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Language and language development in ADHD

Language and language development in ADHD

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Author: David Wilhelm

Language and communication disorders that occur in connection with ADHD have been insufficiently investigated to date and are not considered specific to attention deficit disorder due to a lack of clear evidence of deficits in verbal working memory.1
The basic cognitive characteristic of ADHD is a deficit in visual-spatial working memory, but no deficit in the phonological loop.2
Even if deficits in verbal working memory can be identified in children with ADHD-I, these are usually limited to difficulties in recalling correct word sequences or can be explained by attention problems. Sound or acoustic information processing and auditory memory are not impaired.3
There may even be a shift in performance in favor of the phonological loop, which could explain, for example, why many people with ADHD are musical (hypothesis45 . However, it is still unclear why specific language development disorders occur more frequently together with ADHD and why the neuropsychological findings differ from idiopathic language development disorders.
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1. ADHD & phonological speech disorders

A phonological speech disorder is present when the speech disorder is preceded by an inadequate recognition and processing of speech sounds (phonemes)8. Phonological speech disorders must be distinguished from phonetic speech disorders (articulation disorders), in which only motor pronunciation is impaired. If phonological speech disorders are present, word contrasts such as can-can, cat-paw, cellar-plate cannot be distinguished.9
In the case of phonological language development disorders, inadequate performance is achieved in the “phonological loop” with high diagnostic relevance. There is no preference for common linguistic sound patterns and the vocabulary is usually smaller than in age-appropriate language development. People with language development disorders are generally unable to represent phonetic information in their phonological working memory for a short period of time. In this respect, subjects with ADHD are rarely conspicuous10
In ADHD of the predominantly hyperactive-impulsive (ADHD-HI) and the combined presentation form (ADHD-C), no significant deficits in verbal working memory are usually found. In a group of the predominantly inattentive subtype (ADHD-I), slight deficits in verbal working memory of 0.30 standard deviations were determined in a study by Rhonda Martinussen. According to the authors of the study, the slightly poorer results can be attributed to attention and concentration difficulties.11

2. ADHD & auditory processing and perception disorders (AVWS)

Similar to phonological language disorders, auditory processing and perception disorders (AVSD) are characterized by insufficient processing and storage of linguistic information at higher processing levels. However, AVSD also includes sensory weaknesses in the auditory system and disorders of auditory attention.12
Children with AVWS can hear soft noises or sounds without any problems, but what they hear, including linguistic information, is not processed correctly. This leads to a number of difficulties, including hearing speech in the presence of background noise or in difficult listening situations such as in classrooms, gymnasiums and playgrounds. Because the differentiation of tones, speech sounds and noises is often impaired, learning to read and write can also be affected.13
Extensive deficits in auditory memory are not necessarily a prerequisite for a diagnosis, and according to the American Speech-Language-Hearing Association, auditory attention does not necessarily include auditory memory and phonological memory, i.e. the short-term retention of linguistic information in working memory (rehearsal). In some samples, up to 32% of children diagnosed with AVSD showed no impairment in the auditory short-term memory tests.14
Attention problems, difficulties in focusing on a sound source and in targeted listening are among the main characteristics of AVWS. In addition, sensory performance of subcortical processing in the brain, such as: Localization, discrimination, identification, intensity, differentiation and integration of sound signals are included in the concept of AVSD.

Symptoms of AVWS are15

  • Impairment of auditory attention
  • Problems with understanding auditory information
  • Misunderstandings with verbal prompts
  • Slower processing of verbal information
  • Delayed reaction to auditory or verbal stimuli
  • Weak auditory memory
  • Impaired recognition and differentiation of sound stimuli
  • Disturbed sound source localization
  • Restrictions on speech comprehension and focusing on what is being said in the presence of background noise
  • Limitations in understanding altered speech signals (e.g. incomplete speech signals or speech signals with reduced redundancy)
  • Increased effort when listening and understanding, especially in noisy situations and/or when talking to several people
  • Increased sensitivity to loudness/noise such as hyperacusis or misophonia .16

If the impaired understanding of verbal information is due to limited cognitive resources, the diagnosis of AVWS is not justified. However, it cannot be ruled out that auditory processing and perception disorders may be combined with attention disorders, language development disorders or reading and spelling disorders.

Difficulties in perceiving and paying attention to information heard overlap considerably with attention deficit hyperactivity disorder. However, in comparison to auditory perception and processing disorders, no abnormal findings were found in the tests of speech comprehension under background noise or in auditory working memory. In turn, children with AVSD showed no abnormalities when working on structured tasks in other modalities or when working on worksheets and/or completing homework. Subjects with ADHD performed worse on tasks involving executive functions/inhibition, e.g. continuous performance tests, go/no-go or Wisconsin Card Sorting tasks17
Noise hypersensitivity is often reported by patients with ADHD.18
Another difference is that ADHD subjects have more performance fluctuations within the same tasks and a typical drop in performance after a few minutes, which would be unusual for AVWS subjects. 192014

3. ADHD & articulation disorders (pronunciation disorders)

According to ICD-1121, articulation disorders are listed as developmental disorders of sound formation and speech production that cannot be explained by another language development disorder or intellectual disability. These are circumscribed developmental disorders in which the child’s articulation is below the level of their intelligence age, while other linguistic abilities are within the normal range. Common pronunciation disorders are, for example, sigmatism (lisp), schetism (sh-sound formation), kappacitism (k-sound formation), etc.9
Articulation disorders are six times more common in schoolchildren with ADHD than in the general population.22
The cause of ADHD in connection with the frequent occurrence of articulation disorders may be deficits in oral-motor skills in particular, as phonological processing disorders, which can be attributed to limited auditory comprehension of sounds, are not found more frequently than in the general population. Instead of an impairment of phonological working memory, an impairment of somatosensory feedback to the motor cortex23 can be assumed. This means that tactile sensory stimuli, pressure and position (proprioception (Glossary window: Proprioception: perception of one’s own body according to its position in space24 of the tongue, lips and jaw movements are processed incorrectly by the part of the brain that controls the movements of the human body25 and stored incorrectly in memory.
These then present themselves with slurred speech. Articulation disorders correlate with the severity of the ADHD symptoms and often persist in a milder, more subtle form throughout life.26

4. ADHD & fluency disorders

Between the ages of three and six, many children exhibit phases of speech fluency, such as repetitions of sounds (e.g. “D-d-d-d-that’s stupid.”), syllables or words. These can develop into stuttering, especially if the child struggles against it and is insecure. In most cases, early stuttering disappears again, but in around 1% of all children, manifest stuttering develops with repetitions, elongations or blocks.
Poluttering is a very fast, hurried way of speaking, often combined with unclear articulation and difficulties in understanding speech. Poluttering and stuttering can also occur together.27
Stuttering is a widespread phenomenon in ADHD.
17 % of children with ADHD stutter.28 As a possible cause, an MRI imaging study with n = 82 adult subjects found that ADHD patients had a reduced volume of gray matter in the right gyri temporales transversi29 and 30 people with ADHD-I had a reduced gray matter volume in the left gyri temporales transversi. These are brain areas that are responsible for auditory perception. The results of the study suggest that the structural differences in the gyri temporales transversi and the planum temporale may play a role in speech development. The left gyri temporales transversi and the left planum temporale30 are particularly important for rapid temporal processing and phonemic awareness, which are crucial for speech discrimination. Reduced gray matter in these areas, as found in ADHD-I presentation, could impair the processing of linguistic information. In persons with ADHD who show asymmetric processing between the right and left hemispheres, this could also have an impact on language processing, primarily in relation to prosodic and rhythmic information, which is more strongly associated with the right hemisphere. Such structural and functional differences could influence language development and processing in people with ADHD.31
Further imaging procedures (functional magnetic resonance imaging) suggest a connection to the basal ganglia hypothesis. It states that linguistic dysfluency is the result of possible lesions of the basal ganglia.3233
The investigations prove functional disorders and connectivity disorders in the area of the basal ganglia (more on this at: basal-ganglia-striatum-substantia-nigra-subthalamic-nucleus): Caudate nucleus, substantia nigra, putamen and in the cortico-striatum-thalamo-cortical loop, a complex regulatory loop involved in executive and motor functions. The basal ganglia are crucial for the inhibition of movements and damage leads to dysregulation of motor movements during speech.34
Stuttering-like fluency disorders are very common in ADHD, but they do not always reach the level of an original fluency disorder. The clinical threshold is exceeded when the typical speech fluency of stuttering is detected in at least 3% of the syllables of a representative speech sample. Nevertheless, the studies show that stuttering not only occurs more frequently together with ADHD, but also that speech fluency occurs proportionally more frequently in a speech sample than in idiopathic fluency disorders.3536

5. ADHD & language development

Speech development disorders are defined by the “German Society of Phoniatrics and Pediatric Audiology - DGP” as speech development that deviates from normal speech development in terms of time and content. Speech development disorders (SES) in the narrower sense have organic causes, hearing disorders, damage to left-hemispheric brain areas or damage to the Broca’s area37 in the brain, which is responsible for speech motor skills, etc.38 Specific language development disorders (SSES), on the other hand, often occur together with developmental disorders. In contrast to organic SES, specific language development disorders are not cross-modality, i.e. the disorder does not extend to all expressive and receptive modalities: speaking, understanding, reading, writing (supramodality assumption). 39 Specific language development disorders are usually due to disorders in working memory. People with language development disorders do not have deficits in auditory perception, but they do have weaknesses in auditory memory, time processing or problems with the correct execution of speech in a specific context.4041
Specific language development disorders with long-term Consequences occur only occasionally with ADHD, but almost every fourth child with ADHD begins to speak late, articulation disorders and difficulties in the correct use of grammar often persist.42. This is particularly common in children with ADHD and an additional circumscribed developmental disorder of motor functions. Here, half of all children exhibit a clinical delay in language development.43

“Disorders of motor speech development are exhibited by the vast majority of hyperkinetic children. This often initially involves a delayed onset of speech, with the first words sometimes not being uttered before the end of the second year or during the third year, but sometimes not even in the fourth year.”44

Paradoxically, children with ADHD are statistically very likely to show particularly high IQ values in the areas that measure linguistic comprehension in later intelligence diagnostics. In the Hamburg-Wechsler Intelligence Test for Children (HAWIK-IV), the children tested regularly show the best results in the “linguistic comprehension” category.45 An evaluation of test results from Germany showed that children with ADHD score 3.3 points above the overall IQ in language comprehension. The results of English-language studies are very similar.46 Even ADHD cohorts with additional circumscribed developmental disorders of school skills (e.g. dyslexia) achieve the highest score in the “Language comprehension” category.45
Vocabulary, language comprehension (semantics) and morphology do not appear to be underdeveloped in ADHD. However, there are difficulties in selective (targeted) attention because distracting stimuli have to be suppressed (inhibited), e.g. background noise, unimportant information, own emotions and impulses. As a result, important target information for communication and learning cannot be processed correctly, which could contribute to a delayed onset of language skills in addition to the motor challenges.474849
Conversely, selective language development disorders (SSES) have ADHD as the most common comorbidity. Children with SSES can be considered inattentive due to their comprehension problems. If they do not respond to prompts, respond inappropriately or are unfocused, tired and exhausted in class because they have had to use more cognitive resources to follow what is happening, this can be confused with original ADHD. A precise neuropsychological diagnosis is essential. In the case of simple SSES, no deficits in visual-spatial working memory can be detected. In addition, evidence of insufficient behavioral inhibition is rare.505152

6. Expressive language development delay

Due to the current diagnostic practice of diagnosing ADHD only from the age of six and due to insufficient test material, there are few data sources for language development delays in ADHD.5354
In a large Norwegian long-term study on the development of children with ADHD “Norwegian Longitudinal ADHD Study”55, 1195 children aged 36 months were examined. The study compared preschool children with ADHD without language delay and children with ADHD and additional language development delays. The cohorts were determined using parent and educator exploration, taking into account increased hyperactivity, comparable non-verbal working memory performance and one-day neuropsychiatric testing. 41% of the preschool children showed clinically significant deficits in verbal working memory, but not in phonological awareness, which is typically impaired in language development delays. In the other test categories, the working memory tests, inhibition, impulsivity and motor inhibition, the entire cohort showed poorer results than the control group. Thus, the results of the toddlers with ADHD and language development delays clearly differed from those of typical language development delays and general developmental disorders.5657

7. Early vocabulary

In contrast to language-delayed children with ADHD, some children with ADHD, especially with hyperactive-impulsive symptoms, are reported to have started speaking at a very early age and to have an impressive vocabulary.58
A genome-wide association study with data from 17,298 children concluded that a large vocabulary at 15-18 months of age is genetically associated with a greater risk of ADHD (rg=0.23), while a large receptive vocabulary at 2-3 years of age is associated with a lower genetic risk of ADHD (rg= -0.6 to -0.74).59
However, a larger vocabulary alone is not necessarily a sign of actual or future language competence; the length of what is said is essential. Linguistic competence is characterized by the number of phonemes used. This means that it is not the vocabulary in an utterance, but the number of phonemes used, speech sounds independent of word boundaries, that provides information about a child’s linguistic abilities. (see LMU, Mean Length of Utterance)6061
It must be taken into account here that children with ADHD produce shorter sentences than typically developing children by a marginally significant amount (p = 0.054).62
This could indicate that the vocabulary of younger children with ADHD could be ahead of their actual language comprehension.6364

8. ADHD & pragmatic language disorders

General characteristics of communication with ADHD

Individuals with ADHD often exhibit a very characteristic communication style that can be similarly observed in other disorders with executive dysfunction, whose commonality is deficits in behavioral inhibition.6566
Some examples are:67 (ICD10, WHO, section G3.) 68

  • Aloof and intrusive behavior towards strangers due to reduced impulse control. Difficulties in correctly assessing or initiating a social situation can lead to the impression of inappropriate behavior even in contact with familiar people
  • Conversation rules are not observed. There is often a lack of greetings, farewells or courtesies
  • Interrupting and disturbing others. Interfering in the conversations of others
  • Inappropriate length of speeches and non-compliance with speaker changes, interrupting the interlocutor
  • Increased urge to speak with prolixity and long-windedness, associative digression and semantic vagueness (imprecise formulations)
  • Telling lewd jokes in inappropriate situations
  • Not noticing that the other person wants to leave despite clear indications
  • Frequent excessive talking without responding appropriately to social constraints
  • Frequently blurting out an answer before a question has been finished

9. ADHD & language pragmatics

Children with ADHD often have difficulties adapting communicative expressions and their interpretations to social contexts. By elementary school at the latest, and sometimes even as early as kindergarten, the children are conspicuous for arguments with their peers, which are often due to misunderstandings. Deficits in the pragmatic use of language are particularly strongly linked to hyperactivity and impulsivity.
According to a study by Nina Crespo, children with ADHD at the age of 8 had significant difficulties. They performed significantly (>0.01) worse than the control group in tasks with ambiguous social and context-related tasks. The test subjects with a pronounced inhibition disorder, who also showed deficits in working memory, performed particularly poorly.69
A systematic review study by the University of Oviedo examined language pragmatic comprehension in ADHD in relation to developmental age, which showed that children with ADHD were significantly better able to catch up on their deficits in adolescence compared to children with language development disorders. Furthermore, the studies cited show that there is a connection between weak language pragmatics and ADHD with hyperactivity and impulsivity, although there were no differences in pragmatic language comprehension between the predominantly inattentive type (ADHD-I) and the control group.70
Children with ADHD have great difficulties in the area of narrative skills. Children with ADHD usually give chaotic, meaningless and incoherent accounts of their experiences, stories and essays at school.71 When children with ADHD are asked to report on experiences, they are usually unable to give a coherent, complete and truthful account. This is a consequence of lesions in the prefrontal cortex and should not be interpreted as intentional lying.72 Schoolchildren with ADHD also have considerable difficulties in understanding what is not explicitly said (implications), in understanding conversation partners and in understanding texts.73

The following behavior patterns indicate pragmatic language comprehension disorders:74

  • There are no reactions to verbal statements.

  • Lack of referential eye contact

  • Language usually accompanies the action, questions are barely asked

  • Questions are often answered with “yes” or the answers do not match the question asked

  • Restless conversations with sudden termination

10. ADHD & excessive speaking

Children with ADHD often stand out due to their lack of self-control, which often manifests itself in an excessive need to speak. It is often precisely this symptom that gives rise to a diagnostic clarification, as children with ADHD disrupt lessons or the kindergarten group with their constant speech production. They talk quickly, distract those sitting next to them, interrupt others during a conversation, talk to themselves, sing and hum to themselves, even if they disturb others in the process.75

“…Others always have to talk. They assault their neighbors with completely unimportant messages. They whisper. They helpfully tell someone else. Yes, they talk out loud to themselves when no one is listening. They “think” out loud and, for example, finish a piece of work with the satisfied self-talk: “There. Done! It wasn’t that hard.” Or express their displeasure or anger out loud.” 76

Excessive and frequent talking (DSM 5, Hyperactivity section, point (f)) is a symptom that is closely related to motor hyperactivity, onomatopoeia and tics.77
According to Johanna and Klaus-Henning Krause, the unbridled urge to talk can persist into adulthood. However, this peculiarity deserves greater attention because of its role in developmental psychology.
Russel Barkley considers the externalization of internal language processes to be a cardinal symptom of ADHD and relates this closely to executive dysfunction.
Barkley’s theoretical model of executive dysfunction, whose core deficit is the lack of behavioral inhibition, which is made up of these four executive functions, is as follows:
7879

(a) Working memory (short-term holding and changing of information in the mind, etc.)

(b) Self-regulation of affect, motivation and arousal (the ability to separate one’s own feelings from events and information)

(c) Internalization of language (developing internal monologues, e.g. to give oneself instructions, checking the appropriateness of one’s own behaviour, including metacognition)

(d) Action planning (planning orders of priority on a mental level, finding solutions to problems, etc.)

The basis for Barkley’s model is Bronowski’s (1977) theory on the uniqueness of human language.
Bronowski identified four unique features of human language that distinguish it from animal communication. He argued that human language is not only a means of communication, but also of self-reflection, in which social actions are proposed, acted out and tested. Reflection can only occur when there is a delay between the arrival of a stimulus or event and the reaction to that event. Bronowski regarded this ability to inhibit and delay reactions as a central and defining feature in the evolution of the unique properties of human language.80
According to Barkley, the ability to create a delay (inhibition) between event and reaction creates a small period of time in which a situation can be evaluated and hypotheses of future events can be made. This part of the executive function enables people to free themselves from the “dominance of the moment of immediate circumstances under which all other living beings are governed”.
The internalization of language gives human thought and speech a unique form. During the delay of reaction, language is directed towards the self. It is thus transformed from a primary means of communication with others to a means of communication with oneself, a means of reflection and exploration that allows the construction of possible messages or responses before one is chosen to be uttered or executed. It also enables the creation of self-directed instructions and thus becomes a fundamental tool for self-control.
The psychologist Lev Vygotsky recognized as early as 1930 that children between the ages of three and five often talk to themselves, which usually turns into internalized speech, a kind of inner monologue, as their development progresses. Toddlers comment on their actions and increasingly include social actions in their repertoire. An example from Jean Piaget’s notes: “I, I want to draw that … I want to draw something … I need a big piece of paper… And everything falls over! (the boy knocks over a game)…Now I want to do something else” etc.81
Vygotsky understood language beyond its function as a means of communication with others, as a kind of tool whose function was to organize thoughts.
Vygotsky found that with the help of the descriptive function of words, children begin to direct their attention, organize their thoughts and hold their ideas in their heads.

“The speaking child has the ability to direct its attention in a dynamic way. It can view changes in its present situation from the perspective of past activities, and it can act in the present from the perspective of the future.”8283

In his theoretical model of the internalization of language, Barkley also shows that self-directed language, in addition to its function of solving and reflecting on problems in a purely informative way, also serves to develop rules, which are a prerequisite for controlling one’s own behaviour without having to completely re-evaluate situations.79

Barkley’s theory is very close to Alan Baddeley’s model of working memory.84
In particular, the (mental) manipulation of information in working memory involves the ability to hold, change and organize information in the short term, for example to adapt a verbal utterance to a changed situation.
Manipulation in working memory, in turn, requires inhibition.85
Baddeley also described the function of “rehearsal”, the inner re-speaking and repetition in the articulation loop as part of the working memory, which serves to “maintain the memory trace” and represents a kind of inner practicing, further thinking of what has been heard.

In one of Baddeley’s experiments, subjects were asked to pronounce syllables aloud in the course of a memory test in order to block their inner voice, with the result that the subjects’ ability to memorize was significantly impaired. His tests not only simulate a lack of internalized speech, but also demand a high degree of divided attention from the test subjects.
Inhibition is also the ability to control attention by ignoring distracting, competing information and suppressing inappropriate responses, while its absence as a result of ADHD demands great effort from people with ADHD.8687

11. ADHD & Theory of Mind

The psychological concept of “Theory of Mind” (ToM) describes the ability to attribute and predict the mental states of other people, e.g. thoughts, feelings, expectations, mental states, intentions, etc. The ToM is not yet fully developed in children under the age of five. ToM is not yet fully developed in children under the age of five. Like other social skills, ToM also develops individually and at different speeds.8889

11.1. Inhibition disorder as the cause of the ToM deficit

In order to be able to empathize with the thoughts, emotions and mental states of other people, the inhibition of one’s own thoughts, emotions and representations is necessary. People with ADHD or executive dysfunction have a brain hemiframe due to the incomplete maturation of the inferior frontal lobe* For more information, see Brain hemispheres) have great difficulty inhibiting their own view in order to correctly adopt another person’s view.90 This means that people with ADHD often believe that other people think and feel the same as they do at any given moment. The lack of ability to separate one’s own mental states from others (self-indistinction) is difficult for people with ADHD, but there is insufficient evidence to suggest that there are also problems with social prediction and recognizing intentionality. However, the level of verbal reciprocity remains low due to the inhibition disorder in ADHD.9192
Children with ADHD between the ages of four and 19 showed greater ToM deficits than typically-developing children in a study using magnetic resonance imaging (fMRI). Although the subjects with ADHD showed ToM deficits, these were less pronounced than in children with autism spectrum disorders. Their difficulties lie primarily in the processing of social interactions, particularly in differentiating between social help and threat scenarios. The authors conclude that atypical activation patterns in the orbitofrontal cortex and other ToM brain regions contribute to their social and cognitive challenges.9394
959697

11.2. Joint Attention & Theory of Mind

Being able to focus your attention on two or more stimuli at the same time, e.g. following a conversation and writing at the same time, is called divided attention. People with ADHD perform noticeably worse on tasks that require divided attention.9899
The most popular theoretical model for the causal explanation of theory-of-mind deficits goes back to Simon Baron-Cohen’s assumption of insufficient divided attention in infants. Baron-Cohen and his colleagues assumed that joint attention, e.g. referential pointing to an object, mother and child looking at an object together, is an important basis for the development of the ability to understand the thoughts and feelings of others. If children have difficulties with divided attention, they may also have difficulties initiating triangular gaze, which, according to Baron’s theory, is a prerequisite for learning to recognize the perspective or intentions of others. Therefore, deficits in divided attention are discussed as a possible cause for the difficulties in the development of ToM in autistic children.100101
Michael Tomasello assumes that joint attention is not exclusively a process of shared (social) attention, but that the quality of recognizing communicative symbols and understanding other people as intentionally acting beings are also elementary. It is possible that interest in human reciprocity is a more important prerequisite for the competence “joint attention” than attention processes that are controlled by the executive function.102103
Most studies cannot demonstrate a clear link between performance in divided attention tasks and social communication.104
An interdisciplinary study (Children With Autism Illuminate the Role of Social Intention in Word Learning) compared the abilities of joint attention and social perspective taking of children with ASD with typically developing children. The autistic children were able to name social stimuli just as well when social and perceptual target stimuli matched, e.g. when these were specified by pointing gestures, touching and the adult’s direction of gaze towards an object. The children performed significantly worse in tasks in which the tester’s intentions had to be recognized, so-called false-belief tasks.

Example of a false belief task:

Two children, Sally and Ann, are playing with a ball: Sally puts the ball in the basket and goes for a walk, then Ann takes the ball out of the basket and puts it in a box, unobserved by Sally. Sally then comes back.

The question for the viewer is now: “Where is Sally looking for the ball?”

While four-year-olds answer: “In the basket, because Sally thinks it’s there”, two- and three-year-olds still answer: “In the box”, because they are not yet able to present the change of perspective and cannot yet distinguish reliably between their own beliefs and those of other people.105

The size of the vocabulary of the autistic preschool children depended on their ability to intentionalize (to recognize people as intentional beings), but not on shared or joint attention.106

To summarize, children with ADHD have poorer ToM than their peers, which is closely related to inhibitory regulation. According to autism expert Dr. Sven Bölte, ToM abilities in ADHD lie between those of neurotypically developed and autistic people.107
The results of the studies also suggest that the weaknesses in ToM persist in adults with ADHD, but can develop further thanks to good social intuition and excellent abstraction skills. 108109

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