To ensure the overall well-being of child clients with attention-deficit/hyperactivity disorder (ADHD), counselors frequently work in combination with other service providers such as speech therapists, physical therapists, occupational therapists and sleep specialists. According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), many children with ADHD have also 
experienced speech delays, gross motor delays and fine motor delays. In addition, many clients with ADHD showcase sensory issues or have a comorbid sensory processing disorder. Many children with ADHD seemingly also struggle to settle down at night, especially when parents are trying to get them into bed.
What is the connection between ADHD and these other deficits? If we take a look at the structural and chemical makeup of the ADHD brain, we find similarities with these other areas. First, let’s take a look at what an ADHD brain can look like:
- There can be a smaller frontal lobe with less blood flow to it. This is where the executive functions exist: planning, organization, task initiation, task completion, time estimation, time management, self-regulation, social behavior, short-term memory, working memory, motivation, impulse control, intentionality, purposefulness and the ability to transition effectively. A smaller frontal lobe will lead to emotional immaturity.
- The overall cerebral volume is usually smaller as well.
- The neurotransmitter systems of dopamine and norepinephrine are affected. People with ADHD do not produce enough, retain enough or transport these neurotransmitters efficiently through the brain. MRI studies show that this inefficiency can be due to less white matter and more grey matter in the brains of clients with ADHD, which slows transportation. Dopamine is the main “focus neurotransmitter,” heavily associated with the frontal lobe and the executive functions, in addition to being the “feel good” neurotransmitter. It is also heavily linked to the limbic system, which contributes to people with ADHD reacting in a manner that is disproportionate to the event, either positively or negatively. Norepinephrine is involved in focusing on tasks a person considers to be either boring or challenging. In addition, it plays a role in sleep.
- These clients can have a smaller caudate nucleus with less blood flow to it. The caudate is heavily innervated by dopamine neurons, and it plays an important role in learning, memory, social behavior, voluntary movement and sleep.
- Electroencephalograms (EEGs) have shown that people with ADHD have more slow waves (theta waves) present than the general population when they are in an “awake state.” The increase in slow waves is especially pronounced during reading and listening tasks, causing people to lose focus, daydream or become drowsy.
All of this simply means that the ADHD brain is less mature and has less activity than a neurotypical brain. It is important to note that a doctor will not order an EEG or MRI either to diagnose or rule out ADHD because these findings are not indicative only of ADHD. In fact, many other issues present this way, including the following.
Speech delays: As stated earlier, the frontal lobe plays a key role in ADHD, but it also plays a role in speech production. There is a significant distinction between those with ADHD who have had speech and language delays versus the general population. It is also important to understand that children with speech and language delays typically have attention spans commiserate to where they are developmentally with language. For instance, if a 7-year-old speaks at a 4-year-old level, the child’s attention span may be that of a 4-year-old. This does not mean the child has ADHD. In addition, the child with a speech delay might find it challenging to communicate needs appropriately, so the child may begin to act out, have tantrums or melt down, much as a child with ADHD might demonstrate. Therefore, if a child has a speech and language delay, a thorough investigation needs to be conducted to determine whether the child’s “ADHD types of struggles” (of both attention and behavior) are related to the language delay, or if, in fact, the child also has ADHD.
If a child does have both ADHD and a speech delay, a physical therapist can make recommendations to the speech therapist concerning how to use specific large-body movements during speech therapy sessions. This will bring blood and glucose to the frontal lobe of the brain. This can be beneficial for speech production and will help the child with ADHD to feel more emotionally regulated.
Another speech issue connected with ADHD is speaking too quickly. This will sound almost as if the child’s speech is slurred. This can be due to the cognitive impulsivity related to ADHD. It can be addressed in a psychotherapy session or a speech session by having the child draw slow, wavy lines as the child speaks.
Motor skill delays: The ADHD brain processes slower than a neurotypical brain because of the transportation difficulties with the neurotransmitters and also because of the increase in slow wave (theta wave) movement. Interestingly enough, researchers find that about half of all children with developmental gross motor coordination disorders actually suffer from varying degrees of ADHD.
Why? Possibly because slower brain processing speed is also manifested in motor skill deficiencies. These motor delays are helped by physical therapists. However, there are other techniques used as well because there are activities that can help speed processing in the brain, such as balance-based activities. Physical therapists and occupational therapists tend to work together to incorporate balance-based activities with both motor skill delays and ADHD because the act of balancing the body actually requires the use of both hemispheres of the brain. In turn, this speeds processing, increases focus and decreases impulsivity.
Other extracurricular activities such as gymnastics, yoga and martial arts involve balance and practicing controlled movement, which are crucial for both ADHD and motor skill deficiencies. Some children with ADHD will have difficulty with fine motor issues such as buttoning clothing or tying shoes, and occupational therapists can help with those concerns as well.
Sensory processing disorders: Reward-deficiency syndrome is when the brain is asking for more dopamine. This can be witnessed in the hyperactive response of those with ADHD when they “sensory seek” (spinning around and around, for example) or “novelty seek” (such as hanging over a two-story banister). Dopamine also limits and selects the sensory information that arrives to the frontal lobe, which is one reason that children with ADHD show these sensory issues. In addition, there is a less developed frontal lobe in cases of ADHD. This poses a “double whammy” because both dopamine and frontal lobe issues are involved with sensory concerns as well.
An actual sensory processing disorder occurs when a person has difficulty with the way the brain senses, organizes and utilizes sensory input. This results in unexpected outcomes of movement, emotions, attention and adaptive behaviors. It is as if the brain is using unexpected information on the way in, so, naturally, the unexpected emotions and behaviors come out, which can create further stress and anxiety for the person. Some people with ADHD will have certain sensory concerns without having a full-blown sensory processing disorder, but other people will have both ADHD and a sensory processing disorder. Occupational therapists are skilled at helping children with these issues.
Sleep issues: Children with actual sleep disorders or inconsistent sleep patterns will showcase symptoms similar to ADHD such as irritability, less developed social skills, attention difficulties, memory impairment, lower academic output, increased internalizing and externalizing of problems, not complying with requests and aggression. Because of this particular symptomology, it is crucial to rule out a sleep disorder before diagnosing ADHD.
Can a person have both ADHD and difficulty sleeping? Yes, but not always. A study was published in The New York Times in which researchers focused on children with comorbid diagnoses of ADHD and a sleep disorder. A year after surgeries or treatments for the sleep disorders, only half of the children retained their ADHD diagnosis, meaning that the other half had been misdiagnosed with ADHD; it was only the sleep disorder causing their symptoms.
It’s important to note that “trouble sleeping” was once a symptom qualifier to secure an ADHD diagnosis. The symptom was removed from the DSM in 1987, but the issue can still occur with some people. Remember that the caudate nucleus and norepinephrine are involved in both ADHD and in sleep, which is one reason people may struggle to sleep some nights. Most children with ADHD tend to have difficulty settling down at night and getting into bed because of their hyperactivity and impulsivity, which can spike in the evening hours. But once in bed and calmed down, children with ADHD can usually fall asleep in a time frame that is considered “within normal limits.” Many children with ADHD tend to wake quickly and experience an accelerated start to their day.
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Donna Mac has worked professionally with ADHD for 15 years as a teacher, a YMCA director and currently as a licensed clinical professional counselor in a therapeutic day school. She is also the mother of twins diagnosed with ADHD at age 3. She has published a book titled Toddlers & ADHD, available on Amazon.com, BarnesandNoble.com, Balboapress.com and at her website: toddlersandadhd.com.
the note on the bottom about the author should be changed. No psychologist or medical professional would diagnose adhd at age three. That is ludicrous.
ADHD emerges in children at the age of three, some even in their later 2’s. My daughter started showing signs of ADHD right before she was three years old and was diagnosed at three, took behavioral modification therapy at four and medication at five. My son, on the other hand, showed signs of ADHD (his is more inattentive type than combined like my daughters) so I didn’t even bother with having him diagnosed until after I seen how he did in kindergarten. It was awful. He was failing all classes, being disruptive and having tons of behavioral issues and was on his way to special education classes. I had him diagnosed and prescribed medications and within the next month he was making straight A’s, won the school science fair, making friends and was sitting back with the groups of children instead of by himself in the corner.
Even though the writer’s children are diagnosed doesn’t mean that they are being medicated or anything like that. There isn’t many (I am saying many because I actually know of one who will and he needs his license taken) who will medicated a child before the age of five. Some doctors and psychiatrists like to wait until the age of six, but that depends upon the severity of the ADHD symptoms. You need to make sure you have all of the facts before commenting something rude.
Am Rose
My son is 3 1/2years has been diagnosed with ADHD. What type of medications you gave your Son. Please reply..
It’s all over the place about sleep apnea and kids it makes sense . I work for a orthodontist and it starts with getting tonsils and adenoids out when there little. Then a palletel expander will expand everything open and that will help them breath better at night and make room for there teeth coming in. It’s interesting
My nephew got diagnosed at two year old with ADHD. It transpires now he has aspergers as well. My grand daughter has been diagnosed with autism 3 and a half and now they want her assessed for adhd which she most definitely has I imagine. Whether she actually just has adhd or both autism and adhd is to be determined as she dosnt have all the autistic traits just some of them. The reason she is being tested for adhd is because she MAY have to go on medication because at present she is unable to sit still even for a moment. This is turn affects her brain in regards to learning and retaining anything. My husband and I are all for medication because she is a danger to herself. There is three incidences whereby she could have been killed due to running off and escaping . I could go on but I wont. If my grand daughter is started on medication it is because she needs it. It is called helping . Not to is child abuse.
Hello i read this today and i just want to know how is your grand daugther?? Ehat you say about her it is the same story of my daughter..it is incredible! Its like you were talking about me.
Sorry my english its not bert perfect.i mostly write amd speak spanish. I just want to ask how is your grand daughter doing? And if she has any diagnostic now…my daughter had the same situation …she was with both diagnostics,, but i putted in therapies.y after 6 in therapies and extracurricural classes that helped so much she is now not showing any sign of diagnostics
I found this article to be quite informative. I have a 19 month old who has had her tonsils and adenoids taken out at 15 months old, sensory issues, spins around the room when you put music on,has a severe speech delay of 20 Standard deviation and from reading this article may have ADHD. She is also having gastroenterology issues. The speech therapist wants to have her assessed for Autism just to be sure. I feel as though I’m struggling with my team of specialists when it comes to my baby. Any recommendations on how to advocate for my baby? I am truly overwhelmed but trying to get the help my baby needs to communicate with the rest of the world. I have noticed at night she doesn’t stay asleep, wakes up crying frequently and she still uses a bottle since she doesn’t know how to drink from a cup or straw. Please offer any help or suggestions to a desperate mother who wants to help her baby overcome some of these issues. Thank you in advance.
Did you have your child evaluated by your state’s early intervention program? Well, it usually addresses concerns of parents for children from birth to three years old. The intervention program does have speech language pathology, occupational therapy, physical therapy. I believe there are some other possible therapies. I think all is dependent upon the state in which you live and available resources. If your child requires services past the age of three you will be instructed via Coordinator/ meeting to contact your local school district and they should provide a solution for further treatment for your child.
The only problem with the states early intervention program is that for your child to qualify for speech therapy they have to have a vocabulary deficiency that is equal to a child half their age. My son was advanced in everything, he walked early, studied the world, interacted with others around him all ahead of time. Then when he was two he still wasn’t talking much. His doctor suggested I contact the local early intervention specialists about it. When she met with him there were some motor, social interaction, and speech categories that he wasn’t able to do that a typical two year old should be able to do. Yet he didn’t qualify because half his age is one year old. As far as a one year old is considered he was on par. Finally at three years old he talks. But he still needs speech therapy. He says s in place of g, t, and d. He says u, instead of o. His two year old brother has a great vocabulary that is clear and concise. I am trying to have him retested. I also applied for him to be tested for autism, but again he displayed many signs of autism but not strongly enough to be placed in the program. In 3 days he is having his adenoids and tonsils removed due to sleep apnea. Many things in this article are on point with my son, I am hoping that after the surgery and with speech therapy he can make the progress expected of a chid his age.
“My son was advanced in everything, he… studied the world…” This seems like hyperbole; do you only mean to communicate that he “appeared to observe his surroundings in a somewhat focused manner?”
PANS/PANDAS
Hi Michelle,
It would be good if you get in touch with a biomed doctor as my son also had similar problems and biomed has helped the most.
who is a biomed doctor and how he can help a child of 4 yr. dignosed adhd with delay speech.we are sending him for speech therepy from ladlst 5months. he has improved his sitting habit but slight improvement in attention and speech.
I’ve son 3 years, grinds teeth,speech delay, jovial, is walking in the house but once outside he runs alot,when He wants something he points …is on with occupational therapy ..can he go for speech therapy at same time?
Rose
Many parents find doing multiple therapies address the holistic needs of the child. So, yes, speech therapy is definitely good to do in sync with other therapies. Good Luck and stay positive.
Michelle
It’s sad that doctors make children with ADHD wait until they are a teacher’s problem before they medicate. My daughter is going to be 6 in December and she knows she’s different. She’s been bullied in school thanks to the lack of medical help. She deals with so much every day. She constantly has to be disciplined due to her inability to control her impulses and her behavior. I hate it and so does she. I myself have ADHD so I understand how hard it is, not being 100% in control of yourself. It’s sad that our relationship is strained due to this. I understand psychiatrists don’t want to just hand out medication to children who don’t need it but depriving a child who does need it is wrong. I feel like she’s being deprived of her full potential, like I was as a child. I was undiagnosed for most of my life.
I would try cod liver oil , cold pressed Norwegian!
I love how they call it “less mature” because the brain is a different form that perceives and interacts with the world in a unique way.
What a nice judgement statement of people with “immature adhd brains”.
My son just turned four and I can tell that he has ADHD at least I am pretty sure he does, he falls in every category their is and he also has speach delay and some motor issues not to bad though it’s more his espressive launguage he has issues with. He was tested by a Speach and Laungage Therapist and she has said that he has good receptive language and first said she thought mild autisim or it could be ADHD mimicking some autistic traits but she can’t diagnosis it so I have a appointment with a Behavorial Thearipist. I don’t see autism he don’t fall in most categories there so it’s been tough trying to figure out exactly what issues he has besides the ADHD are friends, family see ADHD too and speach delay so after reading this article it is refreshing to find something that relates to him.
“More grey matter”? Shouldn’t that be “less”?
See, for example: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2829134/
A Very useful and logical article that I have come across. Not sure what we can hope when he can’t sit still for a second. I saw some parent in the thread say she herself have had ADHD diagnosed . That fills me with hope that my son will one day be a parent himself. Otherwise diagnosis and OT don’t seem to have helped much for him to sit in a place unless he has something interesting to concentrate on …. in Europe they don’t prefer meds’ seems that meds might be the only hope …
I have had ADHD all my life (of course, I guess). Both of my children have it too. I wish that doctors would stop saying it may “also” be related to sleep. Sleep is always a problem for people with ADHD. Period. End of story. The sooner the debate ends on this the better — for example, another way to look at the data you presented isn’t that 50% of the children were misdiagnosed who had sleep problems, it’s also that 100% of those left did have ADHD. In my opinion ADHD is a circadian rhythm problem. It is also temporal. It is like being out-of-sync when a cell-phone is glitchy… from sleep to everything related with time and task-management. I live with this every day. Ask people with ADHD. Thank you….
Hii, I am from India. I have a 2.5 years old son. A few months back my son’s Paeditrician said that my son might have autism or ADHD. Ber initial observations were saying very few words as compared to a 2 yr old, no eye contact, low pain realisation during vaccinations. He is 2.5 now and having speech delay. I read the whole article and also comments by different parents discussing their own experiences. As per the doctor’s instructions I took him to a speech therapist and be said that my son shows signs of ADHD. I read many articles but the difference between autism and adhd is so less, that for layman it is difficult to understand.Well very honestly no one in the family including my husband belived in it and so is my inlaws. But I fear that he has some issues. Over the last 1 year, I have noticed that My son has sleep issues especially night time, constantly on the move, cannot sit still for a second, cannot focus on watching one cartoon at a time, keeps changing channels, watches same video again and again, speech delay, cannot follow instructions.Though the therapist has suggested a few ways but he is not much cooperative. Firstly I, as a parent, Want to understand one thing that does speech delay have any connection with ADHD or Autism? Also I read something about the brain’s frontal lobe development.. Does this mean he can be termed as a special child and has to be put into a special school? Also any suggestions where and whom can I meet to be 100% sure of what ailment my son is facing. Apologies if I am asking the same questions which has alreafy been discussed in this forun and for my ignorance, but I need some guidance about how to get this treated and be there for my child. As you all know in India formal school education starts from 3-3.5 yrs, so I have some time in hand. Also Im a working mother. Just want an opinion do you all think I should be there at home full time to cater to my son’s needs. I had a support system in terms of nanny and my own mother, but due to such spike in covid cases I am working from home and managing my son all by myself without any nanny.