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Running head: Dyslexia vs. ADHD

Dyslexia vs. ADHD Anthony Netzel DePaul University

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Dyslexia vs. ADHD This paper will explore the comorbidity between dyslexia and Attention Deficit/Hyperactive Disorder (ADHD). There are some theories that would say that dyslexia and ADHD occur because of the same biological defect in the brain, but there is no strong evidence to support this theory even thought the rate of the two occurring at once is relatively high (Kibby, Kroese, Kerbs, Hill, & Hynd, 2009). This paper will look at the two disorders separately at first. After it will at the comorbidity of the two. Both Dyslexia (RD) and Attention-Deficit/Hyperactive Disorder (ADHD) are classified in the Disorders usually diagnosed in infancy, childhood or adolescence in the DSM-IV-TR. Then they are further divided into Learning Disorders (Dyslexia) and Pervasive Developmental Disorders Not otherwise Specified (ADHD) (DSM-IV-TR 2000). The DSM-IV-TR refers to Dyslexia as Reading Disorder. The diagnostic criterion for Reading Disorder includes three requirements. The first one is the persons reading level must be significantly below the expected reading level for ones age, intellect and education. The second one is that reading level needs to hinder ones academic success or daily life. The third one is if the person has sensory deficit, then the difficulties are beyond what is normally attributed to the defect (DSM-IV-TR 2000). It is estimated that between 5-17 percent of the population has dyslexia. The number ranges because of its difficulty to diagnose and the range of measurements used to diagnose dyslexia. The heribility of dyslexia is between 23 and 60 percent (Shaywitz, & Shaywitz, 2005; and Willcutt, Pennington, & DeFries, 2000). There are several different theories on dyslexia. The two most widely accepted theories are the magnocellular theory and the phonological

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theory. The magnocellular theory states that people with dyslexia have a dysfunction in the visual, auditory, motor and tactical pathways of the brain. The phonological theory says that people dyslexia have a local hindrance in the depiction, storage and retrieval of speech sounds (Ramus, Rosen, Dakin, Day, Castellote, White, & Frith, 2002). Under the phonological theory a person with dyslexia has trouble with the decoding part of reading and not the comprehending part. The trouble comes when the person tries to identify phonologic elements of the letters and corresponding sounds that the groupings symbolize. In other words, dyslexic readers have difficulty at identifying syllables meaning in the spoken langue. This causes a variety of problems including reading out loud and new words. Words that people with dyslexia see more often, words associated to their occupation or hobbies, less trouble with them (Shaywitz, & Shaywitz, 2005). Many scientists would say that the largest with the phonological theory is it does not explain the sensory and motor problems found in many people with dyslexia. An example of a sensory problem found is inability to discriminate sound frequencies. Whereas the magnocellular theory would cover the all areas. The people on the phonological would say that magnocellular is to wide because it encompasses cerebral, auditory, visual and phonological areas of the brain, and the magnocellular theory cannot explain why many do not have any sensory or motor problems. Many of these sensory are also present in ADHD. ADHD the diagnostic criteria includes six or more symptoms that persist over six moth. The can be for inattention or for hyperactivity-impulsivity. Some symptoms of inattention are: give little attention to detail; has difficulty sustaining attention in tasks; does not seem to listen when spoken to directly; has difficulties in organizing tasks or activities; and is easily distracted by extraneous activates (DSM-IV-TR, 53, 2000). Some symptoms for hyperactivity-

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impulsivity are: fidgets with hand or feet; has difficulty playing quietly; talks excessively; has difficulty turn waiting; and often interrupts others (DSM-IV-TR, 53, 2000). There can also be a combination of the two to form the combined subtype. Another requirement to fit diagnostic criteria is the person needs to experience mutilation at home and school/work place. It is also a necessity for the person to have major impairment in their social, work, or academic life in order to reach the criteria for ADHD. The last requirement is the these behaviors are not caused by a more serious disorder such as a mood or psychotic disorder (DSM-IV-TR 2000). ADHD is estimated to appear in 3 to 7 percent. It is also estimated that many more hyperactive/impulsive and combined subtypes are diagnosed because of their extremely overt behavior. Whereas the inattentive subtypes actions are more quiet (Vaidya, Austin, Kirkorian, Ridlehuber, Desmond, Glover, & Gabrieli 1998). The heritability is estimated to be between 60 and 90 percent (Willcutt et. al 2000). There are two different ideas of why people have ADHD. The most common one is that there is an excess of dopamine, and the dopaminergic areas of the brain are smaller (Willcutt et. al 2000). The second theory is that the volume reductions in the right frontal brain regions, caudate, corpus callosum and cerebellum are the reasons why children develop ADHD (Banaschewski, Hollis, Oosterlaan, Roeyers, Rubia, Willcutt, & Taylor, 2005). One reason for support of the dopaminergic theory is that when given stimulants such as methylphenidate (Ritalin) children with ADHD have an increased brain activity and a decrease of symptoms (Vaidya, Austin, Kirkorian, Ridlehuber, Desmond, Glover, & Gabrieli 1998). There have been fMRI studies that show the amount of brain activity for both children with dyslexia and ADHD. In fMRIs of children with ADHD, show less activity in areas of the

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brain that control planning and motor function. Children ADHD who took a stimulant such as methylphenidate showed significantly increased activity in those areas of the brain. The control subjects show the opposite in these studies. The children who did not have ADHD on methylphenidate showed decreased activity, but it was not to the extent of the first ADHD group with no stimulant. In these tests, the children were participating in a variety of activities and the difference was the same in each one. It is assumed that this increase of activity also leads to an increase of control of behavior (Vaidya et al, 1998). The fMRI studies with children and adults with dyslexia have shown that there is less brain activity comparatively to those who have no reading disability. The most interesting phenomenon that was found is that Shaywitz and Shaywitz found, in their twelve year comprehensive study, that people with dyslexia who improved in accuracy while reading had the same amount of brain activity as they had before, but those who did not improve in accuracy had much higher amounts of brain activity. Compared to the controls those who did not improve had almost equal amounts, but the activity was in different areas (Shaywitz &Shaywitz 2005). The brain activity affected in dyslexia and ADHD share some areas but not enough to be significant to draw any conclusions (Ramus, 2004). It has been proposed that the subtypes of ADHD be split into two different types of disorders. Inattentive would be one, and hyperactive/impulsive would be the other. The combined subtype would be put under hyperactive/impulsive. The largest reason for making two separate disorders is because the inattentive subtype is attention deficient whereas hyperactive/impulsive is self-regulation deficient. One reason this is not done is because it is assumed there are different symptoms for the same neurological problem. The other reason is that many of the same treatments work for both subtypes. The most popular treatments for

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ADHD are medical and behavioral. (Goldstein & Naglieri 2008). The most common medical treatments are Ritalin and Adderall. The problem with these are the side effects such as: Reduced appetite, headaches, sleep deficiency and anxiety. The other is behavior modification and environment manipulation. This makes it so the child learns to pay attention more (Goldstein & Naglieri 2008). If ADHD go undiagnosed, it causes irreparable problems for the child. Many children with the hyperactive/impulsive or combined subtypes are labeled as trouble makers, and are treated as such. They are made out to be troublesome because they show a lack of planning, selfmonitoring, and self-correction. Therefore these children do not see the consequences of their future action nor do they learn from their past ones. On top of the low inhibition these children are often over active and restless. This makes many parents, teachers and friends upset (Goldstein & Naglieri 2008). If the child has the inattentive subtype, they are labeled as lazy. Lazy because they are unfocused; carless; look as if they are not listing; leave many projects unfinished; and do not invest in tasks (Goldstein & Naglieri 2008). The less tangible ones are they are easily distracted by visual and auditory stimuli (Vaidya et al, 1998). This innatention could lead to homework being unfinished, constantly switching activities and forgetting of important objects. The ADHD children who have it the worst are the combined subtype because they have symptoms of both and usually have the problems of both (Goldstein & Naglieri 2008). The comorbidity of a person with ADHD having dyslexia is between 25 and 40 percent, and the comorbidity of a person with dyslexia having ADHD is 15 to 35 percent. (Willcutt et. al 2000) Children with both ADHD and dyslexia have trouble in both executive and automatic

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functions. This could be very problematic when it comes to schooling (Shaywitz &Shaywitz 2005 and Goldstein & Naglieri 2008). This is specifically an impairment when it comes to reading. Not only is it difficult to read words especially new words, but it is slow and effortful. As one could imagine, trying to understand the meaning of the text it is not easy when a persons ADHD is not letting him or her concentrate or sit still would be hard. At an early age ones potential is determined by his or her proficiency in school, and when that is hindered at so young of an age it is difficult to be proficient, in work or school, at an older age (Goldstein & Naglieri 2008). Treatments for dyslexia usually focus on phonological breaking down of words. There have been no relevant medical answers like there were for ADHD. Many dyslexic readers learn to adapt and make their reading accuracy go up, but dyslexia never goes away, while ADHD between 50 and 30 percent of people experience symptoms of ADHD when they are adults (Shaywitz &Shaywitz 2005). ADHD and dyslexia go beyond school. As stated earlier, the both affect the motor control in some way. This affects sports and writing (Raberger & Wimmer 2003). Since both disorders are predominately male, and in the male sports dominated culture in this could be a detrimental to a boys self-esteem. In the Ramberger and Wimmer (2003) study on balance and rapid naming, children with dyslexia had lower balance than the controls but they were not as low as the children with ADHD. In the same study, children with dyslexia have very low scores for rapid naming but the children with ADHD had much higher scores and were still below the controls. Although ADHD and dyslexia co-occur with many different disorders ranging from OCD to generalized anxiety disorder, it is one of the most common comorbidities especially

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among the developmental disorders. There are many hurdles when it comes to having ADHD and dyslexia, and to help alleviate those hurdles, parents should be educated on how to spot developmental disorders. When one is diagnosed they should be further educated on how to help their children overcome their disability.

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References American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.)

Banaschewski, T., Hollis, C., Oosterlaan, J., Roeyers, H., Rubia, K., Willcutt, E., & Taylor E., (2005) Towards an understanding of unique and shared pathways in the psychopathophysiology of ADHD. Developemental Science, 8(2), 132-140 doi: 10.1111/j.1467-7687.2005.00400.x Goldstein, S. & Naglieri J.A. (2008). The school neuropsychology of ADHD: Theory, assessment, and intervention. Psychology in the Schools, 45(9), 859-874. doi: 10.1002/pits.20331 Kibby, M.Y., Kroese, J.M., Kerbs, H., Hill, C. E., & Hynd, G.W. (2009) The Pars Triangularis in Dyslexia and ADHS: A Comprehensive Approach. Brain and Language. 111(1), 46-54. doi:10.1016/j.bandl.2009.03.001 Raberger, T., & Wimmer, H.(2003). On the Automaticity/Cerebellar Deficit Hypothesis of Dyslexia: Balancing and Continuous Rapid Naming in Dyslexic and ADHD Children. Neuropsychologia, 41 (11), 1493-1497. doi:10.1016/S0028-3932(03)00078-2 Ramus, F. (2004). Neurobiology of Dyslexia: A Reinterpretation of the Data. Trends in Neurosciences, 27(12), 720-726. doi:10.1016/j.tins.2004.10.004 Ramus, F., Rosen, S., Dakin, S.C., Day, B.L., Castellote, J.M., White, S. & Frith, U. (2002) Theories of Developmental Dyslexia: Insights from a Multiple Case Study of Dyslexic Adults. Oxford Journals, Brain, 126 (4), 841-865. doi: 10.1093/brain/awg076

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Shaywitz, S. E. & Shaywitz, B. A. (2005) Dyslexia (Specific Reading Disability). Biological Psychiatry, 57(11), 1301-1309. doi:10.1016/j.biopsych.2005.01.043 Vaidya, C.J., Austin, G., Kirkorian, G., Ridlehuber, H.W., Desmond, J.E., Glover, G.D., & Gabrieli J.D.E. (1998). Selective Effects of Methylphenidate in Attention Deficit Hyperactivity Disorder: A functional Magnetic Resonance Study. Neurobiology, 95, 14494-14499. Willcutt, E.G., Pennington, B.F., & DeFries, J.C. (2000) Twin Study of the Etiology of Comorbidity Between Reading Disability and Attention-Deficit/Hyperactivity Disorder. American Journal of Medical Genetics (Neuropsychiatric Genetics), 96, 293-301