Working with students who have ADHD

What is ADHD?

ADHD is a medical condition where the brain develops differently in ways that affect a child's executive function skills. These are thinking skills (e.g. working memory, planning, inhibiting impulses) that allow us to take actions moving toward a goal, like completing a specific task. Children with ADHD typically have struggles with attention, hyperactivity/impulsivity, or a combination of the two.

ADHD & Communication

Executive function is a foundation that supports many areas children use to communicate and interact with others: motor skills to produce speech sounds, language skills to understand what people say and make their own responses, understanding the rules for how to use language for social functions, and social-emotional skills to build relationships with peers. Differences in executive function for children who have ADHD are therefore likely to influence their communication skills as well.

Evaluating students for speech & language with ADHD

Since ADHD has influences on communication, when evaluating students with ADHD for speech & language it's often helpful to adapt your administration to account for differences in executive function skills.

1. Give breaks as needed & allow extra time to complete the assessment
2. Adjust your testing environment (e.g. remove potential distractions)​
3. Structure the assessment (e.g. give client sense of what to expect)​
4. Adapt the assessment plan as needed

Speech Assessments

1. Look at speech sounds at levels with increased complexity above just single words (e.g. sentences, reading, structured conversation, unstructured conversation)
2. Check for rate of speech, volume, or intelligibility changes in unstructured contexts
3. Informally observe language/organizational skills in longer speech utterances (e.g. topic maintenance/shifts, narrative skills, organization of details)

Language Assessments

1. Consider working memory & attentional demands in instructions & tasks when selecting the assessment to use
2. Look at narrative skills & organization of ideas in language samples
3. Consider using dynamic assessment to look at whether language skills improve with teaching
4. If assessing for pragmatics, look at social interactions one-on-one vs. in a group setting (e.g. the classroom)

Therapy strategies for students

When working with students who have ADHD, executive function differences are likely to affect how your sessions go. These are some strategies that can help you structure sessions & navigate interactions with students.

1. Guide students back to tasks with redirection & give choices
2. Use visual supports (e.g. visual schedule, first/then, visual timer) for activities to structure session
3. Adjust level of scaffolding (prompts, cues) as needed to support the student. You can use more than one modality (e.g. visuals) if verbal supports aren't enough on their own
4. Give a minimal number of directions or steps at a time
5. Break tasks into smaller chunks
6. Adjust level of movement, sensory inputs/demands (lights, noise, texture, deep pressure)
7. Look at the level of variety or structure in your sessions. E.g. have a consistent routine to transition into sessions, incorporate student interests into activities, or go with the flow and follow your student's lead.

Navigating obstacles/challenges

For students who have ADHD (and students in general!), variability & motivation often affect progress in therapy. SLPs don't medically manage ADHD, or choose whether/how it happens. We don't choose what students do. We do treat areas that are affected by ADHD and its management, and we can choose how we work with students. When navigating sessions and behavior management, here are some recommendations.

1. Look for patterns & contributing factors when sessions go off the rails (e.g. is it happening because they're missing a favorite period or preferred activity? If they take medication, how long has it been since they received it? Are there sensory factors/home life factors at play?)
2. Consider what can you choose vs. not choose in your sessions
3. Adjust expectations for what success is in your sessions
4. Look at the intent vs. impact of behavior that students do
5. Remember that our clients are more than what they do. Our students often pick up on spoken & unspoken perceptions of them, and many times they are looking for people who support them.

Takeaways

ADHD affects foundational skills supporting communication. We can choose how we approach & support students in therapy, and there may not always be simple solutions. Look at your perspective & expectations for what a successful session is for these students.

-Ian Quillen, M.S., CCC-SLP