Reading Learning Disorder Follow-up

Updated: May 27, 2016
  • Author: Eric R Crouch, MD; Chief Editor: Caroly Pataki, MD  more...
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Follow-up

Prognosis

Although parents assume that intervention will help their child catch up with peers, this notion is unsubstantiated by research data. In a Yale longitudinal study, persistently poor readers (ie, children identified in the early grades by their poor phonemic processing) continued to read more poorly than their nondisabled peers. [9] Although these children did learn to read, they continued to lag significantly behind peers throughout high school in decoding, reading rate, and accuracy. Despite poor scores in these areas, their overall reading comprehension scores were only mildly delayed. With persistent intervention and considerable personal effort, these children can achieve an adequate literacy level to function in society, although their reading abilities may still lag behind the skills of their peers.

Comorbidities

A widespread dilemma for physicians is when a child is failing in school and is suspected of having a reading disability, yet the school suspects the child has ADHD. Often, both educators and physicians delay evaluations and diagnosis while awaiting results from the other discipline. Although ADHD and a reading disorder are perceived as independent, significant overlap is observed. [11] In nonreferred epidemiological studies, children with a reading disorder are twice as likely as other children to have ADHD; the rate of such dual incidence approaches 15%. Conversely, individuals diagnosed with ADHD are also twice as likely to have phonological awareness problems directly related to a reading disorder; 36% of patients with ADHD have this difficulty. Comorbidity rates in clinically referred samples are higher, approaching 40% for both groups.

Social maladjustment is also more common in children with a reading disorder. Prevalence rates of anxiety, withdrawal, and depression are much higher than in peers without this disorder. Social problems become more pronounced as children age because they fall further behind in reading skills and in other subjects that require reading ability. Most children who have severe oppositional and conduct disorders have significant reading problems, which are often overlooked as school personnel attempt to cope with the conduct problems. Given that 40-60% of children with dyslexia suffer from depressive, anxiety or ADHD, and that the rate of suicidal behavior is higher in adolescents with dyslexia, children with reading disabilities should be screened for these psychiatric comorbidities. [13]

Children rarely have a single learning disability. Multiple learning disabilities can be expected because reading, spelling, listening, speaking, and writing all involve manipulations of the same linguistic system. Children who have difficulty with reading typically have difficulty with spelling. These difficulties are quite frustrating to parents and students. Parents commonly report working on spelling lists for hours to perfect performance the night before a test, only to have the child fail the test the next morning.

Logically, children who have difficulty spelling single words also have difficulty organizing and expressing more complex thoughts in writing. These children also tend to have difficulty with grammar and syntax. Difficulties become more pronounced in higher grades as instructors place more emphasis on written explanations. Reading disorders can also directly affect mathematics performance and grades, especially when children are required to read and understand word or story problems.