ADHD and Learning Disabilities: Dyslexia, Dyscalculia, Dysgraphia

A student skips lines while reading, mixes up letters, cannot finish a long paragraph. Is their attention drifting, or is reading itself hard?

This question is familiar to me, because during my school years nobody asked it. My grades were not low, I did not cause trouble in class, I did my homework the last night, and I did it. The system finds this sufficient. And once it finds it sufficient, it does not look at what is underneath. Looking back today, this is what I think about most: no one wonders what a student who manages well is managing with.

This article is about the confusion between ADHD and a learning disability. The answer is often "both."

Are the two the same thing

No, but they often occur together.

ADHD is a neurodevelopmental picture concerning attention, impulsivity, hyperactivity and regulation. It affects learning indirectly: sustaining attention, following instructions and finishing the work become harder.

A specific learning disability, on the other hand, is a lasting difficulty in a particular academic skill itself. The DSM-5 describes it in the areas of reading, written expression and mathematics (American Psychiatric Association, 2013). Even when the person gives full attention, they struggle in that skill.

In everyday language these difficulties are known by three names:

• Dyslexia: Difficulty with reading. Trouble decoding words accurately and fluently, and matching letters to sounds.
• Dyscalculia: Difficulty with math. Trouble with the concept of number, arithmetic operations and numerical reasoning.
• Dysgraphia: Difficulty with writing. Trouble with handwriting, spelling, grammar or organizing written thought.

How often they occur together

The review by DuPaul, Gormley and Laracy (2013), which evaluated 17 studies from 2001 to 2011, found the co-occurrence rate of ADHD and learning disability to be on average about 45 percent. This rate is higher than earlier estimates; the authors note that this is partly because writing difficulties were also counted.

Although the rates vary from study to study, the result is clear: in a student with ADHD, the likelihood of a learning disability is too high to be considered an exception.

When ADHD is diagnosed, the evaluation does not end; reading, writing and math skills need to be looked at separately.

Why they occur together

There is no single reason. There are a few explanations under discussion:

A shared hereditary and neurodevelopmental ground. Both pictures are developmental conditions in which heredity plays an important role. They may share some risk factors. In the glossary, heredity.

Shared cognitive processes. Processes such as working memory and information-processing speed can be strained in both ADHD and learning disabilities. A meta-analysis on executive functions shows that these functions are consistently strained in ADHD (Willcutt et al., 2005).

Feeding each other. A student who struggles with reading can lose attention more quickly while reading; a student whose attention drifts can also benefit less from reading practice.

This third one is the one most familiar to me. Reading in me still changes with interest: I do not put down a text I am curious about for hours, while with a required text I read the same paragraph three times and remember none of them. Why this is so I opened up separately in the article why is reading books hard in ADHD.

How one hides the other

When they occur together, one picture can cover the other. This is the most important practical problem.

ADHD can hide a learning disability. A student's reading problems can be explained as "their attention is scattered, they would read if they paid attention." When ADHD is addressed, attention improves but the reading difficulty continues. It is at that point that it is noticed there is a separate learning disability underneath.

A learning disability can hide ADHD. Conversely, the disconnection in class of a student who struggles a great deal with reading can be put down to the reading problem alone. It can be missed that the attention problems continue in areas other than reading.

Intelligence can hide both. A bright student can compensate for both pictures for a long time. The struggle often becomes visible in periods when the school load grows: in middle school, high school, university. I took up the relationship between intelligence and ADHD in the article does ADHD affect intelligence.

How they are told apart

The exact distinction is made by a specialist evaluation. But there are a few clues that help in understanding the distinction:

• Where is the difficulty? If it is only in a particular skill, for example only in reading, and continues even when full attention is given, the likelihood of a learning disability rises. If there is uneven performance in nearly every area where attention is needed, the likelihood of ADHD comes forward.
• The type of error. Skipping a line because attention drifted while reading and being unable to decode letters and sounds consistently are different things.
• Does it change with interest? In ADHD, performance can rise markedly in a subject of interest. In a learning disability, the difficulty with the basic skill continues even when interest is high.
• Does it change when time is given? If the work gets finished when the time is extended, the matter may be more about speed and attention. If the same errors repeat even with more time, the skill side needs to be looked at.
• The response. If, when ADHD is addressed, attention improves while difficulty with a certain academic skill continues, a separate learning disability should be evaluated.

What is recommended in the evaluation

DuPaul and colleagues (2013) emphasize that, regardless of the changes in the DSM-5, the academic skills of students with ADHD should also be evaluated during screening, detailed evaluation and treatment follow-up.

The American Academy of Pediatrics guideline also recommends screening for conditions that may accompany ADHD, including learning disabilities, in the ADHD evaluation (Wolraich et al., 2019).

In Türkiye, alongside child and adolescent psychiatry, the guidance and research centers (RAM) play an important role in this evaluation. Educational assessment and special education support processes are carried out there. I described how the process works for adults in the article how adult ADHD is diagnosed.

When a single diagnosis does not explain everything. If, even though ADHD treatment has begun, difficulty in reading, writing or math clearly continues, before reading this as "the treatment did not work" you need to ask for a separate evaluation for a learning disability.

Support when they occur together

If both pictures are present, support should proceed through two channels together.

For the ADHD side:

• A study environment with fewer distractions. The details are in the article the study environment in ADHD.
• Breaking work into small pieces.
• A visible calendar and reminders.
• If needed, medication on the doctor's recommendation. Both the diagnosis and the medication decision are the doctor's job.

For the learning disability side:

• Special, structured instruction aimed at that skill. For a reading difficulty, for example, phonics-based work.
• Assistive technology: audiobooks, software that reads text aloud, spell check, a calculator.
• Appropriate accommodations in exams. In the glossary, exam accommodation and extra time.

For both:

• An education plan prepared according to individual needs. In the glossary, individualized education program.
• Protecting the student's self-worth. Students who constantly struggle can begin to describe themselves as "stupid"; it is important to keep their strengths visible.

The general accommodations at school are detailed in the article ADHD at school and university.

A common mistake

The mistake I see most often at school is counting a single successful result as proof. When a student gets a good grade on one exam, it is said "so they can do it," and the matter is closed.

No one asks what is behind that grade: how many hours, how many times starting over, how many nights. This is exactly what worked in my school years, and it worked well, until the load increased. A result obtained through compensation is not proof that compensation was not needed.

I have covered how it shows up in particular subjects separately: math and reading comprehension.

In adulthood

Learning disabilities do not go away in adulthood, but most people develop ways of compensating: listening aloud, breaking up the text, making the calculator the default, having someone else read the writing.

Some of the difficulties experienced at school by someone diagnosed with ADHD in adulthood may also have come from an unnoticed learning disability. Noticing this, in hindsight, gives an explanation to many "why" questions. For me this was the best side of the diagnosis too: it does not change the past, but it changes how it is read.

What remains

ADHD and learning disabilities are different pictures but often occur together.

Because when they are together one can hide the other, it is recommended that a student diagnosed with ADHD also have their reading, writing and math skills evaluated separately. Support gives the best result when it also proceeds through two channels together.

And one more thing: a student who manages well does not mean a student who does not need support.