Tuesday, April 17, 2007

Does ADHD make it harder to become more fluent?

Lynne wrote an interesting comment:
My teen son has been diagnosed with ADHD-inattentive type and has stuttered since age 2 or 3. I have always felt that the two were tied together. He has a hard time using the techniques, and if he does, it's hard to concentrate on anything. Processing speed in class is much slower than what is expected and makes the task and speech worse if he is made to hurry.--Lynne
There are some researchers like Per Alm who see a link between the two. Lynne's son might have had some mild neurological incident around age 2-3 and therefore develop stuttering and ADHD-like symptoms. However, it might also be a pure coincidence. For example, some kids stutter and have asthma. That does not necessarily mean that both are related to each other. The kid might just have been unlucky to get both.

Nothing special here. But Lynne's observation is intriguing: ADHD-like symptoms seem to make applying speech techniques much more difficult. Based of this assumption, I can formulate the following prediction. Let's assume you have two possible casual sources of childhood dysfluencies: genetic (design flaw) and neurological incident (design implementation flaw). Kids with either or both of them start stuttering. Their brain tries to compensate to produce fluent speech. The kids with neurological incident are more likely to have ADHA-like symptoms, and are LESS ABLE to compensate. They are therefore LESS LIKELY to recover.

So I would predict that the share of stuttering kids with bad genes as opposed to neuro incident should DECREASE over time!!!


Anonymous said...

Hi Tom!

Thanks for the email and for the posting. Just a quick answer, I'm in England for the moment. Yes, I think you are summarizing the results of my studies appropriately. However, there are a few comments I would like to add (which you may add to you blogg if you like). Firstly, my study was done with adults, and not a very big group. ADHD in general often has a quite strong genetic link, and the thesis by Oyler 1994 support the possibilty of some heritable traits of ADHD in some stuttering children. So, I guess it is possible that among stammering children there are cases with a genetic influence for both stuttering and traits of ADHD. When it comes to the chances of recovery I think there are some indications for a higher risk for persistent stuttering in cases with traits of ADHD, but we would need more information to be able to estimate the numbers.

Yes, as Lynne and you write, traits of ADHD in stuttering might possibly make it more difficult to keep the attention focused if using treatments aimed at controling speech using various fluncy skills. However, I have not seen any no studies about this.

Best wishes,

Anonymous said...

Thanks for commenting. I am trying to work on understanding the neurological side of what is happening, ADHD meds slightly increased stuttering, but a G.I. tract medicine made him unable to speak. The name of it was hyoscyamine. I think it is a muscarinic antagonist, which would increase dopamine? Am I right? His pediatrician is working on the ADD with Lexapro. I think he feels better, but not too much help yet with attention. I'm not a scientist (I am an Occupational Therapist, but it's been a long time since school!). If anyone knows the answer--any ideas. We'd welcome ideas.

Anonymous said...

This is a great topic and one that will certainly occupy more of our research in the future. I would like to make a few comments.

First, one major issue in ADHD is the individual’s ability to monitor their behaviors on-line. Thus, it will be increasingly difficult for a person with ADHD/stuttering to monitor their speech and make corrections at the moment of stuttering.

This has huge intervention consequences if parents or SLPs are pushing a child with ADHD/stuttering to “use their techniques.” As the famous Barkley quote goes, ADHD is not a problem of not knowing what to do, it is a problem of doing what you know.”

Second, there is some evidence to support the idea that stimulant medications for ADHD, which target increasing dopamine levels, may actually increase stuttering. This is also the case with Tourette Syndrome where these meds can increase tic behaviors. Unfortunately these case reports have not been followed up with rigorously controlled studies.

Third, the hypervocalic and impulsive vocal behaviors of many children with ADHD often resemble cluttering. If you look at the DSM IV classification for ADHD and compare it with cluttering symptoms, there is a high level of overlap. I would suggest trying some intervention strategies for cluttering to see whether your results are improved.

Joe D.

Anonymous said...

I did read about the cluttering. My son's speech therapist calls his difficulty "blocking," with repetition. Often no sound comes out, or he can't say a word and has to substitute. This occurs as often as every 5 words. He is a great kid and for the most part just keeps on talking. So I do not think what my son has is "cluttering." He also has no hyperactivity (I think that is a behavior that goes along with "cluttering." Cluttering does sound like my sister's speech. She has a lot of breaks, unusual intonation etc... but she also has a developmental delay.
Alex has had some improvement recently using the "Fluency Master." I think partly because he does not have to constantly think about how to say something. My concern currently is helping with the ADD--organization, keeping up with all the little details of life that pile up especially with school--and to not make a negative impact on his stuttering.
I'm sending these comments along to Alex's speech therapist and perhaps he could comment. I'm only guessing that I would know what cluttering sounds like.
Traditional stimulant meds made the stuttering somewhat worse and made him untypically angry.
Thanks for the comment!

Anonymous said...

Here's something related to the ADHD/ Stuttering thread. What do you think?

ADHD and Stuttering: Similar EEG Profiles Suggest Neurotherapy as an Adjunct to Traditional Speech Therapies

Page Range: 5 - 22
DOI: 10.1300/J184v05n04_02
Copyright Year: 2001

Contributors: Brenda Ratcliff-Baird PhD, Staff Psychologist, Hollins Communications Research Institute, Raonoke, VA, 24020, bratcliff-baird@hollins.edu


Background. This study investigated differences in theta and alpha activity measured by electroencephalography (EEG) at frontal sites between stutterers and nonstutterers during focused attention tasks. Methods. EEG was recorded from 22 male, right-handed developmental stutterers and 22 male, ageand handedness-matched nonstutterers in six conditions: baseline resting-eyes-open; baseline resting-eyes-closed; eyes-open focused attention; eyes-closed focused attention; eyes-closed backwards-counting math task; and eyes-open auditory delayed nonmatchto-sample task. Results. Significantly more theta was recorded at frontal sites (FP1/2, F3/4, F7/8 and FZ) in each condition for stutterers than for nonstutterers. Significantly lower alpha (8-10 Hz) was recorded at these sites in stutterers than nonstutterers in all conditions. No hemisphere effects were found for either group. Conclusion. The finding of more theta and low alpha activity in stutterers lends empirical support to an attentional component of stuttering. There are strong similarities in the EEG, morphology, and behavior of stutterers and individuals with attention-deficit/hyperactivity disorder (ADHD). These similarities suggest that neurofeedback, which has proven successful in the treatment of ADHD, may hold promise as a viable adjunct treatment to traditional speech therapies for stuttering.

Journal Title:
Journal of Neurotherapy:
The Official Publication of the International Society for Neurofeedback and Research
Volume: 5 Issue: 4
ISSN: 1087-4208 Pub Date: 1/1/2001

Unknown said...

As a genetic stutterer with add i feel ive got something to add here. The medication Dextroamphetamine (dexedrine) worked really well for my add AND stuttering. It allowed me to use my techniques and get those thoughts in before the sounds were being made. Plus, it helped with grades and the ADD.
Im still ADD, but ive progressed heavily with my fluency. Im now out of school and a Retail Salesman :-P