Research in Developmental Disabilities 61 (2017) 44–54

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Research in Developmental Disabilities

Mathematical learning disabilities and attention deficit

and/or hyperactivity disorder: A study of the cognitive
processes involved in arithmetic problem solving
Valentín Iglesias-Sarmiento ∗ , Manuel Deaño, Sonia Alfonso, Ángeles Conde
Department of Evolutionary Psychology, University of Vigo, Campus As Lagoas, 32004, Ourense, Spain

a r t i c l e i n f o a b s t r a c t

Article history: Background: The purpose of this study was to examine the contribution of cognitive func-
Received 20 April 2016 tioning to arithmetic problem solving and to explore the cognitive profiles of children with
Received in revised form attention deficit and/or hyperactivity disorder (ADHD) and with mathematical learning
14 November 2016
disabilities (MLD).
Accepted 20 December 2016
Methods: The sample was made up of a total of 90 students of 4th, 5th, and 6th grade
Number of reviews completed is 2
organized in three: ADHD (n = 30), MLD (n = 30) and typically achieving control (TA; n = 30)
group. Assessment was conducted in two sessions in which the PASS processes and arith-
Keywords: metic problem solving were evaluated.
Attention deficit and/or hyperactivity
Results: The ADHD group’s performance in planning and attention was worse than that
disorder (ADHD)
of the control group. Children with MLD obtained poorer results than the control group
Mathematical learning disabilities (MLD)
Arithmetic problem solving in planning and simultaneous and successive processing. Executive processes predicted
Cognitive processes arithmetic problem solving in the ADHD group whereas simultaneous processing was the
unique predictor in the MLD sample.
Conclusions: Children with ADHD and with MLD showed characteristic cognitive profiles.
Groups’ problem-solving performance can be predicted from their cognitive functioning.
© 2016 Elsevier Ltd. All rights reserved.

What this paper adds

This work focused on the study of the cognitive functioning of two groups of students (MLD and ADHD) who have habit-
ually shown difficulties to solve the arithmetic problems proposed at school. The study expands the results of previous
research, drawing on a multidimensional approach based on the PASS theory, which provides alternative information about
the relation between general cognitive processes and performance in solving arithmetic problems. Although some correla-
tional studies relate cognitive processes to mathematics, they have not been carried out consistently in the specific sphere
of solving arithmetic problems with groups of children with MLD and ADHD. This same view is also innovative when inves-
tigating the differences between children with MLD and ADHD. In this sense, the use of the PASS model allowed obtaining
differential cognitive profiles for the two groups and linking their cognitive functioning to their performance in solving arith-
metic problems. Lastly, the study interpreted the results from a comprehensive position, which makes it possible to reconcile
the findings obtained with the different theoretical positions linked to the working memory and executive functioning.

∗ Corresponding author at: Departamento de Psicología Evolutiva y Comunicación, Facultad de Ciencias de la Educación, Universidad de Vigo, Campus
Ourense, As Lagoas S/N, 32004 Ourense, Spain.
E-mail address: visarmiento@uvigo.es (V. Iglesias-Sarmiento).

http://dx.doi.org/10.1016/j.ridd.2016.12.012
0891-4222/© 2016 Elsevier Ltd. All rights reserved.
 V. Iglesias-Sarmiento et al. / Research in Developmental Disabilities 61 (2017) 44–54 45

1. Introduction

Arithmetic problem solving is a complex mathematical activity that involves the mastery of different cognitive skills.
When faced with an arithmetic combination problem in 4th grade of Primary Education such as “My brother Carlos has twice
as many cards as me, and I have one third as many as my cousin Alexander, who has 18 cards. How many cards do we have
among the three of us?," the child must understand the problem (Lee, Ng, & Ng, 2009), understand the arithmetic operations
presented in the statement (Rasmussen & Bisanz, 2005), manipulate and understand the numerical relations established
therein (Fuchs et al., 2006), understand the type of problem on the basis of the arithmetic operations involved (Rittle-
Johnson, Siegler, & Alibali, 2001), and apply the strategies learned to solve it (Geary, Hoard, Byrd-Craven, & DeSoto, 2004).
Recent literature has suggested that these skills and specific strategies are necessary (e.g., Meyer, Salimpoor, Wu, Geary,
& Menon, 2010; Passolunghi & Mammarella, 2010) but insufficient to guarantee arithmetic problem solving because, at
different phases, their development and adequate implementation may demand more general cognitive processes that are
unrelated to mathematics (Swanson, Jerman, & Zheng, 2008).
At present, in spite of the remarkable advance of research, the general processes involved in students’ differential per-
formance are not fully understood. Some authors have lamented the lack of a multidimensional approach to cognitive
functioning to explain how the general processes work and how they relate to the specific skills in order to perform com-
petently (Fuchs et al., 2006; Preston, Heaton, McCann, Watson, & Selke, 2009). In this study, we propose an approach based
on the PASS model (Das, Naglieri, & Kirby, 1994) because of the theory’s comprehensiveness to explain the results gener-
ated in the literature from diverse theoretical positions and because of the possibilities of the Cognitive Assessment System
(CAS; Naglieri & Das, 1997) to analyze individual cognitive differences and identify disorders and learning disabilities (Das
& Naglieri, 2001).
In this context, the purpose of this study was to examine the differential contribution of cognitive functioning to arithmetic
problem solving in children who tend to perform poorly in this type of school task, such as those diagnosed with attention
deficit and/or hyperactivity disorder (ADHD) or mathematical learning disabilities (MLD). The study focuses on these two
disorders because of their comorbidity, incidence, and high rates of associated school dropout, and due to the commonality
of the cognitive variables used to characterize them. The use of the PASS model to study the underlying cognitive functioning
may allow an alternative interpretation of the profiles associated with these disorders and explain the specific contribution
of executive functioning and the processing system to arithmetic problem solving performance.

1.1. Cognitive description and arithmetic problem solving in MLD

It is estimated that between 3.6 and 9.8% of school children present difficulties in the field of mathematics (Lewis,
Hitch, & Walker, 1994; Barbaresi, Katusic, Colligan, Weaver, & Jacobsen, 2005). Approximately 30% of these difficulties may
be specific or associated with other neurodevelopmental disorders, such as ADHD (Zentall, 2007). Analyzed as a group,
students with MLD have been described as presenting specific alterations in number sense (Geary, 2011), in the retrieval of
facts from the long-term memory (Swanson & Jerman, 2006), and in the three working memory components (Toll, Van der
Ven, Kroesbergen, & Van Luit, 2011).
In recent years, visuospatial disabilities have been repeatedly suggested as the main focus of alteration in children with
MLD in the cognitive sphere (Meyer et al., 2010; Szucs, Devine, Soltesz, Nobes, & Gabriel, 2013), and differences have
even been observed between students with more severe disabilities and those who present low arithmetic achievement
(Passolunghi & Mammarella, 2010). More specifically, differences with peers have been found in tasks assessing the phono-
logical loop and the central executive (Mabbot & Bisanz, 2008; Passolunghi, 2011). Some investigations locate the origin of
the deficit of children with MLD in the executive function and, specifically, in inhibitory control (e.g., Geary, 2011; Murphy,
Mazzocco, Hanich, & Early, 2007). In this vein, there is some evidence of its predictive relations with mathematical achieve-
ment between ages 7 and 11 (St. Clair-Thompson & Gathercole, 2006), which seem to decrease with age (van der Sluis, de
Jong, & van der Leij, 2004).
In the specific sphere of this study, arithmetic problem solving has repeatedly been related to the working memory (e.g.,
Lee et al., 2009, Swanson, 2006). This relation is particularly relevant to the executive functioning (Swanson, 2011), globally
analyzed, and to the visuospatial sketchpad (Passolunghi & Mammarella, 2010). Meyer et al. (2010) observed a developmen-
tal tendency in their study whereby children in second grade needed the central executive and phonological processing to
transform problems into numerical representations but, in third graders, solving arithmetic problems depended only on visu-
ospatial representations. Passolunghi and Mammarella have also pointed out the specific contribution of inhibitory control
to arithmetic problem solving in diverse studies, although other investigations have failed to substantiate this relationship
(Lee et al., 2009; Swanson, 2006).

1.2. Cognitive description and arithmetic problem solving in ADHD

Recent research on ADHD has focused on locating the cognitive endophenotypes that allow relating the etiology of the
disorder to its behavioral manifestations (e.g., Doyle et al., 2005; Sowerby, Seal, & Tripp, 2011). Different studies seem to
indicate that, in the cognitive sphere, children with ADHD perform worse than expected in tasks of response inhibition
(Brocki, Randall, Bohlin, & Kerns, 2008, Preston et al., 2009), sustained attention (Sergeant, Geurts, Huijbregts, Scheres, &
46 V. Iglesias-Sarmiento et al. / Research in Developmental Disabilities 61 (2017) 44–54

Oosterlan., 2003; Zentall, 2007), planning (Boyer, Geurts, & Van der Oord, 2014; Shimoni, Engel-Yeger, & Tirosh, 2012),
visuospatial (Kasper, Alderson, & Hudec, 2012; Rapport et al., 2008), updating (Re, Lovero, Cornoldi, & Passolungui, 2016),
and phonological working memory (Brocki et al., 2008; Sowerby et al., 2011).
These difficulties in working memory and in planning and attention processes have been identified as being directly
involved in mathematical difficulties in general and in arithmetic problem solving in particular, resulting in these children’s
slowness, their problems to maintain and manipulate number information, difficulties to focus on the relevant data, follow
the necessary steps, and develop strategies to solve the problem (e.g., Lucangeli & Cabrele, 2006; Miranda, 2011). In addition,
some comparative research has pointed out the difficulties of children with ADHD, compared with their peers, to solve
ordinary mathematical tasks (Biederman et al., 1996; DeShazo, Barry, Lyman, & Klinger, 2002). Preston et al. (2009) have
related the poor mathematical performance in children with ADHD to their selective attention, due to their difficulties
to inhibit irrelevant information and to shift their attention. Zentall (2007) has related difficulties in sustained attention
with these children’s persistent problems to automate arithmetic facts. Other correlational studies have found predictive
relationships between working memory (phonological and visuospatial) and attention (sustained and selective) and the
arithmetic performance of children with ADHD (e.g. Antonini et al., 2016; Thorell, 2007).
The literature linking arithmetic problem solving in children with ADHD to cognitive processes is scarce and not very
clear, mainly with regard to the working memory. Lucangeli and Cabrele (2006) have pointed to planning as the necessary
process to maintain and organize the information in order to correctly solve a problem. It has also been established that, when
problem solving, students with ADHD work very fast and have obvious difficulties to set aside the irrelevant information
while processing the relevant information in the working memory (Zentall, 2007). These attentional difficulties related to
inhibitory control have been underscored in several investigations (e.g.; Passolunghi, Marzocchi, & Fiorillo, 2005; Re et al.,
2016).

1.3. An integrating view of cognitive functioning: the PASS theory

Das et al. (1994) formulated a neuropsychological theory of cognitive functioning that transcends the traditional view of
intelligence due to difficulties concerning the IQ and the instruments used to identify and intervene in learning difficulties
(Siegel, 1999). The PASS model was operationalized through the CAS test (Naglieri & Das, 1997) which has been shown to
be very sensitive to individual differences, disorders, and difficulties (Das & Naglieri, 2001) and to obtain cognitive profiles
that can serve to formulate intervention programs (e.g., Deaño, Alfonso, & Das, 2015; Iseman & Naglieri, 2011).
An interesting aspect of the model is the comprehensiveness of the theory to admit explanations based on other theoretical
models. Planning and attention have been linked to the executive function (Das & Misra, 2015), and poor performance in
these processes has been described as characteristic of the cognitive profile of children with ADHD (e.g., Deng, Liu, Wei,
Chan, & Das, 2011; van Luit, Kroesbergen, & Naglieri, 2005). Simultaneous and successive processing have been linked,
respectively, to spatial and phonological aspects of the working memory (Cai, Li, & Ping, 2013; Naglieri, Rojahn, & Matto,
2007) and indicated as being as deficient in children with MLD (e.g., Cai et al., 2013; Iglesias-Sarmiento & Deaño, 2016).
All four processes have been linked, at different levels, to academic achievement in mathematics (e.g., Iglesias-Sarmiento
& Deaño, 2011; Kroesbergen, van Luit, & Naglieri, 2003). Planning, considered by Das et al. (1994) as the process by which
the individual determines, selects, applies, monitors, and evaluates possible solutions to problems, self-regulating his/her
performance to achieve the desired goal, has recently been linked to the executive function (e.g., Cai, Georgiou, Wen, &
Das, 2016; Das & Misra, 2015). According to Best, Miller, and Naglieri (2011), planning, as assessed by the CAS, should be
considered a complex measure of executive functioning, covering, in each battery task, the functions of updating, inhibition,
and shifting included by Miyake et al. (2000) in their model of executive functioning. Following Goldberg’s (2001) hypothesis
about the frontal lobe, Naglieri et al. (e.g., Iseman & Naglieri, 2011; Naglieri, Goldstein, Iseman, & Schwebach, 2003) have
also noted that planning, understood in this way, seems to support the executive view based on inhibitory control and self-
regulation that was proposed by Barkley (2006) to characterize ADHD. In this sense, the studies carried out with children
presenting combined ADHD (ADHD-C) in the United States (Naglieri, Salter, & Edwards, 2004; Paolitto, 1999) have shown
that they only performed worse than their peers in the planning tasks of the CAS. From the mathematical domain, different
studies have related planning to global arithmetic achievement (Joseph & Hunter, 2001; Kirby & Ashman, 1984) and the
involvement of this process in arithmetic problem solving (e.g., Best et al., 2011; Cai et al., 2013). Recently, Cai et al. (2016)
have pointed out the relevance of planning, along with working memory, in the detection and intervention with children at
risk of developing mathematical difficulties.
Best et al. (2011) have also linked the tasks of the attention scale of the CAS to the executive function because all three
tests contained in the CAS are focused visual attention tasks in which subjects must maintain relevant information in the
short-term memory (sustained attention) and inhibit non-relevant information (selective attention). In this vein, some
studies carried out with heterogeneous samples of children with ADHD in Europe have found that these children score
lower than their peers not only in planning but also in attention (e.g., Taddei, Contena, Caria, Venturini, & Venditti, 2011; van
Luit et al., 2005), which Naglieri and Goldstein (2006) relate to the inattentive presentation of the disorder (ADHD-I). In the
mathematical domain, some studies have reported that attention may be important in arithmetic achievement, specifically,
for arithmetic problem solving (Kroesbergen et al., 2003). However, other studies have failed to find predictive relationships
between attention and arithmetic performance (Cai et al., 2013; Iglesias-Sarmiento & Deaño, 2011).
 V. Iglesias-Sarmiento et al. / Research in Developmental Disabilities 61 (2017) 44–54 47

The PASS theory proposes two processes to manipulate information, which would work in an integrated fashion in
most tasks. These processes are simultaneous processing, whereby the individual integrates the stimuli in a perceptive or
conceptual entirety, and successive processing, by which stimuli are integrated in a specific serial order (Das & Misra, 2015).
From a conceptual viewpoint, simultaneous processing has recently been related to visuospatial capacity (Naglieri et al.,
2007) and, empirically, to tasks that assess the visuospatial sketchpad of the working memory (Cai et al., 2013). Likewise, the
successive processing tasks of the CAS have been linked with verbal memory tests that assess the phonological component of
the working memory (Cai et al., 2013). Various comparative studies have pointed out that children with ADHD have obtained
average scores on both scales (e.g., Naglieri et al., 2004; Taddei et al., 2011) whereas children with MLD have a significantly
worse performance than their peers in simultaneous (e.g., Cai et al., 2013; Iglesias-Sarmiento & Deaño, 2016) and successive
processing (Iglesias-Sarmiento & Deaño, 2011; Kroesbergen et al., 2003). In fact, in the group with difficulties, the two
processes differentiate students with more severe deficits from those with low performance in the group with difficulties
(Iglesias-Sarmiento & Deaño, 2011). In the mathematical domain, recent correlational studies have pointed to simultaneous
processing as the best predictor of arithmetical achievement (e.g., Deng, Zuo, Li, & Das, 2007; Iglesias-Sarmiento & Deaño,
2016). The relevance of simultaneous processing in arithmetic problem solving has been associated with the need to integrate
the different elements to produce an adequate response (Das & Misra, 2015).

1.4. The present study

The initial purpose of this study was to provide new evidence of the differential contribution of cognitive functioning
to arithmetic problem solving in school children with ADHD and MLD between 4th and 6th grade of primary education.
Specifically, we intended to address two issues: (1) Is it possible to establish cognitive profiles of ADHD and MLD? and (2)
Can we predict the arithmetic problem solving performance of children with ADHD or MLD from their cognitive processes?
With regard to the associated profiles, on the basis of prior investigation, we can hypothesize that children with ADHD will
show a lower level of performance than a typically achieving control (TA) group in the executive processes of planning and
attention. Likewise, we hypothesize that children with MLD will have a lower performance than the TA group in planning and
successive and simultaneous processing. On another hand, we expect that executive functioning will specifically contribute
to the arithmetic problem solving performance of children with ADHD. In the sample with MLD, we expect that simultaneous
processing will be the best predictor of arithmetic problem solving.

2. Method

2.1. Participants

The sample of this study included a total of 90 students (53 boys and 37 girls) studying 4th, 5th, and 6th grade of primary
education in urban and semi-urban schools of two provinces of Galicia, which is located in the extreme northwest of Spain.
The socioeconomic environment of the schools is mainly linked to the agricultural and industrial sectors, and most of the
fathers and mothers of the participating subjects have secondary studies and a medium sociocultural level (Instituto Galego
de Estatística [Galician Institute of Statistics], 2016).
The 90 participants were assigned to three groups (ADHD, MLD, and TA) of 30 students, with 10 students of each group
assigned to each one of the educational levels. According to the reports provided by the clinical and educational professionals,
none of the children presented developmental disorders or sensory or cognitive deficits or special education needs due to
sociocultural aspects. Sample selection and allocation of the children to the experimental conditions were carried out with
different procedures.
With regard to the group with ADHD, given that the diagnostic route is usually clinical, we requested the collaboration
of associations and schools of the two indicated provinces. The group was made up using nonprobabilistic, convenience
sampling, based on the reports provided by the clinical professionals and the counselors. The 30 selected children (19 boys
and 11 girls) were assigned to the sample as a function of their clinical diagnosis of ADHD-C, their educational level (10
to each level), and their problems in the curricular area of mathematics. At the time of the study, some of the children
received a clinical diagnosis of ADHD-C by neuropediatricians or clinical psychologists, in accordance with the specifications
of Axis I of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; American Psychiatric
Association [APA], 2000) and others in accordance with the fifth edition (DSM-5; APA, 2013). In any case, the final criterion
adopted to participate in the study was that they met the criteria presented in the DSM-5 (APA, 2013), and that their clinical
diagnosis, in order to make it uniform, complied with the specifications of the assessment protocol of the disorder for the
Galician autonomous community (Xunta de Galicia, 2014). According to the reports provided by the educators, at some
point, all the children of the group showed curricular problems in the mastery of mathematics. The age of the children in
this group ranged between 8 years and 8 months and the 12 years and 8 months, with an average age of 10 years and 5
months. It transpired that 14 (46.7%) of the children were being medicated (methylphenidate and atomoxetine) at the time
of the evaluation.
Regarding the children of the TA and MLD groups, we followed quantitative criteria recently proposed in the spe-
cialized literature (e.g., Mazzocco, 2007), based on the performance in the total scale of the ‘Batería Neuropsicológica de
Evaluación de las Habilidades Aritméticas’ ([Neuropsychological Battery of Arithmetic Abilities Assessment]; BANEVHAR;
48 V. Iglesias-Sarmiento et al. / Research in Developmental Disabilities 61 (2017) 44–54

Iglesias-Sarmiento, 2009). The participants of both groups were selected from the total number of children in the indicated
sociodemographic context (n = 230) whose families gave their consent and who were studying 4th, 5th, and 6th grade in six
schools that agreed to participate. The operational criterion to select the children of the MLD group was having obtained a
score equal to or lower than percentile 10. Of stratum of students who met this criterion, 10 children were randomly selected
from each educational level for a total of 30 (18 boys and 12 girls). The age of these children ranged between 8 years and 5
months and 13 years and 2 months, with a mean age of 10 years and 6 months. Following the same random stratified formula,
30 children (16 boys and 14 girls) were allocated to the TA group, in this case, on the basis of their arithmetic performance
equal to or higher than percentile 26 on the scale. As in the two former groups, 10 children from each educational level were
selected. Their age ranged between 8 years and 7 months and 13 years, with a mean age of 10 years and 9 months.
The analyses conducted showed that the number of boys and girls in the groups was not significantly different, ␹2
(90) = 0.64, p > 0.05. As shown by the factorial ANOVA, no significant differences in mean age were found when the three
groups of mathematical competence were considered conjointly, F(2, 81) = 0.94, p > 0.05, ␩2 = 0.02. Significant differences
were found in the mean ages of the diverse educational levels, F(2, 81) = 138.20, p < 0.001, ␩2 = 0.77. Lastly, the factorial
ANOVA yielded no significant interaction between arithmetical competence and educational level with regard to mean age,
F(4, 81) = 0.43, p > 0.05, ␩2 = 0.02.

2.2. Measures

2.2.1. Cognitive processing

We used the Spanish adaptation of the CAS battery (Naglieri & Das, 1997) to assess the processes of planning, attention,
and simultaneous and successive processing. All the scales provide a global standard score (100, 15) calculated for each age
group in 6-month intervals. The reliabilities of the CAS for the Spanish sample (Deaño, Alfonso, & Fernández, 2006) were
calculated with the split-half procedure for all the simultaneous and successive subtests (except for speech rate), corrected
with the Spearman-Brown formula. For the subtests planning, attention and speech rate, we used retest. The mean reliability
of the sample of 1222 cases on each one of the scales was 0.90 (Planning), 0.89 (Attention), 0.92 (Simultaneous processing),
and 0.91 (Successive processing).
Planning, considered by Das and Georgiou (2016) as the cognitive process involved in cognitive functioning, is assessed
through tasks that oblige the child to formulate a plan of action, use efficient solutions, and to correct or reject the solution
when the task demands change. The Matching Numbers subtest requires the child to find and underline the two numbers
that are the same in the diverse rows that are presented. In the Planned Codes subtest, a legend at the top of each page shows
a correspondence of letters with codes. Children should fill in the appropriate codes in empty boxes beneath each letter. The
last subtest, Planned Connections, requires the children to connect numbers and letters appearing in a quasi-random order
on a page in sequential order.
The Attention scale requires the child to sustain attention and resist distractions to successfully complete the tasks. In the
Expressive Attention subtest, the children are asked to read the names of colors that are arranged haphazardly on a page, reveal
the colors of a series of rectangles, and name the color in which the words are written. In Number Detection, selectiveness
and the capacity to resist distraction are measured through the detection of specific numbers on a page containing many
distracters. The Receptive Attention subtest measures recognition of physically identical (e.g., T but not T t) and lexically
similar pairs of letters (e.g., A a but not A b).
The Simultaneous Processing scale includes tasks requiring the perception of the parts of a Gestalt, comprehension of
logical-grammatical relations, and synthesis of the parts in integrated groups, using both verbal and nonverbal content. All
this takes place through the examination of stimuli during the activity or through recall of the stimuli. In the Nonverbal
Matrices subtest, children are required to discover the relationships among the parts of an element. Verbal Spatial Relations
requires comprehension of logical and grammatical descriptions of spatial relationships. The child’s task is to choose, from 6
options, the drawing that correctly answers the question read by the evaluator and presented in written form at the bottom
of each page of stimuli. In the third subtest, Figure Memory, children are asked to identify the original figure, tracing all its
lines.
Lastly, the subtests of the Successive Processing scale require the children to use the information that is presented in a
specific order. In these subtests, children should reproduce a particular sequence of questions about events or responses,
which require the correct interpretation based on the linearity of the events (Das et al., 1994). In the first subtest, Word
Series, the children must repeat a series of frequently used monosyllabic words in the same order as stated by the examiner.
Sentence Repetition requires the children to repeat orally presented phrases that contain some semantic conflict. In the
last subtest, Sentence Questions, the children are required to respond to questions about the previous subtest. Successful
completion requires having understood the implicit meaning of the phrase.

2.2.2. Arithmetic problem solving

We used the test of arithmetic problem solving from the subtests of Learning Mathematics of the Psychopedagogical
Battery Assess (García & González, 2003) in its versions 4, 5, and 6, which assess the basic acquisitions of the mathematical
syllabus of 4th, 5th, and 6th grade of primary education. Each task presents 15 written arithmetic problems that imply
knowledge of numbers, the decimal number system, number sequences, the differences in value between numbers, and
the acquisition of the operations of addition, subtraction, multiplication, and division. The problems are formulated to pose
 V. Iglesias-Sarmiento et al. / Research in Developmental Disabilities 61 (2017) 44–54 49

Table 1
Descriptive Statistics.

Variable ADHD (n = 30) MLD (n = 30) TA (n = 30)

M SD M SD M SD

Arithmetic problem solving 23.61 20.33 8.87 9.01 63.00 21.92

Planning 89.63 11.75 89.23 9.46 97.03 11.01
Attention 84.83 12.85 93.43 11.05 96.30 14.81
Simultaneous 98.30 14.22 87.07 12.18 100.20 12.91
Successive 96.07 14.04 90.60 10.53 99.13 11.77

two main requirements: comprehension of the problem and selection of the adequate procedure to solve it. The final score
is recorded on a percentile scale directly linked to curricular performance, which allows situating the student’s results
with respect to a standard sample. The rates of reliability of the test, calculated by means of the Cronbach alpha internal
consistency coefficients, were 0.82, 0.92, and 0.85 for 4th, 5th, and 6th grade, respectively.

2.3. Procedure

The children with MLD and the TA group who participated in this study were assessed at their own schools. In the case of
the children with ADHD, when this was not possible, they were assessed in the associations where they receive psychoedu-
cational treatment. After receipt of the permissions from the family and the educational authorities, the assessments were
implemented individually in two sessions. In one session, the cognitive tests of the CAS were administered and in another
session, the mathematical tasks of the Evalúa test.
The study was carried out respecting the ethical standards applicable to this type of research established in general by the
Ethical Committee of Clinical Research of Galicia (CEIC). In this context, the relevance of the study was ensured, taking into
account the available scientific knowledge on the subject, an action protocol regarding the goals of the study was followed,
risks and drawbacks were assessed, a control group was established, a research follow-up was performed, the inclusion and
exclusion criteria of the participants were set, the suitability of research team was assessed, and appropriate compensation
was offered to all those involved (researchers and participating subjects).

3. Results

Table 1 presents the descriptive results of the groups. The results are organized in two sections. In the first one, group
contrasts are described. In the second section are presented the results of the hierarchical regression analysis.

3.1. Group analyses

The results were analyzed with various mixed ANCOVAs in which the independent variables were Group (three groups:
ADHD, MLD, and TA) and School grade (three grades: 4th, 5th, and 6th). The dependent variables were the results obtained
in arithmetic problem solving and in the PASS cognitive processes. Finally, age (at six-month intervals) and gender were
added as covariates in order to control their effect. We used the Bonferroni method for the post hoc contrasts.
The ANCOVA of the results obtained in the arithmetic problem solving test showed significant effects of group, F(2,
79) = 68.62, p < 0.001, ␩2 p = 0.635. No significant effects were found of school grade (p > 0.05) or of the Group x School grade
interaction (p > 0.05). The post hoc analyses showed that the MLD group obtained significantly lower scores than the ADHD
(p < 0.01) and TAgroups (p < 0.001). Significant differences were also found between the ADHD group and the TA group
(p < 0.001).
In planning, the ANCOVA yielded significant effects of group, F(2, 79) = 6.08, p < 0.01, ␩2 p = 0.133. No significant effects
were found of school grade (p > 0.05). No significant effects were found of school grade (p > 0.05) or of the Group x School
grade interaction (p > 0.05). The post hoc analyses indicated that the TA group performed significantly better than the ADHD
(p < 0.05) and MLD (p< 0.01) groups. No significant differences in planning were observed between the ADHD and MLD groups
(p > 0.05).
The ANCOVA performed on the results in attention also yielded main effects of group, F(2, 79) = 5.82, p < 0.01, ␩2 p = 0.128.
No significant effects were found of school grade (p > 0.05) or of the Group x School grade interaction (p > 0.05). The post hoc
contrasts showed that the ADHD group performed significantly worse than the MLD (p < 0.05) and TA groups (p < 0.01). No
significant differences were found between the performance of the children of the MLD and TA groups (p > 0.05).
In simultaneous processing, the ANCOVA revealed significant effects of group, F(2, 79) = 8.03, p = 0.001, ␩2 p = 0.169. No
significant effects were found of school grade (p > 0.05) or of the Group x School grade interaction (p > 0.05). The post hoc
analyses revealed that MLD group had a significantly worse performance than the ADHD (p < 0.01) and TA groups (p = 0.001).
No significant differences were found between the ADHD and TA groups (p > 0.05).
Lastly, the ANCOVA also yielded effects of group in successive processing, F(2, 79) = 3.44, p < 0.05, ␩2 p = 0.080. No signifi-
cant effects were found of school grade (p > 0.05) or of the Group x School grade interaction (p > 0.05). The post hoc contrasts
50 V. Iglesias-Sarmiento et al. / Research in Developmental Disabilities 61 (2017) 44–54

Table 2
Hierarchical Regression Analysis: Specific Contribution of the Cognitive Variables to Arithmetic Problem Solving in each Sample (Final Models).

Sample Variable Beta t p

Planning 0.43 2.17 0.039

Attention 0.38 1.96 0.061
ADHD
Simultaneous 0.01 0.08 0.932
Successive 0.04 0.25 0.802
Planning 0.13 0.83 0.414
Attention 0.24 1.58 0.126
MLD
Simultaneous 0.40 2.53 0.018
Successive 0.34 2.02 0.054

showed that the MLD group performed significantly worse than the TA group (p < 0.05). No significant differences were
found between the MLD group and the ADHD group (p > 0.05) or between the ADHD group and the TA group (p > 0.05).

3.2. Regression analysis

In order to analyze the contribution to arithmetic problem solving of the PASS processes, we conducted two hierarchical
regression analyses with two blocks of variables in each one (see Table 2). In the first model, the executive variables (planning
and attention) were included in the first block, and the second block included the variables related to the processing system
(simultaneous and successive processing). In the second model, the blocks were reversed, such that the first block included
the variables related to the processing system, and the second block included the executive variables. As in the case of the
correlational analyses, these analyses were performed separately for the ADHD and MLD groups.

3.2.1. Sample with ADHD

In the first model, Block 1, related to the executive variables, explained 58.2% of the variance in arithmetic problem solv-
ing, R2 = 0.582, F(2, 27) = 18.83 p < 0.001. When including simultaneous and successive processing in Block 2, the explained
variance did not increase significantly, R2 =0.003, Fchange (2, 25) = 0.08, p > 0.05.
The inversion of the blocks in Model 2 revealed that the variables related to the processing system barely explained 3%
of the variance, R2 = 0.03, F(2, 27) = 0.61, p > 0.05. However, when entering the executive variables (planning and attention)
in Block 2, the explained variance increased to 55.5%, R2 =0.555, Fchange (2, 25) = 16.56, p < 0.001.
The final model, which includes all four PASS cognitive variables, explained a total of 58.5% of the variance in arithmetic
problem solving in the ADHD sample, R2 = 0.58, F(4, 25) = 8.81, p < 0.001. In this case, as seen in Table 2, planning (␤ = 0.37,
t(25) = 3.32, p = 0.001) was the unique predictor for arithmetic problem solving. If only considering Model 1 (which was sig-
nificant), based on the executive variables, both planning (␤ = 0.45, t(27) = 2.60, p < 0.05) and attention (␤ = 0.38, t(27) = 2.18,
p < 0.05) predicted arithmetic problem solving performance.

3.2.2. Sample with MLD

In the first model of the sample of children with MLD, Block 1 (which included the executive variables of planning
and attention) only explained 12% of the variance of arithmetic problem solving, R2 = 0.12, F(2, 27) = 1.83, p > 0.05. The
introduction in Block 2 of the processing system variables captured 38% of the variance in arithmetic problem solving
performance, R2 =0.38, Fchange (2, 25) = 9.44, p = 0.001.
In Model 2, in which the introduction of the blocks was reversed, the processing system variables included in Block 1
explained 41% of the variance, R2 = 0.41, F(2, 27) = 9.52, p = 0.001. On another hand, the contribution of the executive variables
included in Block 2 was nonsignificant, R2 = 0.09, Fchange (2, 25) = 2.27, p > 0.05.
The final model for the MLD sample, which includes the four PASS processes, explained a total of 50% of the variance
of arithmetic problem solving, R2 = 0.50, F(4, 25) = 6.21, p = 0.001. As shown in Table 2, simultaneous processing was the
unique predictor (␤ = 0.40, t(25) = 2.53, p < 0.05). In Model 2 of the sample of children with MLD (which was statistically
significant), based on the processing system variables, simultaneous processing (␤ = 0.44, t(27) = 2.63, p < 0.05) was also the
unique predictor of performance in arithmetic problem solving.

4. Discussion

This study examined two issues concerning the differential contribution of cognitive functioning to arithmetic problem
solving in children with ADHD and MLD. Firstly, we wished to explore the cognitive profiles of children with ADHD and MLD.
The second issue of this study was to determine the cognitive predictors of performance in arithmetic problem solving in
both groups.
 V. Iglesias-Sarmiento et al. / Research in Developmental Disabilities 61 (2017) 44–54 51

4.1. Cognitive profiles

With regard to the first issue, the results of the study seem to confirm the initial predictions for the groups with ADHD
and MLD. Children with ADHD obtained worse results than the control group in the scales of Planning and Attention of the
CAS, whereas their performance in Simultaneous and Successive Processing was similar to that of their peers. These results
are congruent with the recently presented in studies carried out with European (e.g., Taddei & Contena, 2013; van Luit et al.,
2005) and Chinese children (Deng et al., 2011) with ADHD. In any case, the interpretation of the children’s performance in
attention is more controversial because the results of some investigations carried out with North American samples (Naglieri
et al., 2004; Paolitto, 1999) focused the executive deficit on the planning process. These discrepancies between the studies
could be due to the characteristics of the sample (van Luit et al., 2005). In our study, like in the cited North American studies,
the sample was only made up of students with ADHD-C, although incorporating the particularity of presenting academic
problems in mathematics. In this sense, to homogenize the results obtained, we recommend future research to perform a
comparative investigation of ADHD groups with and without difficulties and to describe these aspects in detail. Nevertheless,
the cognitive profile obtained in this study is consistent with the conclusions of research foreign to the PASS model that
has focused the executive deficits of children with ADHD on planning (Boyer et al., 2014; Shimoni et al., 2012), inhibitory
control (Brocki et al., 2008; Preston et al., 2009), and sustained attention (Sergeant et al., 2003; Zentall, 2007).
Secondly, the results of the study confirm the initial hypothesis that stated that children with MLD would have a cognitive
profile associated with a deficient performance in planning, and simultaneous and successive processing. Analyzed globally,
the results obtained with children from 4th, 5th, and 6th grade confirm and extend to this educational stage the results
obtained by Naglieri and Das (1987) in 2nd and 6th grade. In the case of planning, the results are congruent and extend the
predictions arising from some correlational (Cai et al., 2013; Naglieri & Das, 1997) and comparative studies with children
with MLD (Kroesbergen et al., 2003) in which mathematical achievement was linked to this process.
With regard to the processing system, the results of the study support the data of other comparative studies in which chil-
dren of different ages with MLD performed significantly worse than their peers in successive processing (Iglesias-Sarmiento
& Deaño, 2011; Kroesbergen et al., 2003) and, especially, in simultaneous processing (Cai et al., 2013; Iglesias-Sarmiento &
Deaño, 2016). In the light of the evident empirical relation between simultaneous processing and visuospatial constructs,
these results can also be interpreted as support for the conclusions of other research foreign to the PASS model that has
focused on the differences between children with MLD and their peers in tests assessing visuospatial aspects (e.g., Meyer
et al., 2010; Szucs et al., 2013).
The results of the MLD sample in attention are similar to those of other recent investigations (Cai et al., 2013; Iglesias-
Sarmiento & Deaño, 2011) that have found no differences with the control groups or any significant relationships between
attention and arithmetic performance. These results are contrary to the findings of Kroesbergen et al. (2003), who found
a significant contribution of this process to arithmetic problem solving performance. The differences between study of
Kroesbergen et al. and the current one are mainly due to the type of problems used and to sample characteristics related to
the number of cases, age, and selection procedure. In our study, the problems were presented in written form and included
various operations, the sample was smaller than that of the cited work, the children were older, and the selection procedure
was more restricted. Future research should analyze the influence of these variables in the relation between the attention
process and MLD. However, outside of the sphere of the PASS theory, some current investigations (e.g., Gilmore et al.,
2013; McClelland et al., 2014) have linked inhibitory control to arithmetic achievement, and it has also been noted that this
relationship declines with age (van der Sluis et al., 2004), an aspect that, together with the tests used for its assessment,
could explain the cited differences.

4.2. Cognitive predictors

Initially, the regression models seem to provide evidence in favor of the relevance of the cognitive processes in the
controversy about domain general and domain specific variables in the prediction of arithmetic problem solving performance
in children with ADHD (Willcutt, Doyle, Nigg, Faraone, & Pennington, 2005) and children with MLD (Butterworth, 2005).
The full model, with all four PASS variables, explains 58.5% of the variance in the case of the group with ADHD and 50% in
the sample with MLD.
Moreover, in the case of children with ADHD, the results of the analysis confirm the initial hypothesis stating that the
executive variables predict performance in arithmetic problem solving. When entered alone, both planning and attention
were predictors of arithmetic problem solving performance. This model, which was significant, explained 58% of the variance.
When using the full model, which includes all four cognitive variables, planning is the only predictor of performance. These
results are novel with regard to the study of arithmetic problem solving in children with ADHD from the PASS model. In
any case, from alternative theoretical positions, arithmetic problem solving performance has been linked to difficulties in
planning (Lucangeli & Cabrele, 2006) and inhibitory control (e.g., Marzocchi, Lucangeli, De Meo, Fini, & Cornoldi, 2002;
Passolunghi et al., 2005) due to the difficulties that these children have to organize and manipulate the relevant information
to solve the problem.
For children with MLD, the only predictor of arithmetic problem solving performance was simultaneous processing.
These results are also novel with regard to the relation between cognitive functioning and arithmetic problem solving in a
sample with MLD. In any case, they confirm the results obtained in studies in which the dependent variable was arithmetic
52 V. Iglesias-Sarmiento et al. / Research in Developmental Disabilities 61 (2017) 44–54

performance assessed globally (e.g., Cai et al., 2013; Iglesias-Sarmiento & Deaño, 2011). Our results also provide new evidence
supporting studies finding predictive relationships between the visuospatial sketchpad and arithmetic problem solving
performance in normal populations of the three school grades (Meyer et al., 2010; Swanson et al., 2008).

4.3. Conclusions and limitations

Summing up, the study provides new information concerning the differential contribution of cognitive performance
to arithmetic problem solving in school children with ADHD and MLD between 4th and 6th grade of Primary Education.
Compared to their peers, children with ADHD show an executive deficit, manifest in the processes of planning and attention.
In this sample, moreover, executive functioning was the predictor of arithmetic problem solving performance. On another
hand, children with MLD showed a deficit in planning and in the processing system. In the MLD sample, simultaneous
processing was the only predictor of performance in arithmetic problem solving. These data may be of interest in the
detection, diagnosis, and clinical and educational treatment of children with ADHD and MLD.
The main limitation of this study is the size of the groups with ADHD and MLD (30 in each group). However, the use of
restricted criteria, such as the selection of children from 4th, 5th, and 6th grade with ADHD-C and mathematical difficulties
for the ADHD group, or achieving a performance lower than percentile 10 and not having any comorbid disorders for the
MLD group, makes it more difficult to find large samples. On another hand, as the literature has been introducing variables
like reading performance, domain specific skills, or behavioral and socioaffective aspects in the performance of arithmetic
problem solving in general, and in populations with the studied variables in particular, it might be interesting to consider
them in future research. The use of longitudinal designs to allow establishing early predictors and more extensive analyses
is also recommended.

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