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ADHD vs. EF vs. Dyslexia

ADHD vs. EF vs. Dyslexia
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Dr. Roseann Capanna-Hodge

Dyslexia, Attention-Deficit Hyperactivity Disorder (ADHD), and Executive Functioning Disorder (EFD) are the three of the most common neurodevelopmental disorders that school-age children suffer from. These cognitive challenges are connected in many ways because most of their symptoms overlap and impact children's learning.

Due to the associated stress, these clinical issues also impact children's mental health. Processing information slowly or inefficiently makes learning hard, making kids feel “stupid” or “dumb” and overloaded.

Furthermore, the symptoms of each disorder may be exacerbated by the others. Their typical symptoms include slow information processing, poor organizational skills, difficulty planning and prioritizing, working memory deficit, and slow naming speed. Therefore, parents and even some healthcare professionals confuse one disorder for another.  

What is ADHD?

ADHD is a prevalent mental health issue in children and teens. ADHD kids have problems being attentive or staying focused. They also can display hyperactive and impulsive behaviors. But more importantly, they also have issues with executive functioning, which means they lack the ability to see and work toward a goal. 

ADHD affects not just children and teens but also adults. One common misconception is that it disappears in adulthood. However, ADHD isn't a condition that goes away as one age. It affects a person throughout their life. It may look different in a child or teen than in an adult, but ADHD affects individuals at school, work, relationships, and home.

One typical symptom of ADHD that affects children and adults is daydreaming or zoning out. These kids tend to have problems with academic performance, task completion, and social relationships. They miss directions and are often slow to start tasks as a result. When you “zone out,” time blindness is common, and 10 minutes can turn into an hour. 

Some kids with ADHD exhibit externalizing behaviors such as acute emotional responses and behavioral outbursts. These hyperactive-impulsive kids are triggered mainly by frustration, sensory overload, and fatigue. About 70% of those with ADHD also have rejection sensitivity dysphoria or RSD, which means they also experience intense emotional reactions to real or perceived criticism or rejection.

Symptoms of ADHD

  • Makes too many careless mistakes 
  • Overlooks some instructions and details 
  • Gets distracted easily
  • Difficulty in focusing on tasks and conversations 
  • Problems following instructions 
  • Issues with organizing activities and tasks 
  • Refuses activities that require sustained attention 
  • Always forgets or loses and forgets things 
  • Avoids group and leisure activities
  • Blurts out answers 
  • Interrupting and intrusive 
  • Impulse control
  • Attentional issues

What is EF?

Executive functioning refers to one's ability to organize thoughts and actions in preparation for future activities and goals. We all use this mental ability daily, which involves memory, organization, emotional flexibility, self-control, and self-awareness. 

It can be difficult for children and teens who lack executive functioning skills to shift attention and follow directions. They will also have difficulty planning, starting, and completing tasks because the part of the brain that plans and organizes is deficient. 

Executive functioning is the central process involved in giving order and organization to a person's behavior and actions. It affects one's ability to see the future result of a given task and how to achieve it. These skills are learned over time. Even though a child without them is highly impacted, they can be taught. Executive functioning training involves explicitly teaching and reinforcing desired skills.

Symptoms of Executive Functioning Disability

Symptoms of Executive Functioning Disability

Children and teens with poor executive function skills will have problems with the following: 

  • Planning
  • Prioritization
  • Problem solving
  • Defining and achieving goals
  • Organizing behavior 
  • Organizing items
  • Time management
  • Self-awareness
  • Self-regulation of attention, behaviors, and emotions
  • Stress tolerance
  • Behavioral and cognitive flexibility 
  • Regulating words, behaviors, and thoughts
  • Nonverbal and verbal working memory and short-term memory

What is Dyslexia?

Dyslexia is a learning disability that affects a person's reading skills and phonics. This disorder has neurobiological origins. Children and teens with dyslexia have difficulty recognizing words accurately, reading fluently, and spelling correctly due to a phonological deficit in the language. Individuals with developmental dyslexia also have problems with basic decoding and encoding, reading comprehension, and vocabulary. 

Aside from phonological processing, people with dyslexia have problems with letters, numbers, writing, and phonics. Therefore, it's crucial to diagnose dyslexia early so they can remediate phonological deficits, as well as learn proper coping mechanisms. 

Otherwise, they will develop mental health and executive functioning issues that complicate the problem and make it harder to diagnose. Undiagnosed and improperly treated dyslexia always leads to high-stress levels and “brain overload,” so kids can appear inattentive and are often inaccurately diagnosed with ADHD.

Symptoms of Dyslexia

Symptoms of Dyslexia

  • Poor phonetic skills
  • Early learning difficulties
  • Difficulty with rhyming
  • Reads below one's grade level
  • Fails in school
  • Hates reading

ADHD vs. EFD

Many challenges related to ADHD also appear in children with executive function disorder or EFD. For example, if your child has EFD, their brain suffers from poor self-management of daily tasks. Planning for and prioritizing simple and complex daily and learning tasks is very hard when you can't “see” the result.  Additional shared symptoms of ADHD and EFD are poor organizational skills, working memory, and task initiation and completion.

One significant difference between attention problems and EFD is that ADHD is defined as a clinical condition while EFD is not. While Executive Function Dysfunction is a recognized issue, it isn't listed in the Diagnostic and Statistical Manual (DSM). 

It means that ADHD has precise treatments such as medications, neurofeedback, and more techniques to support it, while EFD doesn't have as many experts offering care in a clear way. As a result, children and teens with EF deficits may not get the same school and clinical support. 

Children and teens with poor executive functioning skills are less spontaneous and not as impulsive as those with ADHD. However, kids with EFD can still lack emotional control and self-regulation abilities due to the frustrations of having this condition.

Similarities of ADHD and Executive Functioning Dysfunction

Similarities of ADHD and Executive Functioning Dysfunction

  • Difficulty in paying attention
  • Problem with self-control
  • Issues with managing emotions
  • Trouble keeping important information in their working memory
  • Can't switch from one activity to another
  • Problem starting a specific task
  • Organization problems
  • Trouble keeping track of things and events  
  • Can't complete tasks
  • Acts before thinking 
  • Gets distracted easily 
  • Often forgetful
  • Problem with taking turns

Differences Between ADHD and EFD

Differences Between ADHD and EFD

Even though there is a lot of overlap between attentional and executive functioning issues, there are some apparent differences between them.

  • ADHD is usually detected in the early stages of life, while executive functioning skills aren't something a person is born with. Executive functioning develops over time and fully develops when one reaches their 20s. 
  • Executive functioning skills are learned, while ADHD is a clinical condition caused by chemical deficits in the brain.  
  • Executive function disorder is not a clinical disorder that follows no criteria. For ADHD, there are clear clinical guidelines, and these deficits must exist for at least six months.  
  • ADHD is an attention disorder, while executive function affects one's ability to plan and prioritize for a future task or event.

ADHD vs. Dyslexia

ADHD vs. Dyslexia

Children and teens with dyslexia misread words and have problems reading accurately. On the other hand, kids with Attention Deficit Disorder don't necessarily misread words but often lose their pace when reading. They may skip punctuation marks and entire paragraphs or skip around the page due to distractibility.

Similarities of ADHD and Dyslexia:

  • Difficulty in organizing thoughts when reading and writing
  • Trouble paying attention
  • Problems in communication
  • Keeping an eye on the word or words while reading
  • Difficulty completing tasks
  • Brain fatigue when learning
  • Working memory deficits 

Differences between ADHD and Dyslexia 

  • Dyslexia impacts one's ability to use language, while ADHD affects one's ability to focus.
  • Dyslexia affects one's grammar and spelling abilities, while ADHD impacts one's ability to organize thoughts and actions 
  • Dyslexia causes struggles with understanding the content on a test, while ADHD causes one to make careless mistakes and miss directions due to focus issues.

EF Issues vs. Dyslexia 

Numerous studies have proven that there are correlations between executive functioning deficits and dyslexia symptoms. Children and teens with reading disabilities have problems with working memory and phonological processing. 

Dyslexia can be very complex because reading is one of the most complex neurological tasks we will learn in our lifetime, affecting kids in different ways. However, one common issue among kids with dyslexia is trouble decoding. Decoding refers to sounding out letters in a word to read correctly. It also involves knowing how to take the sounds apart in terms of blending and segmenting them.

Children and teens with dyslexia also have trouble with their working memory, the main element of executive functioning necessary for learning. Dyslexic kids also have problems with visual imagery and attention capacity. They use up so much working memory decoding that their attention breaks down.

Another study tried to verify if kids with dyslexia also suffer from executive function challenges, particularly regarding working memory, shifting, and inhibition. In this study, 47 children and teens aged 8 to 13 participated. Of them, 24 were dyslexic, and 23 followed typical development. 

After a series of neuropsychological tests, results show that dyslexic children exhibit executive function difficulties in the critical areas listed above. In addition, such challenges were affected by phonological working memory deficits associated with dyslexia (Barbosa et al., 2019). This study reflected the intricate relationship between phonological processing, working memory, and executive functioning.

I recall this sweet 8-year-old Hillary, who was severely dyslexic and was first misdiagnosed with ADHD because the school couldn't understand why she couldn't read and thought the “brain overload” behaviors they saw during phonics and reading instruction were attention-related. After a QEEG brain map and a detailed history, it was clear that Hillary was dyslexic and not ADHD. After a course of neurofeedback, Hillary's processing speed improved quickly. After some wrangling with the school district, Wilson's multisensory reading was added, and Hillary's phonics skills took off. With the right instruction, there were no longer any signs of attention issues either, which is a testament to when you get the brain in an alert, efficient state and give it the right instruction, learning happens.

EF Issues vs. Dyslexia

Similarities of EFD and Dyslexia

  • Pauses or hesitates when speaking
  • Needs extra time when answering questions
  • Spaces out when in “brain overload”
  • Poor working memory
  • Inefficient processing
  • Low self-esteem
  • Problems remembering names, dates, lists, and telephone numbers
  • Poor test performance
  • Struggles in finishing tasks or tests on time
  • Exhibits general anxiety

Differences between EFD and Dyslexia 

  • Children with EFD are distracted due to poor organization and planning, while kids with dyslexia are affected if the task requires reading, which drains their efforts.
  • Children with EFD struggle with reading because they have trouble organizing and analyzing information. Dyslexic kids have reading problems because they need much time to sound out each word and read them correctly due to phonological and language-based issues.
  • Children with EFD have poor writing skills because they struggle with organizing their thoughts, while people with dyslexia struggle to write due to problems with spelling and grammar. 

ADHD, EFD, and Dyslexia 

A meta-analysis research study examined groups of children to determine how working memory, switching attention, and inhibition affect kids with dyslexia. It also explored how executive functions are affected if a child has dyslexia and ADHD. Finally, children with dyslexia, ADHD, or both were examined regarding their executive functioning. 

The children with dyslexia exhibited difficulty with a medium to significant effect compared to the control group. However, kids in the comorbid group (ADHD/dyslexia) showed the same difficulty with inhibition, switching attention, and auditory working memory impairment compared to children with dyslexia alone. In simpler terms, the children with dyslexia looked the same on tasks related to executive function as kids diagnosed with ADHD and dyslexia.

The findings of this study demonstrated the presence of executive function deficits in children with dyslexia (Lonergan et al., 2019), which is incredibly meaningful in terms of how we support children with dyslexia. A parent shouldn't rush to fill an ADHD pill bottle because they suspect ADHD when it is known that dyslexics have executive functioning issues requiring skills training.

ADHD pill bottle

Treatment for ADHD, EFD, and Dyslexia

ADHD, EFD, and Dyslexia are connected. The natural treatment and solutions listed below can help alleviate the symptoms and effects of these disorders and help improve the lives of children diagnosed with ADHD, EF, or dyslexia.

Treatment for ADHD, EFD, and Dyslexia

Neurofeedback 

Like what we learned about Hillary, Neurofeedback instructs the brain on processing more efficiently because it can self-regulate, which is something children with dyslexia, executive functioning issues, or ADHD lack.  It helps create focused brain waves by altering the amount and ratios of slow to fast waves to retrain the brain and reduce symptoms. This method will also improve the child's executive functioning by increasing focus, working memory, and processing speed. 

For kids with dyslexia, their brain on a QEEG brain map displays under-activity in the brain's communication and the language centers responsible for phonics. When it comes to learning, certain areas in the brain need to communicate rapidly for efficient processing, and those with dyslexia or executive functioning issues display sluggish processing. 

Neurofeedback has been shown to improve connectivity in the brain so it works more efficiently. Regular sessions may result in better learning and improved working memory and phonological processing.

Cognitive Behavioral Therapy 

There are different types of psychotherapy and coaching that can help children with dyslexia, ADHD, or executive functioning. Cognitive behavioral therapy, when combined with parent coaching, will give children with ADHD more tools to use to deal with their behavioral struggles. 

Executive functioning training allows a child to discover ways to be more productive in everyday life. Specific foundational EF skills need to be developed before advanced EF skills related to project management and writing can be achieved. These skills can be taught and reinforced at a high level to establish learned behaviors. 

Dyslexic children can also benefit from cognitive behavior therapy as they are taught how to self-advocate and self-regulate. Parents will also benefit from this therapeutic coaching from mental health professionals who can introduce to them better ways to support their kids, especially when it comes to boosting their self-esteem and other emotional needs.  

Understanding how attention, executive functioning, and language-based disorders such as dyslexia affect learning at school and home is complex. With Hillary, a QEEG Brain Map got to the bottom of what was going on and led to a treatment plan that included a multisensory reading program through an IEP and neurofeedback.

Citations

Barbosa, T., Camila Cruz, R., Claudia Berlim de, M., Mariana Cristina de Souza e, S., & Orlando Francisco Amodeo, B. (2019). Executive functions in children with dyslexia. https://www.lareferencia.info/vufind/Record/BR_99b17d699bc37a2224a0d4d00960d92f/

Lonergan, A., Doyle, C., Cassidy, C., MacSweeney Mahon, S., Roche, R. A. P., Boran, L., & Bramham, J. (2019). A meta-analysis of executive functioning in dyslexia with consideration of the impact of comorbid ADHD. Journal of Cognitive Psychology, 31(7), 725–749. https://doi.org/10.1080/20445911.2019.1669609

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Dr. Roseann is a Children’s Mental Health Expert and Therapist who has been featured in/on hundreds of  media outlets including, CBS, NBC, FOX News, PIX11 NYC, The New York Times, The Washington Post,, Business Insider, USA Today, CNET, Marth Stewart, and PARENTS. FORBES called her, “A thought leader in children’s mental health.” 

Dr. Roseann - Brain Behavior Reset Parent Toolkit

She is the founder and director of The Global Institute of Children’s Mental Health and Dr. Roseann Capanna-Hodge. Dr. Roseann is a Board Certified Neurofeedback (BCN) Practitioner, a Board Member of the Northeast Region Biofeedback Society (NRBS), Certified Integrative Medicine Mental Health Provider (CMHIMP) and an Amen Clinic Certified Brain Health Coach.  She is also a member of The International Lyme Disease and Associated Disease Society (ILADS), The American Psychological Association (APA), Anxiety and Depression Association of America (ADAA) National Association of School Psychologists (NASP), International OCD Foundation (IOCDF) International Society for Neurofeedback and Research (ISNR) and The Association of Applied Psychophysiology and Biofeedback (AAPB).

© Roseann-Capanna-Hodge, LLC 2023

Disclaimer: This article is not intended to give health advice and it is recommended to consult with a physician before beginning any new wellness regime. *The effectiveness of diagnosis and treatment vary by patient and condition. Dr. Roseann Capanna-Hodge, LLC does not guarantee certain results.

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