Objective and Subjective Voice Assessment in Children With Attention-Deficit/Hyperactivity Disorder

The aim of this study was to compare acoustic voice measures, auditory-perceptual voice quality, and parent-reported voice handicap between children with attention-deficit/hyperactivity disorder (ADHD) and typically developing (TD) peers.

Case-control study.

Voice assessments including acoustic analysis using Praat, auditory-perceptual assessment using GRBAS, and parent-reported voice handicap using the Persian CVHI-10-P were performed in 88 children with ADHD and 88 age- and sex-matched TD children; CVHI-10-P data were available for 86 children with ADHD and 88 TD children.

Acoustic analysis showed that children with ADHD had significantly higher loudness than TD children (P = 0.007), whereas TD children demonstrated significantly higher jitter values (P = 0.001). No significant differences were observed for fundamental frequency (F₀), shimmer, harmonics-to-noise ratio (HNR), and the s/z ratio. In the auditory-perceptual assessment, a significant between-group difference was found only for the Grade (G) component of the GRBAS scale (P = 0.003), while Roughness, Breathiness, Asthenia, and Strain did not differ significantly between groups. Children with ADHD who had dysphonia, based on the overall dysphonia grade of the GRBAS, demonstrated higher jitter and lower HNR than those without dysphonia. Children with ADHD also had significantly higher scores on the Persian CVHI-10-P than TD children (P < 0.001). Overall dysphonia severity was significantly correlated with higher jitter (ρ = 0.493, P < 0.001) and lower HNR (ρ = -0.334, P = 0.002). CVHI-10-P scores were not significantly associated with acoustic measures or overall dysphonia severity (P > 0.05).

Although the values of acoustic measurement were mostly similar between children with ADHD and TD group, children with ADHD demonstrated significantly higher parent-perceived voice handicap and worse overall perceptual voice quality. Given that the Persian CVHI-10-P identified dysphonia in 20.93% of children with ADHD, incorporating parent-reported voice handicap measures into routine clinical settings is strongly recommended.