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To acquire age-appropriate social skills, certain parts of the brain need to develop normally. Children with ADHD may experience social difficulties and experience what is called a social cognition deficit. This chapter outlines social clumsiness in ADHD. It discusses social cognition as a function of the brain, specific social competence deficits (social blindness, egocentricity, lack of appropriate inhibition, insatiability, insensitivity to style and convention, lack of responsiveness, over-talkativeness, difficulties reading facial expression, aggressive tendencies, lack of judgment, poor understanding of group dynamics, misinterpretation of feedback, poor social prediction, poor social memory, lack of awareness of image, poor behaviour-modification strategies), management of social clumsiness, and autism spectrum disorder.

Vanessa was first seen at the clinic one year ago, at the age of eight years. Her teacher had reported that she seemed ‘slower’ than the other children in the class. She observed that Vanessa often did not understand what was going on in the class, and was easily upset by changes in routine. She also had difficulties expressing her ideas and relating her experiences. Her reading, spelling, and writing were all behind those of the rest of the class. A psychologist’s assessment showed Vanessa’s non-verbal intelligence to be in the average range, but with difficulties in comprehension. Her reading, spelling, and writing all showed more than two years’ delay. A doctor could find no abnormalities to account for her problem. Her hearing was tested and found to be normal. Vanessa was referred to a speech therapist. She found that Vanessa’s comprehension was at a level more than two years below her age and that she had many difficulties in her understanding of language. For example, although she understood common prepositions such as ‘in’, ‘on’, and ‘under’, she misinterpreted others such as ‘beside’, ‘behind’, ‘through’, and ‘around’. She also confused past and present tenses. The speech therapist spoke to the parents and the teacher about ways of helping Vanessa. She also started seeing her regularly, once a week, for speech therapy sessions. Now, after 10 months of such help, Vanessa has shown great improvement in her language comprehension and her academic skills. Language plays a central role in specific learning difficulties. Reading requires the ability to decode written language and spelling and writing require the ability to encode spoken language. Arithmetic requires language skills to understand the words used to state problems involving numbers. This chapter deals with the disorders of speech and language that often accompany specific learning difficulties. These may involve the understanding of language (which is referred to as receptive language) and the use of language (which is referred to as expressive language). There may also be involvement of speech (which relates to the clarity and fluency of the spoken word).