Academic journal article Journal of Child and Adolescent Psychopharmacology

Effect of Atomoxetine Treatment on Reading and Phonological Skills in Children with Dyslexia or Attention-Deficit/Hyperactivity Disorder and Comorbid Dyslexia in a Randomized, Placebo-Controlled Trial

Academic journal article Journal of Child and Adolescent Psychopharmacology

Effect of Atomoxetine Treatment on Reading and Phonological Skills in Children with Dyslexia or Attention-Deficit/Hyperactivity Disorder and Comorbid Dyslexia in a Randomized, Placebo-Controlled Trial

Article excerpt

[Author Affiliation]

Sally Shaywitz. 1 Yale Center for Dyslexia & Creativity, New Haven, Connecticut.

Bennett Shaywitz. 1 Yale Center for Dyslexia & Creativity, New Haven, Connecticut.

Linda Wietecha. 2 Eli Lilly and Company and/or one of its subsidiaries, Indianapolis, Indiana.

Sharon Wigal. 3 AVIDA, Inc. , Newport Beach, California.

Keith McBurnett. 4 Department of Psychiatry, University of California, San Francisco, San Francisco, California.

David Williams. 5 inVentiv Health Clinical, Indianapolis, Indiana.

William G. Kronenberger. 6 Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana.

Stephen R. Hooper. 7 School of Medicine, University of North Carolina, Chapel Hill, North Carolina.

These data were presented, in part, at the American Academy of Child and Adolescent Psychiatry (AACAP) 59th Annual Meeting, San Francisco, CA; October 23-28, 2012.

Funding: This research study was funded and conducted by Lilly, USA, LLC.

Address correspondence to: Sally Shaywitz, MD, Yale Center for Dyslexia & Creativity, 129 York St., Suite 1P, New Haven, CT 06511, E-mail: sally.shaywitz@yale.edu

Introduction

Dyslexia (or specific reading disability) represents an unexpected difficulty in reading for an individual's age, intelligence, or professional status. Fluent reading--reading that is rapid, automatic, and with good intonation (prosody)--is very frequently affected, even in dyslexic readers who have learned to read accurately (Shaywitz 1998; Lyon et al. 2003; Ferrer et al. 2010). Dyslexia is highly prevalent and persistent and occurs worldwide. In the United States, dyslexia rates range from 5% to 17.5% (Felton et al. 1990; Bruck 1992; Francis et al. 1996; Shaywitz et al. 1999; Shaywitz 2003). Worldwide prevalence rates also are high, with rates ranging from 8% in mainland China to almost 13% in Hong Kong (Chan et al. 2007; Liu et al. 2012).

At its core, dyslexia is primarily a problem with phonological processing (i.e., getting to the elemental sounds of spoken language) affecting both spoken and written language. To learn to read, the child has to develop the unconscious awareness that spoken words can be pulled apart into the elemental particles of speech (i.e., phonemes) and that the letters in a written word represent these sounds. Evidence from a number of lines of investigation provides overwhelming evidence that a deficit in phonology represents the most robust and specific correlate of dyslexia (Liberman and Shankweiler 1991; Morris et al. 1998; Shaywitz 1998, 2003).

In addition to the centrality of phonological mechanisms in dyslexia, recent evidence supports an important role for attentional mechanisms in dyslexia (Shaywitz and Shaywitz 2008; Kovelman et al. 2012). Cognitive studies suggest that attention is a critical, overlooked component facilitating the translation of print into speech and is particularly important for achieving fluent reading (Reynolds and Besner 2006). Further evidence that attentional processes may be important in reading comes from studies emphasizing the comorbidity of dyslexia and attention-deficit/hyperactivity disorder (ADHD) (August and Garfinkel 1990; Dykman and Ackerman 1991; Shaywitz et al. 1994; Willcutt and Pennington 2000; Germano et al. 2010; Yoshimasu et al. 2010). Estimates of rates in those with dyslexia and comorbid ADHD range from 9% to as high as 60%, whereas patients initially diagnosed with ADHD have a co-occurrence of dyslexia reported to range from 15% to 45% (Willcutt and Pennington 2000; Willcutt et al. 2001; Carroll et al. 2005; Maughan and Carroll 2006; Sexton et al. 2012).

The role of attentional mechanisms in dyslexia is further supported by a recent functional magnetic resonance imaging connectivity analysis. Using data-driven brain parcellation, connectivity profiles were compared between dyslexic and typical readers. …

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