patterns of internal organization that enable them to have the flexibility to cooperate with other schools and with stakeholders beyond the school gate. It means, too, that those who administer school systems have to adjust their priorities and ways of working in response to improvement efforts that are led from within schools.

The role of administrative departments

Policy is made at all levels of an education system, not least at the school and classroom levels (Ball, 2010). As such, the promotion of equity and inclusion is not simply a technical or organizational change - it is a movement in a clear philosophical direction. Moving to more inclusive ways of working therefore requires changes across an education system. These span from shifts in policy-makers' values and ways of thinking, which enable them to provide a vision shaping a culture of inclusion, to significant changes within schools and classrooms.

A culture of inclusion in education requires a shared set of assumptions and beliefs amongst policy-makers and senior staff at the national, district and school level that value differences, believe in collaboration, and are committed to offering educational opportunities to all students (Ainscow, Chapman, & Hadfield, 2020). However, changing the cultural norms that exist within an education system is difficult to achieve, particularly within a context that is faced with so many competing pressures and where practitioners tend to work alone in addressing the problems they face. Leaders at all levels, including those in civil society and other sectors, therefore have to be prepared to analyse their own situations, identify local barriers and facilitators, plan an appropriate development process, and provide leadership for inclusive practices and effective strategies for monitoring equity in education.

National and district administrators have important roles in promoting inclusive ways of managing schools and education processes. In particular, they have to establish the conditions for challenging non-inclusive, discriminatory educational practices. They also need to establish the conditions that build consensus and commitment towards putting the universal values of inclusion and equity into practice. Particular forms of leadership are known to be effective in promoting inclusion in education (Riehl, 2000). These approaches focus attention on teaching and learning; they create strong supportive communities of students, teachers and parents; they nurture the understanding of a culture of education among families; and, they foster multi-agency support.

There is also evidence that school-to-school collaboration can strengthen the capacity of individual organizations to respond to learner diversity (Muijs, Ainscow, Chapman, & West, 2011). Specifically, collaboration between schools can help to reduce the polarization of schools, to the particular benefit of those students who are marginalized at the edges of the system. In addition, there is evidence that when schools seek to develop more collaborative ways of working, this can have an impact on how teachers perceive themselves and their work. Specifically, comparisons of practices in different schools can lead teachers to view underachieving students in a new light. In this way, learners who cannot easily be educated within the school's established routines are not seen as 'having problems', but as challenging teachers to re-examine their practices in order to make them more responsive and flexible.

Local coordination is needed in order to encourage such forms of collaboration (Armstrong & Ainscow, 2018). Indeed, a recent report noted that four of the most successful national education systems - Singapore, Estonia, Finland, and Ontario - each has a coherent 'middle tier', regardless of their differing extents of school autonomy or devolution of decision-making (Bubb, Crossley-Holland, Cordiner, Cousin, & Earley, 2019). In particular, they all had district level structures that offer a consistent view that, to maintain equity as well as excellence, there needs to be an authoritative co-ordinating influence with local accountability.

Having analysed two relatively successful large-scale improvement initiatives, Andy Hargreaves and I have suggested a way of supporting local authorities in responding to these new demands (Hargreaves & Ainscow, 2015). We argue that, in taking on new roles, districts can provide a valuable focus for school improvement, be a means for efficient and effective use of research evidence and data analysis across schools, support schools in responding coherently to multiple external reform demands, and be champions for families and students, making sure everybody gets a fair deal.

The problem is, of course, that not all local school systems are strong. Therefore, a way to reduce variation amongst school districts is to promote collaboration among them so they share resources, ideas, and expertise, and exercise collective responsibility for student success. In adopting this 'leading from the middle' approach, districts can become the collective drivers of change and improvement together.

Thinking about the development of policies for promoting inclusion and equity, it is encouraging to note the progress made in certain countries. For example:

The Italian government passed a law in 1977 that closed all special schools, units and other non-inclusive provision (Lauchalan & Fadda, 2012). This legislation is still in force and subsequent amendments have further strengthened the inclusive nature of the education system. Not only did this close segregated educational facilities but it removed the possibility of exclusion from school as a corrective sanction. Whilst practice varies from place to place, there is no doubt that the principle of inclusion is widely accepted.

Finland is a country which regularly outperforms most other countries in terms of educational outcomes. Its success is partly explained by the progress of the lowest performing quintile of students who take the PISA tests out-performing those in other countries, thus raising the mean scores overall (Sabel, Saxenian, Miettinen, Kristenson, & Hautamaki, 2011). This has increasingly involved an emphasis on support for vulnerable students within mainstream schools, as opposed to in segregated provision (Takala, Pirttimaa, & Tormane, 2009).

Having enacted legislation making disability discrimination in education unlawful, Portugal has gone much further in enacting an explicit legal framework for the inclusion in education of students with and without disabilities (Alves, 2019). Recent legislation requires that the provision of supports for all students be determined, managed and provided at the regular school level, with local multidisciplinary teams responsible for determining what support is necessary to ensure all students (regardless of labels, categorization or a determination of disability) have access to, and the means to participate effectively in education, with a view to their full inclusion in society.

In drawing attention to these examples, I stress that they are not perfect. Rather, they are countries where there are interesting developments from which to learn. They are also varied in respect to the approach being taken and what they have achieved. Consequently, whilst lessons can undoubtedly be learned from these countries, they must be replicated with care.

There are many sources of inequity in education related to political, economic, social, cultural and institutional factors, and these vary across countries. This means that what works in one country may not work elsewhere. This is why an emphasis on system change strategies being contextually sensitive is one of the pervading themes in this paper.

Conclusion

In summary, then, the ideas that have emerged from this review of international experiences, research and policy documents regarding ways of promoting equity and inclusion are as follows:

Policies should be based on clear and widely understood definitions of what the terms Inclusion and equity mean;

Strategies should be informed by evidence regarding the impact of current practices on the presence, participation and achievement of all students;

There should be an emphasis on whole-school approaches in which teachers are supported in developing inclusive practices;

Education departments must provide leadership in the promotion of inclusion and equity as principles that guide the work of teachers in all schools; and

Policies should draw on the experience and expertise of everybody who has an involvement in the lives of children, including the children themselves

These ideas indicate that the promotion of inclusion and equity in education is less about the introduction of particular techniques or new organizational arrangements, and much more about processes of social learning within particular contexts. As I have argued, the use of evidence as a means of stimulating experimentation and collaboration is seen as a central strategy. Copland ( 2003) suggests, inquiry can be the 'engine' to enable the distribution of leadership that is needed in order to foster participation in learning, and the 'glue' that can bind a community together around a common purpose.

Working with schools over many years to introduce this way of thinking, I have become aware of the complexities involved. One way to think about the processes at work is to see them as linked within an 'ecology of equity' (Ainscow et al., 2012). By this I mean that the extent to which students' experiences and outcomes are equitable is not dependent only on the educational practices of their teachers, or even their schools. Instead, it depends on a whole range of interacting processes that reach into the school from outside. These include the demographics of the areas served by schools; the histories and cultures of the populations who send (or fail to send) their children to school; and the economic realities faced by those populations. Beyond this, they involve the underlying socio-economic processes that make some areas poor and others affluent, and that draw migrant groups into some places rather than others. They are also influenced by the wider politics of the teaching profession, of decision-making at the district level and of national policy-making, and the impacts of schools on one another over issues such as exclusion and parental choice. In addition, they reflect new models of school governance, the ways in which local school hierarchies are established and maintained, and the ways in which school actions are constrained and enabled by their positions in those hierarchies.

It is also important to recognize the complexities of interactions between the different elements in this ecology, and their implications for achieving more equitable education systems. As my colleagues and I work on improvement projects with schools, we therefore find it helpful to think of three interlinked areas within which equity issues arise:

Within schools. These are issues that arise from school and teacher practices. They include: the ways in which students are taught and engaged with learning; the ways in which teaching groups are organized and the different kinds of opportunities that result from this organization; the kinds of social relations and personal support that are characteristic of the school; the ways in which the school responds to diversity in terms of attainment, gender, ethnicity and social background; and the kinds of relationships the school builds with families and local communities.

Between schools. These are issues that arise from the characteristics of local school systems. They include: the ways in which different types of school emerge locally; the ways in which these schools acquire different statuses, so that hierarchies emerge in terms of performance and preference; the ways in which schools compete or collaborate; the processes of integration and segregation which concentrate students with similar backgrounds in different schools; the distribution of educational opportunities across schools; and the extent to which students in every school can access similar opportunities.

Beyond schools. This far-reaching arena includes: the wider policy context within which schools operate; the family processes and resources which shape how children learn and develop; the interests and understandings of the professionals working in schools; and the demographics, economics, cultures and histories of the areas served by schools. Beyond this, it includes the underlying social and economic processes at national and - in many respects - at global levels out of which local conditions arise.

Looked at in this way, it is clear that there is much that individual schools can do to tackle issues within their organizations, and that such actions are likely to have a profound impact on student experiences, and perhaps have some influence on inequities arising elsewhere. However, it is equally clear that these strategies do not lead to schools tackling between- and beyond-school issues directly. No school strategy can, for example, make a poor area more affluent, or increase the resources available to students' families, any more than it could create a stable student population, or tackle the global processes underlying migration patterns. But perhaps there are issues of access, or of the allocation of students to schools, that might be tackled if schools work together on a common agenda.

As I have emphasized throughout this paper, all of this has major implications for leadership practice within schools and education systems. In particular, it calls for efforts to encourage coordinated and sustained efforts around the idea that changing outcomes for vulnerable groups of students is unlikely to be achieved unless there are changes in the behaviours of adults. Consequently, the starting point must be with policy-makers and practitioners: in effect, enlarging their capacity to imagine what might be achieved, and increasing their sense of accountability for bringing this about. This may also involve tackling taken-for-granted assumptions, most often relating to expectations about certain groups of students, their capabilities and behaviours.

Disclosure statement

No potential conflict of interest was reported by the author.

References

Ainscow, M. , Booth, T. , Dyson, A. , Farrell, P. , Frankham, J. , Gallannaugh, F. , ... Smith, R. (2006). Improving schools, developing inclusion. London: Routledge.

Ainscow, M. , Chapman, C. , & Hadfield, M. (2020). Changing education systems: A research-based approach. London: Routledge.

Ainscow, M. , Dyson, A. , Goldrick, S. , & West, M. (2012). Developing equitable education systems. London: Routledge.

Ainscow, M. , & Messiou, K. (2017). Engaging with the views of students to promote inclusion in education. Journal of Educational Change, 19(1), 1-17.

Armstrong, P. , & Ainscow, M. (2018). School-to-school support within a competitive education system: Views from the inside. School Effectiveness, School Improvement, 29(4), 614-633.

Booth, T. , & Ainscow, M. (2002). The index for inclusion. Bristol: Centre for Studies on Inclusive Education.

Bubb, S. , Crossley-Holland, J. , Cordiner, J. , Cousin, S. , & Earley, P. (2019). Understanding the middle tier: Comparative costs of academy and LA-maintained school systems. London: Sara Bubb Associates.

Dyson, A. , Howes, A. , & Roberts, B. (2004). What do we really know about inclusive schools? A systematic review of the research evidence. In D. Mitchell (Ed.), Special educational needs and inclusive education: Major themes in education. London: Routledge.

Hargreaves, A. , & Ainscow, M. (2015) The top and bottom of leadership and change. Phi Delta Kappa, November, 2015

Huberman, M. (1993). The model of the independent artisan in teachers' professional relationships. In J. W. Little & M. W. McLaughlin (Eds.), Teachers' work: Individuals, colleagues and contexts (pp. 65-83). New York: Teachers College Press.

Kerr, K. , Dyson, A. , & Raffo, C. (2014). Education, disadvantage and place: Making the local matter. Bristol: Policy Press.

Lauchalan, F. , & Fadda, R. (2012). The 'Italian model' of full inclusion: Origin and current directions. In C. Boyle & K. Topping (Eds.), What works in inclusion? (pp. 107-119). Maidenhead: Open University Press.

Lewis, C. , Perry, R. , & Murata, A. (2006). How should research contribute to instructional improvement? The case of lesson study. Educational Researcher, 35(3), 3-14.

Meijer, C. J. W. , & Watkins, A. (2019). Financing special needs and inclusive education: From salamanca to the present. International Journal of Inclusive Education, 23(7/8), 705-721.

Messiou, K. , & Ainscow, M. (2020). Inclusive inquiry: Student-teacher dialogue as a means of promoting inclusion in schools. British Journal of Educational Research (In Press).

Messiou, K. , Ainscow, M. , Echeita, G. , Goldrick, S. , Hope, M. , and Paes, I. (2016). Learning from differences: A strategy for teacher development in respect to student diversity. School Effectiveness and School Improvement, 27(1), 45-61.

Muijs, D. , Ainscow, M. , Chapman, C. , & West, M. (2011). Collaboration and networking in education. London: Springer.

Opertti, R. , Walker, Z. , & Zhang, Y. (2014). Inclusive education: From targeting groups and schools to achieving quality education as the core of EFA. In L. Florian (Ed.), The SAGE handbook of special education (2nd Revised ed., pp. 149-170). London: SAGE.

Sabel, C. , Saxenian, A. , Miettinen, R. , Kristenson, P. H. , & Hautamaki, J. (2011). Individualized service provision in the new welfare state: Lessons from special education in Finland. Helsinki: SITRA.

Takala, M. , Pirttimaa, R. , & Tormane, M. (2009). Inclusive special education: The role of special education teachers in Finland. British Journal of Special Education, 36(3), 162-172.

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Promoting inclusion and equity in education: lessons from international experiences

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ABSTRACT ABSTRACT This paper focuses on a major challenge facing education systems around the world, that of finding ways of including all children in schools. In economically poorer countries this is mainly about the millions of children who are not able to attend formal education (UNESCO, 2015).

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BridgeUniverse - TEFL Blog, News, Tips & Resources

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Neurodiversity and teaching neurodivergent learners are familiar topics for educators. Most teachers have a few students with individual learning plans (ILP) or struggling with ADHD or dyslexia.

Neurodiversity refers to the idea that no individual experiences the world exactly like another. Just like fingerprints, no two brains are alike. Australian sociologist Judy Singer coined the term in the 1990s to remove the stigma associated with disorders such as autism, ADHD, dyslexia, and other learning disabilities.

While individuals impacted by autism, ADHD, and dyslexia may be more markedly different than those who are considered 'normal,' in a sense, we are all 'neurodiverse' because we all have personal learning modalities.

The issue of neurodiversity has come to the fore in recent years because of the rising number of neurodiverse learners in education. For example, it is estimated that 1 in 36 children is affected by autism in the United States. Whether these numbers reflect better diagnostic screening or the negative influence of factors such as socioeconomic status, nutrition, or environmental causes, the fact remains that these students face challenges that most learners do not.

Thanks to advancements in neuroscience, significant progress has been made over the past three decades in addressing neurodiversity in the context of learning. Organizations such as CAST, the Center for Applied Special Technology, have developed principles and strategies to teach neurodiverse students and accommodate multiple learning styles.

With the above in mind, let's examine some inclusive teaching strategies for supporting neurodivergent students.

Creating an Inclusive Learning Environment

A significant development arising from the focus on neurodiversity is the recognition that teaching strategies must be inclusive and cater to the unique needs of all students. To this end, it is essential that neurodiverse students are placed in an environment that feels safe, where they are listened to, and where they are part of a supportive community.

How to foster psychological safety

A safe environment is essential for all learners to thrive, but it is especially critical for neurodivergent students. Feeling psychologically safe means being comfortable expressing oneself, asking questions, and taking risks without fear of judgment or retribution.

Some steps teachers can take to create a safe psychological environment in the ESL classroom are:

Encouraging students to ask questions and advocate for their needs

Valuing the unique perspectives that neurodivergent students can bring to the class

Eliminating the fear of judgment and ridicule by presenting failures as opportunities to learn

Avoiding constant corrections and adopting other strategies to correct mistakes. The ESL class is all about communication. When students are constantly being corrected, they will be hesitant to express themselves. Instead, try repeating their statements back in the correct form. Eventually, they will internalize it.

Celebrating success to build confidence and pride

Take a deeper dive into the dos and don'ts of error correction when teaching English.
Use active listening and body language

We all know that communication doesn't just happen through words. Body language is equally important. As teachers, we are used to evaluating students' engagement based on these clues.

However, when it comes to neurodiverse students, we must acknowledge that they receive, process, and express information in ways that may differ from neurotypical students. We can convey our understanding and engagement to neurodiverse learners by paying attention to their verbal and non-verbal communication, asking open-ended questions, gently encouraging them to elaborate on their answers (paraphrasing or summing up what they say to show our engagement and understanding), and providing feedback.

We can also use body language by nodding, looking at students in the eyes (if they seem comfortable with it), and maintaining an open and relaxed posture. We must be aware of our deliberate or involuntary body language and remember that neurodivergent students may interpret it differently than neurotypical students.

Build a supportive community

Being part of a supportive community can greatly enhance one's self-confidence and sense of safety. When teaching English to neurodiverse students, teachers can help create such a community by directly engaging parents, caregivers, and the students themselves in developing accommodation plans.

By listening to them, educators can come to know and understand their students' needs better. Parents and caregivers will be familiar with the issues students face and will be able to articulate what strategies have worked for them.

Adapting Teaching Methods for Neurodiverse Learners

Another component of a supportive environment for neurodiverse English learners is the adaptation of teaching materials to their needs. Below are some strategies to accomplish this goal.

Implement multisensory instruction

Multisensory learning is based on the idea that most people learn best when more than one sense is engaged. This strategy can benefit all learners but is especially effective for students with dyslexia who cannot learn the traditional way.

According to the International Dyslexia Association, "Multisensory learning involves the use of visual, auditory, and kinesthetic-tactile pathways simultaneously to enhance memory and learning of written language. Links are consistently made between the visual (language we see), auditory (language we hear), and kinesthetic-tactile (language symbols we feel) pathways in learning to read and spell."

Examples of multisensory learning for English learners include activities focusing on visuals, such as:

using colorful charts, diagrams, or images to illustrate concepts

illustrated flashcards for vocabulary, color-coded grammar, or using different colors to identify different speech components (for example, red for nouns, green for adjectives, blue for verbs)

activities focusing on hearing, e.g., choral reading or listening to a recording while reading its script, using songs and rhymes to learn words in a fun way

kinesthetic activities such as role-play, Total Physical Response, and storytelling with props and gestures

Contextualize learning

Another way to make learning content more approachable for neurodiverse students is to place it in a context they can relate to or that caters to their interests and life experiences. In fact, contextualizing learning makes content meaningful to all students because placing information in a context, rather than presenting it in isolation, enhances students' understanding and ability to recall.

This can be as straightforward as selecting reading materials that reflect students' interests, extracting grammar points and vocabulary from written or audiovisual materials, or even class discussions that engage learners' attention because they are relevant to them.

Use project-based learning (PBL)

This is another valuable tool in the ESL teacher's toolbox when teaching English to neurodiverse students. PBL engages students in meaningful and purposeful tasks connected to the real world. In this process, language emerges naturally from the class activities. PBL also promotes collaboration, communication, creativity, problem-solving, and critical thinking.

Incorporate student-created materials

When students are directly involved in creating their study resources, they develop a sense of ownership and pride in their learning, which in turn nurtures self-confidence and initiative.

Student-created material can range from vocabulary flashcards to presentations, videos, summaries, or personal glossaries. The process of generating one's own study resources further helps students develop self-reliance and independence.
Explore all the English language learning methodologies and find the best teaching methods to implement in your ELT classroom.
Addressing Individual Needs

One of the hurdles teachers face in the classroom is tailoring their teaching strategies to address multiple learning styles, individual needs, and neurodiversity in the classroom. One relatively simple way to solve this problem is to create multiple points of entry through which students can access and engage with learning and show their progress.

Let's look at some steps teachers can take to make learning accessible to all students.

Adjust learning materials for accessibility

Among the problems neurodiverse students may encounter in the ESL classroom is difficulty reading the learning material. This is a well-known problem for dyslexic students. Fortunately, some fonts, such as sans serif or Open Dyslexic Alta, are dyslexia-friendly or were created with the explicit goal of helping individuals with dyslexia.

For students who struggle with reading, teachers can also provide audio versions of the text or alternative reading formats. These include large print texts, digital versions, Braille, and Immersive Reader, among others.

Offer flexible assessment options

Students with learning disabilities should be offered alternative ways to demonstrate their learning. For example, students with dysgraphia can be allowed to type their assignments instead of writing by hand. Teachers can allow students to present orally or use speech-to-text tools.

Break down instructions clearly

For neurodiverse students, understanding instructions can sometimes be challenging. To ease these difficulties, it is important that teachers break down instructions into smaller chunks by providing step-by-step directions and reinforcing them with verbal instructions.

Before starting any task, teachers should ensure that their students clearly understand what is expected of them. Teachers can then monitor students regularly to verify they are on task and that there is no confusion about the why or how of the activity.

Use supports like movement

Neurodivergent learners may find it difficult to sit or concentrate on a task for extended periods of time. In truth, all school-age children and even adults may have trouble attending to a task for too long. When attention is waning and students are becoming restless or fidgety, it may be time to give them a break.

Breaks come in many forms, from allowing students to move around the room or stretch for a few minutes to playing a game like Simon Says or practicing relaxation through deep breathing. Far from being a waste of precious time, breaks allow learners' brains to process and consolidate information.

Students with autism or ADHD can also benefit from fidgeting. Research shows that fidgeting, a behavior particularly common in ADHD students, can help learners relax and focus on a task. Alternatively, teachers can suggest using a fidgeting tool like sensory disks, stress balls, or spinner rings.

However, the research suggests that the efficacy of fidget tools varies widely from person to person and that, in some individuals, it can increase rather than reduce distraction.

Implement a Collaboration and Support System

If your students include neurodivergent learners, you don't have to go it alone. The good news is that in many schools, there is a support system that teachers and students can rely on. Some actions teachers can take to seek support are:

Leverage district resources

ESL teachers can collaborate with speech and occupational therapists and special education teams. They can work together to identify the necessary steps to assist their neurodivergent students.

Encourage cross-team collaboration

ESL teachers can collaborate with school counselors and administrators to implement individualized lesson plans (ILP). In many schools, the work of ESL teachers is critical to ensuring that ESL students perform well across subjects.

By keeping open communication with their colleagues, ESL teachers can be aware of the challenges their students are facing in other classes and find ways to assist and support them. For example, if a student is proficient in math but has trouble understanding instructions, the teacher can provide her with a bilingual math glossary. Or the teacher may choose a specific reading to assist her students with a Social Studies topic, and so on.

For both neurodivergent and neurotypical ESL students, the greatest challenge is often demonstrating what they know in a language they are still learning.

Adopt a strengths-based approach

We all face challenges. Both students and teachers have strengths and weaknesses. What matters is how we address them. By recognizing and confronting them with resilience, we can overcome. By modeling self-awareness and resilience and sharing our challenges with our neurodiverse students, we can help inspire and motivate them.

The focus on neurodiversity over the last thirty years has yielded results that have also impacted the instruction of neurotypical students. Recognizing that all students have individual learning styles and needs has prompted educators to develop more inclusive teaching strategies while gradually moving away from the traditional model of teacher-centered education.

A crucial outcome of research and teacher-led inquiries into neurodiversity is the recognition that, in order to thrive, neurodivergent students require a psychologically safe, structured, flexible, and engaging environment.

Teaching students to advocate for themselves, creating an environment where learners feel safe expressing themselves, and adopting flexible, student-centered teaching strategies are all steps teachers can take to ensure their neurodivergent students have the same opportunity to learn as neurotypical students.

Finally, by engaging families, leveraging the available resources, encouraging cross-team collaboration, and working together with school counselors and administrators, we can help to build a support community for students and teachers alike.

ESL teachers play a crucial role in fostering an inclusive learning community, as students cannot showcase their proficiency in any subject if their English skills are lacking. A significant first step toward a more inclusive classroom is reflecting on current teaching strategies and gradually implementing research-based changes. Ultimately, these changes will benefit all students.

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Strategies for Supporting Neurodiverse Learners in the English Language Classroom - BridgeUniverse - TEFL Blog, News, Tips & Resources

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Discover practical, inclusive strategies to support neurodiverse learners in your English language classroom and meet diverse learning needs.

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Specialized TESOL Specialized TESOL Certificate ProgramsAt Score Guides Academy, we offer three TESL Canada-accredited online certificate programs for

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You can find books, eBooks, laminated guides, specialty items, and recent issues of the TEACHING Exceptional Children journal. CEC publications plus a wide range of curated publications from other publishers are all here. Be sure to check out our new and featured publications.

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Including dyslexic language learners - with Dr. Anne Margaret Smith

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Abstract

(1) Background: Attention Deficit Hyperactivity Disorder (ADHD) and Developmental Language Disorder (DLD) are neurodevelopmental disorders that affect various areas of children's development, such as language. It exists an emerging idea that ADHD is characterised by the presence of language difficulties, which can be explained by the high comorbidity between ADHD and DLD. The aim of this review is to analyse the empirical evidence of language competence in children aged 6-17 years old, diagnosed with ADHD and/or DLD. (2) Method: Fifteen studies with experimental designs were identified from Scopus, PsycINFO, and WoS databases, reporting on language skills in children diagnosed with ADHD and/or DLD. Studies relating executive functioning to language skills in this target population were also included. (3) Results: The literature is heterogeneous and different components of language are also examined. Even though the results are contradictory, they convincingly demonstrate there are overlapping symptoms between ADHD and DLD, such as language skills and executive functions. (4) Conclusions: The differences in the samples limit the generalisability of the results. Therefore, this review highlights the importance of considering language skills when designing individualised interventions for the population with ADHD and DLD, both in comorbidity and in isolation.

Keywords: ADHD, DLD, idiopathic language impairment, neurodevelopmental disorders, comorbidity, language skills

1. Introduction

Idiopathic language difficulties, i.e., difficulties in language development in the absence of an intellectual disability or other cause that might explain the difficulty, have been recognised since the early 19th century [ 1]. Although the terminology used has changed, in recent years the term Developmental Language Disorder (DLD) has come into use. About 7% of the population is affected by DLD, but the prevalence of DLD varies between studies and countries [ 2]. Although its prevalence is high compared to other neurodevelopmental disorders such as autism spectrum disorder (ASD) or childhood hearing loss, DLD is understudied [ 2, 3, 4]. Attention Deficit Hyperactivity Disorder (ADHD) and DLD are two of the most common neurodevelopmental and comorbid disorders [ 5, 6]. Children with comorbid DLD and ADHD may show a wide variety of signs that may overlap and impact different areas, such as language and executive function.

Symptoms of comorbid DLD and ADHD vary in severity and can affect academic and social functioning, increasing interest in understanding these conditions to provide appropriate support and intervention.

1.1. Language Skills

Language skills enable an individual to use language at a level of accuracy that conveys meaning in production and comprehension. These skills include both productive and receptive language skills, such as speaking, listening, reading, and writing, and their effective use in a variety of practical contexts [ 7]. The five basic areas of language (phonology, morphology, syntax, semantics, and pragmatics) are essential for understanding and using language effectively. They work together to form a dynamic, integrated whole that enables individuals to communicate and comprehend spoken and written language [ 7, 8].

Language skills are essential for communication and are crucial for navigating personal and professional life. Limited language skills affect a variety of areas, such as behaviours, acquiring knowledge, future occupation, social aspects, and well-being [ 9].

Language development plays an essential function in early stages of development and in overall cognitive and social progress. However, some children may face challenges in acquiring language skills, which can impact their academic performance and social interactions. Two common conditions that can affect language skills in children are ADHD and DLD [ 10].

1.2. Designations for Idiopathic Language Impairment

Idiopathic language impairment has been given a variety of names. Specific Language Impairment (SLI) was widely used in investigation articles to allude to the subset of children presenting language disturbances with unknown cause [ 11]. However, the term SLI was too restrictive, implying the child had a relatively pure language problem with no other impairments. For this reason, the term SLI was rejected by the CATALISE panel in 2017. Instead of SLI, an alternative terminology, Developmental Language Disorder (DLD), was proposed by the international CATALISE consortium and approved for employ in the cases where the origin of language impairment was unknow [ 12].

The CATALISE consortium also settles: the presence of neurobiological, environmental, or other risk factors does not avoid the diagnosis of DLD; other neurodevelopmental disorders may coexist with DLD (e.g., ADHD); and DLD diagnosis does not need a discrepancy between linguistic and non-verbal abilities [ 12].

Prior to the CATALISE consortium, the American Psychiatric Association (APA) published the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [ 13], which established new guidelines for the diagnosis of language disorders. Instead of the term DLD, the DSM-5 manual adds the naming 'language disorder' within neurodevelopmental disorders to distinguish persevering troubles in using language.

The difference in terminology is a source of instability in establishing criteria for idiopathic language disorders. Following the CATALISE consortium, the term DLD will be used in this study.

Roughly 7.5% of the world's population is affected by DLD. This diverse condition may have implications for using language, both at an expressive and receptive level. Furthermore, DLD may present different degrees of severity and impact various language domains (e.g., semantic, morphosyntactic, pragmatic) [ 14, 15], which may explain the scarcity of proofs concerning the accuracy with which DLD diagnosis is made [ 16].

1.3. ADHD

Concurring to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), ADHD is one of the most common neurodevelopmental disorders, affecting approximately 5-7% of the children and adolescents [ 13].

It is characterized by a persistent inattention, hyperactivity and/or impulsivity that interferes with function or development. ADHD symptoms can vary, and individuals may present primarily with inattention, hyperactivity, impulsivity, or a combination of both. These can lead to several difficulties such as emotional, behavioural, mental, and cognitive problems, and ADHD severity depends on the time of detection [ 13].

Though language challenges are not specifically mentioned as a fundamental diagnostic standard, children who have been diagnosed with ADHD exhibit significant deficiencies in their language skills across various aspects such as expressive, receptive, and pragmatic language modalities, resulting in overall language difficulties [ 17, 18].

1.4. Comorbidity

According to the DSM-5, both ADHD and Language Disorder (LD) are considered neurodevelopmental disorders. These disorders can cause various difficulties such as emotional, behavioural, psychiatric, and cognitive problems, and their severity depends on the time of detection [ 13].

Some empirical reports suggest ADHD and DLD are not only the most common neurodevelopmental disorders, but may also be co-occurring disorders [ 5, 6]. There is a complex relationship between DLD and ADHD, with overlapping and distinct features [ 4].

Scientific evidence supports the link between learning difficulties and executive functioning in neurodevelopmental disorders [ 19, 20, 21]. Children with comorbid DLD and ADHD may exhibit difficulties in executive functions, including working memory, cognitive flexibility, attention, and inhibitory control [ 17, 22]. In this context, some studies have found the coexistence of these conditions had an additional effect on the educational results of children [ 23, 24]. In fact, children with DLD may have attention deficits that are not significant enough to warrant a diagnosis of ADHD, but still affect their learning in the classroom [ 25].

Besides executive deficits, language difficulties are another overlapping symptom in comorbid DLD and ADHD. DLD is a well-defined condition characterized by impairments in receptive and expressive language, as evidenced by difficulty following multi-step instructions, difficulty with coherent conversation and expression, and impairments in reading and writing [ 26, 27]

Overall, language problems are also observed in children with ADHD, although it is unclear which component of language is most affected. Some studies show difficulties at the morphosyntactic level [ 17], while others indicate significant impairments in language skills across expressive, receptive, and pragmatic domains [ 18, 28].

Understanding the symptoms of comorbid DLD and ADHD, it is important to identify and address these difficulties to ensure appropriate diagnosis and treatment for affected children.

1.5. The Current Review

Research shows children diagnosed with ADHD have language impairments [ 6, 17, 29]. In fact, ADHD and DLD are two of the most common neurodevelopmental disorders and are co-occurring disorders [ 5, 6], which increases the interest in comparing them.

Given the high prevalence rates of both ADHD and DLD [ 30], it is crucial to understand how these conditions affect children's ability to use language. The purpose of this systematic review is to examine the current body of literature on language abilities in children with ADHD and/or DLD. By synthesising findings from different studies, we aim to identify the specific language difficulties experienced by these children and to explore potential overlaps or differences between the two conditions.

Understanding the language profiles of children with ADHD and/or DLD can have significant implications for diagnosis, intervention, and support. By identifying the specific language challenges these children face, clinicians, and educators can tailor interventions to address their unique needs. Additionally, this review will contribute to the existing literature by highlighting gaps in knowledge and suggesting avenues for future research.

In summary, this systematic review aims to provide a comprehensive overview of language skills in children with ADHD and/or DLD. By summarising the available evidence, we hope to improve our understanding of the language difficulties these children experience and inform effective strategies for assessment and intervention.

Finally, considering previous scientific literature has identified common symptoms in both ADHD and DLD, the hypothesis was the results would support the development of interventions that stimulate linguistic competencies (i.e., pragmatic skills, morphosyntactic, semantic abilities, ...) as well as EF that usually tend to be impaired, particularly working memory. This is an innovative goal because it aims to identify data that support the need to improve language skills in children with ADHD and EF development in children with DLD.

2. Materials and Methods

The current systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [ 31]. The PRISMA guidelines provide a 27-item checklist which allows reviewers to report the relevant information and make an accurate analysis of all the studies found. The objectives of this review are approved by the ethical committee of the University of Oviedo with the reference code "18_RRI_23" following PRISMA guidelines.

2.1. Search Strategy

The literature search was performed using three databases (Web of Science (WoS), PsycINFO and Scopus) in August 2023. The main objective was to analyse the empirical evidence of language competence in children and adolescents diagnosed with ADHD and/or DLD/SLI. The following key words were used: ("Specific Language Impairment" OR "Developmental Language Disorder" OR "DLD" or "SLI") AND ("ADHD" OR "attention deficit hyperactivity disorder" OR "attention deficit-hyperactivity disorder" OR "attention deficit disorder") AND ("language skills" OR "language" OR "language competence") AND ("comorbid*" OR "co-occurring" OR "coexisting").

2.2. Selection Criteria

The articles produced by the search were selected according to various inclusion/exclusion criteria, as follows.

Articles were selected if they fulfilled the described conditions:

(a)
Empirical studies authored in the English or Spanish language.

(b)
Included samples aged between 6 and 18 years.

(c)
Empirical studies included children and youths diagnosed with ADHD and/or DLD/SLI.

(d)
Published in the last ten years (2013-2023).

(e)
Studies focusing on language skills and/or executive functioning in individuals diagnosed with ADHD and/or DLD/SLI.

On the other hand, articles were excluded if they met the following criteria:

(a)
Conference papers, reviews, doctoral theses, meta-analyses, case reports or book chapters.

(b)
Studies with a sample age range other than 6 to 18 years.

(c)
Articles on neurodevelopmental disorders aside from DLD/SLI and/or ADHD, including cognitive delay, deafness, autism spectrum disorder, neurological deficits, or dyslexia.

(d)
Studies focusing on biological variables, biomarkers, genetic variables, mental health, behavioural problems, clinical trials; studies focusing on parental reports.

2.3. Study Selection

A total of 260 research papers were selected in the reliable databases (219 from Scopus, 23 from WoS, and 18 from PsycINFO). Duplicates (25 results) and results from book chapters, doctoral theses, or conference papers (14 results) were removed. In total, 195 studies were excluded by title ( n = 173) or by abstract ( n = 22). Finally, 15 studies were selected as meeting the inclusion criteria. The whole process is illustrated in the following flowchart ( Figure 1) in accordance with the PRISMA declaration [ 31].

Figure 1.

Flowchart of the article selection process.

3. Results

We first describe the general characteristics of the 15 selected studies ( Table 1). Two-fifths (40%, n = 6) of the studies investigated the language skills of English speakers. The 15 studies were published in 12 different journals and, as Table 1 showed, the most studies were published in 2021.

Table 1.

Author

Year

Journal

Country

Language

Table 1 summarizes the demographic characteristics of the selected studies. The fifteen studies report results from nine countries with sample sizes varying from three hundred and seventy to five participants ( Table 1). We selected studies with participants aged between 6 and 17 years, but in this case most studies ( n = 9) focused on childhood (7-12 years). Only 40% ( n = 6) of the selected studies reported participants' gender.

Just under half (46%, n = 7) of the articles studied populations with both a diagnosis of DLD and a diagnosis of ADHD. Only two of the fifteen studies included participants with comorbid DLD and ADHD, despite DLD and ADHD having high rates of comorbidity [ 30].

Ten of the selected articles compared the performance of different groups (ADHD group, DLD group, typically developing (TD) group) in different language tasks and the remaining five articles included measures of executive function in addition to language skills. There was a great deal of variability in the study of language skills. Some studies focused on narrative skills, while others focused on morphology, syntax, etc. ( Table 2).

Table 2.

Author(s)

Sample

Comorbidity Condition

Instrument(s)

Measures

Summary of Results

Brinton et al. (2018) [ 31]

Age range: 5-10 years
Group(s):
n =5 DLD
Gender:
2 females/3 males

No

Language skills:
Edmonton Narrative Norms Instrument (ENNI)

Narrative skills: internal response expressions in spontaneous and prompted condition.

Production and accuracy of internal plan
Spontaneous condition: expressions were appropriate.
Prompted condition: high production but the accuracy decreased.
Production and accuracy of emotion words.
Spontaneous condition: children describe few emotions.
Prompted condition: greater variety of emotion words.

Delgado et al. (2018) [ 33]

Age range: 7-12 years
Group(s):
n = 6 DLD
n = 6 ADHD
n = 6 TD

No

Language skills: Metapragmatic
Consciousness Assessment Test

Metapragmatic Awareness

El Sady et al. (2013) [ 34]

Age range: 3-6 years
Group(s):
n = 36 DLD + ADHD
n = 25 DLD
Gender:
9 females/27 males
9 females/16 males

Yes

Language skills:
Language testing of Arabic speaking children

Receptive age
Expressive age
Semantic
Syntax and phonology
Pragmatics
Receptive age quotient
Expressive age quotient

Significant difference in the receptive age and the receptive age quotient: DLD + ADHD children had worse reception than DLD + no ADHD children.
Hyperactivity was the most important factor affecting language in ADHD.

Gooch et al. (2019) [ 35]

Age range: 5-8 years
Group(s):
n = 129 DLD
n = 370 TD

No

Language skills:
Expressive One Word Picture Vocabulary Test (EOWPVT)
Receptive One Word Picture Vocabulary Test (ROWPVT)
School-Age Sentence Imitation Test-English 32 (SASIT-E32)
Test for Reception of Grammar (TROG)
Assessment of Comprehension and Expression (ACE)
Executive functions:
Rapid Automatized Naming (RAN)
Visual Search (Apples Task)
Coding (WPPSI-III)
Simple Reaction Time

Children with DLD perform worse on Speed of Processing (SOP) than their TD peers.
The DLD group have elevated symptoms of inattention/hyperactivity, which are often associated with ADHD.
Symptoms of inattention/hyperactivity moderate the effect of SOP on language, but SOP does not predict later language in formal schooling.

Helland et al. (2014) [ 36]

Age range: 6- 12 years
Group(s):
n = 19 DLD
n = 21 ADHD
n = 19 TD
Gender:
2 females/17 males
3 females/21 males
2 females/17 males

No

Language skills:
Children's Communication Checklist-Second Edition (CCC-2)

Speech, syntax, semantics, coherence, inappropriate initiation, stereotyped language, use of context, nonverbal communication, social relations, interests.

Communication disorders were as severe in the ADHD group as in the DLD group.
The ADHD group was as impaired as the DLD group on the scale measuring semantics. Language structure was more impaired in the DLD group.
The ADHD group was more impaired on the interest scale.

Kaganovich et al. (2021) [ 37]

Age range: 7-13 years
Group(s):
n = 18 DLD
n = 18 TD
Gender:
5 females/13 males
7 females/11 males

No

Language skills:
Photographic Expressive Language Test-2nd Edition (SPELT-II)
Photographic Expressive Language Test-Preschool 2 (SPELT-P2)
Core Language Score (Concepts and Following Directions, Recalling Sentences, Formulated, Sentences, Word Structure and Word Classes-2 Total (WC-2,
9-12-year-olds only), and Word Definitions (WD, 13-year-olds only).
Executive Functions:
Verbal working memory and nonword repetition test.
Number Memory Forward.
Number Memory Reversed subtests of the Test of Auditory Processing.
Skills-3rd edition (TAPS-3).

General linguistic aptitude
Working memory

Children with TD, but not children with DLD, can integrate visual information into long-term phonemic representations

O'Neil et al. (2016) [ 38]

Age range: 4-8 years
Group(s):
n = 90 ADHD
n = 60 TD

No

Language domain of the NEPSY.
Wechsler Individual Achievement Test, Second Edition (WIAT-II): Word Reading, Pseudoword, Decoding, Reading Comprehension, and Spelling subtest.
Vanderbilt Assessment Scale, Teacher Informant: Reading and Written Expression performance in school.

Language (NEPSY)
Reading
Writing

Paredes-Cartes y Moreno-Garcia (2021) [ 29]

Age range: 7-12 years
Group(s):
n = 47 DLD
n = 48 ADHD
n = 47 TD
Gender:
20 females/27 males
39 females/9 males
19 females/28 males

No

Language skills: The Objective and Criterion-referenced Language Suite (BLOC)
The Peabody Picture Vocabulary Test (PPVT-III)

Language: morphology, syntax, semantics and pragmatics.
Receptive vocabulary

Significant differences in semantic and pragmatic language skills were found between the three groups.
Children with ADHD had fewer problems with semantic competence than children with DLD.
Pragmatic competence: ADHD group had lower scores than the DLD group and the control group.

Ralli et al. (2021) [ 39]

Age range: 8 years
Group(s):
n = 29 DLD
n = 29 TD
Gender:
14 females/15 males
17 females/12 males

No

Language skills:
Wechsler Intelligence Scale for Children-WISC III: vocabulary scale.
Athena Test: the sentence completion subtest.
Executive functions:

-
Working Memory Test Battery for Children.

-
n-back task.

-
Flanker task.

-
Borella's task.

-
"How many-What number task"

-
Semantic fluency test.

-
Phonological fluency test.

Expressive vocabulary
Sentence completion
Working memory
Updating
Inhibition
Switching
Verbal fluency
Phonological fluency

Children with DLD were outperformed by their TD peers on measures of WM capacity, updating, monitoring (mixing cost), and verbal fluency (phonological and semantic).

Redmond et al. (2015) [ 22]

Age range: 7-9 years
Group(s):
n = 19 DLD
n = 19 ADHD + DLD
n = 19 TD
Gender:
10 females/9 males

Yes

Language skills:
English Nonword Repetition Task.
Test of Early Grammatical
Impairment (TEGI).

Nonword repetition
Sentence recall
Tense marking

No significant differences were found between the ADHD and DLD + ADHD groups.
A moderate positive correlation was found between the severity of
ADHD symptoms and their ability to memorize sentences: children with higher levels of ADHD symptoms performed better than those with lower levels.

Staikova et al. (2013) [ 40]

Age range: 7-11 years
Group(s):
n = 28 ADHD
n = 35 TD

No

Language skills: Children's Communicative Checklist, Second Edition (CCC-2).
Comprehensive Assessment of Spoken Language (CASL).
Test of Pragmatic Language, Second Edition (TOPL-2)
Narrative Assessment Profile: Discourse Analysis (NAP)
Clinical Evaluation of Language Fundamentals, Fourth Edition (CELF-4)

Pragmatic language
General language

Children with ADHD had poorer pragmatic language skills than their peers on all measures, even after controlling for general language skills.

Stanford and Delage (2021) [ 6]

Age range: 8 years
Group(s):
n = 20 DLD
n = 20 ADHD
n = TD

No

Language skills:
Bilan Informatisé du Langage Oral (BILO)
Phonological loop.
Executive functions:
Conners CBRS: inattention, hyperactivity.

Syntax
selective attention, central executive, processing speed, attentional flexibility.

Children with DLD were more sensitive than children with ADHD to visual cues (DLD > ADHD), which were more implicit than the linguistic cues and may have required more attentional resources.
For linguistic signals that require syntactic processing, the opposite pattern was true (ADHD > DLD).

Stanford and Delage (2020) [ 17]

Age range: 8 years
Group(s):
n = 20 DLD
n = 20 ADHD
n = 20 TD

No

Language skills:
Bilan Informatisé du Langage Oral (BILO).
Probe test.
Executive functions:
Sky Search task (TEA-ch)
Digit recall task (WISC-IV)
Opposite Worlds task (TEA-ch)

Vassiliu et al. (2022) [ 41]

Age range: 4-8 years
Group(s):
n = 25 DLD
n =29 ADHD
n = 29 TD
Gender:
8 females/17 males
11 females/18 males
10 females/19 males

No

Language skills:
Logometro tasks

Children with ADHD faced difficulties with language skills and especially with structural language: they performed significantly lower than their TD peers but significantly higher than the DLD group.
From a pragmatic perspective, ADHD children performed numerically worse than any other group, but no statistical significance was found.

Zenaro et al. (2019) [ 42]

Age range: 6-10 years
Group(s):
n = 20 ADHD
n = 20 TD
Gender:
6 females/14 males

No

Language skills:
Frog, Where are you?

Narrative skills

The ADHD group scored lower scores on the structural elements of "theme/topic" and "outcome"
and a narrative with a lower degree of coherence than the TD group.

There was variation in the use of instruments, but the selected studies were consistent in using instruments such as the Children's Communicative Checklist, Second Edition (CCC-2), the Clinical Evaluation of Language Fundamentals (CELF-4), or the Peabody Picture Vocabulary Test (PPVT-III). In terms of executive function, the most frequent items measured were working memory and attention ( Table 2).

The evaluation of various language domains is an integral part of studying language skills. In our collection of articles, we discovered research concentrated on investigating language abilities in a group identified with DLD [ 31, 35, 37, 39]. In these articles, there was a great diversity as they focused on different language domains, notably syntax, semantics, and pragmatics. For example, Kagnovich and colleagues [ 37] measured general linguistic aptitude and working memory and they found children with DLD had difficulties integrating visual information into long-term a-phonemic representations. However, it should be noted none of the selected studies addressed the study of phonology separately.

In the study conducted by Brinton and colleagues [ 32], the researchers analysed how five children with DLD expressed their internal thoughts and emotions when narrating a story based on pictures, as well as when they were directly questioned about these states. The explanations of the emotional states of the story characters' emotions became more intense when prompted, but the children frequently used emotional words that did not precisely portray the events of the story.

Children with ADHD are known to have problems with language skills. In Vassiliu's study [ 41], the performance of the ADHD group showed structural language difficulties, even though the ADHD group performed significantly better than the DLD group. As for pragmatics, the ADHD group performed worse than all other groups, but no statistical significance was found.

Similar results were found in the study of Staikova [ 40], who investigated pragmatic language functioning in children with ADHD using various formal tests and parent questionnaires. They found children with ADHD had less developed skills in several aspects of pragmatic language compared to their typically developing peers, and these problems were evident beyond general language tasks.

Zenaro and colleagues [ 42] carried out a study comparing the oral narrative skills of children with ADHD and children with TD. In line with the aforementioned studies, the researchers discovered the ADHD group displayed reduced levels of coherence compared to the TD group. This was evident in their lower scores concerning the structural components of theme topic and outcome.

Narrative skills refer to the ability to tell a story or event in a coherent and organized manner. The literature suggests children with DLD may have problems with communication skills due to their impaired language function, whereas children with ADHD may have better grammar, general basic language skills, but still struggle with executive functions tasks [ 10]. Narrative tasks engage not only language skills but also executive functions [ 43]. Stanford and Delage [ 6, 17] conducted a study on French speaking children, focusing on syntactic and morphosyntactic aspects, while simultaneously assessing executive-function variables. The EF and morphosyntactic profiles of children with ADHD and DLD are different [ 17]. Morphosyntax deficits are not specific to ADHD, but performance in the ADHD group may mimic morphosyntax impairment. This may explain the difference between the groups in the use of visual cues: children with DLD were more sensitive to visual cues than children with ADHD, which may require more attentional resources. In contrast, the DLD group was less sensitive to linguistic cues, as these cues required syntactic processing [ 6].

To determine which of the language areas is most affected in each of these disorders, and to understand the overlap of symptoms between the two, they need to be studied together. Our selection included six studies involving joint study of ADHD and DLD populations and a control group [ 6, 17, 29, 32, 36, 41], while only two studies included samples with ADHD and DLD as comorbidity [ 22, 34].

The findings are conflicting. In a study conducted by Paredes-Cartes and Moreno-García [ 29], notable distinctions in semantic and pragmatic abilities were observed between the DLD and ADHD groups. These results revealed children with DLD faced greater challenges in semantic language skills, whereas the ADHD group encountered more difficulties in pragmatic language skills. Helland and colleagues [ 36] aimed to investigate the linguistic characteristics of children with DLD. Their findings showed the DLD group experienced significantly greater difficulties than the ADHD group in both language and syntax scales. In terms of pragmatics, both groups faced similar challenges, while in the field of semantics, they showcased an equal degree of impairment.

Conflicting results have also been found in articles examining populations with comorbid ADHD and DLD, particularly in relation to the symptom of hyperactivity and language skills. Redmond and colleagues [ 22] focused on morphosyntactic characteristics of children with comorbid DLD and ADHD, as well as typically developing children, and those with only DLD. In the study, no noteworthy disparities were discovered between the groups with both DLD and ADHD. They additionally found there was a moderately positive correlation between the intensity of ADHD symptoms and the ability to recall sentences. In contrast, El Sady and colleagues [ 34] concluded hyperactivity had the strongest impact on language ability in individuals with ADHD. Specifically, the researchers found children with DLD and comorbid ADHD had poorer language reception compared to those with only DLD.

Delgado and colleagues [ 33] compared the development of metapragmatic awareness in children with DLD, ADHD, and a control group. In the study, it was discovered there was a noticeable impact of age on children with ADHD. However, the DLD group and the control group showed significant differences. On the other hand, children who were diagnosed with predominantly inattentive ADD performed similarly to the control group.

Children with language impairment (LI) often perform worse on processing speed and working memory than their typically developing peers, and processing factors may contribute to an understanding of language disorders [ 44]. Ralli and colleagues [ 39] measured several EF variables, such as verbal fluency and working memory, as well as measures of expressive vocabulary and sentence completion. Their results indicated children with DLD were outperformed by their TD counterparts on measures of WM and verbal fluency (phonological and semantic).

Hyperactivity is also an important factor which affects language in ADHD [ 34]. However, O'Neil and colleagues [ 38] reported there was no significant association between the severity of pre-schoolers' hyperactivity/impulsivity and their language skills at 4-6 years old.

The scientific research suggests processing speed is related to different aspects of language ability, including syntactic development, language impairment, social and language delays, and vocabulary/word learning [ 44, 45].

Gooch and colleagues [ 35] conducted a longitudinal study in a British population to investigate the relationship between speed of processing (SOP), language and inattention/hyperactivity. The results showed the DLD group had increased symptoms of inattention/hyperactivity commonly associated with ADHD. Inattention/hyperactivity symptoms moderate the effect of SOP on language, but SOP does not predict subsequent language development.

After analyzing the results, in general terms, it was found children with ADHD had better general language skills, receptive and expressive language, and especially morphosyntactic skills than children with DLD. The main language problems in ADHD groups occur at the level of pragmatics and narrative coherence. It should be noted problems with language production and/or language comprehension are key features of DLD. Therefore, children with DLD would be expected to have more difficulties in these areas of language, especially semantics, morphosyntax, and structured language, than children with ADHD. Difficulties in the executive functioning of individuals with ADHD and DLD, such as impaired working memory and processing speed, may affect their pragmatic and structured language.

4. Discussion

The purpose of this research was to investigate the particular language challenges faced by children with DLD and/or ADHD and to investigate any potential overlaps or differences between the two disorders.

First, the review showed the symptoms of these two disorders overlap, including language difficulties and deficits in EF.

There is a great deal of variability in the research on the assessment of language skills. Conflicting results are to be expected due to the complexity of conducting assessments in different language domains and because it is important to be aware of the variability of the tests used in our selection of studies.

Some studies focused on receptive language, others on expressive language. The majority of the studies included in this review were concerned with examining grammar, semantics, and pragmatics, as these were the most impaired language areas in DLD and ADHD. However, the results are contradictory. Some research indicated children with DLD had more morphological and semantic difficulties than children with ADHD [ 6, 17, 29]. While other research also identified morphological and semantic difficulties in children with ADHD [ 41].

The studies included in the analysis presented diverse findings regarding the language performance of children with ADHD. Specifically, research focusing on language use among children with ADHD showed challenges in this area when compared to the control group [ 40], although the differences between the two groups were not consistently noteworthy [ 29]. On the other hand, positive correlations were occasionally discovered between symptoms of ADHD and tasks that require recalling sentences [ 22].

The study of language skills is a complex field involving several different factors. For example, the assessment of pragmatic language is challenging. Firstly, the construct encompasses both verbal and non-verbal skills. Furthermore, as the definition of pragmatics is linked to the social context, the assessment of pragmatic skills using standardised tests may not accurately reflect an individual's actual ability to communicate in real-life situations [ 40]. In relation to narrative skills, structural elements are responsible for narrative coherence. These factors are important to build meaning for thematic maintenance and to present a coherent outcome related to the story problem situation that shows the relationship between the events being narrated [ 42]. They are also important in the ability to relate to internal situations, which include not only language deficits, but also limited social and emotional knowledge [ 32].

Another crucial aspect is to consider the relationship between EF and language competence, which are closely linked and interact in different ways [ 46]. In our selection of articles, only five included measures of EF in addition to language measures, which is particularly striking given the type of participants included in the studies (DLD and ADHD) would be expected to have deficits in EF.

It is generally interesting to consider socio-demographic variables, such as gender or age, as these may have an impact on the performance of the proposed tasks. Gender stereotypes may affect the diagnosis of girls with DLD and/or ADHD. There are gender differences in ADHD, with boys more likely to be diagnosed than girls. Despite similar symptoms, there is increasing evidence there are sex and gender differences in prevalence, presentation, expression, progression, and impairment. Girls with ADHD may experience greater functional impairment and have different long-term outcomes than boys with ADHD [ 47].

Gender also plays a role in DLD, with boys being at higher risk of the disorder and more likely to receive speech and language therapy services. A strong gender effect has been consistently reported: several studies have reported the consistent finding that males were more likely to experience language delay and DLD than females [ 48, 49]. All of this shows how important it is to consider gender.

Finally, the age of the sample should be considered, as it may affect children's language development. Children's language skills develop throughout childhood, and the period of pregnancy at birth can also impact language development. In fact, children develop many of the oral language skills as they learn to read when they go to school, and their language skills continue to develop throughout early youth [ 50].

The 'age effect' also needs to be considered in the field of language impairment, especially at an early age. One example is the development of metapragmatic awareness happens recursively, in that as children grow older, they are not only able to identify the error between the context of the communicative act and the context of the communicative act and the linguistic expression, but also to explain it, thus achieving a reflexive control of language [ 33].

This metapragmatic awareness is expected to increase with age. In fact, adults with ADHD are acutely aware of how challenging social interaction situations are for them [ 10]. The executive-level deficits associated with ADHD lead to behavioural problems and pragmatic language difficulties [ 28]. Thus, without early intervention, difficulties at the pragmatic level are expected to persist into adulthood in people with ADHD. For individuals with DLD, difficulties at the structural level of language are expected to persist into adulthood due to deficits in processing speed and short-term memory [ 10, 37, 39]. At the group level, adults with DLD tend to have lower scores on language assessments than normative adults [ 51]. However, language development in DLD at the individual level is very heterogeneous: while some children grow up to be able to establish a valid pattern for social situations, others manifest permanent language difficulties in adulthood [ 10, 52].

These findings highlight the need for longitudinal studies to examine language skills in the ADHD and/or DLD population to gain insight into the trajectories of language development [ 10].

Although language deficits in ADHD and DLD affect different components of language [ 29, 40, 41], language problems in both conditions may be caused by executive function deficits [ 10, 17, 39, 46]. These language difficulties continue throughout adult life and increase with increasing environmental demands, leading to problems with academic success, learning problems, behavioural problems, and sometimes psychoemotional problems [ 10, 24, 26, 51].

These results suggest there should be a standardized assessment tool that measured different language domains. It is important to assess students' language abilities in a broad sense to identify children who may be at risk for language disorders early on. This tool should cover all aspects of language and help to identify children who may have these disorders.

5. Conclusions

This study has important implications for the field of language competences in DLD and/or ADHD. The results contribute to the understanding of language difficulties in these neurodevelopmental disorders by highlighting gaps in knowledge that may be addressed to improve the identification and intervention.

Intervention for ADHD and/or DLD should begin as early as possible to address cognitive and language problems.

Regarding the ADHD interventions, based on the results of the tested studies, we can note in children with ADHD, along with the stimulation of executive functions, language skills should also be promoted. In this sense, pragmatic skills [ 40, 41], as well as processes of syntactic coherence and text, as we have observed, were significantly reduced [ 29, 36, 42].

For its part, in case of children with DLD, it is important to provide targeted stimulation for language abilities, specifically in morphosyntactic [ 17] and lexical aspects [ 29, 36]. Additionally, it is beneficial to focus on improving executive functioning associated with language such as WM and monitoring [ 35, 39].

Medication intake in children with ADHD should be considered, because it can affect task performance [ 10]. But one of the studies selected for this review considered this factor.

Some of the limitations of the study are outlined below. The use of different terminology when talking about idiopathic speech problems makes it difficult to identify the research carried out. Similarly, the number of studies that included participants with comorbidity between DLD and ADHD was very small, even though they were two disorders that often co-occurred. Additionally, the limited number of studies and methodological diversity reduce the precision and generalizability of the findings. Hence, this review underscores the fact that further investigation is needed to clarify the relationship between language competence and these two neurodevelopmental disorders.

Author Contributions

Conceptualization, I.M.-F. and D.A.; methodology, D.A. and I.M.-F.; investigation, I.M.-F., C.R. and D.A.; resources, C.R. and D.A.; writing-original draft preparation, I.M.-F.; writing-review and editing, D.A.; supervision, D.A.; project administration, C.R.; funding acquisition, I.M.-F. and C.R. All authors have read and agreed to the published version of the manuscript.

Conflicts of Interest

The authors declare no conflict of interest.

Funding Statement

This research was funded by a Spanish National Government Project (MCINN-22-PDC2022-133411-I00) and a pre-doctoral grant from the Severo Ochoa Program in the University of Oviedo (BP21-046).

Footnotes

Disclaimer/Publisher's Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

References

8. Koutsoftas A.D. School-age language development: Application of the five domains of language across four modalities. In: Capone-Singleton N., Shulman B.B., editors. Language Development: Foundations, Processes, and Clinical Applications. Jones & Bartlett Learning; Seattle, WA, USA: 2013. pp. 215-229. [Google Scholar]

30. Medici D., Varela M.M.S. Language and school performance in children with diagnosis of attention deficit/hyperactivity disorder. Rev. Mex. Neurocienc. 2017;18:89-99. [Google Scholar]

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