Why do I have to repeat myself, I told you ten times already.
Out with it already! You better have a better explanation than that.
How was school today? And don’t say ‘nothing much,’ something must have happened.
Managing ADHD is never about addressing attention or impulsivity alone. ADHD represents a deficit in executive function, a skill set that includes attention, impulse control… and far more. Seen as a disorder of self-regulation, ADHD potentially impacts anything that requires planning and coordination, from sleep and eating habits to laying out a long-term science project all the way to how someone speaks and listens in conversation.
Executive function acts as our ‘brain manager’ in coordinating our thoughts, actions and ability to plan. It is responsible for sorting through all the complex information we encounter, from paying attention to the right voice in a classroom to organizing responses in the midst of a rapidly-paced discussion. Comprehensive ADHD care requires a broad view of the often subtle effects it has on life, addressing its impact wherever it shows. One of the more commonly overlooked aspects of ADHD is its direct effect on communication.
Talk the Talk
The Diagnostic and Statistical Manual of Mental Disorders (DSM) 5Âis the standard diagnostic manual for clinicians in the fields of child development and mental health. Recently updated (although not yet released), the new version divides communication into three components: speech, language and pragmatics. These skills are defined as follows:
- Speech comprises everything that goes into producing sounds. Common speech concerns include articulation disorders (unexpected inability to produce specific sounds), stuttering and stammering.
- Language is the meaning of words and how we put them together. It includes vocabulary, grammar and narrative discourse along with corresponding receptive language abilities. Under the present system, common diagnoses in this area are expressive language delays (such as using fewer words or sentences than expected) and receptive language delays (understanding less than expected for age).
- Pragmatic language represents all the nonverbal nuances that facilitate everyday conversation, and broadly includes anything regarding the social side of communication. It includes all the unspoken aspects of communication, like reading faces and monitoring tone of voice, as well as adapting ourselves to different situations (such as speaking to a teacher versus a peer). Skills such as understanding gestures, non-literal meetings (such as metaphor, irony and sarcasm), and detecting the emotional meaning behind a change in facial expression depend on an intuitive grasp of pragmatics.
Speech and ADHD
Studies show that children with ADHD are at risk forÂarticulation disorders, which affect their ability to produce letter sounds appropriate for their age. Beyond that, they also commonly have differences in fluency and vocal quality when speaking. One study evenÂdetected ADHD through these speech differences. Compared to peers with learning disabilities alone, children with ADHD showed increased volume and variability in pitch when talking, along with particular patterns such as increased number of vocal pauses.
Children with ADHD produce more vocal repetitions or word fillers as they try to organize their thoughts, somewhat similar to a stammer. This can lead to impatience and misunderstandings from others, especially children, as they generally don’t have the same patience and perspective as adults. A response in the classroom may be along the lines of, “It’s a story abou … um… a story… um… um… it’s about … akidwhofliesakite… um.”
Communication and ADHD
Children with ADHD process language differently as well. For starters, they are at increased risk for significant language delays. Even without specific delays, because of distractibility and related ADHD symptoms, they are more likely to get off-topic when speaking. They also frequently struggle to find the right words and put thoughts together quickly and linearly in conversation. Errors in grammar as they compose sentences also may occur, because of planning difficulties present even when underlying skills in this area are intact. All these ADHD- related symptoms, with or without actual language delays, may impact the ability to communicate effectively.
In ADHD, listening comprehension can be impaired directly, in particular because of difficulty handling rapidly-spoken language or managing distracting, noisy environments like a party or a busy classroom. Again, this is true even when a child doesn’t have an actual language delay; they have the capacity to understand, but because of ADHD, miss details in both conversation and stories. When listening, they may lose track of conversational threads entirely or miss details, and therefore fail to register vital bits of information. These same gaps frequently come across as oppositional behavior when a request appears intentionally ignored instead of not being heard in the first place. These patterns also relate to the reading comprehension difficulties often found with ADHD.
Paying attention to the thread of conversation can become even more problematic for a child with ADHD in groups or when in a noisy situation.The ability to retain focus on a single speaker and to transition between speakers is challenging. This has social implications, leading some children with ADHD to find it easier to get along one-on-one rather than in a group. Distracting classrooms, when multiple activities occur simultaneously, may make it particularly difficult for a child with ADHD to engage.
ADHD also often makes it hard for a child to manage large clumps of conversation all at once. While another 8-year-old may be able to handle hearing as many as twelve words at a clip with good understanding, with ADHD, seven or eight might be the maximum. Anything larger, and information begins to be dropped.
These types of problems in understanding spoken language are often incorrectly labeled as an ‘auditory processing disorder.’ There is nothing wrong with the actual auditory pathway; the information gets in, but executive function impairments mismanage it. The brain manager is asleep on the job again, jumbling the details about what’s being said.
Pragmatics and ADHD
Pragmatic language, as noted above, encompasses all the social mores related to spoken language and nonverbal communication. Core ADHD symptoms undermine this aspect of communication all on their own. Blurting out answers, interrupting, talking excessively and speaking too loudly all break common communication standards, for example. People with ADHD also often make tangential comments in conversation, or struggle to organize their thoughts on the fly. Even for those with advanced vocabularies and understanding for age, these pragmatic difficulties may get in the way of social success.
These pragmatic difficulties are similar to, but not the same, as found in a child with autism. In autism, the underlying issue is that children do not intuitively grasp the social world — which includes pragmatic language delays.Unlike those with ADHD, however, children with autism have an intrinsic developmental delay in a far wider array of social and communication skills.
With ADHD, the ability to understand nonverbal language and social interactions as a whole is most likely intact. They recognize nonverbal communication for what it is, and understand basic rules of communication such as ‘wait your turn to reply.’ Due to distractibility, impulsiveness or other executive function impairments they may fail to follow those same rules at any particular moment, or even notice social cues at all; many will meet criteria for a new DSM-5 category of ‘social (pragmatics) communication disorder.’ So while autism causes a more pervasive impairment in social judgment, because of lapses in pragmatic skills ADHD can undermine social abilities in children all on its own.
Actions Speak Louder Than Words
What can we do to help with ADHD and communication? Look for potential language delays. Intervene when needed. And as adults, adapt our own communication style as much as possible.
• Evaluate for specific delaysÂthrough direct testing, and then initiate appropriate interventions when indicated.
• Wait until you gain your child’s full attentionÂbefore making a request or starting a conversation; otherwise, details will likely be missed. Help transition their attention by using a brief marker, such as “Joseph, I have a question for you.” If it is helpful, engage them physically through gently touching their shoulder or a similar approach, and then try to maintain eye contact as well. The same technique (perhaps without the physical touch) equally supports adults with ADHD.
• Address pragmatic concernsÂfor kids struggling socially as behavioral intervention alone may not be enough, through working with a therapist familiar with this aspect of communication.Â
• Offer ‘extended time’ in conversation, allowing children who may be struggling to pull their thoughts together. Give them ample time to settle themselves and organize their responses.Â
• Pause often and parse language into shorter segmentsÂwhen speaking to someone with ADHD. Annunciate clearly, and use gesture language such as counting bullet points on your fingers. Without judgment or condemnation, rephrase or repeat yourself when needed. Consider having children restate what they’ve understood from what you’ve said.
*Many thanks to Dr. Rosemary Tannock, as this posting quotes extensively from her presentation on the same topic at the recent CHADD conference in San Francisco.
ÂMark Bertin, M.D.
(c) 2014 Mark Bertin, M.D.
FAQs
How does ADHD affect your communication? ›
People with ADHD often exhibit such behaviors as blurting out answers, interrupting, oversharing, and speaking at too high a volume. These things break away from the social norms of interaction and conversation. This can cause difficulties when relating to and interacting with others.
How does ADHD affect language and communication? ›In many cases, ADHD can affect speech and communication. People with ADHD have a higher risk of articulation disorders, problems with the fluency of speech, and the overall quality and tone of their speaking voice.
Why do ADHD people struggle to communicate? ›This is because people with ADHD often have issues with executive function. That's kind of like your brain's manager. It's responsible for sorting through the information in everyday life, like organizing your thoughts in the middle of a fast-paced conversation.
What are good coping mechanisms for ADHD? ›Exercise and spend time outdoors
Working out is perhaps the most positive and efficient way to reduce hyperactivity and inattention from ADHD. Exercise can relieve stress, boost your mood, and calm your mind, helping work off the excess energy and aggression that can get in the way of relationships and feeling stable.
Adults with ADHD often experience even greater communication challenges because ADHD impulsivity may lead to interruptions, even when emotions are not high; and ADHD distractibility may lead your thoughts to wander just as your partner is telling you something very important to him or her.
Do people with ADHD struggle with social cues? ›The Cyclical Nature of Social Challenges
When children with ADHD enter a social setting, they may have a hard time sharing, taking turns, listening, and picking up on social cues. They often become bored, distracted, or check-out of the conversation.
Understanding The Link Between ADHD and Communication
Research from The University of Waterloo in Canada implies that people with ADHD have problems communicating and interacting. Specifically, their ability to consider the perspective of others is reduced compared to people who do not have ADHD.
- Give clear, specific directions.
- Try to break tasks into one or two steps so they do not feel overwhelming.
- Give the child choices.
- Ask questions instead of making statements. This forces a child to stop and think about the alternatives.
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.
Do ADHD people Gaslight? ›One of the best defenses against gaslighting is to educate yourself about this kind of emotional abuse. Adults with ADHD may be more vulnerable to gaslighting due to issues with self-esteem, difficulty with past relationships, and feelings of guilt and shame.
Do people with ADHD struggle with small talk? ›
Small talk can be the Achilles heel for people with ADHD, however. Some find small talk boring, while others find it mystifying or even terrifying. People with ADHD may struggle with recognizing how to start a conversation. Or they may dive right into sharing personal information after a quick chat about the weather.
Does ADHD make less talk? ›People with ADHD tend to talk — a lot. We talk because we're excited or nervous, or because we just want to be a part of the conversation. Sometimes we talk simply to fill the silence because silence is hard for us.
What is masking ADHD? ›If you hide your adult ADHD symptoms from other people, that's called masking. Basically, you're trying to seem more “normal” or “regular.” ADHD causes some people to act hyperactive or impulsive. It makes other folks have trouble paying attention. And still other adults have a combination of those symptoms.
What type of behavior therapy is the most effective for ADHD? ›Cognitive-behavioral therapy is generally considered the gold standard for ADHD psychotherapy. While “regular” CBT can be helpful for ADHD, there are also specific types of CBT for ADHD.
Is ADHD caused by trauma? ›Trauma and traumatic stress, according to a growing body of research, are closely associated with attention deficit hyperactivity disorder (ADHD or ADD). Trauma and adversity can alter the brain's architecture, especially in children, which may partly explain their link to the development of ADHD.
What is the best way to communicate with someone with ADHD? ›- Use I-statements to center the conversation on how specific behaviors affect you. ...
- Listen to their side of things. ...
- Mention concerns in a timely manner, so problems don't fester or create anger and resentment. ...
- If either of you starts feeling stressed or overwhelmed, take a break and try again later.
- Understand and set your boundaries knowing that you will likely need to do some “work” to enforce them. ...
- Start small. ...
- Choose realistic boundaries. ...
- Pick your battles.
Adults with ADHD may find it difficult to focus and prioritize, leading to missed deadlines and forgotten meetings or social plans. The inability to control impulses can range from impatience waiting in line or driving in traffic to mood swings and outbursts of anger.
Why do people with ADHD have lower self esteem? ›ADHD, especially if not managed well, can lead to constant frustration and self-criticism. The cumulative impact of these frustrations, criticisms, real and perceived failures, self-blaming, and guilt turn self-esteem into rubble.
What are life skills for people with ADHD? ›These skills include learning how to manage your time, how to prioritize and remember your tasks each day, as well as healthy daily habits such as getting adequate sleep, regular exercise and good daily nutrition.
How does ADHD affect emotional development? ›
People who have ADHD frequently experience emotions so deeply that they become overwhelmed or “flooded.” They may feel joy, anger, pain, or confusion in a given situation—and the intensity may precede impulsive behaviors they regret later.
What is the best way to communicate with a child with ADHD? ›- Recognize when your child is actually hearing you and paying attention. Most people require eye contact to know that they're being heard. ...
- Give them short and simple directions. Children are easily overwhelmed. ...
- Create communication strategies. ...
- Give them choices.
- Focus on short-term goals. When teaching children with ADHD, keep in mind that long-term goals are often overwhelming. ...
- Rewards work. ...
- Play music. ...
- Teach students about the brain. ...
- Allow them time to calm down. ...
- Include mindfulness activities.
- Provide immediate, frequent feedback about inappropriate behavior and social miscues. ...
- Focus on a few areas that your child is struggling with, such as listening or showing interest in another child. ...
- Schedule play dates with only one or two friends.
Both ADHD and ASD are neurodevelopmental disorders (brain development has been affected in some way). That means both conditions/disorders affect the central nervous system, which is responsible for movement, language, memory, and social and focusing skills.
Is ADHD a Behavioural or emotional disorder? ›It is the most commonly diagnosed behavioral disorder in children. ADHD is diagnosed much more often in boys than in girls. It is not clear what causes ADHD. A combination of genes and environmental factors likely plays a role in the development of the condition.
What causes communication difficulties? ›The cause of a communication disorder is not always known. However, common causes include abnormal structures (oral, pharyngeal, or laryngeal), oral-motor dysfunction, neurological problems or brain injury, learning problems, and hearing loss.
Do people with ADHD tend to be manipulative? ›Yes, those with ADHD, like anyone else, can indeed be untruthful, manipulative, and intentionally misleading. But for those who struggle with ADHD, their various processing issues can often be at the heart of their misleading communication problems.
Are people with ADHD abusive? ›Folks with ADHD may tend to be impulsive or angry, but they're not always violent. ADHD doesn't directly lead to violence or aggression among those who live with this condition, but some people diagnosed with ADHD may be more violent due to symptoms like emotional dysregulation and impulsivity.
Do ADHD adults have empathy? ›In fact, Khan emphasizes that many people with ADHD are highly empathetic.
How does ADHD cause social anxiety? ›
Many teens and young adults with ADHD are susceptible to social anxiety due to executive functioning challenges with emotional control, working memory, and self-awareness (metacognition).
Do people with ADHD have speech delay? ›A delay in speech or language is one of the earliest signs we have for kids that do go on to get a diagnosis of ADHD later in childhood. In this 2012 study, researchers found that two-thirds of the elementary-aged kids with ADHD had a speech or language delay at 18 months.
Why do I find it hard to hold a conversation? ›Social anxiety and social awkwardness can prevent a good conversation. The negative mindset you have can stem from a lot of things, including social anxiety or social awkwardness.
Does ADHD cause oversharing? ›It's common for people with ADHD to overshare information. People may be impulsive and not stop to think about what they're saying. Treating ADHD can help people improve self-control and think about consequences.
Does ADHD medication help with speech? ›Although stimulant medication improves attention and concentration, it does not improve all aspects of language abilities in children with ADHD.
What is ADHD paralysis? ›ADHD paralysis happens when a person with ADHD is overwhelmed by their environment or the amount of information given. As a result, they freeze and aren't able to think or function effectively. This makes it challenging for the individual to focus and complete their tasks—including urgent ones.
What is ADHD symptom spotlight? ›ADHD Symptom Spotlight is a series that dives deep into a hallmark or overlooked symptom of ADHD each week. This series is written by experts who also share their tips on managing these symptoms based on firsthand experience and research-backed insights.
Is ADHD A Neurodivergent? ›Some of the conditions that are most common among those who describe themselves as neurodivergent include: Autism spectrum disorder (this includes what was once known as Asperger's syndrome). Attention-deficit hyperactivity disorder (ADHD). Down syndrome.
What is the gold standard treatment for ADHD? ›What Is the Best ADHD Treatment? Integrative ADHD treatment — combining stimulant medication with directive cognitive behavioral therapy — has been accepted as the gold standard of ADHD treatment for decades.
What is the best learning environment for a child with ADHD? ›According to Dr. Zentall, children with ADHD seek change/novelty and high-interest activities. They do best with an engaging active curriculum at school and an active home environment. Incorporating physical movement and motor activity throughout the day increases successes.
What psychological strategies are there for ADHD? ›
Research suggests that cognitive-behavioural therapy (CBT) for adult ADHD is the most helpful approach to managing problems associated with ADHD in adulthood. In CBT for adult ADHD, a psychologist or other qualified health professional helps the person learn a range of skills that can reduce the impact of ADHD.
What are the root causes of ADHD? ›...
Causes of ADHD
- Brain injury.
- Exposure to environmental risks (e.g., lead) during pregnancy or at a young age.
- Alcohol and tobacco use during pregnancy.
- Premature delivery.
- Low birth weight.
Common ADHD triggers include: stress. poor sleep. certain foods and additives.
Can emotional neglect cause ADHD? ›Conclusions: Results suggested that ADHD cases were more commonly exposed to emotional abuse and neglect. They had significantly more dissociative experiences and reported Post-traumatic Stress Disorder (PTSD) symptoms more frequently.
Can ADHD make you forget words? ›FAQ about ADHD and forgetfulness
A: Yes, there's a link between ADHD and forgetting words or losing your train of thought during a conversation. It all has to do with how the brain processes information and plans out the subsequent verbal response.
- Educate. Educate yourself on how ADHD affects someone. ...
- Don't Take Everything Personally. It's hard not to take something personally when you are in a relationship. ...
- Know They Are Trying. No one asks to have ADHD. ...
- Reflect On Who You Are.
Emotional dysregulation occurs when a person isn't able to control their emotional responses, which is common in ADHD. “Simply put, ADHD takes away the brain's pause button,” Roberts explains. “For many adults with ADHD, it can feel like a roller coaster inside.
How do you focus on conversations with ADHD? ›- Write things down: ...
- Be candid: ...
- Watch out for overwhelm: ...
- Listen and ask questions: ...
- Use the “WAIT-Now” method: ...
- Consider personal space, volume and body language: ...
- Reflect on your behavior in conversations: ...
- Make a plan for when you get distracted, space out or start interrupting:
The so-called 'doorway effect' – forgetfulness caused by moving between rooms – is not as pronounced as previously thought and only occurs when the brain is working hard, new research shows. The doorway effect came to prominence after a 2011 study by researchers at the University of Notre Dame.
Does ADHD cause brain fog? ›ADHD is one of several health conditions that can cause brain fog. Many ADHD symptoms mirror brain fog symptoms. Brain inflammation may be behind some of them. ADHD can also cause sleep disturbances that make brain fog worse.
Does ADHD affect sleep? ›
Beginning around puberty, people with ADHD are more likely to experience shorter sleep time, problems falling asleep and staying asleep, and a heightened risk of developing a sleep disorder. Nightmares are also common in children with ADHD. View Source , especially those with insomnia.