Understanding the Co-morbidity Between Dyslexia and Attention-Deficit Hyperactivity Disorder

Dyslexia and attention-deficit hyperactivity disorder (ADHD) are 2 of the most prevalent complex neurodevelopmental disorders of childhood, each affecting approximately 5% of the population in the United States.

These disorders are also each co-morbid with speech sound disorder and language impairment.

Understanding the nature of the comorbidity among these disorders could lead to advances in developmental theory, a deeper understanding of the genetic and brain mechanisms that cause disability, a more refined diagnostic classification scheme, and new treatments and interventions for children with these disorders.

As part of this special issue of Topics in Language Disorders, this review focuses on the comorbidity between dyslexia and ADHD.

It provides a review of the known etiological mechanisms that underlie each disorder. It describes the reconceptualization of these disorders using a multiple deficit model and provides a synopsis of recent studies that illustrate a cohesive approach to investigating the causes of comorbidity.

Future directions are discussed in the context of expanding these approaches to the co-morbidity among all 4 disorders.  

Read the full paper here

Inside the Hidden World of Dyslexia and ADHD - YouTube

Rarely do we get a look inside dyslexia at the inner city level. Every dyslexic should be in tune with what Headstrong Nation is doing in the arena of Dyslexia advocacy.

We are looking forward to future initiatives from this group!

Crickets, Books, and Bach: Develop a Summer Listening Program

The importance of learning to listen

Listening is an engaging way to learn, a primary approach to developing or strengthening reading strategies, and, in some cases, a necessary means to access information and knowledge.

Listening media, such as audio books and text-to-speech, can be especially helpful to children with learning disabilities, such as those with dyslexia and attention deficit/hyperactivity disorder (ADHD) , who struggle with print-based learning, and central auditory processing disorder (CAPD), who may struggle to listen.

For such students well-chosen listening experiences can open up new vistas of learning, providing access to information and ideas previously 'hidden' in books and supporting the reading process itself.

Such opportunities provide a powerful supplement or alternative to a reading program focused around printed text.

Research has shown that combining reading and listening through the use of audio books or text-to-speech programs improves the literacy skills of struggling readers, including those with learning disabilities.

Reading comprehension, listening comprehension, phonological awareness and blending, and naming skills have shown to be improved with a combined reading-listening program.

Listening while reading helps children learn the patterns of language, the obvious 'code' of letters and words on the page as well as less obvious codes, such as tone, nuance, and implied meaning.

Brain imaging technologies show that when we listen, different parts of the brain are engaged than when we read—or even when we merely hear something.

Listening can provide whole levels of information that are essential to determining the value and validity of a source.

Teaching children to listen to tone of voice not only helps them develop reading skills but can help in the development of their social and conversational skills, too.

For more information, see Plato Revisited: Learning Through Listening in the Digital World by David Rose& Bridget Dalton, published by RFB&D.

Read more here: Crickets, Books, and Bach: Develop a Summer Listening Program | Reading Topics A-Z | Reading Rockets

Attention Towards Special Education Drives Global Special Education Software Market

Special education for students with disabilities is gaining significant attention across the globe.

Pertinently, related institutions are spending more on technologies and software that assist in furthering the dissemination of learning to students with special needs.

Technology remains the answer to all the needs of disabled students in their search for learning, despite their differing disabilities.

Novel technological developments with respect to software and hardware are creating substantial opportunities for students with physical, cognitive or process disabilities to gain from general curriculum.

A recent trend, though, has been the exploration of utilizing this technology for providing skills required by all students.

The growth of digital content and the Internet has emerged as transformative advancements for the disabled, enabling them to speak, read and write.

Assistive technologies in the area of special education have witnessed rapid advancement over the years which has enabled emergence of less costly, portable, and faster devices and software products.

With increasing penetration of web-enabled software programs and classrooms, demand for customizable educational content that is ready-to-use is gaining pace.

Major players profiled in the report include Crick Software Ltd., DynaVox Mayer-Johnson, Excent

Read the full article here: Growing Attention Towards Special Education Drives the Global Special Education Software Market

International Experts Resign From flawed DSM-5 Working group

Roel Verheul

Roel Verheul (Amsterdam) and John Livesley (Canada) both felt compelled to resign from the DSM-5 Personality Disorders Work Group. Here is an email from them describing what went wrong in the preparation of this section:

"We resigned from the DSM-5 Personality and Personality Disorder Work Group in April 2012 with a mixture of sadness and regret.

We believed that the construction of DSM-5 afforded an important opportunity to advance the study of personality disorder by developing an evidence-based classification with greater clinical utility than DSM-IV.

John Livesley

The data and conceptual tools for such an undertaking have been available for some time and the field seemed to recognize the need for change.

Regrettably, the Work Group has been unable to capitalize on the opportunity and has advanced a proposal that is seriously flawed.

It has also demonstrated an inability to respond to constructive feedback both from within the Work Group and from the many experts in the field who have communicated their concerns directly and indirectly.

We also regret the need to resign because we were the only International members of the Work Group which is now without representation from outside the US."

Read the full article here: Two Who Resigned From DSM-5 Explain Why

Antidepressants in water trigger Autism genes in fish

Low levels of antidepressants and other psychoactive drugs in water supplies can trigger the expression of genes associated with autism, in fish at least.

The use of antidepressants has increased dramatically over the past 25 years, says Michael Thomas of Idaho State University in Pocatello. 

Around 80 per cent of each drug passes straight through the human body without being broken down, and so they are present in waste water. In most communities, water purification systems cannot filter out these pharmaceuticals. 

"They just fly right through," says Thomas, which means they ultimately find their way into the water supply.

The concentration of these drugs in drinking water is very low – at most, they are present at levels several orders of magnitude lower than the prescription doses. 

But since the drugs are specifically designed to act on the nervous system, Thomas hypothesised that even a small dose could affect a developing fetus.

Thomas's group created a cocktail of the anti-epileptic drug carbamazepine and two selective serotonin uptake inhibitor (SSRI) antidepressants, fluoxetine and venlafaxine, at this low concentration. 

They exposed fathead minnows (Pimephales promelas) to the drugs for 18 days, then analysed the genes that were being expressed in the fishes' brains.

Although the researchers had expected the drugs might activate genes involved in all kinds of neurological disorders, only 324 genes associated with autism in humans appeared to be significantly altered. Most of these genes are involved in early brain development and wiring.

The finding fits with previous research which had found that pregnant women who take SSRIs are slightly more likely to have autistic children. (Archives of General Psychiatry, DOI: 10.1001/archgenpsychiatry.2011.73).

To test whether these changes actually altered the fish's behaviour, the researchers did an experiment in which they startled the fish. Fish exposed to the drugs tended to panic and behave differently from a control group of fish.

Thomas emphasises that the research is very preliminary – there's no need for pregnant women to worry about their drinking water yet, he says. The researchers next plan to study whether the drugs have a similar effect in mammals. 

They are testing this by lacing the drinking water of pregnant mice with the low-concentration cocktail. 

They are also studying water supplies in areas around the country where there are particularly high concentrations of drugs to determine whether the fish – and people – in these areas have autism-like gene expression patterns.

Journal reference: PLoS One, DOI: 10.1371/journal.pone.0032917

ADHD medication needs a addition of child-friendly message

More than half a million prescriptions for methylphenidate, a stimulant medicine to treat ADHD, sold under the brand names Ritalin, Concerta, and Equasym, are dispensed each year in England.

Up until now, however, the patient information leaflet included with every box has been written with only adults in mind.

Read the full Report here

Following an agreement with drug companies, the Medicines and Healthcare products Regulatory Agency (MHRA) decided that a youth-friendly section should be included in all brands of methylphenidate prescribed and dispensed in the UK.

The work was undertaken by researchers at the  University of Leeds in collaboration with the Leeds-based company Luto Research.

As reported in Pharmaceuticals Journal, the revised patient information leaflet now includes a section called “Information for children and young people” that provides clear and simple information about the consequences of possible side effects, using examples that may be relevant to children and teens.

For example, when advising users to avoid certain activities if they feel dizzy, it refers to horse riding, climbing trees, and riding a bike. The section also offers advice to youngsters who may be sexually active.

“Children and young people are the main consumers of these medicines,” says Theo Raymor, professor of of pharmacy at the University of Leeds.

“It is important that they have the opportunity to know why they have been given this drug treatment and how it can help them. The revised leaflet now gives them a chance to read about their medication in an easy and informative way.”

Words and phrases in the youth friendly section were tested by adults and teenagers, as well as children as young as 10 who read the leaflet with a parent. Feedback from this testing helped ensure that the messages on safety and side effects were clear to a wide range of ages.

“We gave particular thought to the layout of the text, as well as the content,” Raynor says. “Simple changes, such as making headings bolder, using bulleted lists, and dividing long sentences into shorter ones can make a real difference when writing for all people, including children.

“This is the first time that children and teens have had a chance to comment on the information that goes into medicine packs, and it has proven to be very successful.

“We are now hoping that this approach can be taken for other medicines that are used widely by children, perhaps medicines for asthma or epilepsy.”

The work was co-ordinated by the MHRA as part of its drive to help people of all ages understand the medicines they are taking.

“It’s vital that both children and adults understand the medication they are taking,” says MHRA Head of Patient Information Quality, Jan MacDonald.

“Children and young adults with ADHD will be better informed about their healthcare from the new style of patient information.”

More news from University of Leeds: www.leeds.ac.uk/news

Medication is not a way for ADHD kids to cheat

We are students living with learning disabilities and attention deficit hyperactivity disorder. We disagree with the "Abuse of ADHD drugs creates uneven playing field" (Open Forum, March 16), which compared ADHD medication with performance-enhancing steroids in sports and asked: "Is ADHD (medication) use cheating as well?"

While the author rightly criticizes student use of any stimulant or ADHD drug by those who are not diagnosed with ADHD to enhance their performance, and points out that the drugs don't work unless one has ADHD, she suggests that drug use even by those diagnosed with ADHD somehow gives an unfair advantage.

Wrong.

Accommodations and allowing the use of medication are legally required for students with disabilities. Accommodations are like supplying ramps for wheelchairs, assistive listening devices for the hearing-impaired, glasses for those who need them, or software that reads text aloud for the blind and dyslexic.

Accommodations give students with learning disabilities and ADHD an equal opportunity to succeed in an educational environment that caters to a narrowly defined learning style. They level the playing field. They keep us in school.

Medication is no "enhancer" for us. As one of our students with ADHD put it, those who do not have ADHD "only see the drug as a drug, and nothing else.

They don't see the fight that rages on inside me, my constant struggle to focus, my inability to stay organized, and my tireless efforts to complete tasks others would view as easy." For those with ADHD, medication is a tool, not a solution.

Attending school as a student with learning disabilities or ADHD is hard enough. Fighting the stigma is even harder.

Many students, fearful of the stigma, don't seek help, don't want to be identified and are fearful of being different.

Without good support, without the right accommodations (sometimes including medication), without understanding how we learn or discovering our strengths, we fail, we drop out, and society loses out on valuable contributors.

We now know that a disproportionate number of our most successful CEOs and entrepreneurs have dyslexia or ADHD. They think outside the box; standardized education and high-stakes testing does not hinder their brilliance.

So, please: Learning disabilities, including ADHD, are real. It's really hard to be a student with learning disabilities and ADHD. It's harder yet when people talk about us, not with us.

Studying the Causes of ADHD/ADD

Doctors do not know exactly what causes ADHD. Through the years, they have speculated that toxins, abnormal foetal development, diet, injury or poor parenting are to blame.

The earliest research into what is now known as ADHD dates back to 1902, when a British pediatrician described 20 children who were "passionate," obstinant and unable to control their impulses.

At the time, he suggested a brain injury might be the key. This has not been confirmed as a cause in most cases. Since then, practitioners have observed that faulty genetics is the more likely culprit.

Today, scientists are scrutinizing genetics for answers. Many now suspect a series of malfunctioning genes may obstruct the normal secretion of chemicals that guide communication among cells in areas of the brain responsible for inhibition and self-control.

This breakdown leads to a loss of self-control, impeding other brain functions responsible for maintaining attention.

In fact, the brain regions involved have been shown to be smaller and less active on scans taken from children with ADHD compared to those taken from healthy children.

Just what may be causing the reduced size of these brain regions is not yet known. Again, researchers hypothesize a genetic mutation may be to blame.

Many now believe that more than one gene plays a role in ADHD. Evidence shows relatives of children with the disorder are significantly more likely to develop it than children from unaffected families.

Furthermore, the children of a parent who has adult ADHD have up to a one in two chance of also developing it.

Studies of twins have placed the risk of ADHD in a child whose identical twin has the disorder at up to 18 times that of a non-twin sibling of a child with ADHD.

While birth injuries and maternal alcohol or tobacco use may be factors in some cases of ADHD, most experts agree those factors account for less than 10 percent of cases.

As scientists seek clues in the hunt for a definitive cause, many insist that a number of the world's great inventors, artists and thinkers have exhibited traits of attention deficit disorder — and have succeeded because of it, not despite it.

Robert Frost, Frank Lloyd Wright, Samuel Taylor Coleridge, Virginia Woolf, Thomas Edison and Nikola Tesla are examples of creative individuals whose behavior could also be interpreted as the inattention, impulsivity and hyperactivity of ADHD.

Does poor parenting cause ADHD?
No. But some parenting practices can complicate the course of ADHD and lower the success of treatment, such as inconsistent discipline, inconsistency between parents or between parents and the child's caretaker, or inconsistency over time (such as enforcing rules one day but not the next).

These practices do not cause ADHD, but they can make life more difficult for these children and complicate treatment.

Dyslexia ADHD: School for Learning Needs - YouTube video

http://LindenHS.org Linden Hill School in Northfield, MA serves boys ages 9-16 of average to above average intelligence who have learning differences. The School specializes in ADHD, ADD, Learning Disabilities, and Dyslexia.

ADHD: Training and Support for Clinicians

Aims
The ADHD website aims to give information to clinicians including general practitioners, GPWsi's, community paediatricians and CAMHS staff on:
.
a) ADHD and related neurodevelopmental disorders;
b) Identifying the signs and symptoms of ADHD including consideration of the differential diagnoses, co-morbid disorders and associated functional difficulties;
c) Management options for children with ADHD and their families including behavioural strategies and prescribing options;
d) How to manage ongoing care and support for children with ADHD and their families including medication monitoring.
.
The information provided on the website could be used as :

1. an introductory training package for GP's with a special interest (GPWsi's) in children's mental health, in particular in ADHD, who wish to take a lead on this topic within their practice area;
2. an introductory training package for non consultant clinical staff who work in ADHD clinics run by either by Child and Adolescent Mental Health Services (CAMHS) or paediatric departments e.g. GP clinical assistants, senior nurse practitioners and junior/ middle grade medical staff. It is advised that this information is complemented by on site clinical supervision from a consultant with special expertise in ADHD.
3. training materials about ADHD for all GP's who have children and young people on their lists with this disorder and to act as a pointer to websites which may be useful to clinicians and parents. The site may be of particular interest to GP's providing ADHD monitoring enhanced services.
4. an aid for a seamless transfer of specific aspects of patient treatment from the secondary sector to general practice. Information is provided on the nature of the condition treated, the medications in question, the monitoring required and the responsibilities of the parties involved.

This website can also be utilised as a part of a PG Cert Course (30 credits at Masters Level, ‘subject to validation’) with the University of Wales, Newport. Please contact amanda.kirby@newport.ac.uk for further information.
.
The course aims are as follows:
The module will provide student knowledge in the following areas

• An understanding of the signs and symptoms of ADHD in children, adolescents and adults
• An understanding of the assessment and diagnosis of ADHD in children and adolescents
• The principles of a multi-modal treatment package for ADHD.
• The knowledge of non pharmacological interventions for ADHD
• An understanding of the pharmacological interventions for ADHD
• The understanding of issues of medication including
• Starting medication
• Switching medication and polypharmacy
• Medication monitoring
• The issues of the management of the ADHD- follow up clinics
• Consideration of ADHD in relationship to other co-morbid disorders

The Learning Outcomes are as follows:

On completion of the PG Cert module the student would:

1. Have an understanding of current knowledge and theory relating to the aetiology underpinning ADHD and related co-morbid disorders.
2. Be able to critically reflect upon the management and intervention options for supporting an individual with ADHD.
3. Demonstrate knowledge of current practices in the management of the individual with ADHD in the context of common health and educational practices and through a consideration of research undertaken in this area.
4. Demonstrate an understanding of the choices for treatment both pharmacological and non pharmacological.
5. Critically reflect upon the different factors that may impact on the individual’s difficulties at home and at school and in further education.
6. The student will gain knowledge of the management principles of running a follow up ADHD clinic.

These aims are informed by the following philosophy:

Improving access to knowledge on ADHD for the groups of clinicians above will help to combine the best of primary and secondary care for the benefit of these patients and their families.

Shared care arrangements between primary and secondary care are thought to be essential for safe, effective and efficient treatment with complex drugs such as those used in the medical treatment of ADHD.

Entry into a shared care arrangement is voluntary for all parties involved. It should be noted that clinical responsibility lies with the prescribing doctor.

GPs and other clinicians should therefore familiarise themselves with the drug treatments they are prescribing, ensure an acceptable monitoring arrangement is in place and feel confident that they can obtain appropriate specialist support when required.

Glossary of Abbreviations

• ADHD = Attention Deficit HyperactivityDisorder
• ASD = Autistic Spectrum Disorder
• CBT = Cognitive Behaviour Therapy
• CD = Conduct Disorder
• DCD = Developmental Co-ordination Disorder
• DSM-1V= Diagnostic and Statistical Manual of Mental Disorders (4th Edition)
• HKD = Hyperkinetic Disorder
• ICD-10 = International Classification of Diseases (10th version)
• IEP = Individual Education Plan
• LSA = Learning Support Assistant
• LEA = Local Education Authority
• ODD = Oppositional Defiant Disorder
• SDQ = Strengths and Difficulties Questionnaire
• SEN = Special Educational Need
• SENCO= Special Educational Needs Co-ordinator
• TCA = Tricylic antidepressant
• WISC = Wechsler Intelligence Scale for Children 

ADHD: UK NHS Guidelines (2008)

Attention deficit hyperactivity disorder: Diagnosis and management of ADHD in children, young people and adults

Description
The advice in the NICE guideline covers:

• the care, treatment and support that children, young people and adults with ADHD should be offered
• how families and carers can support people with ADHD.

It does not specifically look at:

• the treatment of children younger than 3 years
• the treatment of conditions other than ADHD.

Guidance documents

• Full guideline documents
• NICE guideline PDF format | MS Word format
• Quick reference guide PDF format
• NICE guidance written for patients and carers PDF format | MS Word format | Fformat MS Word
• CG72 Attention deficit hyperactivity disorder (ADHD): NICE guideline (web format)

Children's Under-achievement Could Be Down To Poor Working Memory

Children who under-achieve at school may just have poor working memory rather than low intelligence according to researchers who have produced the world's first tool to assess memory capacity in the classroom.

The researchers from Durham University, who surveyed over three thousand children, found that ten per cent of school children across all age ranges suffer from poor working memory seriously affecting their learning. Nationally, this equates to almost half a million children in primary education alone being affected.

However, the researchers identified that poor working memory is rarely identified by teachers, who often describe children with this problem as inattentive or as having lower levels of intelligence.

Working memory is the ability to hold information in your head and manipulate it mentally. You use this mental workspace when adding up two numbers spoken to you by someone else without being able to use pen and paper or a calculator. Children at school need this memory on a daily basis for a variety of tasks such as following teachers' instructions or remembering sentences they have been asked to write down.

Lead researcher Dr Tracy Alloway from Durham University's School of Education, who, with colleagues, has published widely on the subject, explains further: "Working memory is a bit like a mental jotting pad and how good this is in someone will either ease their path to learning or seriously prevent them from learning.

"From the various large-scale studies we have done, we believe the only way children with poor working memory can go onto achieving academic success is by teaching them how to learn despite their smaller capacity to store information mentally.

"Currently, children are not identified and assessed for working memory within a classroom setting. Early identification of these children will be a major step towards addressing under-achievement. It will mean teachers can adapt their methods to help the children's learning before they fall too far behind their peers."


Read more here Children's Under-achievement Could Be Down To Poor Working Memory

Hypertension in kids linked to ADHD learning problems

A new study, published today in the journal Pediatrics, also finds “that children with hypertension are more likely to have ADHD (attention deficit hyperactivity disorder),” says Heather R. Adams, assistant professor of neurology and pediatrics at the University of Rochester.

“Although retrospective, this work adds to the growing evidence of an association between hypertension and cognitive function. With 4 percent of children now estimated to have hypertension, the need to understand this potential connection is incredibly important.”

Among the study’s 201 patients, all of whom had been referred to a pediatric hypertension clinic at University of Rochester Medical Center’s Golisano Children’s Hospital, 101 actually had hypertension, or sustained high blood pressure, determined by 24-hour ambulatory monitoring or monitoring by a school nurse or at home.

Overall, 18 percent of the children had learning disabilities, well above the general population’s rate of 5 percent. But the percentage among those without hypertension was closer to 9 percent, and among those with hypertension, the rate jumped to 28 percent.

All of the children were between 10- and 18-years-old, and the children’s learning disability and ADHD diagnoses were reported by parents.

The study is part of a series of hypertension studies by Golisano Children’s Hospital researchers, led by principal investigator Marc Lande, a pediatric nephrologist, but it was the first that included children with ADHD. Previous studies excluded them because ADHD medications can increase blood pressure.

Researchers included them this time because, although it is possible that some of the children’s hypertension was caused by medications, it is also possible that the higher rate of ADHD among children with hypertension is a reflection of neurocognitive problems caused by hypertension.

Twenty percent of the children with hypertension had ADHD, only 7 percent of those without hypertension had ADHD among the study participants.

Even when ADHD was factored out of the analyses, there was still a higher rate of learning disabilities in the hypertensive, compared to the nonhypertensive group of children

What does ADHD feel like: Picture

The Impossible art of Erik Johansson