Suggested future research

This is the first known study that investigates the verbal pragmatic characteristics in Arabic speaking children with ADHD. The research has analysed the relationship between ADHD and verbal language use difficulties in Arabic speaking children. The findings of the current study contradict some previous studies and are consistent with others but they add to the existing literature regarding ADHD verbal pragmatic competency. Further studies using this theoretical framework for studying language skills generally and verbal and non-verbal pragmatic skills specifically in the ADHD population would certainly be valuable not just for speech-language pathologists, but also for other professionals, such as psychologists, psychiatrists, teachers, applied behavioural analysts and educators. Further research is needed to extend our knowledge of verbal pragmatic characteristics in children with ADHD, for example, controlling for intellectual

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ability and subtypes of ADHD and using larger numbers of participants, also severity of the symptoms should be considered.

The results of the current study suggest the necessity of assessing expository discourse in addition to the other aspects of language assessment with the purpose of identifying weaknesses at the level of verbal and nonverbal pragmatics. Expository discourse is discourse that explains or describes a topic. According to Nippold et al. (2008) expository discourse is the use of language to convey information and it is important for examining natural language production in children which consists of a monologue providing factual descriptions or explanations of events (i.e., explanations of the rules of a game or procedural descriptions). Expository discourse is often required in educational, social, and vocational contexts that may help to explain why expository tasks are generally more effective than conversational or narrative tasks in eliciting complex syntax in typically developing children. The early detection of language weaknesses in expository discourse may help guide our intervention practices to ensure children possess the required language skills to participate in social interactions with interlocutor (Nippold et al., 2005).

Factors that may contribute to the language and verbal pragmatic deficits of children with ADHD need to be identified. The demand comes from the great need for a better understanding that will be translated positively to more effective clinical practice, at the level of assessment and intervention. The methodological approach adopted in this study, using audio visual recording for the children interacting with UI and FI to collect a language sample proved to be effective. So the researcher would recommend using the same approach in future quantitative or qualitative studies. One of the main strengths in

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the current study is developing an audio-visual data set for Saudi Arabian Arabic speaking children. Below, are outlined specific suggestions for future research work using the present data corpus as well as extending to new protocols.

It will be possible to use the same set of data for the purpose of studying the other aspects of language functioning (i.e., syntax and vocabulary). This would be useful clinically because of the overlap among pragmatic skills, language structure, and narrative discourse. Further research is needed to differentiate between those children who have ADHD plus language impairment, and those who appear to have ADHD only. It would also be useful to use the same methodological procedures as those used in this study in order to investigate the verbal pragmatic skills in children with ADHD when their attentional state was altered with stimulant medication. The consideration of the results in the light of theories about the role of executive function in contributing to the behaviours seen in children with ADHD would be of interest. Since language is a behaviour that requires a high level of organization, the association between executive function and language use would be a useful issue to explore in further investigations.

Future research studies should include other age ranges, especially to see if our results would be replicated with older children. Finally, future research should duplicate the current study to discover if similar results are achieved.

6.4 Limitations

Apart from the limitation of this study to the nature of verbal pragmatic language skills in ADHD Arabic speaking boys specifically for the age range of 4 to 5 years in the Jeddah Region of Saudi Arabia, there are methodological limitations that must be

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mentioned. One major limitation of the study is the small sample included in the study. Data for ten children with ADHD and ten typically developing may not be abundant enough to provide powerful representative statistical analysis. There is a lack of studies that provide solid information about the development of pragmatics in typically developing Arabic speaking children, and a lack of studies that target the language skills in the ADHD population in Arabic speaking children. It would be useful to investigate the possible influence of interlocutor on the verbal productivity of children with ADHD, using a larger sample.

The current study did not take measures of vocabulary and syntax in the participants with ADHD or control for them as inclusion criteria. However, it is important to emphasize that there are no available norms in Saudi Arabia. The time and resources of the current study did not permit the recruitment and involvement of further groups of children (e.g., ADHD without language impairment, language impairment alone), although such information may have been advantageous. Another limitation was related to ADHD subtypes: predominantly inattentive type, predominantly hyperactive and impulsive type, and combined type which were not considered in the current research study.

The possibility that the findings in the current research study might have been influenced by the setting and whether these findings can be generalized to other contexts should be considered. A more naturalistic setting, where FI- child interaction was audio visually recorded at home may have been preferable and more representative of every day interaction. This would not however have allowed comparison with UI interaction. One possibility for future research would be collecting data such as questionnaires and

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personal interviews which may be more culturally appropriate than asking mothers to be videotaped in their homes. Using the same setting arrangements as in the current study, would have the advantage of replication and thus could be used for comparison purposes. Despite the limitations of the current research, strengths lie in the detailed analysis and coding of verbal pragmatic behaviours for children with ADHD and their age and gender matched typically developing peers interacting with two interlocutors. Insights into the pattern of FI- child and UI- child interactions of ADHD and TD can only be achieved with accurate and detailed coding, which the study provided. Although few other studies addressed FI and UI interactions with children with ADHD, this study was novel in that it addressed a new population in a culture that was not studied by any similar research.

Further research is urgently needed to enrich our knowledge of the pragmatic characteristics of Arabic speaking children with ADHD by employing a larger number of participants. A more naturalistic setting and context, and subtypes of ADHD in addition to more qualitative analysis should be included in future studies.

6.5 Conclusion

The present thesis utilized two methodological approaches (quantitative and qualitative) to give a comprehensive view of the verbal pragmatic characteristics of 4-5 year Saudi boys with ADHD in comparison to matched typically developing children. This study provided a clear demonstration that the verbal pragmatic skills exhibited by children with ADHD were different to their matched TD peers at the level of reduced

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verbal productivity, shorter turns, more difficulty with topic maintenance, and less complex verbal responses compared to typically developing children. However, no effect was demonstrated for interlocutor familiarity in ADHD or TD participants. Also, the findings showed that mothers of children with ADHD were using more questions and directives and fewer comments while interacting with their children. A number of implications are drawn from the research with the promise that the present study‟s findings of mother‟s conversational repair and interaction style can influence the selection of intervention goals and shape the nature of their role and involvement in the intervention process.

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