A cognitive tool to diagnose predominantly inattentive ADHD behavior

Abstract

Poor performance on tests of reading comprehension could be the result of weak word-recognition skills, inconsistent attention (ADD), or a combination of the two. Identifying the source of the reading disability (RD) reliably has been difficult because inconsistent attention interferes with reading and weak word recognition skill makes attention wander.

The situation is further complicated by the fact that there are no objective diagnostic tests for ADD (Breggin, 1998; Diller, 1998). We proposed a new model of differential diagnosis of ADHD-I/RD and field-tested its utility in two studies. The new diagnostic procedure utilizes intra-individual differences seen in the performance of at-risk learners on tasks related to reading that vary in the degree of sustained attention required for successful performance. The hypothesis is that children whose attention is inconsistent would perform more poorly on tests such as listening comprehension, which require sustained attention, than on tests such as reading comprehension, which are more tolerant of inattention. Such differences will not be seen in the test scores of children who have only a reading disability because their performance on reading tests is determined more by the difficulty level of the tests than by the sensitivity of the tests to attention.

The validity of this new model was evaluated by determining the relationship between differences seen in the scores of tests that differ in their attention requirement and the degree of inconsistency in sustained attention as measured by Conners’ CPT. The results of the two studies indicate this to be a viable approach. The results of the second study are presented in this report.

Get full access to this article

View all access options for this article.

References

Aaron, P. G. , & Joshi, R. M. (1992). Reading problems: Consultation and remediation. New York: Guilford Press.

Aaron, P. G. , Joshi, R. M. , & Williams, K. (1999). Not all reading disabilities are alike. Journal of Learning Disabilities, 32, 120-137.

Aaron, P. G. , Joshi, R. M. , Palmer, H. , Smith, N. , & Kirby, E. (2002). Separating genuine cases of reading disability from reading deficits caused by predominantly inattentive ADHD behavior. Journal of Learning Disabilities, 35, 425-435.

Accardo, P. J. (2001). ADHD: The neurodevelopmentalist’s perspective. In B. T. Rogers , T. R. Montgomery , T. M. Lock ., & P. J. Accardo (Eds.), Attention deficit hyperactivity disorder (pp. 33-50). Baltimore, MD: York Press.

American Psychiatric Association . (1994). Diagnostic and statistical manual for mental disorders (4th ed.). Washington, DC: Author.

Barkley, R. A. (1996). Linkages between attention and executive functions. In G. R. Lyon & N. A. Krasnegor (Eds.), Attention, memory, and executive function (pp. 307-325). Baltimore, MD: Paul H. Brookes.

Barkley, R. A. (1997). ADHD and the nature of self-control. New York: Guilford Press.

Biederman, J. , Newcorn, J. , & Sprich, S. (1991). Comorbidity of attention deficit hyperactivity disorder with conduct, depressive, anxiety, and other disorders. American Journal of Psychiatry, 148, 564-577.

Bonafina, M. A. , Newcorn, J. H. , McKay, K. E. , V. H. , & Halperin, J. M. (2000) ADHD and reading disabilities: A clinical study. Journal of Learning Disabilities, 33, 297-315.

10.

Breggin, R. P. (1998). Talking back to Ritalin. Monroe, ME: Common Courage Press.

11.

Conners, C. K. (2000). Conners’ Continuous Performance Test II. North Tonawanda, NY: Multi-Health Systems.

12.

Diller, L. H. (1998). Running on Ritalin. New York: Bantom Books.

13.

Gates, A. I. , & MacGinitie, W. H. (1989). Gates-MacGinitie reading tests. Boston, MA: Riverside.

14.

Gilger, J. W. , Pennington, B. F. , & DeFries, J. C. (1992). A twin study of the etiology of comorbidity: Attention-deficit hyperactivity disorder and dyslexia. Journal of American Academy of Child and Adolescent Psychiatry, 31, 343-348.

15.

Gough, P. B. , & Tunmer, W. E. (1986). Decoding, reading, and reading disability. Remedial and Special Education, 7, 6-10.

16.

Hall, S. J. , Halperin, J. M. , Schwartz, S. T. , & Newcorn, J. H. (1997). Behavioral and executive functions in children with attention-deficit hyperactivity disorder and reading disability. Journal of Attention Disorders, 1, 235-247.

17.

Halperin, J. M. , Gittelman, R. , Klein, D. F. , & Rudel, R. G. (1984). Reading-disabled hyperactive children: A distinct subgroup of attention deficit disorder with hyperactivity? Journal of Abnormal Child Psychology, 12, 1-14.

18.

Javorsky, J. (1996). An examination of youth with attention deficit/hyperactivity disorder and language learning disabilities: A clinical study. Journal of Learning Disabilities, 29, 247-258.

19.

Karlsen, B. , & Gardner, E. (1995). Stanford Diagnostic Reading Test (4th Ed.) San Antonio, TX: Harcourt.

20.

Mercugliano, M. (1999). What is attention deficit/hyperactivity disorder? In M. Mercugliano , T. J. Power , & N. J. Blum (Eds.), The clinician’s practical guide to attention-deficit/hyperactivity disorder (pp. 1-15). Baltimore, MD: Paul H. Brookes.

21.

Pennington, B. F. , Grossier, D. , & Welsh, M. C. (1993). Contrasting cognitive deficits in attention deficit hyperactivity disorder versus reading disability. Developmental Psychology, 29, 511-523.

22.

Pisecco, S. , Baker, D. B. , Silva, P. A. , & Brooke, M. (2001). Boys with reading disabilities and/or ADHD: Distinctions in early childhood. Journal of Learning Disabilities, 34, 98-106.

23.

Pliszka, S. R. , Carlson, C. L. , & Swanson, J. M. (1999). ADHD with comorbid disorders: Clinical assessment and management. New York: Guilford Press.

24.

Purvis, K. L. , & Tannock, R. (2000). Phonological processing, not inhibitory control, differentiates ADHD and Reading Disability. Journal of American Academy of Child and Adolescent Psychiatry, 39, 485-493.

25.

Reason, R. (1999). ADHD: A psychological response to an evolving concept (Report of a Working Party of the British Psychological Society). Journal of Learning Disabilities, 32, 85-91.

26.

Schulte, A. C. , Conners, C. K. , & Osborne, S. S. (1999). Linkages between attention deficit disorders and reading disability. In D. D. Drake (Ed.), Reading and attention disorders: Neurobiological correlates, (pp. 167-184). Baltimore, MD: York Press.

27.

Semrud-Clikeman, M. , Biederman, J. , Sprich-Buckminster, S. , Lehman, K. , Faraone, S. , & Norman, D. (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, 439-448.

28.

Shapiro, B. K. (2001). The use and abuse of behavior checklists. In B.T. Rogers , T. R. Montgomery , T. M. Lock ., & P. J. Accardo (Eds.), Attention deficit hyperactivity disorder. (pp. 73-86). Baltimore, MD: York Press.

29.

Tannock, R. , & Schachar, R. (1996). Executive dysfunction as an underlying mechanism of behavior and language problems in attention deficit hyperactivity disorder. In J. H. Beitchman , N. J. Cohen , M. M. Konstantareas , & R. Tannock (Eds.), Language, learning, and behavior disorders: Developmental, biological, and clinical perspectives (pp. 128-155). New York: Cambridge University Press.

30.

Voeller, K. S. (1999). Neurological factors underlying the comorbidity of attentional dysfunction and dyslexia. In D. D. Drake (Ed.), Reading and attention disorders: Neurobiological correlates. (pp.185-211) Baltimore, MD: York Press.

31.

Willcutt, E. G. , & Pennington, B. F. (2000). Comorbidity of reading disability and attention-deficit/hyperactivity disorder: Differences by gender and subtype. Journal of Learning Disabilities, 33, 179-191.

32.

Wood, F. B. , & Felton, R. H. (1994). Separate linguistic and attentional factors in the development of reading. Topics in Language Disorders, 14, 42-57.

33.

Woodcock, R.W. (1991). Woodcock Language Proficiency Battery (Rev.). Itasca, IL: Riverside.