Associations of Pragmatic Language with Internalizing Behavior and Externalizing Behavior in Children with ASD and ADHD

Objectives: This study aimed to (1) compare pragmatic language skills between children with Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD), and (2) examine associations between pragmatic language and internalizing and externalizing behaviors in these children. Methods: Participants included 116 children aged 5 to 13 years (29 with ASD, 87 with ADHD). Pragmatic language was assessed using the Children’s Pragmatic Language Checklist (CPLC), and internalizing and externalizing behaviors were measured via caregiver reports using the Korean Child Behavior Checklist (K-CBCL). Analyses included MANCOVA and multiple regression, controlling for age and full-scale IQ. Results: Children with ASD showed greater challenges in discourse management and nonverbal communication but not other domains of the CPLC compared to those with ADHD. Furthermore, pragmatic language skills were negatively associated with both internalizing and externalizing behaviors across the two diagnostic groups. Conclusion: This study demonstrates that although pragmatic language difficulties are common in both children with ASD and ADHD, the specific patterns of these difficulties differ by diagnosis. In addition, the negative associations between pragmatic language abilities and both internalizing and externalizing behaviors suggest that stronger pragmatic skills may play a protective role in supporting broader psychosocial functioning among neurodivergent children. These findings highlight the need for diagnosis-specific intervention strategies that address the distinct communication profiles and related behavioral challenges of each group.