1 Running Head: ADHD AND READING COMPREHENSION ARTICLE CRITIQUE

EDPS 612.02 Article Critique of

Reading comprehension in Children with ADHD: Cognitive
Underpinnings of the Centrality Deficit
Jacqueline Munroe
University of Calgary








2 Running Head: ADHD AND READING COMPREHENSION ARTICLE CRITIQUE

Article Critique of Reading Comprehension in Children with ADHD: Cognitive Underpinning of
the Centrality Deficit
Purpose
Individuals with Attention Deficit/Hyperactivity Disorder (ADHD) often experience
difficulty with academic achievement (Barkley, 2000; as cited in Miller et al., 2012). While
associated areas of academic difficulty have been listening and reading comprehension, little is
known about the specifics of comprehension issues (Miller et al.). A study conducted by Miller
et al. assessed childrens ability to recall peripheral or central information after reading a
passage. The nature of reading comprehension in children with ADHD was explored by
assessing how well cognitive factors (working memory, inhibition, processing speed, and IQ)
related to their ability to recall central information. The dependent variable of this experiment
was the proportion of central ideas recalled by participants, and the independent variable was
ADHD symptomology. Word reading skills were matched and gender was the covariate of the
study.
Theoretical Explanation/Significance
Children with ADHD frequently display word decoding problems. To account for this,
many studies use listening as opposed to reading when attempting to access the nature of
comprehension deficits (Miller et al., 2012). McInnes et al. (2003) found those with ADHD have
difficulties in responding to inferential questioning, and with higher level language processes (as
cited in Miller et al.) while Purvis & Tannock (1997) found difficulties with organization of
information and passage coherence (as cited in Miller et al.). Miller et al. attempt to apply these
findings to reading (as opposed to listening) comprehension, and propose a centrality deficit in
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children with ADHD. The centrality deficit states that as one comprehends a passage, mental
representations take shape through interrelated connections. Most highly connected ideas form
the central message of the passage, while ideas with fewer connections form the peripheral
information of the passage.
Hypothesis
According to Miller & Keenan (2011), readers who struggle with word decoding draw
cognitive resources away from forming connections, resulting in decreased comprehension and
organization of text material (the centrality deficit).The hypothesis of the current study states that
due to the centrality deficit, children with ADHD (both with and without word decoding
challenges) have symptoms that may interact with cognitive factors and predict a childs ability
to recall central information. This is a testable hypothesis as strict criteria for ADHD group
inclusion were included in this study along with parent/teacher checklists. Important factors that
could impact reading comprehension results were assessed (possible perceptual/inattention
issues) and matched such as VIQ, WM, and Performance IQ along with word reading skills.
Sample
Twenty-seven children (9.16-10.6 years) previously diagnosed with ADHD, as defined
by DSM-IV criteria participated in this study. Symptoms of ADHD had to present before the age
of 7 and cause significant functional impairment across two or more settings (Miller et al.,
2012, p. 477). Participants were categorized as Predominantly Inattentive Type (52%),
Predominantly Hyperactive/Impulsive Type (15%, a representation too low to be included the
study), or Combined Type (33%). Seventy six children without ADHD (8.94-11.22 years) served
as the control group. Parents and teachers were required to complete a DSM-IV checklist to
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assess symptoms of ADHD before the study began. Telephone interviews excluded those with
rare etiologies of ADHD or other known brain injuries. Children who were on stimulant
medication were required to discontinue use 24 hours before the testing. The method of
selection was only briefly identified and states that children were tested in a learning disabilities
research center, as a part of a larger study targeting comprehension skills. How their information
arrived at this center, and whether or not that would make them different from other children in
the general population is unknown. The total sample size of 103 appears to be relatively weak
(should be <50) with 27 participants in each group (the 76 reading matched controls were paired
with one of the 27 ADHD participants). Detailed descriptive statistics of both ADHD and
controls (27 matched) display similar (not statistically significant) word reading z-scores of -0.64
(ADHD) and -.68 (control), paternal levels of education, and mean age of participants 9.78
(ADHD) 9.89 (reading matched-controls). The dominant ethnicity represented in the study was
Caucasian (90%, ADHD and 96.3%, control). IQ was matched, with the Mean Full Scale IQ
being 105 (ADHD group) and 106 (the control group). However, gender differed significantly
between groups with 33% female participants (ADHD) as compared to 82% (control).
Measures
Initial word reading z-scores were obtained from the Timed Oral Reading of Single
Words test (Olsen et al., 1994) in order to match ADHD and control participants. Reading
comprehension was assessed using a passage from the Qualitative Reading Inventory (QRI) an
individually administered informal reading inventory designed to provide diagnostic information
about 1) condition under which subjects can decode and comprehend successfully and, 2)
conditions which appear to result in unsuccessful decoding and/or comprehension (McCabe &
Margolis, 1999, p. 388). The QRI is a guide (not standardized test) to inform users of a childs
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reading skills (McCabe & Margolis). Lack of standardization may potentially lead to
inconsistencies in test administration. Similarly, the QRI only measures a small sample of
behaviour (most passages were taken from commercial readers and textbooks) which may vary
from what students typically read in class (McCabe & Margolis). In terms of psychometric
properties, Lipson and Wixson (1997) state (of the QRI-II) that it "provides a set of procedures
that is both conceptually and psychometrically sound" (p. 341; as cited in McGabe & Margolis,
p. 388). IQ Verbal and Performance IQ were assessed using the Wechsler Intelligence Scale for
Children Revised (WISC-R, 1974) to obtain Working Memory and Processing Speed composite
scores. One factor which may impact scores obtained on the WISC-R is race, which was
accounted for in the predominantly Caucasian participant base. According to Franzen (2000) the
WISC-R is an instrument in which reliability has been well supported, however, insufficient
studies regarding validity (convergent, discriminant, and predictive) has been noted (Franzen).
The Gordon Diagnostic System (GDS) accesses sustained attention, self-control, and vigilance of
participants through completion of three tasks (Gordon, 1987). Test retest reliability is
significant, with a moderate correlation (r >.60) (Harrington, 2004). The GDS also correlated
moderately but significantly, with parent and teacher rating forms of ADHD and other
neuropsychological measures. Further research is needed into the validity of the GDS, as main
findings are from the test developer (Harrington). Combined performance on the Gordon
Vigilance (Gordon 1983), Gordon Distractibility (Gordon), and Stop Signal Tasks (Logan et al.;
1997; as cited in Miller et al., 2012) compromised the inhibition composite. The Stop Signal
Task requires participants to inhibit responses as they are presented with simultaneous stop and
go demands (Soreni et al., 2009). The Colorado Perceptual Speed task is a visual task of
matching letters (assessing participants ability to recognize and group letters) (Decker, 1989).
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The Identical Pictures Task assesses perceptual skills (Bowers et al., 1985) and the Rapid
Automatized Naming (RAN) assesses speed of naming visually presented stimuli (slow naming
speed is characteristic of children with reading disabilities) (Rathvon, 2004).
Procedures
Participants read a fourth grade Amelia Earhart (an expository text) passage from the
QRI that was 263 words in length with 47 idea units. Each QRI passage includes an ideas
checklist to rate ideas in terms of importance to the centrality of the overall passage. To do so, a
Likert scale was used from 0-7 with 0 being unimportant to the passage and 7 being very
important to the passage (Miller et al., 2012, p. 477). Seventeen undergraduate students (a
relatively low number) rated the importance of each idea unit to the overall central idea of the
passage and a mean for each unit was created (high reliability estimates of p<0.001). IQ Verbal
and Performance IQ was assessed using the WISC-R to obtain Working Memory and Processing
Speed composite scores of each participant. Cognitive testing of the participants lasted two full
days. Day one consisted of the WISC-R, the RAN, Colorado Perceptual Speed, Identical Pictures
Tasks, and decoding measures. The following measures were administered one month later:
Sentence Span Task, Trailmaking Task, Gordon Diagnostic System, and the Stop Task, as well
as the QRI. On the QRI (task of reading comprehension) participants were awarded points
according to audio-recorded, recalled responses which were either verbatim or synonyms which
represented the idea. Responses were scored by multiple research assistants who were blind to
the centrality of each unit. Inter-rater reliability was high (p<0.001). Lastly, Participants were
required to respond to 6 open ended questions.
Data Analysis
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A mixed design ANCOVA (2 x 2) (ADHD, reading-matched control group) was used as
a between subjects factor (ADHD symptoms, standardized cognitive variables including
inhibition, WM, verbal PS, motor PS, Verbal IQ, and performance IQ, separate regressions for
each, lastly, cognitive variables, ADHD and interaction) and centrality of recalled information as
a repeated measures factor to assess the effect of these variables (p. 478) on the amount of
recalled information. In the ANCOVA when random assignment is not used, the covariate,
when related to the grouping variable, attempts to control for the confounding effect of the
covariate (Keselman et al., 1998, p. 373). In the case of this study, the covariate was gender as
the distribution across groups was significant. According to Keselman et al., when using the
ANCOVA model data assumptions made include independence, homoscedasticity,
homogeneity of regression slopes, linearity, and conditional normality. Violating the first three
assumptions can seriously affect the Type I error rate (Glass, Peckham, & Sanders, 1972; as cited
in Keselman et al., p. 373). Between groups (ADHD and controls) a significant interaction was
found regarding the information recalled and centrality to the reading passage (p=0.02)
suggesting that children with ADHD demonstrate a centrality deficit (Miller et al., 2012). In
comparison to controls, children with ADHD remembered fewer passage ideas (marginally
significant effect, p=0.07). However, both groups could significantly recall more central than
peripheral ideas (p<0.001, central mean = .44, peripheral mean = .33). No significant difference
was found in the one way ANCOVA when comparing groups on open ended reading
comprehension questions (p=0.68) suggesting that performance is not due to a lack of effort
(Miller et al.). The full sample of 103 was included to examine the relationship between
symptoms of hyperactivity and inattention related to central passage recall. Finding suggests that
the two are negatively correlated. Central recall was positively correlated with all of the
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cognitive variables (Miller et al.). Lastly, six hierarchical regressions were used to determine the
effects of cognitive skills (moderating/mediating effects) on the recall of central ideas. Working
Memory was the only cognitive ability found to be statistically significant in relation to central
ideas recalled (p=0.001).
Results/ Conclusions
Findings suggest that children with ADHD experience a centrality deficit when compared
to controls. The authors propose that additional attention (resource allocation) is required to
maintain focus in children with ADHD. The result is fewer cognitive resources to form
connections between related ideas and create a unitary mental representation. Similarly, the
authors propose that issues with word decoding result in the same limited comprehension, due to
resource allocation occurring at the word decoding stage. This study sought to explain how
cognitive variability in inhibition, working memory, verbal processing speed, motor processing
speed, verbal IQ, and performance IQ (Miller et al., 2013, p. 413) could help to explain the
centrality deficit. Working memory (WM) was the one factor that contributed to unusual
variance in results. Working Memory mediated any relationship between symptoms of ADHD as
well as ability to recall central information. The authors state that while reading, WM
accommodates new information to previous, through the formulation of new connections.
Strengths/Limitations
This is the first study to demonstrate the nature of the reading challenges seen in children
with ADHD. Children were matched based on word reading skills (decoding and fluency) which
was critical to this experiment validity as grade 4 students can have word reading levels spanning
multiple grades. In addition, a reading and retelling format (rather than listening, multiple choice
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or cloze) was used to access comprehension. Mean FSIQ, Verbal IQ, and Performance IQ, were
within one point apart ensuring that this study was a valid measure of reading comprehension,
rather than cognitive ability. Many tests administered on the second day of testing would have
alerted the researchers to participant learning disabilities that could potentially skew reading
comprehension results (such as the RAN, Colorado Perceptual Speed). Limitations of this study
include the inadequate sample (27 participants in each) and a lack of clarity regarding participant
involvement in the overall reading comprehension study. Selection bias is a possibility, and
generalizations cannot be made (inadequate external validity). Parents, who would have their
children involved in these types of studies, may not accurately represent the ADHD population
in general. Similarly, the sample was predominantly Caucasian, therefore, is not representative of
the general population. An interesting finding is that children with ADHD do not demonstrate
comprehension deficits when responding to open ended questions. This may suggest a lack of
sensitivity in the open ended questions (half were stated in the text and required memorization
rather than an inferential response).
Summary/Final Thoughts
A next likely step proposed may be to examine the centrality deficit in all three ADHD
subtypes, which could not occur due to the inadequate sample size of the experiment. Similarly,
determining if the centrality deficit can be seen in both expository and narrative texts should be
explored (one may be more difficult to attend to than another). Further studies could also include
comprehension questions being right there type questions versus inferential questions. This
may uncover if comprehension difficulty experienced by children with ADHD is in building a
coherent representation specifically, rather than in retelling explicit information. Lastly, a future
direction proposed by Miller et al. (2012) is that similar findings regarding limited resource
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allocation and reading comprehension could be applied to English language learners. Miller et
al., (2012) appear to have conducted a comprehensive experiment from which to begin further
and repeated exploration of reading comprehension and the centrality deficit in children with
ADHD. Overall based on experiment procedure, assessment measures, data analysis, and
participant selection, this study appears to be a valid measure of reading comprehension;
however, further studies may be needed in the future to ensure consistency of findings
(reliability).
















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centrality deficit. Journal of abnormal child psychology, 1-11.



















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