My child has ADHD. Should I check their language ?
Yes.
And here’s why. Children who have attention-deficit/hyperactivity disorder are nearly three times more likely to have language problems than kids without ADHD. These language problems refer to spoken and written language understanding and use, as well as how they interact with other people socially.
What is ADHD?
ADHD develops when the brain and central nervous system suffer impairments related to growth and development. A person with ADHD will show varying degrees of these three behaviors: inattention, impulsivity and hyperactivity. ADHD is more common among boys than girls, and the symptoms can be mild, moderate, or severe. Children with ADHD frequently have trouble at home and at school including disruptive classroom behavior, difficulty finishing assignments accurately and efficiently, problems with study skills, difficulty in social interactions, and difficulty following parent and teacher directions, all of which may result in significant impairment at home, school, and in the community. Kids with ADHD and language difficulties can face even more challenges when it comes to school and communicating.
ADHD and Speech Articulation
Studies show that children with ADHD are at risk for articulation disorders, which affect their ability to produce letter sounds appropriate for their age. Beyond that, they also commonly have differences in fluency and vocal quality when speaking. One study even detected ADHD through these speech differences. Compared to peers with learning disabilities alone, children with ADHD showed increased volume and variability in pitch when talking, along with particular patterns such as increased number of vocal pauses.
Communication and ADHD
Children with ADHD also have a great deal of difficulty organizing their thoughts and produce more vocal repetitions or word fillers as they sort through their thoughts, somewhat similar to a stammer. This can lead to impatience and misunderstandings from others, especially other children or their friends, as they generally don’t have the same patience and perspective as adults. A response in the classroom may be along the lines of, “It’s a story abou … um… a story… um… um… it’s about … akidwhofliesakite… um.” It can really limit children’s ability to participate in conversations, classroom discussions, or presentations.
Language and ADHD
Children with ADHD process language differently as well. For starters, they are at increased risk for significant language delays. Even without specific delays, because of distractibility and related ADHD symptoms, they are more likely to get off-topic when speaking. They also frequently struggle to find the right words and put thoughts together quickly and linearly in conversation. Errors in grammar as they compose sentences also may occur, because of planning difficulties present even when underlying skills in this area are intact. All these ADHD- related symptoms, with or without actual language delays, may impact the ability to communicate effectively.
Listening Comprehension and ADHD
In ADHD, listening comprehension can be impaired directly, in particular because of difficulty handling rapidly-spoken language or managing distracting, noisy environments like a party or a busy classroom. Again, this is true even when a child doesn’t have an actual language delay; they have the capacity to understand, but because of ADHD, miss details in both conversation and stories. When listening, they may lose track of conversational threads entirely or miss details, and therefore fail to register vital bits of information. These same gaps frequently come across as oppositional behavior when a request appears intentionally ignored instead of not being heard in the first place. These patterns also relate to the reading comprehension difficulties often found with ADHD.
Social Skills/Pragmatics and ADHD
Paying attention to the thread of conversation can become even more problematic for a child with ADHD in groups or when in a noisy situation.The ability to retain focus on a single speaker and to transition between speakers is challenging. This has social implications, leading some children with ADHD to find it easier to get along one-on-one rather than in a group. Distracting classrooms, when multiple activities occur simultaneously, may make it particularly difficult for a child with ADHD to engage. ADHD also often makes it hard for a child to manage large clumps of conversation all at once. While another 8-year-old may be able to handle hearing as many as twelve words at a clip with good understanding, with ADHD, seven or eight might be the maximum. Anything larger, and information begins to be dropped.
Why are language problems so common in children with ADHD?
We don’t know!
ADHD and language disorders – although different things – often co-occur, and have some common symptoms. Interestingly, some of the diagnostic criteria for different kinds of ADHD include things we often seen in children with language difficulties, e.g.:
“Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction).”
“Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked).”
“Often talks excessively.”
“Often blurts out an answer before a question has been completed (e.g., completes people’s sentences; cannot wait for turn in conversation).”
“Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities).”
Some researchers think that ADHD symptoms – (e.g. poor concentration and attention, or working memory deficits) – may affect how children learn and develop language (e.g. Barkley, 2014), There is also some interesting research looking at developmental brain differences in children with ADHD and children without ADHD, which may be associated with language issues – though this research is still pretty new (e.g. Kibby et al., 2009, Miller et al., 2006).
What can we do to help with ADHD and communication?
Get your child evaluated by a licensed SLP. Look for potential language delays. Seek out skilled language interventions when needed.
Your SLP can make recommendations for accommodations and modifications that your child’s school can put in place to help them succeed.
Wait until you gain your child’s full attention before making a request or starting a conversation; otherwise, details will likely be missed. Help transition their attention by using a brief marker, such as “Joseph, I have a question for you.” If it is helpful, engage them physically through gently touching their shoulder or a similar approach, and then try to maintain eye contact as well.
Don’t overlook social challenges. Medication alone is often not enough for children who are having difficulty consistently interrupting, getting distracted, or are impulsive. Have your SLP design an intervention around your child’s struggles to ensure their ADHD doesn’t get in the way of their friendships.
Offer ‘extended time’ in conversation, allowing children who may be struggling to pull their thoughts together. Give them extra time to settle themselves and organize their responses.
Pause often and split your language into shorter segments when speaking to someone with ADHD. Annunciate clearly, and use gesture language such as counting bullet points on your fingers. Without judgment or condensation, rephrase or repeat yourself when needed. Consider having children restate what they’ve understood from what you’ve said.