Early ADHD Diagnosis? Don’t Forget About Learning Issues

As a neuropsychologist, it’s my job to evaluate kids for learning and thinking differences. Over the years I’ve seen many kids whose learning differences weren’t picked up until late grade school or middle school. I’ve even seen kids who weren’t evaluated until high school or college. And often, these kids were diagnosed with ADHD at a young age.

I recently saw a 12-year-old named Billy in that exact situation. His mom called me in distress because as the school year was ending, he was at risk for failing every subject except math.

Billy had been diagnosed with ADHD (also known as ADD) at age 5. He was a hyperactive preschooler, and his parents were relieved to find that there were good ways to help him be more successful in school. Medication, and some special tutoring in reading skills helped him be fairly successful in the early grades.

But as he moved into middle school, Billy started having a harder time meeting grade-level expectations. This was extremely frustrating because he was getting all the supports he could possibly get. Medication seemed to be working. In fact, he seemed to show fewer ADHD symptoms than ever before. So why was school getting harder for him?

I had my suspicions from the start. Many kids with ADHD also have a like . A full evaluation can determine if a child has both a learning difference and ADHD. That could be a school evaluation or a private one.

But a child who’s evaluated for ADHD at an early age may not have his learning skills assessed. At 5, Billy was too young to be tested for reading issues, for instance. And there were no signs at that point that he might have trouble with reading.

In grade school, however, Billy did struggle to learn to read. And while he got some support for it, he never became a competent reader. That’s because in addition to ADHD, he had dyslexia that wasn’t diagnosed or being treated.

Everyone had just assumed Billy’s problems were due to his ADHD. Like most kids with ADHD, he had issues with attention and other executive functioning skills. So nobody looked beyond that to see what else might have been causing him to have trouble in school.

When I evaluated Billy, the exact cause of his difficulties became clear. He struggled with and reading fluency.

If Billy had been assessed the first time at age 8 instead of 5, the result would probably have been different. He would likely have gotten a diagnosis of both ADHD and dyslexia. But at the end of preschool the ADHD diagnosis was a clear fit. And the learning problems that cropped up later were overlooked.

ADHD can affect nearly all aspects of learning. So it’s not surprising that parents and even professionals might attribute a child’s difficulties in school to his ADHD. But when that child has had good interventions for ADHD and still struggles with learning, it should raise a flag that there might be something going on in addition to the ADHD.

Once a child has been diagnosed with ADHD, it’s important to carefully monitor his challenges and successes. That’s especially true if he was diagnosed at an early age.

If you think your child may have learning differences, don’t put off looking into it. Discuss your concerns with your child’s doctor or with the professional who diagnosed his ADHD. Talk to your child’s teacher or child study team about getting a full evaluation at school. You can also seek a private evaluation.

The sooner you know the cause of your child’s struggles, the sooner he can get supports and services to help him succeed at school.

Learn about how ADHD is diagnosed. Understand the pros and cons of private versus school evaluations. And find out what to do if you think your child might have dyslexia or another learning difference.

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