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News and Local Articles of Interest
Two
Common Reading
By
Reading Disorder-Dyslexia
Although the percentages fluctuate from study to study
about 35 to 50 percent of Combined Type AD/HD adults have learning disorders
(Barkley, 1996). Fifteen to 30 percent of those individuals have RDD (Barkley,
2002). Hynd (2002) reported that 60 percent
of adults with Inattentive AD/HD learning disorders with 21 percent meeting
criteria for RDD. The NICHD research, as well as other
studies have demonstrated AD/HD and RDD are separate and distinct
disorders. However, when they both exist at the same time, these disorders
can have a negative effect on each other. Additionally, many adults with RDD and/or AD/HD have a history
of language disorders in childhood.
The NICHD found RDD to be an inherited disorder that
causes significant anatomical differences in the brain resulting in reading
difficulties (Gilger, 2003;
Perhaps the most important discoveries the NICHD has
made about RDD is what Nancy Mather (Mather,
2000) calls the "triple deficit hypothesis." This includes weaknesses
in phonological awareness, rapid automatized
naming and orthographic processing. Of these three deficits, the research
indicates phonological awareness is the key. Phonological awareness allows
a person to manipulate or study the individual sounds in words. People
with RDD have great difficulty connecting sounds to symbols in words. And pronouncing words phonetically. The second deficit, weak rapid automatized naming,
means those with RDD are impaired in their ability
to rapidly name objects they see. This "dysnomia"
appears to be connected to a slowness in overall
sensory processing speed that makes reading even slower for those with
RDD and makes remembering names of objects and people difficult. The third deficit, weak orthographic processing,
is remembering how words look when correctly spelled and how the letters
relate to the phonics of the word. Thus,
the adult with RDD will have difficulty spelling due to his/her poor ability
to connect sounds to letters (phonics) and poor memory of how the word
looks when spelled correctly.
Recently, Angela Fawcett and Roderick Nicolson
(2001) discovered 80 percent of those with RDD have problems with coordination
and automaticity. These symptoms cause them
significant problems learning to read fluently, as well as difficulties
with physical clumsiness and, "...the ability to repeat previous actions
or thoughts more and more quickly without conscious thought" (p. 101).
Although these symptoms can cause someone with RDD difficulty learning
to read fluently, they can also cause them trouble with learning to converse
socially fluently, or drive a car fluently, smoothly, and effortlessly,
etc.
In sum, the five symptoms of RDD are poor phonemic awareness,
slow rapid automatized naming, poor orthographic
processing, poor coordination and slow automatization.
The most common manifestation of RDD in adults is slow
and labored reading and very poor spelling. RDD adults can also have disorders
of depression and anxiety, as well as suffer from low self-esteem.
How is RDD diagnosed?
The Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV) ( American Psychiatric
Association, 1994) provides a "bare bones" diagnostic criteria. Essentially,
administering a standardized I.Q. test and test of reading achievement
to determine if the person's I.Q. is substantially higher than their reading
achievement is adequate to "diagnose" RDD. However, the NICHD research
indicates such a technique does not differentiate those with RDD from
those with a poor educational background, low intellect or other reasons
for reading difficulties. A standardized I.Q. test and test of reading
achievement can be helpful to determine if an adult suspected of RDD has
sufficient intellect for particular work or educational settings, and
may point out academic skill weaknesses. However, the NICHD research indicates
tests of phonological awareness (i.e., phonemically regular nonsense word
reading - "noil", etc.), rapid automatized
naming (i.e., Boston Naming Test, etc.), and orthographic processing (i.e.,
a standardized spelling test) are necessary to diagnose RDD. Such an evaluation
should include an indepth historical interview
to determine if other disorders accompany RDD, like AD/HD and emotional
disorders, are present. Psychologists, in conjunction with educational
therapist/clinical learning specialists, can conduct such evaluations.
Treatment Options
and Accommodations
How is RDD treated in an AD/HD adult? First it is recommended
the adult make sure their AD/HD is properly treated. This includes management
of their AD/HD with medication and learning how to compensate for their
AD/HD by working with an AD/HD coach, if possible. If needed, a mental
health professional can address emotional concerns such as depression,
anxiety or family problems. Will this cure their RDD? No, but chances
are they will be better able to respond to the following training by being
able to control their AD/HD symptoms of impulsivity, hyperactivity and
inattentiveness.
Once the RDD symptomatology
has been addressed, the RDD issues can be overcome. Although the NICHD
research indicates that there is no cure for RDD, many RDD adults can
improve their reading skills by being taught to read with a systematic-synthetic-multisensory-phonics technique. For example, the adult with
RDD is asked to look at a printed phoneme (one of the 44 sounds of the
English language in written form), make the sound of the phoneme (i.e., B ñ "bu", etc.) and then with their fingers trace the letter
as they look at it and say the sound. This "see it - say it - trace it"
technique has been quite successful in teaching those with RDD to read.
Perhaps the best known of these teaching methods is the Orton-Gillingham.
However, there are over 10 other systematic -synthetic-multisensory-phonics
techniques that are equally as helpful.
More advanced readers are given multisensory
training in prefixes, root words and suffixes. For example, the adult
has a card with a prefix printed on it presented to them; they look at
it, say it and trace it.
These techniques require substantial drill. In the end,
many adults with RDD and AD/HD will find substantial improvement in their
reading using such a technique. Such training can often be obtained from
educational therapists/clinical learning specialists, some adult literacy
volunteers and some speech language pathologists.
In addition to training in multisensory-synthetic-multisensory-phonics,
there are several work and educational accommodations that can be helpful
to eligible adults with RDD. Some of these include Recordings for the
Blind and Dyslexic, Kurzweil 3000 reading machines,
voice activated word processors, Franklin Language Master Special Editions
(hand held spelling checker), Quicktionary Reading
Pen IIs, readers for exams and others.
Civil Rights and Documentation of Disabilities
Reading Disorder of Recall/Comprehension
Unfortunately, the second Reading Disorder that many
adults with AD/HD tend to experience has not been researched as much.
Currently, it is not known what percentage of AD/HD adults suffer from
it or the ratio of women to men. However, many clinicians describe AD/HD
adults who state they can read fluidly both silently and orally, pronounce
all the words, read at an adequate rate and are good spellers, but they
cannot remember what they read. This reading problem has not had a consistent
name associated with it in the scientific literature. Some have called it "Word Calling" or nonspecific reading disability"
(Aaron and Baker, 1991, p. 46-47). The term word calling can be
confusing because it can be associated with what is called Hyperlexia. This disorder is found in many people with autism
spectrum disorders such as Asperger's Disorder.
This is not the same type of reading disorder. For this article, the type
of reading disorder previously described in which AD/HD adults do not
remember what they read will be called Reading Disorder of Recall Comprehension
(RDR/C).
Most AD/HD adults with RDR/C have adequate phonological
awareness, orthographic processing, and rapid automatized
naming. In fact they have no symptoms of RDD at all. They just do not
remember what they read. Some complain of this after reading a sentence
and others after reading a few pages. Scientists are not absolutely certain
what causes this disorder, but there is accumulating evidence that it
could be due to a weakness in working memory. The two types of working
memory involved appear to be verbal and non-verbal in nature. Russell
Barkley (1998) describes verbal working memory as "internalized speech".
When someone talks silently about possible ways to respond to a social
situation properly or "hears" the words "aloud" in their head as they
read silently, he or she is using verbal working memory. He states weaknesses in this area are one of the keys of his
theory. Non-verbal working memory aids us in remembering the spatial location
of objects, planning and gives us a sense of time. It also allows us to
imagine what we are reading about in our "mind's eye". Or, in other words
picture what is happening in the book as we read. Deficits in these two
working memory systems often come together in AD/HD adults to create difficulties
in remembering what they read, thus resulting in a reading comprehension
problem. Often adults with RDR/C
will have other subtle language comprehension problems.
People with RDD may also have difficulty with reading
comprehension, but this is due to weakness in phonological awareness,
orthographic processing, rapid automatized naming
and automatization. AD/HD adults with RDR/C
tend to not have those difficulties; their weaknesses stem from the above-mentioned
memory deficits. Additionally, AD/HD adults with RDR/C can also have RDD.
Diagnosis and Treatment
How does one diagnose RDR/C? Again, the Diagnostic and
Statistical Manual (DSM-IV) offers a "bare bones" assessment suggestion.
An evaluation which includes I.Q. testing and a thorough examination of
all reading skills, especially reading comprehension, is
suggested. This should include sentence and paragraph comprehension. It
is also suggested additional evaluation of working memory, listening comprehension
and a thorough historical interview be conducted. Often a psychologist
and/or educational therapist/clinical learning specialist can do the reading
evaluation. A psychologist should conduct the intellectual testing. Sometimes
AD/HD adults with RDR/C will also have problems with listening comprehension
and other language processing problems. In such cases, a thorough evaluation
by a speech language pathologist is urged. Like those with AD/HD and RDD,
AD/HD-RDR/C adults can have co-morbid conditions such as depression and
anxiety. These should be evaluated by a mental health professional. It
is recommended that written reports of the evaluation for such a disability
follow the AHEAD Guidelines.
Treatment for RDR/C is multifaceted. Often those with
RDR/C find significant reduction in their recall and comprehension problems
when they are placed stimulant medication and/or other non-stimulant medications
for AD/HD (i.e., Strattera-Atomoxitine, etc.).
Those who do not respond sufficiently to this may need to work with an
educational therapist/clinical learning specialist to learn methods of
actively monitoring what they are reading. This would involve learning
ways to survey material prior to reading itótaking note of the bold print,
italicized words, pictures, headings, footnotes, etc. in the text in order
to construct questions to answer while reading. Once they have written
down questions, they actively read the text with the idea of answering
them. The above technique is often called SQ4R, but there are similar
techniques that are equally appropriate. Most educational therapists/clinical
learning specialists are familiar with such techniques and can teach them.
Nanci Bell (1991) believes
people with RDR/C do not adequately use visual or mental imaging as they
read. She has developed a program to teach adults with RDR/C how to image
while they read. She believes learning how to image what is read will
allow them to generalize and grasp the global concepts of the material.
The program is also said to help those with difficulty in oral expression,
oral language comprehension and some written language skills. It is said
to help those with RDR/C create entire images that include color and movement.
Educational therapists, clinical learning specialists and speech language
pathologists using the Visualizing and Verbalizing for Language Comprehension
and Thinking (
Other educational therapists and clinical learning therapists teach the person with RDR/C to draw pictures of what they are reading with the hope they will remember and comprehend what they have read.
Many RDR/C adults qualify for protection under Section
504 of the Rehabilitation Act of 1973 and the Americans with Disabilities
Act of 1990. Several of the above mentioned workplace and educational
accommodations are useful for those with RDD are also helpful with RDR/C.
However, the specific accommodations must be assigned according to the
specific disability profile of the individual. It is recommended that
reports of evaluations of such reading problems follow the AHEAD (1997)
guidelines.
AD/HD adults can have both RDD and RDR/C and these two
reading problems can cause great frustration. Therefore, it is important
that adults receive thorough evaluations of their reading problems, as
well as appropriate treatment and accommodations. By
doing so they can be more successful in school and work, and possibly
have a better quality of life.
Please note: The original unrevised publication of this article was –
Blake, K.T. (May/June, 2000). Two common reading problems experienced
by many AD/HD adults. Attention!, 6 (5), pp. 30-33.
References
Aaron,
P.G., and Baker, C. (1991). Reading Disabilities in College
and High School: Diagnosis and Management.
Association
on Higher Edication and Disability (AHEAD) (1997). Guidelines
for Documentation of a Learning Disability in Adolescents and Adults.
Available from: AHEAD,
American
Psychiatric Association (1994). Diagnostic and Statistical Manual ofÝ Mental Disorders,
Fourth Edition.
Barkley, R.A. (2002). ADHD and Oppositional Defiant Children. Seminar presented
February 19-20,
Barkley, R.A. (1998). Attention
Deficit Hyperactivity Disorder, Second Edition.
Barkley, R.A. (1996). ADHD in Children,
Adolescents, and Adults: Diagnosis, Assessment and Treatment.
Fawcett,
A.J., and
Gilger, J.W. (Spring,
2003). Genes and Dyslexia. Perspectives,
29 (2), pp. 6-8.
Hynd, G. (2002). ADHD and Its
Association with Dyslexia: Diagnostic and Treatment Challenges. Paper
presented at the 53rd Annual International Dyslexia Association
Conference,
Mather, N. (
Moats,
L.C. (1999).
Basic Facts About Dyslexia, Part II: What Every Professional Ought
to Know (The Orton Emeritus Series).
Shaywitz, S.E. (1996). Dyslexia. Scientific American, 275 (5), p. 98-104.
Places to Go for Help
CHADD
International
Dyslexia Association
Learning
Disabilities Association
Recordings
for the Blind and Dyslexic
Lindamood-Bell Learning Processes