# The ADHD Symptoms That Complicate and Exacerbate a Math Learning Disability

Nearly a third of children with ADHD also have a math learning disability. These conditions and other comorbidities, when present in the same patient, are never separate and distinct. Their symptoms impact and complicate one another in ways that educators and clinicians must take into account when designing effective remediation strategies.

At math conferences, I am often the only one talking about learning disabilities. And at learning disabilities conferences, when I present my talk “*What’s math got to do with it? Math learning disabilities, dyslexia, and ADHD,” *I’m often the only one talking about math. There is a near-void of information about the connections and interactions between ADHD, language-based disorders, and math learning disabilities — and the implications for treatment. Yet data tell us this is a critical need.

Roughly 35% of the population experiences math difficulties of some kind, and 6.4% have dyscalculia, or math learning disabilities (MLD). Children with a family history of math difficulties are 10 times more likely than the general population to have trouble with math themselves. This makes MLD as prevalent as dyslexia or attention deficit hyperactivity disorder (ADHD or ADD) — yet it often gets overshadowed in classrooms, IEPs, and clinics.

## What is a Math Learning Disability?

MLD has no biological or qualitative markers. It can’t be diagnosed with a blood test or brain scan. Researchers still debate the areas of deficit and level of severity that constitute an actual math disability. This has led Michèle Mazzocco to call MLD an “obscure term lacking distinct boundaries.^{1}

Like dyslexia, MLD is an umbrella term used when a person has more trouble learning math than would be predicted by other factors. More technically, the DSM-5 defines MLD as a specific learning disorder with impairment in math in which a student displays deficits in one or more of the following areas: number sense, memorization of arithmetic facts, accurate fluent calculation, and/or accurate math reasoning.

*[Take This Test: Symptoms of Dyscalculia in Children]*

To understand MLDs and their connections to ADHD and dyslexia, it is helpful to look at the two types of cognitive processes involved in doing math. Researchers break these processes down into *domain-general* processes and *domain-specific* ones.

Domain-general processes refer to the basic processes of the brain, such as working memory, processing speed, executive functioning, and language processing, which underlie many tasks. These are the processes responsible for most of the overlap with other learning disabilities.

Domain-specific processes solve math problems using the brain’s hard wiring, often referred to as the “number module,” located in the Parietal Lobe. These processes specifically affect math and are responsible for math learning disabilities. And, of course, each individual will have a different profile of MLD and co-morbid ADHD and other LD.

Domain-General Processes | Domain-Specific Processes |

basic processes | Hard wiring for math |

underlie many tasks and executive functions | “number module” |

~ overlaps with ADHD and other LDs | ~ MLD |

## Domain-Specific Processing Problems and Math Difficulties

It turns out humans — and other animals, from primates to birds and even bees — are hard-wired by evolution to do some types of math. The number module in the brain is responsible for detecting, comparing, and manipulating the “numerosity parameter.” This is where the brain subitizes, or automatically recognizes a small amount without counting; compares amounts; and orders amounts from least to greatest.

*[Take This Test: Does My Child Have A Learning Disability]*

Children who struggle with these basic tasks are at great risk of developing an MLD in school. Their struggles with math will be more severe and more foundational than struggles based on ADHD or dyslexia alone, affecting the child’s number sense at its most basic. If adults can recognize and assess these difficulties early — even before school — they can begin remediation early and intensively to get ahead of the MLD and optimize the likelihood of success.

## Domain-General Processing Problems and Math Difficulties

### Working Memory Impairments and Math

Working memory is like the desktop of the brain. It is where we store information for immediate use. When a website sends you an authorization code and you hold it in your head long enough to transfer it from the text message to the online field, you are holding it in working memory.

Limited working memory mainly causes two areas of math difficulty: memorization of math facts and ability to follow procedures. To learn math facts, for example, both the question (2+3) and the answer (5) must be simultaneously active in the brain’s phonological buffer. That way, a neural connection between the two can be formed and strengthened. If the answer pushes out the question because of limited working memory, then the connection is not made.

Students with working memory challenges need explicit instruction in memorizing their math facts. The more neural pathways a brain has to access information, the more efficiently and accurately it does so. That said, rote memorization should be accompanied with manipulatives and models, as long as they are immediately and explicitly connected to the facts.

Solving a problem like 2,305 ÷ 0.3 requires at least 17 steps — each one of which leans on working memory. If a student has to stop to visualize how many times 3 goes into 23 with a remainder, they often come back to the task completely lost. They may understand the concept of division, and even division with decimals perfectly, but their weak working memory leads to a breakdown in procedure.

These students need accommodations like a multiplication chart, mnemonics, checklists, and sample problems. One caveat: students need to be explicitly taught how to use their accommodations.

### Processing Speed Impairments and Math

Slow processing speed, which affects the decay rate in the phonological loop, makes it even harder to move facts from working to long-term memory. Even if a student with processing speed impairments knows their times tables cold, when you ask them what 3 times 7 is, you can almost see their gears slowly turning to bring forward the answer.

While math ability has nothing to do with speed, many teachers use speed as a proxy for mastery. That leaves these kids feeling like failures. Research has shown that timed tests can create serious math anxiety, even in neurotypical kids. And math anxiety can lead to a math learning disability.

### Executive Dysfunctions and Math

Executive function deficits cause a number of problems for math students. Poor inhibition of irrelevant associations clutters already limited working memory. Picture a student thinking 2 + 3 equa… squirrel! When they drag their attention back to the problem, most of it is gone and they have to start all over again. If they are trying *not* to think about lunch, that also takes up valuable processing power.

Difficulty switching between tasks means a student may complete a mixed addition/subtraction practice worksheet completely accurately, if only it were all addition problems. Weak detail analysis may mean a student understands integers perfectly and then completely misses every single negative sign on the test. These students can be significantly helped by a few accommodations:

- Scaffold mixed review: rather than jumping from pages with only one type of problem to a fully mixed review with different problems intermingled, start with a page of half addition (top) and half subtraction (bottom). Move onto a page where the problems switch every other line. Once the student has mastered that, pull out that traditional page of mixed review.
- Color code details: more accurately, have the student devise and use a color code. On a page reviewing order of operations, for instance, they could use a blue highlighter to highlight all the exponents, then a yellow one to highlight all the negative signs. First, you are letting them practice detail analysis separate from the rest of the processing they need. You are training the brain to find which details are salient. In addition, they end up with a color-coded page that didn’t take hours for the teacher to complete.

### Language Processing Impairments and Math

Math requires making robust connections within and between the worlds of real quantities, math language, and written symbols. Difficulty in language processing makes those connections difficult to initiate and maintain. These students will be slower and less accurate in retrieving facts from semantics-based, long-term memory. These kids need math concepts, procedures and facts to be explicitly, consistently and repeatedly linked. They also need a lot more practice to get automatic.

Math is its own language, and it is a complex one with multiple ways to express the same concept. We know people with language-based LDs often struggle with multiple meanings. Think about the simple expression 15 ÷ 3. Fifteen divided by three, right? But what about when we ask, “How many times does three go into fifteen?” or “How many groups of three are in fifteen?” or “Three times what is fifteen?” A student with language processing issues may know how to divide 15 by 3, but fail to connect it to the other phrases. It’s as if they have to learn three separate concepts. And don’t even get me started on the fact that minus, excuse me, subtraction, can mean take away, or compare. These kids need explicit instruction in the language of math, including being told that some words mean one thing outside of math and a different thing inside it. (Operation, anyone?)

Finally, self-talk, or verbal mediation is a strategy many of us use to shore up weak skills, memory, or the understanding we need to accomplish something. We talk our way through it. A student who struggles to find or verbalize words will have trouble with this internal support.

## ADHD Comorbidities

### ADHD and Math

Nearly a third of children with ADHD also have a math learning disability, and 25% of children with MLD have ADHD. We know that ADHD is marked primarily by deficits in the domain-general area of executive functioning. Deficits in working memory and processing speed are also red flags. Without co-morbid dyslexia or pure MLD, these students tend to struggle primarily with memorizing and recalling math facts and accurately executing procedures, not with the conceptual understanding of the math itself.

In addition to ADHD-related struggles with working memory, processing speed, and executive functioning, students with attention deficit disorder face some challenges uniquely their own.

Because the ADHD brain habituates to stimuli very quickly, it can be difficult to maintain attention to repetitive tasks, like, say, practicing math facts. In fact, kids with ADHD sometimes get *less accurate* the better they have their facts memorized. Why? At first the memorization is challenging and keeps their brain engaged. The closer it is to rote, the more boring it becomes and the more sloppy errors enter the picture.

The ADHD brain also has a low frustration tolerance. Sticking with challenging content and working through mistakes literally feels worse for these kids than it does for their non-ADHD peers. Worse, people with ADHD are likely to have what researchers call “reward deficiency syndrome.” Dopamine is the reward neurotransmitter. A burst of it makes us feel good when we accomplish something. ADHD brains have less dopamine and have weaker dopamine receptors. That means getting through that tough problem or that boring page of homework doesn’t feel nearly as good as it does to other students.

What’s more, once people without ADHD get used to a reward, the mere anticipation of it gives us a shot of dopamine. So just sitting down to that page of homework gives a little boost as we think about the reward of being done. Not so for a kiddo with ADHD. To add insult to injury, people with ADHD often have rejection sensitivity — mistakes and struggles affect their self-image more than they do for others. Several strategies to help the ADHD brain include:

- Games, preferably with public acknowledgement — of wins, not losses — (parenthetically, it is amazing how rarely I win games I play with my students!), also preferably on the computer, which is bright and shiny and novel even on the second-to-second, pixel level
- Explicit instruction in self-monitoring, goal setting, and charting progress
- Any stimulation to keep the pre-frontal cortex awake, like fidget toys, music, bouncy balls and gum
- Stimulant medication

### Dyslexia and Math

Approximately 70% to 80% of children with dyslexia also have a math learning disability. That means teachers who work with children with dyslexia are almost certainly working with children who have a math learning disability. On the flip side, 50% to 60% of children with MLD also have dyslexia. Children with MLD and comorbid dyslexia experience more severe math learning disabilities than those with only an MLD.

Remember that dyslexia is not only a language-based learning disability, but often involves weak working memory and slow processing speed. It also sometimes co-occurs with receptive or expressive speech difficulties, affecting both oral and written language. It is tempting to focus on reading and writing as the primary, and most important, deficits in dyslexia, but remember to assess — and address — math as well.

A person who is not math literate is vulnerable to manipulation both as a consumer and as a citizen. And that’s not even to go into the correlation between careers involving math and income.

*[Take This Test: Could Your Child Have an Executive Dysfunction?]*

*The content for this article came from Diana Kennedy’s CHADD presentation titled *“Math Learning Disabilities, Dyslexia, and ADHD: Understanding and Remediating MLD.”

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