ADHD or a learning disability? Dyslexia, dyscalculia and attention

Many adults who struggled in school were told they were "not trying hard enough." Some had ADHD. Some had a learning disability such as dyslexia or dyscalculia. Many had both. In adulthood the struggle often looks similar: avoiding reading-heavy tasks, slow paperwork, mistakes with numbers, trouble keeping up in meetings. This page explains how the two differ, how often they overlap, and which professional answers which question.

What a learning disability is

The National Institute of Child Health and Human Development (NICHD) describes learning disabilities as conditions that affect how a person learns to read, write, speak and do math. They are caused by differences in how the brain functions, and sometimes in its structure, which affect how it processes information. NICHD stresses that a learning disability is not an indication of intelligence and that it can last a person's entire life. Learning disabilities are different from learning problems caused by intellectual and developmental disabilities or by emotional, vision, hearing or motor skills problems.

NICHD describes several common types:

• Dyslexia: problems reading words accurately and with ease (fluency), and often trouble spelling, understanding sentences and recognizing familiar words.
• Dysgraphia: problems with handwriting, such as forming letters, writing within a space, and getting thoughts down on paper.
• Dyscalculia: difficulty understanding arithmetic concepts and doing addition, multiplication and measuring.

Among the signs NICHD lists, some are easy for adults to recognize in themselves: for dyscalculia, trouble with math word problems and making change, and for dyslexia, a slow reading rate, giving up on longer reading tasks and trouble remembering numbers in sequence, like phone numbers.

Why they get confused with ADHD

NICHD's list of common signs of learning disabilities includes problems paying attention, poor memory, trouble following directions and problems staying organized. It also lists impulsiveness and being easily distracted. Each of those also appears in descriptions of ADHD. NIMH describes ADHD in adults as difficulty paying attention, staying on task or being organized, with symptoms such as forgetfulness, trouble following instructions and acting without thinking.

The overlap is real, not just a matter of appearance. NICHD states that ADHD occurs more often in children with learning disabilities than in children without them, and NIMH lists learning disorders among the conditions that commonly co-occur with ADHD. A 2013 review in the Journal of Learning Disabilities examined 17 studies published from 2001 to 2011 and found a mean comorbidity rate of 45.1%. That figure comes from studies of children; good adult estimates are scarcer.

The key differences

Sources for the table: NIMH's adult ADHD publication for the ADHD column; NICHD's learning disabilities pages for the learning disability column.

A practical way to think about it

One question that helps is whether the difficulty is tied to one skill or shows up almost everywhere. A person whose reading is slow and effortful even on a topic they love, while meetings, chores and conversations go fine, has a pattern that points toward a reading problem. A person who loses focus while reading, and also during meetings, phone calls, bill paying and household tasks, has a pattern that fits the "multiple settings" part of ADHD criteria. Many adults have elements of both, which is why the question is answered by assessment rather than by guessing.

Childhood history helps too. NICHD notes that learning disabilities are often first noticed in school when difficulties do not improve over time, and that school evaluations look at development, school performance and family history. Old report cards, individualized education program (IEP) records and teacher comments can help an ADHD evaluator as well. The guide to asking family about childhood symptoms and evaluation without childhood records explain what to do if records are missing.

Which evaluation answers which question

This is where adults often get stuck. NICHD says that diagnosing a learning disability requires special tests and that a full evaluation includes academic and psychological testing, usually done by a team that may include a psychologist, a special education expert and a speech-language pathologist. NIMH says an adult ADHD evaluation relies on clinical interviews, rating scales and reports from people who know you, and that a provider may also ask for psychological tests that look at memory, planning and reasoning to identify strengths and challenges and possible learning disabilities.

So the two questions are related but separate:

• Do I have ADHD? A psychiatric evaluation can answer this. Dr. Shershow's adult ADHD evaluation covers current symptoms, childhood, school and work history, health, and other explanations for symptoms, then explains what it found and which treatment options fit.
• Do I have dyslexia, dyscalculia or another learning disability? This needs academic and psychological (psychoeducational or neuropsychological) testing by a qualified psychologist. Dr. Shershow does not provide that testing.

The NY guide explains the difference between an ADHD evaluation and neuropsychological testing, and the NJ guide covers ADHD testing versus a psychiatric evaluation in New Jersey. If you need documentation for exam or school accommodations, the requirements matter: see ADHD documentation for work, school and exams.

When both are present

NICHD reports that an NICHD-supported study on reading disorders found it important to treat both ADHD symptoms and reading problems; the two needed separate treatments, but those could be done effectively at the same time. The 2013 review reached a similar conclusion: academic skills should be assessed in students with ADHD, and intervention should address both conditions. For adults, NICHD's learning disability program highlights self-advocacy, working with an employer or school on a supportive environment, and assistive technology that can read text aloud or help structure writing. The companion page on ADHD and dyslexia goes into that combination.

When to talk to a clinician

Consider an evaluation if attention, organization or reading and math problems have followed you since school and still cost you at work or at home. If ADHD is the main question, a psychiatric evaluation is a reasonable first step, and the evaluator can tell you whether separate learning disability testing would add useful information. The adult ADHD self-test can help you organize what you notice before a visit; it is a screener, not a diagnosis. Adults in New York or New Jersey can read ADHD testing in NYC or ADHD testing in New Jersey to see how an evaluation with Dr. Shershow works.