The Reading Difficulty Rarely Travels Alone

What the research found

In 2018, five researchers led by Robert Hendren, and including the neuroscientist Fumiko Hoeft, published a review in the journal Frontiers in Psychiatry. Its title was plain: “Recognizing Psychiatric Comorbidity With Reading Disorders.” The authors gathered two decades of studies, from 1997 to 2017, on children under eighteen who have a reading disorder. Reading disorder, often called dyslexia, is a persistent difficulty with accurate or fluent reading that is not explained by poor teaching or low intelligence. It affects roughly 5 to 10 per cent of children, depending on how a study defines it.

The central point of the review is that a reading disorder rarely arrives on its own. The clearest overlap is with attention-deficit/hyperactivity disorder. The authors report that approximately 20 to 40 per cent of children with the inattentive form of ADHD also have a reading disorder, and 20 to 40 per cent of children with a reading disorder also have ADHD. That is a substantial shared population. A child who struggles to read and a child who struggles to attend are, quite often, the same child.

The review then turns to the quieter conditions, the ones that do not disrupt a classroom and so are easier to miss. Children with a reading disorder report more generalised anxiety than their peers. The authors cite a meta-analysis, a study that pools the results of many earlier studies, confirming that children with learning disabilities score significantly higher on anxiety measures than children without them. Importantly, this elevated anxiety remains even after the researchers account for ADHD symptoms. It is not simply a side effect of inattention.

Depression follows a similar pattern. Children and adolescents with a reading disorder show higher rates of depressive symptoms, and more severe reading difficulty is correlated with more severe depression in younger children. One study of adolescents found that self-esteem alone predicted 23 per cent of the variation in depression risk. The authors also note something practical and sobering: children with a reading disorder may have difficulty processing and describing emotions, which means their anxiety and depression can go under-reported. The child may be struggling more than the child can say.

On the question of cause, the review is careful. It does not claim that reading difficulty produces anxiety, nor the reverse. It presents two models. In one, anxiety consumes the attention that reading requires. In the other, the repeated experience of failing at school produces anxiety. The authors conclude that the evidence supports a bi-directional relationship: each can feed the other. They also point to shared roots. Siblings of children with a reading disorder were more than twice as likely to meet the criteria for generalised anxiety disorder, which suggests common familial factors rather than a simple chain of cause and effect.

What it means for you and your child

The first lesson of this review is one of attention, in the ordinary sense of the word. If your child has been identified with a reading difficulty, the difficulty you can see may not be the only one present. The reading is visible because it happens on the page, in front of a teacher, every day. The anxiety and the low mood are private. A bright, conscientious child can carry a good deal of distress while still appearing, to the outside world, merely a slow or reluctant reader.

This matters because the two problems compound one another. A child who is anxious reads less well, and a child who reads poorly has more to be anxious about. The review does not prove that breaking this loop at one point relieves the other, but the pattern it documents is consistent and worth taking seriously. If your child dreads reading aloud, avoids homework, or has grown quiet about school, those are not separate from the reading. They may be part of the same picture.

Be honest, too, about what this single review can and cannot tell you. It is a review, not an experiment. It describes how often these conditions occur together, and it weighs competing explanations, but it does not establish that one causes another in any individual child. When the authors say the relationship is bi-directional, they are being precise, not evasive. For your child specifically, no study can say whether the worry came first or the reading did. That question is answered by knowing your child, not by reading a paper.

What the review does support is a practical stance. The authors argue that treatment should address emotional health alongside reading, not instead of it. They note that cognitive behavioural therapy, a structured talking treatment that works on unhelpful thoughts and behaviours, may ease anxiety and depression in these children, and that mindfulness approaches have shown promise in small studies. They are candid that the evidence base for treating the emotional side is still thin, and that more research is badly needed. So treat any single recommendation as provisional.

The sensible response, then, is neither alarm nor dismissal. If your child is being assessed for reading, ask the assessor to consider attention and mood as well. If your child is receiving reading support, ask whether anyone is watching how they feel about it. Good tutoring is not only technical. A child who begins to read with less fear will often read better, and a child who reads better will often fear less. That is the loop the research describes, and it is one that patient, informed support can help to turn the right way.