A synthesis on the research of the comorbidity of ADHD and LD in Korea: perspective and trend

Attention-deficit/hyperactivity disorder (ADHD) and learning disabilities (LD) are the most commonly diagnosed childhood disorders, and they frequently co-occur with each other. It has been found that students with comorbidity of ADHD and LD experience more difficulties in school. Even though the research interests in the comorbidity of ADHD and LD are increasing, there are inconsistent results in research studies and insufficient understanding of the comorbidity of ADHD and LD. This study attempts to grasp the progress of the studies in the comorbidity of ADHD and LD in Korea and to suggest the future directions for following research. A total of 90 studies published between 1987 and 2009 are examined. First, we analyze the studies that examined the learning problems of ADHD and then identify the characteristics of the learning problems in ADHD group. Afterwards, we investigate the studies that dealt with the attention problems of LD and then discuss the characteristics of the attention problems in LD group. Third, we identify the differences between ADHD and LD and synthesize the research findings. Finally, we analyze the studies conducted in conjunction with the comorbidity of ADHD and LD. On lightening the research of the comorbidity on three aspects, we find the research trend in Korea and provide the implications for future studies on the comorbidity of ADHD and LD. Furthermore, we suggest that it is important to identify comorbid conditions at the early stage, and it is necessary to conduct multidisciplinary research and international comparison research.     

儿童多动症的成因分析及教育干预措施

儿童多动症是以行为障碍为特征的一种综合症,属于儿童期的发展性障碍,以活动过多、注意力缺陷、冲动任性、学习困难以及存在行为问题为主要特征。主要原因在于生理遗传、铅中毒和脑损伤等,也包括家庭教育因素的影响。可从家庭和学校两个方面采取教育干预措施。家庭方面包括：改变教养方式、建立家庭奖励等;学校方面包括：强化消退训练、程序训练和感觉统合训练等。     

Learning disabilities and ADHD: overlapping spectrumn disorders

Clinical and psychoeducational data were analyzed for 119 children ages 8 to 16 years who were evaluated in a child diagnostic clinic. A learning disability (LD) was present in 70% of the children with attention-deficit/hyperactivity disorder (ADHD), with a learning disability in written expression two times more common (65%) than a learning disability in reading, math, or spelling. Children with LD and ADHD had more severe learning problems than children who had LD but no ADHD, and the former also had more severe attention problems than children who had ADHD but no LD. Further, children with ADHD but no LD had some degree of learning problem, and children with LD but no ADHD had some degree of attention problem. Results suggest that learning and attention problems are on a continuum, are interrelated, and usually coexist.     

Children's attitudes towards ADHD,depression and learning disabilities

Attention deficit hyperactivity disorder (ADHD), depression and general learning disabilities (LD) are common difficulties for British primary school children. It has been found that characteristics associated with these difficulties can result in negative attitudes and stigma from other children, causing problems with peer relationships. Furthermore, problematic peer relations can intensify the difficulties associated with these disorders. Packages such as ‘Tackling Stigma: A Practical Toolkit’ aim to combat stigma in schools. However, these packages have not been based on evidence regarding children's attitudes towards different disorders. This study aims to explore children's attitudes towards ADHD, depression and LD from a conative (measure of social distance) and cognitive (measure of positive or negative attributes ascribed to a person) perspective. Participants were 273 children (M= 9.2 years). Vignettes were used to describe a child with ADHD, depression, or LD or a ‘normal’ child. The Shared Activities Questionnaire was utilised to assess conative attitudes, and the Adjective Checklist was utilised to assess cognitive attitudes. Results showed that children generally displayed more negative attitudes to vignettes describing mental health difficulties (MHD) (ADHD and depression) than LD. Children had more negative attitudes towards the ADHD (externalising disorder) vignette than the depression vignette (internalising disorder). Younger children had more positive conative attitudes than older children. Those who had previous contact with children with ADHD, depression and LD had more positive attitudes. These findings can enhance current stigma reduction interventions through contributing a deeper understanding of children's attitudes towards the most common MHD and LD in childhood.     

Assessing college-level learning difficulties and "at riskness" for learning disabilities and ADHD: development and validation of the learning difficulties assessment

This article describes the development and validation of the Learning Difficulties Assessment (LDA), a normed and web-based survey that assesses perceived difficulties with reading, writing, spelling, mathematics, listening, concentration, memory, organizational skills, sense of control, and anxiety in college students. The LDA is designed to (a) map individual learning strengths and weaknesses, (b) provide users with a comparative sense of their academic skills, (c) integrate research in user-interface design to assist those with reading and learning challenges, and (d) identify individuals who may be at risk for learning disabilities and attention-deficit/hyperactivity disorder (ADHD) and who should thus be further assessed. Data from a large-scale 5-year study describing the instrument's validity as a screening tool for learning disabilities and ADHD are presented. This article also describes unique characteristics of the LDA including its user-interface design, normative characteristics, and use as a no-cost screening tool for identifying college students at risk for learning disorders and ADHD.     

A review of the literature on Attention-Deficit Hyperactivity Disorder children: Peer interactions and collaborative learning

ADHD children may have social skill deficits in at least three main areas: social communication, poor emotional regulation, and social-cognitive biases. They also have cognitive difficulties which have implications for their learning. Based on a review of the literature, it is argued that maladaptive classroom peer interactions for ADHD children may disadvantage their learning on collaborative tasks. Although the literature is sparse in the area of peer interactions and collaborative learning for ADHD children, some suggestions for practice and future research are suggested. © 1996 John Wiley & Sons, Inc.     

Written expression performance in adolescents with attention-deficit/hyperactivity disorder (ADHD)

We examined written expression performance in a sample of adolescents with ADHD and subthreshold ADHD using two different strategies: examining performance on standardized measures of written expression and using other indicators of written expression developed in this study. We examined associations between standardized measures of written expression, cognitive processing measures (working memory, processing speed, language, fine motor ability, and reading efficiency) and behavioral ratings of ADHD by parents and teachers. We also developed a coding scheme for a writing sample to measure productivity and the ratio of self-corrections to errors. The results indicated that written expression performance was most consistently associated with cognitive processing measures and not behavioral ratings of ADHD, based on correlational and simultaneous regression analyses. These results were consistent in the analyses with both the standardized measures and the coding scheme measures of written expression. Findings generally remained robust, regardless of whether participants who met criteria for a learning disability were included or excluded in the analyses. The current results suggest that written expression difficulties in adolescents with ADHD are attributable to processing difficulties that may be associated with ADHD, not to ADHD reported symptoms. Implications for assessment and intervention are discussed.     

Supporting children with genetic syndromes in the classroom: the example of 22q deletion syndrome

An increasing number of children are likely to have a known genetic cause for their special educational needs. One such genetic condition is 22q11.2 deletion syndrome (22qDS), a genetic syndrome associated with early speech and language difficulties, global and specific cognitive impairments, difficulties with attention and difficulties with social‐emotional functioning. In this article the learning and behavioural strengths and needs of this genetic syndrome are described along with recommendations for classroom‐based interventions. Suggested recommendations in the learning and emotional‐behavioural domains for the syndrome draw on a number of approaches that have been found to be useful for children with a range of conditions including ADHD, ASD and dyscalculia. While teachers cannot be expected to know about all potential genetic causes for special educational needs, knowing that a genetic condition is likely to be associated with a pattern of relative cognitive and behavioural strengths and needs is important.     

Improvement of Word Problem Solving and Basic Mathematics Competencies in Students with Attention Deficit/Hyperactivity Disorder and Mathematical Learning Difficulties

Problem solving represents a salient deficit in students with mathematical learning difficulties (MLD) primarily caused by difficulties with informal and formal mathematical competencies. This study proposes a computerized intervention tool, the integrated dynamic representation (IDR), for enhancing the early learning of basic mathematical competencies and word problem solving skills. The goal was to compare and contrast the effects of IDR on the acquisition of informal and formal mathematical competencies in students with attention deficit/hyperactivity disorder (ADHD) and MLD. Participants were 216 students (6–9 years), who were classified into three groups: ADHD (n = 72), MLD (n = 82), ADHD and MLD (n = 62). They completed the Test of Early Mathematics Ability (Third Edition). The results showed that all three diagnosed groups improved significantly postintervention in all mathematical competencies, with the MLD‐only group benefiting the most at posttest.     

CORRELATES OF CONDUCT PROBLEMS AND DEPRESSION COMORBIDITY IN ELEMENTARY SCHOOL BOYS AND GIRLS RECEIVING SPECIAL EDUCATIONAL SERVICES

There is limited empirical research on the correlates of conduct problems (CP) and depression comorbidity during childhood. This study investigated 479 elementary school children (48.2% girls). It compared children with comorbidity to children with CP only, depression only, and control children on individual, academic, social, and family characteristics. The study also analyzed gender differences in the associations between correlates and comorbidity. Multinomial logistic regression results revealed that children with CP and depression had higher levels of anxiety and more school difficulties than children with CP only, more social difficulties and more severe attention deficit and hyperactivity disorder (ADHD) symptoms than children with depression only, and more difficulties in all domains than control children. Girls with CP and depression presented a particularly negative profile, including lower school abilities than CP and control girls, and lower social skills and more severe ADHD symptoms than control girls.  Implications for evaluation and intervention planning are discussed.     

Children Diagnosed ADHD: Factors to guide intervention

Psychological, sociological and learning issues and their possible relevance to the behaviour of children diagnosed ADHD were investigated. A questionnaire containing 29 items derived from recommendations for assessment considerations presented in the British Psychological Society's Working Party Report, ADHD-A Psychological Response to an Evolving Concept , was circulated to schools. Teachers provided views as to the extent these items were having a bearing on behaviour for a cohort of 239 pupils. Two main areas of influence were identified-learning difficulties and psychological problems. Correlation analyses suggested clusters of influential items within these two areas occur according to the educational year of the child. A general trend emerged suggesting that as children get older, psychological problems have an increasingly significant bearing on presenting behaviour. Poor literacy is highlighted as a significant area of concern across a range of year groups. The research reveals serious flaws in the effectiveness of inter-professional liaison. Findings are discussed in relation to providing a framework for detailed assessment of factors that may influence behaviour, and thus for planning effective intervention. The value of the ADHD label is questioned.     

An intervention approach for children with teacher- and parent-identified attentional difficulties

Using a multimodal and multi-informant method for diagnosis, we selected 33 children by teacher and parent nomination for attention and work completion problems that met DSM-IV criteria for attention-deficit/hyperactivity disorder (ADHD). Of the 33 children in this group, 21 participated in the initial intervention, and 12 were placed in an ADHD control group and received the intervention after pre- and posttesting. A similarly selected group of 21 children without difficulties in attention and work completion served as a control group. Each child was assessed on pre- and posttest measures of visual and auditory attention. After an 18-week intervention period that included attention and problem-solving training, all children in the intervention and control groups were retested on visual and auditory tasks. Children in both ADHD groups showed significantly poorer initial performance on the visual attention task. Whereas the ADHD intervention group showed commensurate performance to the nondisabled control group after training, the ADHD control group did not show significant improvement over the same period. Auditory attention was poorer compared to the control group for both ADHD groups initially and improved only for the ADHD intervention group. These findings are discussed as a possible intervention for children with difficulties in strategy selection in a classroom setting.     

Factors affecting treatment acceptability for psychostimulant medication versus psychoeducational intervention

Future teachers' judgments of acceptability for two common treatments for children with the Attention Deficit Hyperactivity Disorder (ADHD) label were examined. One hundred forty‐four pre‐service teachers were grouped according to their high school location at graduation (urban vs. rural) and were randomly assigned to read one of four vignettes. The content of the vignettes was held constant but label (ADHD vs no label) and treatments (special education placement vs. Ritalin) were varied. Results indicated a significant main effect on treatment acceptability for High School Location, a Label × Treatment interaction on the attention problems variable, a main effect for Label on the social problems variable, and a High School Location × Treatment interaction on the social problems variable. A number of implications can be made. Observer characteristics such as urban or rural high school experiences may influence judgments about a labeled child more than the characteristics of the child being observed. In this study, the ADHD label evoked greater expectations of attentional difficulties even when the pattern of functioning was similar to nonlabeled children. On the other hand, children with the ADHD label were judged as having better social functioning, which suggests that the ADHD label allows observers to attribute behavioral difficulties or the social problems displayed by these children to some factor that is outside the control of the child, or for which the child does not have personal responsibility. © 2001 John Wiley & Sons, Inc.     

Reading and dual-task balancing: evidence against the automatization deficit explanation of developmental dyslexia

Nicolson and Fawcett (1990) demonstrated specifically impaired balancing performance of children with dyslexia when balancing had to be done simultaneously with a secondary task. This finding was taken as evidence for a general automatization deficit of children with dyslexia. We attempted to replicate this finding with German children with dyslexia, whose characteristic reading difficulty is a fluency problem quite in correspondence with the automatization deficit explanation. Because we were concerned about a potential confound between dyslexia and attention-deficit/hyperactivity disorder (ADHD), we also collected teacher ratings on ADHD symptoms. We found that poor dual-task balancing was limited to children with higher ADHD ratings and that children with dyslexia without higher ADHD ratings performed as well on dual-task balancing as age-matched control children. This finding supports the aforementioned confound. Together with other findings from our research group, it supports the position that, even in consistent orthographies, difficulties in learning to read are caused by a specific phonological deficit.     

Memory modality differences in children with Attention Deficit Hyperactive Disorder with and without learning disabilities

This study assesses information processing and memory functioning in 50 children diagnosed with Attention Deficit Hyperactive Disorder (ADHD) with and without learning disabilities (LD). Mode of presentation (visual vs. auditory), type of memory processing (immediate, short-term, and long-term), and order of recall (ordered vs. unordered) were assessed using the Learning Efficiency Test-II (LET-II). Both groups demonstrated difficulty with auditory ordered recall and lost substantial information from immediate memory to short-term and long-term memory stores. The ADHD/LD group also demonstrated more difficulty with ordered recall than the ADHD only group. While there were no differences between the two groups in regard to immediate recall, the ADHD/LD group demonstrated more problems transferring information into short-term and long-term memory stores than the ADHD only group. Verbal interference effects significantly decreased retention for both visual and auditory processing. Results indicate that ADHD alone presents significant problems in information processing, but the comorbid effects of a learning disability further intensify the negative impact of ADHD. © 1996 John Wiley & Sons, Inc.     

Project DyAdd: Implicit learning in adult dyslexia and ADHD

In this study of the project DyAdd, implicit learning was investigated through two paradigms in adults (18–55 years) with dyslexia (n?=?36) or with attention deficit/hyperactivity disorder (ADHD, n?=?22) and in controls (n?=?35). In the serial reaction time (SRT) task, there were no group differences in learning. However, those with ADHD exhibited faster RTs compared to other groups. In the artificial grammar learning (AGL) task, the groups did not differ from each other in their learning (i.e., grammaticality accuracy or similarity choices). Further, all three groups were sensitive to fragment overlap between learning and test-phase items (i.e., similarity choices were above chance). Grammaticality performance of control participants was above chance, but that of participants with dyslexia and participants with ADHD failed to differ from chance, indicating impaired grammaticality learning in these groups. While the main indices of AGL performance, grammaticality accuracy and similarity choices did not correlate with the neuropsychological variables that reflected dyslexia-related (phonological processing, reading, spelling, arithmetic) or ADHD-related characteristics (executive functions, attention), or intelligence, the explicit knowledge for the AGL grammar (i.e., ability to freely generate grammatical strings) correlated positively with the variables of phonological processing and reading. Further, SRT reaction times correlated positively with full scale intelligence quotient (FIQ). We conclude that, in AGL, learning difficulties of the underlying rule structure (as measured by grammaticality) are associated with dyslexia and ADHD. However, learning in AGL is not related to the defining neuropsychological features of dyslexia or ADHD. Instead, the resulting explicit knowledge relates to characteristics of dyslexia.     

Clinical importance of parent ratings of everyday cognitive abilities in children with learning and attention problems

This study addressed two issues: first, whether parental reports contribute information over and above a standardized psychometric assessment, and second, whether parental reports of everyday cognitive functioning might be useful in distinguishing between children with reading disabilities (RD), attention-deficit/hyperactivity disorder (ADHD), and combined ADHD + RD. Parent-reported information on 159 children with learning or attention problems was obtained using a questionnaire called the Parent Ratings of Everyday Cognitive and Academic Abilities (PRECAA). Psychometric information used for comparison included the Woodcock-Johnson Psychoeducational Battery-Revised, the Bruininks-Oseretsky Test of Motor Proficiency-Short Form, the Vocabulary and Block Design subtests of the Wechsler Intelligence Scale for Children, 3rd edition, and the Developmental Test of Visual-Motor Integration. The PRECAA was found to be sensitive to group differences between children with RD and children with ADHD and combined ADHD + RD. Its inclusion resulted in a significant increase in the number of children correctly classified compared to the use of psychometric measures alone. The PRECAA correctly classified more children (66%) than did the standard psychometric measures (50%). In fact, a very high percentage of children with ADHD (81%) were correctly classified using the PRECAA. These findings suggest that the PRECAA may be a useful aid to clinicians in the identification of children with learning and attention problems.     

The history of attention‐ deficit/hyperactivity disorder

Abstract

As the number of children diagnosed with, and medicated for, Attention‐Deficit/Hyperactivity Disorder (ADHD) increases at an alarming rate there have been questions raised as to whether ADHD is really a disorder or merely a fabricated and socially constructed problems However, there is much evidence which shows that ADHD related difficulties have been observed in children for at least the past century. This paper will provide a detailed account of this evidence and will show that ADHD is a disorder which has affected our children form at least the past 100 years