What is the relationship between ADHD and dyslexia?

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

We will focus on models that emphasize the neural bases and shared cognitive deficits, where intervention will have many common elements. There seems to be consensus among the scientific community that the comorbidity of symptoms and deficits in neurodevelopmental disorders is not the exception but the rule (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 point to highlight is that the comorbidity of these two disorders worsens some of the deficits. This is the case for executive functions, orthographic recognition and accuracy and speed in reading, as well as increased errors in symbol recognition and omission errors in general.

Fundamental principles in an intervention for ADHD and dyslexia

Before looking at the intervention points that are most aggravated in people with ADHD and dyslexia, we must know the most important fundamental principles for establishing interventions. According to Prigatano:

• We must begin 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 mix of cognitive and personality characteristics that we must take into account when designing the intervention.
• Each rehabilitation program must be dynamic, with permanent changes to adjust to the patient’s needs.
• Alterations in the awareness of the deficit are very relevant and can condition the overall success of the treatment program.
• A competent and innovative planning focuses on the adequate understanding of all mechanisms of the pathologies.
• Patient rehabilitation requires the exclusive use of practices based on scientific evidence, necessary to maximize the patient’s recovery and adaptation.

Common deficits in ADHD and dyslexia

It is very important to know which aspects we must assess and intervene in for both disorders. Below, we will develop the most common deficits presented by children with ADHD and dyslexia and that are worsened when both pathologies appear:

Executive functions

Initiation deficit

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

The behavior component is perhaps the most striking and is characterized by a lack of productivity, effort, dependence on others to initiate actions and a decrease in activity in general. Some patients are happy doing activities once they have been pushed by others to do so. Conversely, they are unable to do it spontaneously.

Response inhibition problems or impulsivity

They show an inability to postpone a response, even when there is an explicit instruction not to respond, due to hyperreactivity to environmental stimuli. To show flexible goal-directed behavior it is necessary to have the capacity to curb behaviors and more or less automatic response tendencies.

Perseverative behavior

Patients remain stuck on a type of action schema and are unable to stop them to switch to an alternative schema or mode of response. There are numerous situations in the field of language and communication where patients who ask the same things over and over again, using the same words or phrases, can be observed.

Difficulties generating alternative responses

It involves the difficulty of responding spontaneously, creatively, fluently and flexibly. Many patients with ADHD and dyslexia are unable to generate alternative solutions to a problem, to evoke items from a category or to generate novel ideas and action plans. Patients may give a response but become stuck if it does not work, as they are unable to generate new possibilities.

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

Deficit in maintaining behavior

Many people with ADHD and dyslexia are unable to maintain attention on a task and persist in it until it has been completed. This requires adequate functioning of working memory, as it is there that the goal to be achieved must be kept active. Problems at this level imply that patients abandon tasks before finishing them; although the cause of this abandonment must be analyzed in more detail since it can be different in each case. On many occasions, for example, they abandon because another task that is more interesting to them has arisen.

In the field of language and communication, these difficulties in maintaining behavior may appear as a loss of interest and disconnection from the conversation or failure to maintain the topic, as well as slowed speech.

Disorganization

This is the difficulty in organizing and sequencing acts and thoughts within the same discourse to achieve a goal. In the field of language and communication, patients with difficulties structuring discourse and maintaining the topic of conversation are observed.

Supervision deficit

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

The limited use of information provided by the environment in different situations, which should help modify behavior, can be added.

Decision making

Patients show difficulties with abstract reasoning and a reduced capacity for conceptualization. Decision making requires knowledge of the situation, of the different options and knowledge about the immediate and future consequences of the choice.

General learning problems

It is very common to observe poor school results in children with ADHD and dyslexia. Their performance is inconsistent, they are described as children with poor memory and poor organization since they do not finish work, forget assignments, avoid difficult activities and continuously make inexplicable errors.

In general, these children have poorer language skills than children who do not have these disorders. Although not all present the same levels of difficulty, these deficits can be observed at all structural levels of language and it is necessary to delve into these points and intervene specifically.

Working on this aspect is fundamental for the proper development of learning, since it influences both oral and written language. Below are some typical tasks for the two areas of greatest difficulty for people with ADHD and dyslexia:

Lexical access

• We answer very specific questions about an image (where, who…);
• we make lists of words with different rules (semantic fields, phonological route…);
• description of a social situation that is engaging and familiar to the patient;
• dramatization of processes observed in stories.

Reading speed

• Reading words and pseudowords,
• reading complex syllables (direct and indirect),
• work on scanning and peripheral vision in reading.

Bibliography

• Artigas-Palalrés, J. (2002). Problems associated with dyslexia. REV NEUROL, nº (34), pp. 7-13.
• Periáñez, J.A y Ríos-LAgo. (2017). Speech therapy intervention guide for executive functions. Síntesis.
• Sánchez-Doménech.(2022). Systematic review and implications for psychopedagogical diagnosis: dyslexia/ADHD comorbidity. Common and differentiating deficits. Revista Española de Orientación y Psicopedagogía, Vol. 33 (nº2), pp. 63-84.
• Palazón López, Julián. (2020). Errors in oral reading, reading speed and naming speed in children with ADHD-dyslexia and typical reading development. INFAD Revista de Psicología, (nº2), pp. 139-152.

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¿Qué relación hay entre el TDAH y la dislexia?