Comparing treatments for children with ADHD and word reading difficulties: A randomized clinical trial

Patterns of Physical Activity of Adolescents With ADHD in the School Context: A Cross-Sectional Study for Clinical Practice

OBJECTIVES

To describe the daily Physical Activity (PA) patterns of adolescents with Attention-deficit/hyperactivity disorder (ADHD), to analyze the differences in terms of PA patterns between adolescents with ADHD and those without ADHD, and to study the factors associated with achieving the daily PA recommendations.

METHODS

The sample was composed of 778 adolescents who provided complete information on their PA patterns through the Physical Activity Questionnaire for Adolescents (PAQ-A). Of these, 97 had ADHD according to DSM-5 criteria.

RESULTS

The results show that being a girl or being of foreign origin and having ADHD have an impact on the achievement of the recommended amount of daily PA.

CONCLUSIONS

When promoting PA in adolescents with ADHD within the school environment, it is necessary to consider different domains and specific contexts of a school day, paying special attention to girls and adolescents with ADHD of immigrant origin.

Attention deficit hyperactivity disorder: Neuropsychological profile and study of its impact on executive functions and academic performance

INTRODUCTION

The aim of the study was to describe the neuropsychological profile of patients with attention deficit hyperactivity disorder (ADHD) and the impact of the disorder on executive functioning and academic performance.

PATIENTS AND METHODS

We conducted a retrospective observational and analytical study. The sample consisted of 24 children with a diagnosis of ADHD (aged 6-15 years) without pharmacological treatment and 24 controls without ADHD (aged 7-15 years). A comprehensive neuropsychological evaluation was carried out, encompassing major cognitive domains, in addition to assessment of executive functioning and psychopathological symptoms through the administration of questionnaires to parents and teachers.

RESULTS

The cognitive profile of the ADHD group was characterized by overall scores (including executive functions and academic abilities) in the normal range (z scores between -1 and 1), although significantly lower compared to the control group. Over half of the patients with ADHD (58%) had associated specific learning disorders. Furthermore, teachers tended to report executive function difficulties more frequently in male students.

CONCLUSIONS

In the study sample, the group of patients with ADHD exhibited cognitive performance within the normal range, although with lower scores compared to controls. Behavioural rating scales provide valuable information about functioning outside the clinic, but may yield biased results on account of the focus on externalising symptoms. The neuropsychological evaluation is a useful tool that can facilitate the diagnosis of ADHD and an effective response to the needs and characteristics of patients and families.

Are Reading Interventions Effective for At-Risk Readers with ADHD? A Meta-Analysis

OBJECTIVE

Utilizing a multi-level meta-analytic approach, this review is the first to systematically quantify the efficacy of reading interventions for school-aged children with ADHD and identify potential factors that may increase the success of reading-related interventions for these children.

METHOD

18 studies (15 peer-reviewed articles, 3 dissertations) published from 1986 to 2020 (N = 564) were meta-analyzed.

RESULTS

Findings revealed reading interventions are highly effective for improving reading skills based on both study-developed/curriculum-based measures (g = 1.91) and standardized/norm-referenced achievement tests (g = 1.11) in high-quality studies of children with rigorously-diagnosed ADHD. Reading interventions that include at least 30 hours of intervention targeting decoding/phonemic awareness meet all benchmarks to be considered a Level 1 (Well-Established) Evidence-Based Practice with Strong Research Support for children with ADHD based on clinical and special education criteria.

CONCLUSIONS

Our findings collectively indicate that reading interventions should be the first-line treatment for reading difficulties among at-risk readers with ADHD.

Effects of word length and word frequency among dyslexic, ADHD-I and typical readers

This study aimed to investigate the neuropsycholinguistic functioning of children with Developmental Dyslexia (DD) and Attention-Deficit/Hyperactivity Disorder - inattentive subtype (ADHD-I) in a reading task. The psycholinguistic profile of both groups was assessed using a battery of neuropsychological and linguistic tests and compared to typical readers. Participants were submitted to a silent reading task with lexical manipulation of the text. Eye movements were recorded and compared aiming to find cognitive processes involved in reading that could help differentiate groups. The study examined whether word-frequency and word-length effects distinguish between groups. Participants included 19 typical readers, 21 children diagnosed with ADHD-I and 19 children with DD. All participants were attending 4th grade and had a mean age of 9.08 years. Children with DD and ADHDI exhibited significant different cognitive and linguistic profiles on almost all measures evaluated when compared to typical readers. The effects of word length and word frequency interaction also differed significantly in the 3 experimental groups. The results support the multiple cognitive deficits theory. While the shared deficits support the evidence of a phonological disorder present in both conditions, the specific ones corroborate the hypothesis of an oculomotor dysfunction in DD and a visuo-spatial attention dysfunction in ADHD.

A Cumulative Risk and Resilience Model of Dyslexia

Considerable attention and legislation are currently focused on developmental dyslexia. A major challenge to these efforts is how to define and operationalize dyslexia. In this article, we argue that rather than defining dyslexia on the basis of an underlying condition, dyslexia is best viewed as a label for an unexpected reading disability. This view fits well with a preventive approach in which risk for reading disability is identified and addressed prior to children experiencing reading failure. A risk-resilience model is introduced that proposes that dyslexia is due to the cumulative effects of risk and resilience factors. Evidence for the multifactorial causal basis of dyslexia is reviewed and potential factors that may offset this risk are considered. The implications of a cumulative risk and resilience model for early identification and intervention is discussed.

Combined Treatment for Children with Attention-Deficit/Hyperactivity Disorder: Brief History, the Multimodal Treatment for Attention-Deficit/Hyperactivity Disorder Study, and the Past 20 Years of Research

Decades of research support 3 interventions for youth with attention-deficit/hyperactivity disorder (ADHD): behavioral intervention, stimulant medication, and their combination. However, professional organizations have long disagreed regarding the best approach for implementing evidence-based interventions for ADHD in practice. The accompanying Society of Developmental and Behavioral Pediatrics guidelines for complex ADHD provide a framework for initiating treatment with behavioral intervention and adding stimulant medication as necessary, resulting in combined/multimodal treatment for many, if not most, children. In this special article, we review the extant literature on combined treatment, with special emphasis on the past 15 years of research that have led to the recommendation for this approach. Specifically, we review the literature on dosing and sequencing of multimodal treatment for youth with ADHD and the impact of multimodal interventions on areas of functional impairment. The extant research provides clear support for a psychosocial-first approach in treating youth with complex ADHD.

Society for Developmental and Behavioral Pediatrics Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents with Complex Attention-Deficit/Hyperactivity Disorder

Attention-deficit/hyperactivity disorder (ADHD) is the most common childhood neurodevelopmental disorder and is associated with an array of coexisting conditions that complicate diagnostic assessment and treatment. ADHD and its coexisting conditions may impact function across multiple settings (home, school, peers, community), placing the affected child or adolescent at risk for adverse health and psychosocial outcomes in adulthood. Current practice guidelines focus on the treatment of ADHD in the primary care setting. The Society for Developmental and Behavioral Pediatrics has developed this practice guideline to facilitate integrated, interprofessional assessment and treatment of children and adolescents with "complex ADHD" defined by age (<4 years or presentation at age >12 years), presence of coexisting conditions, moderate to severe functional impairment, diagnostic uncertainty, or inadequate response to treatment.

Outcomes of School-Home Intervention for Attention and Behavior Problems: Teacher Adherence Matters

This study evaluated the effects of teacher adherence to behavioral treatment on student outcomes. Eighty-four children (ages 7-11) completed a 12-week, collaborative school-home behavioral intervention designed for youth with significant attention-deficit/hyperactivity disorder symptoms and impairment. Teacher adherence was assessed via school mental health provider (SMHP) ratings and Daily Report Card (DRC) implementation. Pre- and post-treatment outcomes included parent and teacher ratings of organizational skills and problem behaviors, observational measures of classroom task engagement and off task behaviors and report card standard grades. Using multi-level models to account for clustering by school, teacher adherence rated by SMHPs predicted improvement across teacher- and parent-rated organizational skills, parent-rated problem behaviors, and classroom observations of task engagement and off-task behavior. Higher rates of DRC implementation only predicted improvements in parent-rated organizational skills; percentage of days parents signed the DRC only predicted teacher-rated improvement in organizational skills. Post-hoc analyses indicated that teacher adherence and child success with academic targets on the DRC during the first month predicted parent-rated improvement in organizational skills. These results suggest that teacher adherence, particularly when rated by SMHPs, is an important predictor of positive treatment outcomes across both school and home settings. Future research is needed to better understand methods for measuring and optimizing teacher adherence to classroom behavioral interventions.

Trajectories of Response to Treatments in Children with ADHD and Word Reading Difficulties

This study investigated patterns of response to intervention in children with co-occurring attention-deficit/hyperactivity disorder (ADHD) and reading difficulties (RD), who participated in a randomized clinical trial examining the efficacy of reading intervention, ADHD treatment, or combined treatments. Growth Mixture Modeling (GMM) was used to investigate trajectories of parent and teacher academic impairment ratings and child oral reading fluency, and whether trajectories were predicted by pre-treatment covariates (ADHD severity, reading achievement, phonemic awareness, rapid letter naming, anxiety, oppositional defiant disorder), for 216 children with ADHD/RD in 2nd-5th grade (61.1% male; 72.2% African American; 8.8 ± 1.3 years of age). GMM revealed three trajectories for academic impairment (6.9-24.2% stable, 23.7-78.7% moderately improving, and 14.1-52.1% steeply improving) and oral reading fluency (20.8% low improving, 42.1% moderate improving, and 37.1% high improving). Children in the reading intervention were more likely to be in the stable or moderately improving trajectory than those in the ADHD and combined treatments, who were more likely to be in the steeply improving trajectory for academic impairment. Relative to the ADHD intervention, children in the reading intervention were more likely to be in the high improving trajectory than the moderate or low improving trajectory for oral reading fluency. Children without comorbid anxiety and with better reading skills showed a more positive treatment response for teacher-rated academic progress and oral reading fluency. Results highlight the importance of examining individual differences in response to reading and ADHD interventions. Intervention modality predicted differences in parent/teacher ratings of academic progress as well as reading fluency.

Development of an Eco-Biodevelopmental Model of Emergent Literacy Before Kindergarten: A Review

IMPORTANCE

Literacy has been described as an important social determinant of health. Its components emerge in infancy and are dependent on genetic, medical, and environmental factors. The American Academy of Pediatrics advocates a substantial role for pediatricians in literacy promotion, developmental surveillance, and school readiness to promote cognitive, relational, and brain development. Many children, especially those from minority and underserved households, enter kindergarten unprepared to learn to read and subsequently have difficulty in school.

OBSERVATIONS

Emergent literacy is a developmental process beginning in infancy. Component skills are supported by brain regions that must be adequately stimulated and integrated to form a functional reading network. Trajectories are associated with genetic, medical, and environmental factors, notably the home literacy environment, which is defined as resources, motivation, and stimulation that encourage the literacy development process. Eco-biodevelopmental models are advocated by the American Academy of Pediatrics, and these models offer insights into the neurobiological processes associated with environmental factors and the ways in which these processes may be addressed to improve outcomes. Emergent literacy is well suited for such a model, particularly because the mechanisms underlying component skills are elucidated. In addition to cognitive-behavioral benefits, the association of home literacy environment with the developing brain before kindergarten has recently been described via neuroimaging. Rather than a passive approach, which may subject the child to stress and engender negative attitudes, early literacy screening and interventions that are administered by pediatric practitioners can help identify potential reading difficulties, address risk factors during a period when neural plasticity is high, and improve outcomes.

CONCLUSIONS AND RELEVANCE

Neuroimaging and behavioral evidence inform an eco-biodevelopmental model of emergent literacy that is associated with genetic, medical, and home literacy environmental factors before kindergarten, a time of rapid brain development. This framework is consistent with recommendations from the American Academy of Pediatrics and provides insights to help identify risk factors and signs of potential reading difficulties, tailor guidance, and provide direction for future research.

Problem Behaviors and Response to Reading Intervention for Upper Elementary Students With Reading Difficulties

This study investigated the extent to which problem behaviors were factors associated with response to a year-long multicomponent reading intervention for fourth- and fifth-grade students with reading difficulties. Students scoring ≤85 standard score on the Test of Silent Reading Efficiency and Comprehension (n = 108), a reading fluency and comprehension screener measure, were randomized to the researcher-provided treatment condition (n = 55) or the business-as-usual comparison condition (n = 53). Results indicated that problem behaviors were associated with lower reading comprehension outcomes. Findings also suggested that students with higher levels of overall problem behaviors and externalizing behaviors in the treatment condition outperformed similar students in the comparison condition on the Gates-MacGinitie Reading Test (p < .05). Future research is needed on how to best identify, develop, and adapt effective interventions for students with reading difficulties and problem behaviors within school-wide response to intervention frameworks.

[Executive functions disorders in children with dyslexia]

OBJECTIVE

To study the severity of disorders of executive functions in children with dyslexia and to assess the effectiveness of treatment of this pathology with cortexin.

MATERIAL AND METHODS

The main study group included 60 children, aged 8-11 years, with a specific reading disorder (F.81.0). Reading skills were assessed using methods of T.A. Fotekova, T.V. Akhutina. Diagnostic examination included neurological examination with dyspraxia test, electroencephalography with visual and quantitative analysis. To objectify the severity of memory impairments, the «Working memory» technique was used. Attention and impulsivity disorders were quantified using SNAP-IY and the Test of Variables of Attention (TOVA). The control group consisted of 60 children of the same age without symptoms of dyslexia. Cortexin was used to treat 30 patients from the study group, 30 patients received encephabol. A control study to analyze the effectiveness of the therapy was carried out one month after the end of therapy.

RESULTS AND CONCLUSION

Children with dyslexia are characterized by a higher level of inattention and impulsivity, as well as significantly lower indicators of working memory compared to children from the control group. The decrease in attention and working memory as well as an increased level of impulsivity are manifestations of impaired executive functions in children with dyslexia. The results of the control study after treatment showed a significant increase in reading skills in both groups. In addition, there was an improvement in indicators of attention and working memory. However, the effectiveness of treatment with cortexin was slightly higher compared to encephabol (improvement was noted in 73.3% and 60.0%of patients, respectively). According to a comparative analysis of EEG results, after a course of treatment with cortexin, children with dyslexia have significant neurophysiological changes that indicate the activation of the brain regulatory systems.

Understanding, educating, and supporting children with specific learning disabilities: 50 years of science and practice

Specific learning disabilities (SLDs) are highly relevant to the science and practice of psychology, both historically and currently, exemplifying the integration of interdisciplinary approaches to human conditions. They can be manifested as primary conditions-as difficulties in acquiring specific academic skills-or as secondary conditions, comorbid to other developmental disorders such as attention-deficit hyperactivity disorder. In this synthesis of historical and contemporary trends in research and practice, we mark the 50th anniversary of the recognition of SLDs as a disability in the United States. Specifically, we address the manifestations, occurrence, identification, comorbidity, etiology, and treatment of SLDs, emphasizing the integration of information from the interdisciplinary fields of psychology, education, psychiatry, genetics, and cognitive neuroscience. SLDs, exemplified here by specific word reading, reading comprehension, mathematics, and written expression disabilities, represent spectrum disorders, each occurring in approximately 5% to 15% of the school-aged population. In addition to risk for academic deficiencies and related functional social, emotional, and behavioral difficulties, those with SLDs often have poorer long-term social and vocational outcomes. Given the high rate of occurrence of SLDs and their lifelong negative impact on functioning if not treated, it is important to establish and maintain effective prevention, surveillance, and treatment systems involving professionals from various disciplines trained to minimize the risk and maximize the protective factors for SLDs. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Effect of Vergence/Accommodative Therapy on Reading in Children with Convergence Insufficiency: A Randomized Clinical Trial

SIGNIFICANCE

The results of this study suggest that clinicians providing vergence/accommodative therapy for the treatment of childhood convergence insufficiency should not suggest that such treatment, on average, will lead to improvements on standardized assessments of reading performance after 16 weeks of treatment.

PURPOSE

The purpose of this study was to determine the effect of office-based vergence/accommodative therapy on reading performance in 9- to 14-year-old children with symptomatic convergence insufficiency.

METHODS

In a multicenter clinical trial, 310 children 9 to 14 years old with symptomatic convergence insufficiency were randomized in a 2:1 ratio to 16 weeks of office-based vergence/accommodative therapy or office-based placebo therapy, respectively. The primary outcome was change in reading comprehension as measured by the reading comprehension subtest of the Wechsler Individual Achievement Test, Third Edition (WIAT-III) at the 16-week outcome. Secondary reading outcomes of word identification, reading fluency, listening comprehension, comprehension of extended text, and reading comprehension were also evaluated.

RESULTS

The adjusted mean improvement in WIAT-III reading comprehension was 3.7 (95% confidence interval [CI], 2.6 to 4.7) standard score points in the vergence/accommodative therapy group and 3.8 (95% CI, 2.4 to 5.2) points in the placebo therapy group, with an adjusted mean group difference of -0.12 (95% CI, -1.89 to 1.66) points that was not statistically significant. No statistically significant treatment group differences were found for any of the secondary reading outcome measures.

CONCLUSIONS

For children aged 9 to 14 years with symptomatic convergence insufficiency, office-based vergence/accommodative therapy was no more effective than office-based placebo therapy for improving reading performance on standardized reading tests after 16 weeks of treatment.

Learning Disorder Confers Setting-Specific Treatment Resistance for Children with ADHD, Predominantly Inattentive Presentation

Attention deficit/hyperactivity disorder-predominantly inattentive presentation (ADHD-I) and specific learning disorder (SLD) are commonly co-occurring conditions. Despite the considerable diagnostic overlap, the effect of SLD comorbidity on outcomes of behavioral interventions for ADHD-I remains critically understudied. The current study examines the effect of reading or math SLD comorbidity in 35 children with comorbid ADHD-I+SLD and 39 children with ADHD-I only following a behavioral treatment integrated across home and school (Child Life and Attention Skills [CLAS]). Pre- and posttreatment outcome measures included teacher-rated inattention, organizational deficits, and study skills and parent-rated inattention, organizational deficits, and homework problems. A similar pattern emerged across all teacher-rated measures: Children with ADHD-I and comorbid ADHD-I+SLD did not differ significantly at baseline, but between-group differences were evident following the CLAS intervention. Specifically, children with ADHD-I and comorbid ADHD-I+SLD improved on teacher-rated measures following the CLAS intervention, but children with ADHD-I only experienced greater improvement relative to those with a comorbid SLD. No significant interactions were observed on parent-rated measures-all children improved following the CLAS intervention on parent-rated measures, regardless of SLD status. The current results reveal that children with ADHD-I+SLD comorbidity benefit significantly from multimodal behavioral interventions, although improvements in the school setting are attenuated significantly. A treatment-resistant fraction of inattention was identified only in the SLD group, implying that this fraction is related to SLD and becomes apparent only when behavioral intervention for ADHD is administered.

The Effects of ADHD Treatment and Reading Intervention on the Fluency and Comprehension of Children with ADHD and Word Reading Difficulties: A Randomized Clinical Trial

Many students with reading difficulties and disabilities (RD) also have Attention Deficit/Hyperactivity Disorder (ADHD). This randomized clinical trial compared the effects of ADHD treatment alone (medication, parent training), intensive reading intervention alone, and their combination on the reading fluency and comprehension of students with both disorders. Students with ADHD and RD were randomly assigned to receive (a) Reading Intervention only (n=74), (b) ADHD Treatment only (n=78), or (c) simultaneous Combined ADHD and RD Treatment (n=70). For phonemic decoding fluency, the Reading Intervention group and the Combined Treatment group both had significantly better outcomes than the ADHD Treatment group, but did not differ from one another. For passage comprehension, the ADHD Treatment group had significantly better outcomes than the Reading Intervention group, while the other groups did not differ from one another. ADHD treatment may support passage comprehension in this population, while fluent decoding is best supported through intensive reading intervention.

Cost effectiveness of optimal treatment of ADHD in Israel: a suggestion for national policy

OBJECTIVES

There are well known behavioral complications of ADHD at adulthood such as learning difficulties resulting in lower education attainments; increased rate of car and other accidents; substance abuse; misconduct and imprisonment. These complications can be prevented or alleviated by effective treatment. In this study we calculated the economic burden of ADHD among adults in Israel and the cost of diagnosing and treating ADHD from childhood to adulthood. We then obtained the cost-benefit ratio of the treatment.

METHODS

The data were calculated using accepted estimations of prevalence and cost for the Israeli population assuming a prevalence of 4% among adults which is based on the ADHD prevalence among school age children.

RESULTS

The estimated cost per person with ADHD due to lower education attainment, higher involvement in crime and car accidents and more drug abuse is 289,969 USD and the estimated cost for optimal treatment is 41,667 USD. Hence, the benefit cost ratio is 7.02 and, assuming only 50% success of treatment, it is 3.51, still a very high cost benefit ratio.

CONCLUSIONS

Since early diagnosis and appropriate treatment of ADHD is very effective in reducing the various symptoms and complications at adulthood thus enabling a better education and higher income, it seems important to diagnose and offer comprehensive treatment to children with ADHD. Moreover, it seems equally important to continue treatment at adulthood.

A Meta-Analytical Review of the Genetic and Environmental Correlations between Reading and Attention-Deficit Hyperactivity Disorder Symptoms and Reading and Math

According to the Multiple Deficit Model, comorbidity results when the genetic and environmental risk factors that increase the liability for a disorder are domain-general. In order to explore the role of domain-general etiological risk factors in the co-occurrence of learning-related difficulties, the current meta-analysis compiled 38 studies of third through ninth-grade children to estimate the average genetic, shared environmental, and nonshared environmental correlations between reading and attention-deficit/hyperactivity disorder (ADHD) symptoms, and reading and math, as well as their potential moderators. Results revealed average genetic, shared and nonshared environmental correlations between reading and ADHD symptoms of .42, .64, and .20, and reading and math of .71, .90, and .56, suggesting that reading and math may have more domain-general risk factors than reading and ADHD symptoms. A number of significant sources of heterogeneity were also found and discussed. These results have important implications for both intervention and classification of learning disabilities.

Cognitive, Intervention, and Neuroimaging Perspectives on Executive Function in Children With Reading Disabilities

The role of executive function (EF) in the reading process, and in those with reading difficulties, remains unclear. As members of the Texas Center for Learning Disabilities, we review multiple perspectives regarding EF in reading and then summarize some of our recent studies of struggling and typical readers in grades 3-5. Study 1a found that a bi-factor structure best represented a comprehensive assessment of EF. Study 1b found that cognitive and behavioral measures of EF related independently to math and reading. Study 1c found that EF related to reading, above and beyond other variables, but Study 1d found no evidence that adding an EF training component improved intervention response. Study 1e found that pretest EF abilities did not relate to intervention response. Neuroimaging studies examined EF-related brain activity during both reading and nonlexical EF tasks. In Study 2a, the EF task evoked control activity, but generated no differences between struggling and typical readers. The reading task, however, had group differences in both EF and reading regions. In Study 2b, EF activity during reading at pretest was related to intervention response. Across studies, EF appears involved in the reading process. There is less evidence for general EF predicting or improving intervention outcomes.

Using ADHD Medications to Treat Coexisting ADHD and Reading Disorders: A Systematic Review

Attention-deficit/hyperactivity disorder (ADHD), the most common pediatric neurobehavioral disorder, frequently presents with coexisting reading disorders (RDs). Despite this, it is unclear whether medication improves symptoms and function in children with comorbid ADHD and RD. We present a systematic review of studies investigating the effects of ADHD medications on ADHD symptoms, academic outcomes, and neuropsychological measures in this important group.

Recognizing Psychiatric Comorbidity With Reading Disorders

Reading disorder (RD), a specific learning disorder (SLD) of reading that includes impairment in word reading, reading fluency, and/or reading comprehension, is common in the general population but often is not comprehensively understood or assessed in mental health settings. In education settings, comorbid mental and associated disorders may be inadequately integrated into intervention plans. Assessment and intervention for RD may be delayed or absent in children with frequently co-occurring mental disorders not fully responding to treatment in both school and mental health settings. To address this oversight, this review summarizes current knowledge regarding RDs and common comorbid or co-occurring disorders that are important for mental health and school settings. We chose to highlight RD because it is the most common SLD, and connections to other often comorbid disorders have been more thoroughly described in the literature. Much of the literature we describe is on decoding-based RD (or developmental dyslexia) as it is the most common form of RD. In addition to risk for academic struggle and social, emotional, and behavioral problems, those with RD often show early evidence of combined or intertwined Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition childhood disorders. These include attention deficit hyperactivity disorder, anxiety and depression, disruptive, impulse-control, and conduct disorders, autism spectrum disorders, and other SLDs. The present review highlights issues and areas of controversy within these comorbidities, as well as directions for future research. An interdisciplinary, integrated approach between mental health professionals and educators can lead to comprehensive and targeted treatments encompassing both academic and mental health interventions. Such targeted treatments may contribute to improved educational and health-related outcomes in vulnerable youth. While there is a growing research literature on this association, more studies are needed of when to intervene and of the early and long-term benefits of comprehensive intervention.