Nearly 8 million adults in the United States have attention deficit hyperactivity disorder (ADHD). These adults often find speech, social and executive function skills challenging, affecting their social communication. As speech-language pathologists, we can help people with ADHD through educating and coaching social communication skills and self-awareness.
Adults with ADHD experience difficulty forming social relationships, communicating clearly in those social relationships, and controlling executive functions. SLPs understand social communication and skills from our work with people on the autism spectrum, we understand treating executive function impairments through work with acquired brain injury, and we certainly know about treating speech.
The following affected areas fall within our scope of practice:
- Clarity (mumbling)
- Social skills and relationships
- Non-verbal communication (posture, gestures, non-verbal communication)
- Topic maintenance (tangentiality)
- Voice quality
- Executive functions
- Organizing ideas
- Emotional regulation
It makes sense then, for SLPs to help adults with ADHD develop greater self-control, self-awareness and social inclusion. I’ve experienced success working with clients with ADHD using the tips below.
- Set goals: Your client may wish to work on multiple areas of concern in one treatment session. Rather than skimming over multiple treatment goals at once, however, maintain focus on one or two goals at a time. Establish clear and specific goals in the first sessions, then break them down into manageable steps.
- Savor the conversational level: Adults with ADHD spend most of their time in treatment working on conversation. Resist the temptation to consider a goal achieved prematurely. The bulk of sessions will probably get spent on “social” conversation and practicing applied skills.
- Set boundaries and guidelines: SLPs might find that adults with ADHD have difficulty with administrative tasks. Provide consistent appointment reminders—via email, text, calls—written homework instructions and attendance contracts. Also, consider your boundaries for accepting emails or phone calls between sessions, as well as guidelines on exceeding the allotted time for sessions or late arrivals.
- Gentle feedback and empathy: Adults with ADHD might have difficulty receiving feedback objectively. I always use a higher degree of patience and compassion when giving feedback. Try using gestural cues instead of verbal ones. This method reduces risk of embarrassment for your client. I also use reflective listening techniques to help the client understand their own feelings and resistance. Empathetic listening and rephrasing help reduce the intensity of negative emotion that some adults with ADHD have regarding feedback.
- Troubleshoot conversations: When working on social skills, set aside a portion of each session to discuss and reflect on weekly social interactions. When listening to your client’s social successes and challenges, take notes. Compliment your client on instances of successful behavior and revisit any social difficulties. Revisiting a social difficulty can include discussing what the client thinks went wrong, role-playing the situation and enacting role reversals.
- Minimize authority reminders: Many adults with ADHD found school challenging and might continue to resist authority. Power relationships in general, like that of a teacher/student, might trigger anxiety or frustration. With this in mind, set up sessions as a safe space, free from triggers of past struggles. Sit in armchairs instead of behind a desk, for example, and be mindful of the language you use.
Struggling with ADHD symptoms as an adult can be isolating. As SLPs, we can help—as we do with all populations we treat—to facilitate connection through communication.
Do you have any tips on working with adults with ADHD? Share in the comments.
Melissa James, MHSc., Reg. CASLPO, focuses on speech, social and communication skills within her Toronto-based private practice, Well Said: Toronto Speech Therapy. She provides services to high-functioning adults in person and via firstname.lastname@example.org.