+

ADHD and Reading Fluency:

Predictive Validity of Rating Scales and Computer-Based Diagnostic Tools

S. Kathleen Krach, Ph.D., NCSPTroy 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

+

Review of Literature

+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 Symptoms Subtypes

+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) 2002 Timimi (and 33 others) 2004

+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)

+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

+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).

+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.

+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 Speed Reading Impulsivity

+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?

+

Methods

+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

+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.

+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)

+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

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Statistics

+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

+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

+Regressions

ANAM CAARSWJ-III:ACH

ReadingFluency

CAARSWJ-III:ACH

ReadingFluency

ANAMWJ-III:ACH

ReadingFluency

Models 1 - 4

Models 5 - 8

Models 9 - 12

+Model 2: Regression Results(12.45% of the Variance)

ANAMPRT (All)

WJ-III:RFGroup

None others were statistically significant!

+Sobel Regression Models

ANAMWJ-III:ACH

ReadingFluency

CAARS

+Sobel Regressions

Although 64 separate Sobel regressions were run, not one

provided the statistical significance needed

to indicate the predicted mediating relationship.

+

Discussion

+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?

+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.

+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)

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

No.

+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.

+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).