Skip to main content

Do Working Memory Deficits Underlie Reading Problems in Attention-Deficit/Hyperactivity Disorder (ADHD)?


Reading problems are common in children with ADHD and show strong covariation with these children’s underdeveloped working memory abilities. In contrast, working memory training does not appear to improve reading performance for children with ADHD or neurotypical children. The current study bridges the gap between these conflicting findings, and combines dual-task methodology with Bayesian modeling to examine the role of working memory for explaining ADHD-related reading problems. Children ages 8–13 (M = 10.50, SD = 1.59) with and without ADHD (N = 78; 29 girls; 63% Caucasian/Non-Hispanic) completed a counterbalanced series of reading tasks that systematically manipulated concurrent working memory demands. Adding working memory demands produced disproportionate decrements in reading comprehension for children with ADHD (d = −0.67) relative to Non-ADHD children (d = −0.18); comprehension was significantly reduced in both groups when working memory demands were increased. These effects were robust to controls for foundational reading skills (decoding, sight word vocabulary) and comorbid reading disability. Concurrent working memory demands did not slow reading speed for either group. The ADHD group showed lower comprehension (d = 1.02) and speed (d = 0.69) even before adding working memory demands beyond those inherently required for reading. Exploratory conditional effects analyses indicated that underdeveloped working memory overlapped with 41% (comprehension) and 85% (speed) of these between-group differences. Reading problems in ADHD appear attributable, at least in part, to their underdeveloped working memory abilities. Combined with prior cross-sectional and longitudinal findings, the current experimental evidence positions working memory as a potential causal mechanism that is necessary but not sufficient for effectively understanding written language.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2


  1. Results were unchanged when excluding children with autism spectrum disorders. As recommended in the K-SADS, oppositional defiant disorder was diagnosed clinically only with evidence of multi-informant/multi-setting symptoms. ODD comorbidity is 41% in the ADHD group and 9% in the Non-ADHD group based on parent-reported symptom counts.

  2. As discussed by Rapport et al. (2013), the maximum expected far transfer benefit can be estimated by multiplying the training effect by the association between working memory and the outcome. The estimated effect of 0.05 is based on multiplying the SD change in working memory by the SD change in reading comprehension attributable to working memory (0.30 × 0.18 = 0.05).


  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

  • Baddeley, A. (2007). Working memory, thought, and action. New York: Oxford.

  • Barkley, R. A. (2006). Primary symptoms, diagnostic criteria, prevalence, and gender differences. Attention-Deficit Hyperactivity Disorder: A handbook for diagnosis and treatment, 3, 76–121.

    Google Scholar 

  • Barkley, R. A., Fischer, M., Smallish, L., & Fletcher, K. (2006). Young adult outcome of hyperactive children: Adaptive functioning in major life activities. The American Academy of Child & Adolescent Psychiatry, 45(2), 192–202.

    Article  Google Scholar 

  • Barry, T. D., Lyman, R. D., & Klinger, L. G. (2002). Academic underachievement and attention-deficit/hyperactivity disorder: The negative impact of symptom severity on school performance. School Psychology, 40(3), 259–283.

    Article  Google Scholar 

  • Bennett, K.J., Brown, K.S., Boyle, M., …, Offord, D. (2003). Does low reading achievement at school entry cause conduct problems?. Social Science & Medicine, 56(12), 2443–2448.

  • Bickett, L., & Milich, R. (1990). First impressions formed of boys with learning disabilities and attention deficit disorder. Journal of Learning Disabilities, 23(4), 253–259.

    Article  PubMed  Google Scholar 

  • Biederman, J., Faraone, S., Milberger, S., Guite, J., Mick, E., Chen, L., et al. (1996). A prospective 4-year follow-up study of attention-deficit hyperactivity and related disorders. Archives of General Psychiatry, 53, 437–446.

  • Brock, S. E., & Knapp, P. K. (1996). Reading comprehension abilities of children with attention deficit/hyperactivity disorder. Journal of Attention Disorders, 1, 173–185.

  • Cain, K., Oakhill, J., & Bryant, P. (2004). Children's reading comprehension ability: Concurrent prediction by working memory, verbal ability, and component skills. Educational Psychology, 96(1), 31–42.

    Article  Google Scholar 

  • Chacko, A., Bedard, A.C., Marks, D.J., …, Ramon, M. (2014). A randomized clinical trial of Cogmed working memory training in school-age children with ADHD: A replication in a diverse sample using a control condition. Journal of Child Psychology & Psychiatry, 55(3), 247–255.

  • Chen, C.S., Lee, S.Y., & Stevenson, H.W. (1996). Academic achievement and motivation of Chinese students: A cross-national perspective. Growing Up the Chinese Way: Chinese Child & Adolescent Development. In: S. Lau (Ed.), Growing Up the Chinese Way: Chinese Child & Adolescent Development (pp 69–92). Lady Ho Tung Hall: Chinese University Press

  • Christopher, M.E., Miyake, A., Keenan, J.M., …, Olson, R.K. (2012). Predicting word reading and comprehension with executive function and speed measures across development: A latent variable analysis. Experimental Psychology: General, 141, 470–488.

  • Chrysochoou, E., Bablekou, Z., & Tsigilis, N. (2011). Working memory contributions to reading comprehension components in middle childhood children. The American Journal of Psychology, 124(3), 275–289.

    Article  PubMed  Google Scholar 

  • Conway, A.R., Kane, M.J., Bunting, M.F., …, Engle, R.W. (2005). Working memory span tasks: A methodological review and user’s guide. Psychonomic Bulletin & Review, 12, 769–786.

  • de Carvalho, C.A.F., Kida, S.B., …, de Avila, C.R.B. (2014). Phonological working memory and reading in students with dyslexia. Frontiers in Psychology, 5, 746.

  • Diamantopoulou, S., Rydell, A. M., Thorell, L. B., & Bohlin, G. (2007). Impact of executive functioning and symptoms of attention deficit hyperactivity disorder on children's peer relations and school performance. Developmental Neuropsychology, 32(1), 521–542.

    Article  PubMed  Google Scholar 

  • DiStephano, C., Zhu, M., & Mîndrilă, D. (2009). Understanding and using factor scores: Considerations for applied researchers. Practical Assessment, Research & Evaluation, 14(20), 1–11.

    Google Scholar 

  • DuPaul, G. J., Rapport, M. D., & Perriello, L. M. (1991). Teacher ratings of academic skills: The development of the academic performance rating scale. School Psychology Review, 20(2), 284–300.

    Google Scholar 

  • DuPaul, G. J., Gormley, M. J., & Laracy, S. D. (2013). Comorbidity of LD and ADHD: Implications of DSM-5 for assessment and treatment. Journal of Learning Disabilities, 46(1), 43–51.

    Article  PubMed  Google Scholar 

  • Engle, R. W., Tuholski, S. W., Laughlin, J. E., & Conway, A. R. (1999). Working memory, short-term memory, and general fluid intelligence: A latent-variable approach. Experimental Psychology: General, 128(3), 309–331.

    Article  Google Scholar 

  • Finn, J. D., Gerber, S. B., & Boyd-Zaharias, J. (2005). Small classes in the early grades, academic achievement, and graduating from high school. Educational Psychology, 97(2), 214–223.

    Article  Google Scholar 

  • Frazier, T. W., Youngstrom, E. A., Glutting, J. J., & Watkins, M. W. (2007). ADHD and achievement: Meta-analysis of the child, adolescent, and adult literatures and a concomitant study with college students. Journal of Learning Disabilities, 40(1), 49–65.

    Article  PubMed  Google Scholar 

  • Frick, P. J., Kamphaus, R. W., Lahey, B. B., Loeber, R., Christ, M. A. G., Hart, E. L., & Tannenbaum, L. E. (1991). Academic underachievement and the disruptive behavior disorders. Journal of Consulting and Clinical Psychology, 59, 289.

  • Friedman, L.M., Rapport, M.D., Raiker, J.S., …, Eckrich, S.J. (2017). Reading comprehension in boys with ADHD: The mediating roles of working memory and orthographic conversion. Journal of Abnormal Child Psychology, 45 (2), 273–287.

  • Froehlich, T. E., Lanphear, B. P., Epstein, J. N., et al. (2007). Prevalence, recognition, and treatment of attention-deficit/hyperactivity disorder in a national sample of US children. Archives of Pediatrics & Adolescent Medicine, 161(9), 857–864.

    Article  Google Scholar 

  • Gadow, K., & Sprafkin, J. (2002). Child symptom inventory 4: Screening and norms. Stony Brook: Checkmate Plus.

  • Gathercole, S.E., & Baddeley, A.D. (2014). Working memory and language. New York: Psychology Press.

  • Ghelani, K., Sidhu, R., Jain, U., & Tannock, R. (2004). Reading comprehension and reading related abilities in adolescents with reading disabilities and attention-deficit/hyperactivity disorder. Dyslexia, 10(4), 364–384.

    Article  PubMed  Google Scholar 

  • Gremillion, M. L., & Martel, M. M. (2012). Semantic language as a mechanism explaining the association between ADHD symptoms and reading and mathematics underachievement. Journal of Abnormal Child Psychology, 40(8), 1339–1349.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hinshaw, S. P. (1992). Academic underachievement, attention deficits, and aggression: Comorbidity and implications for intervention. Journal of Consulting and Clinical Psychology, 60(6), 893–903.

    Article  PubMed  Google Scholar 

  • Hollingshead, A. B. (1975). Four factor index of social status. New Haven: Yale 1975.

    Google Scholar 

  • Holmes, J., Hilton, K. A., Place, M., Alloway, T. P., Elliott, J. G., & Gathercole, S. E. (2014). Children with low working memory and children with ADHD: Same or different? Frontiers in Human Neuroscience, 8, 976.

    Article  PubMed  PubMed Central  Google Scholar 

  • Institute for Educational Sciences(IES) . (2017). What Works Clearinghouse. Retrieved from

  • Jacobson, L. A., Ryan, M., Martin, R. B., Ewen, J., Mostofsky, S. H., Denckla, M. B., & Mahone, E. M. (2011). Working memory influences processing speed and reading fluency in ADHD. Child Neuropsychology, 17(3), 209–224.

    Article  PubMed  PubMed Central  Google Scholar 

  • JASP Team (2017). JASP. Version 0.8.2.

  • Jensen, P. S., Eaton Hoagwood, K., Roper, M., et al. (2004). The services for children and adolescents- parent interview: development and performance characteristics. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 1334–1344.

  • Kasper, L. J., Alderson, R. M., & Hudec, K. L. (2012). Moderators of working memory deficits in children with ADHD: A meta-analytic review. Clinical Psychology Review, 32, 605–617.

    Article  PubMed  Google Scholar 

  • Kaufman, A. S., & Kaufman, N. L. (2014). Kaufman test of educational achievement–third edition (KTEA-3) technical & interpretive manual. Bloomington: Pearson.

    Google Scholar 

  • Kaufman, J., Birmaher, B., Brent, D., et al. (1997). Schedule for affective disorders and schizophrenia for school-age children (K-SADS-PL): Initial reliability and validity data. The American Academy of Child & Adolescent Psychiatry, 36, 980–988.

    Article  Google Scholar 

  • Kofler, M. J., Raiker, J. S., Sarver, D. E., Wells, E. L., & Soto, E. F. (2016). Is hyperactivity ubiquitous in ADHD or dependent on environmental demands? Evidence from meta-analysis. Clinical Psychology Review, 46, 12–24.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kuntsi, J., Oosterlaan, J., & Stevenson, J. (2001). Psychological mechanisms in hyperactivity: I response inhibition deficit, working memory impairment, delay aversion, or something else? Journal of Child Psychology & Psychiatry, 42(2), 199–210.

    Article  Google Scholar 

  • Lakens (2016). Bayesian Power T test [Computer software]. Retrieved from Accessed 5 June 2018.

  • Loe, I. M., & Feldman, H. M. (2007). Academic and educational outcomes of children with ADHD. Journal of Pediatric Psychology, 32, 643–654.

  • Lonigan, C. J. (2015). Literacy development. In R. M. Lerner, L. S. Liben, & U. Müeller (Eds.), Handbook of child psychology and developmental science. Volume 2: Cognitive Processes (pp. 763–805). Hoboken: Wiley and Sons.

    Google Scholar 

  • Mannuzza, S., Klein, R. G., Bessler, A., Malloy, P., & Hynes, M. E. (1997). Educational and occupational outcome of hyperactive boys grown up. Journal of the American Academy of Child & Adolescent Psychiatry, 36, 1222–1227.

  • Maughan, B., Gray, G., & Rutter, M. (1985). Reading retardation and antisocial behaviour: A follow-up into employment. Journal of Child Psychology & Psychiatry, 26(5), 741–758.

    Article  Google Scholar 

  • Mayes, S. D., & Calhoun, S. L. (2006). Frequency of reading, math, and writing disabilities in children with clinical disorders. Learning and Individual Differences, 16(2), 145–157.

    Article  Google Scholar 

  • McGee, R., Prior, M., Williams, S., …, Sanson, A. (2002). The long-term significance of teacher-rated hyperactivity and reading ability in childhood: Findings from two longitudinal studies. Journal of Child Psychology & Psychiatry, 43(8), 1004–1017.

  • Melby-Lervåg, M., Redick, T. S., & Hulme, C. (2016). Working memory training does not improve performance on measures of intelligence or other measures of “far transfer” evidence from a meta-analytic review. Perspectives on Psychological Science, 11(4), 512–534.

    Article  PubMed  PubMed Central  Google Scholar 

  • Miller, M., Nevado-Montenegro, A. J., & Hinshaw, S. P. (2012). Childhood executive function continues to predict outcomes in young adult females with and without childhood-diagnosed ADHD. Journal of Abnormal Child Psychology, 40(5), 657–668.

    Article  PubMed  PubMed Central  Google Scholar 

  • Miller, A.C., Keenan, J.M., Betjemann, R.S., …, Olson, R.K. (2013). Reading comprehension in children with ADHD: Cognitive underpinnings of the centrality deficit. Journal of Abnormal Child Psychology, 41(3), 473–483.

  • Morrison, E. F., Rimm-Kauffman, S., & Pianta, R. C. (2003). A longitudinal study of mother–child interactions at school entry and social and academic outcomes in middle school. School Psychology, 41(3), 185–200.

    Article  Google Scholar 

  • Nee, D.E., Brown, J.W., Askren, M.K., …, Jonides, J. (2013). A meta-analysis of executive components of working memory. Cerebral Cotrex, 23, 264–282.

  • Pelham, W. E., Fabiano, G. A., & Massetti, G. M. (2005). Evidence-based assessment of attention deficit hyperactivity disorder in children and adolescents. Journal of Clinical Child & Adolescent Psychology, 34(3), 449–476.

    Article  Google Scholar 

  • Pelham, W. E., Foster, E. M., & Robb, J. A. (2007). The economic impact of attention-deficit/hyperactivity disorder in children and adolescents. Ambulatory Pediatrics, 7(1), 121–131.

    Article  PubMed  Google Scholar 

  • Peng, P., Barnes, M., Wang, C., Wang, W., Li, S., Swanson, H. L., …, & Tao, S. (2018). A Meta-analysis on the Relation Between Reading and Working Memory. Psychological bulletin, 144, 48–76.

  • Perfetti, C., Yang, C. L., & Schmalhofer, F. (2008). Comprehension skill and word-to-text integration processes. Applied Cognitive Psychology, 22(3), 303–318.

    Article  Google Scholar 

  • Pikulski, J. J., & Chard, D. J. (2005). Fluency: Bridge between decoding and reading comprehension. The Reading Teacher, 58(6), 510–519.

    Article  Google Scholar 

  • Polanczyk, G. V., Willcutt, E. G., Salum, G. A., Kieling, C., & Rohde, L. A. (2014). ADHD prevalence estimates across three decades: An updated systematic review and meta-regression analysis. International Journal of Epidemiology, 43(2), 434–442.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rapport, M. D., Alderson, R. M., Kofler, M. J., Sarver, D. E., Bolden, J., & Sims, V. (2008). Working memory deficits in boys with attention-deficit/hyperactivity disorder (ADHD): The contribution of central executive and subsystem processes. Journal of Abnormal Child Psychology, 36(6), 825–837.

    Article  PubMed  Google Scholar 

  • Rapport, M. D., Bolden, J., Kofler, M. J., Sarver, D. E., Raiker, J. S., & Alderson, R. M. (2009). Hyperactivity in boys with attention-deficit/hyperactivity disorder (ADHD): a ubiquitous core symptom or manifestation of working memory deficits? Journal of Abnormal Child Psychology, 37, 521–534.

  • Rapport, M. D., Orban, S. A., Kofler, M. J., & Friedman, L. M. (2013). Do programs designed to train working memory, other executive functions, and attention benefit children with ADHD? A meta-analytic review. Clinical Psychology Review, 33, 1237–1252.

    Article  PubMed  Google Scholar 

  • Reynolds, C.R., & Kamphaus, R.W. (2004). Behavior assessment system for children (2nd ed.). Circle Pines: American Guidance Service.

  • Ritchie, S. J., & Bates, T. C. (2013). Enduring links from childhood mathematics and reading achievement to adult socioeconomic status. Psychological Science, 24(7), 1301–1308.

    Article  PubMed  Google Scholar 

  • Roberts, G., Quach, J., Spencer-Smith, M., Anderson, P. J., Gathercole, S., Gold, L., et al. (2016). Academic outcomes 2 years after working memory training for children with low working memory: a randomized clinical trial. JAMA Pediatrics, 170, e154568–e154568.

  • Rogers, M., Hwang, H., Toplak, M., Weiss, M., & Tannock, R. (2011). Inattention, working memory, and academic achievement in adolescents referred for attention deficit/hyperactivity disorder (ADHD). Child Neuropsychology, 17, 444–458.

  • Rouder, J. N., & Morey, R. D. (2012). Default Bayes factors for model selection in regression. Multivariate Behavioral Research, 47, 877–903.

  • Sala, G., & Gobet, F. (2017). Working memory training in typically developing children: A meta-analysis of the available evidence. Developmental Psychology. Advance online publication.

  • Sarver, D.E., Rapport, M.D., Kofler, M.J., …, Bolden, J. (2012). Attention problems, phonological short-term memory, and visuospatial short-term memory: Differential effects on near-and long-term scholastic achievement. Learning & Individual Differences, 22(1), 8–19.

  • Seigneuric, A., & Ehrlich, M. F. (2005). Contribution of Working Memory Capacity to Children’s Reading Comprehension: A Longitudinal Investigation. Reading and Writing: An Interdisciplinary Journal, 18, 617–656.

  • Sesma, H. W., Mahone, E. M., Levine, T., Eason, S. H., & Cutting, L. E. (2009). The contribution of executive skills to reading comprehension. Child Neuropsychology, 15, 232–246.

  • St Clair-Thompson, H. L., & Gathercole, S. E. (2006). Executive functions and achievements in school: Shifting, updating, inhibition, and working memory. The Quarterly Journal of Experimental Psychology, 59(4), 745–759.

    Article  PubMed  Google Scholar 

  • Snyder, H. R., Miyake, A., & Hankin, B. L. (2015). Advancing understanding of executive function impairments and psychopathology: bridging the gap between clinical and cognitive approaches. Frontiers in psychology, 6, 328.

  • Swanson, L., & Kim, K. (2007). Working memory, short-term memory, and naming speed as predictors of children's mathematical performance. Intelligence, 35(2), 151–168.

    Article  Google Scholar 

  • Tarle, S.J., Alderson, R.M., Patros, C.H., …, Arrington, E.F. (2017). Attention-deficit/hyperactivity disorder and phonological working memory: Methodological variability affects clinical and experimental performance metrics. Neuropsychology, 31(4), 383.

  • Thorell, L. B. (2007). Do delay aversion and executive function deficits make distinct contributions to the functional impact of ADHD symptoms? A study of early academic skill deficits. Journal of Child Psychology and Psychiatry, 48, 1061–1070.

  • Unsworth, N., & Engle, R. (2007). On the division of short-term and working memory: Examination of simple & complex span & their relation to higher-order abilities. Psychological Bulletin, 133, 1038–1066.

    Article  PubMed  Google Scholar 

  • Visser, S. N., Danielson, M. L., Bitsko, R. H., Holbrook, J. R., Kogan, M. D., Ghandour, R. M., Perou, R., & Blumberg, S. J. (2014). Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003–2011. The American Academy of Child & Adolescent Psychiatry, 53(1), 34–46.

    Article  Google Scholar 

  • Valo, S., & Tannock, R. (2010). Diagnostic instability of DSM–IV ADHD subtypes: Effects of informant source, instrumentation, and methods for combining symptom reports. Journal of Clinical Child & Adolescent Psychology, 39, 749–760.

  • Wager, T. D., & Smith, E. E. (2003). Neuroimaging studies of working memory. Cognitive, Affective, & Behavioral Neuroscience, 3(4), 255–274.

    Article  Google Scholar 

  • Wagenmakers, E.-J., Morey, R. D., & Lee, M. D. (2016). Bayesian benefits for the pragmatic researcher. Current Directions in Psychological Science, 25, 169–176.

  • Wang, S., & Gathercole, S. E. (2013). Working memory deficits in children with reading difficulties: Memory span and dual task coordination. Journal of Experimental Child Psychology, 115, 188–197.

  • Wåhlstedt, C., Thorell, L. B., & Bohlin, G. (2009). Heterogeneity in ADHD: Neuropsychological pathways, comorbidity and symptom domains. Journal of Abnormal Child Psychology, 37, 551–564.

    Article  PubMed  Google Scholar 

  • Wechsler, D. (2014). WISC-IV and WISC-V Wechsler intelligence scale for children. Pearson.

  • Wilens, T. E., Biederman, J., Brown, S., Tanguay, S., Monuteaux, M. C., Blake, C., & Spencer, T. J. (2002). Psychiatric comorbidity and functioning in clinically referred preschool children and school-age youths with ADHD. Journal of the American Academy of Child & Adolescent Psychiatry, 41, 262–268.

  • Willcutt, E.G., Pennington, B.F., Boada, R., …, Olson, R.K. (2001). A comparison of the cognitive deficits in reading disability and ADHD. Abnormal Psychology, 110, 157.

  • Willoughby, M. T., Kuhn, L. J., Blair, C. B., Samek, A., & List, J. A. (2016). The test–retest reliability of the latent construct of executive function depends on whether tasks are represented as formative or reflective indicators. Child Neuropsychology, 1–16.

  • Woodcock, R., McGrew, K., & Mather, N. (2001). Woodcock-Johnson tests of academic achievement (Research ed.). Chicago: Riverside.

    Google Scholar 

  • Zimmerman (2016). Bayesian Power Analysis T test [Computer software]. Retrieved from Accessed 5 June 2018.

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Michael J. Kofler.

Ethics declarations

Conflict of Interest

The authors have no conflicts of interest to report.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from caregivers of all individual participants included in the study.

Electronic supplementary material


(DOCX 391 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kofler, M.J., Spiegel, J.A., Soto, E.F. et al. Do Working Memory Deficits Underlie Reading Problems in Attention-Deficit/Hyperactivity Disorder (ADHD)?. J Abnorm Child Psychol 47, 433–446 (2019).

Download citation

  • Published:

  • Issue Date:

  • DOI:


  • ADHD
  • Working Memory
  • Reading
  • Comprehension
  • Fluency
  • Bayesian