ADHD and communication

Also called Attention deficit hyperactivity disorder and communication, ADD and communication

Interrupting, losing the thread, blurting and drifting: the communication side of ADHD, and the difference between not attending and not understanding.

What it is

ADHD is a neurodevelopmental difference in attention, impulse control and activity level, and the Health A-Z covers it as ADHD. This entry is about communication, where ADHD shows up in ways that get read as rudeness or carelessness: interrupting, talking over, blurting the answer, going off on tangents, losing the thread of a story mid-sentence, missing half an instruction, and zoning out of a conversation that's gone on too long.

None of that is a language problem. The person understands the words and can produce them. What's different is the attention and impulse control that conversation runs on, and the working memory that holds a long instruction or a turn while waiting for it. But ADHD does often travel with DLD and with cluttering, and a child with both needs both looked at.

Who it can help

Children and adults with ADHD, diagnosed or not, and the teachers, partners and colleagues who find conversation with them exhausting and don't know why. It's especially useful for the inattentive presentation, more common in girls, where the person is quiet, seems to be listening, and has missed most of it.

It's not a substitute for assessment, and it's not the right lens if the person also struggles to understand ordinary sentences; that's language, and needs a therapist.

How it works

Attention is the gate. If a spoken instruction is long, the middle of it never arrives; the child does the first and last parts and is told they weren't listening. If a conversation is slow or predictable, attention drifts and the person comes back having lost the place. Impulsivity means the thought comes out the moment it arrives, which is the interruption, and the blurted answer, and the tangent.

Working memory is the second piece. Holding a turn in mind while someone else finishes is hard, so the person interrupts before they lose it. Holding the shape of a story while telling it is hard, so it wanders. Neither is a lack of understanding, and treating it as one, with slow, simplified language, makes attention worse.

Medication helps many people with exactly these things. Structure helps everyone: short instructions in writing, one at a time; agreed signals; note-taking as a way of holding the turn; and movement, which for many people with ADHD is what makes listening possible.

Getting started

Write instructions down as well as saying them, and keep them to one or two steps. Ask the person to say back what they'll do. In meetings and classrooms, let them doodle, fidget or stand; it isn't inattention.

Agree a way to hold a thought without interrupting: a notepad, a raised finger, a "park it" gesture. Practise the repair phrase: "sorry, I jumped in, go on."

For a child, ask school for reasonable adjustments: a seat at the front, instructions on the board, movement breaks. Ask whether a speech and language therapist has ruled out a language difficulty alongside.

Where to get help

Assessment is via the GP to the local ADHD or neurodevelopmental service; waits are long and the GP can say what's available. Speech and language therapy through school or the GP if language is in question, and the RCSLT explains the profession. Speech and Language UK covers attention and listening in children, and Mind has plain guidance on ADHD in adults.