well hello fellow Travelers on the road to better understanding of ADHD thanks for joining me this week for another commentary on ADHD still trying to spread the science of ADHD out there this week I want to speak about a topic actually related to the video from last week last week I talked about a Fantasia which is a technical term for the absence or deficiency in the ability to make mental images this week we're going to talk about its coraly or alternative uh and that is in the area of speech uh and the term for this is anasia so the question we're raising is is ADHD linked to a deficiency or absence of private internal anend ofasa so let's take a quick look at this and see what might be going on why would I want to concentrate on this well it turns out that just this week over at the website neuroscienc news.com there was an article from a recent science paper psychological paper called Inside The Quiet Mind the absence of inner speech and it's about people who suffer from this anend ofasa this complete absence or very deficient internal dialogue that most people have and people vary on the extent to which they have this internal dialogue but when it is absent or very weak it has been given a term and people with weak internal speech have been compared to others for what kinds of cognitive and other problems might they be experiencing due to this deficiency in mental selfs speech so uh we're going to take a look at that in just a moment but I want to point out that there has been a long history in ADHD studying the delays and the irregularities in the development of private or inner speech in ADHD going all the way back to one of the first pap ERS is this one back in 1999 by Laura Burke and Michael pots Laura went on to actually publish an entire book of edited chapters on this topic but Laura focused her research on ADHD children and their development of private speech and what she found is that the whole process of development in ADHD was delayed compared to the speech of other children and that the quality of the speech they were using was filled much more with off task or task irrelevant speech that had little to do with the task the children were supposed to be working on that they were verbalizing out loud during task performance longer into their development than typical children do typical children eventually begin to start to use whispering to themselves and then eventually internal mental speech that you can't hear anymore and ADHD children seem to be delayed in that and that they were talking out loud more this may help to explain by the way why excessive talking is related to ADHD it may be that children and even adults with ADHD talk out loud more because they have less private speech whereas others are talking more to themselves in their mind mind and of course other people can't hear that so it's a rather compelling hypothesis nonetheless we know that people with ADHD talk more than others we know that when you're talking out loud you cannot engage in private speech because it uses the same speech system as public speech uses so either you're doing one or you can do the other but you can't talk to yourself and talk to another person at the same time in any case this goes back more than 30 years that we have known that private speech is a problem for children and probably for adults with ADHD so uh let me show you what I'm talking about here I'll bring up my PowerPoint because I've been studying this for a very long time and private speech is part of my larger theory of executive functioning and its extension to understanding ADHD so um is ADHD linked to deficient private speech the answer is yes we have many many studies showing that there's at least a developmental delay in the emergence of private speech in people with ADHD so does this then mean that people with ADHD have more anasia that is they're more likely not to have any private speech or to have very weak private speech well let's take a look at what's associated with anasia because I think you're going to see that many of the difficulties that these people experience are also difficulties that we see in people with ADHD so remember we're speaking now about a significant weakness or absence of the capacity for generating private mental or internal speech this problem with internal speech in typical people has been noted to be associated with difficulties with verbal working memory tasks well we know that ADHD is associated with that too substantially actually there's a robust literature demonstrating with problems with holding verbal information in mind that's guiding Behavior over time no surprise then people with anasia have trouble with verbally guided Behavior either talking to themselves to guide their performance or following the instructions of other people again that relies on representing what others have said in our mind in speech form and then using that speech to guide ourselves well we know the people with ADHD struggle with that as well listening to others doing what they're told to do that is and even talking to themselves and using their external speech to guide themselves all of that has been found to be problematic in people with ADHD anend phasic have also been found to have difficulties with rhyming tasks I don't know that that's been studied an ADHD but this has been people with anasia have difficulties with reading comprehension we know that when we read to ourselves silently or even subvocally kind of whispering we have to hold the content of the passage in mind in order to extract its meaning so we need verbal working memory for reading comprehension and if you don't have internal speech and that imp impairs your verbal working memory it's got to impair your reading comprehension and along with that your ability to comprehend the stories that other people may be telling you about narrating to you in verbal form and as I've said we know that people with ADHD struggle mightily with difficulties with reading comprehension and with story comprehension as read by others finally research has shown that phasic also have problems with narrative writing writing down their thoughts in order to create a written narrative perhaps writing an essay for a class in school uh and so on so that's quite an array of difficulties that anasia is associated with and people with ADHD have been found to have similar difficulties raising the possibility that the absence or weakness of private speech is part of ADHD now as you know from my theory of executive functioning I have argued that as children develop they don't have executive functioning to begin with when they're one or two or even three but right around 2 to three years of age we start to see children beginning to turn behavior on themselves and one of the first things that was discovered by vigotsky no less the Russian neuropsychologist is that when we study how children develop a mind's voice they go through this process of internalization and it goes like this at the beginning over here on the left side of our diagram young children have people who speak to them and they respond with language or they just generate language but they're not talking to themselves by the time they're between 3 and 5 years of age represented here in the middle graph or diagram we begin to see them have mental representations about events and they start to talk to them themselves even when no one is around so self-peer selfe that's very visible to other people it doesn't help to guide them they can't use it for self-control yet but talking to themselves has begun now over the next 5 to 10 years as represented here on the right that speech is going to become private the child is going to learn to inhibit their face their lips their larynx and going to be able to talk to themselves in their mind and we see this transition when children go from talking out loud when they're alone to Whispering like this when they're doing math for instance and then eventually you can't see the face moving and language that is internal speech is now in the head they can talk in their mind so and what's going on as you see over here is that they're talking in their brain but that that signal isn't entering the spinal cord to generate external speech it remains private or internal and I believe that that's how the executive function of verbal working memory develops and as I've said there's ample research to show that verbal working memory is deficient in people with ADHD and I have argued that it's deficient because of the delay in this development from public to selfs speech to private mental speech leading to problems with an inner voice and with verbal working memory so theoretically I've been talking about this since the early 1990s in my books on Executive functioning and extended to ADHD so let's come back then and ask that question again why might anend fasia be associated with ADHD sorry I'm using the graph from last week so we see the a Fantasia word here that should be a nasia so why might that be associated with ADHD well as we said last week ADHD is linked to deficiencies and a wide variety of executive functions one of those is verbal working memory and verbal working memory is founded on the internalization of speech and the use of self- speech in our mind and that anasia so it's very possible that anasia is linked to the difficulties with verbal working memory but it's also possible just as I said last week that it's not so much the absence of an internal voice that's the problem in ADHD though it still could be by adulthood we know it is in kids but it's the reduced capacity of that selfs speech to actually guide Behavior remember what we said ADHD is a performance Disorder so even if you're using private speeech in your mind or you're talking to yourself out loud that doesn't necessarily mean that's going to be very effective at guiding performance over time this is why we often tell people to write down their du list or instructions to themselves and to put it in a physical visual form around them and not rely so much on some talking to themselves in their mind to help them with self-control so there we have it I do think that there's a strong possibility that many people with ADHD suffer from anasia the absence of or a weakness in private speech and if they don't we certainly have ample evidence that that private speech is interfering with verbal working memory and that they're having difficulties using it to guide their speech over time and as I've said before a lot of the problems we saw with anend phasic are problems that we see in ADHD as well and here is that list once again that I talked about so um I'd love to hear from you on this have you found that either you or other people with ADHD seem to have difficulties with private speech it tends to be more irrelevant it tends to be weak it tends not to guide Behavior very much or they simply don't have it at all let me know what you think of this and let me know about yourself and if that's a problem because I love hearing from my subscribers and I hope you enjoyed this presentation because I think it helps us to understand some of the self-regulation and executive functioning difficulties that ADHD produces thanks for joining me this week everybody I hope you found it informative I see you again next week with another commentary on a ADHD and as always be well and live well thanks everybody bye now