ADHD and dyslexia in adults: when both are present

Reading slowly, losing your place on the page and needing to reread paragraphs can come from more than one cause. In ADHD, attention drifts. In dyslexia, decoding the words themselves takes effort. Many adults have both, and many were only ever told about one. This page covers how often ADHD and dyslexia occur together, why they need two different kinds of evaluation, and what the evidence says about treating both.

If you are trying to work out which one explains your difficulties, see ADHD or a learning disability. This page is about having both.

What dyslexia is

The National Institute of Child Health and Human Development (NICHD) describes dyslexia as a learning disability in which people have problems reading words accurately and with ease (fluency), and may have a hard time spelling, understanding sentences and recognizing words they already know. People with dyslexia usually have trouble connecting letters with sounds.

ADHD is different. The National Institute of Mental Health (NIMH) describes it as a persistent pattern of inattention and/or hyperactivity and impulsivity that causes problems in at least two areas of life, with symptoms starting before age 12. Reading can suffer in ADHD because attention wanders, not because the words are hard to decode.

How often they occur together

Most of the research comes from children and students, and good figures for adults are scarce. What exists points the same way:

• A 2013 review of 17 studies published from 2001 to 2011 found a mean co-occurrence rate of 45.1% between ADHD and learning disabilities in general (reading, math and writing combined). The authors noted that including writing disorders may have pushed the figure up.
• A twin study published in 2000 found that people with a reading disability were more likely than others to meet criteria for ADHD, and that the link was stronger for inattention than for hyperactivity and impulsivity. Parents and teachers reported similar rates, suggesting the ADHD symptoms were not just frustration with schoolwork.
• NICHD notes that ADHD occurs more often in children with learning disabilities than in children without them.
• The UK's NICE guideline NG87 lists people with specific learning difficulties among the groups in whom ADHD is more common.

A 2010 review in Developmental Neuropsychology adds that children with both conditions tend to show more severe cognitive difficulties and worse academic and behavioral outcomes than children with either one alone. The link between inattention and reading problems is one reason an adult with dyslexia may be told only about the reading problem, or an adult with ADHD may have a reading disability nobody tested for.

Two conditions, two kinds of evaluation

The ADHD column reflects NICE recommendations 1.3.1 and 1.3.2. The dyslexia column reflects NICHD's description of learning disability evaluations, which also include a medical exam to rule out other causes and a review of family history.

Dr. Shershow's practice performs the ADHD part: a psychiatric evaluation of current symptoms, childhood, school and work history, health, sleep and substances, and other explanations for the symptoms. The practice does not perform psychological, psychoeducational or neuropsychological testing, so it does not diagnose dyslexia. If the history suggests a reading disability, the evaluation can say that testing may be worth pursuing elsewhere. The difference is explained further in ADHD evaluation vs neuropsychological testing.

NICE also asks clinicians to give information about ADHD in a form that takes account of any learning disabilities, so it is reasonable to ask for written summaries in plain language, or to have information explained aloud, if reading is hard.

Questions worth asking at an ADHD evaluation if you suspect dyslexia too:

• Does my history suggest that reading testing would be useful?
• Which kind of professional should do that testing?
• How might ADHD treatment change what the testing shows, and should testing happen before or after treatment starts?

Bring what you have: old report cards, any reading or special education evaluations, an old IEP, or past testing reports. These help both kinds of evaluator.

Treating both

The clearest public statement on treatment comes from NICHD, which reports that an NICHD-supported study on reading disorders found it is important to treat both the ADHD symptoms and the reading problems. Both need separate treatments, and the interventions can be done effectively at the same time.

In practical terms:

• ADHD treatment targets attention, organization and impulsivity. For adults, that can include medication when appropriate, with follow-up. See ADHD medications approved for adults.
• Reading support, as NICHD describes it for students, includes intensive, step-by-step reading instruction, extra time and other modifications, and technology such as audiobooks and word-processing programs. That help comes from educators and learning specialists rather than a psychiatrist.

One medication question comes up often. In a 2017 randomized trial of 209 children aged 10 to 16, atomoxetine improved some reading measures in children with dyslexia alone and in children with ADHD plus dyslexia, compared with placebo. The trial was funded by the drug's manufacturer, involved children only, and does not establish atomoxetine as a dyslexia treatment for adults. It is a reason to ask questions, not a recommendation. More about the drug is on the Strattera (atomoxetine) page.

Accommodations at school, work and on exams

Testing agencies, colleges and employers each set their own documentation rules. An ADHD diagnosis from a psychiatric evaluation documents ADHD; it does not document a reading disability. If you need accommodations for both, expect to need both kinds of documentation. The 2013 review of ADHD and learning disabilities also recommends that academic skills be assessed in students with ADHD, which is the kind of testing that supports learning disability accommodations. For details, see ADHD documentation for work, school and exams and ADHD accommodations in college.

When to talk to a clinician

If reading has always been slow and effortful, and attention, organization or follow-through are also a long-standing struggle, it can be worth looking at both. The adult ADHD self-test is a screener that can help you describe attention symptoms; it is not a diagnosis, and it does not screen for dyslexia. To arrange an ADHD evaluation, see ADHD testing in NYC or ADHD testing in New Jersey, or call the office.