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ADHD & Stuttering: Are They Related?

by Team Stamurai
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With new studies on stuttering, it is becoming apparent that it may share more than one link with neurodevelopmental disorders like Attention Deficit Hyperactivity Disorder (ADHD). Between 3% and 7% of children in the US are diagnosed with ADHD each year.

Does ADHD increase a child’s chances of developing a stutter? If your child stutters, should you get them checked up for ADHD as well?

Come, let’s explore the facts and stats together!

What is Stuttering?

Stuttering or stammering is a speech disorder. It involves disruptions of speech flow with repetitions, blocks, and prolongations.

Children may begin showing symptoms of stuttering as young as 18 months old. As per research, the incidence of developmental stuttering coincides with the rapid expansion of a child’s language skills and vocabulary.

Between 5 and 10% of all children, either stutter or will do so in their life. The stuttering can last from a couple of weeks to several years or even their lifetime.

What is ADHD?

Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed neurodevelopmental disorders in children in the US and across the world. Experts typically base their diagnosis of ADHD on three symptoms –

  1. Impulsive behavior
  2. Short attention span
  3. Hyperactivity

Children diagnosed with ADHD often show language and communication disorders. Reports suggest that 16% to 37% of children with ADHD also show signs of language impairment.

Studies by Baker and Cantwell, 1992, report that children with ADHD also show articulation disorders. The research findings are in agreement with previous studies (Zental et al, 1983).  They show that children with ADHD have a higher incidence of speech disfluencies as compared to those without ADHD.

A survey found that among 109 children who stuttered, 4% had signs of ADHD. A significant percentage of the children who stutter have ADHD, although it is not a popular subject of research.

Both stuttering and ADHD arise due to anomalies in the structures of the brain. Not one but several areas of the brain are involved in the production and processing of speech. One of them, Broca's area is also involved in ADHD.

Broca’s area is critical in the production and processing of speech.

Those with ADHD have low rates of spontaneous neural activity. People with ADHD exhibit several functional anomalies in Broca’s area. The study indicates an overall lower level of activity in a particular area of the brain in the study group.

Recent brain imaging studies have shown that children and even adults with ADHD may have a smaller Broca's area as compared to those who don't.

Similarly, neuroimaging studies by Chang et al in 2008 show that children who stutter and those who have recovered from stuttering (after therapy) possess deficits in the areas of the brain related to the production of speech.

The deficits involve less gray matter volume in the frontal lobe including the Broca's area. It can affect speech interpretation and processing developed in the Wernicke's area followed by speech planning and execution in the Broca's area.

The link between ADHD and stuttering is not merely acquired or behavioral. The connection lies deep within the frontal lobe of one’s brain.

Recent studies suggest that the treatment of stuttering in those with ADHD is entirely possible. However, due to short and inconsistent attention spans, hyperactivity, and/or impulsivity, speech language pathologists (SLPs) need to modify the stuttering therapy protocols.

Kerianne Druker studied 185 preschool children who stutter in 2018. She noted that 50% of the study group exhibited elevated ADHD symptoms. These were also the same children who needed 25% more clinical intervention and attention to achieve the same levels of fluency as those who didn’t exhibit ADHD symptoms.

Druker’s study showed that ADHD impedes the recovery rate of children who stutter. The severity of ADHD symptoms directly influences the response time to therapy and impedes their fluency outcome.

How to Treat Children with ADHD Who Also Stutter?

Treating stuttering in children, who also have ADHD, should account for their difficulties in focusing, behavioral problems, and communication issues. Therefore, speech therapy for children with ADHD needs to be modified to adapt to treatment objectives.

Here are a few ways speech therapists and SLPs modify stuttering treatment for children with ADHD –

Medication

Although there is no medication for stuttering, there are several compounds that doctors prescribe for ADHD. One of the most common and popular ones include Ritalin (methylphenidate).

It helps children become more receptive to external stimuli. The effects of the medication peak after 1-hour of consumption. It provides speech therapists with a roughly 2-hour window to talk to the child, assess their knowledge and attitude towards stuttering, and teach them fluency techniques.

Modification of the Environment

Environment plays a significant role in how a child with ADHD reacts. For example, a classroom with a window overlooking a garden or playground may be overly distracting for the child.

On the other hand, a closed room with muted colors and no artwork on the walls can help the child focus. Combining medication with a modified environment can help SLPs reach out to a child with ADHD who also stutters.

Mode of Instruction

Children with ADHD often perform well when placed alone instead of in big groups. Whenever possible, SLPs should insist on one-on-one therapy with the child instead of group therapy.

Most importantly, the duration of the instruction should not exceed the attention span of the child. It is the therapist’s responsibility to keep the sessions interesting for the child.

Behavior Modification

Increasing positive behavior can be quite challenging initially since children with ADHD may appear impulsive and hyperactive. However, positive reinforcement has been shown to be most effective in modifying the behavior of children who have ADHD.

For example, the SLP can establish a reward system. Each time the child identifies a disfluency they can receive a token. They can later barter the tokens for reinforcers like playtime or toys.

SLPs should remember that children with ADHD will require considerable positive reinforcements. Therefore, they should provide reinforcers quite frequently.

Language Training

ADHD impairs social and communication skills in children. It is up to the SLP to teach the child to be a good listener while teaching them to identify and reduce disfluencies.

SLPs should emphasize the importance of steady eye contact, and waiting for one's turn to speak. That can teach a child to become a good communicator as well.

Stuttering and ADHD share quite a few neurological factors. Therefore, it is no surprise that a significant percentage of children who stutter also have ADHD.

ADHD makes treating stuttering in children all the more challenging due to the short attention spans and hyperactivity. However, it isn't impossible. With experience and patience, an SLP can have a breakthrough with a child who stutters who has ADHD.

If you suspect that your child is showing signs of stuttering, speak to a speech therapist and get them checked up for signs of ADHD. Starting therapy early can help them learn good communication and social skills. It will help your child make friends, take chances, and embrace success in life.

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