Attention Deficit or Speech Delay or Behavior Problems?

This seems to be the ultimate question that I get asked when working with little ones and school age kids! It is also one of the hardest questions to answer since it isn’t always clear. To help with the process, there are some key questions to consider. 

Definitions

Before we dive into the information, I want to clarify the difference between behavior difficulties and attention deficits and speech and language disorders.

Attention Deficits: There is a WIDE range of severity concerning attention difficulties/deficits. Problems with attention is developmental and symptoms include one or more of the following: decreased attention, distractibility, short attention for tasks, decreased organization, impulsivity, restlessness, shouting out, hyperactive, being off topic. Some children with attention problems may need environmental modifications, compensatory strategies (such as movement breaks or preferential seating in class), and/or medication.

Behavior Disorders: The term behavior disorders or behavior problems can mean MANY things. Basically (for the sake of time), this term can be used to include mental health disorders such as bipolar, anxiety, or oppositional defiant disorder. It can also include children who have trouble following the rules or have inappropriate types of behavior for the situation but have no clinical origin. 

Speech and language disorders: This term can mean MANY things. If you want more in-depth information, please read Speech and Language Disorders Page. A child who has a speech or language disorder has difficulty communicating. For a quick overview, he/she may have trouble saying sounds (articulation), clearly expressing ideas in verbal or written form (expressive language), understanding language in verbal or written form (receptive language), and/or eating food safely (feeding/swallowing)

So which is it?

Speech, behavior or attention?!

Well, again, this can be difficult to tease out for many reasons. It could also be that a child has all three! To examine this question, let’s discuss children by age!

Under 3 Years Of Age

Speech/Language VS Behavior

I’ll never say never, but from my clinical experience, most children under 3 years of age who have a speech or language disorder are not not talking because of behavior concerns. Language at this age is fun, new, and more importantly POWERFUL! 

Some parents say my child is lazy, likes the attention or is being manipulative. Personally, I have not found this to be common. This is from personal, clinical experience. 

Attention VS Speech Delay

At times, attention may play a small role. A child may not be talking because he or she is too busy being busy!!

If this is the case, you may want to encourage speech and language development during some “heavy lifting” tasks. Literally….heavy lifting! Have your child move “heavy (relative for their strength)” blocks or buckets of water while trying some language elicitation techniques. You can build a fort or water plants and work on language at the same time! A busy child will exert their excess energy during the “heavy lifting” task and then will be able to attend to speech and language development 

You can also work on speech and language development during meals. At mealtime, a child has to sit and attend for a few minutes as least! Refer to this our page for ideas to try.

For more, first word ideas, don’t forget to check out Toddler Talk!

Preschool: 3-6 Years of Age

At this age, things get a bit trickier to decipher whether a child is having behavioral issues, attention deficits, and/or a speech delay. It is possible to have more than one, but sometimes, one can look like the other.

As a parent or professional, you need to consider if the child acting out because he/she doesn’t understand and/or doesn’t know what to say or if the child acting out because he/she has behavioral and attention issues (speech/language development is fine).

At this age, standardized assessment can come in handy. Standardized assessments are normed based on age and look at speech and language skills in isolation. You need to know….does a child know their stuff? For example, when you take away environmental distractions, can a child follow directions, understand vocabulary, retrieve vocabulary, etc…? Just keep in mind that standardized testing does have some cultural bias and is taken out of context. It’s not perfect.

Okay...let’s say the child does well on the standardized testing, yeah! This means, most likely, their breakdowns in communication at home or school may be due behavioral or attention deficits….NOT speech or language deficits.

Let’s say the child did poorly on the standardized testing. This could mean a few things. For starters, if the results are reliable, the child has deficits in speech and language. HOWEVER, there still could be behaviors or attention deficits causing/compounding this delay.  

To decide if attention or behavior needs to be addressed as well as speech/language delay, It is important to observe the child in his/her natural environment and see if/how these compounding factors could be affecting speech and language development. 

For example, let’s say a child is able to answer questions, listening to stories, follow directions right after recess. Well, this may indicate that movement breaks allow the child to be available to learn. Therefore, if a child has frequent movement breaks, his/her attention will improve as well as language learning. Win win!

Another example, let’s say a child is sitting right in front during story time. She appears to be listening and focused. Then, a teacher calls on her and asks her a questions. She gets it wrong. Well, this child may just have a delay in language and no attention/behavior concerns.

If you are concerned with your child’s language development and want activities to try today, Preschool Talk might be right for you!

Elementary Age Children

Deciphering if a child as a speech/language disorder or attention deficits or negative behaviors will look similar to the preschool age section.

First, I recommend gathering data in a small room without distraction and/or complete standardized testing if possible. This will give you an idea if a student has the language skills or not. 

Normal Test Results, Reliable Evaluation

If the child tests in the average range and the results are reliable, (child attended during the evaluation and there were no negative behaviors that would have affected the results), then the child does not have a speech/language delay. However, this does not mean the child isn’t having difficulties at home or in the classroom. It just means that if a child has trouble answering questions, telling stories, or following directions, these difficulty may be due to attention deficits or behavioral problems. The attention and behavior needs to be  addressed through use of environment modifications or compensatory strategies. Once this addressed, speech/ language skills should improve.

Below Average Test Results, Reliable Evaluation

If the child does not test in the average range on standardized testing and and the results are reliable, (child attended during the evaluation and there were no negative behaviors that would have affected the results), this DOES NOT necessarily mean the child has a speech/language disorder!! A child’s decreased attention and/or behavior problems may have caused him/her to fall behind due to lack of attention to language (i.e., the child can’t attend his/her environment long enough to learn needed language skills). This child would qualify for speech language therapy to work on needed areas; however, if attention and behavior are a concern, this MUST be addressed. If not, this child will be in speech therapy forever trying to play catch up. 

Below Average Test Results, Unreliable Evaluation

If a child does not test in the average range but the results were unreliable, (child had poor attention or refused to participate), this DOES NOT necessarily mean the child has a speech/language disorder!! Informal observations need to be made, parent/teacher interviews need to be conducted, and further testing may need to be attempted to paint a full picture.  


Hope this helps answer some of your questions!

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Bridget is an ASHA certified, practicing speech language pathologist. She is passionate about providing parents with information on child speech and language development as well as provide functional, easy activities to do at home! Parents have the power to make a real difference. Follow Bridget at Facebook and Pinterest for more fun!

Author of  child language development eBook series



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