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Pragmatic Language Impairment & ADHD

Instructor: Lisa Millraney

Lisa has 27 years of experience treating speech, language, memory and swallowing disorders. She has a master's degree in speech pathology from Vanderbilt University.

In this lesson, we will learn about how ADHD impacts a person's communication skills, especially in the area of pragmatics, the functional use of language. We will also explore how people with ADHD and those around them can help them improve their ability to communicate.

ADHD and Communication--Focus On Pragmatics

ADHD (attention deficit-hyperactivity disorder) affects a person's ability to focus and concentrate. It is a chronic brain condition that is usually first noted in children, but affects a person throughout life. One important area impacted is communication.

More goes into communication than people realize. Speech is, of course, how we produce sounds and words. Language is how we put those sounds and words together to make sense. One major element of language that is particularly vulnerable to the problems of ADHD is pragmatics.

Pragmatics is the use of social language, both verbal and nonverbal. Much of a child's pragmatic language skill is developed as they grow, simply by observing others. However, because of the overall difficulty that children with ADHD have in paying attention to anything, they often can't apply those cues. This is sometimes given a separate name, social communication disorder (SCD).

How Does ADHD Affect Pragmatics?

Some common pragmatic language issues experienced by people with ADHD include:

  • trouble with word finding, turn taking, and adapting speech to different settings
  • missing important details presented verbally, and thus having trouble following directions
  • poor reading comprehension--the difficulty with details extends throughout other modes of communication like the written word
  • speaking too loudly
  • voice problems, often as a result of speaking too loudly and abusing the vocal cords

Case in Point: Mark

To see some of these issues and more in action, let's look at Mark, who's twelve years old. His cognition, his ability to think and understand and learn, is intact. His ADHD, though, causes him to have difficulty communicating, especially following pragmatic rules.

In class, Mark blurts out answers without raising his hand. He talks over classmates and sometimes even the teacher. When talking to his soccer coach, he sometimes stutters because his brain is running so fast his mouth can't keep up. During games, it's often next to impossible for him to pay attention to the coach's instructions, because he can't filter out the noise of the fans and the other team.

At home, Mark seems to ignore his parents. They ask him to take out the trash or feed the dog, but it doesn't happen. He protests that he never heard them ask, though his hearing is normal.

With his friends, he frequently loses track of conversation, especially if something else is happening at the same time. If the subject changes, he may not catch it, and says things that have nothing to do with the topic. Things come to a head when he is working with a group of classmates on a project and the other kids get mad at him for not doing his share.

Asking for Help--How to Address Pragmatic Language Impairment

Mark knows the rules of social language. He just gets distracted much too easily and says whatever is in his head. This is typical of children with ADHD.

Upset because he feels he has let his group-mates down, Mark goes to his teacher, Mrs. Irvine, to ask that their grades on the project not be lowered because of him. She is touched, and concerned about him. She calls Mark's parents and Wendy, the school speech pathologist, and sets up a meeting.

At the meeting, Wendy educates everyone on pragmatic language, and why children with ADHD often have trouble with it. She reassures Mark that they know he isn't being deliberately disruptive. Mark's dad tells them that their family doctor is about to start Mark on a new medication to address his ADHD. Wendy and Mrs. Irvine hope this will help, but they feel one-on-one training will help too.

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