Support for the idea of executive function deficits in ADHD children is found in work where ADHD children have been identified as having difficulty carrying out strategies when working on tasks (Douglas, 1980), being less able to communicate the strategies they use to others (Saunders et al., 1996) and lacking the metacognitive abilities needed for the planning and evaluation of current cognitive strategies. Cited difficulties with memory (Conte, 1991; Saunders & Chambers, 1996) are further indications of executive function deficits since working memory is considered to be one aspect of these functions.
Barkley (1996) has developed a theoretical model of ADHD that provides further insight into the role of executive functions in causing ADHD behaviours. This model is represented in figure 1. The model places inhibition as the primary executive function that affects four other executive functions, that of working memory, self-regulation of affect/motivation/arousal, internalisation of speech, and reconstitution. These secondary functions are dependent on inhibition for their optimal operation. However, the quality of the primary function of inhibition can be influenced through changes in quality of any or all of the second order functions, with all the executive functions being interactive.
Figure 1: Barkley's (1996) model linking inhibition, executive function and motor-control fluency
An analysis of the executive function deficits experienced by ADHD children indicate that these deficits would impact on the reader's ability to recall and apply relevant background knowledge, as well as the capacity of executive control functions to monitor the meaning construction process. Motivation to initiate and maintain reading effort would also be difficult to achieve. The result is likely to be an underachieving child who views themself as a non-reader and reading as a threatening and unenjoyable experience. A model based on Barkley's model of executive function deficits is displayed in figure 2. This model shows the impact of executive function deficits on the reading process.
Figure 2: The effects of executive function deficits on the reading process
First, the intervention enhances the executive function of inhibition through the direct action of stimulant medication, self-instruction and self-monitoring. Stimulant medication causes a reduction in 'disinhibition' creating a delay in responding. Self-instruction, which is the self-verbalisation of the steps undertaken when engaged in a task (Conte, 1991), acts to cause a delay in responding as it directs the child to engage in thoughtful responses. In using self-instruction the student focuses on the self-statements needed to prepare for reading, such as 'What do I know about the topic of this book?' and 'What do I know about how the book is organised?'. To initiate and maintain monitoring of meaning construction statements the child is taught to ask such questions as 'Does this make sense?' and the student is encouraged to select and assess appropriate repair statements like 'This doesn't make sense, I'll try the read-on strategy'. Self-monitoring creates planned pauses in action, to allow for structured reflection on strategic reading behaviour. This cognitive approach focuses on the reader's use of reading strategies during the reading of a text. Inhibition is indirectly acted on by self-reinforcement as this component supports the process of self-monitoring.
The action of working memory is directly supported through self-instruction and the visual and kinaesthetic strategy cues of a memory-cue bookmark. The pre-reading self-statements appear on the bookmark and activate the retrieval of relevant background knowledge about text content and structure, allowing the development of a useful anticipatory set. Self-statements such as 'Does this make sense?' during reading help to hold-on line the need to monitor for meaning. The bookmark is likely to prompt action when meaning loss is detected as it reminds the reader of meaning repair actions. Retention of the repertoire of fix-up strategies in working memory is also facilitated through use of the bookmark. Using both visual and kinaesthetic cues on the bookmark provides the multisensory input required by ADHD children (Ostoits, 1999).
Self-regulation of affect/motivation/arousal is directly supported by self-reinforcement and conditional strategy training. Self-reinforcement is designed to increase motivation to engage in the training process and modify reading behaviours. Training in the value of strategy use also increases motivation to act strategically (Paris & Oka, 1986). Self-monitoring also influences affective change as it supports attribution of success to changed reading behaviours by making these changes explicit and assessable. This aims to cause an increase in self-efficacy and the development of a positive attitude to reading (Paris et al., 1986).
Internalisation of speech is enhanced directly through cognitive training in self-statements, which is supported by strategy training and self-monitoring. The cognitive training process facilitates the development of effective internal speech. It provides self-statements that are able to efficiently and effectively direct and control cognition and provides support for the child as they move to internal use of the statements. Strategy training informs self-statements so that readers are able to incorporate statements of action specific to the reading process. Self-monitoring promotes the use of appropriate self-statements as it provides a means of self-reflection and evaluation of quality and effectiveness of these statements. Use of self-instruction and self-monitoring is further supported by self-reinforcement.
The capacity for reconstitution is enhanced through the action of all intervention components as they influence the reading process and so increase comprehension. This change is likely to improve the reader's ability to use information and understanding from texts to create novel responses. The ability to create multiple plans of action also is likely to improve since strategy training provides an array of strategies from which to choose and self-instruction acts to direct and control the development of plans and strategies.
In summary, the intervention provides a multimodal approach that addresses the academic needs of the ADHD reader as well as the executive function deficits associated with ADHD. It provides the tools to access text (strategies), a means of controlling cognition during reading (self-instruction), and promotes the attribution of success to the actions of the reader. In doing so it establishes affective and cognitive conditions conducive to successful reading. Once initial training is mastered by the student, the intervention should be relatively easy for the classroom teacher to maintain by continuing the self-reinforcement system, managing the resource materials including access to interesting texts appropriate to the reader's ability, and the memory-cue bookmark.
When attempting to meet the needs of ADHD children in the classroom, teachers need to provide interventions that are able to be maintained and extend the ideas described above to other subject areas since ADHD children often have difficulty generalising learning strategies from one context to another. Identification of ADHD girls also needs to be addressed as an educational priority, particularly if the disorder has already been identified in another member of the family. It is the aim of inclusive education for all children to achieve to the best of their ability. Providing ADHD children with appropriate interventions will facilitate the achievement of this goal.
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders IV.
Baker, J. (1994). Attention Deficit Hyperactivity Disorder: A creation of the medical profession? Australian Journal of Guidance and Counselling, 4 (1), 65-80.
Barkley, R. (1989). Attention Deficit Hyperactivity Disorder. In E. Mash & R. Barkley (Eds), Treatment of childhood disorders (pp. 39-72). New York: The Guilford Press.
Barkley, R. (1996). The North American perspective on Attention Deficit Hyperactivity Disorder. The Australian Educational and Developmental Psychologist, 13 (1), 2-23.
Cantwell, P., & Baker, L. (1991). Association between Attention Deficit Hyperactivity Disorder and learning disabilities. Journal of Learning Disabilities, 24 (2), 88-95.
Conte, R. (1991). Attention disorders. In B. Wong (Ed.), Learning about learning disabilities (pp. 59-101). San Diego: Academic Press.
Douglas, V.I. (1980). Higher mental processes in hyperactive children. In K.R.M. & D.J. Bakker (Eds), Treatment of hyperactive and learning disordered children: Current research (pp. 65-91). Baltimore: University Park Press.
Epstein, M., Shaywitz, S., Shaywitz, B. & Woolston, J. (1991). The boundaries of Attention Deficit Disorder. Journal of Learning Disabilities, 24 (2), 78-86.
Garner, R. (1994). Metacognition and executive control. In R. Ruddell, M. Ruddell & H. Singer (Eds), Theoretical models and processes of reading (pp. 715-732). Newark, Delaware: International Reading Association.
Goodman, G. & Poillion, M. (1992). ADD: Acronym for Any Dysfunction or Difficulty. The Journal of Special Education, 26 (1), 37-56.
Gordon, C. (1994). Attention Deficit Hyperactivity Disorder: Issues for special educators. Australasian Journal of Special Education, 18 (2), 36-49.
Grainger, J. (1997). Children's behaviour, attention and reading problems. Melbourne: The Australian Council for Educational Research.
Gross, M. (1997). The ADD brain. New York: Nova Science Publishers.
Hay, D. & Levy, F. (1996). The differential diagnosis of ADHD. The Australian Educational and Developmental Psychologist, 13(1), 69-78.
National Health and Medical Research Council. (1997). Attention Deficit Hyperactivity Disorder (ADHD). Canberra: Australian Government Publishing Service.
Ostoits, J. (1999). Reading strategies for students with ADD and ADHD in the inclusive classroom. Preventing School Failure, 43 (3), 129-134.
Paris, S. & Oka, E. (1986). Self-regulated learning among exceptional children. Exceptional Children, 53 (2), 103-108.
Purvis, K. & Tannock, R. (1997). Language abilities in children with attention deficit hyperactivity disorder, reading disabilities, and normal controls. Journal of Abnormal Child Psychology, 25(2), 133-145.
Rosenblatt, L. (1994). The transactional theory of reading and writing. In R. Ruddell, M. Ruddell & H. Singer (Eds), Theoretical models and processes of reading (pp. 1057-1092). Newark, Delaware: International Reading Association.
Ruddell, R. & Unrau, N. (1994). Reading as a meaning-construction process: The reader, the text, and the teacher. In R. Ruddell, M. Ruddell & H. Singer (Eds), Theoretical models and processes of reading (pp. 996-1056). Newark, Delaware: International Reading Association.
Rumelhart, D. (1994). Toward an interactive model of reading. In R. Ruddell, M. Ruddell & H. Singer (Eds), Theoretical models and processes of reading (pp. 864-894). Newark, Delaware: International Reading Association.
Saunders, B. & Chambers, S. (1996). A review of the literature on attention deficit hyperactivity disorder children: Peer interactions and collaborative learning. Psychology in the Schools, 33 (4), 333-340.
Wodrich, D. (1994). Attention deficit hyperactivity disorder: What every parent wants to know. Baltimore: Paul H. Brookes.
Zentall, S., Gohs, D. & Culatta, B. (1983). Language and activity of hyperactive and comparison children during listening tasks. Exceptional Children, 50 (3), 255-266.
|Author details: Kathy Baker is working on a PhD thesis at Central Queensland University entitled 'Managing the impact of ADHD on reading achievement'. Before working full-time on her thesis was a classroom teacher. It was through dealing with the real impact of ADHD, on both the individual and the whole classroom, that sparked Kathy's interest in pursuing a research study in this area. (email: firstname.lastname@example.org)
Please cite as: Baker, K. B. (2001). Attention deficit hyperactivity disorder and reading achievement. Queensland Journal of Educational Research, 17(1), 68-84. http://education.curtin.edu.au/iier/qjer/qjer17/baker.html