Our journey through the dual diagnosis of DLD and ADHD

In a previous post titled "My Introduction to "real-life" DLD", I talked about my personal journey towards a diagnosis of a developmental language disorder (DLD) for my daughter. Part of my doctoral study focused on the identification of DLD in young monolingual and bilingual children living in a minority context. I was somewhat surprised, initially, to see that my daughter had a language impairment, but over the years, it has become more and more obvious that so many of her difficulties are due to weaknesses in comprehension and in the production of language. However, it was also clear that she had deficits in attention, which was no surprise since this is present in our family. It is quite common to find children with a dual diagnosis of DLD and attention-deficit/hyperactivity disorder (ADHD). ADHD affects approximately 3 to 5% of school-age children. But one question remains: which comes first, the egg or the hen? Were her difficulties with language due to her inability to focus on the details around her, making it difficult to acquire language? Or, on the other hand, were her language difficulties making it difficult for her to focus in class? It has been shown that people with ADHD have a difficult time focusing on things that are not important to them. They need to be interested in the topic in order to pay attention. Second hand importance, that is, what the teacher finds important, is not necessarily something that will be important to the child. 

Research has been conducted on these two groups and the consensus thus far is that a dual diagnosis is possible, however, symptoms in only one of the two disorders are usually more salient, with less distinctive symptoms in the other. In fact, one could argue that my daughter also has dyslexia due to her difficulties with writing. Others suggest that we should use a broader term such as "neurodevelopment disability" to describe children who have significant difficulties and require support, without needing two, three, or more labels. What's important is that the child receives the attention needed to succeed.

As I mentioned previously, my daughter was formally diagnosed with ADHD towards the end of first grade with the option of course to turn to medication for the treatment of ADHD. We researched ADHD and the different types of medication quite extensively. Some sites were better than others. We particularly enjoyed Stephen Tonti's Tedx Talk, which I have included in this post. He talks about ADHD as a difference in attention as opposed to a deficit in attention. He truly focuses on the positives of ADHD, as opposed to all the negatives. We also liked the book "Scattered Minds" by Dr. Gabor Mate. He too focuses on the positive "side-effects" of ADHD and the power of emotional support, patience and love.  The ADDitude podcast is also quite interesting and helpful and I strongly encourage you to listen to a few podcasts on your way to and from work to make good use of your time in your daily commute. In our case, our daughter was prescribed a psychostimulant to help her focus her thoughts and ignore distractions. We decided to medicate her during school days only and work on self regulation on weekends. She is not hyperactive but has difficulty paying attention to things that are not interesting or intriguing to her. One of the most important features of ADHD is that the attention is not deficit, it's inconsistent. In fact, people with ADHD are genetically and neurologically wired to get engaged in a different way then other neurotypically developing people. Once in their zone, they can often hyper focus on the task at hand. She also has poor impulse control and difficulties regulating her emotions, but those are things that we are working on at home, when she is not medicated.  These are actually very common in people with ADHD since they often react very strongly to any kind of rejection and lead very intensive emotional lives. Still, I wouldn't change a thing about her. I love her perspective on life and I learn greatly from her every day, through the ups and downs of daily life.

It was a difficult decision, but in the end, we were happy that we chose to treat my daughter's ADHD with medication for school learning. Prior to that, she was falling behind her peers in terms of reading and writing. Within two months, she had caught up to her peers with her reading, although writing is still a struggle, in part due to her visual-perceptual difficulties and to DLD. My daughter is aware of her diagnosis and recognizes the benefits of taking her medication. We have forgotten to give it to her a few times, which wasn't such a bad thing because she realized that paying attention to the lesson was much more difficult, and that, at the young age of 7 years. Since the formal diagnosis of ADHD, my daughter has been formally identified by an Identification, Placement, and Review Committee (IPRC) at her school. The IPRC will decide whether the student is an exceptional pupil and if so, what type of educational placement is appropriate. This was a concerted effort involving the classroom teacher, the resource teacher, the principal, the special education advisor and myself. We were so fortunate to have such a wonderful team. All those around the table wanted what was best for my daughter, which made the process much easier and very positive. She now receives speech and language intervention through the school and privately, she goes to the resource centre, or the 'club' as they call it, for math, and is given extra time to complete certain tasks. Her teacher even found ways to motivate her to wear her cool new glasses everyday. Kudos to her! She is surrounded by people who care for her and who have a great attitude about her dual diagnosis. I know that she can sense that. She is such a happy child and loves going to school, despite her difficulties.


So yes, my daughter has DLD and ADHD, and maybe even dyslexia, but she is learning at her own pace and according to her interests. I work with her every day on some of her difficulties. At times, she doesn't even realize it, since to her, we are just chatting! I have also worked very closely with her speech-language pathologist and teachers to explain to them, as a parent and advocate, how she learns and emphasized her strengths. As a clinician and researcher, this journey has opened my eyes to a whole new world. Children can learn, despite the many challenges they are faced with. We need to tap into their strengths, build their self-esteem, focus on the positives and help them get into their zone. Self-esteem and socialization is not always an easy one. A study conducted over 20 years ago showed that by 12 years of age, children with ADHD have heard negative messages about their behaviour 20 000 more times than neurotypical kids. What a scary thought! I try to remember that when things get tough and choose my words very carefully. Kids with ADHD are just as amazing as any other kids. We need to focus on their strengths and build on them.

It's been a great journey and one that I look forward to in the years to come. As I mentioned, learning language is difficult for kids with a dual diagnosis. Especially since it's used in math, in French, in gym class, in social studies, outside in the school yard... it's all around us. Did I mention my daughter is also bilingual? Learning a second language is a bit of a struggle for her, but she is learning it the best way she can and has surpassed my expectations ten fold. Just imagine all of the cognitive advantages she is gaining from learning a second language! I will touch on that soon.

My next post will be on June 15th . I have yet to decide what the topic will be. If you have any suggestions, please feel free to let me know.

By Chantal Mayer-Crittenden, 2015.