Attention-Deficit/Hyperactivity Disorder (ADHD)

ADHD is a developmental disorder with symptoms of inattention, impulsivity, and/or hyperactivity, that persist for more than 6 months, starting before the age of 12.

Symptoms of inattention include difficulty paying attention, keeping on task, or staying organized. Symptoms of hyperactivity include often moving around, feeling restless, or talking excessively. There may also be signs of impulsivity, such as interrupting others, difficulty waiting for one’s turn. 

For people with ADHD, these behaviors are more frequent than expected and happens across several situations.

Feeding and Nutrition: What You Need to Know 

ADHD has been associated with eating disorders in both children and adults. ADHD may impact feeding in the following ways:

• Impulsivity: People with ADHD may act impulsively, impacting their choices and the amount of food they eat, potentially leading to overeating.
• Inattention: A lack of attention may result in difficulty sitting through a meal, or difficulty focusing on the meal. 
• Disorganisation: A difficulty with routines may result in irregular mealtimes for someone with ADHD, therefore impacting their appetite and nutrition
• Sensory preferences: Some people with ADHD have specific sensory preferences that can affect the variety of food they take and potentially impacting on their nutrition. 

Ways to support the feeding of someone with ADHD include: 

• Establishing a routine and regular mealtimes
• Minimising distractions during mealtimes
• Modelling positive eating habits. Eating as a family can be an avenue to model desirable feeding habits
• Exposure to a variety of food with consideration of the person’s sensory preferences

A speech therapist can support a child with ADHD in increasing his food variety, and a dietitian can help optimise his nutrition. 

How Attention-Deficit/Hyperactivity Disorder (ADHD) Affects Speech Development 

ADHD may affect a child’s learning in school.

For example, a child who presents primarily with inattention may

• Appear distracted or not to be listening when spoken to
• Miss out details or make careless mistakes in schoolwork
• Have difficulty sustaining attention through tasks or activities
• Appear disorganised, and often losing his/her belongings 
• Appear forgetful, and not follow through instructions, or not finish assigned tasks 

A child who presents primarily with hyperactivity may

• Often fidget or move out of seat when expected to be seated
• Appear to be moving excessively when it is not appropriate 
• Have difficulty doing work or participating in activities quietly
• Talk excessively or interrupt someone else
• Have difficulty waiting for their turn

Specific to speech and language, a child with ADHD may

• Talk too quickly or too loudly
• Have difficulty expressing their ideas in an organised or coherent manner
• Have difficulty maintaining a conversation (e.g. keeping to topic, taking turns)

Ways we can support the communication of a child with ADHD include

• Minimising distractions when communicating
• Giving clear, specific and concise instructions to increase their success of following through
• Use of visual cues, such as words and/or pictures, to help your child remember expectations or information
• Pausing and waiting, to give your child time to process information and respond to you
• Reminding your child gently to slow down or wait for his turn when he’s talking too fast or too much or when he’s interrupting someone else 
• Teaching about social rules and cues, such as through stories and role-play
• Giving opportunities for your child to express him/herself verbally

Speech therapy can be useful to support the development of the communication skills of a child with ADHD, such as working on

• Language skills (including vocabulary, sentence structure, etc)
• Narratives (e.g. organising details and sequences when storytelling)
• Social skills (e.g. conversation rules)

Occupational therapy is also useful to work on a child’s executive functions, such as planning ad organsiation in daily activities. 

Movement and Motor Skill Challenges 

More than 50% of children with ADHD have difficulties with gross and fine motor skills. 

A child with ADHD may present with

• Late walking or running
• Difficulties with coordination and balance 
• Slow reaction time
• Handwriting difficulties 
• Poor hand eye coordination
• Difficulty completing self-care tasks 
• Sensory processing difficulties 

Ways you can support the motor development of your child with ADHD:

• Encourage regular physical activities
• Encourage your child to participate in self-care activities (e.g. buttoning shirt) regularly, so that he/she gets frequent practice to refine his motor skills
• Break fine motor tasks into more manageable steps, such as helping your child focus on one part of his homework at a time 

Occupational therapy can support children with sensory processing difficulties, and physiotherapy and occupational therapy can support the development of their gross and fine motor skills. Therapists can provide tailored exercises and activities to address specific motor challenges.

Supporting Your Child’s Development 

ADHD sometimes co-occur with other disorders, such as autism spectrum disorder, tic disorders, dyslexia and developmental coordination disorder, further impacting on their development in communication, movement and feeding. 

Ways we can support a child with ADHD in his/her daily lives include

• Helping to create a predictable routine
• Helping him/her get organised, such as placing belongings in the same place so he/she will be less likely to lose them
• Minimising distractions – e.g. providing a clean workspace, turning off TV when he/she is doing homework
• Reducing choices offered so that he/she will not be overwhelmed 
• Helping your child break complex tasks into more manageable steps
• Praising positive behaviours and efforts

With adequate support from caregivers and professional, the development and daily functions of people with ADHD can be improved.

References:

https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd

https://www.cdc.gov/adhd/diagnosis/index.html

https://www.imh.com.sg/Mental-Health-Resources/Conditions-and-Challenges/Pages/Attention-Deficit-Hyperactivity-Disorder-ADHD.aspx 

M.-L. Kaiser, M.M. Schoemaker, J.-M. Albaret, R.H. Geuze. What is the evidence of impaired motor skills and motor control among children with attention deficit hyperactivity disorder (ADHD)? Systematic review of the literature. Research in Developmental Disabilities, Volume 36, 2015, Pages 338-357, ISSN 0891-4222, https://doi.org/10.1016/j.ridd.2014.09.023.

Méndez-Freije I, Areces D, Rodríguez C. Language Skills in Children with Attention Deficit Hyperactivity Disorder and Developmental Language Disorder: A Systematic Review. Children (Basel). 2023 Dec 21;11(1):14. doi: 10.3390/children11010014. PMID: 38275435; PMCID: PMC10814652.

Mokobane M, Pillay BJ, Meyer A. Fine motor deficits and attention deficit hyperactivity disorder in primary school children. S Afr J Psychiatr. 2019 Jan 22;25:1232. doi: 10.4102/sajpsychiatry.v25i0.1232. PMID: 30899581; PMCID: PMC6424539.

Panagiota Kaisari, Colin T Dourish, Suzanne Higgs. Attention Deficit Hyperactivity Disorder (ADHD) and disordered eating behaviour: A systematic review and a framework for future research. Clinical Psychology Review, Volume 53, 2017, Pages 109-121, ISSN 0272-7358, https://doi.org/10.1016/j.cpr.2017.03.002.