Reading Outcomes of Children and Adolescents with Attention-Deficit/Hyperactivity Disorder and Dyslexia Following Atomoxetine Treatment

By Shaywitz, Bennett A.; Williams, David W. et al. | Journal of Child and Adolescent Psychopharmacology, October 2014 | Go to article overview

Reading Outcomes of Children and Adolescents with Attention-Deficit/Hyperactivity Disorder and Dyslexia Following Atomoxetine Treatment


Shaywitz, Bennett A., Williams, David W., Fox, Bethany K., Wietecha, Linda A., Journal of Child and Adolescent Psychopharmacology


[Author Affiliation]

Bennett A. Shaywitz. 1 Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut.

David W. Williams. 2 InVentiv Health Clinical, Indianapolis, Indiana.

Bethany K. Fox. 3 Eli Lilly and Company, Indianapolis, Indiana.

Linda A. Wietecha. 4 Lilly USA, LLC, Indianapolis, Indiana.

Statistical consultant: David W. Williams

Funding: This study was supported by Eli Lilly and Company.

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

Introduction

Two of the most prevalent developmental disabilities among school-age children are dyslexia, by far the most common learning disability accounting for at least 80% of all learning disabilities, and attention-deficit/hyperactivity disorder (ADHD) (Shaywitz 2003). Recently released data report that 7.2% of children and adolescents 4-17 years of age have a current diagnosis of ADHD (Visser et al. 2010). Reading, particularly skilled automatic reading, is difficult for a significant number of children. Results of the National Assessment of Educational Progress, often referred to as the Nation's Report Card, indicate that 26% of high school seniors and 33% of fourth grade children are reading below the most basic levels (National Center for Education Statistics 2010a,b). In the Connecticut Longitudinal Study sample survey in which each participant was individually assessed, 17.5% of students were reading below age or ability levels (Shaywitz et al. 1994). Of the children diagnosed with dyslexia, 12-24% also had ADHD, and of the children diagnosed with ADHD (without considering subtypes), 15-30% were estimated to have comorbid dyslexia (Tannock and Brown 2000).

Explaining the nature and causes of the comorbidity between ADHD and dyslexia has been the subject of much research. The use of structural and functional neuroimaging studies, behavioral genetic and molecular approaches, and cognitive processes, reviewed by Boada and colleagues (2012) and Sexton and colleagues (2012), have shown the complexity of the relationship between these two disorders. The process of explaining comorbidity of the disorders should lead to the discovery of the underlying mechanisms, which then will enlighten diagnostic and treatment approaches.

Pharmacotherapy for ADHD is well established (Wigal 2009), with a literature dating back to 1937 (Bradley 1937). Early studies exploring the effects of pharmacotherapy (primarily stimulants) on cognitive processes in children were disappointing (Rie et al. 1976a,b; Ottenbacher and Cooper 1983), with one influential report concluding that "Ritalin should not be used to 'treat' learning disorders." Based on these reports, the prevailing dogma of the time was that pharmacotherapy was helpful for treating the behavioral symptoms of ADHD, but any improvement in school achievement was the result of general improvement in attention. Later reports suggest a more optimistic picture, proposing that stimulants may have beneficial effects on reading in children with both ADHD and dyslexia who were rated hyperactive by having a score of 2.5 (on a scale of 1-4) on the hyperactivity factor of the Conners' Teacher Rating Scale (Kupietz et al. 1988; Richardson et al. 1988). The analyses reported herein used data from a study designed to examine the effects of a nonstimulant pharmacological agent, atomoxetine, in children with ADHD (patients were predominantly combined [54%] or inattentive [43%] subtype) and dyslexia (Sumner et al. 2009). Atomoxetine is a selective norepinephrine reuptake inhibitor and is approved for treatment of ADHD in children, adolescents, and adults. Atomoxetine demonstrates efficacy across attention and hyperactivity/impulsivity symptoms of ADHD subtypes (Michelson et al. 2002). The efficacy of atomoxetine in children and adolescents with ADHD and a comorbid reading disorder has not been well studied (Sumner et al. …

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