It was almost inevitable that my child would be diagnosed with ADHD. Having it myself, and having a family tree full of ADHDers, I knew my son was another leaf on the tree.
However, it was clear in kindergarten that he was also struggling with something else. His teacher told us that he could not read the word “the” even after repeated exposures to the word. She felt he was paying attention, but could not read words at his age level and intellectual capacity. After a full neuropsychological assessment, before beginning first grade, it was discovered that he was also severely dyslexic.
About 50 to 60 percent of ADHDers also have a learning disability. The most common of these is dyslexia, a language-based learning disability that affects reading. Eight to 17 percent of the population is affected by dyslexia, and it is vastly misunderstood.
Contrary to popular belief, dyslexia is not reading letters or words backward. It manifests itself in different ways in different people. Dyslexics may have difficulty with phonemic awareness, which is the recognition, and breaking down, of the sounds of letters. A difficulty in segmenting words is also common to the disorder. A patient of mine named Ryan told me that he used to read the word “doctor” as “do-ctor,” instead of “doc-tor.” Rhyming and fast, effortless recognition of sight words (such as “the”) are also problems. All of these difficulties affect the rate, accuracy, fluency, and comprehension of material that is read.
Retrieving even simple words can be challenging. My patient, Jane, was telling me a story, and became frustrated when she spoke of “the thing we eat meat with” because she couldn’t think of “fork.” Incorrectly substituting words is common. For example, one boy with dyslexia said, “Hawaii has lots of tornadoes,” instead of volcanoes.
The rapid naming of letters, objects, colors, and pictures may be impaired. Learning the alphabet is more difficult for dyslexic children. These challenges often coexist with high verbal abilities. A patient, Jack, scored above the 90th percentile in vocabulary and verbal comprehension, but was in the 5th percentile in reading indices. We tend to expect good speakers to be good readers. This is not the case with dyslexics. Other challenges include spelling, cursive writing, foreign languages, and any information that relies on rote memory (phone numbers and so on).
Dyslexia runs in families and has a genetic component. Many children with dyslexia have a dyslexic parent. My wife and I had our own reading challenges when we were younger. The prevalence rate of dyslexia among individuals with an affected sibling is about 50 percent. Dyslexia is a neurologically-based condition, and substantial research has found differences in dyslexic and non-dyslexic brains.
Differences and Similarities
ADHD symptoms are exacerbated by dyslexia, and vice versa. Both ADHD and dyslexia have several symptoms in common, such as information-processing speed challenges, working memory deficits, naming speed, and motor skills deficits. So it is easy for a parent or a professional to mistake dyslexic symptoms for ADHD.
“We didn’t even suspect my daughter may have dyslexia,” said one patient’s mother. “We assumed that reading was tough because of the inattentive symptoms of ADHD. Now we realize that it was dyslexia that was exacerbated by the ADHD.”
ADHD symptoms are usually apparent from the first day of school, whereas dyslexia is often not fully recognized until fourth or fifth grade, when the shift is made from learning to read to reading to learn. Parents who express concern early on are often told by teachers that “every student reads differently and they will catch up.”
Differences and similarities between the two conditions include:
> Dyslexic students who haven’t been diagnosed with ADHD will exhibit concentration and attention problems, primarily with reading demands but generally not in other situations. ADHDers’ attention is low in any unstimulating environment or task.
> Generally, those diagnosed with dyslexia are better at auditory processing than those with ADHD.
> Those with ADHD and/or dyslexia are at high risk for self-esteem issues. Marcus, a patient of mine, became clinically depressed and afraid of school due to his severe dyslexia and ADHD.
Interventions for Dyslexia
> It is essential that someone diagnosed with either ADHD or dyslexia is assessed for the other condition. The longer dyslexia goes unnoticed, the worse its impact on reading development and self-esteem.
> Consult a dyslexia expert to help your child get the right intervention. Schools are not always equipped to teach a dyslexic student. There are specific reading interventions for dyslexia — Orton-Gillingham, Wilson, and Lindamood-Bell, to name just a few. Guided reading is not an intervention for dyslexia. Make sure your child gets an intervention that has been empirically validated for dyslexic students, not one designed to help struggling (non-dyslexic) readers.
> Treating ADHD can help overall focus, concentration, and working memory, but it will not cure dyslexia.
> Parents sometimes fear the label of “dyslexia” for their child. They do not want their child to feel different, but dyslexic kids do feel different, because they are. It is our responsibility to see that the difference is not equated with inferiority. Studies show that when children are diagnosed as having “dyslexia” — versus vague labels like “specific learning disability”—their self-esteem is positively affected.
> Develop an IPP. Instead of the IEP that is used in school, I developed an IPP (Ignorance Protection Plan) for my son. When he was first diagnosed, I explained to him that some people will incorrectly think he is not intelligent because of his dyslexia, and may be unkind about it. And there will be other people who will be shocked that he has such an advanced vocabulary. So we came up with a plan to deal with those responses.
My son and I rehearsed ways he should act and what he should say when someone says, “You don’t know how to read?!” Proud tears welled in my eyes just one week later, when he came home from school citing an interaction with another student who was surprised that he could not read the lyrics to a song in class. He told her that he had dyslexia, a learning difference that Walt Disney and many other successful people had. He said that dyslexia makes reading difficult for him, but that he is smart.
There are many gifts that come along with the ADHD/dyslexic brain. However, these gifts are fully expressed only when the pitfalls are properly assessed and treated. A study conducted at Cass Business School, in London, found that 35 percent of entrepreneurs were dyslexic. Dyslexics were more likely than non-dyslexics to delegate authority, and to excel in oral communication and problem-solving. In other words, dyslexia and success can go hand in hand.