Toddlers and preschoolers at risk to receive a diagnosis of ADHD are often impulsive and inattentive. These children also demonstrate a higher incidence of problems with language development. In some studies as many as 50% to 70% of young children with hyperactive and impulsive behavior were experiencing problems in understanding and expressing ideas through language. These children also demonstrated a high rate of learning disability when they entered school. It is unclear whether their temperament contributes to delayed language or delayed language contributes to their difficulty temperamentally.
Before they learn to speak and begin to attach verbal labels to things, infants must touch, feel and taste as a means of gaining information about the world. Once they learn to use language effectively, words replace touch. Impulsive toddlers, however, often have difficulty making this transition. Typically they continue to need to touch and feel things, possibly as a means of gaining sensory input from the world. This problem may lead to difficulty understanding personal space in older children with ADHD.
In long-term studies, Dr. Walter Mischel and colleagues found a most interesting relationship between a young child’s ability to use language skills while waiting for rewards and later success as a teenager or young adult. In Dr. Mischel’s study, a group of preschool children were given a snack and asked to wait a period of time before eating it. Some were able to wait, others ate the snack immediately. The children were then given a second snack and told if they could delay eating for a specific period of time they would be rewarded with additional snacks. Again some children immediately ate the snack and some did not. Dr. Mischel discovered that those who were able to wait talked to themselves and convinced themselves that waiting was worthwhile. In other words, they used language to delay gratification. In the smaller group of children who could not wait, verbal strategies were often absent. These children often attempted to use physical strategies such as covering their eyes as a means of delaying gratification, often with little success. Dr. Mischel attempted to teach these children verbal strategies similar to those used by the children capable of waiting but this group could not implement these strategies independently.
Both groups of children were followed as they grew up. As teenagers the group able to delay eating the snack functioned significantly better in many areas, including academic achievement, college entrance exams and general behavior than the group who could not wait. While the snack test is certainly not a clinical measure and would not be expected to be an accurate predictor of future behavior for every child, findings from this research are important. Research in this area helps us understand the relationship between language, the ability to wait for rewards and future success. Impulsive children, unfortunately, appear to have greater problems using language to guide their behavior. As we have come to understand that the core problem for children with ADHD is an immaturity in the development of self-control and self-regulation the connection between language and ADHD has become better understood. Language appears to be the primary means by which each of us develops, strengthens and maintains the capacity for self-control. Self-control enables us to delay gratification or reward. Self-control enables us to stick with boring, repetitive, effortful or uninteresting activities, to manage our emotions, to plan, organize, inhibit and open a window between experience and response. Self-control enables us to consider our actions, change the course of action if it is ineffective and monitor our behavior as we progress. The use of language in this semantic way, as a means of relating and conveying meaning, appears to be critically tied to the development of self-control and the capacity to sustain attention and inhibit impulsive behavior.
Past efforts focused on helping children develop self-control skills through the use of language based self-talk strategies, however, have not been found to be particularly effective in modifying the symptoms and consequences of ADHD. If current theory is correct, why haven’t these strategies been effective? In part, I believe it is because knowing what to do is not the same as doing what you know. Thus, simply teaching a child with ADHD a language based strategy to facilitate self-control does not guarantee the child will be sufficiently self-cued as to when to use the strategy nor capable of consistently implementing and bringing the strategy on line at the right moment. Keep in mind that most children with ADHD appear to know what to do but don’t do what they know. Increasingly we believe as a profession that this problem results from an inability to track cues and to use language to facilitate self-control.
I suggest that the reason children with ADHD have not benefitted from the development of self-control strategies is not failure of the strategies but failure of the mindset of facilitators. Just as some children take an inordinately long period of time to develop the skills to swim or ride a bicycle, children with ADHD are going to take a long time to learn to use language for efficient self-directed behavior. If parents and professionals develop a “learning to swim mindset” accepting that some children take longer and recognizing that with repeated trials all kinds of skills can develop then they are more likely to help children with ADHD develop self-control. Remember that ADHD has a strong biological basis. Therefore, if these problems are not the result of a faulty reinforcement history, simply modifying consequences is not likely to lead to long-term significant change. With the children in our Center, I am increasingly directing their parents and teachers to utilize a model developed by Myrna Shure (author of the texts Raising a Thinking Child and I can Problem Solve) as a means of creating daily dialogue to facilitate self-control development in children with ADHD. Time will tell as to the effectiveness of this intervention. However, the development of self-control appears to be an essential component for the future life success of children with ADHD.
