EEG analysis of children with attention-deficit/hyperactivity disorder and comorbid reading disabilities

This study investigated electroencephalographic differences between two groups of children with attention-deficit/hyperactivity disorder, combined type, with reading disabilities (ADHD + RD) or without (ADHD) and typical control participants. Twenty participants were included in each group. All participants were between the ages of 8 and 12 years, and groups were matched on age and gender. The electroencephalographic (EEG) was recorded during an eyes-closed resting condition from 21 monopolar derivations, which were clustered into nine regions for analysis. The EEGs were Fourier-transformed to provide absolute and relative power estimates for the delta, theta, alpha, and beta bands. Ratio coefficients were also calculated for the theta/alpha and theta/beta ratios. Compared with controls, the clinical groups demonstrated the increased slow-wave and reduced fast-wave activity commonly reported in the ADHD literature. The ADHD + RD group had more relative theta, less relative alpha, and a higher theta/alpha ratio than the ADHD group. A number of hemispheric differences were also found in the delta and alpha bands. These results suggested that some of the EEG divergences found in the ADHD + RD group represent an electrophysiological component associated with the reading disability that is independent of the EEG divergences found in ADHD.     

Comorbidity of reading disability and attention-deficit/hyperactivity disorder: differences by gender and subtype

This study used a community sample of 494 twins with a reading disability (223 girls, 271 boys) and 373 twins without a reading disability (189 girls, 184 boys) to assess the relation between reading disability (RD) and attention-deficit/hyperactivity disorder (ADHD). Symptoms of DSM-III and DSM-IV ADHD were classified into symptoms of inattention and symptoms of hyperactivity-impulsivity (H/I). Results indicated that individuals with RD were more likely than individuals without RD to meet criteria for ADHD and that the association between RD and ADHD was stronger for symptoms of inattention than for symptoms of H/I. Parents and teachers reported similar rates of ADHD, suggesting that ADHD symptoms were pervasive across settings and were not solely attributable to academic frustration. Analyses of possible gender differences revealed that RD was significantly associated with inattention in both girls and boys but associated with H/I only in boys. This difference may provide a partial explanation for the discrepancy between the gender ratio obtained in referred (approximately 4 boys to 1 girl) and nonreferred (1.2 to 1.5 boys to 1 girl) samples of individuals with RD. Specifically, the hyperactive and impulsive behaviors exhibited by boys with RD may be more disruptive than the inattentive behaviors exhibited by girls and may therefore precipitate more frequent referrals for clinical attention.     

Evidence for unexpected weaknesses in learning in children with attention-deficit/hyperactivity disorder without reading disabilities

This study examined the mechanisms underlying verbal learning in children with and without attention-deficit/hyperactivity disorder (ADHD), none of whom had reading disabilities. Children with ADHD were compared to typically developing children on both process and product scores from the California Verbal Learning Test for Children. The findings indicated that children with ADHD initially learned the same number of words as controls but showed weaknesses recalling the words after delays, suggesting that children with ADHD are less efficient learners. Regardless of ADHD status, boys and girls performed differently. Boys used semantic clustering less frequently and recalled fewer words from the middle region of the list than girls; girls also outperformed boys in terms of overall performance, despite lower verbal IQ scores. These findings show that children with ADHD can exhibit unexpected weaknesses in learning even without a formal learning disability. Gender differences in verbal learning are also illustrated.     

Separating genuine cases of reading disability from reading deficits caused by predominantly inattentive ADHD behavior

Conventional methods of differentiating reading disability (RD) caused by deficits in decoding skills or comprehension from poor reading performance caused by inconsistent attention associated with attention-deficit/hyperactivity disorder (ADHD) have produced equivocal results. This study presents a model of differential diagnosis of attentional problems and RD that differs from these conventional approaches. The new diagnostic procedure uses intraindividual differences seen in the performance of at-risk learners on tasks related to reading that vary in their sensitivity to the sustained attention required for successful performance. The hypothesis is that children with inconsistent attention would perform more poorly on tests that require sustained attention, such as listening comprehension, than on tests that are more tolerant of inattention, such as reading comprehension. Such differences would not be seen in the test scores of children who have only RD, because their performance is determined more by the difficulty level of the reading tests than by the degree of sensitivity of the task to attention. The validity of this new model was evaluated by determining the capability of the differences seen in the scores of tests that differ in their sensitivity to sustained attention to predict the degree of inconsistency in sustained attention as measured by a continuous performance test. The data obtained from 39 children who are at risk for RD suggest that this is a viable model.     

Cognitive deficits in reading disability and attention deficit disorder

This paper presents data from three studies (a cross-sectional study of school-referred children, a test-retest study of subtypes of reading disabilities, and a study of a large, random sample of first graders) that focus on specifying the cognitive deficits associated with reading difficulties and separating them from those associated with attentional deficits. The cognitive deficits associated with difficulty in reading were consistent across samples, developmental levels, definitions, and subtypes of reading disabilities. With IQ, age, and sex controlled for, poor readers were significantly impaired on measures of naming and phonological awareness. The effects of attentional deficits were more variable and complex but were clearly separate from the reading disability effects.     

Children with attention-deficit/hyperactivity disorder: A review of the literature on social skills deficits

Social interactions between children with Attention-Deficit/Hyperactivity Disorder (AD/HD) and their teachers, peers, and parents are discussed. The extent to which these interactions may be termed problematic may depend on the social skills deficits displayed by this population. Although the general trend in the liternature has been to examine and describe children with deficient social skills, changing the focus to children with AD/HD who are not experiencing these difficulties may prove beneficial. A review of the previous literature is discussed, as well as suggestions for practice and future research needs.     

Including students with attention-deficit/hyperactivity disorder in mainstream schools

Around 80% of pupils with attention deficit disorders are educated in mainstream schools. The difficulties relating to inattention, impulsivity and hyperactivity experienced by such pupils present mainstream educators with a unique set of challenges and opportunities. In this article, Neil Humphrey, Senior Lecturer in the Psychology of Education at the University of Manchester, presents and discusses key evidence-based strategies and approaches to facilitate the inclusion of pupils affected by attention deficit/hyperactivity disorder (AD/HD). These include the need to reframe AD/HD, to understand the role of medication, to minimise distractions, to provide predictability, structure and routine, and to apply cognitive and behavioural strategies.     

Sleep disturbances in adolescents with symptoms of attention-deficit/hyperactivity disorder

We evaluated 32 nonmedicated male adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD) in childhood, 35 male adolescents similarly diagnosed who were receiving methylphenidate (MPH), and 77 control boys. Both ADHD groups completed self-report questionnaires assessing sleep disturbances; weekday and holiday sleep duration; and symptoms of ADHD, anxiety, and depression. Parents and teachers rated the severity of the participants' ADHD. The control group completed self-report questionnaires assessing sleep disturbances. We found that nonmedicated participants and controls did not differ in the severity of sleep disturbance. In contrast, the medicated participants demonstrated a significantly greater severity of sleep disturbance compared with the nonmedicated participants and reported elevated levels of symptoms of ADHD, anxiety, and depression. Specific analyses showed that depressive symptoms contributed significantly to the degree of sleep disturbance when controlling for ADHD diagnosis and MPH treatment. These findings suggest that among adolescents with ADHD symptoms, the severity of symptoms of depression may contribute to the degree of sleep disturbance in addition to the effect of their primary disorder and MPH treatment.     

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.     

Temporal processing and reading disability

The present investigation examined thehypothesis that early auditory temporalprocessing deficits cause later specificreading disability by impairing phonologicalprocessing (Farmer & Klein 1995; Tallal1980, 1984). Temporal processing ability atschool entry was examined using Tallal'sRepetition Test in a large unselected sample ofover 500 children followed over subsequentyears. Although our data confirmed the presenceof certain non-speech auditory processingdeficits in children later classified asspecific reading-disabled, many findings wereclearly at odds with a causal interpretation ofthis relationship. (1) Reading-disabled (RD)children were impaired at school entry on thesubtest with long interstimulus intervals(ISIs) but not the critical short-ISIsubtest. (2) RD children were not inferior toreading-age (RA) controls. (3) A subgroup of RDchildren with evidence of temporal deficitswere no less proficient on later phonologicalor reading measures than RD children with noevidence of early temporal impairment. (4)Although there was a reliable concurrentcorrelation between temporal deficits andphonological awareness at school entry(suggesting a possible common causeexplanation), early temporal deficits did notpredict later phonological impairment,pseudoword processing difficulties, or specificreading disability. On the other hand, earlytemporal deficits did predict later oralreceptive vocabulary and reading comprehensionweaknesses. These findings suggest thatauditory temporal deficits in dyslexics may beassociated with the same dysphasic-typesymptoms observed by Tallal and her colleaguesin specific language-impaired populations, butdo not cause the core phonological deficitsthat characterize dyslexic groups.     

Diagnostic considerations in children with reading disability

Summary Nine out of ten children with reading disability are found to have a basic syndrome consisting of signs related to lack of clear-cut cerebral dominance. Two of these nine children have additional signs suggestive of structural brain damage. One out of ten children with reading disability does not have any of these findings. The methods of detecting these groups are described and therapeutic implications indicated. The data described in this paper have been previously reported in: SILVER, A. A. and HAGIN, R., “Specific Reading Disability: Delineation of the Syndrome and Relationship to Cerebral Dominance,” COMPREHENSIVE PSYCHIATRY, 1, 2 (April, 1960), pp. 126–134. The author is indebted to Dr. Rosa A. Hagin for permission to use this material. From BULLETIN OF THE ORTON SOCIETY, Vol. XI, 1961, pp. 5–12.     

Postsecondary attention-deficit/hyperactivity disorder and deliberate practice: Study time,study quality,and self-perceptions

The current study examined study habits of postsecondary students with attention-deficit/hyperactivity disorder (ADHD) through the theoretical context of deliberate practice. The responses of participants with and without ADHD were compared on a survey of study time, study quality, and self-perceptions of study habits, as well as a measure of test anxiety. Groups were equivalent on reports of study time and time spent in other activities, percentage of classes they attend, use of conducive study environments, and planning of studying. Despite similar study behaviors, ADHD participants were more likely to feel unprepared for tests, reported significantly higher test anxiety, and had lower grade point averages. Regardless of ADHD status, the majority of study participants were not implementing deliberate practice behaviors, with the exception of class attendance, and study times fell far below recommended levels. Findings provided evidence that emulating the study behaviors of peers is not sufficient for students with ADHD to experience similar outcomes.     

Phonological,visual and temporal processing in adults with and without reading disability

The primary goal of this study was to comparethree theoretical accounts of readingdisability (RD) by simultaneously studyingphonological, visual, and temporal processingskills. Adults with and without RD werecompared on measures of phonological processingwith the Auditory Analysis Test (AAT) and theWoodcock Reading Mastery Test (WRMT-R) WordAttack subtest. Visual processing was assessedwith the Useful Field of View test (UFOV®)and the Frequency Doubling Technology Perimeter(FDT). The Repetition Test was used toevaluate temporal processing skills. Adultswith RD evidenced poorer phonological andtemporal processing skills than did adultswithout RD, but no significant differencesbetween the groups were found in visualprocessing. Future research is needed toclarify the relations among phonological,visual, and temporal skills and the roles theyplay in RD. The trajectory and co-existence ofdeficits throughout development, as well as howspecifically such impairments affect reading,warrant further investigation.     

Visualisation to support children with attention-deficit/hyperactivity disorder learning to solve mathematical word problems: A randomised controlled trial

This randomised controlled trial experimental study compared the effectiveness of using two different types of visualisation – self-constructed visualisation (SCV) and passively received visualisation (PRV) – to help children with attention-deficit/hyperactivity disorder (ADHD) solve mathematical word problems. While SCV refers to drawings that children create to help solve given word problems, PRV refers to pre-made images that accompany word problems. Twenty children with ADHD in Kuwait, aged nine to 11 years, were randomly assigned to either the SCV or PRV group, where they were taught to use either SCV or PRV to solve word problems across 20 daily one-to-one sessions. The results showed that regardless of the visualisation type, children's word problem-solving ability significantly improved. Children with ADHD should thus be encouraged to use visualisation to help make the word problem-solving process more accessible to them.     

Phonological and semantic priming in children with reading disability

Lexical priming was assessed in children with reading disability (RD) and in age-matched controls ( M = 11.5 years), in visual and auditory lexical decision tasks. In the visual task, children with RD were found to have deficits in semantic (SHIP–BOAT), phonological/graphemic (GOAT–BOAT), and combined (FLOAT–BOAT) priming. The same pattern of semantic priming deficits also occurred in auditory lexical decisions, suggesting that the semantic deficits are not confined to reading. Children with RD also showed less priming than reading-age matched controls, suggesting that their priming deficits are not simply due to lower reading level but are due to the reading disability in particular. These semantic deficits may contribute to both the word reading and the comprehension problems seen in children with RD.     

Experimental training of children with attention deficit/hyperactivity disorder

Attention-deficit/hyperactivity disorder （AD/HD） negativelly affects the cognitive and psychomotoric spheres of the pupil＇s social behavior and social adaptation. The review of many studies states that pupils with AD/HD achieve worse learning results because of insufficiently functioning cognitive processess, such as attention, （work） memory, thinking, problem solving, language, small- and large- scale motorics. Behavioral features, exhibited with AD/HD, include low-frustration tolerance, temper problems, persistence, emotional liability, depression, peer rejection, poor self-concept and poor self-esteem. Because of insufficiency of the cognitive processes, the difficulties of social behavior and social adaptation, pupils with AD/HD more often have a dysfunction of pupils＇ role that manifests by learning difficulties and behavior problems. The manifestation of the disorder in the younger school age in the context of children＇s school activities and roles actualizes the exceptional interest of the educational science in the analyzed phenomenon. The search and construction of effective means of socio-educational help for AD/HD primary class pupils should be associated with coordination and adaptation of different effective educational methodologies of different conceptual origin. In order to develop cognitive, psycho-motoric abilities and social behavior of the group of primary class pupils with AD/HD （N=22）, activities of supplementary education were organized after classes （their duration was 6 months）. During the forming experiment, original methodologies were constructed and national and foreign researchers＇ educational methodologies were adapted and tested in new, specific conditions （methods of fairy-tales, correction of cognitive behavior, graphical-logical tasks, games in the sport hall）. Even by relatively rare activities of supplementary education in a homogeneous group of children suffering from AD/HD positive changes of cognitive, psychomotoric sphere, social behavior and social adaptation were achieved.     

Preschool twin study of the relation between attention-deficit/hyperactivity disorder and prereading skills

Numerous studies have examined the etiology of the association between reading difficulties and attention-deficit hyperactivity disorder (ADHD) in school-age children, but little is known about the relation between prereading skills and ADHD behaviors prior to the beginning of formal reading instruction. A population-based sample of 809 pairs of preschool twins completed an extensive battery of prereading measures, and the parent of each twin completed an ADHD rating scale. Phenotypic analyses revealed small but significant correlations between DSM-IV inattention ratings and six prereading composite measures, whereas hyperactivity–impulsivity symptoms were not independently associated with any of the prereading scores. Multivariate twin analyses indicated that virtually all of the phenotypic correlation between inattention and prereading performance is attributable to common genetic influences, consistent with results obtained in studies of older twins. Although additional research is needed to test alternative causal models in children younger than five years old, these results are most consistent with the hypothesis that reading difficulties and inattention symptoms are attributable to common genetic influences.     

Linkages between child abuse and attention-deficit/hyperactivity disorder in girls: behavioral and social correlates

OBJECTIVE: The objectives of this study were to examine whether girls with attention-deficit/hyperactivity disorder (ADHD) are at increased risk of having histories of abuse and to assess whether the presence of an abuse history may constitute a distinct subgroup of youth with ADHD. METHOD: We examined rates and correlates of child abuse in an ethnically and socioeconomically diverse sample of girls with attention-deficit/hyperactivity disorder (ADHD; n=140) and a matched comparison sample of girls without ADHD (n=88), all aged 6-12 years. A thorough chart review reliably established documented rates of physical and sexual abuse in both samples. RESULTS: There were significantly higher rates of abuse for girls with ADHD (14.3%) than for the comparison sample (4.5%), with most of the abuse found in girls with the Combined as opposed to the Inattentive type. Higher rates of externalizing behaviors (including objective observations in a research summer camp) and peer rejection (indexed through peer sociometric nominations) characterized the subgroup of girls with ADHD with abuse histories compared to the subgroup without such histories, with moderate to large effect sizes. Subgroup differences regarding internalizing problems and cognitive deficits did not emerge. Findings regarding peer rejection were explained, in part, by higher rates of observed aggressive behavior in the abused subgroup. CONCLUSIONS: The findings raise important questions about the possible etiologic and/or exacerbating role of abusive trauma in a subgroup of children with ADHD.