Understanding Reading / Writing Problems of Students with ADHD Workshop on Students who are gifted and /or have ADHD Rudolf Stockling MSc (Psych) MAPS Lexicon Reading Center 7/12/2010

Session Outline 1. Definition of ADHD 2. Types of ADHD 3. Executive Functions and Reading 4. ADHD and Reading 5. Children with ADHD and Dyslexia 6. Activity: Case Study

Definition of ADHD “ADHD consists of developmental deficiencies in the regulation and maintenance of behavior by rules and consequences. These deficiencies give rise to problems with inhibiting, initiating, or sustaining responses to tasks or stimuli and adhering to rules of instructions….” Barkley, R. (1990). Attention-deficit hyperactivity disorder: A Handbook for diagnosis and treatment. New York: Guilford, p.71.

ADHD, Predominantly Hyperactive-Impulsive ADHD, Predominantly Inattentive Type ADHD, Combined Type: DSM-IV, Text Revision. Washington, DC, American Psychiatric Association, Three types of ADHD

Nancy Cushen White, Ed.D.5 Attention and Executive Function M. Levine, MD MENTAL EFFORT  Ability to mobilize  Ability to appropriately allocate  Ability to maintain/sustain

Nancy Cushen White, Ed.D.6 Attention and Executive Function SELECTIVE FOCUS AND CONCENTRATION  Filtering out irrelevant stimuli  Focusing actively and deliberately on relevant stimuli  Resisting distractions  Shifting attention as required

Nancy Cushen White, Ed.D.7 Attention and Executive Function M. Levine, MD INTENTION/IMPULSIVITY/HYPERACTIVIT Y  Thinking about and analyzing demands of a task  Making decisions about appropriate strategies for accomplishing a task  Acting purposefully, at optimal pace, while monitoring efforts throughout a task

ADHD and Other Disorders Associated disorders: disorders that are a direct result of the ADHD –A result of the deficits in executive function –General Learning Problems Co-morbid disorders: disorders that exist in addition to the ADHD –Specific Learning Disability

ADHD & reading I’m a very slow reader. In high school & middle school I really hated to read because it took me a long time & I would have to read things over and over again. I would find myself at the end of the chapter & not remember anything I had just read…I realized would have to go back and read it all over again. It got to the point in middle school where I was sick of school already & I hated going.” Knowles (2006): Grant, a 21-yr-old college student

ADHD and Co-morbid Disorders Externalizing disorders (Type One) –Conduct disorder –Oppositional defiant disorder –Learning Difficulties (including reading) Internalizing disorders (Type Two) –Anxiety/depression –Speech/language disorders affecting phonology, syntax, semantics –Dyslexia (deficits in decoding)

Impact of ADHD on Reading  Phonological processing: OK maybe problem inattentive type  Rapid Automatised Naming: Slow Reading fluency: Slow Reading Comprehension: Weak –Factual – OK –Inferential - Weak –Comprehension Strategies - Weak Fluency Text Comprehension DEEP UNDERSTANDING

Literacy and ADHD: Comprehension Comprehension requires the student to –Attend to input –Organize information –Comprehend vocabulary –Identify main ideas & their connections (Caplan et al., 2007 for review) Students with ADHD –have significant weaknesses in comprehension across a range of tasks (Keenan et al. 2008) –show weaknesses with understanding inferences & error monitoring, but not with recalling factual information (McInnes et al., 2003)

Literacy and ADHD Written Expression Written Expression Requires: Transcription skills –Legible and fluent handwriting –Encoding Skills –Spelling Text generation –Thinking of ideas –Organization/coherence of text –Monitoring –Revising text Juggling these tasks concurrently requires WORKING MEMORY and self-regulation

ADHD: Written Expression Students with ADHD” –Write less –Make more spelling, punctuation, and grammatical errors –Written work is poorly organized –Handwriting is often illegible

ADHD Reading Disabilities 25% to 50% ADHD & co-existing Reading Diability

ADHD & DYSLEXIA DyslexiaADHD Phonological processing XOK Verbal STM XOK Working memoryX (auditory-verbal) X (visual-spatial) Rapid automatised naming X (letters, digits) X (colors, objects) Orthographic processing XX Listening comprehension OK (generally) X Reading comprehension Sometimes OK Reading poorer than listening X (inferential) Listening poorer than reading

INTERVENTION If Reading Problems are associated with ADHD –General ADHD Support and Accommodation –Medication likely to lessen literacy problems –Still need to teach specific skills Reading problems are due to Dyslexia comorbidity –Specific Multi-sensory Dyslexia Intervention