ADHD and Communication Disorders

http://www.netacc.net/~gradda/sp99como.html

"Communication disorders describe developmental speech and/or

language disorders. These children have elevated rates of ADHD. It is

also clear that children referred for psychiatric problems and given

a diagnosis of ADHD have undiagnosed speech and language disorders in

a number of cases, as high as 40% and 50% in some samples. The nature

of this relationship is not well understood. It may be that the

speech and language disorders lead to attentional problems in some

particular way or that they are both due to some common underlying

factor, such as some type of central nervous system (CNS)

dysfunction.

The long-term outcome of children with speech and language disorders

is fairly good for the disorders themselves. However, these children

are highly likely to develop learning disorders as a residual outcome

of their speech and language disorders. Thus, the presence of

communication disorders is likely to lead in ADHD children, as it

does in non-ADHD children, to the development of academic performance

problems due to specific learning disabilities in the language-

related areas. This probability must be taken into account in the

design of treatment plans to alter long-term negative outcome."

American Speech Hearing Association

ADHD: Speech and Language

http://www.asha.org/speech/disabilities/Attention-Deficit-HyperactivityDisorder.cfm

"Inattention, hyperactivity, and impulsivity have their effects on

speech and language. Following instructions carefully and completely

is difficult. Answers to questions may be blurted out before the

teacher or others have finished asking a question. Time may not be

taken to use well-formed and grammatical sentences. Stories or

discussions about the day at school may be so disorganized that

listeners cannot follow what is being said. Or, the child assumes

knowledge of the listener that he or she does not have. For example,

I left that place. I talked to her. I ate cereal this morning.

Speakers may be interrupted, or language may not be changed for

different communication partners. For example, the more casual,

informal language used with friends on the playground may be

inappropriately used with teachers or other authority figures in the

school.

Specific speech and language patterns vary from child to child with

ADHD. For example, some children with ADHD also have learning

disabilities that affect their speech and language. Evaluation of

each child's individual speech and language pattern is critical to

developing an appropriate treatment plan.

Speech and Language Assessment

The speech-language pathologist works collaboratively with other

professionals (regular, special education, and resource teachers;

doctors; nurses; psychologists; employers when applicable) and

families to provide a comprehensive and individualized evaluation and

treatment plan.

The speech-language pathologist will observe the student's

interactions with peers and authority figures in the classroom/work

setting and during formal testing. If possible, she will observe

conversation with parents and other family members.

The speech-language pathologist will interview parents regarding the

student's speech and language development. If the student is old

enough, the therapist may interview him or her to evaluate self-

awareness of needs and difficulties.

The speech-language pathologist will complete a formal evaluation of

speech and language skills, such as fluency (whether or not he or she

stutters), speech articulation (pronunciation and clarity of speech),

understanding and use of grammar (syntax), understanding and use of

vocabulary (semantics), awareness of speech sounds (phonemic

awareness). She will evaluate the student's ability to relate an

extended narrative. Can he or she explain something or retell a

story, centering on a topic and chaining a sequence of events

together? Is narrative speech coherent or is it difficult to follow?

Social communication skills (pragmatic language) are evaluated by

observing the student relating to peers and communicating in school

settings (e.g., interacting with the teacher, participating in class

discussions, working in groups with other students). The student may

be asked to roleplay different communication scenarios. He or she may

be asked to discuss stories and the points of view of various

characters. Does he or she understand how the characters are feeling,

and why they are reacting a certain way? Can the student explain how

different characters actions affect what happens in the story?

The speech-language pathologist assesses the student's ability to

plan, organize, and attend to details. She may ask him or her to make

a plan for completing a specified task. She may read an incomplete

story and ask for a logical beginning, middle or conclusion.

Treatment

Speech and language intervention for the student with ADHD is always

individualized, as each person has a different set of symptoms and

needs.

A physician will work with the family and student to prescribe

medication, if needed, to help with attention. If medication is

prescribed, the speech-language pathologist will work collaboratively

with other educational professionals to observe the student's pre-

and post-medication behavior. As part of the educational team, the

speech-language pathologist will communicate with the family and

physician regarding any post-medication behavioral changes. Is the

student drowsy? Is sustained attention better/worse? How long does it

take for the medication to take effect? The physician will use these

observations to adjust dosage, the time medications are administered,

and which medication is used.

The speech-language pathologist, along with other team members, will

work with the teacher to manipulate the classroom environment (e.g.,

sitting the student in the front of the classroom, having the student

repeat directions before following them, using checklists and other

visual organizers to help with planning and follow-through).

Speech-language treatment will focus on individualized language

goals, such as teaching better communication in specific social

situations, and study skills (planning/organizing/attention to

detail). Again, language goals will differ depending on the needs of

the individual student."

ADHD And Communication Skills

http://add.miningco.com/library/weekly/aa052002a.htm

"There are a number of ADD symptoms that can become barriers to

effective communication."

"There are however, a number of things that a person can do to help

to improve their conversation skills."

IMPULSIVITY, INATTENTION AND LANGUAGE

Sam Goldstein, Ph.D.

http://www.samgoldstein.com/articles/0106.html

"Toddlers and preschoolers at risk to receive a diagnosis of ADHD are

often impulsive and inattentive. These children also demonstrate a

higher incidence of problems with language development. In some

studies as many as 50% to 70% of young children with hyperactive and

impulsive behavior were experiencing problems in understanding and

expressing ideas through language. These children also demonstrated a

high rate of learning disability when they entered school. It is

unclear whether their temperament contributes to delayed language or

delayed language contributes to their difficulty temperamentally.

Before they learn to speak and begin to attach verbal labels to

things, infants must touch, feel and taste as a means of gaining

information about the world. Once they learn to use language

effectively, words replace touch. Impulsive toddlers, however, often

have difficulty making this transition. Typically they continue to

need to touch and feel things, possibly as a means of gaining sensory

input from the world. This problem may lead to difficulty

understanding personal space in older children with ADHD.

In long-term studies, Dr. Walter Mischel and colleagues found a most

interesting relationship between a young child's ability to use

language skills while waiting for rewards and later success as a

teenager or young adult. In Dr. Mischel's study, a group of preschool

children were given a snack and asked to wait a period of time before

eating it. Some were able to wait, others ate the snack immediately.

The children were then given a second snack and told if they could

delay eating for a specific period of time they would be rewarded

with additional snacks. Again some children immediately ate the snack

and some did not. Dr. Mischel discovered that those who were able to

wait talked to themselves and convinced themselves that waiting was

worthwhile. In other words, they used language to delay

gratification. In the smaller group of children who could not wait,

verbal strategies were often absent. These children often attempted

to use physical strategies such as covering their eyes as a means of

delaying gratification, often with little success. Dr. Mischel

attempted to teach these children verbal strategies similar to those

used by the children capable of waiting but this group could not

implement these strategies independently.

Both groups of children were followed as they grew up. As teenagers

the group able to delay eating the snack functioned significantly

better in many areas, including academic achievement, college

entrance exams and general behavior than the group who could not

wait. While the snack test is certainly not a clinical measure and

would not be expected to be an accurate predictor of future behavior

for every child, findings from this research are important. Research

in this area helps us understand the relationship between language,

the ability to wait for rewards and future success. Impulsive

children, unfortunately, appear to have greater problems using

language to guide their behavior. As we have come to understand that

the core problem for children with ADHD is an immaturity in the

development of self-control and self-regulation the connection

between language and ADHD has become better understood. Language

appears to be the primary means by which each of us develops,

strengthens and maintains the capacity for self-control. Self-control

enables us to delay gratification or reward. Self-control enables us

to stick with boring, repetitive, effortful or uninteresting

activities, to manage our emotions, to plan, organize, inhibit and

open a window between experience and response. Self-control enables

us to consider our actions, change the course of action if it is

ineffective and monitor our behavior as we progress. The use of

language in this semantic way, as a means of relating and conveying

meaning, appears to be critically tied to the development of self-

control and the capacity to sustain attention and inhibit impulsive

behavior.

Past efforts focused on helping children develop self-control skills

through the use of language based self-talk strategies, however, have

not been found to be particularly effective in modifying the symptoms

and consequences of ADHD. If current theory is correct, why haven't

these strategies been effective? In part, I believe it is because

knowing what to do is not the same as doing what you know. Thus,

simply teaching a child with ADHD a language based strategy to

facilitate self-control does not guarantee the child will be

sufficiently self-cued as to when to use the strategy nor capable of

consistently implementing and bringing the strategy on line at the

right moment. Keep in mind that most children with ADHD appear to

know what to do but don't do what they know. Increasingly we believe

as a profession that this problem results from an inability to track

cues and to use language to facilitate self-control.

I suggest that the reason children with ADHD have not benefitted from

the development of self-control strategies is not failure of the

strategies but failure of the mindset of facilitators. Just as some

children take an inordinately long period of time to develop the

skills to swim or ride a bicycle, children with ADHD are going to

take a long time to learn to use language for efficient self-directed

behavior. If parents and professionals develop a "learning to swim

mindset" accepting that some children take longer and recognizing

that with repeated trials all kinds of skills can develop then they

are more likely to help children with ADHD develop self-control.

Remember that ADHD has a strong biological basis. Therefore, if these

problems are not the result of a faulty reinforcement history, simply

modifying consequences is not likely to lead to long-term significant

change. With the children in our Center, I am increasingly directing

their parents and teachers to utilize a model developed by Myrna

Shure (author of the texts Raising a Thinking Child and I can Problem

Solve) as a means of creating daily dialogue to facilitate self-

control development in children with ADHD. Time will tell as to the

effectiveness of this intervention. However, the development of self-

control appears to be an essential component for the future life

success of children with ADHD."

"More articles by Dr. Sam Goldstein."

http://www.samgoldstein.com/articles.html

Informative Resourceful Books

by Drs. Robert Brooks and Sam Goldstein

http://www.samgoldstein.com/products.html

Thanks to Cindy of Childrens apraxia net..

Jyoti kennedy