Emerging research suggests people with attention deficit hyperactivity disorder (ADHD) may face challenges when communicating and interacting with other people.
In Canada, University of Waterloo researchers say “people with ADHD are often less able to consider the perspective of their conversational partner.”
“Understanding that this may be an issue will lead to new approaches and training that could improve the way individuals with the disorder interact and communicate with others,” say the researchers.
The research appears in two published studies. The first paper is found in the Journal of Speech, Language, and Hearing Research and addresses issues that may be found among children. The second paper addresses adults and appears in the Journal of Attention Disorders.
“In conversation, individuals need to pay attention to the knowledge and perspective of one another,” said Professor Elizabeth Nilsen, Ph.D., co-author of the studies.
“The ability to see the perspective of the other is essential for successful communication, allowing each speaker to modify their response or reaction accordingly.”
In one study, researchers examined children with and without a diagnosis of ADHD, and in the other study undergraduate students with varying levels of ADHD symptoms participated.
Participants had to follow instructions on how to move objects in a display case based on direction from another person who had an obstructed view of some of the items.
Video cameras captured where the participants were looking as they heard the instructions, showing that the participants with ADHD made more errors interpreting which items they were asked to move based on their partner’s limited view of the objects.
“These studies suggest the more severe ADHD symptoms individuals have, the less they use the perspective of the speaker to guide their interpretation of basic statements,” said Nilsen.
The ability to consider another’s perspective during conversation requires cognitive resources such as retaining information for a temporary period and the ability to suppress a response.
These skill areas tend to be weaker for individuals with ADHD, and may be why their communicative behavior is often more egocentric, or based on their own perspective.
The researchers are interested in how these findings may relate to other social behaviors, potentially providing better understanding of ADHD-related difficulties in more complex social situations.
“Our findings are important because they allow us to think about possible remediation strategies,” said Nilsen.
“Social skills training programs for children with ADHD often don’t show substantial benefits when children return to their social environments, and if we have a better sense of what is causing the difficulties in communication and then target remediation at these particular skills, intervention programs may be able to achieve more beneficial outcomes.”
Source: University of Waterloo
Woman not paying attention in conversation with man photo by shutterstock.
The exact cause of ADHD is unknown. The most likely cause is genetics. Many children with ADHD have a family history of the disorder.
A person with ADHD may show some of the following signs:
- Has trouble concentrating
- Starts thinking about other things
- Has problems staying focused on tasks
- Does not seem to listen
- Does better on some tasks than others
- Has problems planning, organizing, and finishing tasks on time
- Has problems learning new things
- Seems unable to sit still
- Is restless and fidgety
- May bounce from one activity to the next
- Often tries to do more than one thing at once
Childhood Communication Disorders FAQ
What Is Meant by “Communication Disorders”?
The term communication disorders encompasses a wide variety of problems in language, speech, and hearing. Speech and language impairments include articulation problems, voice disorders, fluency problems (such as stuttering), aphasia (difficulty in using words, usually as a result of a brain injury), and delays in speech and/or language. Speech and language delays may be due to many factors, including environmental factors or hearing loss.
Hearing impairments include partial hearing and deafness. Deafness may be defined as a loss sufficient to make auditory communication difficult or impossible without amplification. There are four types of hearing loss. Conductive hearing losses are caused by diseases or obstructions in the outer or middle ear and can usually be helped with a hearing aid. Sensorineural losses result from damage to the sensory hair cells of the inner ear or the nerves that supply it and may not respond to the use of a hearing aid. Mixed hearing losses are those in which the problem occurs both in the outer or middle ear and in the inner ear. A central hearing loss results from damage to the nerves or brain.
Many communication disorders result from other conditions such as learning disabilities, cerebral palsy, mental retardation, or cleft lip or cleft palate.
What Are Some Characteristics of Children with Communication Disorders?
A child with speech or language delays may present a variety of characteristics including the inability to follow directions, slow and incomprehensible speech, and pronounced difficulties in syntax and articulation. Syntax refers to the order of words in a sentence, and articulation refers to the manner in which sounds are formed. Articulation disorders are characterized by the substitution of one sound for another or the omission or distortion of certain sounds.
Stuttering or dysfluency is a disorder of speech flow that most often appears between the ages of 3 and 4 years and may progress from a sporadic to a chronic problem. Stuttering may spontaneously disappear by early adolescence, but speech and language therapy should be considered.
Typical voice disorders include hoarseness, breathiness, or sudden breaks in loudness or pitch. Voice disorders are frequently combined with other speech problems to form a complex communication disorder.
A child with a possible hearing problem may appear to strain to hear, ask to have questions repeated before giving the right answer, demonstrate speech inaccuracies (especially dropping the beginnings and endings of words), or exhibit confusion during discussion. Detection and diagnosis of hearing impairment have become very sophisticated. It is possible to detect the presence of hearing loss and evaluate its severity in a newborn child.
Students who speak dialects different from standard English may have communication problems that represent either language differences or, in more severe instances, language disorders.
How Many Children Have Communication Disorders?
The overall estimate for speech and language disorders is widely agreed to be 5% of school-aged children. This figure includes voice disorders (3%) and stuttering (1%). The incidence of elementary school children who exhibit delayed phonological (articulation) development is 2% to 3%, although the percentage decreases steadily with age.
Estimates of hearing impairments vary considerably, with one widely accepted figure of 5% representing the portion of school-aged children with hearing levels outside the normal range. Of this number, 10% to 20% require some type of special education. Approximately one-third of students who are deaf attend residential schools. Two-thirds attend day programs in schools for students who are deaf or day classes located in regular schools. The remainder are mainstreamed into regular school programs.
What Are the Educational Implications of Communication Disorders?
Many speech problems are developmental rather than physiological, and as such they respond to remedial instruction. Language experiences are central to a young child’s development. In the past, children with communication disorders were routinely removed from the regular class for individual speech and language therapy. This is still the case in severe instances, but the trend is toward keeping the child in the mainstream as much as possible. In order to accomplish this goal, teamwork among the teacher, speech and language therapist, audiologist, and parents is essential. Speech improvement and correction are blended into the regular classroom curriculum and the child’s natural environment.
Amplification may be extremely valuable for the child with a hearing impairment. Students whose hearing is not completely restored by hearing aids or other means of amplification have unique communication needs. Children who are deaf are not automatically exposed to the enormous amounts of language stimulation experienced by hearing children in their early years. For deaf children, early, consistent, and conscious use of visible communication modes such as sign language, finger spelling, and cued speech and/or amplification and aural/oral training can help reduce this language delay. Some educators advocate a strict oral approach in which the child is required to use as much speech as possible, while others favor the use of sign language and finger spelling combined with speech, an approach known as total communication. There is increasing consensus that whatever system works best for the individual should be used.
Many children with hearing impairments can be served in the regular classroom with support services. In addition to amplification, instructional aids such as captioned films and high interest/low vocabulary reading materials are helpful. For most children with hearing impairments, language acquisition and development are significantly delayed, sometimes leading to an erroneously low estimate of intelligence.
Students whose physical problems are so severe that they interfere with or completely inhibit communication can frequently take advantage of technological advances that allow the individual to make his or her needs and wants known, perhaps for the first time.
ADHD linked to interaction of genetics and psychology
ADHD may be caused by alterations in the serotonin neurotransmission system combined with a tendency to experience psychosocial distress.
Researchers writing in BioMed Central's open access journal Behavioral and Brain Functions found that ADHD behaviors in children and adolescents were associated with interactions between low and high serotonin activity and self-blame in relation to inter-parental conflict.
Molly Nikolas, from Michigan State University, USA, worked with a team of researchers to study a key serotonin genetic region, 5HTTLPR, and the tendency for children to blame themselves for parental arguments in 304 youths. They found that those children who reported more self-blame, and had variants of the region associated with both high and low serotonergic activity, had more ADHD symptoms. According to the authors, "To date, studies have mostly focused on the effects of genetic and environmental influences on ADHD separately. Our work examines the interaction between a specific gene variant and a family environmental risk factor in order to determine their roles in the development of ADHD via behavioral and emotional dysregulation in children."
5HTTLPR is a functional genetic region responsible for regulating the production of a protein that transports the neurotransmitter serotonin it has previously been linked to a range of neuropsychiatric disorders and personality traits. Tendency to self-blame was assessed by questionnaire. The authors stated, "Overall, these results complement growing evidence suggesting that 5HTTLPR variants confer a liability for ADHD that is activated in particular environments, rather than conferring risk for ADHD directly."
Materials provided by BioMed Central. Note: Content may be edited for style and length.
ADHD and Executive Function
Executive function deficits affect a person’s ability to get started, organize, and sustain effort on tasks. The individual may even experience a sense of paralysis associated with a task or project—wanting to get started, but unable to make progress forward in any manner.
This sense of paralysis can quickly lead to feelings of being overwhelmed, procrastination, and avoidance, and ultimately results in problems with productivity.
It can also result in negative reactions from others who become confused and frustrated by the inconsistencies in the person with ADHD who is able to perform well when the task is stimulating and interesting or when it is novel and exciting but does not perform as well when the task is tedious or repetitive.
Even if the person is able to begin the task, they may have great difficulty staying alert and persisting in this effort. Though they may know what they need to do to get things completed, as hard as they try, they just can’t.
Boredom results in all sorts of problems for kids and adults with ADHD. Maintaining focus on a boring task may seem nearly impossible as an individual’s attention wanders away to more interesting activities and thoughts.
What can also happen is that after repeated frustrations, the child or adult with ADHD can begin to feel less motivated. It can be hard to get excited and hopeful about something and then crash down again and again.
Screen media use and ADHD-related behaviors: Four decades of research
The diagnosis of attention-deficit/hyperactivity disorder (ADHD) among children and adolescents has increased considerably over the past decades. Scholars and health professionals alike have expressed concern about the role of screen media in the rise in ADHD diagnosis. However, the extent to which screen media use and ADHD are linked remains a point of debate. To understand the current state of the field and, ultimately, move the field forward, we provide a systematic review of the literature on the relationship between children and adolescents' screen media use and ADHD-related behaviors (i.e., attention problems, hyperactivity, and impulsivity). Using the Differential Susceptibility to Media effects Model as a theoretical lens, we systematically organize the existing literature, identify potential shortcomings in this literature, and provide directions for future research. The available evidence suggests a statistically small relationship between media and ADHD-related behaviors. Evidence also suggests that individual child differences, such as gender and trait aggression, may moderate this relationship. There is a clear need for future research that investigates causality, underlying mechanisms, and differential susceptibility to the effects of screen media use on ADHD-related behaviors. It is only through a richer empirical body that we will be able to fully understand the media-ADHD relationship.
Keywords: ADHD attention problems individual differences media effects media theory.
Communication Strategies for Parents of Children with ADHD
Parenting a child with attention deficit disorder or attention deficit hyperactivity disorder is a challenge. Communication is essential and communicating with a child who has attention or sensory challenges can be difficult. Below are strategies for strengthening communication with your child.
- Recognize when your child is actually hearing you and paying attention.
Most people require eye contact to know that they’re being heard. However, a child with ADD or ADHD has a mind that is operating at a fast pace. They may not be able to make or maintain eye contact with you. This doesn’t mean that they’re not listening. On the contrary, many children fidget with objects when they’re listening. Pay attention to your child’s cues.
- Give them short and simple directions.
Children are easily overwhelmed. When you’re teaching them something or asking them to perform a task, give them step-by-step instructions. However, don’t lay out all the steps at once. Give them one or two simple steps and then move on once each step is completed.
- Create communication strategies.
You may need to get creative when trying to communicate with your child. For example, introduce a ‘listening ball.’ Instruct your child to hold the ball or toss it from hand to hand while they listen to you. You can also use visual cues to indicate what you want or need your child to do. When it’s time for bed, show them a picture of a bed or give them the stuffed animal that they sleep with.
- Give them choices.
Children learn to quickly tune their parents out, especially when they perceive that you’re talking at them rather than to them. However, when you give your child a choice, it’s easier for them to listen. They often allow themselves to slow down and weigh the choices so that they can make the most appealing decision. For example, when it’s time for bed you might say, “It’s time for bed. Which pajamas do you want to wear tonight – the red ones or the blue ones?”
- Use visual aids.
Children with ADD and ADHD respond to visual aids. Instead of telling them what they need to do to get ready for bed, create a poster with a series of pictures demonstrating the steps.
- Talk softly and remain calm.
As you become agitated or raise your voice, it can stimulate your child. This is the opposite of what you’re trying to accomplish, especially if they’re already agitated or upset. Speak quietly to your child and remain calm. If they’re throwing a tantrum or are agitated, step away and engage in a quiet activity that they may find interesting. Build a tower with blocks, color, or work on a puzzle. Your calm can and will influence them.
- Explain your expectations.
When your child knows what is expected of them and what they can expect, they tend to behave better. Rewarding positive behavior also supports future cooperation.
Raising a child with ADD or ADHD requires some creative parenting. Learn your child’s cues and triggers. Observe their learning style and support that style in your communication. If you’re struggling, join a support group. Sometimes talking to other parents can help you not only cope but you can also pick up some new tips.
Psychological Preparations Affecting the Emotions of Children with Developmental Disorders Toward Hospitals
Background: The psychological preparation factors associated with positive or negative emotions in pediatric patients with developmental disorders are not well known. We aimed to clarify which psychological preparation factors affect positive (favorable) or negative (fear) emotions toward hospitals in pediatric patients with autism spectrum disorder (ASD) or attention deficit hypertensive disorder (ADHD), using the questionnaires for the patients and guardians.
Methods: The questionnaires were sent by mail via prefectural patient-family groups to pediatric patients (6 to 15 years old diagnosed with ASD or ADHD) and their guardians living in seven prefectures in Japan. Thereafter, we statistically analyzed the associations between the background factors or psychological preparations and the patients' positive or negative emotions toward the hospital.
Results: The questionnaire results of 68 patients (age: 6-15 years 15 = females 53 = males) and their guardians indicated the main diagnoses for patients were ASD (n = 54) and ADHD (n = 14). Intellectual disability and hypersensitivity were positively associated with fear experiences in the hospital. In contrast, the staff's explanations during interventions negatively associated with patients' fear experiences. The psychological preparations performed by doctors during the medical checks were positively associated with the patient's positive emotions toward the hospital.
Conclusion: Regarding the psychological preparations for patients with ASD or ADHD, interpersonal communication with doctors and staff promotes positive emotions and reduces anxiety in the hospital.
Keywords: attention deficit hyperactivity disorder autism spectrum disorder developmental disorder preparation.
Conditions Similar to ADHD
Your child’s behavioral issues could be due to any number of biological, physiological, and emotional disorders that appear like ADHD. These are some of the most common.
Anxiety disorders. About one-fifth of kids with ADHD also have some type of anxiety disorder, including separation anxiety, social anxiety, or general anxiety. And children with ADHD are more likely than others to get anxiety. The type of medication they take for ADHD makes a big difference if they also have anxiety. Stimulants can make anxiety worse, but antidepressants can help with it.
Depression. About 1 in 7 children with ADHD are also diagnosed with depression. Experts think it could be made worse by the stress from having ADHD. To complicate things even more, certain ADHD medications have side effects that can look like symptoms of depression, including changes in eating and sleeping habits.
Autism spectrum disorder. Like ADHD, this is a condition that affects brain development. The two disorders sometimes happen together, but experts aren’t sure why. Both can cause children to hyperfocus on one thing. But kids who are on the autism spectrum may avoid eye contact and may not want to play with other kids. Their speech tends to develop slowly or not at all.
Oppositional defiant disorder. Kids who lose their temper a lot, refuse to follow rules, argue with adults, and say mean things to other people are often diagnosed with oppositional defiant disorder (ODD). ODD is more common in boys than girls. It goes away within 3 years in about 60% of kids. As with ADHD, your doctor will probably wait until your child is at least 4 years old to diagnose ODD. This kind of behavior can be “normal” at 2 or 3 years old, but it becomes a problem if it continues as your child gets older. They’ll want to wait to make a firm diagnosis until your child’s behavior is more extreme than what is age-appropriate.
Call your doctor if you notice that your child acts this way around at least one person, other than a sibling, for at least 6 months -- especially if it’s affecting their schoolwork and your home life.
Conduct disorder. About 30% to 50% of children with ADHD and ODD may get conduct disorder (CD), a more serious pattern of antisocial behavior. These children often lie or steal and tend to disregard the welfare of others. They risk getting into trouble at school or with the police.
Learning disabilities. Around half of children with ADHD also have a learning disability. Many kids with learning disabilities also get into trouble at school for not listening, not finishing work, or being disorganized. Like ADHD, a learning disability doesn’t affect intelligence, but it can make kids lag behind others in school and at work. For example, dyslexia, a type of reading disorder, is often seen in children with ADHD. A diagnosis of learning disabilities requires specific academic testing, which is done by a psychologist.
Bipolar disorder. Studies have shown that symptoms of bipolar disorder often overlap with those of ADHD, making it hard to diagnose both of these disorders. Bipolar disorder is marked by mood swings between periods of intense emotional highs and lows. The bipolar child may have elated moods and grandiosity (feelings of importance) alternating with periods of depression or chronic crankiness.
Sensory processing disorder. This condition causes severe sensitivity to things like touch, sound, or light. Children may act out in response, causing ADHD-like symptoms such as trouble with attention, behavior, or learning.
Seizure disorders. A type of epilepsy called absence seizures is often misdiagnosed as the inattentive kind of ADHD. Both conditions make children zone out or stare into space. With ADHD, you can get them to focus again by touching them or making a loud noise. But with absence seizures, they may seem entirely out of reach.
Hearing or vision loss. If your child can’t see or hear properly, they can have trouble at school. They might not be able to see the board or hear their teacher. These issues can lead to poor grades and bad conduct, which might seem like ADHD symptoms when they’re not.
Tourette's syndrome. Very few children have this syndrome, but many people with Tourette's syndrome also have ADHD. Tourette's syndrome is a neurological condition that causes nervous tics and repetitive mannerisms. Some people may blink often, clear their throats a lot, snort, sniff, or bark out words. Sometimes, these tics can be made worse by ADHD medication.
Sleep disorders. These conditions are very common in children and adults who have ADHD. But they can sometimes get mixed up, too. When children are tired, they often do things that can look like ADHD, such as being hyperactive or impulsive, being aggressive, or acting out.
Substance abuse. About half of children have tried an illicit drug at least once by their senior year in high school. It’s important to consider this possibility if your child starts showing ADHD symptoms in their teen years.
National Institutes of Health.
CDC: “Attention-Deficit/Hyperactivity Disorder.”
American Academy of Child and Adolescent Psychiatry: “ODD: A Guide for Families.”
National Institute of Mental Health: “Attention Deficit Hyperactivity Disorder.”
Mayo Clinic: “Oppositional defiant disorder (ODD).”
American Academy of Child and Adolescent Psychiatry: “Oppositional Defiant Disorder,” “Oppositional Defiant Disorder Resource Center: Frequently Asked Questions.”
CHADD: “ADHD and Autism Spectrum Disorder,” “Sensory processing disorder & ADHD: What to know,” “ADHD and Sleep Disorders.”
THINK Neurology for Kids: “Inattention vs. Absence Seizures: How to Tell the Difference.”
This is the most common type of ADHD. People with it have symptoms of both inattentive and hyperactive-impulsive types.
National Institute of Mental Health: "Attention Deficit Hyperactivity Disorder."
WebMD Live Events Transcript: "ADHD: Diagnosing a Disorder," Dec. 17, 2003.
The American Psychiatric Association. Council on Children, Adolescents and Their Families: "Brain Imaging and Child and Adolescent Psychiatry with Special Emphasis on Single Photon Emission Computed Tomography (SPECT)."
FDA:"FDA permits marketing of first brain wave test to help assess children and teens for ADHD."