ADHD%20and%20Reading%20Fluency:

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ADHD and Reading Fluency
S. Kathleen Krach, Ph.D., NCSP Troy
University   Michael P. McCreery,
Ph.D. University of Arkansas at Little Rock   W.
Paul Jones, Ed.D. Scott A. Loe, Ph.D. Paul
Stohlberg, M.S. Kristen Bjork, M.S. Leslie
Hughes, M.S. University of Nevada, Las Vegas

• Predictive Validity of Rating Scales and
  Computer-Based Diagnostic Tools

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Review of Literature
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Attention Deficit Hyperactivity Disorder (ADHD)
DSM-IV

• Primary Symptoms

• Subtypes

• Inattention poor sustained attention,
  disorganization, forgetfulness, and difficulty
  listening and following directions.
• Hyperactivity squirming, fidgeting, getting out
  of seat, inappropriately loud volume.
• Impulsivity difficulty taking turns,
  interrupting others, and not waiting to provide
  an answer to a question (blurts out).

• ADHD Predominantly Inattentive
• ADHD Predominantly Hyperactive-Impulsive
• ADHD Combined

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ADHD The Great Debate The International
Consensus on ADHD

• Barkley (and 85 others) 2002

• Timimi (and 33 others) 2004

• ADHD exists.
• Studies linking to neurological impairments are
  conclusive.
• Studies linking to genetics are conclusive.

• Symptoms of ADHD may actually be some other
  condition or a systems issue
• Studies linking to neurological impairments are
  inconclusive.
• Studies linking to genetics are inconclusive.

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Assessment Tools Rating Scales

• The primary method used in diagnosing ADHD is the
  use of rating scales.
• Rating scale publishers indicate strong
  psychometrics
• Rating scales have issues with
• Inconsistency across cultural groups
• Inconsistency across gender
• Halo effects
• (Domínguez de Ramírez Shapiro, 2005 Hartung,
  et al., 2006 Jackson King, 2004 Mann, et al,
  1992 Pellegrini, 2011 Sciutto and Eisneberg,
  2007)

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Assessment Tools (CPT)Continuous Performance
Test

• O

• CPTs often described as measures of attention and
  impulsivity
• Factors other than those intended may affect CPT
  scores.
• Internal clients personality, drugs, and
  motivation.
• External white noise, presence of an examiner,
  and time of day.
• Excellent job of identifying those with ADHD
  however, tends to over diagnose those without
  ADHD.
• (Corkum Siegel,1993 Schatz, 2001)

• Y

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Symptoms of ADHD are linked to

• Lower levels of academic performance (Marshall,
  Hynd, Handwerk, Hall, 1997)
• Often experience a comorbid diagnosis of learning
  disability (Mayes, Calhoun, Crowell, 2000).

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LaBerge Samuels Automaticity Theory

• Theory proposes a direct link between reading
  fluency and attention.
• As readers became more adept, they focus less
  attention on the specific subcomponents needed to
  process written language.
• With increased ability comes a speed and ability
  to shift focus from basic word reading to reading
  comprehension.

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Reading Fluency Subtypes

• Accuracy and Speed

• Reading Impulsivity

• Accuracy How well can you read (words correct).
• Reading Speed How quickly can you read?
• Accuracy by speed How many words can you read
  (and understand) within a set period of time.
• Assessed by scoring correct items read in a timed
  situation.

• A reader does not take the time to process the
  entire word or sentence before determining its
  meaning.
• Impulsive readers will read the first phoneme and
  examine the length of the word.
• Example Cat becomes Car but not carpenter.
• Assessed by examining errors made in reading.

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Research Questions

• Are ADHD rating scale scores an accurate
  predictor of reading fluency and/or reading
  impulsivity scores?
• Are CPT scores an accurate predictor of reading
  fluency and/or reading impulsivity scores?
• Do rating scales scores and CPT scores provide
  shared information useful in predicting reading
  fluency and/or reading impulsivity scores?

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Methods
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Participants

• 91 undergraduate student volunteers
• General population from College of Education
• Sex
• 17 Male
• 74 Female
• Ages 18 45 (mean 23 years, SD 5 years)

• Race / Ethnicity
• 4.4 Asian
• 9.9 African American
• 2.2 Native Hawaiian or
• Pacific Islander
• 67 White Non Hispanic
• 5.5 Hispanic
• 11.0 Other

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Conners Adult ADHD Rating Scales (CAARS)
Fake Sample Items Never Sometimes Often Always
Other people say that I am loud.
I enjoy activities that require focus.
I have trouble staying organized.
I interrupt when others are talking.

• Scores Obtained
• Inattention/ Memory Problems
• Impulsivity/ Emotional Lability
• Hyperactivity/ Restlessness
• Problems with Self-Concept
• ADHD Index (Composite)

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WJ-III Achievement Reading Fluency
Fake sample items (timed)
Dogs moo at passing cars. Yes No
Businessmen often wear suits. Yes No
Giraffes have long necks Yes No
Computers can have a keyboard and a mouse. Yes No

• Forms A and B (for this study)
• A group
• B individual
• Scores
• Individual standard scores ( correct -
  incorrect raw score)
• Group standard scores ( correct - incorrect
  raw score)
• Difference scores (individual group)
• Error scores ( of incorrect from A of
  incorrect from B)

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Automated Neuropsychological Assessment Matrices
(ANAM) Procedural Reaction Time

• Example of Items
• 2 3 are LOW numbers
• (click left mouse for LOW)
• 4 5 are HIGH numbers
• (click right mouse for HIGH)

• 4

• Scores
• PRT1 Basic Block
• PRT2 Intermittent Block
• Accuracy correct
• Efficiency correct per minute

• 2

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Statistics
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Descriptive Statistics
Note. ANAM Automated Neuropsychological
Assessment Matrices. PRT1 Procedural Reaction
Time Basic Block. PRT2 Procedural Reaction Time
- Time Uncertainty Block. Accuracy (ACC)
Percentage Correct. Efficiency (EFF) Correct
Responses Per Minute. CAARS Conners Adult ADHD
Rating Scales. Inatt Inattention. Impul
Impulsivity. Hyper Hyperactivity. Comp
Composite. WJ-III ACH RF Woodcock Johnson
Tests of Achievement, Third Edition Reading
Fluency. Indiv Individual. Diff Difference.
p lt .05. p lt .01
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Correlation Statistics
Note. ANAM Automated Neuropsychological
Assessment Matrices. PRT1 Procedural Reaction
Time Basic Block. PRT2 Procedural Reaction Time
- Time Uncertainty Block. Accuracy (ACC)
Percentage Correct. Efficiency (EFF) Correct
Responses Per Minute. CAARS Conners Adult ADHD
Rating Scales. Inatt Inattention. Impul
Impulsivity. Hyper Hyperactivity. Comp
Composite. WJ-III ACH RF Woodcock Johnson
Tests of Achievement, Third Edition Reading
Fluency. Indiv Individual. Diff Difference.
p lt .05. p lt .01
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Regressions
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Model 2 Regression Results(12.45 of the
Variance)
None others were statistically significant!
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Sobel Regression Models
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Sobel Regressions

• Although 64 separate Sobel regressions were run,
  not one
• provided the statistical significance needed
• to indicate the predicted mediating relationship.

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Discussion
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Research Questions

• Are ADHD rating scale scores an accurate
  predictor of reading fluency and/or reading
  impulsivity scores?
• Are CPT scores an accurate predictor of reading
  fluency and/or reading impulsivity scores?
• Do rating scales scores and CPT scores provide
  shared information useful in predicting reading
  fluency and/or reading impulsivity scores?

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Are ADHD rating scale scores an accurate
predictor of reading fluency and/or reading
impulsivity scores?

• Rational for Question
• Individuals with ADHD exhibit more academic
  problems (Marshall, Hynd, Handwerk, Hall,
  1997).
• Individuals with ADHD often experience a comorbid
  diagnosis of learning disability (Mayes, Calhoun,
  Crowell, 2000).
• Finding
• There is NO significant relationship between any
  of the ADHD rating scale scores and any of the
  reading fluency scores.

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Are CPT scores an accurate predictor of reading
fluency and/or reading impulsivity scores?

• CPT scores sometimes do predict scores on reading
  fluency.
• Neither the inattention scores (as defined by
  group / individual difference scores) nor the
  reading impulsivity scores (as defined by the
  error scores) were predicted by any of the CPT
  scores
• It appears that the CPT used in this study may be
  a measure of something else other than ADHD
  symptoms.
• General neurological functioning (Alloway, et
  al., 2009 Preston, Fennell, Bussing, 2005)
• Intellectual skills (Jones, et. al, 2007)
• Processing speed (Stolberg, Jones, Krach, Loe,
  2009)

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Do rating scales scores and CPT scores provide
shared information useful in predicting reading
scores?

• No.

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Rating Scale vs. CPT

• At this time, rating scales are the clear
  frontrunner ADHD diagnostic tool (Macmann,
  Barnet, Lopez, 1993 Sattler Hoge, 2006
  Sciutto Eisenberg, 2007).
• Rating scales have significant issues that should
  give any good diagnostic specialist pause before
  using them as a sole method of data collection
  for ADHD (Hartung, et al., 2006 Jackson King,
  2004 Pellegrini, 2011 Rosenbaum Valsiner,
  2011).
• Clearly we need a direct method to add to our
  toolkit.

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Researcher vs. Practitioner

• In the argument for whether the absence or
  presence of neurological symptoms is a basis for
  explaining symptoms associated with ADHD
  (Barkely, et al., 2002 Timimi, et al., 2004),
  CPTs should be included as a data collection
  tool.
• As a diagnostic tool, it may more useful to
  assess neurological concerns linked to ADHD and
  less useful in evaluating inattention,
  impulsivity, an hyperactivity directly (Corkum
  Siegel, 1993).