ADHD and Social Communication. Say What?
It is not uncommon for kids to struggle at times to pay attention, listen, follow directions, sit still or wait their turn. However, for children with attention deficit and hyperactivity disorder (ADHD), the struggles are harder and may happen more often. ADHD is commonly found in children, accounting for 3 to 10% of school-age population. According to the DSM-V (Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition), ADHD is characterized by a series of behaviours that affect the performance of a person in various environments. The symptoms are divided into two categories: the category of inattention, or that of hyperactivity and impulsivity. Children who are inattentive have trouble paying attention to details or concentrating and staying on task. They may not listen well to directions, may miss important details and may not finish what they started. They may also avoid undertaking a task, especially if they aren’t interested in it, and may seem forgetful and distracted. On the other hand, children who are hyperactive and impulsive need to constantly move, are restless and easily bored. They may be unable to sit still, wait their turn, stay quiet, interrupt and speak excessively. They may also rush through things and act too quickly before thinking as well as make careless mistakes. In order to be diagnosed with ADHD, children must have at least six symptoms from both categories or from the combined categories. These behaviours may cause problems at home and school and affect the child’s ability to learn and get along with others. If you are concerned about your child and think that he or she may have ADHD, consult your family physician.
Social difficulties are commonly found in these children, especially since they are often poor conversational partners because of their deficits in pragmatic language (social communication), making it difficult for them to communicate well in social contexts. Pragmatics is defined as the social use of language and is essential to ensure the development of other aspects of language that are used in conversations. Think about it… we are constantly monitoring ourselves and observing our communication partner when we interact. Do they seem interested?; Am I saying too much?; Maybe I should ask about their day.; Oh, what’s that puzzled look on their face? Maybe they didn’t grasp what I was saying...These skills are learned by doing in social settings but some people have a difficult time reading all of those cues. Pragmatic difficulties are characterized by speech that can often deviate from the topic of conversation, several false starts, revisions and repetitions. For example, children with pragmatic difficulties may not respond or they may continue to play without eye contact, they may interrupt, speak at inappropriate times, speak too loudly, speak to strangers in an overly familiar way, or speak excessively without taking into consideration if someone is listening to them. Social communication difficulties occur in 52% to 82% of children who have ADHD. The rejection of their peers is a frequent consequence that prevents the child from interacting fully with those around them.
It is becoming increasingly clear that some children who have ADHD also have significant language difficulties such as a Developmental Language Disorder. When children with ADHD are compared to typically developing children, they are at higher risk of encountering challenges in certain domains of language such as poor performance on standardized tests and impoverished pragmatic abilities, as previously mentioned. As a result, these children often have trouble finding their words and putting their ideas together in a conversation. Speech-language pathologists are often asked to evaluate and document the coexistence of a developmental language disorder (DLD) in children with ADHD. In fact, DLD can coexist in 35-50% and up to 90% of children with ADHD symptoms.
DLD is defined as a developmental disorder characterized by difficulties with language comprehension and/or expression that cannot be explained by any other apparent cause such as hearing loss, mental retardation, emotional disturbance or other biomedical conditions. DLD affects about 7% of the general population, or two children per classroom. The YouTube video below gives a very good synopsis of how DLD can impact a child’s learning in school.
Students who have difficulty concentrating on classroom activities or doing homework because of attention problems and classroom distractions are likely to be less effective learners than their classmates of the same level without attention difficulties. In addition, children who have ADHD with DLD may have more academic difficulties than those who have ADHD or DLD alone. However, we do know that ADHD does not exacerbate DLD per say. Meaning that the language disorder is not worse off because of ADHD.
So what can be done to help these children? It is important to understand the underlying cause of the difficulties. Language difficulties will be treated very differently than difficulties with attention and focus. It is also important to involve the teachers, resource teachers, speech-language pathologist, psychologist, etc. As a parent, it is very important to advocate for your child and to find out more about their difficulties. Consulting a paediatrician is a very good first step. Having your child assessed by a speech-language pathologist will help determine if your child’s language abilities are up to par. It is crucial however that all languages spoken by the child be taken into consideration. If your child is bilingual, both languages need to be assessed. If you are suspecting ADHD, be sure to mention it to your child’s speech-language pathologist so that your child’s social language skills can be thoroughly assessed. This is often done by using parent and teacher questionnaires and observations in social settings. Social skills, as mentioned above, can be taught. But they first need to be flagged by a trained professional. It is important to understand the repercussions of poor social skills on a child’s social well-being. Communication, either oral or written, is of the utmost importance. Especially between peers and especially during the adolescent years. To learn more about social language skills during the teenage years, we strongly recommend the following book by Sarah Spencer (Editor): Supporting Adolescents with Language Disorders.
We hope that this post helped shed some light on ADHD, DLD and social language difficulties. We are in the process of conducting research on this topic so stay tuned for more details over the next few months. If you have any questions or comments, please feel free to ask me directly or by posting them below.
By Stéphanie Frenette and Chantal Mayer-Crittenden, 2019