30 Examining the Bilingual Advantage in Executive Functioning in ADHD: A Retrospective Study
Authors: Lee Collin , Hom Christy 
Published: December 2023

Objective:Several studies have found a bilingualism advantage on executive functioning tasks like cognitive flexibility, inhibitory control, switching, and working memory in typically developing populations. (Grote et al., 2015, Foy & Mann, 2014). However, some studies have found deficits in inhibitory control and switching for bilingual individuals with Attention Deficit/Hyperactivity Disorder (ADHD) compared to monolingual individuals and control groups (Bialystok et al., 2017, Mor et al., 2015). They suggest that this disadvantage is due to the burden of managing two language systems which perpetuates the executive dysfunction seen in ADHD. The current study aims to examine if there is a bilingualism advantage in other aspects of executive function, including inhibitory control, planning, problem solving, switching, and working memory among children and adults diagnosed with ADHD.Participants and Methods:The medical records of 170 patients evaluated in an outpatient neuropsychology clinic from 20182022 were reviewed. Sixty participants diagnosed with ADHD, between the ages of 6 and 46 (61.67% male), comprised the final sample. Forty-one were monolingual and 19 were bilingual or multilingual. Language status was based upon patient or parental report. Outcomes on various direct and indirect measures of executive function were examined.Results:Linear regression models, adjusting for age and sex, revealed a significant bilingual advantage on the following measures: Wechsler Intelligence Scale for Children- Fifth Edition (WISC-V) and Wechsler Adult Intelligence Scale - Fourth Edition (WAIS-IV) Digit Span Backwards and Digit Span Sequencing, WISC-V Picture Span, and Behavior Rating Inventory of Executive Function, 2nd Edition (BRIEF-2) Parent-Report Emotion Regulation Index (ERI). There were no significant differences in scores between monolinguals and bilinguals on the following measures: Delis-Kaplan Executive Function System (D-KEFS) Color-Word Interference Inhibition versus Combined Naming Contrast Score and Inhibition/Switching versus Inhibition Contrast Score, D-KEFS Trail Making Number-Letter Switching versus Combined Number Sequencing and Letter Sequencing Contrast Score, A Developmental Neuropsychological Assessment, 2nd Edition (NEPSY-2) Naming versus Inhibition Contrast Score and Switching versus Inhibition Contrast Score, Wisconsin Card Sort Task Learning to Learn Index, BRIEF-2 Parent-rated Behavioral Regulation Index (BRI), Cognitive Regulation Index(CRI), and Global Executive Composite(GEC), BRIEF-2 Self-rated BRI, ERI, CRI, and GEC, or BRIEF Adult Version BRI, Metacognitive Index, and GEC.Conclusions:Bilingual status is associated with stronger auditory and visual working memory among people with ADHD, but not with stronger inhibitory control, switching, planning, or problem solving skills. At the same time, there were no significant differences between monolingual and bilingual ADHD patients on BRIEF parent- or self-rated behavioral or cognitive dysregulation. Our results suggest that bilingualism may confer an advantage in some aspects of executive function among a population with weak attention and executive function skills more broadly. Furthermore, we did not find any type of disadvantage for those who are bilingual. Future studies should examine whether lower parental ratings of emotion dysregulation among ADHD patients who are bilingual are due to bilingual children’s better ability to adapt to different situations or cultural differences in parenting practices.