Dyslexia | TREATMENT

TREATMENT

Dyslexia and the other learning disabilities are appearing more to be diagnoses of exclusion. Many conditions can mask or mimic dyslexia, and these should be identified and treated adequately prior to the assessment of the dyslexic. Counseling should be the first line therapy, but one should not be reluctant to accept medical intervention. Some of the medical therapies suggested in this paper have not received indication from the FDA for the condition or age group, but they have been successfully used by primary care physicians, psychiatrists, and neurologists. We have divided these conditions into two lists, Acquired and developmental. The Acquired conditions are conditions that could be circumvented by early intervention. The Developmental conditions are considered to be inherent.

ACQUIRED CONDITIONS

The following provides a list of the acquired conditions. The approach in treating some of these conditions is sometimes controversial.

Poor Self-Esteem

This condition can be crippling for individuals without a learning disorder, but really has an impact on students with learning disorders. An area in which the child excels should be identified. Every effort should be made to facilitate success in that area. Positive re-enforcement can also be of benefit, along with having the child accept his condition, and accept that it is OK to be different. It is a good practice not to discuss a child's failures with others in the student's presence.

Oppositional Defiant Disorder

Although pharmaceutical intervention has been used for this condition, it has been shown that Cognitive Behavior therapy has been the most efficacious. See below for a list of medications, doses, and most prominent side effects.

ODD of CHILDHOOD
Medication Klonopin Clonidine BuSpar
Initial dose 0.1-6mg tid 0.1-0.2mg bid 5-20mg tid
Max. dose 20mg/day 0.6mg/day 60mg/day
Side effects Drowsiness,
CNS depression
Drowsiness,
dry mouth
Dizziness

 

Childhood Depressive Disorder

The literature does not make any distinction in the therapy of the etiology of depression. Below provides a list of medications that have been used.

CHILDHOOD DEPRESSION
Medication Tofranil Wellbutrin Effexor Zoloft
Initial dose 25mg/day 100mg bid 37.5mg bid 25mg/day
Max. dose 2.5mg/kg/day 450mg/day 225mg/day 200mg/day
Side effects EKG, changes,
dry mouth
Seizure,
dry mouth
HA, nausea,
dry mouth
HA, nausea,
dry mouth

 

Oppositional Defiant Disorder/Conduct Disorder

There is no therapy that is specifically efficacious in these conditions, but the drugs listed below have been used. Both of these conditions are thought to be of the same path, therefore they can be treated the same.

ODD/CD
Medication BuSpar Clonidine Luvox
Initial dose 5-20mg tid 0.1-0.2mg bid 25mg/day
Max. dose 60mg/day 0.6mg/day 300mg/day
Side effects Dizziness Drowsiness,
dry mouth
Nausea,
sleep disturbances

 

DEVELOPMENTAL CONDITIONS

It is thought that these children possess the propensity to develop these conditions and that the environment has little influence. What are not clear, however, are these conditions due to genetics, in utero insults, or perinatal insults. We do know that ADHD are more prevalent in the urban areas, which leads me to believe that the environment has to make a contribution. But to what degree and in which of the conditions is not known. More studies are needed in this area.

Attention Deficit and Hyperactivity Disorder

Attention Deficit and Hyperactivity Disorder with and without hyperactivity and impulsivity responds to the same pharmacologic intervention. Those with Attention Deficit only seem to respond to a lower dose. The FDA approves all on the list below.

ADHD WITH & WITHOUT  
Medication Ritalin Dexedrine Cylert Adderall
Initial dose 5-20mg tid 2.5-15mg tid 18.75-25mg tid 5mg/day
Max. dose 60mg/day 40mg/day 75mg/day 60mg/day
Side effects Insomnia,
anorexia
Insomnia,
anorexia, HA.
Tic, irritability Insomnia,
anorexia

 

Central Auditory Processing Deficit

Central Auditory Processing Deficit has not been shown to be responsive to pharmaceutics. Cognitive management has been shown to be the most efficacious. The Easy Listening Device should be used when communication is necessary in a noisy background. Earplugs are helpful during reading or when auditory communication is not necessary. Parents and teachers should give instructions to students in a quiet surroundings and encourage the student to paraphrase these instructions. Information on intervention can be obtained from the speech pathologist and audiologist.

Helpful suggestions have also been added to this site under the following topics:

Obsessive Compulsive Disorder

Obsessive Compulsive Disorder can now be treated very successfully with the advent of recent pharmaceutics. See below for a partial list of suitable medications.

OCD
Medication Luvox Anafranil Serzone Zoloft
Initial dose 25-300mg/day 25mg/day 100mg bid 25mg/day
Max. dose 300mg/day 3mg/kg or 100mg/day 300mg/day 200mg/day
Side effects Nausea,
sleep disturbances
Somnolence,
dizziness, dry mouth
Nausea, dry mouth,
somnolence
Nausea,
sleep disturbance

 

Absence Seizures

Absence Seizures are being treated effectively with Valproic Acid, which is the drug of choice, but Clonazepam, and Carbamazepine has also been used successfully.

ABSENCE SEIZURE
Medication Klonopin Depakote Zaeontin
Initial dose 0.1-6mg tid 15mg/kg/day in
2-3 divided doses
250mg/day
divided
Max. dose 20mg/day 60mg/kg/day 1.5gm/day
Side effects Drowsiness,
CNS Depression
Hepatic failure,
nausea, somnolence
Blood dyscrasias

 

Schizophrenia

Schizophrenia is not one of the conditions you look for in your student or child; it usually does not become recognizable until in adolescence. It is, however, one of the Inattentive Disorders and needs to be treated. There are several drugs on the market, four of which are listed below. The extrapyramidal side effect is the most feared but there needs to be a balance between this and sedation.

SCHIZOPHRENIA
Medication Haldol Promazine Loxitane
Initial dose 0.5mg bid 10mg bid 10mg bid
Max. dose 5mg bid 50mg qid 75mg tid
Side effects Extrapyramidal effects,
dry mouth
Extrapyramidal effect,
dry mouth
Extrapyramidal effect,
drowsiness

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