Subsequent psychiatric disorders in attention deficit and hyperactivity children receiving speech therapy

doi:10.5498/wjp.v15.i5.100731

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May 19, 2025 (publication date) through Apr 30, 2025

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World Journal of Psychiatry

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2220-3206

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Psychiatry. May 19, 2025; 15(5): 100731
Published online May 19, 2025. doi: 10.5498/wjp.v15.i5.100731

Table 1 Comparisons of demographic characteristics in attention deficit and hyperactivity disorder children with or without speech and language therapy before propensity matching, n (%)

Variable	ADHD children		P value
Variable	Non-ST cohort (n = 9076)	ST cohort (n = 2911)	P value
Gender			0.253¹
Girls	2031 (22.4)	622 (21.4)
Boys	7045 (77.6)	2289 (78.6)
Age at ADHD diagnosis (mean ± SD)	5.99 (1.47)	4.92 (1.54)	< 0.001²
≥ 4 years	1012 (11.2)	809 (27.8)	< 0.001¹
> 4 years	8064 (88.8)	2102 (72.2)
Urbanization			< 0.001¹
1 (highest)	3159 (34.8)	881 (30.3)
2	2525 (27.8)	753 (25.9)
3	1938 (21.4)	570 (19.6)
4	1035 (11.4)	313 (10.8)
5 (lowest)	419 (4.6)	394 (13.5)
Comorbidities
Cerebral palsy	121 (1.3)	229 (7.9)	< 0.001¹
Autism	420 (4.6)	712 (24.5)	< 0.001¹
Hearing loss	569 (6.3)	648 (22.3)	< 0.001¹
Delay development (including language or speech delay)	2729 (30.1)	2361 (81.1)	< 0.001¹
Mental retardation	1035 (11.4)	1063 (36.5)	< 0.001¹
Behavioral interventions			< 0.001¹
No	4951 (54.6)	1153 (39.6)
Yes	4125 (45.4)	1758 (60.4)
ADHD medication used			< 0.001¹
None	4481 (49.4)	1454 (49.9)
Methylphenidate HCL (Ritalin/Concerta)	4574 (50.4)	1450 (49.8)
Atomoxetine (Strattera)	391 (4.3)	184 (6.3)
Used 2 types	370 (4.1)	547 (4.6)

¹P χ² test.

²P t-test.

ADHD: Attention deficit and hyperactivity disorder; ST: Speech and language therapy; HCL: Hydrochloric acid.

Table 2 Comparisons of demographics and comorbidities between attention deficit and hyperactivity disorder patients that received speech and language therapy (speech and language therapy cohort) and propensity score matched attention deficit and hyperactivity disorder patients without speech therapy (non-speech and language therapy cohort), n (%)

Variable	ADHD children propensity score matching		P value
Variable	Non-ST cohort (n = 1883)	ST cohort (n = 1883)	P value
Gender			> 0.999¹
Girls	371 (19.7)	371 (19.7)
Boys	1512 (80.3)	1512 (80.3)
Age at ADHD diagnosis (mean ± SD)	5.26 (1.58)	5.26 (1.48)	0.589²
≥ 4 years	396 (21.0)	382 (20.3)	0.573¹
> 4 years	1487 (79.0)	1501 (79.7)
Urbanization			0.555³
1 (highest)	611 (32.4)	634 (33.7)
2	512 (27.2)	504 (26.8)
3	408 (21.7)	390 (20.7)
4	208 (11.0)	212 (11.3)
5 (lowest)	144 (7.6)	143 (7.6)
Comorbidities
Cerebral palsy	86 (4.0)	73 (3.9)	0.865¹
Autism	241 (12.8)	224 (11.9)	0.375¹
Hearing loss	277 (14.7)	264 (14.0)	0.552¹
Delay development (including language or speech delay)	1321 (70.2)	1342 (71.3)	0.219¹
Mental retardation	444 (23.6)	432 (22.9)	0.638¹
Behavioral interventions			0.810¹
No	869 (46.1)	877 (46.6)
Yes	1014 (53.9)	1006 (53.4)
ADHD medication used			0.809³
None	965 (51.2)	982 (52.2)
Methylphenidate HCL (Ritalin/Concerta)	912 (48.4)	897 (47.6)
Atomoxetine (Strattera)	101 (5.4)	107 (5.7)
Used 2 types	95 (5.0)	103 (5.5)

¹P McNemar test.

²P paired t-test.

³P Wilcoxon test.

ADHD: Attention deficit and hyperactivity disorder; ST: Speech and language therapy; HCL: Hydrochloric acid.

Table 3 Incidences and hazard ratios of subsequent psychiatric disorders between attention deficit and hyperactivity disorder patients who received speech and language therapy (speech and language therapy cohort) and propensity matched comparison subjects who did not receive speech therapy (non-speech and language therapy cohort as reference group); also stratified by sex, age, and comorbidity

Variable	ADHD children						Adjusted hazard ratio (95%CI)
	Non-ST cohort			ST cohort
	Event	PY	Rate	Event	PY	Rate
Any disorder	701	21677	32.34	531	24622	21.57	0.72 (0.63-0.82)^c
Affective disorder	64	32725	1.96	51	32681	1.56	0.76 (0.51-1.14)
Schizophrenia	21	33393	0.63	10	33314	0.30	0.43 (0.17-1.12)
Psychosis	13	33598	0.39	20	33088	0.60	1.63 (0.67-3.92)
Conduct disorders	3	33794	0.09	4	33467	0.12	1.33 (0.30-5.60)
Impulsive disorder	13	33651	0.39	8	33402	0.24	0.64 (0.25-1.64)
Oppositional defiant disorder	76	32600	2.33	60	32600	1.84	0.80 (0.56-1.15)
Emotional disturbances	249	29734	8.37	207	30201	6.85	0.81 (0.67-0.99)^a
Personality disorders	3	33764	0.09	4	33442	0.12	1.00 (0.14-7.10)
Anxiety disorders	420	26354	15.94	318	28002	11.36	0.73 (0.67-0.86)^c
Adjustment disorder	112	31467	3.56	66	32256	2.05	0.52 (0.36-0.73)^c
Sex
Girls	124	4121	30.09	88	5095	17.27	0.70 (0.52-0.96)^a
Boys	577	17247	33.45	443	18516	23.93	0.72 (0.63-0.83)^c
Age at ADHD diagnosis, years
< 4	112	4934	22.70	94	5287	17.78	1.50 (0.80-2.82)
> 4	589	16561	35.57	437	18437	23.70	0.73 (0.62-0.85)^c
Any comorbidities
No	124	4864	25.49	85	4754	17.88	0.70 (0.50-0.99)^a
Yes	577	15962	36.15	446	19491	22.88	0.73 (0.63-0.84)^c

^aP < 0.05.

^cP < 0.001.

Study and comparison subjects were matched by propensity scores. Rate represents incidence rate (per 1000 person-years). Multivariate Cox model controlled for age, gender, comorbidities, behavioral interventions, and drug used. Any comorbidities included cerebral palsy, autism, hearing loss, delay development, or mental retardation. ADHD: Attention deficit and hyperactivity disorder; ST: Speech and language therapy; PY: Person-years; 95%CI: 95% confidence interval.

Table 4 Incidence and adjusted hazard ratios of overall subsequent psychiatric disorders in attention deficit and hyperactivity disorder children with speech and language therapy (speech and language therapy cohort) and propensity matched attention deficit and hyperactivity disorder children without speech therapy (non-speech and language therapy cohort as reference group) upon receiving different interventions for attention deficit and hyperactivity disorder

Variable	ADHD children						Hazard ratio (95%CI)
	Non-ST cohort			ST cohort
	Event	PY	Rate	Event	PY	Rate
Treatment
No medication or behavioral interventions	94	9730.61	9.66	60	10754.52	5.58	0.65 (0.36-1.21)
Only ADHD medication used	76	2307.20	32.94	67	2530.55	26.48	0.54 (0.22-1.35)
Only behavioral interventions	85	3271.39	25.98	84	3549.51	23.67	1.50 (0.67-3.34)
Both medication and behavioral interventions	446	5185.40	86.01	320	6609.63	48.41	0.60 (0.45-0.79)^c

^cP < 0.001.

Rate represents incidence rate (per 1000 person-years). Study and comparison subjects were matched by propensity scores. Multivariate Cox model controlled for age, gender, comorbidities, behavioral interventions, and drug used. Comorbidity included cerebral palsy, autism, hearing loss, delay development, or mental retardation. ADHD: Attention deficit and hyperactivity disorder; ST: Speech and language therapy; PY: Person-years; 95%CI: 95% confidence interval.

Citation: Tzang RF, Lin YW, Kao KL, Chang YC, Huang HC, Wu SY, Wu SI, Stewart R. Subsequent psychiatric disorders in attention deficit and hyperactivity children receiving speech therapy. World J Psychiatry 2025; 15(5): 100731
URL: https://www.wjgnet.com/2220-3206/full/v15/i5/100731.htm
DOI: https://dx.doi.org/10.5498/wjp.v15.i5.100731