Dyslexia: Co-occuring Attention & Executive Function Deficits

[Tokyomarie]

As you folks know, I've been trying to puzzle out the role of in/attention & executve function in my son's whole learning profile, which includes dyslexia & dysgraphia. Since the topic has come up in another current thread, I thought I would create a new thread to discuss the frequency of attention deficits & executive dysfunction co-occuring with dyselxia, and the possible impact on the severity of dyslexic symptoms.

 

I found an article on Medscape that includes discussion of various issues that are seen in dyslexic students, and pulled out these quotes:

 

Current Status of Treatments for Dyslexia: Critical Review by Ann W. Alexander, MD and Ann-Marie Slinger-Constant, MD

 

"Deficits in these executive functions are being considered as a possible third core deficit in dyslexia after the phonologic and rapid naming core deficits (Berninger VW, personal communication, 2003)."

"The most prevalent comorbid condition impacting the development of the individual with dyslexia is attention deficit. Optimal attention increases learning. Attention deficit results in inconsistent perception of stimuli hampering the development of strong neural connections and weakens the working memory necessary for processing multiple perceptions. Optimal treatment of the attention deficit is an imperative."

 

I found it to be particularly interesting that at least one researcher feels that executive function deficits may be part of the main package of the dyslexic profile. Second quote seems to back up what Renee in FL has experienced with her son in a rather dramatic way.

 

There are quite a few interesting nuggets in this article.

[EKS]

I know that my dyslexic son responds well to stimulant medication.

[Tokyomarie]

Here's an abstract I found on the topic of executive functions in dyslexics at ScienceDirect:

 

Neuropsychologia

Volume 40, Issue 12, 2002, Pages 2144-2155

 

Executive functioning in adults and children with developmental dyslexia

 

Mark Brosnan, James Demetre, Stephen Hamill, Kate Robson, Haidee Shepherd, Gerard Cody

 

Department of Psychology, School of Social Sciences and Law, University of Greenwich, London SE9 2UG, UK

 

Received 28 March 2001; revised 18 March 2002; Accepted 20 March 2002. Available online 12 April 2002.

 

Abstract

 

The performance of developmentally dyslexic children and adults was studied upon a range of tasks that involved executive functioning. Both adult and child samples of dyslexics were found to under-perform on the group-embedded figures test. This test required the identification of constituent parts from within complex visual arrays, with good performance necessitating the inhibition of the processing of the surrounding context. A general deficit on visual–spatial tasks was eliminated as an explanation as dyslexics performed normally upon a range of other non-verbal assessments. The dyslexics consistently demonstrated a deficit in digit span tasks, a decrement that was increased with distractors, again suggesting difficulties in inhibiting the processing of the surrounding context. A deficit was also identified upon a verbal fluency task without a deficit in vocabulary level. Additionally, a specific deficit in the recollection of the temporal order of the presentation of items was in evidence, without a deficit in the recognition of the items themselves. The findings taken as a whole suggest that dyslexic individuals show deficiencies in executive functions relating to inhibition of distractors and to sequencing of events, a set of tasks associated with left prefrontal cortex functioning in the acquired neuropsychology literature.

[Renee in NC]

My 10yo (as the OP said) responded dramatically to Vyvanse. However, as I recently posted, methylphenidates did *not* have the same effect for him. I want to also mention that my 13yo had severe reactions to both (agitation, aggressiveness, etc.)

 

The doctor says it is the norepinephrine reuptake inhibitor that seems to work for him, but we'll see once the Strattera kicks in. Vyvanse affects dopamine and norepinephrine (as do most stimulants) while Strattera works more on just the norepinephrine.

 

For us, the comorbid conditions are so intertwined that it is hard to tease out the root cause.

 

My 9yo is a good example - he is dx CAPD, low IQ, dyslexic, mixed expressive-receptive language delays, and extremely low working memory. It's like a chicken and egg question, though! Is his lower IQ caused by the CAPD? What about his speech issues? Then, he is very impulsive - is that an executive function problem (related to ADHD) or is that a by-product of the working memory problems? We don't really know and probably won't ever know.

[Tokyomarie]

My 10yo (as the OP said) responded dramatically to Vyvanse. However, as I recently posted, methylphenidates did *not* have the same effect for him. I want to also mention that my 13yo had severe reactions to both (agitation, aggressiveness, etc.)

 

The doctor says it is the norepinephrine reuptake inhibitor that seems to work for him, but we'll see once the Strattera kicks in. Vyvanse affects dopamine and norepinephrine (as do most stimulants) while Strattera works more on just the norepinephrine.

 

It will be interesting to see how he does on Strattera. It would be an interesting survey/study to see if there is a discernable pattern as to which kinds of medications kids with both dyslexia & attention deficits respond to vs. kids with only an attention deficit diagnosis.

 

For us, the comorbid conditions are so intertwined that it is hard to tease out the root cause.

 

My 9yo is a good example - he is dx CAPD, low IQ, dyslexic, mixed expressive-receptive language delays, and extremely low working memory. It's like a chicken and egg question, though! Is his lower IQ caused by the CAPD? What about his speech issues? Then, he is very impulsive - is that an executive function problem (related to ADHD) or is that a by-product of the working memory problems? We don't really know and probably won't ever know.

 

My middle child did not have any hyperactive/impulsive symptoms, though her original evaluator suggested we think about the possiblity of ADHD inattentive.

 

She did however have a diagnosis of mixed receptive/expressive language disorder. Her verbal IQ was significantly lower than her performance IQ, which was quite strong. After several years of remediation for auditory processing skills & intensive 1-on-1 language development, her academic skills were showing strong growth. By the time she was 18yo, her scores on the SAT/ACT were high enough to qualify her for the best scholarship at the university she first attended. Though she never had another IQ test, I suspect based on her college entrance scores & academic functioning that she would have tested 30 points higher than she first scored.

[PeterPan]

My dh, dyslexic, has no clinical issues with EF (not the way we're talking about here). My dd, also to all appearances dyslexic, clearly has EF issues. The Eides make the case for a processing load overburden that reduces working memory. I haven't yet seen in their book where they correlate dyslexia and EF. I'm just glancing quickly, but it looks like in that quote you gave the study is looking at working memory as an aspect of EF. There are clearly degrees of EF issues, and I don't see how you could lump *only* working memory issues (which I tend to think the Eides are probably right about) with kids who have the entirety of the rest of the EF problems.

Edited October 10, 2011 by OhElizabeth

[Tokyomarie]

My dh, dyslexic, has no clinical issues with EF (not the way we're talking about here). My dd, also to all appearances dyslexic, clearly has EF issues. The Eides make the case for a processing load overburden that reduces working memory. I haven't yet seen in their book where they correlate dyslexia and EF. I'm just glancing quickly, but it looks like in that quote you gave the study is looking at working memory as an aspect of EF. There are clearly degrees of EF issues, and I don't see how you could lump *only* working memory issues (which I tend to think the Eides are probably right about) with kids who have the entirety of the rest of the EF problems.

 

I'm not seeing much, if any, elaboration about specific executive functions but the article does seem to separate them out from working memory. There are several sentences in which the phrase "executive function" appears in a list with "working memory." This sentence is one example: "The child's attention, working memory, and executive functions must be assessed and treated optimally."

[Tiramisu]

As you folks know, I've been trying to puzzle out the role of in/attention & executve function in my son's whole learning profile, which includes dyslexia & dysgraphia. Since the topic has come up in another current thread, I thought I would create a new thread to discuss the frequency of attention deficits & executive dysfunction co-occuring with dyselxia, and the possible impact on the severity of dyslexic symptoms.

 

I found an article on Medscape that includes discussion of various issues that are seen in dyslexic students, and pulled out these quotes:

 

Current Status of Treatments for Dyslexia: Critical Review by Ann W. Alexander, MD and Ann-Marie Slinger-Constant, MD

 

"Deficits in these executive functions are being considered as a possible third core deficit in dyslexia after the phonologic and rapid naming core deficits (Berninger VW, personal communication, 2003)."

 

"The most prevalent comorbid condition impacting the development of the individual with dyslexia is attention deficit. Optimal attention increases learning. Attention deficit results in inconsistent perception of stimuli hampering the development of strong neural connections and weakens the working memory necessary for processing multiple perceptions. Optimal treatment of the attention deficit is an imperative."

 

I found it to be particularly interesting that at least one researcher feels that executive function deficits may be part of the main package of the dyslexic profile. Second quote seems to back up what Renee in FL has experienced with her son in a rather dramatic way.

 

There are quite a few interesting nuggets in this article.

 

When they say "optimal treatment of the attention deficit disorder," what specifically are they talking about? Medication, I guess. But medication only?

[rafiki]

.

[Renee in NC]

When they say "optimal treatment of the attention deficit disorder," what specifically are they talking about? Medication, I guess. But medication only?

 

For my ds's ADHD, there is no other option besides medication. Behavioral therapy can help behavior, but there isn't a therapy that can increase actual processing.

 

There is an ADHD clinic at Duke University that I spoke to briefly a few months ago. Their stance is that medication AND therapy is optimal, but one without the other is pointless in almost all cases. They won't work with an unmedicated child unless there is some circumstance that won't allow for meds.

[Tokyomarie]

When they say "optimal treatment of the attention deficit disorder," what specifically are they talking about? Medication, I guess. But medication only?

 

I'd have to look again, but I don't think the authors gave a definition of what they consider to be optimal.

[Tiramisu]

My dh, dyslexic, has no clinical issues with EF (not the way we're talking about here). My dd, also to all appearances dyslexic, clearly has EF issues. The Eides make the case for a processing load overburden that reduces working memory. I haven't yet seen in their book where they correlate dyslexia and EF. I'm just glancing quickly, but it looks like in that quote you gave the study is looking at working memory as an aspect of EF. There are clearly degrees of EF issues, and I don't see how you could lump *only* working memory issues (which I tend to think the Eides are probably right about) with kids who have the entirety of the rest of the EF problems.

 

Thanks for all the responses to my "optimal treatment" question.

 

We don't have any dyslexia issues but I want to read the Eides book anyway because of that bolded bit above. I definitely want to know more about that.

 

OhElizabeth, I read Freed's book but it didn't really offer much more than I'd heard/read before. Once I heard a conference tape, by someone other than Freed, that now seems like it wasn't anything other than a summary of Freed's book. Somehow I feel the right brain/left brain model is too simplistic to cover what what I've seen in my family. The descriptions of right brain behaviors is so right on, though, that I had to laugh at times because the scenes were so familiar to me. And, the questionaire showed I'm extremely left-brained which means my mom has something right when she laughs and tells me I'm a left-brained mom with right-brained kids. I'll also add I have a right-brained mom and right-brained dh. I may as well give up!

 

One thing I liked about the Freed book is that it gives the okay for using sight reading with right-brained kids when phonics doesn't work. One of my dd's fit that situation. Since we have no dyslexia it worked, but I don't know if it would be advisable across the board.

[PeterPan]

Kelli, I totally agree with what you're saying about the oversimplifying. The Eides' DA book is interesting because it actually attempts to explore some of the physical, structural things they're discovering about the brain. And like you say, I *don't* think these attributes are necessarily limited to people with certain markers or labels. This stuff intertwines so much I think it's valuable to read across labels and take whatever WORKS.

[proudmamma]

I'm not sure exactly what I want to say because I haven't read the articles and I am in a pretty big hurry. BUT... my son (15) has severe dyslexia. His reading has improved dramatically but not where I want it yet and his spelling has a long way to go.

 

Long story short, he struggles greatly with focusing. From time to time he is able to really concentrate and he is able to do things that would normally take forever and be extremely frustrating. Neither of us can pinpoint exactly how he is able to really focus but somehow he is able to force himself out of sheer will. If he could only do this all or even most of the time.... He has no hyperactivity associated with attention problems. He finds himself zoning out a lot and sometimes I feel like he goes there because it is just easier than making himself think. Thinking for school seems actually painful for him at times.

 

All that said, I just feel there is a physical reason for this and I don't feel like medication will actually fix the problem. I want to fix this and I feel like it has to be something that is lacking -- something nutritionally that the body needs that these kids are so deficient in that they can't concentrate, etc. I am not trying to bash anyone who choses to give their children medication, please don't misunderstand. I just would love to be able to work through the physical whys and how to remedy this in a natural way (as much as possible).

 

Can anyone explain how and why the medication works? Maybe there is something that can do the same through nutrition (even though it will take longer). I would love to discuss further if anyone is interested in going down this trail :)

[Renee in NC]

Most ADD meds work because they are stimulants - they increase dopamine which makes the brain work faster (and often then increase norepinephrine as a side benefit.) Vyvanse and Adderall are different in that they increase dopamine and act as norepinephrine reuptake inhibitors. Strattera is a non-stimulant that acts only on norepinephrine. All of these things work on actual physical problems related to neurotransmitter deficiencies.

 

My 10yo (who has an EXTREMELY severe case of ADHD) can concentrate on something when he really needs to. It's called hyperfocus and is common in ADD/ADHD. However, when he does that, he can't pay attention to anything else. When he was in school, his teacher told him that he could not move his feet because it was distracting. So he didn't. The problem was that he couldn't pay attention to what she was teaching AND not move his feet. I imagine if they are ever able to develop a test that measures brain chemicals that he would test extremely low on norepinephrine.

 

Just doing a google search, it seems that some claim that certain amino acids can increase norepinephrine. The site I found also claimed that they could test neurotransmitter levels through a urine test, so take what it says with a grain of salt.:glare: As far as I know, there is no legitimate way to increase norepinephrine through nutrition or supplements. Some people get results from fish oils and removing certain things from the diet.

 

I hope you are able to find answers for your ds. Attention/concentration problems are very difficult on a person. It's particularly hard if they think they should be able to control themselves from doing this and then they can't.

[peacefully]

.

[Melabella]

 

In our case, the "chicken" was ds's language disorder, and the egg was these quirky behaviors and lack of attention. Remediating his working memory and language processing issues have cleared up the ADHD-like symptoms. He still spaces out sometimes, but the difference is that now *he* can self-regulate and bring himself back to the task at hand. The compulsions to fiddle with stuff, move his legs, yawn, look around his environment, bang and make noise, vocalize, stammer, etc. are just gone. I haven't seen those behaviors for a few months now.

 

What did you do to remediate the working memory and language processing issues?

[Tiramisu]

Kelli, I totally agree with what you're saying about the oversimplifying. The Eides' DA book is interesting because it actually attempts to explore some of the physical, structural things they're discovering about the brain. And like you say, I *don't* think these attributes are necessarily limited to people with certain markers or labels. This stuff intertwines so much I think it's valuable to read across labels and take whatever WORKS.

 

Not sounding very humble here, but I'll say it anyway. :tongue_smilie:

 

Freed's book is probably a good start to explore these kinds of issues, but I think many of us who have been reading and mulling over this stuff for some time have moved on to meatier things. We want the specific neurological factors (structural, chemical, etc.), the digestive connections, and the latest research on all of it, to try to get at the root of what's going on and give us ideas for addressing what we're seeing. Right? :)

[PeterPan]

Yllek, that's what is so interesting to me, that you can take these kids with the subcomponent labels, not an overall dyslexia label, and you find them fitting the "dyslexic processing" profile, the overall picture the Eides paint.

 

Kelli, I have the Freed book, read some of it, could go back and read more. I think at the time I was annoyed with his generalizations and blanket terms. Some things you have to grow into, kwim? He was saying ALL add/adhd kids would be VSL (if I'm remembering correctly), and that was such a BIG leap for me at the time, I was really struggling with it. It made me set the book aside. I went back a few times and read tidbits here and there which I found helpful. So I have it and can go back and read more. I *think* maybe the Eides' comments on brain structure are newer than anything in Freed's book. But I'm with you on the interest in the chemistry and stuff. I was just researching some of those probiotics from that other thread and the interesting places it could lead. (homeopathy, minerals, etc.)

 

On the VSL/Freed thing, I think my dd actually *is* VSL but that it couldn't come out before because of her vision problems. Since reading Freed, I've been watching her. She has finally started saying things about thinking in pictures (I didn't solicit that, she just said it). But I honestly don't think before VT she did. Before VT she was processing totally auditorily, because her visual was so weak. It's like she's finally coming into her own and becoming who she was meant to be.

[FairProspects]

She has finally started saying things about thinking in pictures (I didn't solicit that, she just said it). But I honestly don't think before VT she did. Before VT she was processing totally auditorily, because her visual was so weak. It's like she's finally coming into her own and becoming who she was meant to be.

 

Boy do I agree with this! I had thought ds was primarily an auditory learner since he processed so well this way, only after some OT and VT did I realize just how visual he was. He just could not do it initially since his primary mode of visual (and fine motor for drawing) was weak. It really was amazing to see the transformation.

[siloam]

Love this thread.

 

Figured out that my ds diffidently is not CAPD. He follows multi-step oral directions without problems. That said he still struggles to hear the sounds in simple CVC words and accurately recall the corresponding letters, but can accurately recall the sounds when reading so that he reads above grade level.

 

What I find interesting in relation to EF is that reading came together for him in a week when we started using Barton reading. I have always attributed that to the movements used, and how it helped him focus. Taping under each letter while saying the sounds, doing a slow blend while making a u with his finger under the word, and then blending fast while running his finger under the word. So simple but it made reading "click" for him and points to EF issues.

 

As a teen I always preferred to do homework with music on. Everyone thought I was nuts, but I think it also might point to EF. Loud predictable music (stuff I already know well) would keep distracting noise out and allow me to hyperfocus.

 

Like Renee's ds to this day I will do copywork while listening to a sermon in church because otherwise my mind wanders based on what I see and hear.

 

In high school my nick name was spaced out, and I once even had an employer comment on it. When I am overwhelmed I sort of check out, frozen and unable to make a decision. In day to day life I use routine to combat this, but it can get me into trouble in a work environment because I can choose routine over something that needs immediate attention.

 

When I am reading on a topic and have reached my fill, the feeling is like I have so many ideas pulling at me I need to stop let them settle...ponder each one? Otherwise it feels like I start loosing ideas, they just drop off and I have to go back and re-read to find them again.

 

All my kids use headphones (with music or just sound blocking) on a regular basis, including myself when doing corrections. At the same times I will have times when my dh will come over and ask me, "Don't you hear that?" I will realize that the kids are arguing and I have been blocking it out, hyperfocusing. It has to get to a certain volume/tone for me to pull out and hear it on my own.

 

All of the kids and myself show signs of problems with working memory connected to being interrupted. As if when interrupted we do a memory wipe. Half finished math problems, unfinished sentences in writing or general conversation, that sort of thing. Just this week I discovered that I set up all our bills to pay a month late. I suspect this was because I paid our mortgage first, which means I look at the next month to see when the first lands and it was a weekday or a weekend. I suspect I was then interrupted and when I came back to it I forgot I was looking at the next month. Luckily I caught that the print out had all the dates a month out and correct them. But it is typical around here. Normal people do it too, but generally not as often, and not with so small of interruptions (like a child just telling me they are going outside to play).

 

Heather