Why underlying speech and language disorders in conditions from ADHD and autism to dyslexia and DSI need to be addressed

Even though speech and language disorders are the number one disability in children, and on the rise for some reason, genetic or environmental or both, and even though the importance of early detection and treatment to children exhibiting early speech and language delays has been well researched and documented, there is little awareness about its impact on learning and behavior. The silence both from and about “late talker” children is not golden. Awareness can help bring more children a voice, which is why The Late Talker book is so important.

According to the analysis of the US Department of Education 2001 statistics by Dr. Mark Geier, while there has been a 4 fold increase in the numbers of children with autism, there has been a 30 fold increase in the numbers of children with speech and language disorders in the past ten years. As alarming as that sounds, we suspect the numbers of children with an undetected underlying speech and language disorder could in fact could be higher. It is hard to know the exact numbers of how many children have speech and language impairments for two main reasons:

1. Speech and language disorders are frequently attributed as part of another diagnosis.
2. Speech and language disorders are often undiagnosed.

The problem in not recognizing if a child has a specific speech and language disorder either alone, or co-existing with another diagnosis, is that the child may or may not receive the appropriate therapies to address the communication impairment to give the child the best prognosis. Most appreciate that there are specific appropriate therapies for autism, dyslexia, sensory integration dysfunction, central auditory processing disorder, and ADHD, and that they can vary. Yet most don’t address the fact that there are also specific appropriate therapies for speech and language disorders as well, which are also unique. In the case of severe speech disorders such as apraxia, it is critical to do these specific therapies frequently and intensively.

If disorders of speech and language go undiagnosed and/or untreated, or they continue to be attributed to another diagnosis, we are not addressing the full problem and not providing children with undetected underlying speech and language disorders the best chance at being a successful communicator in the future.

As my coauthor of The Late Talker, a neurodevelopmental pediatrician, states, ” We know that many children who have neurologic problems do not have just one problem, but multiple overlapping signs and symptoms. A child can have a speech and language impairment, sensory issues, ADHD, PDD….”

The Late Talker Book

So keeping that in mind, why then is the importance of addressing specific speech and language disorders with appropriate therapies ignored or downplayed in so many conditions?

Through CHERAB’s outreach many report that in addition to the speech and language disorder their child has also been diagnosed as having another condition, or two, or three… Some children do have more than one condition, and some have been misdiagnosed. When you read some of the symptoms of other diagnoses it’s no wonder. Perhaps we need to stop listing speech and language as part of another diagnosis and address it for what it is -a disorder that is on the rise to epidemic proportions.

Here are examples of how speech and language disorders are attributed to other conditions. All have specific therapies, however I’ll only touch on them for example. As you read the following -think of your “late talker child” and how closely he falls into the following descriptions of:

Autism

“Autism is a term that refers to a collection of neurologically-based developmental disorders in which individuals have impairments in social interaction and communication skills” … “People with autism can make progress if they receive appropriate, individual intervention. Pre-school children who receive intensive, individualized, behavioral interventions show good progress. In addition, limited pharmacological interventions are available to treat symptoms associated with autism.” http://www.cdc.gov/nip/vacsafe/concerns/autism/autism-facts.htm

…could they also suggest speech and occupational therapy? At least speech therapy? Was something left out here or is it me?

CAPD

“Children with CAPD may demonstrate difficulties in speech, language, and/or learning” http://www.ldonline.org/ld_indepth/process_deficit/capd_perc.html

Dyslexia

The British Dyslexia Association describes a sign of dyslexia as “Later than expected speech development ” and states “There is a large body of research linking speech and language difficulties in early childhood to later literacy problems.” And according to the Society for Neuroscience, “Many scientists have identified brain regions related to dyslexia with high-tech imaging techniques that photograph the brain in action. The tools have helped them link the disability to speech sound processing, vision and language brain systems” Therapy? According to Dr. Harold Levinson, a world-renowned psychiatrist and neurologist “some dyslexics will have severe reading, spelling and speech difficulties while others will have major problems with only math, memory and concentration. Yet all suffer from an inner-ear-determined dysfunction”

…What is and is speech therapy good for “inner-ear-determined dysfunction” for dyslexics who exhibit speech problems?

Sensory Integration Dysfunction

In the book The Out of Sync Child (which I love!) the author Carol Kranowitz “gives excellent examples of typical indicators that can signal a parent (or grandparent or caregiver) that a sensory integration dysfunction may be present. A few of the examples of typical symptoms in children include oversensitivity to touch, movement, sights, or sounds; an activity level that is unusually high or unusually low; coordination problems; delays in speech, language, motor skills”

And the list goes on…

Since I don’t have time or room to go into every disorder, impairment, disability, and condition that also credits “speech delay or difficulty” as part of the diagnosis, let’s just study what we found above.

Motor planning problems, speech delays, and difficulties, the signs of the various conditions above, are signs of a speech or language disorder as well as discussed in “The Late Talker” What about ADHD someone may ask. (OK so one of you did which is why I built this new page) “Are there links between ADHD and speech problems?”

Since I list ADHD in my top ten reasons to celebrate the new book, ‘The Late Talker’, let’s concentrate on ADHD.

Did you know in some samples those with a diagnosis of ADHD have “undiagnosed” speech and language disorders as high as 40% and 50% of the time?

As a mom, I have personal experience ( twice ) with late talkers. One of my late talker boys also has ADHD.

Due to a traumatic birth, my oldest son Dakota was in therapy overseen by a neurologist from three weeks old. Dakota also was a late talker, (which we all considered the least of his problems in comparison to his eating and breathing problems) Dakota has been diagnosed by neurologists and developmental pediatricians as having either ADHD, ADD, or CAPD (central auditory processing disorder) numerous times as well (and ADHD “suspected” and pointed out to me by each of his teachers from preschool to second grade… as well as most baby sitters, strangers in the supermarket, and one neurologist who left the exam room for a second to get a pen and came back to find Dakota knocked his entire wall shelf down that I was trying to put back up!)

Diet May Help ADHD More Than Drugs

Even though Dakota has been diagnosed with ADD, due to educational and therapeutic strategies, and without any medication, Dakota is a brilliant gifted third grade student who receives straight A’s academically. Dakota is mainstreamed, and classified for his ADHD, and he receives pull out speech therapy two times a week through the school district. Dakota, like Tanner, has benefited from the right formula of Omega 3 and Omega 6 oils. (You can read about that here) Dakota is a true success story and a testament to early intervention. Quite a few doctors have called Dakota the “miracle child” at this point. Perhaps it was part miracle, part therapy, part early intervention, and part brain stimulation. Either way, with or without ADD, Dakota is “normal” now, actually better than normal, and for that we couldn’t be happier, no matter how it happened.

– Lisa Geng, President
The Cherab Foundation

ADHD and Communication Disorders

Here are some snips from articles about the relationships between ADHD and speech and language development.

Comorbidity in ADHD and Associated Outcomes
by Dennis P. Cantwell, M.D.

“…Communication disorders describe developmental speech and/or language disorders. These children have elevated rates of ADHD. It is also clear that children referred for psychiatric problems and given a diagnosis of ADHD have undiagnosed speech and language disorders in a number of cases, as high as 40% and 50% in some samples. The nature of this relationship is not well understood. It may be that the speech and language disorders lead to attentional problems in some particular way or that they are both due to some common underlying factor, such as some type of central nervous system (CNS)
dysfunction.

The long-term outcome of children with speech and language disorders is fairly good for the disorders themselves. However, these children are highly likely to develop learning disorders as a residual outcome of their speech and language disorders. Thus, the presence of
communication disorders is likely to lead in ADHD children, as it does in non-ADHD children, to the development of academic performance problems due to specific learning disabilities in the language- related areas. This probability must be taken into account in the
design of treatment plans to alter long-term negative outcome…”

Impulsivity, Inattention, and Language
Sam Goldstein, Ph.D.

“Toddlers and preschoolers at risk to receive a diagnosis of ADHD are often impulsive and inattentive. These children also demonstrate a higher incidence of problems with language development. In some studies, as many as 50% to 70% of young children with hyperactive and impulsive behavior were experiencing problems in understanding and expressing ideas through language. These children also demonstrated a high rate of learning disability when they entered school. It is unclear whether their temperament contributes to delayed language or delayed language contributes to their difficulty temperamentally.

Before they learn to speak and begin to attach verbal labels to things, infants must touch, feel and taste as a means of gaining information about the world. Once they learn to use language effectively, words replace touch. Impulsive toddlers, however, often have difficulty making this transition. Typically they continue to need to touch and feel things, possibly as a means of gaining sensory input from the world. This problem may lead to difficulty
understanding personal space in older children with ADHD.

In long-term studies, Dr. Walter Mischel and colleagues found a most interesting relationship between a young child’s ability to use language skills while waiting for rewards and later success as a teenager or young adult…

ADHD: Speech and Language
American Speech Hearing Association

“Inattention, hyperactivity, and impulsivity have their effects on speech and language…some children with ADHD also have learning disabilities that affect their speech and language. Evaluation of each child’s individual speech and language pattern is critical to developing an appropriate treatment plan…”

ADHD And Communication Skills
Eileen Bailey Director of ADDHelpline

“There are a number of ADD symptoms that can become barriers to effective communication (see a list here) …The ADD brain, always active, yet lacking in certain chemicals cannot always retrieve the accurate data it needs. The right descriptive word may be filed somewhere in their brain, but not readily accessible. We have all “known” something that we can’t remember and say that it is “on the tip of our tongue.” Somewhere in our brain, we have the knowledge, but at the moment we do not have the ability to locate it.

So it is with an ADD brain. With thoughts constantly moving quickly around and distractions taking attention away, it can be hard to locate the piece of information within the vast storage of the brain. Therefore, the correct words or phrases do not come. The ADD person becomes frustrated because they know what they want to convey, they can feel what they want to convey, and sometimes they think they have conveyed that very thought. But somewhere, it has been misconstrued, or not understood. Those that do not understand ADD may feel lost in the conversation, get annoyed or just look at you with amusement or non-comprehension.

Whatever happens, the communication can break down and cause frustration on both ends…”