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S. Kathleen Krach, Ph.D., NCSP


Troy University

Michael P. McCreery, Ph.D.


University of Arkansas at Little Rock

W. Paul Jones, Ed.D.


Scott A. Loe, Ph.D.
Paul Stohlberg, M.S.
Kristen Bjork, M.S.
Leslie Hughes, M.S.
University of Nevada, Las Vegas

ADHD and Reading Fluency:

Predictive Validity of Rating Scales


and Computer-Based Diagnostic Tools
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Review of Literature
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Attention Deficit Hyperactivity
Disorder (ADHD): DSM-IV
Primary Symptoms Subtypes
 Inattention: poor sustained  ADHD: Predominantly
attention, disorganization, Inattentive
forgetfulness, and difficulty
listening and following
directions.  ADHD: Predominantly
Hyperactive-Impulsive
 Hyperactivity: squirming,
fidgeting, getting out of seat,  ADHD: Combined
inappropriately loud volume.

 Impulsivity: difficulty taking


turns, interrupting others, and
not waiting to provide an answer
to a question (blurts out).
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ADHD: The Great Debate
The International Consensus on ADHD

Barkley (and 85 others) 2002 Timimi (and 33 others) 2004


 ADHD exists.  Symptoms of ADHD may
actually be some other
condition or a systems issue

 Studies linking to neurological  Studies linking to neurological


impairments are conclusive. impairments are inconclusive.

 Studies linking to genetics are  Studies linking to genetics are


conclusive. inconclusive.
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Assessment Tools:
Rating Scales

 The primary method used in diagnosing ADHD is the use of


rating scales.

 Rating scale publishers indicate strong psychometrics

 Rating scales have issues with


 Inconsistency across cultural groups
 Inconsistency across gender
 Halo effects

(Domínguez de Ramírez & Shapiro, 2005; Hartung, et al., 2006; Jackson & King, 2004; Mann, et al,
1992; Pellegrini, 2011; Sciutto and Eisneberg, 2007)
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Assessment Tools: (CPT)
Continuous Performance Test
 CPTs often described as
measures of attention and
impulsivity

 Factors other than those


intended may affect CPT scores.
O
 Internal: client’s personality,
drugs, and motivation.
 External: white noise,
presence of an examiner, and
time of day.

Y
 Excellent job of identifying
those with ADHD; however,
tends to over diagnose those
without ADHD.

(Corkum & Siegel,1993; Schatz, 2001)


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Symptoms of ADHD are linked to

 Lower levels of academic


performance (Marshall, Hynd,
Handwerk, & Hall, 1997)

 Often experience a comorbid


diagnosis of learning
disability (Mayes, Calhoun, &
Crowell, 2000).
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LaBerge & Samuels:
Automaticity Theory
 Theory proposes a direct link
between reading fluency and
attention.

 As readers became more


adept, they focus less attention
on the specific
subcomponents needed to
process written language.

 With increased ability comes a


speed and ability to shift focus
from basic word reading to
reading comprehension.
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Reading Fluency: Subtypes

Accuracy and Speed Reading Impulsivity


 Accuracy: How well can you  A reader does not take the
read (words correct). time to process the entire
word or sentence before
 Reading Speed: How quickly determining it’s meaning.
can you read?
 Impulsive readers will read
the first phoneme and
 Accuracy by speed: How many examine the length of the
words can you read (and word.
understand) within a set
period of time.  Example: “Cat” becomes
“Car” but not “carpenter.”
 Assessed by scoring correct
items read in a timed situation.  Assessed by examining errors
made in reading.
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Research Questions

 Are ADHD rating scale scores an accurate predictor of


reading fluency and/or reading impulsivity scores?

 Are CPT scores an accurate predictor of reading fluency


and/or reading impulsivity scores?

 Do rating scales scores and CPT scores provide shared


information useful in predicting reading fluency and/or
reading impulsivity scores?
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Methods
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Participants

 91 undergraduate student  Race / Ethnicity


volunteers  4.4% Asian
 General population from  9.9% African American
College of Education  2.2% Native Hawaiian or
Pacific Islander
 Sex
 67% White Non Hispanic
 17% Male
 5.5% Hispanic
 74% Female
 11.0% Other
 Ages 18 – 45 (mean = 23 years,
SD = 5 years)
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Conners Adult ADHD Rating
Scales (CAARS)
Never Sometimes Often Always
Fake Sample Items
Other people say that I am loud.
I enjoy activities that require focus.
I have trouble staying organized.
I interrupt when others are talking.

 Scores Obtained
 Inattention/ Memory Problems
 Impulsivity/ Emotional Lability
 Hyperactivity/ Restlessness
 Problems with Self-Concept
 ADHD Index (Composite)
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WJ-III: Achievement Reading
Fluency
Fake sample items (timed)
Dogs moo at passing cars. Yes No
Businessmen often wear suits. Yes No
Giraffes have long necks Yes No
Computers can have a keyboard and a mouse. Yes No

•Forms: A and B (for this study)


•A = group
•B = individual

•Scores:
•Individual standard scores(# correct - # incorrect = raw score)
•Group standard scores (# correct - # incorrect = raw score)
•Difference scores (individual – group)
•Error scores (# of incorrect from A + # of incorrect from B)
+ Automated Neuropsychological Assessment
Matrices (ANAM): Procedural Reaction Time

 Example of Items
 2 & 3 are LOW numbers
4
(click left mouse for LOW)
 4 & 5 are HIGH numbers
(click right mouse for HIGH)

 Scores
 PRT1: Basic Block
 PRT:2 Intermittent Block 2
 Accuracy: # correct
 Efficiency: # correct per
minute
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Statistics
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Descriptive Statistics

Note. ANAM = Automated Neuropsychological Assessment Matrices. PRT1 = Procedural Reaction Time
Basic Block. PRT2 = Procedural Reaction Time - Time Uncertainty Block. Accuracy (ACC) = Percentage
Correct. Efficiency (EFF) = Correct Responses Per Minute. CAARS = Conners Adult ADHD Rating Scales.
Inatt = Inattention. Impul = Impulsivity. Hyper = Hyperactivity. Comp = Composite. WJ-III: ACH RF =
Woodcock Johnson Tests of Achievement, Third Edition Reading Fluency. Indiv = Individual. Diff =
Difference. * = p < .05. ** = p < .01
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Correlation Statistics

Note. ANAM = Automated Neuropsychological Assessment Matrices. PRT1 = Procedural Reaction Time
Basic Block. PRT2 = Procedural Reaction Time - Time Uncertainty Block. Accuracy (ACC) = Percentage
Correct. Efficiency (EFF) = Correct Responses Per Minute. CAARS = Conners Adult ADHD Rating Scales.
Inatt = Inattention. Impul = Impulsivity. Hyper = Hyperactivity. Comp = Composite. WJ-III: ACH RF =
Woodcock Johnson Tests of Achievement, Third Edition Reading Fluency. Indiv = Individual. Diff =
Difference. * = p < .05. ** = p < .01
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Regressions

Models 1 - 4 WJ-III:ACH
ANAM Reading
Fluency

Models 5 - 8 WJ-III:ACH
CAARS Reading
Fluency

Models 9 - 12 WJ-III:ACH
ANAM CAARS Reading
Fluency
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Model 2: Regression Results
(12.45% of the Variance)

ANAM WJ-III:RF
PRT (All) Group

None others were statistically significant!


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Sobel Regression Models

CAARS

WJ-III:ACH
ANAM Reading
Fluency
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Sobel Regressions

Although 64 separate Sobel regressions were run, not one

provided the statistical significance needed

to indicate the predicted mediating relationship.


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Discussion
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Research Questions

 Are ADHD rating scale scores an accurate predictor of


reading fluency and/or reading impulsivity scores?

 Are CPT scores an accurate predictor of reading fluency


and/or reading impulsivity scores?

 Do rating scales scores and CPT scores provide shared


information useful in predicting reading fluency and/or
reading impulsivity scores?
+ Are ADHD rating scale scores an accurate predictor of reading
fluency and/or reading impulsivity scores?

 Rational for Question:


 Individuals with ADHD exhibit more academic problems
(Marshall, Hynd, Handwerk, & Hall, 1997).
 Individuals with ADHD often experience a comorbid diagnosis of
learning disability (Mayes, Calhoun, & Crowell, 2000).

 Finding:
 There is NO significant relationship between any of the ADHD
rating scale scores and any of the reading fluency scores.
+ Are CPT scores an accurate predictor of reading fluency
and/or reading impulsivity scores?

 CPT scores sometimes do predict scores on reading fluency.

 Neither the inattention scores (as defined by group / individual


difference scores) nor the reading impulsivity scores (as defined
by the error scores) were predicted by any of the CPT scores

 It appears that the CPT used in this study may be a measure of


something else other than ADHD symptoms.

 General neurological functioning (Alloway, et al., 2009;


Preston, Fennell, & Bussing, 2005)

 Intellectual skills (Jones, et. al, 2007)

 Processing speed (Stolberg, Jones, Krach, & Loe, 2009)


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

 No.
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Rating Scale vs. CPT

 At this time, rating scales are the clear frontrunner ADHD


diagnostic tool (Macmann, Barnet, & Lopez, 1993; Sattler &
Hoge, 2006; Sciutto &Eisenberg, 2007).

 Rating scales have significant issues that should give any


good diagnostic specialist pause before using them as a sole
method of data collection for ADHD (Hartung, et al., 2006;
Jackson & King, 2004; Pellegrini, 2011; Rosenbaum & Valsiner,
2011).

 Clearly we need a direct method to add to our toolkit.


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Researcher vs. Practitioner

 In the argument for whether the absence or presence of


neurological symptoms is a basis for explaining symptoms
associated with ADHD (Barkely, et al., 2002; Timimi, et al.,
2004), CPTs should be included as a data collection tool.

 As a diagnostic tool, it may more useful to assess


neurological concerns linked to ADHD and less useful in
evaluating inattention, impulsivity, an hyperactivity directly
(Corkum & Siegel, 1993).