Why Every Child with ADHD Should Have a Speech Language Evaluation
Hi there! Katie here. Today, I am making the case for why I have the best job. OK, I'm kidding. Sort of. What I should actually say is, I'm a speech language pathologist who gets to work directly with a team of psychologists. On most of our diagnostic evaluations, we are able to collaborate and do both psych and speech/language testing, and I love having both disciplines work together.
One of the first things we tell families who come to our practice is: If your child has a diagnosis of ADHD (or autism, developmental delay, or a learning disorder), a speech language evaluation is an important part of understanding the whole picture of your child's strengths and needs. In this blog, I will address the primary questions that parents have about speech language evaluations for children with ADHD.
Why does my child with ADHD need a speech language evaluation?
Most people understand how important language testing is for autistic children. Since social communication is part of autism, parents are usually sent to an SLP for additional testing. The connection between ADHD and language, however, is not always common knowledge.
Russell Barkley, a leading researcher in ADHD, has cited that as many as ⅔ of children with ADHD also have speech and language disorders, with some studies indicating that the prevalence is as high as 90%.
It's hard to imagine that as many as 9 out of 10 children with ADHD may have difficulties with some aspect of speech, language, or communication! We also know that children with ADHD are creative and can be very thoughtful, because they can see the world differently. As parents, we want to make sure that our child's ideas are understood!
What areas of speech and language can be affected in children with ADHD?
Executive Function
One of the main areas of language that is impacted in children with ADHD is executive function. In previous blog posts, I have shared tons of information about executive function, including what the executive functions are, why they are important, what ages they develop, and concrete strategies parents can use to help improve their child's executive function. The executive functions help us to set a goal, stay on track, and finish the goal. They also help us stay calm when frustrated, change plans, and manage time. A speech language evaluation can help pinpoint specific areas of executive function that are challenging for your child so that goals can be developed to address these. Even more important: Many SLPs can help your child improve their executive function skills through evidence-based treatment!
Beyond the executive functions, there are many other areas of speech, language, and social skills that can be impacted in children with ADHD.
Social Communication
Social skills are often impacted in children with ADHD, because social interaction and perspective taking require the child to pause, observe, interpret, and make a plan... all within a few milliseconds of time! If your child is having trouble paying attention, these social processes may move too quickly and will likely feel confusing. A speech language evaluation will assess your child's social language skills, such as inferencing and problem solving.
Language Processing
Language processing refers to the way we understand and recall information (think of it as the "input" of language). As you know, for children with ADHD, it can be incredibly challenging to follow directions or listen to long lectures from teachers. This can be the result of several factors, including working memory issues and inattention. During speech language testing, our goal is to look at exactly what types of language the child can understand. That way, therapy can be focused on any specific skill-based deficits that exist.
- Vocabulary: Do they have difficulty understanding a specific term, like "left/right" or "before/after," which causes them to make a lot of errors when following directions?
- Length and Complexity: Do they struggle more with complex sentences and grammar structures?
- Visualization: Is it easier for them to understand information when there are pictures? Or are they able to comprehend information without pictures?
Expressive Language
Simply put, expressive language refers to language "output" or the way a person can express themselves. For children with ADHD, there are several areas of expressive language that are often impacted.
- Narrative language: The ability to tell a story that makes sense and is in the correct order. I often hear from parents who say, "I ask them what they did today, and they just shrug and say I don't know!" Parents are inevitably frustrated, because their child absolutely does know what they did during the day! They just can't put all of the events in order and share details about their day. For children with ADHD, it can be extremely difficult to start at the beginning, give enough background information, keep the events in order, and stay on topic while telling a story.
- Word retrieval: The ability to quickly and accurately find the right words. Children with ADHD will sometimes use a closely related word instead of the word they are actually looking for. For example, they may say "timer thingy" for "alarm clock." In other instances, children with ADHD have trouble choosing specific words and instead use nonspecific words like, "stuff" or "those ones" which can make it hard to understand their ideas.
- Grammar: The rules that govern our language can be challenging for children with ADHD to learn. Because they sometimes have trouble paying attention to detail, children with ADHD can make grammatical errors when talking as well as when writing.
Speech Sounds
Some children with ADHD also have speech/articulation challenges. When a child makes errors on specific sounds or groups of sounds, this is often classified as a speech sound disorder. Because children with ADHD often struggle with self-monitoring, they may not self-correct these errors as readily, and speech therapy would be needed in order to teach the correct pronunciation of sounds. I shared specific information about speech sound disorders here. Speech issues are important to address at a young age when possible, because there is a strong link between pervasive speech sound errors and long-term reading difficulty, such as dyslexia.
Reading and Writing
Many children with ADHD struggle with some aspect of reading or writing. ADHD and dyslexia co-occur at very high rates, with some estimates ranging from 25-40%. Writing is also often affected because it is such a complex process which requires several skills to work together at the same time. Reading and writing are, in many ways, the academic forms of listening and speaking. A speech language pathologist can evaluate reading and writing to help parents understand exactly where the breakdowns are occurring.
Where can I get a speech language evaluation?
Speech and language evaluations should always be conducted by a certified speech language pathologist (SLP). If ADHD is suspected or confirmed, it’s important to collaborate with a psychologist or have the SLP review their report to understand a bigger picture of the child (for example, cognitive skills or behavior history).
- If there are concerns at school, your child may be able to get speech language testing done in the school environment, which will be focused primarily on any areas of academics that are impacted, such as processing language in the classroom (sequencing complex instructions), writing (planning and editing), or social skills.
- Private practice/medical speech language testing will often be more in-depth due to fewer time constraints. It may be covered by insurance, but can also be on the expensive side. If you are looking for a private speech language evaluation, check with your insurance company and ask around for referrals to a good practice in your area.
Thanks for following along! Please let us know if you have more questions about speech language evaluations; we would love to answer them for you on the blog or over our social media.
If your child has been diagnosed with ADHD, or you suspect they may have ADHD, check out our FREE ADHD Treatment Guide which takes the guesswork out of intervention. Or, if you are ready to take the leap, join our online parenting course about ADHD. You can watch Creating Calm from anywhere in the world, at a time that works for you... in your jammies!
Have a beautiful week,
