Journal of Cognitive Psychology

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A meta-analysis of executive functioning in

dyslexia with consideration of the impact of
comorbid ADHD

Aoife Lonergan, Caoilainn Doyle, Clare Cassidy, Shane MacSweeney Mahon,

Richard A.P. Roche, Lorraine Boran & Jessica Bramham

To cite this article: Aoife Lonergan, Caoilainn Doyle, Clare Cassidy, Shane MacSweeney Mahon,
Richard A.P. Roche, Lorraine Boran & Jessica Bramham (2019) A meta-analysis of executive
functioning in dyslexia with consideration of the impact of comorbid ADHD, Journal of Cognitive
Psychology, 31:7, 725-749, DOI: 10.1080/20445911.2019.1669609

To link to this article: https://doi.org/10.1080/20445911.2019.1669609

Published online: 03 Oct 2019.

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JOURNAL OF COGNITIVE PSYCHOLOGY
2019, VOL. 31, NO. 7, 725–749
https://doi.org/10.1080/20445911.2019.1669609

REVIEW

A meta-analysis of executive functioning in dyslexia with consideration of

the impact of comorbid ADHD
Aoife Lonergana, Caoilainn Doyleb, Clare Cassidyc, Shane MacSweeney Mahona, Richard A.P. Roched,
Lorraine Boranb and Jessica Bramhama
a
Department of Psychology, University College Dublin, Dublin, Ireland; bSchool of Nursing and Human Sciences, Dublin City
University, Dublin, Ireland; cDepartment of Psychology, National University of Ireland, Galway, Ireland; dDepartment of Psychology,
Maynooth University, Kildare, Ireland

ABSTRACT ARTICLE HISTORY

This meta-analysis examined inhibition, switching attention and auditory working Received 28 October 2018
memory in children with dyslexia. As a secondary outcome the impact of comorbid Accepted 7 September 2019
ADHD on executive functions in dyslexia was examined. Twenty-six controlled studies
KEYWORDS
examining executive functions in children with dyslexia alone and/or comorbid Executive function; dyslexia;
dyslexia/ADHD were reviewed. Outcomes were reaction times, errors and accuracy on ADHD; comorbid
measures of inhibition, switching attention and auditory working memory. Children
with dyslexia demonstrated difficulty with inhibition, switching attention, and auditory
working memory, with a medium to large effect relative to controls. Children with
comorbid dyslexia/ADHD exhibited relatively the same degree of inhibition, switching
attention and auditory working memory impairment compared to children with
dyslexia alone. Findings support the presence of executive function deficits in children
with dyslexia. Executive functioning may be a shared deficit, underpinning variants of
neurodevelopmental disorders. Future studies may benefit from examining executive
functions in children with dyslexia while controlling for attention difficulties.

Introduction
Dyslexia is a neurodevelopmental disorder charac-
terised by slow and inaccurate word recognition
(Peterson & Pennington, 2012). It is the most
common learning disability, accounting for approxi-
mately 80% of all learning difficulties, and affecting
between 8% and 12% of the population (Eden &
Vaidya, 2008). Under the DSM 5, dyslexia falls
under the neurodevelopmental disorder category
of specific learning disorder, with impairment in
reading (American Psychiatric Association, 2013).
For a diagnosis of specific learning disorder, with
impairment in reading, hereafter referred to as dys-
lexia multiple criteria must be met. Difficulties must
be present for 6 months, despite the provision of
interventions that target those difficulties (American
Psychiatric Association, 2013). The affected reading
skill must be below that expected for the individuals
chronological age and cause significant interference
with academic/occupational functioning, as
confirmed by standardised achievement measures
and clinical assessment (American Psychiatric
Association, 2013).
While theoretical reports of dyslexia highlight the
primary deficit to be in the phonological system
(Hulme & Snowling, 2009; Vellutino, Fletcher, Snowl-
ing, & Scanlon, 2004), deficits in the executive
system have also been reported (Pickering & Gather-
cole, 2004; Swanson, 2006). It has been suggested
that these problems are over and above deficits in
the phonological system (Swanson, 2006). Studies
examining difficulties with reading comprehension
suggest working memory skills (Hulme & Snowling,
2009) and the ability to update and inhibit distrac-
tors are impaired (Palladino, Cornoldi, De Beni, &
Pazzaglia, 2001). Difficulties in the ability to update
working memory and inhibit distractors has been
implicated in research on reading difficulties (Palla-
dino et al., 2001). These higher order cognitive pro-
cesses fall under the umbrella of executive function’s
(EF) and may have implications for responsiveness
to reading intervention (Sesma, Mahone, Levine,

CONTACT Jessica Bramham jessica.bramham@ucd.ie

© 2019 Informa UK Limited, trading as Taylor & Francis Group
726 A. LONERGAN ET AL.
Eason, & Cutting, 2009; Swanson, 2006). EFs are pro-
cesses that control and regulate thought and action
(Friedman, Miyake, Corley, Young, DeFries, & Hewitt,
2006) and engagement in goal directed behaviour
(Lyon & Krasnegor, 1996). A growing body of evi-
dence suggests that executive functioning is
related to reasoning ability (Engle, Tuholski, Laugh-
lin, & Conway, 1999; Gathercole & Pickering, 2000;
Kyllonen & Christal, 1990) and is involved in aca-
demic abilities such as reading (Daneman &
Merikle, 1996; De Jong, 1998; Swanson & Sachse-
Lee, 2001). However, currently the exact EF profile
of dyslexia is unclear.
Epidemiological and aetiological studies of dys-
lexia have consistently found that Attention Deficit
Hyperactivity Disorder (ADHD) is the most
common co-occurring disorder (Carroll, Maughan,
Goodman, & Meltzer, 2005; Maughan & Carroll,
2006). It is estimated that 15–40% of children with
dyslexia are also diagnosed with ADHD (Semrud-Cli-
keman et al., 1992; Willcutt & Pennington, 2000).
When left untreated, dyslexia and ADHD pose sig-
nificant barriers for school success and later adap-
tation in a variety of settings (Cornwall & Bawden,
1992; Mannuzza, Klein, Bessler, Malloy, & Hynes,
1997). These problems are greatly compounded in
individuals with co-morbidity. A significant volume
of research indicates that the presence of executive
dysfunction is well established in ADHD (Barkley,
1997; Eden & Vaidya, 2008; Nigg, 2001, 2006; Pen-
nington, 2002; Pennington & Ozonoff, 1996; Willcutt,
Doyle, Nigg, Faraone, & Pennington, 2005). However,
far less is known about the impact of comorbid
ADHD on EF in dyslexia. EF as a possible area of
shared or additive difficulty in both dyslexia and
ADHD has received increasing attention in recent
research. The gaps and current limitations in the lit-
erature regarding the EF profile of children with dys-
lexia makes it an important area for further
investigation to inform EF theories of dyslexia.
Executive functioning in dyslexia and ADHD
Factor analytic studies have validated at least three
EFs; inhibition, set shifting and updating working
memory as independent but correlated EFs
(Miyake et al., 2000; Pennington & Ozonoff, 1996).
While some studies have found children with dys-
lexia to be impaired on measures of EF (Beneventi,
Tønnessen, Ersland, & Hugdahl, 2010; Brosnan
et al., 2002), others have reported little or no EF
impairment (Bental & Tirosh, 2007; Reiter, Tucha, &
Lange, 2005). Booth, Boyle, and Kelly (2010) con-
ducted a meta-analysis of 48 studies comparing
the performance of children with reading disability
with their typically developing peers on tasks of
EF. An overall effect size of 0.57 was obtained, indi-
cating that children with reading disability had
impairments on tasks of EF (Booth et al., 2010).
However, moderator analysis found that the task
modality and IQ achievement discrepancy
definitions of reading disability influenced the mag-
nitude of effect (Booth et al., 2010). Booth et al.
(2010) found that the EF impairment of children
with reading disability is not uniform across all
tasks, indicating that some areas of EF may be
more impaired than others. In attempting to
explain the heterogeneity of dyslexia, Pennington
(2006) proposed a multiple deficit model that
regards dyslexia as the result of multiple risk and
protective factors, both environmental and genetic.
According to this framework, each symptom’s
dimension can be predicted by several underlying
cognitive factors (Peterson et al., 2017). Comorbidity
among symptom dimensions or disorders arises
because some of the underlying cognitive skills are
shared by disorders (Peterson et al., 2017). Until
further research allows the exact nature of the EF
impairment to be isolated, it is not possible to say
whether the impairment is specific to areas such as
inhibition and working memory, or involves more
areas, but just perhaps to differing degrees (Booth
et al., 2010).
While EF deficits have been found in children
with ADHD (Pennington & Ozonoff, 1996; Sergeant,
Geurts, Huijbregts, Scheres, & Oosterlaan, 2003), it
is unclear, whether the comorbidity of ADHD with
dyslexia has an effect on EFs, as EF deficits may
also occur in children with dyslexia only (Donfran-
cesco, Mugnaini, & Dell’Uomo, 2005). The cognitive
subtype hypothesis suggests that children with
both ADHD and dyslexia have a different or more
severe form of dyslexia or ADHD than children
with either disorder alone (Rucklidge & Tannock,
2002). Willcutt et al. (2001) found evidence for this
hypothesis, reporting a double dissociation
between ADHD and reading disability, as children
with ADHD had difficulties in EF (e.g. inhibition
and set shifting), while children with dyslexia exhib-
ited phonological and working memory deficits.
Children with comorbid ADHD/reading disability
were more impaired on inhibition and phonological
measures than ADHD, reading disability or control
groups (Willcutt et al., 2001). This suggest that

children in the comorbid group had a more severe
subtype of ADHD and reading disability than the
children with reading disability alone (De Jong, Oos-
terlaan, & Sergeant, 2006; Willcutt et al., 2001). This
may have implications for EF as a target of assess-
ment and intervention for underlying deficits
across both disorders.
Inhibition
For conscious, reflective problem solving to occur,
inhibition of automatic responses is required to
allow strategic processing in favour of a long-term
goal (Altemeier, Abbott, & Berninger, 2008). Based
on their findings, Miyake et al. (2000) and other
researchers, argue that inhibition might be the key
factor, as all EFs involve inhibitory processes
(Barkley, 1997; van der Sluis, de Jong, & van der
Leij, 2004). For example, updating working
memory requires the discarding and suppression
of irrelevant incoming information (van der Sluis
et al., 2004). Similarly, shifting attention requires
the suppression of an irrelevant mental set in
favour of a new one (van der Sluis et al., 2004).
This indicates that while EFs are all distinct con-
structs, they are not entirely unrelated (Booth
et al., 2010). Inhibition is thought to affect memory
at both the encoding and retrieval stages (De Ribau-
pierre, 2001). Efficient retrieval of the phonological
codes for letters and letter units, for example, may
be affected by the ability to suppress irrelevant
codes and quickly search and retrieve the relevant
response (Altemeier et al., 2008). In the decoding
process inhibition and set shifting occur moment
to moment in linking letters and sounds (Altemeier
et al., 2008). Inhibitory processes mediate selective
attention and the inability to inhibit distractors
may underlie the distractibility frequently reported
by individuals with dyslexia (West, 1997). Earlier
studies demonstrated that children with reading dis-
orders have deficits in inhibitory processing (Närhi &
Ahonen, 1995; Nigg, 1999; Purvis & Tannock, 2000;
van der Schoot, Licht, Horsley, & Sergeant, 2000; Will-
cutt, Pennington, Olson, Chhabildas, & Hulslander,
2005). However, several studies have produced
inconsistent results (Altemeier et al., 2008;
Landerl, Moll, Fussenegger, & Willburger, 2009; van
der Sluis et al., 2004).
Meta-analyses indicate that deficits in working
memory (weighted effect sizes 0.47–0.85) and inhi-
bition (weighted effect sizes 0.58–0.61) are strongly
associated with ADHD (Kasper, Alderson, & Hudec,
JOURNAL OF COGNITIVE PSYCHOLOGY 727
2012; Lijffijt, Kenemans, Verbaten, & van Engeland,
2005; Martinussen, Hayden, Hogg-Johnson, &
Tannock, 2005; Willcutt et al., 2005). However, exam-
ination of possible shared EF deficits in ADHD and
dyslexia has been rare and has produced conflicting
findings. In exploring the overlap between reading
disability and ADHD, Shanahan, Pennington, and
Yerys (2006) showed that processing speed was
likely a shared cognitive deficit that could account
for the comorbidity between these disorders.
Extending this work, McGrath et al. (2011) tested a
multiple cognitive deficit model of reading disability
and ADHD. They found that processing speed was
the only cognitive predictor shared by both
symptom dimensions. These results suggest that
comorbidity between dyslexia and ADHD may be
primarily attributable to shared genetic influences
that lead to slow processing speed. A possible
reason for the inconsistencies between studies of
EF in dyslexia may be differences in measurement
tools used (Wang, Tasi, & Yang, 2012). As most
studies in dyslexia have used only a single task to
assess EFs of interest, results are nearly always a
mixture of non-EF, common EF (inhibition) and
specific EF components, making interpretation of
results difficult (Snyder, Miyake, & Hankin, 2015).
Switching attention
Set shifting, or switching attention, is the ability to
flexibly shift attention as task demands change
(Altemeier et al., 2008). Cognitive control, such as
the ability to react in a flexible way to information
in our environment, has been explored with a
variety of experimental paradigms. Using a task
switching paradigm, Poljac et al. (2010) found
that children with dyslexia demonstrated a signifi-
cantly larger switch cost, suggesting difficulties
specifically related to switching between different
tasks (Poljac et al., 2010). However, Stoet and
Snyder (2007) found no evidence for specific
impairments in task switching in undergraduate
students with dyslexia. A possible explanation
for the different finding could be a difference
between the ages of participants and the stimuli
used in these studies. While Poljac et al. (2010)
used only incongruent stimuli, half of the stimuli
used by Stoet and Snyder (2007) were congruent.
Congruency effects have been found to modulate
the size of the switch cost so that incongruent situ-
ations produce a relatively larger switch cost
(Meiran, 2000).
728 A. LONERGAN ET AL.
Attention shifting and interference control show
less consistent differences between ADHD and
control children across studies (Willcutt et al.,
2003). Effect sizes of EF measures are small (d = .4
− .6) in light of the wide overlap in the group distri-
butions (Eden & Vaidya, 2008). Furthermore, almost
all other developmental disorders also exhibit
some level of problems with EF, suggesting that
executive dysfunction is a pervasive, shared
outcome of multiple pathological developmental
processes (Eden & Vaidya, 2008). In examining set
shifting some studies have identified no deficit in
children with reading disability alone (van der Sluis
et al., 2004; Willcutt et al., 2013). However, van der
Sluis et al. (2004) found that children with both arith-
metic disability and reading disability were impaired
on both set shifting and inhibition tasks. It was
shown that reading plus arithmetic disabled chil-
dren experienced the additive combination of pro-
blems that characterise children with a single
learning deficit (van der Sluis et al., 2004). Further
research is needed to identify if this is also the
case with comorbid dyslexia and ADHD.
Working memory
Working memory is the cognitive system that allows
the storage and manipulation of a limited amount of
information over a short period. Its functioning is
essential for a wide range of complex cognitive
tasks, such as reading, general reasoning, and
problem solving (Shah & Miyake, 1996). In reading,
working memory is involved in both single word
decoding (Christopher et al., 2012; Swanson, Howard,
& Saez, 2006; Swanson, Zheng, & Jerman, 2009) and
comprehension of longer texts (Christopher et al.,
2012; Daneman & Merikle, 1996; Sesma et al., 2009;
Swanson et al., 2006). Individual differences in
working memory are significantly impacted by indi-
vidual differences in ability to control attention
(Arrington, Kulesz, Francis, Fletcher, & Barnes,
2014). These attentional processes are crucial for
cognitive processes supporting language and
reading comprehension (Gathercole & Baddeley,
2014). Increasing demands on working memory
resources results in increased difficulty in controlling
inhibition (Pennington, Bennetto, McAleer, &
Roberts, 1996). Working memory is perhaps one of
the most widely studied EFs in dyslexia. A
common paradigm for assessing working memory
capacity is the digit span task. In dyslexia, digit
spans decrease with verbal distractors (Brosnan
et al., 2002). This suggests sensitivity to distraction
may be related to the diminished working memory
capacity in dyslexia. A smaller working memory
capacity will reach capacity earlier and place
demands on inhibitory resources earlier (Brosnan
et al., 2002; Spironelli, Penolazzi, & Angrilli, 2008).
The process of learning to read is highly inte-
grated with working memory (Gathercole &
Alloway, 2008). The multicomponent subsystem
model of working memory initially presented by
Baddeley and Hitch (1974) is well supported by
research (Alloway, Gathercole, Willis, & Adams,
2004). According to the revised model, working
memory consists of four integral components.
There are two slave storage systems; the phonologi-
cal loop which temporarily stores phonological
information, and the visuospatial sketchpad which
temporarily maintains visual or spatial information
(Baddeley & Hitch, 1974). The episodic buffer, inte-
grates and stores information from the phonological
loop and visuospatial sketchpad with long term
memory (Baddeley, 2000). These three storage
systems work under the influence of the central
executive, which is responsible for retrieving and
manipulating information, and directing resources
to the storage components (Baddeley & Hitch,
1974). These components function together to
create working memory, allowing for the completion
of many complex cognitive tasks such as reading
(Dawes, Leitão, Claessen, & Nayton, 2015).
Working memory has been found to be less
effective in children with dyslexia than in typically
reading children (Barnea, Lamm, Epstein, & Pratt,
1994; Breznitz, 1997; Chiappe, Siegel, & Hasher, 2000;
Poblano, Valadéz-Tepec, de Lourdes Arias, & García-
Pedroza, 2000; Vargo, Grosser, & Spafford, 1995; Will-
cutt et al., 2001). In a meta-analysis of 28 studies exam-
ining working memory in children with reading
disabilities, Jerman and Lee (2005) found a large
mean effect size 0.89 (SE = 0.8) indicating that children
with reading disability were impaired on tasks asses-
sing working memory. Furthermore, Martinussen
and Tannock (2006) found impaired performance
across both verbal and visuospatial working memory
domains for children with reading disabilities.
However, some studies have found that the perform-
ance of children with reading disability is comparable
to that of typically developing controls (e.g. McGee,
Brodeur, Symons, Andrade, & Fahie, 2004).
In examining working memory, Rucklidge and
Tannock (2002) found evidence in support of the
cognitive subtype hypothesis. A double dissociation

was reported in that naming and working memory
deficits were characteristic of reading disability,
and inhibition deficits were characteristic of ADHD.
In contrast, the comorbid ADHD and reading disabil-
ity group exhibited both deficits in inhibition and
working memory. The comorbid group exhibited
more severe naming problems than the two single
disorder groups (Willcutt et al., 2001). This suggests
that the comorbid group had a more severe automa-
tisation problem than the children with ADHD or
reading disability only.
More recently, Peterson et al. (2017) tested a mul-
tiple cognitive predictor model of word reading,
math ability and attention in twins, aged 8–16 with
a history of attention, reading or math difficulties.
Each symptom was predicted by multiple cognitive
dimensions, some of which were shared across symp-
toms, e.g. processing speed predicted reading, math
and attention; verbal comprehension predicted
reading and math (Peterson et al., 2017). There was
no evidence that EF skills accounted for covariation
among these skill domains. Instead, specific EFs
differentially related to certain outcomes, for
example inhibition to attention. Peterson et al
(2017) interpreted their findings within the context
of a multiple deficit framework for neurodevelop-
mental disorders. Peterson et al.’s (2017) study is
limited by a number of factors. Firstly, as participants
were not formally diagnosed with dyslexia or ADHD it
may be that they present with a less severe symptom
profile than those meeting these criteria. Secondly,
the age range of participants is quite broad. This is
important due to the potential impact of brain devel-
opment during the age of 8–16 years on EF.
Many studies examining dyslexia and comorbid
dyslexia/ADHD mix the domains of working
memory they are assessing which may contribute
to mixed results. If working memory is divided into
verbal or auditory and visuospatial components,
auditory working memory deficits are more often
associated with dyslexia than with ADHD (Martinus-
sen & Tannock, 2006; Rucklidge & Tannock, 2002;
Swanson, Mink, & Bocian, 1999; Willcutt et al.,
2001), whereas visuospatial working memory
deficits are more pronounced in ADHD than dyslexia
(Marzocchi et al., 2008).
Understanding the co-morbidity of dyslexia
and ADHD
As dyslexia is known to co-occur with many other
developmental disorders, such as ADHD (Tannock,
JOURNAL OF COGNITIVE PSYCHOLOGY 729
1998), the identification of areas of difficulty
specific to dyslexia is complex. Children with dys-
lexia exhibit impairments in many of the same
domains as children with ADHD, including proces-
sing speed (De Jong et al., 2009; Ghelani, Sidhu,
Jain, & Tannock, 2004; Rucklidge & Tannock, 2002;
Shanahan et al., 2006; Smith, Taylor, Rogers,
Newman, & Rubia, 2002; Tannock, Martinussen, &
Frijters, 2000; Willcutt, Pennington, et al., 2005);
attention, auditory working memory (De Jong
et al., 2009; Rucklidge & Tannock, 2002; Tridas,
2007; Willcutt et al., 2003), response inhibition (De
Jong et al., 2009; Purvis & Tannock, 2000; Willcutt
et al., 2003) and visuospatial working memory (De
Jong et al., 2009; Martinussen & Tannock, 2006;
Purvis & Tannock, 2000).
Numerous theories for the co-occurrence of dys-
lexia and ADHD have been suggested. Models that
propose a single cognitive dysfunction that is
unique to each disorder cannot easily account for
the pervasive comorbidity between different dis-
orders (Willcutt et al., 2010). Studies of dimensional
measures of reading and ADHD symptoms report sig-
nificant correlations that are low to moderate in mag-
nitude (r = .2 − .5) (Bauermeister et al., 2005; Nigg,
Hinshaw, Carte, & Treuting, 1998; Willcutt et al.,
2001; Willcutt, Doyle, et al., 2005). Findings such as
this, have precipitated a reconceptualization of theor-
etical models of dyslexia and ADHD (Willcutt et al.,
2010). The multiple deficit model describes complex
disorders such as dyslexia and ADHD as hetero-
geneous conditions that arise from the additive and
interactive effects of multiple genetic and non-
genetic risk factors that lead to weaknesses in multiple
cognitive domains (Pennington, 2006; Sonuga-Barke,
Sergeant, Nigg, & Willcutt, 2008; Willcutt, Sonuga-
Barke, Nigg, & Sergeant, 2008). The high comorbidity
rates across these disorders suggest a similar cogni-
tive profile involving executive dysfunction.
Systematic studies of EFs in dyslexia, ADHD and
co-morbid dyslexia/ADHD groups indicate that,
while each disorder exhibits their own characteristic
deficits (e.g. poor response inhibition in ADHD, pho-
nological coding deficits in dyslexia, and both in the
co-morbid groups), all groups also exhibit abnormal-
ities with processing speed (Rucklidge & Tannock,
2002) and auditory working memory (Willcutt
et al., 2001). Furthermore, Willcutt et al. (2001) exam-
ined the performance of twin children with reading
disability, ADHD or reading disability and ADHD.
Findings indicated that the reading disability and
comorbid ADHD group was most impaired on
730 A. LONERGAN ET AL.
virtually all measures, including inhibition, set shift-
ing and auditory working memory (AVM) (Willcutt
et al., 2001). It is difficult to conclude from the
current research whether EF problems in comorbid
groups are (a) due to the presence of ADHD, (b) a
combination of both deficits found in dyslexia and
ADHD, or (c) a more severe profile in the co-
morbid group than either disorder alone. Clarity
regarding these issues has theoretical and practical
implications for understanding the role of EF
across these highly comorbid conditions and may
inform possible EF intervention across disorders.
Rationale and novelty of current study
Many studies have argued against the existence of
EF deficits in particular populations based on null
results that may have arisen from power limitations
due to poor task sensitivity and reliability or small
sample size, rather than reflecting a lack of impair-
ment (Snyder et al., 2015). Currently, there is substan-
tial discrepancy in the diagnostic terminology used
in research examining impairments in reading,
including dyslexia, reading disability/difficulty and
learning difficulty (Vellutino et al., 2004). To over-
come these limitations, the proposed meta-analysis
will primarily aim to review controlled studies exam-
ining inhibition, set shifting and auditory working
memory deficits in children with dyslexia. This aim
will help inform EF theory as it relates to the
symptom profile of children with dyslexia. This has
implications for informing possible interventions tar-
geting EF in children with dyslexia. Currently, no
known meta-analysis has systematically reviewed
these three EFs in children with dyslexia.
It is well known that all these EFs are problematic
in ADHD through previous meta-analyses (e.g.
Kasper et al., 2012; Lijffijt, Kenemans, Verbaten, &
van Engeland, 2005; Martinussen et al., 2005; Will-
cutt, Doyle, et al., 2005). However, considerably less
is known about the impact of comorbid ADHD on
EFs in children with dyslexia. The secondary aim of
this review will be to compare the EF profile of chil-
dren with dyslexia alone, and comorbid Dyslexia/
ADHD in order to gain an understanding of possible
shared and additive EF deficits across these groups.
This may contribute to EF theory as it relates to
deficits in reading alone and comorbid ADHD. This
can then inform EF intervention across disorders.
This meta-analysis aims to draw conclusions from
controlled studies, in examining the presence of
inhibition, switching attention and auditory
working memory deficits in children with dyslexia
and comorbid dyslexia and ADHD. The primary
outcome measure is response time as well as error
and accuracy rates in children with dyslexia. The sec-
ondary outcome measures are these variables in
children with co-morbid Dyslexia/ADHD. These
outcome measures have been chosen due to their
consistent use in controlled studies of dyslexia and
ADHD. This meta-analysis will add to the literature
by minimising the impact of the task impurity
problem by using consistent outcome variables
and comparing different EFs.
Dyslexia is known to consist of difficulties with the
phonological components of language (Hulme &
Snowling, 2009; Vellutino et al., 2004). In light of this,
traditional interventions for dyslexia have focused on
training phonological skills. However, increasing evi-
dence demonstrates that impairments associated
with dyslexia extend beyond reading and phonologi-
cal skills alone (Swanson, 2006). Growing research
points to the wide reaching detrimental impact of dys-
lexia on the academic functioning, attention, socio-
emotional well-being and adjustment of affected chil-
dren. These difficulties have the potential for a lifetime
negative impact on children’s mental health and occu-
pational and social functioning as they move into
adulthood. These difficulties have their counterparts
in the cognitive domain and cumulative research
points to the role of executive functions (EFs). This
research is being conducted in order to make a
novel contribution to EF theory by exploring the role
of EFs in difficulties associated with dyslexia and the
potential benefits of targeting EF for intervention.
Research exploring these skills has neglected examin-
ation of the possible impact of highly comorbid
difficulties, such as ADHD on the symptoms profile
of dyslexia. While ADHD is well known to be associated
with EF deficits, it is unclear if EF difficulties in children
with the comorbid conditions purely reflect the
influence of ADHD or are also present in children
with dyslexia. Increasing evidence indicates that chil-
dren who face the additive problems of both disorders
are at a greater risk for academic failure, psychosocial
consequences and poor long-term outcomes that
persist into adulthood. This meta-analysis aims to
address this gap, by also examining the impact of
ADHD symptoms on EF in children with dyslexia.
Method
The primary aims of this meta-analytic review were
to identify and describe published frameworks of

the role of inhibition, auditory working memory and
switching attention in dyslexia and to analyse
whether these EFs are deficits in children with dys-
lexia as compared to typically developing controls
(TDCs). A secondary aim was to understand EF
deficits in children with dyslexia alone and co-
morbid dyslexia/ADHD as compared to TDCs.
These aims were chosen to help develop EF theory
as it relates to dyslexia alone as well as co-morbid
with ADHD which may inform possible EF interven-
tions across disorders.
Study design
A literature search was conducted with the aim of
identifying controlled trials on EF in children with
dyslexia and co-morbid Dyslexia/ADHD. The EFs
switching attention, inhibition and auditory
working memory were the EFs of interest. The
meta-analytic review was designed according to
the methodology checklist and quality guidelines
proposed by PRISMA (2009). As the focus of the
review will be to explore the presence of EF
deficits, the systematic review method will be
based on quantitative analysis.
Search methods
Previous meta-analytic and systematic reviews of
dyslexia and comorbid dyslexia/ADHD were con-
sulted to develop and implement search strategies
to identify evidence relevant to the review objec-
tives. The search strategy was designed to be as
extensive as possible to identify all possible eligible
studies, which were refined according to the
inclusion and exclusion criteria detailed below.
ADHD only was not included as significant research
has already identified EF as a deficit in this disorder.
Search terms
Research where EFs were assessed, such as profiling
or intervention studies, were included if control con-
ditions involving a TDC group were present to allow
for the presence of EF deficits to be isolated. Only
studies published in English from 2000 to 2016 in
peer-reviewed journals or relevant grey literature
were included. Grey literature can be defined as
materials produced on levels of governmental, aca-
demic, business and industry in print and electronic
formats, but which is not controlled by commercial
publishers (Hopewell, Clarke, & Mallett, 2005) (e.g.
JOURNAL OF COGNITIVE PSYCHOLOGY 731
conference abstracts, research reports, book chap-
ters, unpublished data, dissertations and policy
documents). The reference lists from included
studies were screened to ensure data saturation.
Grey literature was examined through advanced
search options in Google Scholar. A search of the
major databases, PsycINFO, MEDLINE and CINAHL,
was conducted using combinations of search
terms relating to each EF of interest, i.e. (inhibit*
OR “interference control” OR “response suppress*”
OR “executive function*” OR “executive dysfunc-
tion*” OR “dysexecutive syndrome” OR “executive
control”); (“switch* attention*” OR “attention*
switch*” OR “mental flexib*” OR “cognitive flexib*”
OR “switch cost” OR “switch dysfunc*” OR “cognitive
control*” OR “switch deficit*” OR “response switch*”
OR “attention* shift*” OR “shift* attention*” OR “set
shift*” OR “task switch*” OR “switch* task”);
(“working memory” OR “updating memory” OR
“updating working memory” OR “memory updat-
ing”) were combined with terms for dyslexia and
Dyslexia/ADHD, i.e (Dyslexi* OR “Reading Disab*”
OR “Reading difficult*” OR “Learning disab*
reader*” OR “Reading disorder*” OR “Specific learn-
ing disab*” OR “Specific learning difficult*” OR
“Learning difficult*”). and (ADHD OR “Attention
deficit hyperactivity disorder*” OR ADD OR “Atten-
tion deficit disorder” OR “Attention-deficit/hyperac-
tivity disorder*” OR AD/HD OR inattention) and
terms for children or adolescents (i.e. “child* and
adol*” OR child* OR adol* OR “young people” OR
teen* OR juvenile OR “school age”) and finally with
terms for controlled studies (i.e. control*).
As both dyslexia alone and co-morbid dyslexia/
ADHD were of interest, a separate search was con-
ducted using the search terms for both. The last
search was conducted on the 14 August 2016. In
total 295 articles were identified. After an initial
screening of titles, non-relevant articles, e.g. dupli-
cates, review articles, single case studies and uncon-
trolled articles (k = 160) were removed. Initial
screening of titles was conducted by two indepen-
dent researchers. Studies in which no diagnosis of
dyslexia was present (e.g. reading disability/
difficulty), were excluded to control for the high
degree of variability in how reading disorders were
assessed and defined across studies. Studies were
selected for review if they had a group design,
included a homogenous group of cases, were con-
trolled studies and utilised reliable baseline
measures of target EFs. A second independent
researcher extracted data relating to
732 A. LONERGAN ET AL.
methodological features present in a randomly
selected sub-sample of 23% of studies (k = 6).
Inter-rater agreement was 86% on methodological
features present. Where inconsistencies were
present this was discussed and agreement reached
on appropriate coding.
Applying the above search criteria, 133 articles
were screened at abstract level and 124 studies
were assessed at full text level. A second indepen-
dent researcher screened all titles to ensure consist-
ency of selection for full review. Inter-rater
agreement was 91% on articles selected for full
review. A third independent researcher screened
articles where there was disagreement and indi-
cated if these should be screened at full article
level. In total 26 studies were selected for inclusion
in this meta-analysis. The literature search flow is dis-
played in Figure 1.
Overview of studies
The characteristics of the 26 studies selected for
review are given in Table 1. All studies were pub-
lished between 2000 and 2016. Studies were cate-
gorised into three groups based on type of EF in
order to control for the possible differential profile
of EFs; (i) inhibition (k = 12) (ii) switching attention
(k = 8); and (iii) auditory working memory (k = 14).
The limited number of controlled studies examining
EFs in children and adolescents diagnosed with dys-
lexia and/or co-morbid dyslexia/ADHD necessitated
the use of a relatively small number of studies. The
combined number of children and adolescents
across studies is N = 1,611; in the dyslexia (N = 729),
co-morbid dyslexia/ADHD (N = 82) and control
groups (N = 800). Participants’ ages ranged from 5
to 18 years, with the majority being male. Partici-
pants included in selected studies were referred
through multiple sources including schools, mental
health and medical professionals. All studies
included a measure of the EFs inhibition, switching
attention or auditory working memory.
Methodological features
Methodological features of all studies included in
this review are summarised in Table 2. All studies
included a measure of EF, a control group and diag-
nostically-homogeneous groups. Six studies detailed
the presence of co-morbid difficulties, while the
remaining studies highlighted co-morbid difficulties
as exclusion criteria. All studies included measures of
the EFs of interest collected by researchers. All
studies included participants diagnosed with dys-
lexia. The statistical significance of differences
between groups was reported in all studies. Data
on concurrent treatment at the time of assessment
were given in five studies; all of these related to
the use of medication. No studies detailed the pres-
ence of any current dyslexia interventions that may
impact EF. Twenty-two studies provided information
relating to the assessment of IQ or general cognitive
abilities in both clinical and control groups. This con-
trolled for the potential impact of differences in
general cognitive functioning outside of EFs on
symptomology. The studies reviewed here are
sufficiently well designed to allow relatively reliable
conclusions to be drawn about the types of EFs they
evaluated.
Substantive findings
Tables 3 and 4 contain summaries of the results of all
26 studies. Studies were grouped into three cat-
egories based on type of EF: (i) inhibition (ii) switch-
ing attention, and (iii) auditory working memory. The
primary outcome was performance of the dyslexia
group on measures of reaction time, error rates
and accuracy. The performance of children with
co-morbid dyslexia/ADHD on these same measures
was a secondary outcome of interest. All studies uti-
lised a researcher-administered standardised assess-
ment of the EFs of interest. Cohen’s d standardised
mean difference was calculated using DeFife’s
(2009) effect size calculator for all variables of inter-
est. The effect sizes calculated where weighted
based on sample size. Following Cohen’s (1992)
interpretation guidelines, effect sizes of 0.2 were
considered small, 0.5 medium, and 0.8 large. Given
many participants required medication as part of
their standard medical care for ADHD, use of medi-
cation was not exclusionary as long as this was con-
trolled for via the use of a comparison group. As
many studies took part in different countries, type
of language orthography was not used as an exclu-
sionary criterion. It is important to note that studies
from different countries/orthographies mean that
dyslexia is measured/differentially captured to
studies with English as the primary language. As per-
formance on reading tasks was not assessed, the
impact of orthography on outcomes is likely
limited. Due to the high variability in the operationa-
lisation of reading difficulties, absence of a diagnosis
of dyslexia was exclusionary. However, differences in
 JOURNAL OF COGNITIVE PSYCHOLOGY 733

Records identified through database Additional records identified through

searching (k = 295) other sources (k = 9)

Records after duplicates removed

(k =133)

Records screened (k = 133)

Full-text articles excluded,

with reasons (k = 98)

No control group,
participants not children or
Full-text articles assessed for eligibility adolescents, no diagnosis of
(k = 124) dyslexia, review paper, case
study, single group design or
process articles, presence of
co-morbid difficulties beyond
ADHD, inconsistent
measures, did not assess EFs
of interest, Pre 2000, required
Studies included in meta-analysis (k = 26) data for meta-analytic
calculations not provided,
non-English language.

Meta-analyses:

1. Inhibition: dyslexia (k =12), comorbid

dyslexia/ADHD (k = 1)
2. Switching attention: dyslexia (k = 8);
comorbid dyslexia/ADHD (k = 2)
3. AWM: dyslexia (k = 14); comorbid
dyslexia/ADHD (k = 3)

Figure 1. Literature search and study categorisation flow.

how this is diagnosed across countries in which
English is not the primary language is an important
limitation to note as it may impact severity of poss-
ible EF deficits in children diagnosed with dyslexia
across countries.
Inhibition
Design
Participants across all 12 inhibition studies were
demographically similar and assigned to a control
or dyslexia group based on diagnosis. Inclusion cri-
teria were children aged under 18 years, meeting
diagnostic criteria for dyslexia and/or dyslexia and
comorbid ADHD. One study classified a group as
dyslexia/co-morbid ADHD symptoms. Children
were classified as having significant ADHD symp-
toms in this study if they had six or more symptoms
in either the inattention or hyperactivity/impulsivity
domain, as rated by either their parent or teacher. Of
the 42 children meeting these criteria, 15 already
had a diagnosis of ADHD. Eight studies classified
the presence of a co-morbid psychiatric disorder as
exclusionary criteria. Control groups consisted of
children and adolescents with no known difficulties
and average intellectual ability.
Measures
Reaction time was measured in ten studies. Six of
these assessed reaction time during the interference
trial of the Stroop task, while three studies measured
reaction time using the SSRT of the stop signal task.
The Stop Signal Reaction Time (SSRT) is calculated by
subtracting each child’s mean stop signal delay from
their mean reaction time, providing an index of the
 734
Table 1. Characteristics of studies included in meta-analysis.
Study Study Mean age & Co-morbid
No. type Authors Year Country N per gp range Gender diagnosis Measure EF measured Referral Study setting

A. LONERGAN ET AL.
1 CS Bexkens, van den 2015 Netherlands D = 28 D = 10.11 D = m 60% None present SSRT Inhibition School teachers, parents, –
Wildenberg, and Tijms C = 31 C = 11.2 D = f 40% psychological &
9–12y C = m 53% educational services
C = f 47%
2 CS Gooch, Snowling, and 2011 United D = 17 10.23y m 61% 20% D/ADHD/AS SSRT Listening recall Inhibition, CAMHS School –
Hulme Kingdom D/ADHD = 25 5.58y – 14.75y f 39% AWM
C = 42
3 CS Moores and Andrade 2000 United D=9 15y – None present Go Gap Stop task RT, Inhibition – University
Kingdom C=7 14–16y Errors
4 CS Schmid, Labuhn, and 2011 Germany D = 20 D = 9.7 m 58% None present SSRT Inhibition Psychiatrists Schools University
Hasselhorn C = 16 C = 9.3 f 42%
5 CS Helland and Asbjørnsen 2000 Norway D = 25 D = 13.07y D = m 76%, f 24% 53% pre-school SLI SI RT & Accuracy Inhibition, Schools Schools OP
C = 20 C = 12.11y C = m 80%, f 20% (excluded from WCST Perseverative SA Clinicians clinic
analysis) errors
6 CS Faccioli, Peru, Rubini, 2008 Italy D=7 8–10y m 57%, f 43% None reported Stroop, Colour word Inhibition – –
and Tassinari C=7 RT
7 CS Protopapas, Archonti, 2007 Greece D = 16 D = 10 – 13y D = m 75%, f 25% None present SI RT & Errors Inhibition Psychiatric Hospital Psychiatric
and Skaloumbakas C = 72 C = 11y – 13y C = m 49%, f 51% School Hospital
School
8 CS Reiter et al. 2005 Germany D = 42 D = 10.8y m 62%, f 38% None present Stroop; Interference Inhibition, Psychologist –
C = 42 C = 10.6y RT & errors SA, AWM
MCST; Accuracy, PE,
BDS
9 CS Kapoula et al. 2010 France D = 10 D = 15.1 – None present SI errors Inhibition School –
C = 14 C = 14.3
12–15y
10 CS de Lima, Azoni, and 2013 Brazil D = 20 9y D = m 55%,, f 45% None present Stroop; Colour Word Inhibition, OP clinic University
Ciasca C = 20 7–11y C = m 50%, f 50% RT, Errors SA School
TMT B RT, Errors
11 CS Brosnan et al. 2002 United D = 30 D = 14y – None reported GEFT Accuracy Inhibition School –
Kingdom C = 30 C = 13.8y
13–14y
12 CS Tiffin-Richards et al. 2008 Germany D = 20 10–14y m 75%, f 25% ADHD 34% WCST adaptation SA, AWM OP clinic OP clinic
D/ADHD = 20 11.8y Perseverative error, School
C = 19 BDS
13 CS Moura, Simões, and 2015 Portugal D = 50 8–12y D = m 74%, None present TMT B RT SA Medical, Psychological, –
Pereira C = 50 9.8y f 26% educational professions
C = m 64%, f 36% and parents
14 CS Cruz-Rodrigues, Barbos, 2014 Brazil D = 39 8–12y m 64%, f 36% None present WCST Accuracy, BDS SA, AWM Medical, Psychological, OP clinic &
Toledo-Piza, Miranda, C = 34 10.66y educational professions Schools
and Buen & parents
15 CS Palmer 2000 United D = 16 14y m 69%, f 31% None present WCST Perseverative SA Schools –
Kingdom C = 16 12 −18y errors
16 CS Poljac et al. 2010 Netherlands D = 25 12–18y m 80%, f 20% ADHD 4% Matching task RT, SA Schools
C = 27 errors
17 CS Lewandowska et al. 2013 Poland D = 57 9–13y m 67%, f 33% None present BDS AWM Psychological, University
C = 40 11y counselling centre Schools
18 CS Maehler and Schuchardt 2016 Germany D = 31 7–10y m 61%, f 39% D/ADHD 37% BDS AWM Counselling centre –
D/ADHD = 37 9y
C = 31
19 CS Maehler and Schuchardt 2011 Germany D = 20 7–10y m 53%, f 47% None present BDS AWM – –
C = 25 8y
20 CS Schuchardt, Maehler, 2008 Germany D = 30 7–10y D = m 60%, f 40% None present BDS AWM Counselling centre Schools
and Hasselhorn C = 30 9y Schools
21 CS Göthe, Esser, Gendt, and 2012 Germany D = 21 7–8y – None present BDS AWM Research study School, home,
Kliegl C = 20 7.8y laboratory
22 CS Layes, Lalonde, Mecheri, 2015 Algeria D = 36 10.7y m 71%, f 29% None present Word span AWM __ __
and Rebaï C = 20
23 CS Chung, Ho, Chan, Tsang, 2013 China D = 26 12–15y m 56%, f 44% None present Listening recall AWM Schools –
and Lee C = 26 13.8y
24 CS Helland and Asbjørnsen 2004 Norway D = 12 10–16y m 66%, f 34% Preschool language BDS AWM Psychologist OP clinic
C = 20 12.4y impairment 6%
25 CS Chik et al. 2012 China D = 101 9.7y – None present Listening recall AWM Schools –
C = 101
26 CS Jeffries and Everatt 2004 United D = 21 10.9y m 88%, f 13% None present Stroop interference Inhibition, Schools –

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Kingdom C = 40 RT, BDS AWM
Note: CS = A controlled study. D = Dyslexia, C = Control, D/ADHD = comorbid dyslexia & ADHD, AWM = Auditory Working Memory, SA = Switching attention, m = male, f = female, RT = reaction time, SSRT = Stop signal
response task reaction time, SI = Stroop Interference, GEFT = group embedded figures test, TMT = Trail making Test, BDS = Backward Digit Span, WCST = Wisconsin Card Sorting Task, CAMHS = Child and Adolescent
Mental Health Service.

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A. LONERGAN ET AL.
Table 2. Methodological features of executive function studies.
Study Number
Feature S1 S2 S3 S4 S5 S6 S7 S8 S9 S10 S11 S12 S13 S14 S15 S16 S17 S18 S19 S20 S21 S22 S23 S24 S25 S26
Control group 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
Diagnostic homogeneity 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
Comparable for co-morbidity 0 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0
Demographic similarity 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
Baseline assessment 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
Diagnosis present 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
Parent’s ratings 0 1 0 1 0 0 0 1 0 0 0 1 0 1 0 0 0 1 0 0 0 0 0 1 0 0
Child’s symptom assessed 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
Teacher ratings 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0
Researcher ratings 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
Clinician ratings 0 0 0 0 1 1 1 1 1 1 1 1 1 1 0 0 1 0 0 0 0 0 0 1 0 0
Differences in general cognitive abilities/IQ assessed 1 1 1 1 1 1 1 0 0 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0
Statistical significance of difficulties assessed 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
Data on concurrent treatment given 0 1 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 1 0 0 0 0 0 0 0 0
Total 9 13 9 10 11 10 10 10 10 11 9 13 11 11 10 10 11 13 9 9 9 9 9 12 9 8
Note: S = study. 1 = design feature was present. 0 = design feature was absent.
Table 3. Summary of results of effects of executive function tasks on reaction time, error rate and accuracy.
Study Number and condition
S1 S2 S3 S4 S5 S6 S7 S8 S9 S10 S11 S12 S13 S14 S15 S16 S17 S18 S19 S20 S21 S22 S23 S24 S25 S26
D D D/ADHD D D D D D D D D D D D/ADHD D D D D D D D/ADHD D D D D D D D D
V V V V V V V V V V V V V V V V V V V V V V V V V V V V V
Variable C C C C C C C C C C C C C C C C C C C C C C C C C C C C C
Reaction time
Inhibition 0.3 0.2 0.5 0.1 0.4 1.2 1.7 1.2 0.5 – 0.6 – – – – – – – – – – – – – – – – – 0.0
Set shifting – – – – – – – – – – 0.6 – – – 0.8 – – 0.7 – – – – – – – – – – –
Working memory – – – – – – – – – – – – – – – – – – – – – – – – – – – – –
Error rate
Inhibition – – – 0.2 – – – 0.5 0.3 0.9 0.7 – – – – – – – – – – – – – – – – – –
Set shifting – – – – – 0.3 – – 0.3 – 0.9 – 0.5 0.8 – – 3.3 .6 – – – – – – – – – – –
Working Memory – – – – – – – – – – – – – – – – – – – – – – – – – – – – –
Accuracy
Inhibition – – – – – 1.0 – – – – – 1.2 – – – – – – – – – – – – – – – – –

JOURNAL OF COGNITIVE PSYCHOLOGY

Set shifting – – – – – – – – 0.4 – – – – – – 3.8 – – – – – – – – – – – – –
Working Memory – 0.2 0.3 – – – – – 0.5 – – – 1.1 1.5 – 4.5 – – 0.4 0.6 0.4 0.9 0.7 0.2 1.7 1.3 1.3 0.7 1.5
Note: D = Dyslexia group, C = Control group, D/ADHD = comorbid dyslexia and ADHD group.

737
 738
Table 4. Summary of main findings of 26 evaluation studies of executive function.
Study Study Group
No. type Authors Year N per group EF differences Key Findings

A. LONERGAN ET AL.
1 CS Bexkens et al. 2015 1. D = 282. C= 31 Inhibition 1=2 . Children with dyslexia differed from controls on naming speed, literacy skill, phonological processing
and processing speed, but not on inhibition as measured by SSRT.

2 CS Gooch et al. 2011 1. D = 17 a. Inhibition a. 1=2=3 . There were non-significant trends for children with dyslexia to demonstrate a longer SSRT than
2. D/ADHD = 25 b. AWM b. 1=2=3 controls, reflecting greater difficulty with interference control. The comorbid D/ADHD group
3. C = 42 demonstrated a greater mean trend of difficulty in this area than both controls & dyslexia alone. D/
ADHD children demonstrated a mean trend of weaker AWM than controls & dyslexia alone.

3 CS Moores and 2000 1. D = 9 Inhibition 1=2 . Children with dyslexia demonstrated no significant difference in errors or RT during the GGS test of
Andrade 2. C = 7 inhibition compared to controls. Response inhibition may be an important component of the standard
SART, in which children with dyslexia were significantly weaker than controls.

4 CS Schmid et al. 2011 1. D = 20 Inhibition 1=2 . Children with dyslexia demonstrated a mean trend of longer SSRT than controls, suggesting greater
2. C = 16 difficulty inhibiting interference. The authors interpret findings as suggesting activation of
phonological strategies during performance of the stop signal task in controls, but not in dyslexia.

5 CS Helland and 2000 1. D = 25 a. Inhibition a. 1 > 2 . Children with dyslexia demonstrated a significantly longer RT & errors when demands where placed
Asbjørnsen 2. C = 20 b. SA b. 1=2 on their inhibition skills.
. Children with dyslexia showed a non-significant greater number of mean perseverative errors than
controls indicating a difficulty in SA. This difficulty only reached significance when comparing groups
based on overall errors.

6 CS Faccioli et al. 2008 1. D = 7 Inhibition 1>2 . Children with dyslexia responded significantly slower to incongruent stimuli during a Stroop task than
2. C = 7 controls. Greater demands placed on inhibition skills may result in a significant delay in response for
children with dyslexia.

7 CS Protopapas et al. 2007 1. D = 16 Inhibition 1>2 . Children with dyslexia had significantly greater deficits inhibiting non target stimuli in incongruent
2. C = 72 conditions as compared to congruent conditions. This was evident in significantly longer RT during
interference trials. However when examining number of errors on the colour word trial in isolation, no
significant differences were identified

8 CS Reiter et al. 2005 1. D = 42 a. Inhibition a. 1 > 2 . Children with dyslexia required significantly longer to inhibit during the Stroop & demonstrated a non-
2. C = 42 b. SA b. 1 = 2 significant mean trend of greater errors during interference trials. In SA, children with dyslexia
c. AWM c. 1 > 2 demonstrated a greater number of perseverative errors during the MCST which did not reach
statistical significance.

9 CS Kapoula et al. 2010 1.D = 10 Inhibition 1>2 . Teenagers with dyslexia made significantly more errors & required significantly more time than
2. C = 14 controls to inhibit interference. However insufficient data was available to calculate ES for RT.

10 CS de Lima et al. 2013 1. D = 20 a. Inhibition a. 1 > 2 . Children with dyslexia made significantly more errors during the interference trial of the Stroop than
2. C = 20 b. SA b. 1 > 2 controls. Children with dyslexia also demonstrated a mean trend of longer RT inhibiting distracting
stimuli. Findings suggest children with dyslexia have deficits in inhibitory control.
. Children with dyslexia demonstrated significantly greater difficulty than controls when SA, evident in a
significantly greater number of errors & longer RTs.
11 CS Brosnan et al. 2002 1. D = 30 Inhibition 1>2 . Children with dyslexia had significantly greater difficulty than controls accurately inhibiting the
2. C = 30 processing of distracting visual context to identify target parts of the stimuli.
12 CS Tiffin-Richards 2008 1. D = 20 a. SA a. 1 = 2 = 3 . In SA, children with dyslexia and D/ADHD did not demonstrate a significant deficit in comparison to
et al. 2. D/ADHD =20 b. AWM b. 2>1>3 controls as measured by perseverative errors.
3. C = 19 . Both dyslexia & D/ADHD groups demonstrated a significant deficit in AWM which may reflect a
cognitive overlap partly explaining the high rate of co-occurring dyslexia & ADHD. Mean trends
indicated children with co-morbid D/ADHD had greater AWM impairment than dyslexia alone.
13 CS Moura et al. 2015 1. D = 50 SA 1>2 . Children with dyslexia were found to take significantly longer than controls to SA during the TMT B
2. C = 50 task. They took significantly longer to complete TMT B in comparison to the sequencing TMT A,
thereby isolating a specific deficit in SA.
14 CS Cruz-Rodrigues 2014 1. D = 39 a. SA a. 1 > 2 . Children with dyslexia demonstrated significant deficits in AWM and SA as compared to controls.
et al. 2. C = 34 b. AWM b. 1>2 Deficits were identified in backward DS tasks & the WCST.
15 CS Palmer 2000 1. D = 16 SA 1>2 . Children with dyslexia demonstrated a significant deficit SA compared to controls, evidenced by a
2. C = 16 greater number of perseverative errors than controls.
16 CS Poljac et al. 2010 1. D = 25 SA 1>2 . Children with dyslexia demonstrated a significant switch-specific delay relative to controls. They took
2. C = 27 longer to switch task & made significantly more errors than controls. Authors interpret their findings as
reflecting switch specific deficits in dyslexia additional to deficits in general information processing
reported in the literature.
17 CS Lewandowska 2013 1. D = 57 AWM 1=2 . No significant difference between groups AWM measured by the backward DS was identified.
et al. 2. C = 40
18 CS Maehler and 2016 1. D = 31 AWM 1 = 2=3 . Findings identified no significant difference between groups AWM measured by backward DS.
Schuchardt 2. D/ADHD =37
3. C = 31
19 CS Maehler and 2011 1. D = 20 AWM 1>2 . Children with dyslexia performed significantly worse than controls on tasks of AWM. This pattern was
Schuchardt 2. C = 25 repeated on multiple AWM tasks not detailed in this review e.g. word span backwards.
20 CS Schuchardt et al. 2008 1. D = 30 AWM 1>2 . Children with dyslexia were found to have deficits in AWM evidenced by significantly weaker
2. C = 30 backwards DS compared to controls.
21 CS Göthe et al. 2012 1. D = 21 AWM 1=2 . Children with dyslexia exhibited a non-significant, mean lower backward DS than controls. Findings
2. C = 20 may reflect children with dyslexia performing equally to controls in AWM.
22 CS Layes et al. 2004 1. D = 36 AWM 1>2 . Children with dyslexia were found to perform significantly weaker than controls on word span task
2. C = 20 assessing AWM. Children with dyslexia accurately recalled significantly less words than controls.
Regression analysis showed that AWM was significantly associated with literacy.
23 CS Chung et al. 2013 1. D = 26 AWM 1>2 . Children with dyslexia exhibited significant deficits in AWM, recalling significantly less target words
2. C = 26 than controls. Approximately 50% of the adolescent readers with dyslexia had a deficit in AWM

JOURNAL OF COGNITIVE PSYCHOLOGY

associated with difficulties in processing, storage & retrieval of information & performing concurrent
cognitive activities.
24 CS Helland et al. 2004 1. D = 12 AWM 1>2 . A subgroup of children with dyslexia, without language comprehension impairments performed
2. C = 20 significantly worse than controls on a backward DS task assessing AWM. When not allowed to use
strategies e.g. finger counting, children with dyslexia accurately recalled significantly less digits than
controls.
25 CS Chik et al. 2012 1. D = 101 AWM 1>2 . Children with dyslexia demonstrated significant deficits in AWM compared to controls in a sentence
2. C = 101 recall task.
26 CS Jeffries and Everatt 2004 1. D = 21 a. AWM a. 1 > 2 . Children with dyslexia demonstrated a significant AWM deficit compared to controls in a backward DS
2. C = 40 b. Inhibition b.1 = 2 task.
. Children with dyslexia had a comparable RT to controls during the interference trial of the Stroop,
indicating no inhibition deficit impacting RT.
. Children with dyslexia demonstrated significant deficits in AWM compared to controls, on a backward
DS task.

Note: CS = Controlled Study, D = Dyslexia group, C = Control group, D/ADHD = comorbid dyslexia and ADHD group, TDC = typically developing controls, SA = Switching Attention, AWM = Auditory Working Memory, DS =
digit span, RT = reaction time, WCST = Wisconsin card sorting task, SSRT = Stop signal response time.

739
740 A. LONERGAN ET AL.
duration of the inhibitory process, independent of
mean reaction time (Gooch et al., 2011). A long
SSRT is indicative of poorer inhibition. One study
assessed reaction time during the Go Gap Stop
Test (GGST) of response inhibition. All these tests
assessed children’s speed of inhibition in compari-
son to typically-developing controls. Error rates
were collected in five studies. Four of these assessed
error rates during the interference trial of the Stroop
task while one study assessed error rate during the
GGST. Only two studies examined participant’s accu-
racy during measures of inhibition. One of these uti-
lised the group embedded figure test (GEFT) while
another examined accuracy during the interference
trial of the Stroop colour word test.
Results
Children with dyslexia were compared to controls
based on reaction time across ten inhibition
studies. Effect sizes for reaction time during inhi-
bition tasks ranged from 0 to 1.7. The mean effect
size was 0.62 (medium). For five studies, results indi-
cated that children with dyslexia had a significantly
longer reaction time than controls on tasks of inhi-
bition. However, in five studies differences in reac-
tion time between dyslexia and controls were non-
significant. In three of these, mean trends indicated
that children with dyslexia responded slower than
controls.
For the co-morbid dyslexia/ADHD group reaction
time data were available for one study comparing
this group and controls. The effect size was 0.5
(medium). These findings indicated that children
with comorbid dyslexia/ADHD demonstrated a
mean trend of longer reaction times, with a
medium effect size in comparison to controls. This
impairment was found to be somewhat worse
than that of dyslexia alone in Gooch et al.’s (2011)
study.
Dyslexia error rate was compared to controls
across five studies when inhibiting non target
stimuli. Effect sizes for error rates ranged from 0.2
to 0.9. The mean effect size was 0.5 (medium). For
two studies, results indicated children with dyslexia
made significantly more errors than controls on
tasks requiring inhibition. However, in three
studies differences in error rates between dyslexia
and controls demonstrated a non-significant mean
trend for higher errors in dyslexia. These findings
indicate that children with dyslexia have an
impaired ability to accurately inhibit irrelevant
stimuli, with a medium effect, in comparison to con-
trols. None of the studies identified included infor-
mation relating to inhibition error rates for children
with co-morbid Dyslexia/ADHD.
Two studies examined inhibition accuracy. Effect
sizes for accuracy were 1.0 and 1.2. The mean
effect size was 1.1 (large). Both of these studies
found that controls were significantly more accurate
than children with dyslexia when inhibiting irrele-
vant stimuli. No studies identified included inhi-
bition accuracy information for children with co-
morbid dyslexia/ADHD.
Switching attention
Design
Participants across all eight switching attention
studies were demographically similar and
assigned to a control or dyslexia group based on
diagnosis. Inclusion criteria were children aged
under 18 years meeting diagnostic criteria for dys-
lexia and/or comorbid dyslexia/ADHD. Four
studies classified the presence of a co-morbid psy-
chiatric disorder as an exclusionary criterion. One
study identified a single participant in the dyslexia
group as possessing a diagnosis of ADHD; no
other co-morbid difficulties were present. One
study contained comorbid ADHD as an inclusion
criterion, while the presence of medication or
any other comorbidity was exclusionary. Control
groups consisted of children and adolescents
with no known difficulties and average intellectual
ability.
Measures
Reaction time was measured in three studies. Two of
these utilised the Trail Making Task, Part B, while one
used a matching task. Error rate data was collected
in six studies. Four of these assessed perseverative
errors when required to switch task in the Wisconsin
Card Sorting Test (WCST) or an adaptation of a card
sorting task. Two studies assessed overall errors
during a switching attention task, as measured by
the TMT B and the matching task. Two studies exam-
ined accuracy while switching attention. One of
these examined the number of categories in which
participants successfully completed switching atten-
tion tasks in the WCST while another utilised the
Modified Card Sorting Test (MCST) to assess switch-
ing accuracy.
 JOURNAL OF COGNITIVE PSYCHOLOGY 741

Results group based on diagnosis. Inclusion criteria were

children aged under 18 years meeting diagnostic cri-
The reaction times of children with dyslexia were
teria for dyslexia and/or co-morbid Dyslexia/ADHD.
compared to controls across three studies. Effect
Three studies classified a group as having dyslexia
sizes for reaction times during switching attention
and co-morbid ADHD symptoms. Eight studies
tasks ranged from 0.6 to 0.8. The mean effect size
classified the presence of a co-morbid psychiatric
was 0.7 (medium effect). For two studies, results indi-
disorder as an exclusionary criterion. Control
cated children with dyslexia had a significantly
groups consisted of children and adolescents with
longer reaction time than controls when required
no known difficulties and average intellectual
to switch attention. For the co-morbid dyslexia/
ability. All tasks assessing auditory working
ADHD group reaction time data were not available.
memory did so in relation to participant accuracy.
These findings suggest that children with dyslexia
Consequently no reaction time or error rate data
have impaired reaction times, with a medium
are available for this variable.
effect, when required to switch attention in compari-
son to controls.
The outcome measure, error rate, was collected in Measures
six studies examining switching attention. Effect
The primary outcome, accuracy, was measured in
sizes for switching attention errors ranged from 0.3
14 studies. Ten of these assessed auditory
to 3.3. The mean effect size was 0.9 (large). For two
working memory accuracy using the backward
studies, results indicated that children with dyslexia
digit span task. Three studies utilised a listening
made significantly more switching attention errors
recall task in which participants were required to
than controls. For the comorbid dyslexia/ADHD
hold increasing verbal information in memory
group error rate data were available for one study.
while answering a comprehension question
The effect size for this study was 0.8 (large). Mean
related to the sentence, followed by recall of the
trends indicated that children with co-morbid dys-
last word in each sentence. One study measured
lexia/ADHD exhibited greater switching impairment
auditory working memory accuracy based on
than children with dyslexia alone and controls.
ability to recall a list of animals presented verbally,
However, this difference was not significant.
in a reorganised order.
Accuracy data were collected in two studies
assessing switching attention in children with dys-
lexia. The effect size for these studies varied con- Results
siderably from 0.4 to 3.8, the mean effect size was
Auditory working memory accuracy for children
2.1. For one study, results indicated that children
with dyslexia was compared to controls in 14
with dyslexia demonstrated a mean trend of accu-
studies. Effect sizes for accuracy during auditory
rately completing fewer items during a switching
working memory tasks ranged from 0.2 to 4.5. The
attention task; this effect was on the borderline of
mean effect size was 1.1 (large). Ten studies demon-
significance at .05 (Reiter et al., 2005). In contrast,
strated that children with dyslexia were significantly
Cruz-Rodrigues et al. (2014) found that children
less accurate in tasks assessing auditory working
with dyslexia were significantly less accurate than
memory than controls.
controls when switching attention. It is noteworthy
For the co-morbid dyslexia/ADHD group accuracy
that Cruz-Rodrigues et al. (2014) utilised ambiguous
data were available for three studies comparing
cards in the WCST while Reiter et al. (2005) did not in
these groups with controls. The effect sizes ranged
the MCST. No accuracy or reaction time data were
from 0.3 to 1.5. The mean effect size was 0.7
available in relation to comorbid dyslexia/ADHD
(medium). For one study the co-morbid group was
when switching attention.
significantly less accurate than both controls and
children with dyslexia alone. One study identified a
Auditory working memory non-significant trend towards reduced accuracy on
measures of auditory working memory than both
Design
controls and children with dyslexia alone. One
Participants across all 14 auditory working memory study identified no significant difference between
studies were demographically similar and assigned both controls and children with dyslexia alone and
to a control, dyslexia or co-morbid dyslexia/ADHD comorbid dyslexia/ADHD.
742 A. LONERGAN ET AL.
These findings indicate that children with dys-
lexia have impaired accuracy on auditory working
memory tasks, with a large effect size, in comparison
to controls. In contrast, a three-way comparison of
children with dyslexia only, co-morbid dyslexia/
ADHD and controls produced more varied results.
The comorbid group was found to demonstrate
somewhat impaired auditory working memory accu-
racy, with a medium effect, in comparison to con-
trols. Interpretation of results is limited by the
small number of studies examining a comorbid dys-
lexia/ADHD.
Discussion
This meta-analysis aimed to draw conclusions from
26 controlled studies, in examining the presence of
inhibition, switching attention and auditory
working memory deficits in children and adoles-
cents with dyslexia. As a secondary outcome the
impact of comorbid ADHD on EF in dyslexia was
also examined.
Inhibition
In terms of inhibition, children with dyslexia demon-
strated a greater impairment than TDCs, with a
medium effect, based on a longer reaction time (d
= 0.62) and a higher number of errors (d = 0.5). Fur-
thermore, children with dyslexia were less accurate
when required to inhibit (d = 1.1) non-target infor-
mation than controls with a large effect size.
Approximately half of the studies reported a signifi-
cant difference between children with dyslexia and
controls on this domain, while the majority of
remaining studies reported mean trends indicating
children with dyslexia experienced greater
difficulty inhibiting non-target stimuli. This is
largely consistent with literature reporting inhibitory
processing deficits in children with a reading disabil-
ity (Närhi & Ahonen, 1995; Nigg, 1999; Purvis &
Tannock, 2000; van der Schoot et al., 2000; Willcutt
et al., 2005). However, as with previous research
(Altemeier et al., 2008; Landerl et al., 2009; van der
Sluis et al., 2004), results are inconsistent, with
several studies identifying non-significant deficits
or no difficulties with inhibition at all.
These results are similar to the comorbid Dys-
lexia/ADHD group who also demonstrated a mean
trend of greater impairment in speed of response
during inhibition tasks (d = 0.5) than controls, with
a medium effect (Gooch et al., 2011). This
impairment was found to be somewhat worse
than that of dyslexia alone, but not to a significant
degree (Gooch et al., 2011). The relatively similar
effect sizes for the dyslexia alone and co-morbid
Dyslexia/ADHD studies reviewed contradicts
studies that found comorbid Dyslexia/ADHD rep-
resented a more severe subtype of ADHD and
reading disability than the children with reading dis-
ability alone (De Jong et al., 2006; Willcutt et al.,
2001). However, the comorbid Dyslexia/ADHD reac-
tion time data in the current meta-analysis are based
on one study (Gooch et al., 2011), limiting interpret-
ation of results. Findings may support a multiple
deficit model in which shared EF deficits may
underlie both disorders.
Switching attention
Children with dyslexia demonstrated greater impair-
ment than controls in switching attention reaction
time (d = 0.7) with a medium effect. They also
demonstrated a greater magnitude of errors (d =
0.9) and lower accuracy rates (d = 2.1) than controls,
with a large effect size. The majority of studies ident-
ified deficits ranging from mean trends to statisti-
cally significant difficulties. This indicates that
children with dyslexia experienced greater
difficulty in switching attention than controls. The
particularly large effect size for switching attention
supports the findings of Poljac et al. (2010) in
which children with dyslexia were slower and less
accurate on a switching attention task than control
children. This difficulty with general task execution
could be due to difficulties in visual processing,
including possible difficulties in inhibition of the sur-
rounding context (Brosnan et al., 2002), or due to
deficits in working memory already reported in the
literature on dyslexia.
Only one study was available which examined
switching attention errors in children with comorbid
Dyslexia/ADHD. Children with Dyslexia/ADHD
demonstrated a greater number of errors when
required to switch attention (d = 0.8) than controls
with a large effect size (Tiffin-Richards, Hasselhorn,
Woerner, Rothenberger, & Banaschewski, 2008).
Mean trends indicated that this difficulty was
worse than that of dyslexia alone, but not to a signifi-
cant degree (Tiffin-Richards et al., 2008). This sup-
ports the possible presence of a shared deficit in
switching attention in both dyslexia alone and co-
morbid Dyslexia/ADHD (Shanahan et al., 2006; Will-
cutt et al., 2003; Willcutt, Pennington, et al., 2005).

Auditory working memory
Children with dyslexia were found to be less accu-
rate when required to recall verbally presented
information (d = 1.1) than controls, with a large
effect. The large majority of studies included ident-
ified these deficits as significantly worse than for
controls. This indicates that children with dyslexia
exhibit deficits in auditory working memory as com-
pared to controls. This is consistent with previous
literature identifying working memory deficits in
children with reading disability (Barnea et al.,
1994; Breznitz, 1997; Chiappe et al., 2000; Poblano
et al., 2000; Vargo et al., 1995; Willcutt et al.,
2001). Additionally, it supports previous meta-ana-
lyses identifying a large effect of working memory
deficits in children with reading disabilities as com-
pared to controls (Jerman & Lee, 2005). These
findings contradict studies which found the per-
formance of children with reading disability to be
comparable to that of typically-developing controls
(e.g. McGee et al., 2004). This may be due to the
consistent use of auditory working memory
measures in this meta-analysis, while numerous
previous studies have mixed the use of auditory
and visual working memory tasks. It is possible
results would be different if all measures used
assessed working memory in the visual domain, or
were cross-modal.
Children with comorbid Dyslexia/ADHD were
found to be less accurate in tasks of auditory
working memory (d = 0.7) than controls, with a
medium effect. For one study the comorbid group
was significantly less accurate than both controls
and children with dyslexia alone (Tiffin-Richards
et al., 2008). However, the other two studies
included did not identify a significant difference
between both controls and children with dyslexia
alone and comorbid dyslexia/ADHD (Gooch et al.,
2011; Maehler & Schuchardt, 2016). This suggests
that comorbid ADHD does not result in more
severe auditory working memory deficits than in
dyslexia alone. However, it does indicate that both
clinical groups present with auditory working
memory deficits in comparison to controls. This
suggests auditory working memory may be a
shared deficit across neurodevelopmental disorders.
Broadly, these results support previous research
identifying working memory deficits in both ADHD
and dyslexia (Barkley, 1997; Castellanos & Tannock,
2002; De Jong, 1998; Pennington & Ozonoff, 1996;
Willcutt, Pennington et al., 2001).
JOURNAL OF COGNITIVE PSYCHOLOGY 743
Conclusions
Overall, children with dyslexia were found to have
difficulty with inhibition, switching attention, and
auditory working memory (with a medium to
large effect) relative to TDCs. Across all EFs, children
with dyslexia were found to have greater difficulty
relative to typically-developing children when per-
formance was assessed based on accuracy (large
effect) and error rates (medium-large effect),
rather than reaction times (medium effect). This
indicates that the chosen metric for interpreting
performance may be a factor leading to mixed
results relating to EFs in dyslexia. This supports
Wang et al.’s (2012) argument that a possible
reason for the inconsistencies between studies of
EF in dyslexia may be differences in measurement
tools used. Children with comorbid Dyslexia/
ADHD exhibited relatively the same degree of
impairment in terms of inhibition, switching atten-
tion and auditory working memory as children
with dyslexia alone. Findings have theoretical and
clinical implications for the need to assess for and
intervene when EF deficits are identified in children
with dyslexia. Furthermore, findings have prelimi-
nary theoretical implications for supporting EF as
a possible a shared deficit underpinning variants
of neurodevelopmental disorders. This may make
EF an important area for intervention where comor-
bidities of neurodevelopmental disorders such as
dyslexia and ADHD are present. However, these
findings are tentative due to the limitations dis-
cussed below.
Limitations and further research
This systematic review is limited by the relatively
low numbers of studies, particularly in relation to
co-morbid Dyslexia/ADHD. Studies from varied
languages of mixed orthographic depth were
included. This may have implications for the assess-
ment and diagnosis of dyslexia as well as symptom
severity across countries included. However, as per-
formance on reading tasks was not assessed, the
impact of this is likely minimal. In order to draw
on studies examining diagnostically-homogeneous
groups this review only included studies in which
a diagnosis of dyslexia was made. There is consider-
able debate over the validity of distinguishing
between children who have a large discrepancy
between reading ability and IQ (dyslexia) and
those who do not have this discrepancy (Fletcher,
744 A. LONERGAN ET AL.
Coulter, Reschly, & Vaughn, 2004). Lack of consen-
sus surrounding the choice of diagnostic measure
of reading disability is an important limitation to
existing research (Sexton, Gelhorn, Bell, & Classi,
2012). This review is also limited by the task impur-
ity problem whereby most studies on EF have used
only a single task to assess the EF processes of
interest, often resulting in a mixture of non-EF,
common EF (inhibition), and specific EF component
effects, making interpretation of the results difficult
(Snyder et al., 2015). This limitation was managed,
where possible, by using the same measures
across studies to address the specific EFs of inter-
est. As there have been few controlled studies
examining EF in children with dyslexia and comor-
bid dyslexia/ADHD a review of the literature has, at
times necessitated the inclusion of research which
is relatively old. This highlights the novelty of this
meta-analysis and reflects the current gap in the lit-
erature for research examining this topic. The limit-
ation was managed by the inclusion of controlled
studies published between 2000 and 2016 in
order to reduce the likelihood of excluding relevant
studies while also including as recent studies as
possible.
A limitation of this, and any systematic review is
possible publication bias. Publication bias occurs
when the publication of studies depends on the
nature and the direction of the results, so that pub-
lished studies may be systematically different from
those of unpublished studies (Dickersin, 1990;
Song, Hooper, & Loke, 2013). In general studies
with statistically significant or positive results are
more likely to be published than those with non-
significant or negative results (Song et al., 2010)
leading to systematic reviews potentially drawing
on biased information. In order to help manage
this, relevant grey literature was included in the sys-
tematic search in order to screen unpublished rel-
evant studies for inclusion as well as published
studies. As this review was examining baseline
measures of EF, rather than the impact of an inter-
vention publication bias is also minimised. The
small number of studies for each EF meant statistical
methods such as a funnel plot would not be appro-
priate in this study. However future studies may
benefit from the statistical examination of possible
publication bias if possible.
As the purpose of this meta-analysis was not to
test theories of comorbidity, it was beyond the
scope to include a group consisting of children
with ADHD only. This meant that theories such as
the cognitive sub-type hypothesis and multiple
deficit theory could not be directly tested.
However, as the presence of EF deficits in children
with ADHD alone is well established in current
research, inferences can be made as to whether
these theories fit with the broad results of this
study. Studies directly testing these theories with
the addition of an ADHD only group would
provide more conclusive evidence in this regard.
Finally, the large majority of included studies did
not indicate that the presence of ADHD symptoms
were screened for at baseline assessment. This
means that the possibility of an undiagnosed
ADHD profile in children with dyslexia alone
cannot be ruled out.
This meta-analysis highlights a number of impli-
cations for future research. Firstly, future studies
may benefit from examining the presence of EFs in
children with dyslexia where attention has been
specifically assessed and controlled for. This may
shed light on the potential impact of an ADHD
profile on dyslexia symptomology. Secondly, future
research may benefit from utilising multiple
measures of each EF to limit the task impurity
problem. Further well-controlled studies are
needed to examine the specific profiles of dyslexia
alone or combined with ADHD in comparison to
controls. This could potentially help explain
whether the deficits experienced by children with
dyslexia or co-morbid Dyslexia/ADHD represent sep-
arate profiles, shared deficits, or an additive effect of
EF difficulties. This could add to our theoretical
understanding of EF in the development of these
highly comorbid difficulties. Overall these findings
provide preliminary support for the presence of EF
deficits in children with dyslexia. This indicates this
is an important area for further research to inform
EF theory in dyslexia and possible intervention.
Better understanding of EF deficits in dyslexia may
have implications for evidence-based assessment
and intervention advancement, including enhan-
cing screening, prevention and treatment (Snyder
et al., 2015).
Disclosure statement
No potential conflict of interest was reported by the
authors.
Funding
The author’s have no funding to report.

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