ADHD and Communication Links
Written by Michelle Mifsud, Speech and Language Pathologist.
When we speak of Attention Deficit Hyperactivity Disorder (ADHD) these three words scream at us – hyperactivity, inattention and impulsivity BUT we often overlook the impact these have on language development. Research and first hand clinical experience has made us more and more aware of the significant impact that inattention and hyperactivity have on communication development.
In order for communication to be effective we need to be able to understand language as well as use it while being aware of social cues and social rules.
A defiant child or a struggling child?
While language comprehension is not a difficulty found in all children with ADHD, several children with ADHD struggle with listening. This is likely because they find it difficult to process language or because they find it challenging to filter out background noise such as in a classroom or an animated home. Think of a classroom, you’ve got windows – people, birds and vehicles passing by; the door – other students and educators walking in the corridors; all this on top of all the distractions already present in the classroom – other children chatting, charts on walls, stationary to fidget with on the desk… the list goes on and on.
Considering all the above, it’s no surprise that children with ADHD may not always follow instructions, and are likely to miss details in conversation, stories and lesson explanations. While ‘listening’ these children often lose track of what is being said and this is often mistaken for oppositional behaviour. Mind you, YES, statistics indicate that nearly half of children with ADHD also have Oppositional Defiant Disorder (ODD). ODD is a disorder where children present with extreme noncompliant behaviour. They are often vindictive towards authoritative figures, defiant and argumentative and experience bursts of rage. However, this is different to not following instructions because the child has genuinely missed on crucial bits of information because of inattention.
ADHD often makes it difficult for a child to process and understand chunks of information all at once. When large chunks of information are presented, the child with ADHD is likely to pick up on some words while being unable to follow the rest. As a result they miss out on blocks of information.
The nature of these difficulties is often mistaken for ‘auditory processing disorder.’ However, the auditory pathway is functioning as it should, in that, the information gets in, but impairments in 'executive function' mismanage it. Executive functioning is the process our brain uses to coordinate and organise thoughts. It's as if the manager that runs the brain is often napping at work so tasks aren't running smoothly. In turn, information and details are jumbled up. Hence, these children are often described as 'defiant', 'lazy' and 'like to tease'. As above-mentioned, several children with ADHD also face ODD, however, it is not always the case. Other children genuinely, struggle to listen and attend to tasks.
Due to deficits in executive functioning, above-mentioned, individuals with ADHD often use lots of filler words like ‘um’/’er’/’ah’ while they organise their thoughts. Similarly, they are likely to have grammatical errors and poor sentence structure because of the planning difficulties they struggle with.
What about socialisation?
ADHD may also have an indirect impact on social interactions since following the track of thought in a group conversation/noisy environment may prove even more challenging.
The impulsivity factor in ADHD also often results in children speaking out of turn, overlapping speech in conversation and intruding in group conversations, blurting out answers in class, talking excessively, rapidly and too loudly. The significant challenge these children face with organising their thoughts often results in them going off at a tangent in conversation and going off topic. Despite the ability to understand language and formulate sentences, these difficulties often come in the way of successful social interactions.
These difficulties in social skills may be regarded as similar to those faced by children with autism, however, they are intrinsically very distinct. The child with autism has significant underlying difficulties in understanding social contexts and social rules. Differently, the child with ADHD can very well understand these social expectations but is too impulsive or distracted to follow them.
What can you do to support successful communication when engaging with a child with ADHD? A few pointers:
Make sure you have the child's full attention before addressing them. Address the child by name prior to giving instructions or asking questions. If this is not sufficient to gain the child's attention, it may be helpful to physically go down to the child's level, and if necessary gently touch the child's shoulder/hand.
Allow the child ample time to process what you've said and to formulate a response - this way children have time to organise their thoughts and plan a response. Yes, it takes a lot more energy and effort than you can imagine.
Avoid asking several questions in a row, do not bombard the child.
Allow pauses and segment information into small chunks to support listening. You may consider asking the child to repeat what they’ve understood from what you’ve said.
Bottom line?
Not all children with ADHD who do not follow instructions are defiant or oppositional. ADHD has an indirect impact on social interactions which should not be undermined.
Whenever in doubt, reach out, we are here to support your journey.
