Narrative and Non-Narrative Discourse Skills in ADHD Across the Lifespan: A Systematic Review of the Literature

OBJECTIVE: Discourse-level language abilities are critical for successful participation in social, academic, and vocational pursuits. These abilities encompass both narrative and non-narrative genres, each serving distinct communicative functions. Narrative discourse involves spoken accounts of events or experiences, typically with a setting, characters, and a sequence of actions. Non-narrative discourse includes genres like explanations, arguments, and descriptions that convey information or ideas without a temporal structure. The aim of this review was to synthesise extant literature on discourse abilities of children and adults with ADHD across these genres. METHODS: Systematic searches were conducted via CINAHL, PsycINFO, Medline, and ProQuest. The review adhered to PRISMA guidelines and was registered with PROSPERO CRD 42022377007. RESULTS: Thirty-nine studies were included in our review. Most studies investigated the narrative abilities of children with ADHD. ADHD was associated with atypical verbal output, characterised by atypical brevity and verbosity, dysfluency, reduced syntactic complexity, and grammatical errors. Individuals with ADHD produced fewer pronouns and conjunctions. Additionally, their discourse was less coherent and included more frequent topic changes. Similarly, speakers with ADHD omitted critical components of discourse genres. The effect of ADHD on discourse varied between adults and children with ADHD and was evident in both narrative and non-narrative discourse. CONCLUSION: Published evidence to date indicates that ADHD affects micro-linguistic to super-structural discourse features in children and adults, likely impacting communication success in social and academic environments. Assessing the structure and content of narrative and non-narrative genres should form routine functional evaluation in ADHD for adults and children. More research is indicated given current major gaps in areas reviewed.