How to Look for an ADHD/LD Overlap
Think it’s attention deficit holding your child back in school? It may be time to think again, and look for learning disabilities.
Andrew was 10 years old and in the fifth grade when I first evaluated him. He was diagnosed with ADHD in first grade and had been taking medication since that time. Andrew did well in first through third grades. But he struggled through fourth grade, and was having greater academic problems in the fifth grade.
During my assessment, I found that on ADHD medication, his hyperactivity, ability to stay on task, and organization improved. However, on or off medication, he had difficulty with reading. He could read, and he could understand what he had just read, but he did not always retain the subject matter. He also had trouble organizing his thoughts when doing a writing assignment. An evaluation confirmed that, in addition to his ADHD, he had Learning Disabilities (LD).
Melissa was an eighth-grader. She was failing her courses. Her teachers reported that she often did not pay attention or stay on task. They “hinted” that her parents should discuss the possibility of an attention problem with her family doctor. The physician referred her to me. Melissa found it challenging to pay attention when she had to do independent schoolwork in class and while doing homework. She couldn’t retain what she read, nor could she do writing assignments. She had no difficulty staying on task when she did chores or when with her friends. She didn’t have problems with attention in elementary school.
Her inattention began in middle school. I decided that she did not have ADHD, and I looked for other reasons for her problems. My informal assessment suggested that her reading, writing, and math skills were weak for her grade level. She also struggled with organization (of materials and of information) as well as with time management. These clues suggested that she might have LD. Formal psychological and educational testing confirmed that Melissa did indeed have LD.
All About LD
Between 30 and 50 percent of all individuals with ADHD also have LD. The reverse is also true. Between 30 and 50 percent of individuals with LD also have ADHD. This high level of comorbidity requires that parents have their child evaluated for LD.
Melissa’s case illustrates another problem that confuses parents and teachers. If LDs are not addressed, a child will become insecure and anxious in school, fidgeting or doodling or misbehaving. We often think these are signs of ADHD. Such behaviors might also reflect anxiety because of difficulty doing and keeping up with the work.
So, how do you tell which it is? If such behaviors are the result of ADHD, they will have been observed in previous grades. That is, they are chronic and pervasive. However, if these behaviors start at a certain time (started no sooner than fourth grade) or occur only in certain situations, such as when asked to work independently at one’s desk, the possibility of LD must be considered.
If your child reminds you of Andrew or of Melissa, you need to know precisely what the problems are and insist on the proper services to help. Don’t blame the victim or hand over all responsibility to the teacher.
In preschoolers, look for:
- Slow language development, difficulty with speech, poor understanding of what is being said.
- Poor coordination and uneven motor development, such as delays in learning to sit, walk, color, use scissors. Later, watch for difficulty forming letters and numbers.
- Problems with memory, routines, and multiple instructions.
- Delays in socialization, including playing with and interacting with children.
In early elementary school, look for:
- Problems with rapid letter recognition and with learning phonemes; difficulty blending sounds and letters to pronounce words.
- Problems remembering familiar words by sight. By late second or early third grade, difficulty with reading comprehension.
- Problems writing letters and numbers. Later, problems with spelling and grammar.
- Difficulties in learning math skills and doing math calculations.
- Difficulty remembering facts.
- Difficulty organizing materials (notebooks, binders, papers), information, and/or concepts.
- Losing or forgetting materials, or doing work and forgetting to turn it in.
- Not understanding oral instructions; difficulty expressing oneself verbally.
In later elementary school, look for:
- Difficulty reading material independently and retaining what was read, as well as organizing thoughts for written work.
- Difficulty learning new math concepts and successfully applying them.
- Increasing difficulty organizing school and personal materials.
In middle school, look for:
- Increased difficulty retaining what was read (reading fluency), organizing and writing answers and doing reports, and mastering advanced math concepts.
- Increased difficulty with organization, and with developing learning strategies.
Game Plan for Managing LD
As a first step, discuss your concerns with the teacher. If she agrees, most public schools will do a three-tier evaluation of your child. First, the teacher observes him and tries different approaches to help. Second, if there is no improvement, the teacher consults a special education teacher. Modified teaching strategies or materials might be tried. If these do not help, a formal evaluation for LD is done.
If your child’s teacher does not respond to your concerns, speak with the principal. (Note: You are still entitled to help if your child attends a private school.) The principal should set up a meeting of school professionals to discuss your concerns. Ideally, this group will agree to observe your child in class, and suggest an evaluation. This evaluation might consist of observations and possible interventions. If none of these are successful, psycho-educational tests should be done.
You might choose a private professional to do a psycho-educational evaluation. If the results confirm your suspicions, he or she should go to your school and ask that these findings be dealt with.
If your child tests positive for LD, it is important to remediate the problems. Appropriate accommodations may be needed in the classroom. My best advice for parents — and the child — is always the sooner, the better.