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Reading Comprehension in Boys with ADHD: The Mediating Roles of Working Memory and Orthographic Conversion

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Abstract

Reading comprehension difficulties in children with ADHD are well established; however, limited information exists concerning the cognitive mechanisms that contribute to these difficulties and the extent to which they interact with one another. The current study examines two broad cognitive processes known to be involved in children’s reading comprehension abilities—(a) working memory (i.e., central executive processes [CE], phonological short-term memory [PH STM], and visuospatial short-term memory [VS STM]) and (b) orthographic conversion (i.e., conversion of visually presented text to a phonological code)—to elucidate their unique and interactive contribution to ADHD-related reading comprehension differences. Thirty-one boys with ADHD-combined type and 30 typically developing (TD) boys aged 8 to 12 years (M = 9.64, SD = 1.22) were administered multiple counterbalanced tasks assessing WM and orthographic conversion processes. Relative to TD boys, boys with ADHD exhibited significant deficits in PH STM (d = −0.70), VS STM (d = −0.92), CE (d = −1.58), and orthographic conversion (d = −0.93). Bias-corrected, bootstrapped mediation analyses revealed that CE and orthographic conversion processes modeled separately mediated ADHD-related reading comprehension differences partially, whereas PH STM and VS STM did not. CE and orthographic conversion modeled jointly mediated ADHD-related reading comprehension differences fully wherein orthographic conversion’s large magnitude influence on reading comprehension occurred indirectly through CE’s impact on the orthographic system. The findings suggest that adaptive cognitive interventions designed to improve reading-related outcomes in children with ADHD may benefit by including modules that train CE and orthographic conversion processes independently and interactively.

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Notes

  1. Studies by Rosen and Engle (1997) and others (e.g., Colom et al. 2005; Swanson and Kim 2007) provide compelling evidence that forward and backward simple digit span tasks load on a PH STM factor and are statistically separable from PH WM measures such as complex span tasks, the latter of which are more highly correlated with measures of children’s reading competence.

  2. All participants met criteria for ADHD-Combined Type using DSM-5 diagnostic criteria.

  3. Scores for one TD child exceeded 1.5 SDs on one of the two parents’ but not teachers’ rating scales. Parent interview revealed no significant ADHD symptoms or symptoms associated with other clinical disorders for the child. Seven children with ADHD had subthreshold scores on teacher-rated hyperactivity/impulsivity. Follow-up clinical interviews, however, indicated the subthreshold symptoms were attributable to substantial psychostimulant effects while they were rated, and that all children demonstrated a history of significant, persistent levels of hyperactivity/impulsivity both at home and at school.

  4. PH WM and VS WM performance data for a subset of the current sample were used in separate studies to evaluate conceptually unrelated hypotheses (Alderson et al. 2010, 2012; Kofler et al. 2010, 2011, 2014; Raiker et al. 2012; Rapport et al. 2008a, 2009a; Sarver et al. 2015). We have not previously reported the reading comprehension or orthographic speed/accuracy data or their associations with our WM tasks for any children in the current sample.

  5. The N-to-K ratio of 61:2 was within recommended guidelines for deriving the Orthographic Conversion variable (Hogarty et al. 2005).

  6. Age was examined as a potential covariate given its trend towards significance and was a significant covariate for two of the mediators (CE and Orthographic Conversion) but not a significant covariate for any of the model’s dependent variables. The marginal covariate effects did not affect the pattern or interpretation of results.

  7. Other alternative approaches, such as using a GAI, were considered but not adopted because the GAI shares considerable variance with WM (i.e. r = 0.50 to 0.63) and because VCI and PRI factor scores also share considerable variance with WM.

  8. Briefly, the wider 95 % confidence interval increases the likelihood that the confidence interval for c′ will include 0.0, indicating that diagnostic status and reading comprehension are no longer related significantly after accounting for the mediator (i.e., full mediation). In contrast, the narrower 90 % confidence interval is less likely to include 0.0, and therefore is likely to result in a more conservative conclusion regarding the magnitude of the relation between diagnostic status and reading comprehension after accounting for the mediator (i.e., partial mediation). For discussion and specific examples of this phenomenon, see Shrout and Bolger (2002).

  9. Contemporary use of the terms near transfer and far transfer effects refers to an increase in performance on tasks that are highly similar and dissimilar to those used during training, respectively.

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  1. Department of Psychology, University of Central Florida, 4111 Pictor Lane Psychology Bldg 99, Orlando, FL, 32816, USA

    Lauren M. Friedman, Mark D. Rapport, Sarah A. Orban & Samuel J. Eckrich

  2. Department of Psychology, Florida International University, 11200 S.W. 8th St. AHC 1, Room 239, Miami, FL, 33199, USA

    Joseph S. Raiker

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Friedman, L.M., Rapport, M.D., Raiker, J.S. et al. Reading Comprehension in Boys with ADHD: The Mediating Roles of Working Memory and Orthographic Conversion. J Abnorm Child Psychol 45, 273–287 (2017). https://doi.org/10.1007/s10802-016-0171-7

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