Social Communication and ADHD in Schools
By: Gabrielle Dupuis & Chantal Mayer-Crittenden
To begin, I would like to introduce myself. My name is Gabrielle Dupuis and I am a master’s student in speech-language pathology at Laurentian University. I come from Hearst, a small francophone town in Northern Ontario. When I was a little girl, a teacher told me: “If I could start over again, I think I would be a speech-language pathologist.” Since then, I have always been interested in speech-language pathology. Social communication is something that happens everywhere, so I decided to learn more about it by pairing it with a disorder that interests me greatly, attention-deficit hyperactivity disorder (ADHD). My thesis supervisor, Dr. Chantal Mayer-Crittenden, and I have created a video to raise awareness of this issue. The video was created as a result of participants’ responses to a survey carried out to meet the requirements for a master’s degree in speech-language pathology.
Almost everyone knows a child who has ADHD. It is well known that these children usually have behavioural problems, but what about their communication? In the video, we explain the impact of ADHD on communication and the role of the speech-language pathologist. In a social context, pragmatics are most obvious. Pragmatics reflect the organization of language and are based on the use of language’s social function in society. In fact, studies show that from kindergarten onwards, children favour friends who have a good command of language and avoid children who have communication disorders or communicate less effectively than others.
Let’s look at the components listed above in more detail:
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (APA, 2013), a child has a social communication disorder when they have persistent difficulties in the social use of verbal and nonverbal communication as manifested by all of the following:
- Deficits in using communication for social purposes, such as greeting and sharing information, in a manner that is appropriate for the social context:
- Reading facial expressions of others
- Making good eye contact
- Taking turns in a conversation
- Impairment in the ability to change communication to match context or the needs of the listener and impaired ability to understand abstract concepts
- Deficits in social communication that can create several barriers to and limit effective communication, such as difficulties with:
- Social integration
- Developing peer relationships
- Academic achievement
Attention-Deficit Hyperactivity Disorder (ADHD)
ADHD is a neurodevelopmental disorder. According to the DSM-5, individuals with this disorder may show patterns of inattention, hyperactivity, impulsivity, cognitive difficulties and deficits in executive functioning. However, regardless of the symptoms, people with ADHD often face pragmatic difficulties. In addition, people with ADHD may also have a developmental language disorder (DLD). Some research suggests that ADHD is the most common concomitant mental disorder in children with DLD. In fact, up to two-thirds of children with ADHD have DLD as well. So if, in a school of 300 students, 30 of them have ADHD, we can expect 20 students to have DLD as well.
Developmental Language Disorder (DLD)
Studies show that approximately two children per classroom, or about 7%, have a DLD. These children have difficulty learning and using language. They often have difficulty understanding more abstract concepts, such as ‘temperature’ and ‘hibernation’, for example, for these concepts cannot be handled, touched or seen. These children also tend to understand information very literally and may thus have some significant difficulties in a social context. Research shows that children with DLD often have difficulty belonging to a group of friends and are at greater risk of developing mental health problems. It can be difficult to distinguish the social difficulties associated with ADHD from those attributed to DLD because the language difficulties of both disorders are very similar. However, the difficulties due to ADHD alone are more social (pragmatic) in nature, whereas those due to both ADHD and DLD are manifested linguistically, with verbal memory and pragmatic difficulties. One thing is clear, the language development of children with DLD is not made worse by ADHD.
ADHD + DLD ≠ more speech-language difficulties per se
The Role of the Speech-Language Pathologist (S-LP)
S-LPs play a central role in the remediation of relational problems that go beyond speech and language, for they also work on non-verbal social signals and rules for conversation, among other things. A tailored program designed by an S-LP can help children whose social communication skills are impaired by ADHD and DLD. It is important to refer children to a S-LP when they have difficulties:
- Initiating or ending conversations with other students appropriately
- Respecting rules for speaking in class or elsewhere at school
- Contributing to class discussions in a relevant way
- Providing adequate information
- Asking for information about the schedule for the day
- Reacting appropriately when asked to change a behaviour (by accepting or refusing)
- Decoding or interpreting non-verbal signals appropriately
- Making appropriate use of non-verbal signals (e.g., facial expressions, body language, voice intonation, etc.)
We know that children with ADHD have several pragmatic difficulties, which can have several consequences. In fact, several researchers have found that people with ADHD have a higher than average rate of criminality and victimization by peers. Could this be partly due to their impaired pragmatics? In addition, we know that there is a strong correlation between developmental language disorder and incarceration. Some researchers even mention that in many cases, language disorders are often not recognized or treated. However, very few studies have examined the impact of speech-language therapy on criminality, hence the importance of intervening with this population as early as possible. It is therefore important to refer children with suspected social communication difficulties to an S-LP so that the latter can assess their social communication skills and intervene as needed.