Attention Deficit Disorder
The letters ADD are commonly used to refer to Attention Deficit Disorder-Inattentive Type; whereas ADHD refers to Attention Deficit Disorder with Hyperactivity. Both patterns of attention deficits are very common among children with dyslexia. Also, it is very common for children with dyslexia to be misdiagnosed as having ADD because of symptoms that are common to both conditions.
It is not clear why it is so common for children to have both ADD and reading problems. Of course, the ADD child will find it difficult to learn if she cannot focus attention in a classroom, but it is more likely that there is a common set of learning traits to both conditions.
Some educators believe that, like dyslexia, ADD stems from a predominantly right-brained learning style. Like dyslexia, ADD is often seen in highly creative individuals and is common in gifted children. In many ways, the symptoms of ADD may be the result of an overactive mind and an unharnessed imagination.
Your child with dyslexia is twice as likely as other children to have ADD; about 15 percent of students with reading problems are also diagnosed with ADD. Conversely, a child with ADD is twice as likely to have difficulties with reading; about 36 percent of children with ADD also have dyslexia.
Inattention-Type Attention Deficits
Because there is so much overlap between symptoms of attention deficits and dyslexia, it is important to understand how ADD/ADHD is diagnosed. The appropriate criteria for diagnosis are clearly set out in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV), which specifies that a child can be diagnosed with ADHD (inattention type) if he has six or more of the following symptoms:
Fails to pay close attention to details or makes careless mistakes in schoolwork, work, or other activities.
Has difficulty holding attention in tasks or play activities.
Does not seem to listen when spoken to directly.
Does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not because he is rebelling or has not understood instructions).
Has difficulty organizing tasks and activities.
Avoids or dislikes tasks that require sustained mental effort (such as schoolwork or homework).
Loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools).
Is easily distracted by extraneous stimuli.
Is forgetful in daily activities.
Although it is estimated that 15 percent of school children have dyslexia, only 5 percent are ever identified. The remaining 10 percent have a hidden disability, but it is possible that many of these children are mislabeled as having ADD or some other behavioral or psychological problem.
However, each of the above symptoms is also a common characteristic of dyslexia. Your child's academic and language processing difficulties will simply make it very difficult for her to sustain attention, follow instructions, or complete schoolwork. Thus, you should be careful before accepting a diagnosis of “inattentive” type ADHD. In some cases, a mistaken diagnosis can lead to delays in getting help or special tutoring to address reading problems. Studies show that medications commonly prescribed for ADHD do not help children learn academic skills.
The second type of ADHD, hyperactivity-impulsivity type, is more distinct from dyslexia. According to the DSM-IV, it is diagnosed when the child has six or more of the following symptoms:
Fidgets with hands or feet or squirms in seat.
Does not stay in seat in classroom or in other situations in which remaining seated is expected.
Runs around or climbs excessively in situations in which it is inappropriate (in adolescents, may be limited to subjective feelings of restlessness).
Has difficulty playing or engaging in leisure activities quietly.
Is often “on the go” or often acts as if “driven by a motor.”
Blurts out answers before questions have been completed.
Has difficulty awaiting turn.
Interrupts or intrudes on others (e.g., butts into conversations or games).
Many of these behaviors may also be a result of the learning problems associated with dyslexia. A child who is frustrated or confused in a classroom will have a hard time sitting still or obeying rules. Again, it is important for you to consider the context surrounding the observed behavior.
Avoiding a Misdiagnosis
In order for attention deficit disorder to be properly diagnosed, some of the symptoms must have been present before the age of seven and the symptoms must be present in two or more settings, such as both school and home. These additional criteria help to sort out ADD from school problems, as children whose difficulties are only manifested in the classroom environment simply do not have attention deficit disorder. Many children are highly active but function normally at home or at play, where they can engage in a reasonable amount of physical activity and have freedom to choose which tasks to focus their energy on.
Symptoms of ADD can also be a result of physical health problems, such as vitamin deficiencies or exposure to toxins such as lead or mercury. Some children have food allergies or sensitivities that affect their behavior, including reactions to food additives and sweets or sodas.
The National Institute of Mental Health cautions that the behaviors associated with ADD may merely reflect a child's response to a defeating classroom situation. Such symptoms can stem from feelings of frustration in a child who has a learning disability or who is emotionally immature, or from boredom in a child who finds the classwork tedious and unchallenging. A child with true ADD will exhibit difficulty concentrating and completing tasks even in situations when it is clear that the child wants to participate fully, or will show signs of impulsivity and hyperactivity outside of the restricted environment of a school classroom.