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My 14-month-old granddaughter has no words yet and is very, very active. Is delayed speech a sign of ADHD?

Kids develop at different speeds in different areas; progress on all fronts is what we look for 

Steven G. Dickstein, MD

Pediatric Psychopharmacologist, formerly with the ADHD and Disruptive Behavior Disorders Center
Child Mind Institute

Q: I have a 14-month-old granddaughter who is still not developing any words. She began walking within the normal timeframe.  Prior to that she was a very fussy baby who was not easily soothed unless you picked her up and kept moving. Now that she is mobile, she never stops moving, and doesn't engage in any activity for very long before moving on to something else. I am concerned that she may have ADHD. Can a speech delay be a part of that condition?

Fourteen months is really early in development, and it's important to keep in mind that development comes in spurts, and a single child can develop at different speeds in different areas. One child might be a fast talker—talk early, be very verbal—but not be a fast mover, or not be very physically coordinated or strong. Or vice versa. Yes, we expect kids to have their first words by the first year, but there's a whole range of normal. The best way to keep on top of this is to have a good relationship with a primary care pediatrician and keep track of those developmental milestones. What you want to see, in addition to meeting major benchmarks, is that there is progress on all fronts—emotional development, social development, language development, motor development. You want to see them all progressing.

If you're concerned, there is a national program called Early Intervention (EI) that is federally funded and available in every community to do a good thorough evaluation of a young child, to look at his behavior and compare it to developmental norms, and, if necessary implement services. Their responsibility is to evaluate kids under 3 and work with kids who have developmental delays, because the earlier kids get help the better the outcome. Pediatricians are very familiar with EI evaluations and can help guide the process.

Regarding the question as to whether speech delays are a part of ADHD, it is important to know that while a given child can have both speech delays and ADHD, they are different disorders. Speech delay isn't specific to ADHD, although certainly kids with ADHD can have co-occurring learning difficulties, including language delay. 

It must be said that 14 months is too young to see if a child has ADHD. Our earliest controlled treatment studies of ADHD are in preschool children, ages 3 to 5, and even at that age it can be challenging to make diagnoses, because attention spans are low and impulsivity is high in all young kids. To make a diagnosis of ADHD, one has to be able to observe behavior that is developmentally out of the normal range age-related peers and make sure that the difference is not due some other disorder, environmental stressor, or medical illness.

Another thing to keep in mind about a young child who is hard to manage is that there are good evidence-based behavior training therapies—Parent-Child Interaction Therapy, the Incredible Years and others—that can help adults and strong willed kids get along better and increase compliance, even if you don't change the child's actual level of hyperactivity or impulsivity. This kind of intervention can help foster good attachment, helping parents find the balance between following the child's lead and also setting firm, clear, consistent, and loving limits.

As a grandmother, of course, you need to voice your concerns in a way that will be constructive, and not alarmist, so the child's parents won't feel criticized and can hear what you're saying. Encouraging them to monitor your granddaughter's development across all domains, and stay in close touch with their pediatrician, is the best way to start.

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