Clinical implications of the two studies

The children with ADHD in the current study showed evidence of weak communicative skills compared to the typically developing age-matched children. The findings suggested that the core behavioural characteristics of ADHD (i.e., inattention, impulsivity, and hyperactivity) are negatively affecting their verbal pragmatic skills compared to TD peers, as represented by reduced verbal productivity, shorter turns, more

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difficulty with topic maintenance, and less complexity of responses. Very careful attention is needed in assessing children with ADHD to determine the nature and the extent of their language use difficulties. The results of the current study highlight the areas of deficit in the verbal and verbal pragmatic skills of children with ADHD. All targeted behaviours in the current study (e.g. verbal productivity in terms of extending topic through responses and appropriate spontaneous contributions) could be included as main areas in pragmatic intervention programs for ADHD. The existence of a relationship between pragmatic competency and ADHD has been proposed in previous studies (Ketelaars, et al., 2010). Difficulties with appropriate use of language, exhibited by children with ADHD, can be associated with their lack of social competence, which will be reflected in their conversational skills. The lack of attention to details and interest in extended discussion on a topic may also be due to underdeveloped linguistic complexity. Cohen et al. (1998) reported that language difficulties experienced by children with ADHD might also lead to social difficulties. Including conversational skills as a main element in the intervention program for children with ADHD will have a great impact on the level of progress that may be achieved. Intervention strategies for enhancing appropriate conversational exchanges and eliminating inappropriate pragmatic behaviours in the children with ADHD should focus on verbal productivity, turn-taking, initiating a topic, topic maintenance, ending conversation, enhancing the complexity of responses and responding to conversation partners. There are also examples of interventions where the family is involved and conversational partners such as parents and peers are trained to optimize their interactions to enable the child with ADHD to participate fully. Several current language-based interventions may also be of benefit to

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children with ADHD where the ability to develop extended language, especially as oracy is known to underlie educational attainment and literacy (Pepper and Weitzman, 2004). ASHA (1996) claimed that children with ADHD are different from each other in clinical manifestations, cognitive profiles, aetiologies, responses to treatment and prognosis. Because of the multidimensional nature of attention disorders, no one intervention approach will be sufficient. It is recommended that the speech-language pathologist and other professionals employ multiple methods from several sources.

The results presented in the current study underline the importance of a systematic routine screening of communication skills by a speech-language pathologist to be performed as a part of the assessment procedures in children referred to ADHD assessment. The pervasive role language skills play in regulating children‟s behaviours emphasizes the need for speech-language pathologist to act as an effective member in a multidisciplinary assessment team for ADHD. At present no such standard procedure exists in Saudi Arabia. The area of speech and language is generally not assessed; however it depends on the interest of each individual professional. The lack of easily administrable assessment tools for Arabic may have contributed to this situation. We suggest that the Saudi Arabian adaptation of standardized tests is needed in order to help in assessing Saudi children‟s language and communication abilities. However assessments with appropriate stylistic and content analysis such as Peter and the Cat (Black Sheep Press) which could be translated and adapted to Saudi culture could be valuable in tracking progress from interventions. The needs can also be prioritized through careful dynamic assessment throughout any intervention (Peña et al., 2014).

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during the FI-ADHD interaction used questions more frequently than statements and descriptions. Also, it was observed that mothers used more directives (i.e., commands) which probably indicate the mothers‟ tendency to use controlling and directive interactions with their children with ADHD. MacDonald and Carrol (1992) and more recently Pepper and Weitzman (2004) suggested that the use of comments should be valued over questions and commands, since comments allow the conversation to continue back and forth while questions can limit the child‟s responses and end the conversation. This is especially the case with closed questions (e.g., yes/no questions). They further suggested that one way for an interlocutor to interact with a child is to match the child‟s level of communication. This can be achieved by using simpler sentences rather than complicated sentences. By doing this the mother or other adult bridges the gap from the child‟s level of communication to the age appropriate performance level that is expected from that age group. It is also essential to emphasize the importance of parent training by providing mothers with strategies that would assist them to enhance the development of their children's communication and more specifically their verbal pragmatic skills. Jones et al. (2007) concluded that parent training programs are considered to be a viable first line intervention for the preschool children with ADHD. The literature mentioned parent-professional partnerships in approaching intervention with children (Pepper and Weitzman, 2004). This partnership views the parent as an expert in relation to their child and views the speech-language pathologist as a consultant that provides the parent with proper advice regarding the child‟s disorder which was suggested by Weitzman and Greenberg (2002).

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verbal interaction checklist. The researcher is intending to use the results of the current study as the first step in creating a checklist that can be used clinically to assess mother- child interaction at the verbal level. Speech-language pathologists and other professionals may use this checklist as a guide in their intervention plans as to what skill is expected to improve as a result of using a specific interaction strategy. The checklist will be piloted on typically developing children. The mothers of these children will be encouraged to comment about the checklist and suggest further items. Future research will include developing norms for the checklist, as the first of its kind in region. Also, the plan is to include other Arab countries beside Saudi Arabia.