One in Four Diagnosed Children Had Both

What the research found

A team led by Shujjah Haider screened 1,260 children between the ages of 5 and 19 across four Pakistani cities: Chakwal, Rawalpindi, Islamabad and Lahore. The children were drawn from special education schools, rehabilitation centres and paediatric clinics between 2022 and 2023. This is worth holding in mind from the outset. These were not randomly chosen children from the general population. They were children already in settings where learning and attention difficulties are common. That shapes what the study can and cannot tell us.

From those 1,260 screened children, 288 met the diagnostic criteria for developmental dyslexia, ADHD, or both. Dyslexia is a specific difficulty with reading and spelling that is not explained by low intelligence or poor teaching. ADHD, attention-deficit hyperactivity disorder, is a pattern of inattention, impulsivity or restlessness that interferes with daily life. The team used a battery of standard tools to reach these diagnoses, including the Standard Progressive Matrices, an Urdu-language intelligence test, the Woodcock-Johnson tests, the Bangor Dyslexia Test and the Conners Parent Rating Scale, all interpreted against DSM-V criteria.

The headline number concerns overlap. Of the 288 diagnosed children, 192 had dyslexia alone, 20 had ADHD alone, and 76 had both conditions at once. That means roughly one in four of the diagnosed group, about 26 per cent, carried both diagnoses. Looked at another way, among the children who had ADHD, the great majority, 76 of 96, also had dyslexia. The two conditions clustered together closely in this sample.

A second clear finding was the gender split. Boys made up 65 per cent of the diagnosed cases and girls 35 per cent, a roughly two-to-one ratio. This mirrors a pattern seen in many attention and learning studies, though it may partly reflect who gets referred and assessed rather than who is affected.

The authors also measured blood chemistry and reported one difference: the diagnosed children had lower vitamin D3 levels than the 27 control children, an average of about 20 against 31 nanograms per millilitre, at a p-value of 0.05. Beyond this, they found no meaningful differences in blood biochemistry and no significant link between the diagnoses and the families’ social or demographic circumstances.

What it means for you and your child

The most useful takeaway for a parent is also the simplest. When a child struggles with reading, it is worth watching for attention difficulties too, and the reverse. This study adds to a substantial existing literature suggesting that dyslexia and ADHD often occur together. A child who has been diagnosed with one is not thereby cleared of the other. If reading is hard and concentration is also fragile, both may need attention, and support aimed at only one may leave the other unaddressed.

That said, this single study establishes less than its numbers might suggest, and honesty about its limits matters. The 26 per cent overlap figure describes the children who were already diagnosed, not children in general. Because the sample was drawn from special schools and clinics, it tells us how often the two conditions coincide among children already flagged for difficulty. It does not tell us how common either condition is in the wider population of Pakistani schoolchildren, and it should not be read that way.

The vitamin D finding deserves particular caution. A p-value of exactly 0.05 sits right at the conventional threshold, and the comparison rested on just 27 control children, a number the authors themselves acknowledge as too small to draw firm conclusions from. More importantly, a difference of this kind cannot tell us direction. Lower vitamin D might contribute to difficulties, might result from them, for instance if affected children spend less time outdoors, or might simply travel alongside them for unrelated reasons. Nothing here supports the idea that a vitamin D supplement would treat dyslexia or ADHD. Please do not read it that way.

The authors are appropriately measured about their own work. They note that the small control group limited the strength of their comparisons, and that drawing children from only four cities limits how far the findings generalise. This is a descriptive, cross-sectional snapshot. It counts and characterises; it does not follow children over time, and it cannot establish that one thing causes another.

For practical purposes, then, treat this study as confirmation of a pattern rather than a discovery. If your child has been assessed for a reading difficulty, it is reasonable to ask whether attention was also evaluated, and vice versa. A thorough assessment by a qualified professional, using the kind of standardised tools this study relied upon, remains the right route to understanding an individual child. What this research usefully underlines is that the two conditions are near neighbours, and a careful look at one should keep an eye on the other.