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Attention-deficit/hyperactivity disorder

Attention-deficit/hyperactivity disorder or ADHD is a common childhood condition that is primarily characterised by the co-existence of attention problems and/or hyperactivity symptoms. The disorder impairs social and academic functioning and is often noticed in children who are failing to learn at school.

 

ADHD has three main presentations:

To fulfill a diagnosis of ADHD, each symptom must persist for six months or more.

 

1. Predominantly hyperactive & impulsive – a child diagnosed with this may present with some or all of the following:

  • Fidgets with hands or feet and squirms in their seat

  • Leaves their seat when remaining seated is expected

  • Talks nonstop

  • Blurts out inappropriate answers and comments before the question is completed

  • Moves around constantly, touching or playing with anything and everything in sight

  • Has difficulty playing and engaging in quiet tasks or activities

  • Often ‘on the go’

  • Shows their emotions without restraint (impulsive)

  • Acts without regard for consequences

  • Has difficulty waiting for things they want or waiting their turn in games

  • Interrupts others

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2. Predominantly inattentive – a child diagnosed with this may present with some or all of the following:

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  • Daydreams, becomes easily confused and moves slowly

  • Has difficulty processing information quickly and accurately 

  • Often does not pay close attention to details or makes careless mistakes

  • Often does not seem to listen when spoken to directly

  • Often does not follow instructions

  • Frequently switches from one activity to another

  • Often loses things (e.g., pencils, toys, assignments) needed to complete tasks or activities

  • Is easily distracted

  • Becomes bored with a task after only a few minutes, unless doing something enjoyable

3. Combined hyperactive / impulsive and inattentive – a child diagnosed with this presentation has six or more symptoms of both inattention and hyperactivity/impulsivity. Most children with ADHD have the combined type.

 

Myths about ADHD

Myth #1: All kids with ADHD are hyperactive.

Some children with ADHD are hyperactive, but many others with attention problems are not. Children with ADHD who are inattentive, but not overly active, may appear to be daydreamers and unmotivated.

 

Myth #2: Kids with ADHD can never pay attention.

Children with ADHD are often able to concentrate on activities they enjoy. But no matter how hard they try, they have trouble maintaining focus when the task at hand is boring or repetitive.

 

Myth #3: Kids with ADHD choose to be difficult and could behave better if they wanted to.

Children with ADHD may do their best to be good, but still be unable to sit still, stay quiet, or pay attention. They may appear disobedient, but that doesn’t mean they’re acting this way on purpose.

 

Myth #4: Kids will eventually grow out of ADHD.

ADHD often continues into adulthood, so don’t wait for your child to outgrow the problem. Treatment can help your child learn to manage and minimise the symptoms.

The Speech Pathologist’s role in assessing and treating the symptoms of ADHD

A child or adolescent with ADHD and learning problems will often present to the Speech Pathologist with a range of language problems that are contributing to their learning disorder .The types of language problems experienced by children and adolescents with ADHD are varied and can cover all the modalities of language including:

  • Syntax: a difficulty using and/or comprehending the structural components of sentences (oral and written grammar)

  • Semantics: a difficulty with word meanings and organisation, comprehending written and spoken language, vocabulary, word-finding, and using context to help with reading comprehension

  • Pragmatics: a difficulty using language as a means to interact with others socially or for a specific purpose (e.g. requesting information, expressing feelings, holding a conversation with people of different ages)

  • Metalinguistics: a difficulty reflecting on language objectively - to know and understand that language is a rule-bound code - e.g. humour, multiple meaning of words, ambiguity, figurative language (metaphors etc)

 

Children and adolescents with ADHD are more likely to have language processing difficulties than a simple language delay.There may be no early developmental history of speech and language problems - the language problems may only become apparent as the child progresses through school. This is particularly relevant in the clever, even gifted, student with subtle language problems and ADHD

 

In particular, the ADHD child with language problems can have difficulties such as:

  • Short-term auditory memory weakness

  • Problems following instructions

  • Slow speed of processing written and spoken language

  • Difficulties listening in distracting environments (e.g. the classroom)

  • Problems in listening for information when someone is talking or reading to them - they may miss out on details, or get the details but be unable to grasp the 'main idea'

  • Getting information from reading - reading comprehension

 

They can also have language difficulties related to their impulsivity and poor organisational skills resulting in:

  • Problems with classroom discourse and discussions

  • Poor writing skills

  • Tangential narratives and conversations

  • Word-finding problems

  • Difficulties inferring meaning - 'looking beyond the obvious'

  • Problems with generative language

  • Social language problems

 

Not all students with ADHD however have language problems - and the types of language problems seen in ADHD can also be seen in children without ADHD. However, problems with information processing, frequently include language-related difficulties and it is therefore particularly important that these difficulties are identified and addressed

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