Learning Disabilities Research & Practice, 16(3), 152–160

Copyright 
C 2001, The Division for Learning Disabilities of the Council for Exceptional Children

The Double-Deficit Theory of Reading Disability Does Not Fit All

Peggy T. Ackerman, Carol A. Holloway, and Patricia L. Youngdahl
University of Arkansas for Medical Sciences
Roscoe A. Dykman
Arkansas Children’s Hospital

The double-deficit theory of reading disability (Wolf & Bowers, 1999) was examined in a
sample of 56 reading-disabled and 45 normal-reading elementary school children (aged 8 to
11). As hypothesized, the two groups differed markedly on all phonological analysis tasks
and on rapid continuous naming of digits and letters (the double deficits), but they differed
as well on orthographic tasks, attention ratings, arithmetic achievement, and all WISC-III
factors except perceptual organization. Within the reading-disabled (RD) sample, children in
the double-deficit subgroup were no more impaired in reading and spelling than those with a
single deficit in phonological analysis, and those with a single deficit in rapid naming were
no more impaired than those with neither deficit. Multiple regression analyses suggest that a
multiple causality theory of RD is more plausible than a double-deficit theory.

Numerous reports in the past decade document phonologi-
cal impairments in children who experience difficulty learn-
ing to read and spell (see reviews by Goswami & Bryant,
1990; Pennington, 1991; Wagner & Torgesen, 1987). Many
researchers consider phonological impairment to be the
major deficit, and a few theorize it may be the only proximal
cause of reading failure (Gough & Walsh, 1991; Stanovich,
1992; Tunmer & Hoover, 1992). Gough and Walsh (1991)
state that children have to learn the cipher (i.e., that sounds
map onto letters) in order to become proficient readers. They
concede that children do learn to read perhaps hundreds of
sight words well before they master the cipher, but argue that
it is hard to acquire an adequate reading vocabulary without
the cipher. They further posit that word-specific knowledge
(needed to pronounce nonphonetic exception words) can be
acquired only with the aid of the cipher.
Perhaps the most stringent measure of “the cipher” is abil-
ity to pronounce nonsense words (Goswami, 1993). Indeed, in
a large sample of elementary school children with reading or
attention disorders, we (Ackerman & Dykman, 1993) found a
correlation of 0.85 (p < 0.001) between number of real words
and number of nonsense words successfully read. Both real
and nonsense word-reading levels were best predicted by the
same set of underlying variables: age and verbal IQ (forced
first), plus sensitivity to rhyme and alliteration as measured
by Bradley’s (1984) auditory oddity task, continuous naming
speed (Denckla & Rudel, 1976; Wolf, 1991), and an auditory
echoic memory measure (Cohen & Netley, 1981). Thus, our
data support the Gough and Walsh position in that children
who can read short nonsense words can read real words profi-
ciently; that is, they “have the cipher,” to use their term. But,
our data further suggest that in order to master the cipher, the
Requests for reprints should be sent to Peggy T. Ackerman, C.A.R.E.
Unit, Department of Pediatrics, Arkansas Children’s Hospital, 800 Marshall
Street, Little Rock, AR 72202.
child must have auditory phonological sensitivity as well as
other skills. One of these skills is rapid naming.
Our interest in studying continuous naming speed deficits
in reading-disabled children stemmed from the pioneering
work of Denckla and Rudel (1976) and from the impressive
body of research by Wolf, Bowers, and colleagues (Bowers,
Sunseth, & Golden, 1999; Bowers & Wolf, 1993; Wolf, 1991;
Wolf & Bowers, 1999; Wolf, 1999; Wolf & Obregon, 1992;
1995) and by Spring and his associates (Spring & Capps,
1974; Spring & Davis, 1988; Spring & Perry, 1983). Bowers
and Wolf (1993) were the first to propose the double-deficit
theory of reading disability. They report that children with
both phonological and rapid naming deficits are the poorest
readers, but those with either deficit are less proficient than
children who are fast continuous namers and phonologically
competent.
Although some investigators (e.g., Wagner & Torgesen,
1987) have viewed continuous naming speed as a measure
of phonological competence, we have found only a modest
correlation between naming speed and phonological sensitiv-
ity to rhyme and alliteration (Ackerman & Dykman, 1993).
Baddeley (1986) had proposed that a slow articulation rate
could be the overarching determinant of both slow nam-
ing and impaired phonological sensitivity, but our findings
(Ackerman & Dykman, 1993) did not support this theory.
Rather, our data support Bowers and Wolf (1993) in show-
ing that both naming speed and phonological skill account for
unique variance in word-list reading level. However, our find-
ings suggest there may be more than two contributory factors.
This is also the position of Badian (1997), whose studies
implicate visual matching of alphanumeric stimuli (i.e.,
orthographic processing). Further, the studies of Meyer,
Wood, Hart, and Felton (1998) suggest that poor rapid
naming alone is not sufficient to cause chronic poor reading.
Yet if investigators choose to study rapid naming or coding
or any of several other measures of processing speed, they

will almost without exception find a significant difference
between groups of normal and disabled readers (Ackerman
& Dykman, 1996; Dykman & Ackerman, 1991; Fawcett &
Nicholson, 1994; Tallal, Miller, & Fitch, 1993; Wolff, Ovrut,
& Drake, 1990).
The present study was undertaken to look at the relative
contributions of phonological analysis and rapid naming
to literacy acquisition in normally intelligent elementary
school children. It was assumed, however, that these two
abilities would not be sufficient to explain all instances of
reading failure, and, given our past research history, we
particularly wished to evaluate the effects of attentional
problems, arithmetic acquisition, and cognitive abilities.
The cognitive abilities of greatest interest to us are those
tapped by the once clinically popular ACID pattern subtests
of the Wechsler Intelligence Scale for Children (Arithmetic,
Coding, Information, Digit Span). These subtests challenge
short-term, long-term, and working memory, as well as
speed of mental processing, and are frequently depressed in
learning-disabled children (Ackerman, Dykman, & Peters,
1977; Dykman & Ackerman, 1991; Swartz, 1974).
We hypothesized that our samples of normal and disabled
readers would be robustly separated on measures of phono-
logical analysis, naming speed, attention, verbal skills, short-
term and working memory, and arithmetic achievement. We
also hypothesized that children with multiple deficits would
be the most retarded readers. As a corollary we assumed
that children will vary in degree of impairment on under-
lying abilities and that multiple regression analyses would
therefore explain literacy skill differences better than catego-
rization.
Finally, we wished to see whether there are orthographic
skills that are separable from phonological skills and thus
might identify children who are poor readers and spellers
despite phonological analysis strengths.
METHOD
Participants
Two groups of elementary school children (aged 8 to 11)
served as participants. The reading-disabled (RD) group
(N = 56) included 23 Caucasian boys, 13 African-American
boys, 17 Caucasian girls, and 3 African-American girls. The
normal-reading (NR) comparison group (N = 45) included
25 Caucasian boys, 2 African-American boys, 13 Caucasian
girls, and 5 African-American girls.
The reading-disabled children were referred to the project
from several sources: The Child Psychiatry and the Dennis
Developmental Clinics at Arkansas Children’s Hospital
(ACH), local child psychologists, and local schools. Letters
describing the project were mailed to all these sources and
referrals were invited. The control children were recruited
via advertisements placed on bulletin boards at ACH.
All children considered for selection had to be in good
health with no limiting physical disabilities, and they had
to have had normal schooling opportunities. Additionally,
all had to speak English as a first language. Parents signed a
LEARNING DISABILITIES RESEARCH 153
consent form approved by our Internal Review Board and the
children freely gave their assent. Parents were compensated
$50 and children $10. Meal tickets were provided for lunch
at the ACH cafeteria.
Prior to acceptance into the project, all children were
given the Wechsler Intelligence Scale for Children-III
(WISC-III) and the basic reading, spelling, and numerical
operations subtests of the Wechsler Individual Achievement
Test (WIAT). Those accepted into either group achieved
either a Full Scale or Verbal IQ of 85 or higher. The children
designated as normal readers (NR) had standard scores of
90 and higher on the WIAT reading and spelling subtests.
Those designated as RD had standard scores of 86 or lower
on one or both subtests. The Wide Range Achievement Test
Revision-3 (WRAT-3) was given to obtain confirmatory data.
Behavioral Data
Subjects were not excluded for a known or suspected diag-
nosis of Attention Deficit Hyperactivity Disorder (ADHD).
However, any child taking stimulant medication was required
to omit the medication on the day of testing. The accompany-
ing parent was asked to complete the Child Behavior Check-
list (Achenbach, 1991) and an ADHD questionnaire adapted
from DSM-IV. The questionnaire listed 18 symptoms, with
severity of each to be rated on a 4-point scale (0 = not a
problem, 1 = just a little, 2 = pretty much, 3 = very much).
The first 9 items assessed problems with attention, the next 5
assessed overactivity, and the last 4 impulsivity.
Phonological Awareness Battery
1. An abbreviated (13 item) form of the Test of Audi-
tory Analysis Skills (TAAS) (Rosner & Simon, 1971),
recently used by other investigators (Badian, 1996;
1997; Fawcett & Nicolson, 1995). Each word is pro-
nounced by the examiner who then instructs the child
to repeat the word, then to repeat it again but to omit
a specified sound. On the first of two demonstration
trials, the examiner says “cowboy” and then asks the
child to repeat the word and then repeat the word with-
out “boy.” Then follows “steamboat.” Test words are
arranged in order of difficulty, and testing is discon-
tinued after 4 consecutive errors. The examiner pro-
nounces the specific sound to be omitted and not the
letter name(s). For example, item 4 is “coat” with the
“kuh” sound omitted. Badian (1997) reported a test–
retest reliability coefficient of 0.84 for this task.
2. Bradley’s (1984) Auditory Sound Categorization Test.
The Bradley Test consists of 24 series of 4 words
each, wherein 1 word does not sound like the other
3. Sixteen of the trials involve rhyme judgment and 8
require detection of alliteration. Normal readers have
near perfect scores on this task by age 8 or 9 (Bradley,
1984).
3. Pig-Latin Test (Olson, Wise, Conners, & Rack, 1989).
The subject is asked to segment the initial phoneme
154 ACKERMAN ET AL.: DOUBLE-DEFICIT THEORY
from spoken words, place the phoneme at the end
of the word, add the sound “ay,” and pronounce the
result. Thus, pig becomes ig-pay; dog becomes og-
day; bird becomes ird-bay; etc. Following 5 training
trials, wherein the examiner demonstrated what was
to be done to each word, 20 such 1-syllable words
were presented. The examiner provided the correct
answer if the child erred. Testing was discontinued if
the child erred 5 times in a row.
4. Rhyme Fluency Test. Fluency was assessed with a
rhyme-generation task (Olson et al., 1989). Four stim-
ulus words (eel, ate, cat, kite) were used and the chil-
dren were asked to name as many words as they could
that rhymed with each (1 minute per trial). The exam-
iner illustrated by giving rhymes to and.
Phonological Decoding
The 1- and 2-syllable pseudoword lists of the Decoding Skills
Test (Richardson & DiBenedetto, 1985) were given to each
child. The child sees a series of cards with 5 pseudowords on
each card and is asked to pronounce each item. There are 30
1-syllable and 30 2-syllable items. Testing is discontinued on
each list when the child makes 5 consecutive errors.
Orthographic Skills
Four tests assessed the children’s recognition of written or-
thographic patterns.
Part 1 of a written test of rhyme recognition utilized or-
thographically similar (regular) word-word or word-nonword
pairs (for example cat, hat; fat, zat), 20 of each type. Foils
were orthographically similar but nonrhyming words (e.g.,
cat, car) and nonwords (fat, fav), 20 of each type. The
completely randomized list was presented to the child and he
or she was asked to highlight the pairs that rhymed. In Part
II of the rhyme-recognition test, the word-word pairs were
orthographically dissimilar; 20 rhymed (e.g., blue, new) and
20 did not (e.g., rows, hole). The children were given as
much time as they needed to complete these tests.
Another task assessed spelling recognition. Ten graded
lists of 10 stimulus trials were used. The lists sampled from
preprimer, primer, and 1st- to 7th-grade master lists. The
child was asked to highlight the real word in each trial. One
foil was a phonologically legitimate spelling of the real word
(a pseudohomonym) and the other foil was not. For example,
a trial from the 1st-grade list was room, rume, ruom; a trial
from the 4th-grade list was blays, blaze, blais. Testing was
discontinued at the level where the child got fewer than 5
correct answers.
A second spelling test assessed the child’s ability to spell
irregular words relative to regular words at his or her spelling
level ability. The word lists of the Boder-Jarrico Test (1982)
were used here. If a child’s spelling grade level on the
WIAT was grade 2, for example, we asked the child to
write the spellings of 10 words from the grade 2 reading
list; 5 were phonetically regular words and 5 were irregular
words.
Rapid Automatized Naming (RAN)
Three types of stimuli were presented to the children for
rapid naming: digits only, letters only, and alternating digits
and letters. The children saw 50 stimuli (5 columns and 10
rows) on each 5- by 7-inch card. They were asked to read
the stimuli aloud (row after row) as rapidly as possible.
The children were given the numbers card first, the letters
second, and the alternating list last. The examiner used a
stopwatch to time each trial.
RESULTS
The reading-disabled (RD) and normal-reading (NR) groups
were well matched for age. As is usually the case in referred
RD samples, male children outnumbered females almost 2
to 1. The ratio of Caucasian to African-American children
within the RD group was 2.5 to 1, which is reflective of the
regional population ratio for school-age children. The gender
and race composition of the NR group is similar to that of
the RD group except that African-American boys comprise
a higher percentage of the RD than NR group (23% versus
4%).
Preliminary analyses (ANOVAs) of selection variables
evaluated possible gender and race differences and inter-
actions within the group. No significant interactions were
found. African-American (AA) children scored significantly
lower on WISC-III Verbal, Performance, and Full Scale IQs
(F1, 93 = 16.46, 6.98, and 16.76, respectively, p < 0.01 for
each). Mean differences for the three IQs were 12.6, 8.3,
and 11.4 points. Boys had significantly higher Performance
IQs than girls (F1, 93 = 4.12, p = 0.045): 102.2 (12.0) versus
98.7 (12.7). Reading and spelling standard scores from the
WIAT and WRAT-3 were somewhat lower for AA children
but differences were not significant. There were no gender
differences on the reading and spelling tests.
IQ and achievement test group differences (with gender
and race ignored) are given in Table 1. Since the groups were
selected to differ in reading and spelling, the large mean dif-
ferences are as expected. Given a substantial correlation in the
WIAT and WRAT-3 standardization samples between arith-
metic and reading/spelling scores, it is predictable that the
NR and RD groups would also differ in arithmetic scores.
Three of the four WISC-III factor scores and the ACID pat-
tern (Arithmetic, Coding, Information, Digit Span; Swartz,
1974) separated the groups.
Table 2 presents behavioral rating scores for the two
groups. Given the high level of comorbidity of ADHD and
learning disabilities (Dykman & Ackerman, 1991), it was to
be expected that the RD group would have more adverse rat-
ings on both the Child Behavior Checklist and the ADHD
rating scale. In mixed model ANOVAs of these behavioral
ratings, race and gender did not emerge as significant fac-
tors.
As predicted, all the oral tests in the phonological skills
battery significantly separated the two groups (see Table 3).
Also, as expected, the Decoding Skills Test, requiring cor-
rect phonological pronunciation of pseudowords, provided
the most robust group differences.
 LEARNING DISABILITIES RESEARCH 155
TABLE 1 TABLE 3
Demographic and Selection Measures: Group Means and Standard Phonological Skills: Group Means and Standard Deviations
Deviations (SD)
Reading Disabled Normal Reading
Reading Disabled Normal Reading
Mean SD Mean SD t(99df)
(N = 56 ) (N = 45 )
Test of Auditory 3.93 1.92 1.96 1.73 5.37∗∗∗
Measure Mean SD Mean SD t(99df)
Analysis (errors)
u Bradley Sound 5.50 4.22 1.69 1.98 5.99∗∗∗
Age (months) 116.6 8.3 115.8 8.1 0.48
WISC-III Categorization
Verbal IQ 94.3 10.3 106.9 12.3 5.58∗∗∗ (errors)
u Pig Latin (correct) 10.86 7.51 16.73 5.69 4.47∗∗∗
Performance IQ 97.6 11.0 105.0 12.8 3.15∗∗
Full Scale IQ 95.4 9.3 106.3 11.9 5.18∗∗∗ Rhyme Generation 15.88 7.32 22.60 8.74 4.21∗∗∗
(correct)
Verbal 95.3 10.7 106.8 12.5 4.97∗∗∗
Decoding Skills I 8.33 5.83 21.89 5.67 11.76∗∗∗
Comprehension
Perceptual 99.4 11.9 103.9 14.2 1.73 (correct)
Organization
u Decoding Skills II 3.66 3.77 16.53 7.26 10.78∗∗∗
(correct)
u Freedom from 90.4 9.9 103.5 12.4 5.75∗∗∗
Distractibility Note. u = unequal variances, ∗∗∗ p < 0.001.
Perceptual Speed 98.6 12.0 108.2 11.8 3.98∗∗∗
ACID pattern 33.1 6.2 43.5 6.8 8.06∗∗∗
WIAT
TABLE 4
u Reading ss 79.7 7.0 103.6 12.4 11.51∗∗∗
Orthographic Skills: Group Means and Standard Deviations (SD)
u Spelling ss 79.5 7.3 101.8 14.1 10.20∗∗∗
Arithmetic ss 92.4 10.4 102.2 11.2 4.56∗∗∗
WRAT Reading Disabled Normal Reading
u Reading ss 76.9 9.6 101.3 12.8 10.63∗∗∗ Mean SD Mean SD t(99df)
u Spelling ss 78.7 7.2 100.3 14.5 9.13∗∗∗
Arithmetic ss 90.2 11.8 102.5 10.2 5.53∗∗∗
u Rhymes O+ (errors) 7.30 9.44 4.27 5.86 1.98∗
Rhymes O− (errors) 12.29 4.00 4.47 3.91 9.86∗∗∗
Note. SS = standard u = unequal ∗ p < 0.05,
scores, variances, u Spelling Detection 44.20 22.71 78.53 14.86 9.14∗∗∗
∗∗ p < 0.01, ∗∗∗ p < 0.001.
(correct)
Spelling, Regular 3.14 1.15 3.80 1.08 2.93∗∗
(correct)
The tests of orthographic skills likewise significantly sep- Spelling, Irregular 1.41 1.44 2.67 1.22 4.63∗∗∗
arated the groups (see Table 4), as did the Rapid Automatized (correct)
Naming tasks (Table 5). Note. O+ = orthographically similar, O− = orthographically dissimi-
lar, u = unequal variances, ∗ p < 0.05, ∗∗ p < 0.01, ∗∗∗ p < 0.001.

RD Subgroup Analyses
formance on the RAN tests to define a naming speed deficit.
A primary reason for this study was to compare the Error scores of 4 or higher on the TAAS, 5 or higher on the
reading spelling performance of RD children with single- Bradley, and 8 or more on the 20 Pig Latin items are con-
versus double-deficit profiles. To that end, we created four sidered suspect for children in the age range here studied,
subgroups using performance on the oral TAAS, Bradley, judging from prior studies comparing normal and disabled
and Pig Latin tests to define a phonological deficit and per- readers (Badian, 1997; Bradley, 1984; Olson et al., 1989).
Thus, we elected to classify a subject as phonologically im-
paired if his or her error scores on two of the three tests
TABLE 2 reached these cut-scores. Rhyme fluency was not used in this
Behavioral Data: Group Means and Standard Deviations classification algorithm since it does not as directly assess the
ability to break words into component sounds.
Reading Disabled Normal Reading
Child Behavior
Checklist Mean SD Mean SD t
TABLE 5
Total ss 59.8 11.5 50.8 11.0 4.03∗∗∗ Rapid Automatized Naming
Internalizing ss 57.7 12.1 52.9 11.6 2.01∗
u Externalizing ss 56.3 13.1 48.6 10.3 3.31∗∗∗ Reading Disabled Normal Reading
ADHD Mean SD Mean SD t(99df)
Attention sum 15.8 6.3 8.5 7.4 5.25∗∗∗
Hyperactivity & u Digits(sec) 35.6 10.4 24.8 5.9 6.57∗∗∗
Impulsivity sum 11.7 8.2 6.0 5.8 4.11∗∗∗ Letters (sec) 40.5 10.5 29.5 7.5 5.98∗∗∗
u Alternating (sec) 50.4 15.8 35.7 9.3 5.85∗∗∗
Note. ss = standard scores, u = unequal variances, ADHD = Attention
Deficit Hyperactivity Disorder, ∗ p < 0.05, ∗∗ p < 0.01, ∗∗∗ p < 0.001. Note. u = unequal variances, sec = seconds, ∗∗∗ p < 0.001.
156 ACKERMAN ET AL.: DOUBLE-DEFICIT THEORY

TABLE 6
Phonological and Rapid Naming Values for RD Subgroups

Neither Slow Phono Both

N = 18 N = 13 N =9 N = 16 F3,52 p Pairwise

TAAS errors 2.7 2.8 5.7 5.3 18.44 <0.000 1 = 2<3 = 4

Bradley errors 2.6 3.3 9.7 8.2 17.82 <0.000 1 = 2<3 = 4
Pig Latin errors 3.9 7.0 13.3 14.4 10.09 <0.000 1 = 2<3 = 4
RAN time sum 102.9 141.8 101.0 155.2 17.23 <0.000 1 = 3<2 = 4
Rhyme sum 19.4 19.0 11.6 11.8 6.42 0.001 1 = 2>3 = 4
Note. RD = reading disabled, TAAS = Test of Auditory Analysis Skills, RAN = Rapid Automatized Naming.

The child was classified as a slow namer if the sum of his
or her times for the three RAN tasks exceeded 116 seconds
(see Badian, 1997). These cut-score decisions are somewhat
arbitrary but gave the sharpest discrimination of the RD and
NR groups and provided four RD subgroups with reasonable
numbers for analyses: 18 had neither deficit, 16 had both, 13
were slow only, and 9 were phonologically impaired only.
The four subgroups did not differ in age but the
racial makeup varied. The “neither deficit” subgroup had
no AA children, and these children were overrepresented
in the “phonological only” and “both” subgroups (chi-
square = 12.01, p < 0.01 for 3 df).
Table 6 shows how widely the subgroups were separated
by the cut-score algorithm. Of interest, 3 children in the NR
group would be classified as “slow only” by this algorithm,
4 as “phonological only,” and 1 would be in the “both” sub-
group.
Reading and spelling standard scores for the four RD sub-
groups appear in Table 7. In pairwise contrasts, the “slow
only” and “neither” subgroups did not differ on any of the
literacy measures even though the “neither” subgroup had
higher WISC-III Verbal Comprehension and ACID scores
than the “slow only” subgroup. The “neither” subgroup had
higher scores on all measures than the “phonological only”
and “both” subgroups. The “slow only” subgroup performed
better than the “phonological only” and “both” subgroups on
the reading but not spelling tests. The greatest separation of
the subgroups was on the Decoding Skills Test where the
“phonological only” and “both” subgroups were far worse
than the other two.
The subgroups did not differ on other WISC-III factors,
or on CBCL or ADHD ratings. Nor did they differ on the
orthographic tasks listed in Table 4.
Regression Analyses
The above subgroup analyses did not reveal the hypothesized
incremental deficiencies in reading and spelling scores at-
tributable to dual underlying deficits in phonological analysis
and naming speed. The “slow only” subgroup was no more
impaired than the “neither” subgroup, and the dual-deficit
(“both”) subgroup was no more deficient than the “phono-
logical only” subgroup. Still, in the sample as a whole both
phonological and naming deficits as well as other factors sep-
arated the NR and RD groups. Thus, we opted to use stepwise
regression analyses to better understand the data.
In order to limit the number of independent variables
entering into these analyses, we computed a single factor
score for the phonological variables, which were all highly
intercorrelated, and we computed a single RAN measure
(the sum of seconds on the three subtests). In addition to
the WISC-III Verbal Comprehension factor scores, we in-
vestigated the ACID factor (arithmetic, coding, information,
and digit span) because of its discriminating power in earlier
studies of learning-disabled children (Ackerman et al., 1977).
Other independent variables included the ADD index and
WRAT-3 arithmetic standard scores. Race and gender were
included in initial exploratory analyses but were not found
to explain any significant variance. The same was the case

TABLE 7
Differences Between RD Subgroups

Neither Slow Phono Both

N = 18 N = 13 N =9 N = 16 F3,52 p Pairwise

WISC Verbal Factor 101.9 93.6 87.9 93.6 4.81 0.005 1>2=3=4
ACID Pattern 36.1 31.1 32.4 31.7 2.39 0.080 1 > 2,4
WIAT Read ss 82.9 81.5 76.8 76.2 3.84 0.015 1=2>3=4
WIAT Spell ss 83.3 80.4 75.8 76.7 3.76 0.016 1 > 3,4; 1 = 2
WRAT Read ss 81.8 80.6 72.8 70.6 6.52 0.001 1=2>3=4
WRAT Spell ss 81.4 80.2 75.2 76.3 2.53 0.067 1 > 3,4; 1 = 2
Literacy Sum 329.4 322.7 300.6 299.9 5.81 0.002 1=2>3=4
Decoding Skills 18.5 16.4 3.8 5.8 19.96 <0.000 1=2>3=4
Note. WISC = Wechsler Intelligence Test for Children, ACID = WISC Arithmetic + Coding + Information + Digit Span, WIAT = Wechsler Individual
Achievement Test, WRAT = Wide Range Achievement Test, ss = Standard Scores.
 LEARNING DISABILITIES RESEARCH 157
TABLE 8
Correlation Matrix and Factor Loadings

1 2 3 4 5 6 7 8 Loadings on Factor I

1. Literacy Sum — 0.923

2. Decoding Skills Sum 0.886 — 0.864
3. ADD Index −0.576 −0.490 — −0.649
4. ACID factor 0.755 0.650 −0.538 — 0.892
5. WISC Verbal Factor 0.605 0.567 −0.306 0.756 — 0.742
6. Phonological Factor −0.703 −0.777 0.406 −0.606 −0.574 — −0.801
7. RAN Sum −0.594 −0.528 0.433 −0.560 −0.345 0.519 — 0.686
8. WRAT Arithmetic 0.671 0.505 −0.459 0.760 0.517 −0.451 −0.429 — 0.758
Note. ADD = Attention Deficit Disorder, ACID = WISC Arithmetic + Coding + Information + Digit Span, WISC = Wechsler Intelligence Scale for Chil-
dren, RAN = Rapid Automatized Naming, WRAT = Wide Range Achievement Test. All correlation coefficients are significant at p < 0.01 or higher.

for hyperactivity ratings and internalizing and externalizing p < 0.01). An obvious initial question is how well the
scores from the CBCL. For dependent measures we used the independent variables predict the DST scores. Table 9 sum-
sum of correct responses on the Decoding Skills Tests and marizes these analyses. Only the phonological factor scores
the sum of standard scores on the WIAT and WRAT-3 read- and the ACID factor scores were accepted to achieve a robust
ing and spelling tests (labeled literacy sum). Intercorrelations R of 0.81 (p < 0.000). If the ACID factor is not included in
of these dependent and independent variables are given in the regression for DST, the ADD and Verbal Comprehension
Table 8. Principal components factor analysis of these vari- factors are accepted along with the phonological factor to
ables yielded only one factor with an eigenvalue > 1.0. Load- yield a virtually identical R (0.810). If the ADD index is not
ings are shown in the last column. included, the WRAT-3 arithmetic score is chosen in Step 2
The first set of regression analyses used the entire sample. to yield an R of 0.792. The RAN variable enters only if the
Decoding Skills Test (DST) scores and reading/spelling ACID, ADD, and arithmetic measures are excluded. Then,
scores are generally robustly correlated (Ackerman & it is taken third after the phonological factor and Verbal
Dykman, 1993), which was the case here (R = 0.886, Comprehension to yield an R of 0.799.
Next the literacy sum scores were predicted, excluding
TABLE 9 DST scores. In addition to ACID and phonological factor
Regression Analyses: Entire Sample scores, ADD and WRAT arithmetic scores were accepted to
yield an R of 0.844 (p < 0.000). If ACID is not allowed to en-
Dependent R R2 Final Beta Weight ter, the solution is as shown for Literacy Sum II. When DST is
allowed to enter in the prediction of literacy sum (see example
I. Decoding Skills Sum III), the phonological factor drops out but WRAT arithmetic
Step 1. Phonological factor 0.777 0.603 −0.605 and ADD remain along with RAN to yield an R of 0.931
Step 2. ACID factor 0.809 0.654 0.284 (p < 0.000). If only the phonological and RAN variables
II. Decoding Skills Sum
are allowed to enter, R is only 0.753, with the phonological
Step 1. Phonological factor 0.777 0.603 −0.606
Step 2. ADD index 0.800 0.639 −0.195
factor explaining 49% of the variance and RAN adding 7%.
Step 3. Verbal comprehension 0.810 0.656 0.160 A second set of multiple regression analyses was limited
I. Literacy Sum to the RD group. At issue here is the degree of reading/
Step 1. ACID factor 0.755 0.571 0.271
Step 2. Phonological factor 0.816 0.666 −0.368 TABLE 10
Step 3. ADD index 0.832 0.693 −0.181 Regression Analyses: RD Group
Step 4. WRAT arithmetic 0.844 0.713 0.216
II. Literacy Sum Dependent R R2 Final Beta Weight
Step 1. Phonological factor 0.703 0.494 −0.317
Step 2. WRAT arithmetic 0.807 0.652 0.285 I. Decoding Skills
Step 3. ADD index 0.830 0.689 −0.195 Step 1. Phonological Factor 0.773 0.597 −0.773
Step 4. RAN sum 0.841 0.707 −0.169 I. Literacy Sum
Step 5. Verbal comprehension 0.850 0.722 0.157 Step 1. Phonological Factor 0.615 0.378 −0.535
III. Literacy Sum Step 2. WRAT Arithmetic 0.742 0.551 0.424
Step 1. Decoding skills 0.886 0.785 0.662 II. Literacy Sum
Step 2. WRAT arithmetic 0.923 0.852 0.283 Step 1. Phonological Factor 0.615 0.378 −0.287
Step 3. RAN sum 0.928 0.861 −0.096 Step 2. WRAT Arithmetic 0.742 0.551 0.458
Step 4. ADD index 0.931 0.867 −0.094 Step 3. Decoding Skills 0.768 0.590 0.313
Note. ADD = Attention Deficit Disorder, ACID = WISC Arithmetic + Note. ADD = Attention Deficit Disorder, ACID = WISC Arithmetic +
Coding + Information + Digit Span, WISC = Wechsler Intelligence Scale Coding + Information + Digit Span, WISC = Wechsler Intelligence Scale
for Children, RAN = Rapid Automatized Naming, WRAT = Wide Range for Children, RAN = Rapid Automatized Naming, WRAT = Wide Range
Achievement Test. All correlation coefficients are significant at p < 0.01 or Achievement Test. All correlation coefficients are significant at p < 0.01 or
higher. higher.
158 ACKERMAN ET AL.: DOUBLE-DEFICIT THEORY
spelling impairment, which ranges from mild to severe. The
literacy sum scores for the RD children ranged from 231
to 357 (SD = 27.0), and the Decoding Skills (DST) sum
ranged from 0 to 32 (SD = 8.7). Table 10 summarizes these
analyses. The DST sum is predicted only by the phonological
factor. The literacy sum is predicted by the phonological
factor and the WRAT arithmetic scores (R = 0.742). If
the literacy sum independent variables list includes DST
scores, the phonological factor scores are taken as step 1
because they were more strongly correlated with literacy
sum than the DST (–0.615 versus 0.553). However, the
beta weight for the DST was somewhat higher in the final
solution.
The orthographic tasks formed a single factor that was
so robustly correlated with reading and spelling standard
scores and the phonological factor and DST scores as to cast
doubt on its use as an independent variable. Rather, this factor
appears to tap phonological as much as orthographic ability
(see Velutino, Scanlon, & Chen, 1995, on this issue).
Follow-Up Analyses of RAN
Because the subgroup and regression analyses did not show
as adverse effect of slow naming as expected, we performed
several post hoc exploratory analyses with RAN scores to try
to discover why our findings are not strongly supportive of
the double-deficit theory.
Even in our first major study to combine RAN and phono-
logical variables, we had to include Verbal IQ and a test of
short-term memory in order to achieve a robust multiple R
in the prediction of reading level (Ackerman & Dykman,
1993). The current model (Table 9) incorporating ACID pat-
tern scores, standardized arithmetic scores, and ADD ratings
provides an even better fit. Examination of Table 8 offers at
least a partial explanation. Note that RAN scores are sig-
nificantly related to ACID scores (–0.56) and phonological
scores (0.52), which have the highest correlations with lit-
eracy sum. Of the four WISC subtests making up the ACID
pattern, RAN times are most strongly correlated with Coding
(–0.50, p < 0.001) but each of the other associations are also
significant (Arithmetic, –0.41; Information, –0.40, and Digit
Span –0.34, all p = 0.001). When RAN sum was included
with all the WISC subtests in a principal components fac-
tor analysis, its loading was –0.71 on a presumed perceptual
speed factor with Coding (0.78) and Symbol Search (0.70).
Information, Arithmetic, and Digit Span had high loadings
with the other Verbal subtests. Thus, ACID scores appear to
offer a good estimate of academic aptitude because of the
inclusion of measures of long-term, short-term, and working
memory, as well as speed of processing. RAN is not as inclu-
sive a measure as ACID, but does appear to measure speed
of mental processing just as well as Coding (see Ackerman
& Dykman, 1996).
Earlier we had found that RAN scores were not as charac-
teristic of “garden variety” (non-IQ discrepant) poor read-
ers as of discrepant poor readers (Ackerman & Dykman,
1993; Ackerman, Weir, Metzler, & Dykman, 1996). With the
present RD children, we created two RAN groups (median
split at 116 seconds), and looked at the differences between
Verbal IQ scores and reading and spelling standard scores
(averaged for the WIAT and WRAT-3). The faster namers
had higher Verbal IQs (96.3) but no larger gap between IQs
and reading and spelling (16 and 15, respectively) than the
slower namers (IQ = 92.7, gap = 16 for both reading and
spelling).
The current RD sample includes more girls and more
African-American children than our past studies, but we
found no gender or race differences in mean RAN scores
and no interactions with group. Age was not significantly
correlated with RAN scores. The RD sample also includes a
large number of children with attention problems, but slow
and fast namers (median split) did not differ on the ADD
index.
RAN has been hypothesized to relate to orthographic pro-
cessing, but within our RD sample the slower and faster
namers (median split) did not differ significantly on any of
our orthographic tasks. The slow namers had virtually iden-
tical reading and spelling standard scores (77 and 78) as did
the faster namers (80 for both). Thus, the slow namers were
not more impaired in spelling than reading.
DISCUSSION
Insofar as differentiating normal and disabled readers, this
study successfully replicated other studies from our labora-
tory and from other RD investigators. As expected, the RD
and NR groups clearly differed on oral word analysis skills
and on rapid naming speed. They also differed on parental
ratings of attention and behavioral problems and on three of
the four WISC III factor scores as well as the once clinically
popular ACID factor (Swartz, 1974; Ackerman et al., 1977;
Frederickson, 1999). Although selected for reading/spelling
deficits, the RD group was also impaired in arithmetic. The
comorbidity of attention disorder and RD has often been re-
ported (Dykman & Ackerman, 1991; Willcutt & Pennington,
2000) as has the comorbidity of reading/spelling and arith-
metic disabilities (Ackerman & Dykman, 1995). While read-
ing disabilities and attention disorders occur at all levels of
intelligence, it is nonetheless the case that referred and/or
recruited samples of RD children generally have somewhat
lower IQs and higher levels of attention problems than stan-
dardization samples. Likewise, samples of ADHD children
generally have somewhat lower IQs and achievement scores
than standardization samples.
A primary reason for the current study was to assess pos-
sible additive effects of impaired oral word analysis (phono-
logical) skill and slow continuous naming on degree of read-
ing/spelling impairment. This question was addressed first
by subgrouping and then by stepwise multiple regression
analysis. The subgrouping maneuver revealed, as expected,
that those RD children with phonological deficits read and
spelled worse than those without serious phonological defic-
its. However, there was no evidence of an additive effect of
slow naming. Rather, the RD children with double defic-
its read and spelled no worse than those with a phono-
logical deficit only, and the children with a single deficit
in naming performed no worse than those with neither
deficit.

The various multiple regression analyses likewise failed
to show much of an adverse impact from slow naming when
other contributory variables were considered. RAN scores
were robustly correlated with literacy sum (reading plus
spelling from the WIAT and WRAT-3) but explained only
7% of additional variance once the phonological factor en-
tered. The ACID factor and WRAT-3 arithmetic scores were
much stronger predictors when taken with the phonological
scores. Within the RD group, once the phonological factor
was accepted, the RAN sum did not enter in the prediction
of literacy sum.
Our failure to find strong support for the phonologi-
cal/naming speed double-deficit theory of reading disabil-
ity may, of course, simply be attributable to the vagaries of
sampling. But, it could also be that the lesson of the blind
men and the elephant is being ignored by some investiga-
tors (but see Wolf & Bowers, 1999, pp. 422–423). Let us as-
sume that rapid naming of alphanumeric stimuli is an index
of speed of mental processing and resistance to mental fa-
tigue during continuous processing, both necessary to good
working memory. Evidence of this comes from significant
correlations of RAN sum with three WISC subtests: Cod-
ing (–0.498, p < 0.001), Arithmetic (–0.409, p < 0.001), and
Digit Span (−0.335, p < 0.001). RAN times are also corre-
lated with Information (–0.403, p < 0.001) and Vocabulary
(–.324, p = 0.001), suggesting association with the “g” fac-
tor. Additionally, RAN times are correlated with ADD in-
dex scores (0.433, p < 0.001), and with Arithmetic achieve-
ment scores (–0.420, p < 0.001) as well as with Reading
and Spelling achievement scores (–0.602 and –0.553, respec-
tively, p < 0.001 for each).
Our regression analyses suggest there are multiple deficits
underlying literacy acquisition and that rapid naming is asso-
ciated with several of these. However, other measures, such
as the ACID factor, the ADD index, and Arithmetic achieve-
ment, provided stronger associations with literacy acquisition
than RAN times. Also RAN times and the phonological factor
were not independent (R = 0.52).
Two puzzling questions arise from, but are partially an-
swered by, our regression analyses. First, why is it that there
are children who have normal oral phonological analysis
skill and are adequate namers (the neither subgroup) yet are
poor readers? What weaknesses do they exhibit? Secondly,
why are there children who exhibit deficits common to poor
readers yet who read at age-expected levels? How do they
compensate?
To address the first question, in the “neither” RD sub-
group (N = 18), all except 6 had either low ACID scores
(<36) or high ADD scores (≥15) or both. Adverse scores on
these two measures clearly contribute to literacy deficits (see
Tables 8 and 9). Also, the “neither” group, despite having oral
phonological analysis skills in the range of normal readers,
did not perform as well as the NR group on the Decoding
Skills Test (mean total decoded of 18.5 versus 38.4). Most
had not mastered “the cipher.”
As for the second question, in the normal-reader group,
there were 3 who were slow namers only (>116 seconds), 4
with phonological deficits only, and 1 with both deficits. None
of these NR children with naming or phonological deficits had
ACID scores <36 or arithmetic standard scores <85. Perhaps
LEARNING DISABILITIES RESEARCH 159
strength in memory allowed them to acquire academic skills
at a normal rate. As if to defy those who wish to categorize
children, the NR child with the naming/phonological deficit
also had high ADD scores yet was above average in reading
and arithmetic although low average in spelling. Her phono-
logical deficit is questionable, however, since she decoded 31
pseudowords on the DST. Indeed, only 1 NR child who met
the cut-score algorithm for a phonological deficit had a very
low DST score, his being 12.
Denckla and Cutting (1999) have recently reviewed the
history of testing for rapid automatized naming. They con-
clude that rapid naming is a complex ability, and that the RAN
tasks tap at minimum both visual-verbal ability (language do-
main) and processing speed (executive domain). Our factor
analysis (Table 8) suggests there is an overall “g” factor for
literacy achievement and that rapid naming loads robustly on
the factor, although not as strongly as phonological analysis.
Our various statistical maneuvers also show that there are yet
other underlying abilities that must be measured to account
for all instances of impaired literacy acquisition.
Unfortunately, we did not obtain a measure of reading
speed for connected text. In the age group studied here,
where level of word recognition skill varied from early 1st
to 8th grade, it was not possible to find an appropriate
passage for oral reading on which all subjects could be
compared. In an earlier study of adolescent RD subjects
(Ackerman & Dykman, 1996), we were able to compare
the reading speed of slower and faster continuous namers
(median split). These subjects all read aloud a 3rd-grade-
level paragraph. The slower namers were the slower readers
and vice versa (Chi Square = 10.03, p < 0.01). Further, those
adolescents who were slow namers only were as prone to
be slow readers as slow namers with phonological deficits,
and those with phonological deficits only were prone to be
faster readers of the 3rd-grade text than those who were
slow namers only. Thus, isolated slow naming may eventu-
ate in reading impairment, even though the student has “the
cipher.” Wolf and Bowers (1999) concur on this point. As
we have noted before (Ackerman & Dykman, 1996), slow
readers are not as apt to read for pleasure and likely will not
acquire the spelling proficiency that accrues from repeated
exposure to print. Additionally, very slow readers tax working
memory and are therefore not as good comprehenders of text
(Baddeley, 1986).
Several practical implications arise from the findings
of the present study. Foremost is the advisability of eval-
uating RD children’s abilities in memory, attention, and
speed of processing as well as their phonological awareness
skills. As Lovett and her colleagues (Lovett, Lacerenza, &
Borden, 2000) have amply demonstrated, the remedial pro-
cess should include instruction in strategies for recognizing
and remembering recurring orthographic patterns as well as
direct instruction in phonological analysis. Indeed, strategic
instruction may be just what is needed for RD children who
do seem to have phonological awareness, yet not the know-
how to utilize this oral analysis ability in decoding written
words. The issue of whether automaticity and fluency can be
abetted in slow namers who are also slow readers has only
begun to be addressed (see Wolf, Miller, & Donnelly, 2000).
Early results suggest that Wolf ’s so-called RAVE-O program
160 ACKERMAN ET AL.: DOUBLE-DEFICIT THEORY
(Retrieval, Automaticity, Vocabulary, Elaboration, Orthogra-
phy) can produce positive results.
NOTE
This research was supported by Grant 5R01 HD34182 from
the National Institute of Child Health and Human Develop-
ment and by Arkansas Children’s Hospital Research Insti-
tute. We are grateful to coworkers Nancy B. Stewart, Shane
Eilts, and Dannette Rook for their help in data collection
and manuscript preparation. We are also grateful to Jeanette
McGrew, Dr. Larry Clarke, Dr. Glen Lowitz, and local ele-
mentary school principals for help in recruiting reading dis-
abled participants.
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