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Language Disorders and Attention Deficit Hyperactivity Disorder

Philippa Greathead
Speech Language Pathologist
Speech-Language-Learning Centre
Westmead, NSW, Australia


The child or adolescent with ADHD and learning problems will often present to the Speech Language Pathologist with a range of clinical problems in language that are contributing to the learning disorder.

The types of language problems experienced by children with ADHD are varied and can cover all the modalities of language. Typically problems are seen in:

Syntax:
Disorders of syntax (oral and written grammar) are difficulties using and/or comprehending the structural components of sentences.

Semantics:
Semantic difficulties in language involve problems with word meanings and organization. School problems include difficulties comprehending written and spoken language, poor vocabulary, word-finding difficulties and difficulties using context to help with the comprehension of reading.

Pragmatics:
Pragmatics is the term used for the social use of language - i.e. the ability to use 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 age levels).

Metalinguistics:
This is the ability to reflect on language objectively - to know and understand that language is a rule-bound code - e.g. humour, multimeaning in words, ambiguity, figurative language (metaphors etc), ability to segment words into syllables or phonemes (sounds).


Related areas of difficulty

Auditory processing:
Children with language problems often have related auditory processing difficulties - particularly in the ADHD population. Problems can be found in the areas of speed of processing, auditory memory, auditory attention, processing of auditory information, auditory analysis and auditory discrimination. Following directions or getting information from reading and listening can be a nightmare for such children.

Metacognition: This is the ability to think about thinking in general. To know what you know and to understand what you need to know in order to learn effectively. Students with difficulties in this area cannot easily deal with the strategies involved in problem solving.


What makes the ADHD child with a language problem different to other children with language problems?
The child with ADHD is 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 the school system. 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 auditory processing 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 expecting them to listen - 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 organizational skills resulting in:
  • Problems with classroom discourse
  • Poor writing skills
  • Tangential narratives and conversations
  • Word-finding problems - 'thing, thingy, it, you know' plus gesture
  • Difficulties inferring meaning - 'looking beyond the obvious'
  • Problems with generative language
  • Social language problems

Learning styles and ADHD
The student with ADHD is likely to have difficulties with the learning style supported by the school system - that of being a good listener, being able to sit and focus for extended periods of time and of having good reading and oral language skills.

The use of learning styles as a therapeutics and diagnostic tool gives an added dimension to the role of the Speech Language Pathologist working with school-aged children and adolescents.

Considering learning styles broadens the approaches taken in intervention and helps in the development of strategies for the general management of language-related problems.

Children with language difficulties are often unaware of their own thinking and learning processes - they have poorly developed metacognition. They either do not know that there are certain strategies that can be used to help their learning or they use the wrong strategies for their particular learning style.

Analyzing the child's learning style can give invaluable information to help you understand how best to support the child's learning. One method of describing that learning style is the Visual - Auditory - Kinaesthetic - Print-Orientated - Interactive (VAK POINT) model developed by Glenn Capelli.

Some common characteristics of these learning styles are:

Visual learners
  • Learn best by looking, watching and observing
  • Want to see how things are done
  • Enjoy poster, visual overhead, colours
  • Learn well from videos
  • Doodle and draw
  • Work well with information mapping systems (e.g. Mind Maps)
  • Picture well (visualize) inside their heads
Auditory learners
  • Learn well by listening and communicating with others
  • Learn through rhythm and rhyme
  • Learn from audiotapes
  • Have good auditory discrimination for sounds and auditory attack skills for reading
  • Learn languages easily
Kinaesthetic learners
  • Use their hands and whole bodies to learn
  • Create things, make things, pull things apart and rebuild them
  • Use their feelings
Print-orientated learners
  • Read to learn and for pleasure
  • Have good reading comprehension
  • Write well and write for pleasure
Interactive learners
  • Learn well by interacting with others
  • Learn from discussion and dialogue
  • Group work and co-operative learning
  • Have an ability to lead, follow and be flexible socially
Children learn by their individual learning styles. Teachers tend to teach in a way that complements their own learning style. This is one reason children may learn well with one teacher and not another.

Children with school-based learning difficulties are often deficient in one or more of these learning modalities and need to focus their learning on the area that is their greatest strength - as well as building up the weaker areas.

Typically, the child with ADHD and language problems struggles with the auditory and print-orientated styles of learning. Interestingly, some who struggle with visual learning also have language-based problems - usually related to organization, planning and overall 'whole picture' understanding of language-based skills.

Strategies to help children with language processing problems

The 'pulse style' approach to learning
One strategy that is useful in dealing with the ADHD child with language processing problems is recommending a 'pulse style' approach to learning. This can be applied to any learning task and is a great way to get optimal learning happening. See Diffused learning patterns.

Classroom and parent management strategies
See Strategies for students with auditory processing difficulties.

Teaching to learn styles
If the ADHD student with a language disorder has problems with a particular style of learning e.g. auditory learning, try to work with their most successful learning style, say kinaesthetic, in order to support the weaker style.

For example, a student with weak auditory learning skills and strong kinaesthetic skills benefits from being physically involved in the learning process. If the class if doing a 'listening type task' it would be helpful if the ADHD child was demonstrating something or holding something rather than just 'listening'. It is also very difficult for the poor listener to cope with comments like 'I am only going to say this once!' - the added anxiety this causes makes the learning even harder.

Summary
Not all students with ADHD 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 these have to be dealt with at home, school, socially and in a learning environment.


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Click to view information on:

Diffused learning patterns
Strategies for students with auditory processing difficulties
Strategies for children who have confused story-telling skills
Visual learning strategies



Diffused learning patterns

Have you ever wondered why you might start to fall asleep when listening to someone lecturing or why your child gets restless after a few minutes of concentrated work?

It seems our brains need 'time out' from concentrated learning (diffusion) so that they can keep focused on the task in hand - see the diagram below…

Optimal learning pattern for 10-year-old students


This means doing things like:

...Read for 10 minutes, move around for 2 minutes, then write for 10 minutes...

Younger children can concentrate for shorter periods before spacing out or becoming agitated. Add 2 minutes to your child's age, up to a maximum of 20 minutes, and that's the limit for optimal concentration. For example, a 5-year-old can work for about 7 minutes before becoming 'brain tired' and starting to lose concentration.

An ADHD student will need even less time between breaks - experiment with your child! Breaks can be simple e.g. run to the toilet and back, stretch and bend several times, throw and catch a soft ball, use an indoor basketball hoop, swap to asking questions instead of reading.

Homework, study and project activities can be completed with fewer tears, raised voices and family upsets when breaks are regular and often. Your children will also feel more confident in their ability to work well!


Strategies for students with auditory processing difficulties

Students with auditory processing difficulties may have problems in some or all of the following areas:
  • Short-term auditory memory
  • Following instructions - from simple to complex
  • Speed of processing instructions
  • Listening in distracting environments - e.g. the classroom
  • Listening for information when someone is talking, reading or lecturing - they miss out on details or get details but are unable to grasp the 'main idea'
Some strategies to help students include:
  • Always pairing 'listening with looking' - i.e. give written or graphic explanations to a learning task as well as the spoken instruction
  • Keep instructions short and specific
  • Place the student in a prominent position in the class, where their teacher is most likely to be aware of any confusion or lack of comprehension
  • When giving instructions to the student, ask him/her to repeat the instruction back to you
  • Instructions may need to be repeated before the student fully understands what they have to do. You may need to simplify or slow down your original instruction to help the student process more efficiently
  • Allow extra 'thinking' time for the student who processes information slowly, before giving further instructions
  • When teaching new concepts, the student will benefit from repetition, use of concrete examples, accompanying hands-on and visual materials
  • Emphasize key words in what you say by stress and variation in your voice


Strategies for children who have confused story-telling skills

Children with poor story-telling skills may have problems in some or all of the following areas:
  • Keeping on the topic
  • Describing something clearly and precisely
  • Starting at the beginning of a story, then giving the middle and finishing off with the end!
  • They may focus on small details - but not give the 'whole picture' of the story
  • If the story is about a problem, they may not really know what the problem is
  • They may have difficulty remembering words - and use lots of 'fillers' like 'thing, thingy, it, um, er, you know'
Some strategies to use when talking to these children include:
  • When your child is trying to tell you a story, relieve his/her stress by sitting with your child and maintaining eye contact and interest. Be an active and interested listener!
  • Cue your child in to the sequence of the story e.g. 'That sounds great! Now, tell me again, what happened first? Then what happened? What happened at the end?'
  • If your child goes off at a tangent, keep bringing her/him back to the topic e.g. 'Hang on, what happened after you did...?'
  • Ask your child specific questions e.g. 'Tell me what happened when you first got to school?' rather than 'What happened at school today?'
  • Lead your child's story e.g. 'And after Mrs Smith said hello to the new boy, she said...?'
  • Use the first sound to help your child find the correct word if he/she is struggling e.g. 'a ss...' for a word starting with 's'
  • Correct your child by giving a choice of 2 words e.g. 'Did you mean he threw the ball, or he caught the ball?'
  • Give your child the opportunity to retell their story to a new listener (e.g. Dad, then Grandma). This allows them to practice and improve their story-telling skills with familiar material.


Visual Learning Strategies

Visual learning strategies are great for students with oral and reading comprehension difficulties. These include:

Memory mapping (Mind Maps, Learning Maps etc)



Visualization techniques
These can include the Visualizing and Verbalizing Programme, simple visualization exercises that you may devise, and using strong visual representation in your teaching.

Remember - these students may be slower to process information than others - so keep the visual information around until they have finished with it.

Instructions for class work, assignments etc need to be clearly written down. These students often find it difficult to translate verbal instructions accurately - and may end up doing the wrong work.

Use Post-it pads for multiple purposes - great for quick memory jogs!

Comprehension passages
  • Read the questions first - use a highlighter pen to mark the key points in the questions
  • Read the passage - highlight the key points
  • Do the questions - tick off the parts in the passage that you have covered as you go - it is unlikely that you will be asked to refer to that piece of text again the comprehension exercise
Getting information from reading
As well as memory mapping, try the following:
  • Use highlighter pens in your textbooks
  • Make simple graphic notations are you read e.g. a light bulb, stars, a picture of key for a key sections, exclamation marks etc
  • Create a story from text - story-linked information is generally easier to follow than straight text



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