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A.I.D.A.I. Newsletter • Primavera 2005RELAZIONE MAGISTRALEEffects of combined pharmacological and academic intervention on childrenwith ADHD plus comorbid dyslexiaR. TannockResearch Institute of The Hospital for Sick Children & University of Toronto,CanadaAttention-Deficit/Hyperactivity Disorder and Dyslexia (ADHD+RD) are both prevalentchildhood problems, that frequently co-occur in the same child and persist intoadolescence and adulthood, with poor outcomes. However, there is no robust evidenceto date of an effective intervention approach to ameliorate both the behaviouraland reading problems. Here, I present findings from our randomized controlled clinicaltrial of combined academic and pharmacological intervention, involving 65 children,aged 7 to 12 years of age, with confirmed diagnosis of ADHD+RD. Childrenwere randomly assigned to receive one of three academic remedial treatment programsin combination with either stimulant medication (MED) or placebo (PL). Twoprograms focused specifically on reading remediation but differed in approach(PHAB, direct instruction in phonological analysis and blending; and WIST, wordidentification and strategy training). The third (CSS), focused on specific skills in theclassroom, such as time, organization, planning, and the language of instruction. Eachprogram provided 35 hours of instruction across a 10-week period (1 hr/day, fourdays/week); children were taught in small groups of three (matched for age and wordidentification skill) by an experienced certified teacher in a dedicated classroom in apublic school in Toronto. Findings suggest that this combined treatment approach(reading instruction + stimulant medication) may be an effective approach for improvingboth the behavioral and reading problems in children with ADHD+RD. Bothreading programs improved single word reading and phonological processing abilitiesas measured by standardized tests, with evidence of generalization of effects. Asexpected, stimulant medication improved behavioral symptoms of ADHD (as reportedby teachers) but had no overall effect on phonological processing. However, evidencethat the combination of direct phonological instruction plus stimulant medicationproduced the greatest gains in reading, suggests that stimulant medication maypotentiate effects focused academic instruction. Also, combined treatment with stimulantmedication and intense instruction in time concepts, organization and planningskills, enhanced children’s performance on a standardized test of arithmeticcomputation. This study represents the first controlled, randomized treatment outcomestudy designed to address the cognitive deficits presumed to underlie comorbidADHD+RD.2
A.I.D.A.I. Newsletter • Primavera 2005SIMPOSIO: I BAMBINI CON DDAI E LA MATEMATICAcoordina M. C. Passolunghi - Università di Milano Bicocca1. Developmental DyscalculiaR. ShalevShaare Zedek Medical Center, Jerusalem,IsraelDevelopmental dyscalculia is a specific learningdisability affecting the acquisition of arithmeticskills. The prevalence of this cognitivehandicap in school-age children is 3-7%, a figurefound in countries as diverse as the UnitedStates, England, Germany, India and Israel.This prevalence is similar to that of other neurocognitivedisorders such as dyslexia and ADHDbut, unlike them, is as common in girls as inboys. Although dyscalculia can manifest itselfas an isolated learning disability, comorbiditywith ADHD and dyslexia is common, occurringin 15-25% of affected children. Dyscalculia isfrequently encountered in neurological disorderssuch as developmental language syndromes,epilepsy, neurofibromatosis, Fragile Xsyndrome and Turner’s syndrome.Dyscalculia appears to be a persisting learningdisability although its natural history has yet tobe confirmed in different countries and cultures.It should be emphasized that the acquisition oflearning skills evolves over a variable spectrumof time, so that a delay in achieving competencein arithmetic does not necessarily indicate dyscalculia.Indeed, difficulties in arithmetic duringkindergarten or first grade may merely reflectvariations in normal development. Moreover,at this age, children with arithmetic problemscan show considerable improvement inmastering counting procedures and fact retrievalskills. However, when older elementaryschool children with dyscalculia were prospectivelyfollowed and re-examined in 8 th and 11 thgrades, their prognosis was not favorable: 95%achieved scores falling in the lowest quartile fortheir school class and 40% in the lowest 5 th percentile.Thus, dyscalculia diagnosed in late elementaryschool is a persistent learning disabilityin almost half of affected individuals. Factorsassociated with persistence of dyscalculia areseverity of the arithmetic disorder, inattentionand a relatively low, albeit normal IQ. Socioeconomicstatus, gender and co-occurrence ofdyslexia were not associated with its persistence.It was disappointing to find that neither theextent nor types of remedial educational interventionsreceived altered the outcome of dyscalculia.The consequences of dyscalculia andits impact on education, employment and psychologicalwell-being of affected individualsare yet to be determined.Ref: Shalev RS. Developmental Dyscalculia.Journal of Child Neurology 19:765-71, 20043
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