1. + ADHD and Reading Fluency: Predictive Validity of Rating Scales and Computer-Based Diagnostic Tools 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

2. + Review of Literature

3. + Attention Deficit Hyperactivity Disorder (ADHD): DSM-IV 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 Primary SymptomsSubtypes

4. + ADHD: The Great Debate The International Consensus on ADHD 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. Barkley (and 85 others) 2002Timimi (and 33 others) 2004

5. + 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)

6. + 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: client’s 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

7. + 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).

8. + 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.

9. + Reading Fluency: Subtypes 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 it’s 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. Accuracy and SpeedReading Impulsivity

10. + 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?

11. + Methods

12. + 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

13. + Conners Adult ADHD Rating Scales (CAARS) Fake Sample Items NeverSometimesOftenAlways 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)

14. + WJ-III: Achievement Reading Fluency Fake sample items (timed) Dogs moo at passing cars.YesNo Businessmen often wear suits.YesNo Giraffes have long necksYesNo Computers can have a keyboard and a mouse.YesNo 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)

15. + 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) Scores PRT1: Basic Block PRT:2 Intermittent Block Accuracy: # correct Efficiency: # correct per minute 4 2

16. + Statistics

17. + 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 <.05. ** = p <.01

18. + 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 <.05. ** = p <.01

19. + Regressions ANAMCAARS WJ-III:ACH Reading Fluency CAARS WJ-III:ACH Reading Fluency ANAM WJ-III:ACH Reading Fluency Models 1 - 4 Models 5 - 8 Models 9 - 12

20. + Model 2: Regression Results (12.45% of the Variance) ANAM PRT (All) WJ-III:RF Group None others were statistically significant!

21. + Sobel Regression Models ANAM WJ-III:ACH Reading Fluency CAARS

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

23. + Discussion

24. + 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?

25. + 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.

26. + 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)

27. + Do rating scales scores and CPT scores provide shared information useful in predicting reading scores? No.

28. + 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.

29. + 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).