Thanks for joining me for another speech and language topic. This week please welcome my colleague, Stephanie M. Nixon, Ph.D., CCC-SLP, who will be discussing Attention Deficit Hyperactivity Disorder and how it can impact speech and language development.
What is Attention Deficit Hyperactivity Disorder (ADHD)?
Attention Deficit Hyperactivity Disoder is a medical condition that leads to problems with inattentiveness, hyperactivity, impulsivity, or a combination of these. It affects how well a person can sit still, focus, and attend. 4.4 million or 7.8% of 4-17 year-old children have a history of ADHD by parent report (CDC, MMWR Weekly, 54: 842-847, 2005).
What are the symptoms of ADHD?
* Fails to give close attention to details
* Difficulty sustaining attention
* Does not seem to listen (e.g., needs instructions repeated frequently by teacher)
* Does not follow through
* Difficulty organizing tasks and assignments
* Reluctant to engage in tasks that require sustained mental effort
* Frequently loses objects
* Easily distracted
* Runs around
* Excessively loud/noisy
* On the go
* Talks too much
* Blurts out the answer before the question is completed
* Difficulty waiting his/her turn in line
* Interrupts/intrudes on others
* Acts without thinking
* Uncomfortable doing things slowly and systematically
* Difficulty resisting temptations/opportunities
In order for a diagnosis of Attention Deficit Hyperactivity Disorder to be made, these criteria must appear in 2 or more situations and must appear by age 12. These are more obvious when a person is studying or working and less during vacation. There must be clear evidence of these interfering with or reducing the quality of social, academic, or occupational functioning. (Source: DSM- V)
In 1993, Hallowell said “it [ADHD] is like driving in the rain with bad windshield wipers. Everything is smudged and blurred and you’re speeding along, and it’s really frustrating not being able to see very well”.
This is a perfect description of how it feels to have ADHD. Attention Deficit Hyperactivity Disorder can interfere with a person’s ability to study and learn because they have difficulty focusing on what they are studying and then retaining what they learned.
Are there subtypes?
Yes. A child does not have to be hyperactive to be diagnosed with Attention Deficit Hyperactivity Disorder. In fact, researchers have observed that girls with ADHD present different from boys with ADHD in that the girls are less overtly active but tend to present as more “hyper verbal” (i.e., talk too much) and have more difficulty maintaining focus.
Can a child ever “grow out” of ADHD?
What are the treatments?
Behavioral and Medication (stimulant and non-stimulant) are options. Both have their benefits as well. A MTA Randomized controlled trial found the following:
* Medication plus behavioral therapy is the best
* Medication alone is better than behavioral therapy alone/community care alone
* Behavioral therapy alone is better than community care alone
Basically, the medication works best if the individual is taught behavioral strategies that work for children with ADHD. A child with ADHD must be taught how to organize their surroundings including their desk, their backpack, their computer, etc. In the long run, this will help a child with internal organization.
As an example, a 6th grader with ADHD once told me he had cleaned his room. I looked at him and said, “Did everything get shoved under the bed?” He looked shocked and said “How did you know?”. Unless individuals with ADHD are directly shown how to organize, it is like the information was all just shoved in their head without being organized into the “file folders” we need to maintain.
What are the outcomes for individuals with ADHD? (Barbaresi, Klein, DuPaul, 2012)
* Preschoolers are more likely to be suspended from preschool or daycare for disruptive behavior (15% vs. 0.8%; Angold et al., 2007).
* Drivers with ADHD have more accidents than those who don’t have ADHD.
* More frequent emergency room visits
* More likely to be chronically late/absent
* More likely to have trouble at work
* Turn in fewer assignments than peers
* More likely to drop out
* Higher likelihood of grade retention and failure to graduate
The need for seeking an evaluation and intervention for ADHD is very important.
So how does ADHD affect speech and language?
* Difficulty organizing and generating speech when responding to task demands
* More verbose than peers in normal conversation, less verbose in confrontational questioning
* Children with ADHD are more likely to have fair to poor motor coordination
* Difficulties learning from past mistakes and with perseveration (hindsight deficits)
* Difficulties with organization/planning (forethought deficits)
* Difficulties with recalling larger and more complex amounts of information, particularly with a delay period
* Poor reading comprehension
* Lack structure in story retelling tasks
* Deficient rule following
* Increased emotional reactivity
Sometimes these difficulties are not detected in a standard speech and language evaluation. The speech-language-pathologist must evaluate the child’s organization of language with specific measures. Areas that may be included are problem solving, language processing, written language, and social language.
What can I do if I think my child has ADHD?
First speak to your pediatrician about your concerns. I generally recommend seeking out a neuropsychological or psychoeducational evaluation specific to ADHD. These evaluations are provided by a neurologist or neuro-developmental pediatrician who specializes in ADHD. With regards to your child’s speech and language skills, make sure the clinician who will be performing the evaluation has knowledge about ADHD. Even though a speech-language pathologist can not diagnose ADHD, they will be able to provide you with information in regards to your child’s strengths and weaknesses in terms of attention, working memory and expressive/receptive language.
Where can I go to learn more about ADHD?
Stephanie M. Nixon is a speech-language pathologist at Children’s National Medical Center in Laurel, MD as well as the owner of Nixon Education Services. She has earned her earned 3 degrees in Speech and Communications: B.S. from University of North Texas; M.S. from Arizona State University, and Ph.D. from University of Pittsburgh. She has done research in the areas of phonology, orthography, and semantics as well as ADHD. You can reach her via e-mail.