Objective: Although most children with ADHD experience school problems, only a subset of these youth meet psychometric criteria for learning disabilities (LD) in reading or mathematics. Considering the well-documented adverse impact of both ADHD and LD on school performance, the presence of both conditions in a given child may herald a particularly poor educational outcome for affected youth. This issue has not been adequately addressed in previous follow-up studies of ADHD.
Design: In a four-year follow-up study of ADHD children, the educational, psychiatric, and psychosocial outcomes in ADHD youth with and without LD were examined.
Results: Among children with ADHD, LD at baseline selectively predicted poorer educational functioning at follow-up, as manifested by higher rates of grade retention, in-school tutoring, and placement in special classes. In contrast, psychiatric comorbidity and psychosocial outcomes were comparable in ADHD youth with and without LD.
Conclusions: Results suggest that LD predicts impaired academic outcomes among ADHD children. It does not, however, predict impaired social or psychiatric outcomes. These results stress the importance of including an evaluation of LD in the assessment of ADHD youth.
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References
1.
Achenbach, T. M., McConaughy, S. H., & Howell, C. T. (1987). Child/adolescent behavioral and emotional problems: Implications of cross-informant correlations for situational specificity . Psychological Bulletin, 101 (2),213-232.
2.
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.)- Primary Care Version. Washington, DC: author .
3.
Anderson, J. C., Williams, S., McGee, R., & Silva, P. A. (1987). DSM-III disorders in preadolescent children: Prevalence in a large sample from the general population. Archives of General Psychiatry, 44, 69-76.
4.
Biederman, J. (1990). The diagnosis and treatment of adolescent anxiety disorders. Journal of Clinical Psychiatry, 51 (Suppl.5), 20-26.
5.
Biederman, J., Faraone, S. , & Chen, W. (1993 ). Social adjustment inventory for children and adolescents: Concurrent validity in ADHD children. Journal of the American Academy of Child and Adolescent Psychiatry, 32 (5), 1059-1064.
6.
Biederman, J., Faraone, S. V., Mick, E., Williamson, S., Wilens, T., Spencer, T., Weber, W., Jetton, J., Kraus, I., Pert, J., & Zallen, B. (1999). Clinical correlates of attention deficit hyperactivity disorder in females: Findings from a large group of pediatrically and psychiatrically referred girls. Journal of the American Academy of Child and Adolescent Psychiatry, 38 (8), 966-975.
7.
Biederman, J., Faraone, S. V., Keenan, K., Benjamin, J., Krifcher, B., Moore, C., Sprich-Buckminster, S., Ugaglia, K., Jellinek, M. S., Steingard, R., et al. (1992). Further evidence for family-genetic risk factors in attention deficit hyperactivity disorder. Patterns of comorbidity in probands and relatives psychiatrically and pediatrically referred samples . Archives of General Psychiatry, 49 (9), 728-738.
8.
Cantwell, D. P. (1985). Hyperactive children have grown up: What have we learned about what happens to them?Archives of General Psychiatry, 42, 1026-1028.
9.
Cantwell, D. P., & Baker, L. (1991). Association between attention deficit-hyperacitivity disorder and learning disorders. Journal of Learning Disabilities , 24 (2), 88-95.
10.
Denckla, M. B. (1989). Executive function: The overlap zone between attention deficit hyperactivity disorder and learning disabilities. International Pediatrics, 4, 155-160.
11.
Deuel, R. K. (1981). Minimal brain dysfunction, hyperkinesis, learning disabilities, attention deficit disorder. Journal of Pediatrics, 98 (6), 912-915.
12.
Douglas, V. I. (1972). Stop, look and listen: The problem of sustained attention and impulse control in hyperactive and normal children. Canadian Journal of Behavioral Science, 4, 259-282.
13.
Douglas, V. I. (1976). Perceptual and cognitive factors as determinants of learning disabilities: A review chapter with special emphasis on attentional factors. In R. M. Knights & D. J. Bakker (Eds.), The Neuropsychology of Learning Disorders: Theoretical Approaches. Baltimore: University Park Press.
14.
Duane, D. D. (1989). Neurobiological Correlates of Learning Disabilities. Journal of the American Academy of Child and Adolescent Psychiatry, 28 (3), 314-318.
15.
Edelbrock, C., Costello, A. J., & Kessler, M. D. (1984). Empirical corroboration of attention deficit disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 23 (3), 285-290.
16.
Federal Register. (1977a). Assistance to states for education of handicapped children: Procedures for evaluating specific learning disabilities (Vol. 42). Bethesda, MD: U.S. Department of Health, Education, and Welfare.
17.
Federal Register. (1977b). Title 45-Public Welfare: Part 121a—Assistance to states for the education of handicapped children (Vol. 42).
18.
Faraone, S., Biederman, J. , Krifcher-Lehman, B. K., Keenan, K., Norman, D., Seidman, L., Kolodny, R. , Kraus, I., Perrin, J., & Chen, W. ( 1993). Evidence for the independent familial transmission of attention deficit hyperactivity disorder and learning disabilities: Results from a family genetic study. American Journal of Psychiatry , 150 (6), 891-895.
19.
Faraone, S. V., Biederman, J., & Milberger, S. ( 1995). How reliable are maternal reports of their children's psychopathology?: One year recall of psychiatric diagnoses of ADHD children . Journal of the American Academy of Child and Adolescent Psychiatry, 34 (8), 1001-1008.
20.
Faraone, S. V., Biederman, J., Krifcher-Lehman, B. K., Spencer, T., Norman, D., Seidman, L., Kraus, I., Perrin, J., Chen, W., & Tsuang, M. T. (1993). Intellectual performance and school failure in children with attention deficit hyperactivity disorder and in their siblings. Journal of Abnormal Psychology, 102 (4), 616-623.
21.
Fletcher, J. M., Francis, D. J., Rourke, B. P., Shaywitz, S. E., & Shaywitz, B. A. (1992). The validity of discrepancy-based definitions of reading disabilities. Journal of Learning Disabilities, 25 (9), 555-573.
22.
Fletcher, J. M., Shaywitz, S. E., Shankweiler, D. P., Katz, L., Liberman, I. Y. , Stuebing, K. K., Francis, D. J., Fowler, A. E., & Shaywitz, B. A. (1994). Cognitive profiles of reading disability: Comparisons of discrepancy and low achievement definitions. Journal of Educational Psychology, 86, 6-23.
23.
Frick, P. J., Lahey, B. B. , Kamphaus, R. W., Loeber, R., Christ, M. A. G., Hart, E. L., & Tannenbaum, L. E. (1991). Academic underachievement and the disruptive behavior disorders. Journal of Consulting and Clinical Psychology, 59 (2), 289-294.
24.
Gershon, E. S., Hamovit, J., Guroff, J. J., Dibble, E., Leckman, J. F., Sceery, W., Targum, S. D., Nurnberger, J. I., Jr., Goldin, L. R., & Bunney, W. E., Jr. (1982). A family study of schizoaffective, bipolar I, bipolar II, unipolar, and normal control probands . Archives of General Psychiatry, 39 (10), 1157-1167.
25.
Gilger, J. W., Pennington, B. F., & DeFries, C. ( 1992). A twin study of the etiology of comorbidity: Attention deficit hyperactivity disorder and dyslexia. Journal of the American Academy of Child and Adolescent Psychiatry, 31 (2), 343-348.
26.
Gittelman, R., Mannuzza, S., Shenker, R., & Bonagura, N. (1985). Hyperactive boys almost grown up: I. Psychiatric status. Archives of General Psychiatry, 42, 937-947.
27.
Hollingshead, A. B. (1975). Four Factor Index of Social Status. New Haven, CT: Yale Press.
28.
Huessy, H. R., Metoyer, M. , & Townsend, M. ( 1974). 8-10 year follow-up of 84 children treated for behavioral disorder in rural Vermont. Acta Paedopsychiatrica, 40(6), 230-235.
29.
John, K., Gammon, G. D., Prusoff, B. A., & Wamer, V. (1987). The Social Adjustment Inventory for Children and Adolescents (SAICA): Testing of a new semistructured interview . Journal of the American Academy of Child andAdolescent Psychiatry, 26 (6), 898-911.
30.
Kavale, K. (1988). The Long-Term Consequences of Learning Disabilities (Vol. 2). Toronto, ON: Pergamon.
31.
Kavanagh, J. F., & Truss, T. J. (Eds.). (1988). Learning Disabilities: Proceedings of the National Conference. Parkton, Maryland : York Press.
32.
Kendler, K. S. (1990). The super-normal control group in psychiatric genetics: Possible artifactual evidence for coaggregation. Psychiatric Genetics, 1, 45-53.
33.
Lahey, B. B., Schaughency, E. A., Strauss, C. C., & Frame, C. L. (1984). Are attention deficit disorders with and without hyperactivity similar or dissimilar disorders?Journal of the American Academy of Child and Adolescent Psychiatry, 23 (3), 302-309.
34.
Levine, M. D., Busch, B. , & Aufseeser, C. ( 1982). The dimension of inattention among children with school problems. Pediatrics, 70, 387-395.
35.
Loeber, R., Green, S. M. , Lahey, B. B., & Stouthamer-Loeber, M. (1991). Differences and similarities between children, mothers, and teachers as informants on disruptive child behavior. Journal of Abnormal Child Psychology, 19 (1), 75-95.
36.
Orvaschel, H., & Puig- Antich, J. (1987). Schedule for Affective Disorders and Schizophrenia for School-Age Children: Epidemiologic 4th Version . Ft. Lauderdale, FL: Nova University, Center for Psychological Study.
37.
Reynolds, C. R. (1984). Critical measurement issues in learning disabilities. Journal of Special Education, 18, 451-476.
38.
Sandberg, S. T., Rutter, M., & Taylor, E. ( 1978). Hyperkinetic disorder in psychiatric clinic attenders . Developmental Medicine and Child Neurology, 20, 279-299.
39.
Sattler, J. (1988). Psychological Assessment (4th ed.). New York : McGraw-Hill.
40.
Semrud-Clikeman, M. S., Biederman, J., Sprich, S., Krifcher, B., Norman, D. , & Faraone, S. V. ( 1992). Comorbidity between ADHD and learning disability: A review and report in a clinically referred sample. Journal of the American Academy of Child and Adolescent Psychiatry, 31 (3), 439-448.
41.
Silver, L. B. (1981). The relationship between learning disabilities, hyperactivity, distractibility, and behavioral problems. Journal of the American Academy of Child and Adolescent Psychiatry, 20 (2), 385-397.
42.
Silver, L. B., & Brunstetter, R. W. (1986). Attention deficit disorder in adolescents. Hospital and Community Psychiatry, 37 (6), 608-613.
43.
Weiss, G. (1985). Follow up studies on outcome of hyperactive children. Psychopharmacological Bulletin, 21 (2), 169-177.
44.
Weiss, G., Hechtman, L., Milroy, T., & Perlman, T. (1985). Psychiatric status of hyperactives as adults: A controlled prospective 15-year follow-up of 63 hyperactive children. Journal of the American Academy of Child and Adolescent Psychiatry, 24 (2), 211-220.
45.
Weiss, G., Hechtman, L., Perlman, T., Hopkins, J. , & Wener, A. ( 1979 ). Hyperactives as young adults: A controlled prospective ten-year follow-up of 75 children. Archives of General Psychiatry , 36, 675-681.
46.
Weissman, M. M., Leckman, J. F., Merikangas, K. R., Gammon, G. D., & Prusoff, B. A. (1984). Depression and anxiety disorders in parents and children: Results from the Yale Family Study. Archives of General Psychiatry, 41 (9), 845-852.
