ADHD, Speech Pathology

What does a Speech Pathologist have to do with ADHD?

Did you know that a speech pathologist (or speech-language pathologist) can have a vital role in the ADHD team?

I have been a speech pathologist for almost 20 years and have extensive experience working with children with and without ADHD. In my experience, people don’t know what a speech pathologist does. They usually equate a paediatric speech pathologist with someone who helps children who stutter, or who have “speech problems.” While this is true, we actually work with a whole range of communication and swallowing disorders.

Speech pathologists see children with swallowing issues, speech sound disorders, developmental language disorders, stuttering, voice disorders, social communication disorders and literacy disorders. Just to name a few.

So, what has any of this got to do with ADHD, I hear you ask? Let me tell you!

Communication impairments are prevalent in children diagnosed with ADHD. In fact, it is estimated that 45% of children with ADHD have a communication impairment, compared to approximately 3-5% of the general population.

 Children with ADHD are more likely to have the following communication difficulties:

  • Social communication skills

These are also known as pragmatic skills. Pragmatics is the use of language in a social situation. It covers:  

  • Using our language for different purposes, like greeting someone “Hello. How are you?” to requesting information, “What’s your address?.” This also includes being able to have a structured language framework for being able to retell stories or communicate narratives (e.g. beginning, middle, end).
    • Adapting language depending on our communication partner, like talking to a friend as opposed to a teacher.
    • The rules of conversation such as taking turns when talking, not interrupting, or talking over the top of people, staying on the same topic, using non-verbal communication, like eye contact and respecting personal space.

Research suggest that children and adolescents with ADHD have weaker pragmatic skills than their neurotypical peers. Specifically, deficits in the following areas have been found in 52-82% of children with ADHD: skills in taking turns in conversations, introducing or expanding topics for discussion, repairing conversations when they break down, storytelling and non-verbal skills.

  • Developmental Language Disorder (DLD)

DLD is a disorder characterized by language difficulties that can’t be explained by another diagnosis and are persistent despite adequate language-learning opportunities. It can affect oral and written language, comprehension (e.g. listening, following instructions, reading comprehension) and expression (e.g. vocabulary development, sentence formulation, retelling stories, spelling and reading, written sentences or stories).

A child with ADHD is three times more likely to have DLD than their neurotypical peer. Research indicates that children with a diagnosis of ADHD – Inattentive presentation (ADHD-I) are most likely to have DLD, followed by ADHD – Combined presentation (ADHD-C). It is not often associated with ADHD – Hyperactive/Impulsive presentation (Hyperactive impulsive).

If you are concerned that your child may have difficulties in their development of language you can visit the Hanen Centre website, the Raising Children website, the Raising Awareness of Developmental Language Disorder website or Speech Pathology Australia for information on communication milestones.

  • Dysfluency / Stuttering

Research tells us that children with ADHD have more dysfluencies than children without ADHD. These dysfluencies are typically stuttering-like dysfluencies (e.g. repeating a word at the beginning of a sentence). These dysfluencies are more likely to be present when a child with ADHD is telling a story or describing a picture. Research has also noted that the more focused attention that is needed for a task, the more dysfluency a child with ADHD will present with.

Research is variable on the prevalence of stuttering in the ADHD population, however, it suggests that 4-26% of children with ADHD stutter, compared with 5% in the general population.

To find out more information in regards to stuttering, you can look at this fact sheet from Speech Pathology Australia or head over the Australian Stuttering Research Centre for more information.

  • Specific Learning Disorders

Research indicates that 23-28% of children with ADHD have numeracy, reading/spelling and writing scores below benchmark in Year 3 compared with 11% of children without ADHD.  ADHD is the most common disorder that co-occurs with reading disorders. Children with literacy difficulties are more likely to have a diagnosis of ADHD.

Check out the five from five websites,  SPELDNSW website or this fact sheet from Speech Pathology Australia for more information.

  • Voice disorders

Children with ADHD are more likely to develop vocal nodules than children without ADHD. Vocal nodules are callous-like growths that develop on the vocal folds from repetitive abuse or misuse of the voice. Vocal abuse or misuse behaviours are yelling, talking excessively, excessive crying, cheering, and making sound effects. It can lead to a hoarse sounding voice and even dysphonia (losing the voice). One study found that 78% of children studied with a diagnosis of ADHD had vocal nodules.

The American Speech-Language-Hearing Association (ASHA) have a good webpage that outlines more about vocal nodules if you have any concerns.

The impact of communication disorders and ADHD

Children and adolescents with social communication disorders, developmental language disorder, speech sound disorders and learning disorders are at risk of poor academic progress, bullying and behavioural issues at school. Children with ADHD, particularly boys, have fewer friendships and are more often disliked by peers, than their neurotypical counterparts1. This peer rejection has been associated with substance abuse, early school dropout, academic difficulties, and higher rates of mental health issues.2

Teenagers with developmental language disorder are overrepresented in the youth justice system3. In Australia, 46-52% of young offenders have a language impairment. Add into that further research that indicates that approximately 21-45% of the prison population around the world meets the diagnostic criteria for ADHD.

Recent research, however, suggests that appropriate early speech-language pathology services for children identified as having DLD may reduce their contact with police in adolescence and early adulthood.

So how can a speech pathologist help?

A speech pathologist is a university-trained professional who studies, diagnoses and treats communication and swallowing disorders across the lifespan.

In the context of a child or adolescent with ADHD and communication impairment, a speech pathologist can:

  1. Work together with the family to assess and diagnose a communication difficulty
  2. Collaboratively develop an evidence-based management plan
  3. Provide therapy to facilitate communication skills and/or scaffold the environment to allow the child to use the skills they have.
  4. Train parents and teachers in a range of strategies to support the child at home and in the classroom setting, and other people involved in the care of the child or adolescent.

I do highly recommend that when you are looking for a speech pathologist, you find one who understands ADHD. ADHD often makes communication management and therapy more complex. It would be best if you had a speech pathologist that understands the specific challenges your child and family face. They can then provide management and support using evidence-based assessment and management.

Of course, not all children with ADHD have communication difficulties. Still, research shows that children with ADHD are more likely to have communication difficulties that can have a significant impact on their long term educational and workplace outcomes. If in doubt, you can contact a speech pathologist and discuss whether you feel as though your child would benefit from an assessment.

In Australia, you can find a certified practising speech pathologist at Speech Pathology Australia’s website.

If you have any questions, please comment below!

Let’s get ADHD Done Differently.

  1.  Erhardt D, Hinshaw SP. Initial sociometric impressions of attention-deficit hyperactivity disorder and comparison boys: predictions from social behaviors and from nonbehavioral variables. J Consult Clin Psychol. 1994;62(4):833-842.
  2. Greene RW, Biederman J, Faraone SV, Sienna M, Garcia-Jetton J. Adolescent outcome of boys with attention-deficit/hyperactivity disorder and social disability: results from a 4-year longitudinal follow-up study. J.Consult Clin.Psychol. 1997;65:758–767
  3. Snow, P. C., & Powell, M. B. (2004). Developmental language disorders and adolescent risk: a public-health advocacy role for speech pathologists? Advances in Speech Language Pathology6(4), 221 – 229.

Photos by Torsten Dederichs, Rohit Farmer & Ben White on Unsplash

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