Specific Learning Difficulties and the challenges of co-morbidity

Most SpLDs: dyslexia, attention deficit, dyspraxia, language problems and some aspects of autism are co-morbid. Co-morbidity refers to different conditions that co-exist. Although a child’s initial assessment may show Attention Deficit Disorder to be their main area of need, they are certain to experience degrees of dyslexia, dyspraxia, autistic traits, dyscalculia or language difficulties. 

These additional SpLDs may not be acknowledged in the initial assessment because co-morbidity makes the identification of the root of a problem complicated. A primary aged child may be diagnosed with dyslexia but, in addition to their obvious difficulties with literacy, they experience problems with: following instructions, concentration, grasping overviews of texts, poor motor skills and problems with number. These challenges could be due to the child’s dyslexia or alternatively, as a result of their ADHD, dyspraxia, dyscalculia or language problems. The child may not have reached the threshold for a positive diagnosis of those specific learning difficulties when assessed and, as literacy problems are the child’s immediate difficulty, dyslexia will seem to be the most pragmatic label that can be given.

Dyspraxia, speech and language disorder or dyslexia are observed in 50% of individuals with ADHD, and in nearly all of the children diagnosed with Asperger’s Syndrome.

While it is usual for one SpLD to be dominant at a certain stage of a child’s life, it is also usual for other co-morbid conditions to be more challenging at other times. A pre-school child may have speech and language issues; the same child will experience literacy / dyslexic type difficulties in primary school; and then attentional weaknesses in secondary school. Sometimes, as a result of unassessed needs, the young person may be viewed as experiencing social, emotional and behavioural problems by the time they are a teenager. 

The individual’s problems will continue into adult life, although the focus and impact of the difficulty will change. For example in the case of ADHD, the outward display of attentional problems common in childhood, will be replaced in an adult by internal turmoil. The individual will complain of stress, panic attacks and exhaustion; they may be diagnosed with anxiety, depression or bi-polar disorder. Other adults may be treated for insomnia, or develop eating disorders related to their impulsive behaviour. Pensioners may be assumed to be experiencing Alzheimer’s, and referred to memory clinics, although a poor memory and slow processing are common amongst individuals with SpLDs. Treatment for anxiety, depression, sleeping disorders, eating disorders and dementia will be ineffective because the underlying problem is not being treated.

It is vital that the impact of co-morbid SpLDs such as ADHD on adults is understood by medical professionals and the person themselves. The ideal initial assessment for an individual would involve a multidisciplinary team of professionals providing a comprehensive overview of all the person’s primary and co-morbid needs. Without such overarching, holistic assessments, there is a danger that many individuals will experience chronic unhappiness throughout their adult life, as a direct result of unrecognised difficulties and misdirected treatment and support.