Assessing speech, language and communication difficulties in children referred for ADHD: a qualitative evaluation of a UK child and adolescent mental health service

Background: Attention-deficit hyperactivity disorder (ADHD) is one of the most common childhood neuropsychiatric disorders and is highly comorbid with speech, language and communication difficulties (SLCDs). However, it is unclear how often SLCDs are identified in ADHD referrals in routine practice and whether there are unidentified SLCDs within this population. Method: A thematic analysis was conducted on a random sample of case notes from 18 referrals for ADHD made to a child and adolescent mental health service (CAMHS) in London, United Kingdom. Analyses aimed to identify (a) the types of SLCDs detected during assessment, (b) at which point of the episode of care these SLCDs were suspected and (c) whether a referral or consultation was made to a speech and language therapist (SLT) for further evaluation. Results: Out of 18 cases investigated, 15 were found to have possible SLCDs based on case notes and reports provided by external agencies. However, only four were referred by CAMHS for further assessment. It is unclear what, if any, steps other external agencies took. Themes describing types of SLCDs, comorbidities and the process of identification are discussed. Conclusion: The analysis of this service’s case notes revealed a range of different routes to the identification of SLCDs, and it was unclear what steps were taken as a result of assessment. A limitation is that this is just one service and the results may not generalise. However, given the similarity in practitioner training received across the country and that practitioners move from service to service, there are grounds for repeating the study in other services. We recommend a more structured approach to identifying SLCDs and recording assessment and treatment decisions made

Reasoning as we read:establishing the probability of causal conditionals

Indicative conditionals of the form if p then q (e.g., if student tuition fees rise, then applications for university places will fall) invite consideration of a hypothetical event (e.g., tuition fees rising) and of one of its possible consequences (e.g., applications falling). Since a rise in tuition fees is an uncertain event with equally uncertain consequences, a reader may believe the statement to a greater or lesser extent. As a conditional is read, the earliest point at which this probabilistic evaluation can take place is as the consequent clause is wrapped up (e.g., as the critical word fall is read in the example above). Wrap-up processing occurs at the end of the clause, as it is evaluated and integrated into the evolving discourse representation. Five sources of probability may plausibly influence the evaluation of a conditional as it is wrapped up; these are P(p), P(q), P(pq), P(q|p), and P(not-p or q). A total of 128 conditionals were constructed, with these probabilities calculated for each item in a pretest. The conditionals were then embedded in vignettes and read by 36 participants on a word-by-word basis. Using linear mixed-effects modeling, we found that wrap-up reading times were predicted by pretest ratings of P(p) and P(q|p). There was no influence of P(q), P(pq), or P(not-p or q) on wrap-up reading times. Our findings are consistent with the suppositional theory of conditionals proposed by Evans and Over (2004) but do not support the mental-models theory advanced by Johnson-Laird and Byrne (2002)