This blog is written by Karen Gill Our Clinical Lead in Speech and Language Services, it helps explain the Overlap between Language Difficulties and AD(H)D!
AD(H)D is defined as a pattern of behavioural symptoms of inattention, impulsivity, and hyperactivity that may occur in various combinations; it is diagnosed by Psychiatrists and Clinical Psychologists – so where does Speech and Language come in to it?
What lies beneath these outward symptoms of high levels of activity, inattention and poor organization is thought to be a deficit in ‘executive functioning’. Executive functioning is like a control centre in the brain which helps us plan, organize, monitor, evaluate behavior and inhibit responses to the world around us (e.g. don’t pay attention to the birds outside – listen to teacher instead). Due to this deficit in ‘executive processing’ or this control centre; behaviour inhibition and poor organization are present, both hallmarks of AD(H)D.
Executive processing is also linked with our linguistic skills – language and communication by its very nature requires planning and organizing, it is produced in response to our ever changing environment (we have to structure our sentences properly so they make sense, plan when to say things and do it at appropriate times in response to the environment). So it is not surprising that children with AD(H)D will also have problems with language and communication.
Language and Social Difficulties in AD(H)D
Children with AD(H)D are at a higher risk for language problems and social problems. Studies have found that from 50-80% of children with AD(H)D have language difficulties. They may have deficits in receptive and expressive language, typically having difficulties following instructions and in expressing and organising their thoughts.
Children with AD(H)D can also be poor conversationalists, they may not necessarily be able to plan, organize or monitor their communication. They may have difficulty telling a story in a coherent way, where the sequence of events may be muddled up with no start, middle or end.
They can also have difficulty monitoring and adapting their communication to the context, may ask inappropriate questions, interrupt others and may be unable to introduce or maintain conversational topics. These types of social skill difficulties can lead to problems with friendships.
The link between ADHD, self regulation and inner language (self talk)
If you think about it we all use our language or self-talk to plan, organise, monitor and regulate ourselves. For example we use our self talk to organise ourselves everyday – ‘today I need to post the letters, get to the meeting for 9 and do the shopping after work’ or ‘I won’t ask that question now as I don’t want to interrupt’. Thus self-regulation and linguistic processes seem to be interlinked.
Interestingly, children with ADHD are thought to be delayed in their development of the use of self-talk or internalised speech.The Russian Psychologist Lev Vygotsky (1930) proposed that self-talk (the internalisation of speech) is critical to cognitive and social development. Children with ADHD can benefit from being taught this skill of self-talk to encourage them to monitor their behaviour and their self-direction.
Overall, it seems there is a connected relationship between executive functioning, self regulation and language skills.
We recommend that if you suspect that your child has AD(H)D or your child has a diagnosis of AD(H)D that you have a full speech and language assessment to assess their linguistic skills. Language therapy can target attention and listening skills, receptive and expressive language and social skills.
To find out more about AD(H)D please click here. Thanks to Karen for writing this blog. Karen has a special interest in working with children with ADHD and language difficulties. If you would like an appointment please click here.