A Guide for Professionals: Addressing Dyslexia in Children with ADHD Through Evidence-Based Neuropsychology

Neuropsychologist Paola Díaz Infante presents a clinical protocol for the dual assessment and intervention of dyslexia and ADHD.

Introduction

The coexistence of dyslexia and attention-deficit/hyperactivity disorder (ADHD) poses a particular clinical challenge. Professionals must distinguish which difficulties arise from reading acquisition, which are related to attentional and executive regulation, and, above all, how both interact when a child faces real-world demands: reading a text, following instructions, copying from the board, studying, or answering an assessment. 

The comorbidity of both disorders is common, although rates vary according to diagnostic criteria and the samples studied. More important than the exact figure is its clinical implication: ADHD alone does not explain a persistent decoding difficulty, just as dyslexia does not explain every error resulting from inattention, impulsivity, or poor organization. Therefore, the approach should be dual, but not necessarily sequential. 

This guide focuses on professional practice: what to assess, how to formulate goals, which intervention components have the strongest support, how to integrate executive-function supports without displacing explicit reading instruction, and what role new technologies may play.

Dyslexia and ADHD comorbidity: more than two coinciding diagnoses 

Dyslexia is a specific learning disorder characterized by persistent difficulties with accurate and fluent word recognition, decoding, and spelling. ADHD, in turn, is characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with everyday functioning (American Psychiatric Association, 2022). 

The high rate of co-occurrence between the two disorders cannot be explained solely by chance. The literature describes partially shared genetic and cognitive risk factors; however, this does not mean that there is a single common brain abnormality. 

A structural neuroimaging meta-analysis found largely distinct patterns for dyslexia and ADHD and limited overlap (McGrath & Stoodley, 2019). It is therefore more accurate to speak of partially shared risk mechanisms and neurocognitive profiles that may interact. 

In practice, this interaction may increase the demands of a task. A child with dyslexia may need to devote much of their resources to decoding; if they also have difficulty sustaining attention, monitoring errors, or organizing a response, prolonged reading may become even more demanding. This does not mean that executive functions cause dyslexia; rather, they may modulate how the difficulty is expressed and how the child responds to academic demands. 

Why should the approach be dual?

Reading intervention remains necessary when ADHD is present. Explicit, systematic instruction in sound-letter relationships, decoding, spelling, fluency, and comprehension should not be replaced by general attention or memory exercises. 

At the same time, ignoring ADHD may hinder participation, adherence, and generalization. A randomized clinical trial in children with ADHD and reading difficulties showed that intensive reading intervention was particularly relevant to phonemic decoding, whereas ADHD treatment benefited other components of reading performance (Denton et al., 2020). 

The clinical implication is clear: each need requires specific treatment, and both components can be addressed in parallel.

Neurobiological and cognitive foundations of dyslexia and ADHD

The reading brain and the neuroanatomical networks involved

Reading does not depend on a single brain region. Learning to read involves reorganizing and coordinating preexisting visual and language networks until processing becomes increasingly rapid and automatic. 

In dyslexia, differences are observed primarily in left-hemisphere circuits involved in phonological and orthographic processing and in the integration of letters and sounds; nevertheless, it is a heterogeneous, multifactorial disorder, so there is no single “brain region for dyslexia” (Dehaene et al., 2015; Peterson & Pennington, 2015). 

Left occipitotemporal region

The left ventral occipitotemporal region, where the visual word-form area is commonly described, contributes to the rapid recognition of letters, orthographic sequences, and familiar words. As reading experience increases, this circuit helps make visual word recognition more efficient and less dependent on conscious decoding (Dehaene et al., 2015). 

Different activation patterns have been described in children with dyslexia in this network, although these findings should not be interpreted as an individual diagnostic marker.

Temporoparietal network

Left temporal and parietal regions contribute to phonological analysis and the integration of orthographic and phonological representations. This helps explain why phonological awareness and learning grapheme-phoneme correspondences are central to reading development and dyslexia intervention. 

The relationship between phonological skills and reading acquisition has extensive meta-analytic support (Melby-Lervåg et al., 2012).

Inferior frontal regions

The left inferior frontal cortex contributes to phonological, articulatory, and language processes, especially when reading still requires conscious, effortful processing. Skilled reading emerges from coordination between these posterior and frontal networks, not from the isolated functioning of a single region (Dehaene et al., 2015). 

Cognitive impact: interaction between executive functions and reading

ADHD adds a distinct cognitive dimension to the reading profile. It is associated with heterogeneous difficulties in networks related to cognitive control, attention, and behavioral regulation. In practice, this may be reflected in difficulty maintaining a task goal, inhibiting hasty responses, organizing steps, holding relevant information in working memory, or monitoring errors. 

Executive functions constitute a relevant transdiagnostic domain across different neurodevelopmental conditions (Sadozai et al., 2024). When ADHD and dyslexia coexist, these difficulties may interact. 

For example, a child who must devote substantial effort to decoding may have fewer resources available to keep information active, check whether they understood a sentence, or sustain attention through a long text. In turn, impulsivity may promote guessing, omissions, or responses before the word has been fully analyzed; planning and working-memory difficulties may affect writing, the organization of ideas, and following directions. 

This does not mean that ADHD causes dyslexia or that training executive functions is sufficient to correct decoding. Dyslexia involves core difficulties related to learning to read and write, whereas ADHD may increase cognitive load and alter how those difficulties are expressed in the classroom. Therefore, clinical care should integrate both profiles and select specific goals for each need. 

Neuropsychological intervention protocol

Rather than applying an identical program to every child, the goal is to build a clinical formulation connecting assessment, intervention, and everyday functioning. 

Phase 1. Define the profile before intervening

The assessment should identify both reading skills and factors that may interfere with their expression. Depending on the case, it is advisable to examine: 

• Accuracy and speed when reading words and pseudowords;
• phonological awareness and grapheme-phoneme knowledge;
• reading fluency and comprehension;
• spelling and written production;
• oral language;
• attention and inhibitory control;
• working memory and organization;
• executive functioning in everyday life;
• school history, response to previous interventions, and functional impact.

Standardized tests should be integrated with interviews, clinical observation, and information from family and school. Diagnosis should not depend on a single score. 

Phase 2. Intervene directly on reading

When a reading difficulty is present, specific intervention should begin from the outset. Meta-analyses of controlled trials particularly support systematic, explicit phonics instruction for improving reading and spelling in children with reading difficulties (Galuschka et al., 2014). 

Phonemic awareness and the alphabetic principle

The child needs to understand that spoken words can be segmented into sound units and that these units are systematically related to graphemes. Tasks may progress from identification and segmentation to blending, phoneme deletion, and substitution, always connecting sounds to letters when the developmental level allows. Meta-analytic evidence confirms the close relationship between phonological skills and reading acquisition (Melby-Lervåg et al., 2012). 

Decoding and encoding

Reading and writing should be addressed in coordination. Explicit teaching of orthographic patterns, syllables, words, and pseudowords makes it possible to determine whether the child truly masters sound-to-spelling correspondences rather than relying on visual memory for familiar words. 

Fluency

The goal is not to speed the child up indiscriminately, but to increase accuracy and automaticity. Modeled, assisted, and repeated reading may be used with texts matched to the reader’s level, recording both errors and changes in fluency. 

Comprehension

When decoding consumes too many resources, comprehension may deteriorate. Vocabulary, prior knowledge, inferences, identification of main ideas, and monitoring strategies should be addressed. For a child with ADHD, it may be particularly useful to break the text into sections, establish the goal in advance, and check comprehension at intermediate points. 

Phase 3. Integrate supports for ADHD and executive functions

Executive supports should respond to observable difficulties. 

For example, brief blocks with explicit goals and frequent feedback may be used when the child has difficulty sustaining a task; “stop-read-check” routines may help with impulsivity; and segmented directions, visual supports, and reduced simultaneous information may help with working-memory difficulties.

This differs from assuming that the child must first complete an executive-function program to be “ready” to learn to read. Reading intervention and ADHD supports can coexist from the first session.

Phase 4. Measure response and adjust

Follow-up should use measures sensitive to change: 

• accuracy, 
• error type, 
• correct words per minute when appropriate, 
• performance on pseudowords, 
• spelling, 
• comprehension 
• and level of support required. 

It is also important to measure functional outcomes: 

• independence, 
• task completion, 
• spontaneous use of strategies 
• and transfer to the classroom. 

If progress is insufficient, the question should not simply be “does the child need more sessions?” but rather which component is not responding, whether the intensity is appropriate, whether the task is at the right level, and whether other linguistic, cognitive, emotional, or educational variables are interfering. 

Technology in intervention: tools that expand therapeutic possibilities

Technology can add value when integrated into a therapeutic plan with defined goals. Digital tools make it possible to 

• grade difficulty, 
• increase practice opportunities, 
• provide immediate feedback, 
• record performance 
• and facilitate continuity between sessions. 

Evidence on personalized and adaptive learning shows positive effects on reading proficiency,  although the benefit depends on student characteristics and implementation (Alrawashdeh et al., 2023). 

Neurorehabilitation platforms

Cognitive stimulation and rehabilitation platforms allow professionals to work systematically on processes such as attention, working memory, planning, inhibition, language, and other components that may influence academic performance. 

In children with ADHD and dyslexia, they can complement specific goals: for example, training monitoring, maintaining verbal information actively, organizing sequences, or working on language components related to the reading task. 

Their main strength is the ability to individualize difficulty, track progress, and combine domain-specific tasks—such as language or reading—with general cognitive processes. In this sense, technology need not be treated as separate from intervention: it can be part of the intervention as long as the selected activity serves a clinical goal and its transfer to everyday functioning is monitored.

Telerehabilitation

Telerehabilitation can be especially useful as a continuity tool. It allows practice frequency to be maintained between in-person sessions or during periods when attending the clinic is difficult, such as vacations, illness, travel, or logistical problems. It also facilitates brief, frequent home programs under professional supervision. 

A recent review of telerehabilitation for dyslexia indicates that this format may promote intensity, personalization, monitoring, and family participation, and reports studies in which remote outcomes were comparable to those obtained in person. The authors specifically emphasize its value for integrating and continuing treatment, rather than as an automatic replacement for clinical intervention (Casalini & Pecini, 2024). 

Virtual reality

Virtual reality makes it possible to build controlled environments that simulate everyday demands and manipulate distractors, difficulty, and attentional load. In ADHD, this is particularly interesting for assessing or training attention, inhibition, and responses to distractors in more ecological settings. 

A systematic review and meta-analysis found promising effects of immersive interventions on some cognitive deficits in children with ADHD, although protocol heterogeneity remains substantial (Corrigan et al., 2023). 

For an ADHD and dyslexia profile, virtual reality may be complementary when the clinical goal is clearly defined: not only for observing performance in a distracting environment, but also for designing graded tasks requiring self-regulation, following directions, and response control.

Eye tracking

Eye tracking objectively records where readers fixate, how long they look, which saccadic movements they make, and when they return to previously read material. These measures make it possible to study visual behavior during reading and relate it to fluency, cognitive demands, and text-exploration patterns. 

A recent systematic review confirms that eye tracking is used in children with dyslexia to study reading processes and explore its usefulness in assessment and detection (Toki, 2024). 

In practice and research, this information can complement other measures of accuracy, speed, comprehension, and attention. Its value lies in providing another window into the reading process and helping characterize profiles, always as part of a broader clinical and educational assessment.

Neurofeedback

Neurofeedback aims to help people learn to modulate certain patterns of brain activity through real-time feedback. 

In ADHD, it has been studied particularly as an intervention for attentional symptoms and self-regulation. The review by Westwood and colleagues (2025), which brings together randomized clinical trials, shows that outcomes depend on the type of measure and evaluator blinding; therefore, its clinical usefulness should be interpreted within the overall evidence and the patient’s profile. 

In this article, it is more useful to understand it as a potentially complementary tool for specific ADHD goals, not as an intervention targeting the decoding difficulties characteristic of dyslexia. 

Overall, digital platforms, telerehabilitation, virtual reality, eye tracking, and neurofeedback expand the professional toolkit. None replaces the neuropsychological, educational, or medical intervention indicated in a given case. Their value emerges when they are selected according to the child’s profile, integrated with concrete therapeutic goals, and used for what they are: tools that can complement, intensify, monitor, or continue treatment. 

Technology tool	Goal / Processes involved	Clinical usefulness and benefits
Neurorehabilitation platforms	Attention, working memory, planning, inhibition, and language.	They make it possible to individualize difficulty, track progress, and combine specific tasks, such as reading, with general cognitive processes.
Telerehabilitation	Continuity of treatment and family participation.	It helps maintain practice frequency through brief home programs under supervision, overcoming logistical barriers.
Virtual reality	Attention, inhibition, self-regulation, and responses to distractors.	It builds controlled, ecological environments that simulate everyday demands for graded tasks.
Eye tracking	Analysis of visual behavior during reading.	It provides objective measures of gaze fixation and saccadic movements to relate them to fluency and cognitive demands.
Neurofeedback	Attentional symptoms and self-regulation (ADHD).	It helps people learn to modulate patterns of brain activity through real-time feedback.

Educational adaptations for dyslexia and ADHD

Adapting does not mean lowering expectations. It means preventing a difficulty unrelated to the learning goal from keeping a student from demonstrating what they know, while maintaining direct intervention on the skills they need to develop. 

Measures that can be individualized include: 

•  Breaking lengthy tasks into parts and making the goal of each section visible;
• providing brief, sequenced instructions with visual supports;
• reducing distractors during high-demand activities;
• adjusting time when reading speed is not the skill being assessed;
• reducing unnecessary copying from the board;
• using text-to-speech, audiobooks, or speech-to-text when the goal is not specifically to train the skill these tools replace; 
• incorporating brief, planned breaks; 
• teaching metacognitive routines for planning, reviewing, and correcting;
• offering alternative response formats when assessing knowledge rather than decoding;
• coordinating goals across school, family, and professionals.

The recommendation should be concrete. “Work on attention” offers little guidance to a teacher. By contrast, “present one instruction at a time, ask the student to restate it, and mark each completed step on a visual checklist” translates the neuropsychological profile into an observable action. 

Five common errors in clinical practice

1. Attributing every reading difficulty to ADHD. Inattention may increase errors and variability, but it does not by itself explain a persistent decoding difficulty. 
2. Waiting for executive functions to improve before addressing reading. When both profiles coexist, goals can be addressed in parallel and in an integrated manner. 
3. Presenting cognitive stimulation and reading instruction as opposing interventions. Attention, working memory, planning, and language contribute to reading and writing performance; therefore, cognitive stimulation/rehabilitation can complement specific reading and writing intervention. The key is to connect cognitive tasks with functional goals and meaningful language and academic activities. 
4. Adding technology without defining the clinical goal. A platform or device adds value when we know which process we want to address, how we will grade the task, and which indicators we will use to verify change. 
5. Measuring only performance during the session. The ultimate goal is for improvements to be reflected in reading, writing, independence, organization, and academic participation outside the clinic.

The future: toward more personalized and ecological interventions

One of the most important changes in addressing dyslexia and ADHD is moving from protocols defined solely by diagnostic labels toward interventions tailored to each child’s cognitive, reading, behavioral, and contextual profile. 

Two patients with the same diagnoses may need very different priorities: one may require greater intensity in phonological awareness and decoding; another may also need substantial support for working memory, self-regulation, planning, or comprehension.

Personalization means using the initial assessment and treatment response to decide what to address, at what intensity, and how to adjust difficulty. Personalized and adaptive learning technologies show a positive, although modest, effect on reading proficiency; importantly, the size of the benefit varies according to student, contextual, and implementation characteristics (Alrawashdeh et al., 2023). 

In this direction, digital platforms can modify difficulty according to performance, record learning curves, and provide immediate feedback; telerehabilitation can extend practice into the home; virtual reality can bring certain tasks closer to everyday contexts; and eye tracking provides additional information about reading behavior. The potential lies not in using more technology, but in using information more effectively to adjust intervention. 

Therefore, the future will probably be hybrid: neuropsychological assessment, specific reading and writing intervention, ADHD treatment when indicated, cognitive stimulation linked to functional goals, coordination with school and family, and technological tools that enable personalization, monitoring, and continuity. 

In this model, personalizing does not mean improvising a completely different treatment for every child. It means starting from evidence-based principles and adapting their intensity, sequence, supports, and format to the individual profile. This combination of evidence, progress data, and clinical knowledge can move us toward increasingly precise and ecological interventions. 

Conclusions

When dyslexia and ADHD coexist, the clinical challenge is not to decide which disorder “explains” the child. It is to identify which processes are limiting functioning and select specific interventions for each need. 

Explicit, systematic reading instruction remains the core treatment for reading difficulties. ADHD, in turn, requires its own supports and interventions, which can be integrated in parallel to promote attention, self-regulation, adherence, and transfer. 

Technology expands the tools available, but it does not replace clinical reasoning or automatically turn an activity into an evidence-based intervention. The neuropsychologist’s role is precisely to connect evidence, assessment, and context so that changes observed in therapy translate into more functional reading, greater independence, and more effective academic participation. 

References

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