What are the medical management options for a patient with dyslexia, potentially co-occurring with Attention Deficit Hyperactivity Disorder (ADHD)?

Medical Management of Dyslexia

Dyslexia has no medical management—it is a language-based learning disorder requiring intensive educational interventions focused on phonological awareness, decoding, and fluency training, not pharmacological treatment. 1

Core Treatment Approach

Educational remediation is the only evidence-based treatment for dyslexia itself. The disorder stems from deficits in the phonological component of language affecting the alphabetic code for decoding written words, requiring direct intervention targeting this etiology rather than medical management. 1

Essential Educational Components

• Daily intensive individualized instruction explicitly teaching phonemic awareness and phonics application is the foundation of effective dyslexia treatment. 1
• Specific instruction in decoding, fluency training, vocabulary, and comprehension must be incorporated into remedial programs. 1
• Phonological proficiency training enables patients to detect phonemes (input), think about them (performance), and use them to build words (output). 2
• Work with rhymes, listening capacity, phrase and word identification, and handling syllables and phonemes allows preventive intervention enhancing letter identification, phonological analysis, and single-word reading. 2

Individualized Education Program Requirements

Educational interventions and individualized instructional supports, including school environment modifications, class placement, instructional placement, and behavioral supports, are necessary and often include an IEP or 504 plan. 3

Management When ADHD Co-occurs

Diagnostic Clarification

Screen all children with dyslexia for ADHD and vice versa, as these conditions frequently co-occur and require different treatment approaches. 3 ADHD symptoms must have onset before age 12 and be present across multiple settings since childhood to meet diagnostic criteria. 3

Pharmacological Intervention for Comorbid ADHD

When ADHD and dyslexia co-occur, prescribe FDA-approved ADHD medications (stimulants as first-line) as they improve reading performance in this population beyond their effects on attention alone. 4, 5

• Methylphenidate significantly improves reading performance in children with both ADHD and dyslexia by improving learning conditions, though it cannot cure the reading disorder itself. 4
• Atomoxetine treatment improves critical reading components including decoding and reading vocabulary in patients with dyslexia only and ADHD with comorbid dyslexia. 5 These improvements in reading scores are distinct from improvement in ADHD inattention symptoms alone. 5
• For elementary and middle school-aged children (ages 6-12) with comorbid ADHD and dyslexia, prescribe FDA-approved ADHD medications along with parent training in behavior management and behavioral classroom interventions. 6
• Titrate ADHD medication doses to achieve maximum benefit with tolerable side effects. 6

Combined Treatment Protocol

Optimal management of comorbid ADHD and dyslexia requires both pharmacological treatment of ADHD and intensive educational remediation of dyslexia simultaneously. 3 Combined medication and behavioral therapy is superior to either alone for ADHD symptoms. 3

What Does NOT Work

Ineffective Vision-Based Treatments

Vision therapy, muscle exercises, ocular pursuit-and-tracking exercises, behavioral/perceptual vision therapy, "training" glasses, prisms, and colored lenses and filters are NOT effective treatments for dyslexia. 1 Children with dyslexia have the same visual function and ocular health as children without such conditions. 1 There is no valid evidence that children who participate in vision therapy are more responsive to educational instruction than those who do not. 1

Chronic Care Management

Manage children with dyslexia (especially when comorbid with ADHD) following chronic care model principles with ongoing monitoring for emergence of additional comorbid conditions throughout development. 3 This includes screening for anxiety disorders, depression, oppositional defiant disorder, conduct disorders, and substance use. 3

Critical Pitfalls to Avoid

• Do not prescribe medication for dyslexia alone—there is no pharmacological treatment for the reading disorder itself. 1
• Do not delay intensive educational intervention while pursuing vision-based therapies or other unproven treatments. 1
• Do not treat ADHD medication as a cure for dyslexia when conditions co-occur—medication improves learning conditions but intensive phonological remediation remains essential. 4
• Do not fail to implement educational supports (IEP/504 plan) even when medication is prescribed for comorbid ADHD. 6, 3