Anxiety, ADHD, and Dyslexia

Dyslexia rarely travels alone. Two conditions in particular — anxiety and attention-deficit/hyperactivity disorder (ADHD) — co-occur with dyslexia at rates far above what chance would predict. Understanding the relationship between dyslexia and these comorbidities is essential for developing a complete support plan, because treating one condition while ignoring the others limits the effectiveness of all interventions.

Anxiety and Dyslexia

Anxiety is extremely common among dyslexic individuals, and the reasons are straightforward. A child who faces daily reading tasks they cannot perform reliably, who dreads being called on to read aloud, who watches peers complete tasks with apparent ease while they struggle, who repeatedly fails at something that is publicly evaluated — that child is accumulating a significant stress burden. Over time, the experience of repeated failure and the anticipation of failure produce anxiety that becomes its own barrier to learning.

Anxiety manifests in several patterns in dyslexic individuals:

Test anxiety: The timed examination environment is particularly activating for dyslexic students, who know from experience that time pressure exposes their processing speed limitations. Even a student who knows the material may freeze, panic, or perform far below their actual knowledge level under these conditions.

Reading avoidance: Anxiety about reading leads to avoidance of reading, which in turn prevents the reading practice necessary for improvement. This creates a reinforcing cycle that is difficult to break without addressing both the skill deficit and the emotional response.

Generalized anxiety: In some individuals, the specific anxiety associated with reading generalizes to broader worry, school refusal, physical complaints (stomachaches, headaches before school), social withdrawal, and depressed mood.

Treatment for Anxiety

The evidence-based treatments for anxiety in dyslexic individuals are the same as for anxiety generally:

• Cognitive-Behavioral Therapy (CBT): Helps individuals identify and reframe catastrophic thinking patterns, develop coping strategies, and gradually face feared situations. CBT is the first-line psychological treatment for anxiety disorders in children and adults.
• SSRIs (Selective Serotonin Reuptake Inhibitors): When anxiety is severe and significantly impairing, medication may be appropriate alongside or preceding CBT. Medication decisions should be made in consultation with a psychiatrist or pediatrician familiar with these medications.
• Mindfulness: Mindfulness-based practices — learning to observe thoughts and feelings without being controlled by them — have growing evidence support for anxiety management and are accessible to children as well as adults.

Critically, treating anxiety without also addressing the underlying dyslexia is insufficient. If reading instruction is effective, the daily anxiety-provoking experiences decrease, and the overall anxiety burden typically diminishes along with them.

ADHD and Dyslexia

ADHD and dyslexia are the two most common neurodevelopmental conditions affecting school-age children, and they co-occur in roughly 30–40 percent of cases — significantly more often than chance. Both conditions affect academic performance, but through different mechanisms that require different treatments.

Dyslexia affects the phonological processing system — the ability to decode written language. A student with dyslexia cannot read fluently because the neural systems for word recognition are not functioning efficiently.

ADHD affects executive function — attention, impulse control, working memory, and self-regulation. A student with ADHD may have perfectly adequate phonological processing but cannot sustain the attention and effort required to apply that processing consistently.

When both conditions are present, each can mask the other or amplify its impact. A student whose inattention prevents them from benefiting from reading instruction will appear to have a more severe reading disability than they actually do. A student whose effortful reading exhausts their attentional capacity will appear more inattentive than they actually are.

Treatment for ADHD

The evidence-based treatments for ADHD include:

• Stimulant medications (methylphenidate, amphetamines): The most effective treatment for core ADHD symptoms in most individuals. When working effectively, stimulants improve attention, impulse control, and working memory, which increases the student’s ability to engage with and benefit from reading instruction.
• Non-stimulant medications (atomoxetine, guanfacine): Alternative options for patients who cannot tolerate stimulants or for whom stimulants are not sufficiently effective.
• Behavioral interventions: Structured routines, environmental organization, consistent feedback systems, and parent training to support behavior management at home.

Growth Mindset

Both anxiety and ADHD interact with an individual’s beliefs about their own capabilities. Shaywitz emphasizes Carol Dweck’s concept of the growth mindset — the understanding that abilities are not fixed but can be developed through effort and effective strategies. Dyslexic individuals who believe their reading difficulty is permanent and reflects a fixed limitation on their capability tend to disengage from difficult tasks. Those who understand that reading skill can genuinely improve with the right instruction — and who have seen evidence of their own progress — are far more resilient in the face of setbacks.

Based on “Overcoming Dyslexia” by Sally Shaywitz, M.D. (2020 edition)