In this article, early intervention specialist speech therapist Marta Chans Sánchez explains the relationship between attention deficit hyperactivity disorder (ADHD) and dyslexia, two frequently comorbid neurodevelopmental disorders.

We will focus on models that support shared neural bases and cognitive deficits, where intervention will have many common points. There seems to be consensus among the scientific community that comorbidity of symptoms and deficits in neurodevelopmental disorders is not the exception but the norm (Boada et al., 2012; Ijeoma and Chinelo, 2019).

It is important to know how we can help children with ADHD and dyslexia, and the main aspect to highlight is that the comorbidity of these two disorders exacerbates some of the deficits. This is the case with executive functions, orthographic recognition, reading accuracy and speed, as well as an increase in errors in symbol recognition and general omission errors.

Fundamental principles in ADHD and dyslexia intervention

Before addressing the intervention points that are more aggravated in individuals with ADHD and dyslexia, we must understand the most important fundamental principles for establishing interventions. According to Prigatano:

• We must start the intervention by focusing on the patient’s subjective and phenomenological experience to reduce their frustrations and involve them in the rehabilitation process.

• The patient’s symptomatology is a combination of cognitive and personality characteristics that we must consider when designing the intervention.

• Each rehabilitation program must be dynamic, with permanent changes to meet the patient’s needs.

• Awareness of the deficit is highly relevant and can influence the overall success of the treatment program.

• Competent and innovative planning focuses on proper understanding of all the mechanisms of the pathologies.

• Patient rehabilitation requires the exclusive use of evidence-based practices, necessary to maximize the patient’s recovery and adaptation.

Common deficits in ADHD and dyslexia

It is very important to know which aspects we should evaluate and intervene in both disorders. Next, we will develop the most common deficits that children with ADHD and dyslexia present, which are aggravated when both pathologies appear:

Executive functions

Initiative deficit

The main characteristic of this deficit is a decrease in spontaneous behavior. Patients show difficulties in initiating a simple action plan. This difficulty not only affects complex tasks but also those that involve almost automatic responses to environmental stimuli, such as picking up a phone or turning off an alarm clock.

The behavioral component is perhaps the most striking and is characterized by a lack of productivity, effort, dependence on action initiation, and a decrease in overall activity. Some patients are happy to engage in activities once they have been pushed by others. On the contrary, they are unable to do so spontaneously.

Response inhibition or impulsivity problems

They are unable to postpone a response, even when there is an explicit instruction not to respond, due to hyperreactivity to environmental stimuli. To exhibit flexible behavior, the ability to inhibit more or less automatic behaviors and response tendencies is necessary.

Perseverative behavior

Patients remain fixated on a particular pattern of action and are unable to stop it to switch to an alternative action or mode. There are numerous situations in the language and communication field where patients may repeatedly ask the same questions using the same words or phrases.

Difficulties in generating alternative responses

This implies difficulty in responding spontaneously, creatively, fluently, and flexibly. Many patients with ADHD and dyslexia are unable to generate alternative solutions to a problem, evoke elements from a category, or generate novel ideas and action plans. Patients can provide a response but get stuck if it doesn’t work because they are unable to generate new possibilities.

Regarding language and communication, a patient with this difficulty would be unable to propose conversation topics, and their responses would be very similar or repetitive.

Behavioral maintenance deficit

Many individuals with ADHD and dyslexia are unable to maintain attention on a task and persist until it is completed. This requires adequate functioning of working memory, as it is where the goal to be achieved must remain active. Problems at this level involve patients abandoning tasks before finishing them, although the cause of this abandonment must be further analyzed since it can be different in each case. Often, for example, they abandon a task because another one, more interesting to them, has arisen.

In the realm of language and communication, these difficulties in maintaining behavior can manifest as loss of interest and disconnection from the conversation, inability to maintain the topic, and slowed speech.

Disorganization

It refers to difficulty in organizing and sequencing actions and thoughts within the same discourse to achieve a goal. In the realm of language and communication, it is observed in patients with difficulties in structuring discourse and maintaining the conversation topic.

Supervision deficit

This component includes difficulties in evaluating one’s own behavior and an inability to detect one’s own errors and use them to improve performance.

Additionally, there is limited utilization of information provided by the environment in different situations, which should help modify behavior.

Decision-making

Patients show difficulties in abstract reasoning and reduced conceptualization capacity. Decision-making requires knowledge of the situation, different options, and awareness of immediate and future consequences of the choice.

General learning problems

It is very common to observe poor academic performance in children with ADHD and dyslexia. Their performance is irregular, and they are described as having poor memory and organization because they fail to complete tasks, forget assignments, avoid challenging activities, and continuously make unexplained errors.

In general, these children have weaker linguistic skills compared to children without these disorders. Although not all of them present the same level of difficulty, these deficits can be observed in all structural levels of language, requiring specific intervention.

Working on this aspect is essential for proper learning development as it influences both oral and written language. Below are some sample tasks for the two most challenging points for individuals with ADHD and dyslexia:

Lexical access

• Answer specific questions about an image (where, who…);

• create word lists according to different rules (semantic fields, phonological pathways…);

• describe a common and appealing social situation for the patient;

• dramatize processes observed in stories.

Reading speed

• Read words and pseudowords,

• read complex syllables (direct and indirect),

• work on tracking and peripheral vision in reading.

Bibliography

• Artigas-Palalrés, J. (2002). Problemas asociados a la dislexia. REV NEUROL, nº (34), pp. 7-13.
• Periáñez, J.A y Ríos-LAgo. (2017). Guía de intervención logopédica en las funciones ejecutivas. Síntesis.
• Sánchez-Doménech.(2022). Revisión sistemática e implicaciones para el diagnóstico psicopedagógico: comorbilidad dislexia/TDAH. Déficits comunes y diferenciadores. Revista Española de Orientación y Psicopedagogía, Vol. 33 (nº2), pp. 63-84.
• Palazón López, Julián. (2020). Errores en lectura oral, velocidad lectora y velocidad de denominación en niños con TDAH-Dislexia y desarrollo normolector. INFAD Revista de Psicología, (nº2), pp. 139-152.

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