Guide to ADHD Support

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Communication & Social Skills Development with Speech & Language Therapy

Most children with ADHD (Attention Deficit Hyperactivity Disorder) have difficulties communicating but therapy can be of significant benefit. The Irish Association of Speech & Language Therapists (IASLT) has produced a “Speech and Language Therapy Guide to ADHD Support”. Speech and language therapists work with children and young people with ADHD on areas of communication and have produced this guide so parents can also help their child with ADHD develop their communication skills and build friendships.

Children with ADHD:

  • Are easily distracted
  • Are restless and overactive
  • Are inattentive and find it hard to focus
  • Are impulsive; doing before thinkingThree main areas of communication that can be affected are:-

    Comprehension Expression Social Skills

    The child’s ability to understand or comprehend language

    This is a child’s ability to understand, including listening skills, following instructions and understanding words and sentences.

    Children with ADHD often struggle to listen, find it hard to follow instructions at home and at school, get distracted when someone is talking to them and lose focus.

    Speech and Language Therapy Advice:

    • Less is more! Generally, when you’re talking to a young person with ADHD it’s best not to talk too much, stick to the point and be brief – that way it’s easier for them to stay focussed.
    • Try to be face-to-face when you expect your child to listen.
  • Limit the distractions in the environment when you’re talking – turn off the TV/ radio/ computer etc.
  • Give your child a prompt before you start an instruction. For example, say ‘listen!’ or use his name and wait for him to look at you, at the beginning. This way you have his attention before you give the instruction.
  • If you have to give a longer instruction, try breaking it up in to shorter parts to help your child follow it through (e.g. “pick up your socks and jeans, [pause], bring them in to the bathroom, [pause], and put them in the pile with the other dark clothes.”). ..then check back that he got it! Sometimes it’s easier to remember the whole instruction by repeating in your head over and over while you complete it – encourage your child to do this.The child’s ability to express themselves

    ADHD often affects a child’s ability to get their message across well, make meaningful sentences and express feelings appropriately. Children who have ADHD often seem to rush when they’re talking, and need some help to make sure they’re making good sense.

    Also, behavioural difficulties are often associated with ADHD – children with ADHD often act out their frustrations and need help to express their feeling in appropriate ways, using words not actions.

    Speech and Language Therapy Advice:

  • Speak to your child slowly and in a fairly quiet, calm voice – often, we match the person we’re speaking to in the way we speak. Careful, though! You may need to be more animated at times, just to keep his attention!
  • If you lose the thread of what your child is saying, pause him and ask him to clarify, while at the same time reassuring him that you were listening by letting him know some of what you did understand. For example, “ok, wait a second, so I heard that you were in the park and you wanted to play something, (pause) but tell me who was there and what did you want to play?” This not only gives your child the message that what he says is important, it also shows him how to ask for clarification, a very important skill.
  • Be a good example in terms of expressing your feelings well. Use lots of feeling words and ‘I’ statements e.g. “thanks for helping with the garden in granny’s today – I am so proud of you!” Also, acknowledge your child’s feelings and label them if you can, for example, ‘I know this maths is hard and you’re feeling frustrated, but you need to speak nicely to me. We’ll do three more, then we’ll finish”.

The child’s social skills

These are the skills needed to get along well with others including conversation skills (e.g. not interrupting, staying on topic, etc), body language (e.g. eye contact, facial expression etc.) and social problem solving skills.

ADHD means that a child may be distractible, impulsive and inattentive in conversations and in play. So, a child with ADHD often interrupts, talks all the time, has problems taking turns, can be loud and take over in social situations.

Non-verbal skills can also be affected, for example a child who is easily distracted often doesn’t make eye contact and this makes others feel he’s not interested. Children with ADHD often find it really hard to figure out better solutions to problems and find it hard to see the consequences of their behaviour.

Speech and Language Therapy Advice:

  • Encourage your child to face the person he’s talking to and to look them in the eye – explain that when he doesn’t the other person might think he’s not interested and the conversation won’t go well.
  • If your child has difficulty taking turns in conversation (e.g. hogging the turns, talking about his own interests too much, interrupting, dominating), there are a number of strategies you can use depending on his age, including signalling turns using your hand or a tap on the table, using an egg timer, using verbal prompts (e.g. “your turn!”), or charts to reinforce good turn-taking in conversations.
  • Many children with ADHD fidget and this can be very distracting socially. Encourage your child to notice his own fidgeting and provide him with an alternative, like a special fidget toy – this can be something simple like a small rubber ball or an elastic band that he can still fidget with, but isn’t so distracting.
  • Social problem solving is a key skill for any child to learn, especially one with ADHD. There are four basic building blocks(1) Identify the problem
    (2) Think of other solutions
    (3) Think of the consequences for each solution (4) Plan for future situations.

    When your child has experienced a difficult situation, (for example if he has been aggressive with another child who teased him), use these building blocks to think about the situation together to try to prevent it happening again.

What to do if concerned about ADHD – The IASLT advises that If you are concerned that your child has ADHD, please contact your GP for a referral to your local Child and Adolescent Mental Health Service (CAMHS).

 

Stammering : How Parents Can Help

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Stammering can cause both children and parents a lot of concern and can often be very confusing and frustrating. The Irish Association of Speech & Language Therapists (IASLT) offers some key advice on How to Help Children who Stammer.

It is important for parents to know that the causes of stammering are many and it is usually a combination of reasons. There are also many strategies that parents can use to support the child in decreasing their stammer.
First of all, remember that the child may not recognise that there is anything wrong with his/her speech (from here ‘his’ will be used). However, continually asking a child to “slow down, think first” etc may be interpreted as a correction of his speech. This may initially be a mystery to him but if the “correction” continues he may perceive himself as doing something ‘wrong’ each time he speaks and stammers, and may feel that his parents disapprove. He may begin to try not to stammer and in the effort of trying, the tension increases, stress about speaking develops, and the stammer symptoms may then increase in frequency and severity. Learn to stop “correcting” the stammering and make sure that nobody else “corrects” it. However, as with all children, some children do not respond in this way to correction because personality type also plays a part. Reactions to stammering alone do not cause stammering.

It is always helpful to be aware of how we react to the child, who stammers, both verbally and non-verbally. We frequently communicate our feelings and thoughts through body language, facial expression etc. Therefore, also try to avoid showing disapproval or anxiety non-verbally. E.g. nervous glance to partner or grandparent just after child stutters while telling a story. Not “correcting” is only part of the wider picture of reacting more positively. Reacting in a more neutral way such as holding eye contact with your child as they are speaking and maybe stuttering is more likely to support recovery, particularly in the younger child.

As far as possible parents could try to remove or ease the possible pressures on the child’s speech in the early stages. These pressures are not the cause of the stammer, but changes that work to ease these pressures are again associated with reduction of stammering and/or recovery. Keep a daily diary and chart anything that may be contributing to making the stammering increase/decrease, however small. Use this information to guide you in deciding which changes to make, what changes to keep going with etc e.g. earlier bed time, time out on his own with his juice and a cartoon for ten minutes following play school. This information and how your child and his stammering respond will also help the speech and language therapist in deciding the best management for your child.

The rate of a child’s speech will also affect a child’s fluency. The more children have to say the faster they tend to talk. Asking your child to slow down is really asking the impossible (even for some adults!) and it may also contribute to him thinking there is something wrong with how he speaks. Working indirectly is found to be the most effective. So as much as possible:

  •   Slow down your own rate of talking and use a gentle, soft tone as this helps create a calm and relaxed atmosphere for speaking.
  •   Use a 2-3 second pause when answering your child’s question to let him know that it is okay to take time to gather your thoughts.
  •   When necessary, play down excitement by keeping calm and refrain from getting too excited in your interactions with your child.
  •   Make sure the child knows he has plenty of time to speak and as much as possible try not to make him/her hurry over anything. Getting down to his level on your knees may support this.
  •   Establishing a time, when everyone does deliberately gentle speech will also support the experience of reducing speech rate.Interrupting may also be viewed as another speech pressure and may contribute to the child speaking faster. Every time the child is interrupted or interrupts, it means that he is in a situation where he needs to start what he was saying again, which becomes a speaking pressure. Pay attention to the number of times the child who stammers is being interrupted and interrupts others. Maybe this is a pressure that requires change with your child? Stammering may also increase when there is “competition to speak”. No family can completely avoid this speech pressure but being aware that this competition to speak exists, makes it possible for parents to control it to a large extent by encouraging the “one person at a time” rule.Instead, encourage all of your children to develop and practise good turn- taking skills. Turn taking develops best when it is a family affair! Explain to all the family, the importance of taking turns when talking. This concept is best taught during normal play time at first e.g. board-games: ‘Mammy’s turn’, ‘Now it’s Paul’s turn’, ‘Oh wait, it’s not your turn, it’s Katie’s turn’ ‘now it’s Daddy’s turn’. The child learns to trust that their turn will come, and that it works! If turn-taking is then mentioned and reinforced when all children are battling for attention to tell their story about school, turn-taking is a familiar concept that worked before. Make sure all family members take turns so that there is no special attention given to the child who stammers or is going through a phase of stammering.

    As much as possible, try to show your child you are interested in what he is saying.
    Inattention, half attention or attention lost half-way through the child’s conversation may contribute to stammering because there is a pressure on your child to get your attention and keep your attention. In these situations they may start their story, stop and start again or rephrase. Giving your child full attention while he speaks is not always realistic and it is perfectly okay to say to your child that you have 8 more potatoes to peel and you will be all ears when you are finished but make sure that you follow through. Holding eye contact with your child as he is speaking shows your child he has your full attention.

    Try not to bring any attention to your child about how he speaks.
    The onset of stammering occurs most frequently during the same time that a child’s language development peaks. Early stammer type sounds may appear as the child learns more speech sounds, more words, longer words and longer sentences. Try not to bring his attention to any aspect of his speech (e.g. pronunciation or grammar errors), particularly if you suspect he is developing a stammer. Instead focus on WHAT he is saying and respond as he would like you to, this will allow you to enjoy your chat with your child and it will be as positive as possible for him. Learning to predict situations that may trigger stammering through keeping the diary will also ease your anxiety as the element of surprise may be removed.

Most therapy has a component that works on empowering parents with knowledge and strategies that will develop changes in the child’s home environment to best support recovery. It is not that what was previously happening at home acted alone in causing the stammering but that these recommended changes are associated with reduction of stammering or recovery from stammering. It generally works best to pick one or two changes that mean the most (turn-taking tends to be quite popular!) and work on those changes over a month rather than trying to make several changes all at once. Too much change too quickly will not help anyone in the family and you will not get any thanks for it! Parents working together and agreeing on the same changes also works best.

These changes can be challenging to make alone as parents so it is recommended to refer to a speech and language therapist if you are concerned. This will enable a detailed assessment to be carried out that will best inform which changes to make and how.

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