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ADHD? Learning Disability? It May Be Both

Getting appropriate and effective treatment for a condition depends on getting an accurate diagnosis. But if two or more conditions such as ADHD and learning disorders exhibit similar symptoms, or when those conditions co-occur, accurate or differential diagnosis can be challenging. What is the relationship between learning disorders and ADHD, and what does that mean to you?

Learning challenges in ADHD

ADHD is a neurodevelopmental disorder that can be diagnosed in early childhood, and persists into adulthood. The three presentations of ADHDinattentive, impulsive/hyperactive, and combinedaffect many behaviors and life skills, including ability to learn. The inattention and impulsivity of ADHD are typically accompanied by impaired executive function in the brain. (The executive function, when unimpaired, enables understanding of short- and long-term consequences of actions, the ability to plan for desired results, make real-time evaluations of actions, and adjust as necessary.) Those three conditions result in behaviors that make learning difficult:

  • trouble paying attention
  • inattention to details; makes careless mistakes
  • easily distracted
  • loses supplies, forgets to turn in assignments
  • trouble finishing assigned work 
  • trouble listening
  • trouble following multiple instructions
  • blurts out answers
  • impatience
  • fidgets or squirms
  • seems "on the go"
  • interrupts or intrudes on others

What is a learning disability?

ADHD is not, in itself, a learning disability (LD), but its behavioral manifestations impair the person’s ability to learn. For that reason, the Individuals with Disabilities Education Act (IDEA) has defined the term Specific Learning Disability (SLD) as: 

A “disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, ability to listen, think, speak, read, write, spell, or do mathematical calculations. Such term includes such conditions as perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia.”

Although IDEA’s definition does not specifically refer to ADHD, its description coincides with many of the behavioral manifestations of ADHD. Therefore it canalong with Section 504provide justification for obtaining appropriate school accommodations for your child.  

Specific Learning Disorder

It is believed that learning disorders are caused by a difficulty with the nervous system that affects receiving, processing, or communicating information. They may also run in families. For diagnostic purposes, your healthcare professional relies on guidelines in the DSM-5, in which Specific Learning Disorder has been included, with ADHD and others, in the neurodevelopmental disorder category. The DSM-5 has defined Specific Learning Disorder as:

“A neurodevelopmental disorder of biological origin manifested in learning difficulty and problems in acquiring academic skills markedly below age level and manifested in the early school years, lasting for at least 6 months; not attributed to intellectual disabilities, developmental disorders, or neurological or motor disorders.”

The DSM-5 lists subtypes of impairment in learning disorders:

Accurate diagnoses help define an effective treatment plan. For diagnosed learning disorders, such a plan will include academic and, where appropriate, workplace accommodations.

When ADHD and learning disorders co-occur

Because both ADHD and learning disorders are neurodevelopmental disorders, it is not surprising that they may often co-occur. Various research studies have calculated the prevalence of such co-occurrence at 30 percent to 50 percent. What is the impact of this double whammy?

One research study found that children with LD and ADHD had more severe learning problems than children who had LD but no ADHD, and those with both disorders also had more severe attention problems than children who had ADHD but no LD. Another more recent study derived associations between LD and ADHD: 

  1. the association between ADHD and achievement difficulties is driven more by inattentive than hyperactive-impulsive symptoms, 
  2. deficits in working memory and processing speed are shared across ADHD and LDs, 
  3. multiple genes seem involved in the etiology of both ADHD and reading disabilities, and 
  4. neither cognitive nor behavioral constructs fully account for the relationship between ADHD and LDs.
What can you do?

Carefully record all your child’s behaviors, difficulties, and symptoms. Use that and information provided here to advocate for accommodations for your child in school, and for accurate diagnoses and treatment plan from his healthcare provider.

But these disorders do not magically disappear after childhood. They persist, to one degree or another, into adulthood, even though they are often overshadowed by other co-occurring disorders for adults. Thatalong with learned adaptive and maladaptive behaviorscan make accurate diagnoses extra difficult for your professional. Which means that you must persist!

This article appeared in ADHD Weekly on August 31, 2017.

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