Comorbid Reading Research Articles

Severe Pandemic Learning Loss and the Promise of Remotely Delivered Intervention in Students With Comorbid Reading and Mathematics Learning Difficulty

Analyses were conducted with second graders, drawn from an ongoing multi-cohort randomized controlled trial (RCT), who had been identified for RCT entry based on comorbid reading comprehension and word-problem solving difficulty. To estimate pandemic learning loss, we contrasted fall performance for 3 cohorts: fall of 2019 (pre-pandemic; n = 47), 2020 (early pandemic, when performance was affected by the truncated preceding school year; n = 35), and 2021 (later pandemic, when performance was affected by the truncated 2019 to 2020 school year plus the subsequent year’s ongoing interruptions; n = 75). Across the 2 years, declines (standard deviations below expected growth) were approximately 3 times larger than those reported for the general population and for students in high-poverty schools. To estimate the promise of structured remote intervention for addressing such learning loss during extended school closures, we contrasted effects in the RCT’s 2018 to 2019 cohort (entirely in-person intervention delivery; n = 66) against the same intervention’s effects in the 2020 to 2021 cohort (alternating periods of remote and in-person delivery; n = 29). Large intervention effects were not moderated by pandemic status, suggesting potential for structured remote intervention to address student needs during extended school closures.

Planning processing in ADHD with comorbid reading disabilities is worse than in ADHD: Based on Das-Naglieri Cognitive Assessment System.

ObjectiveTo explore and compare the cognitive processing weakness of children with Attention deficit hyperactivity disorder (ADHD) and comorbid reading disabilities (RD) (ADHD+RD) and children with ADHD only using the Das-Naglieri Cognitive Assessment System (DN:CAS).MethodsEighty-eight children with ADHD who visited the hospital for the first time from September 2021 to November 2021 and had a Full scale intelligence quotient (IQ) of ≥85 on the Wechsler Intelligence Scale for Children revised in China (C-WISC) were selected (Age: 6–12 years; Grade: 2–6). Based on comorbidity with RD and the subtypes of ADHD (e.g., Inattention dominant type, ADHD-I, Hyperactivity/Impulse dominant type, ADHD-H and Combined type, ADHD-C), these children were divided into the ADHD+RD group (n = 30) and ADHD group (n = 58) as well as the corresponding subgroups. Clinical data on gender, age, grade, IQ scores, and DN:CAS processing scores were compared between both groups/subgroups. Spearman's correlation test was used for correlation analysis of results of interest.ResultsNo differences in age, grade, male-to-female ratio, verbal IQ, performance IQ, and full scale IQ were observed between the ADHD+RD group and ADHD group as well as the corresponding subgroups (P > 0.05). Children in the ADHD-C+RD subgroup had lower scores in Planning processing of DN:CAS than those in the ADHD-C subgroup (P = 0.040). However, there were no significant difference between the ADHD-I+RD subgroup and ADHD-I subgroup in Planning scores of DN:CAS assessment; The grade of ADHD-C+RD and ADHD-I+RD subgroups were positively correlated with the Planning scores of DN: CAS (r = 0.599, P = 0.030 and r = 0.508, P = 0.044, respectively). The grade of ADHD-C subgroup was positively correlated with the Planning and Simultaneous processing scores of DN: CAS (r = 0.409, P = 0.042 and r = 0.406, P = 0.044, respectively).ConclusionOur study confirmed that children of ADHD-C with comorbid RD have a more severe Planning processing weakness compared to children with ADHD-C only. Among the children of ADHD-C+RD, ADHD-I+RD and ADHD-C, such a Planning processing impairment may improve with increasing educational skills.

Predicting Risk for Comorbid Reading and Mathematics Disability Using Fluency-Based Screening Assessments.

The first purpose of this study was to examine the prevalence of risk for comorbid reading and mathematics disabilities (RMD) at start of first grade, when measured in a representative sample of 3,062 students with first-grade fluency measures (word reading; computation). The second purpose was to examine the utility of these measures for predicting RMD status within a sample of 577 students when RMD status was assessed at the end of second grade in terms of reading and math accuracy. When set at or below the 16th percentile, first-grade risk for RMD was two times more common than chance; at or below the 7th percentile, it was five times more common. Logistic regression showed that the two first-grade fluency measures accurately distinguished students with and without RMD in second grade; however, when cut scores were set to capture 85% of students with RMD, false positives were high. Overall, the results provide support for the use of fluency measures as an initial gating procedure in first grade, but additional gating steps appear necessary in the screening process to reduce false positives.

Mathematics Difficulties and Psychopathology in School-Age Children

This study investigated the relationship between mathematics difficulties and psychopathology in a large community sample (N = 881) of youth (8–18 years of age) in the United States. The primary aims of the study were to (a) test the associations between mathematics difficulties and specific components of internalizing, externalizing, attention, and social problems; (b) examine potential age and gender differences; and (c) investigate the longitudinal relationship between mathematics and psychopathology using 5-year follow-up data. Results indicated that individuals with mathematics difficulties exhibited elevations in most dimensions of psychopathology, including anxiety, depression, externalizing behaviors, attention problems, and social problems. Furthermore, mathematics impairment was associated with internalizing problems, rule-breaking behaviors, inattention, and social problems even after controlling for comorbid reading difficulties. Results suggested that the associations between mathematics and psychopathology are generally similar in males and females. Finally, preliminary longitudinal evidence suggested that initial mathematics difficulties predicted elevations of conduct disorder, rule-breaking behavior, inattention, hyperactivity, and social problems at follow-up, with several of these associations remaining significant even after controlling for initial reading. In contrast, there was no significant association between initial mathematics ability and internalizing symptoms at follow-up, demonstrating some amelioration of internalizing symptoms over time.

Selective visual attention skills differentially predict decoding and reading comprehension performance across reading ability profiles.

The purpose of this study was to examine the relationship between selective visual attention (SVA), reading decoding, listening comprehension and reading comprehension in children with and without a reading disorder. We used longitudinal data from the Avon Longitudinal Study of Parents and Children. We split children into four groups: Typical Readers, Dyslexics, Poor Comprehenders and Comorbid Reading Disorder. We included measures of single word reading, nonword reading, spelling, phonological processing, vocabulary, receptive language, nonverbal intelligence, selective attention and reading comprehension. We used analysis of variance, correlations and structural equation modelling to examine the relationship between SVA and reading. We fit two possible models: SVA Indirect and SVA Direct. The difference between these models was the inclusion of a direct path from SVA to reading comprehension. We examined an indirect model, where SVA predicted reading comprehension through word decoding and listening comprehension, and a direct model, which included a pathway from SVA to reading comprehension. Based on our analysis of variance and correlation results, we collapsed the Dyslexic, Poor Comprehenders and Comorbid Reading Disorder groups for the structural equation modelling. We found evidence that for Typical Readers, an indirect model was the best fit, whereas the direct model was the best model for children with a reading disorder. Selective visual attention is related to reading comprehension. This relationship differs for children with and without a reading disorder.

The effect of an integrated reading and anxiety intervention for poor readers with anxiety.

A recent systematic review has reported that poor reading is reliably associated with anxiety. However, we currently lack evidence-based intervention for children who have both poor reading and anxiety (PRAX). In this study, we tested a new PRAX intervention in 8- to 12-year-old children using a double-baseline intervention case series design. Analyses of both group and individual data revealed that 12 weeks of PRAX intervention significantly improved children’s reading and spelling accuracy, and significantly reduced both anxiety disorders and symptoms. These results support PRAX intervention as a treatment for comorbid reading and anxiety problems in children and pave the way to a randomised controlled trial.

A Synthesis of Elementary Mathematics Interventions: Comparisons of Students With Mathematics Difficulty With and Without Comorbid Reading Difficulty

In this synthesis, we reviewed 65 studies involving elementary students (i.e., grades 1–5) identified with mathematics difficulty (MD) in which authors implemented a mathematics intervention. Of these studies, we identified 33 group designs, 9 quasi-experimental designs, and 23 single-case designs. We aimed to synthesize performance differences between students with MD with and without reading difficulty (RD). We identified three categories of students for analysis: Students with MD+RD, MD-alone, or MD-nonspecified (i.e., no reading information provided). Overall, 80% of studies included students with MD-nonspecified, and the interventions for these students demonstrated strong effects. For the limited number of studies with students with MD+RD or MD-alone, intervention effects were strong for students with MD+RD and variable for students with MD-alone. In the three studies directly comparing the performance of students with MD+RD versus MD-alone, we noted differential patterns of performance. To tailor interventions to student need, more research must be conducted to understand whether students with MD with variable reading profiles respond differentially to mathematics intervention.

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.

Do Chinese Children With Math Difficulties Have a Deficit in Executive Functioning?

Several studies have shown that Executive Functioning (EF) is a unique predictor of mathematics performance. However, whether or not children with mathematics difficulties (MD) experience deficits in EF remains unclear. Thus, the purpose of this study was to examine if Chinese children with MD experience deficits in EF. We assessed 23 children with MD (9 girls, mean age = 10.40 years), 30 children with reading difficulties and MD (RDMD; 12 girls, mean age = 10.82 years), and 31 typically-developing (TD) peers (16 girls, mean age = 10.41 years) on measures of inhibition (Color-Word Stroop, Inhibition), shifting of attention (Planned Connections, Rapid Alternating Stimuli), working memory (Digit Span Backwards, Listening Span), processing speed (Visual Matching, Planned Search), reading (Character Recognition, Sentence Verification), and mathematics (Addition and Subtraction Fluency, Math Standard Achievement Test). The results of MANOVA analyses showed first that the performance of the MD children in all EF tasks was worse than their TD peers. Second, with the exception of the shifting tasks in which the MD children performed better than the RDMD children, the performance of the two groups was similar in all measures of working memory and inhibition. Finally, covarying for the effects of processing speed eliminated almost all differences between the TD and MD groups (the only exception was Listening Span) as well as the differences between the MD and RDMD groups in shifting of attention. Taken together, our findings suggest that although Chinese children with MD (with or without comorbid reading difficulties) experience significant deficits in all EF skills, most of their deficits can be accounted by lower-level deficits in processing speed.

Combined Modality Intervention for ADHD With Comorbid Reading Disorders: A Proof of Concept Study

To evaluate the relative efficacy of two reading programs with and without adjunctive stimulant medication for children with attention-deficit/hyperactivity disorder and comorbid reading disorder (ADHD+RD). Sixty-five children (7–11 years in age) were assigned randomly to one of three intensive remedial academic programs (phonologically or strategy-based reading instruction, or general academic strategy and social skills training) in combination with either immediate-release methylphenidate or placebo. Multiple-blind procedures were used for medication/placebo, given twice daily. Children received 35 hours of instruction in 10 weeks, taught by a trained teacher in a separate school classroom, in small matched groups of 2 to 3. Children’s behavior and reading abilities were assessed before and after intervention. Stimulant medication produced expected beneficial effects on hyperactive/impulsive behavioral symptoms (reported by classroom teachers) but none on reading. Children receiving a reading program showed greater gains than controls on multiple standardized measures of reading and related skills (regardless of medication status). Small sample sizes precluded interpretation of possible potentiating effects of stimulant medication on reading skills taught in particular reading programs. Intensive reading instruction, regardless of treatment with stimulant medication, may be efficacious in improving reading problems in children with ADHD+RD and warrants further investigation in a large-scale study.

Distinct differences in striatal dysmorphology between attention deficit hyperactivity disorder boys with and without a comorbid reading disability

There is evidence of greater cognitive deficits in attention deficit hyperactivity disorder with a comorbid reading disability (ADHD/+RD) compared to ADHD alone (ADHD/−RD). Additionally, the striatum has been consistently implicated in ADHD. However, the extent of morphological alterations in the striatum of ADHD/+RD is poorly understood, which is the main purpose of this study. Based on structural MRI images, the surface deformation of the caudate and putamen was assessed in 59 boys matching in age and IQ [19 ADHD/−RD, 15 ADHD/+RD and 25 typically developing controls (TDC)]. A vertex based analysis with multiple comparison correction was conducted to compare ADHD/−RD and ADHD/+RD to TDC. Compared to TDC, ADHD/+RD showed multiple bilateral significant clusters of surface compression. In contrast, ADHD/−RD showed fewer significant clusters of surface compression and restricted to the left side. Regarding the putamen, only ADHD/−RD showed significant clusters of surface compression. Results demonstrate for the first time a greater extent of morphological alterations in the caudate of ADHD/+RD than ADHD/−RD compared to TDC, which may suggest greater implicated cortical areas projecting to the caudate that are associated with the greater neuropsychological impairments observed in ADHD/+RD.

The written expression abilities of adolescents with Attention-Deficit/Hyperactivity Disorder

Students with Attention-Deficit/Hyperactivity Disorder (ADHD) often experience deficits in academic achievement. Written expression abilities in this population have not been extensively studied but existing prevalence estimates suggest that rates of comorbid writing underachievement may be substantially higher than rates of comorbid reading and mathematics underachievement. The current study examined written expression abilities in a school-based sample of 326 middle school age students with ADHD. The prevalence of written expression impairment, the associations between written expression and academic outcomes, and specific patterns of written expression were investigated. Students with ADHD in this sample experienced written expression impairment (17.2–22.4%) at a similar rate to reading impairment (17.0–24.3%) and at a slightly lower rate than mathematics impairment (24.7–36.3%). Students’ written expression abilities were significantly associated with school grades and parent ratings of academic functioning, above and beyond the influence of intelligence. Analyses of patterns suggest that students with ADHD exhibit greater deficits in written expression tasks requiring organization and attention to detail, especially in the context of a complex task.

Pediatric epilepsy and comorbid reading disorders, math disorders, or autism spectrum disorders: Impact of epilepsy on cognitive patterns

IntroductionIn pediatric epilepsy, comorbidities are reported to be frequent. The present study focusedon the cognitive patterns of children with isolated epilepsy, children with isolated neurodevelopmental disorders (reading disorders, math disorders, autism spectrum disorders), and children with epilepsy and these neurodevelopmental disorders as comorbidities. MethodsBased on two samples of referred children, one with epilepsy, reading disorders, math disorders, or ASDs occurring in “isolation” (n=117) and one with reading disorders, math disorders, and ASDs occurring comorbid with epilepsy (n=171), cognitive patterns were compared. The patterns displayed by verbal and nonverbal abilities from the WISC series were studied with repeated measures ANOVA. Thereafter, an exploratory 2∗3∗2 factorial analysis was done to study the independent contribution of the type of comorbidity and of the presence or absence of epilepsy to the VIQ–PIQ pattern. ResultsIn isolated epilepsy, a VIQ>PIQ pattern was found, which was not seen in the other disorders. When epilepsy and another disorder co-occurred, patterns were altered. They resembled partly the pattern seen in isolated epilepsy and partly the pattern seen in the isolated neurodevelopmental disorder. In comorbid reading disorders, the VIQ>PIQ pattern was mitigated; in comorbid math disorders, it was exacerbated. In comorbid ASDs, no clear pattern emerged. In the presence of epilepsy, patterns characteristic of isolated disorders appeared systematically shifted toward relatively lowered performance abilities or relatively spared verbal abilities. The similar “impact” exerted by epilepsy on the patterns of the various conditions suggested shared mechanisms.

At the Intersection of Math and Reading Disabilities

Individuals with comorbid disabilities in mathematics and reading face significant challenges in acquiring the componential skills related to each domain. Persons with these comorbid conditions are significantly understudied and this paucity of work limits how effective practitioners can be at addressing the needs of this population. In the United States, roughly 7% of all children suffer from math disability; of these, an estimated 17% to 66% also has a comorbid reading disability. Underspecification of current conceptualizations of math and reading disabilities, including how to best identify and classify individuals with one or more of these disabilities, hampers our efforts to intervene effectively. To conceptualize how to move forward in these areas, the Eunice Kennedy Shriver National Institute of Child Health and Human Development held a workshop focused on examining the etiology, classification, and remediation of comorbid math and reading disabilities. This special issue, titled At the Intersection of Math and Reading Disabilities, continues that discussion. Contributing authors articulate a path forward to address the needs of these learners and inform the foundational understanding of both conditions in isolation and as they interact.

Rise Time Perception in Children With Reading and Combined Reading and Language Difficulties

Using a non–speech-specific measure of prosody, rise time perception, Goswami and her colleagues have found that individuals with dyslexia perform significantly worse than nonimpaired readers. Studies have also found that children and adults with specific language impairment were impaired on these tasks. Despite the high comorbidity of these disorders, only one study has assessed rise time sensitivity in children with comorbid reading and oral language difficulties. The authors further examined rise time sensitivity in children with both reading and oral language difficulties. They compared performance on rise time perception tasks between 18 children with reading difficulties, 15 children with combined reading and oral language difficulties, and 17 chronological age–matched controls. The authors found a significant interaction between group and performance on auditory tasks. Further tests revealed that chronological age–matched controls were significantly better on the rise time measures compared to both groups of children with reading difficulties. Performance between the groups of children with reading difficulties did not significantly differ.

Clinical Utility of the Vanderbilt ADHD Rating Scale for Ruling Out Comorbid Learning Disorders

The goal was to examine the clinical utility of using the Vanderbilt Attention-Deficit/Hyperactivity Disorder (ADHD) Rating Scale (VARS) to determine when to refer children with ADHD for learning disorder (LD) evaluations. A total of 128 stimulant-naive children with ADHD, 7 to 11 years of age, were included in the study. The parents and teachers of 128 children with diagnosed ADHD completed the VARS. The reading, numerical operations, and spelling subtests from the Wechsler Individual Achievement Test, Second Edition, were used to identify children with a comorbid LD. We examined the predictive validity and clinical utility of the VARS performance items for ruling in/out the presence of a comorbid LD. Thirty-eight percent of the samples met the criteria for a comorbid LD. A cutoff score of 7.5 for the sum of the VARS parent and teacher reading items had excellent clinical utility for ruling out both reading and spelling LDs. Cutoff scores of 4 for the VARS teacher reading and writing items had excellent utility for ruling out comorbid reading and spelling LDs, respectively. None of the VARS performance items effectively identified or ruled out math LDs. The VARS performance items should be used with an interview about school functioning and a review of school records to rule out the presence of a comorbid reading or spelling LD for children with diagnosed ADHD.

Skill development in different components of arithmetic and basic cognitive functions: Findings from a 3-year longitudinal study of children with different types of learning difficulties.

Arithmetic and cognitive skills of children with mathematical difficulties (MD-only), with comorbid reading difficulties (MD-RD), with reading difficulties (RD-only), and normally achieving children were examined at 3 points from Grades 3-4 to Grades 5-6 (age range, 9-13 years). Both MD groups displayed severe weaknesses in 4 domain-specific arithmetic components (factual, conceptual, procedural, and problem-solving skills) during all 3 measure points. Telling time and approximate arithmetic were also problematic for children with MD. Both MD groups displayed a small weakness related to visual-spatial working memory, and the MD-RD group also displayed small weaknesses related to verbal short-term memory, processing speed, and executive functions. The 4 groups developed at similar rates within all domain-specific components as well as basic cognitive functions. These findings demonstrate that children identified as having MD when they are 9 years old do not catch up with their normally achieving peers in later school grades, when they are 13 years old. They also continue to lag behind their peers with respect to the domain-general cognitive system.

EEG coherence in children with attention-deficit/hyperactivity disorder and comorbid reading disabilities

This study investigated EEG coherence differences between two groups of children with attention-deficit/hyperactivity disorder Combined type (AD/HD), with or without comorbid Reading Disabilities (RD), and normal control subjects. Each group consisted of 20 children between the ages of 8 and 12 years, and groups were matched on age and gender. EEG was recorded during an eyes-closed resting condition from 21 monopolar derivations. Wave-shape coherence was calculated for 8 intrahemispheric electrode pairs (4 in each hemisphere), and 8 interhemispheric electrode pairs, within each of the delta, theta, alpha and beta bands. In the intrahemispheric comparisons, the AD/HD groups compared to controls showed across-hemisphere reductions in coherences in the delta band at longer inter-electrode distances. Interhemispheric coherences in the frontal areas were elevated in theta and reduced in alpha; in the temporal area, coherences were reduced in alpha. Compared with children with AD/HD without comorbid RD, intrahemispheric coherences at shorter inter-electrode distances in children with comorbid RD were reduced in the left hemisphere for slow wave activity, particularly delta. Across hemispheres, the comorbid group also showed a reduced level of intrahemispheric coherence at longer inter-electrode distances in alpha. There were no interhemispheric differences associated with RD. The present results indicate that children with AD/HD and comorbid RD show deficits additional to those found in AD/HD patients without comorbid RD. These involve reduced lateralisation and impaired coupling of frontal and occipital brain regions in children with comorbid RD. Results confirm and clarify the additivity of brain dysfunctions in children with comorbid AD/HD and RD, previously reported by EEG power studies. Findings suggest that optimal treatment of these children should recognise the need to specifically address the RD, in addition to employing a medication regime focussed on the AD/HD symptoms.

Verbal and Visual Short-Term Memory in Children with Arithmetic Disabilities

With the exception of the explication of the Nonverbal Learning Disability Syndrome, our knowledge of cognitive characteristics of children with isolated arithmetic (A) disabilities contrasted with those with comorbid arithmetic and reading (AR) disabilities is limited. Of the existing studies, most suggest that visual deficits are characteristic of Subtype A. This study examined short-term memory in 45 children who were classified into these two subtypes. Children in Subtype A displayed better verbal memory on some tasks than children in the AR subtype, but no subtype differences in visual memory were found. Counter to our hypothesis, children in Subtype A did not display relatively poorer visual memory than verbal memory. These results suggest a mixed neuropsychological profile, and the absence of visual short-term memory weaknesses as descriptive of the A subtype.

Basic numerical skills in children with mathematics learning disabilities: A comparison of symbolic vs non-symbolic number magnitude processing

Forty-five children with mathematics learning disabilities, with and without comorbid reading disabilities, were compared to 45 normally achieving peers in tasks assessing basic numerical skills. Children with mathematics disabilities were only impaired when comparing Arabic digits (i.e., symbolic number magnitude) but not when comparing collections (i.e., non-symbolic number magnitude). Moreover, they automatically processed number magnitude when comparing the physical size of Arabic digits in an Stroop paradigm adapted for processing speed differences. Finally, no evidence was found for differential patterns of performance between MD and MD/RD children in these tasks. These findings suggest that children with mathematics learning disabilities have difficulty in accessing number magnitude from symbols rather than in processing numerosity per se.