Kathy Baker

Faculty Education and Creative Arts

Central Queensland University

Yaamba Rd

Rockhampton 4702

Email: k.baker@cqu.edu.au

Significant numbers of ADHD students have associated learning difficulties, the most common of which are reading difficulties. While acknowledging that the current understanding of ADHD is still incomplete and many aspects remain controversial, the latest understanding of the disorder has been used to design a reading intervention to remediate reading difficulties in ADHD students. The intervention will be useful for teachers who are faced with the problems associated with trying to teach ADHD students with associated reading difficulties how to read, since as yet there is a paucity of literature on the topic. This paper reports on a study that used a case study methodology to evaluate the effectiveness of this reading intervention for ADHD students who ranged from year three to senior high school.

ADHD is a developmental disorder that affects a significant proportion of the population . A survey carried out in 1998 found that 11.2% of children in Australia aged six to seventeen years had ADHD . This figure indicates that there would be as many as three ADHD children in the average sized class. Of these students affected by ADHD 80% also have learning difficulties with reading difficulties being the most common .

In order to understand why such a significant number of ADHD students struggle with reading, and to begin to consider ways of supporting the ADHD reader, current understanding of both the disorder and the reading process were reviewed. The following section briefly outlines a current theory of ADHD and is followed by an adaptation of this theory that begins to describe how the ADHD student might engage in the reading process. The remainder of the paper outlines the intervention that was developed and summarises early findings from the trial of this intervention.

Current understanding of the disorder indicates that ADHD results in deficits in executive functioning . Executive functions have been described as those functions that allow for analysis of information, reflection on current knowledge, planning and organisation, self-monitoring , mobilising attention, and inhibiting responding . They allow self-regulation and are necessary for the initiation and maintenance of goal directed behaviour .

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 reproduced in Figure 1 and forms part of the theoretical framework used to design the reading intervention.

The model identifies inhibition as the primary executive function that affects four other executive functions: working memory, self-regulation of affect/motivation/arousal, internalisation of speech, and reconstitution.

In Barkley's model behavioral inhibition is seen as having three roles, to create a delay or pause before responding to a situation or task, to protect that delay from outside distractions, and to help stop inappropriate reactions or behaviours that may have already started. Deficits in inhibition prevent and/or interrupt thoughtful responses or actions.

Working memory retrieves relevant information from long-term memory and allows students to remember that they intend/need to finish a task. It also assists students to remember what the task requires as well as prompting students to get back on task after an interruption.

Self-regulation of affect allows students to consider emotional responses before responding and helps to modify inappropriate responses. It promotes self-motivation and so allows students to carry out boring and repetitive tasks that have no motivating factors or inherent interest for the students. This executive function also helps students to be more objective and realistic in their self-evaluation.

Internalisation of speech is the self-talk used to evaluate and direct behaviour of the self. It allows students to reflect before acting and to select behaviour or action that is going to help them reach their goal. The self-talk used by ADHD students tends to be less task oriented and efficient than that used by non-ADHD students.

Reconstitution allows students to analyse and use information to create a novel response such as reciprocal speech during a conversation. It also promotes effective and flexible problem solving where alternative plans of action need to be generated.

An analysis of the executive function deficits experienced by ADHD children indicate that these deficits are likely to impact the ADHD reader's ability to successfully engage in the reading process. Both affective and cognitive conditions of the ADHD reader, as well as the capacity of executive control functions to monitor the meaning construction process are likely to be compromised.

Reading is a meaning constructing process that involves the reader in a continuous series of hypotheses and revisions . This process is monitored by executive control functions to assess progress toward the goal of understanding the text . It is a process that relies on the active use of the reader's past life experiences and knowledge to facilitate interaction with the text. The result of successful reading is the construction of meaning that is both relevant and meaningful to the reader and true to the intended meaning of the text , with meaning evolving through the interactions between the text and reader.

The following model demonstrates the adaptation of Barkley's theory to show the possible impact of ADHD on the reading process.

As can be seen from this model the influence of executive function deficits on the reading process tends to be significant and pervasive. It begins as the ADHD student attempts to engage in the reading process and continues throughout the reading experience, reducing his/her ability to successfully complete post-reading activities. The end result is generally an underachieving student who sees themselves as a non-reader, and reading as an unenjoyable threatening experience.

Reading instruction for underachieving ADHD students is likely to be successful if it addresses the impact of executive function deficits on the reading process. The reading intervention trailed in this study supports executive functioning by combining reading strategy training, the cognitive training components of self-instruction, self-monitoring, self-reinforcement , and visual memory prompts.

Self-instruction for the intervention focuses on the self-statements needed to prepare for reading, to initiate and maintain monitoring of meaning construction and to select and assess appropriate repair strategies. To ensure that a repertoire of appropriate strategies is available, and that strategy use is seen as valuable, the intervention also involves explicit teaching of reading strategies used for monitoring and repairing meaning.

Self-monitoring is used to record the use of reading strategies and self-reinforcement is contingent on the use of taught reading strategies, detected through self-monitoring. Visual memory prompts are used to help maintain all available reading strategies on-line and to aid in the recall of events/information gained from reading the text.

The study to be reported on in this paper follows a pilot study carried out in 2001 where the intervention was shown to be successful in improving reading achievement as well as attitude and motivation towards reading for a group of seven students in a regional Queensland State primary school .

A multiple case study method was used for the follow-up study and included nine students identified as having ADHD. Of these nine students seven were from two state primary schools in regional Queensland, ranging from year three to year six. The remaining two were from a state high school in regional Queensland, one from year eight and one from year eleven. All students had been identified by both school and parents as being ADHD and were on medication prescribed for the disorder. Of the primary students, two were female and five male, one of the high school students was male and one female.

All students were pre-tested using standardised reading tests for both comprehension and sight vocabulary, and miscue analyses were conducted on samples of oral reading. Parent, teacher and student participants were interviewed also.

Following pre-testing the students were involved in an eight week training program. During this time each student worked with a student-teacher, teacher aide or classroom teacher, each of whom had been trained in the implementation of the intervention and had attended a presentation on the theoretical background to the study and general information about ADHD.

After this initial training period the students were again tested and teachers, parents and students interviewed, before commencing a maintenance period of ten weeks. Classroom teachers were asked to maintain the intervention by providing silent reading periods of about fifteen to twenty minutes, twice a week during the maintenance phase. The teachers were also asked to continue the reward system established during the training period. All classroom teachers had been trained in the implementation of the intervention and had attended a presentation on the theoretical background of the intervention and general information about ADHD. The students were again tested and all participants interviewed at the end of the maintenance phase.

Following the initial training period all students demonstrated an increase in comprehension shown by their results on the standardised tests as well as their retelling of the texts used for miscue analysis. The degree of improvement varied between students with four of the nine students improving by more than one year reading age and the other five students improving by six to ten months on reading age. Improvements in comprehension were also detected by classroom teachers through observation of the students. Parents who were regularly involved in hearing their children read also reported an improvement in comprehension. All students reported an improvement in reading comprehension.

Post-testing following the maintenance phase indicated that all students, except two, continued to improve their comprehension. The two students who did not improve maintained the initial gain they had made on their comprehension. Both of these students had made over a one-year improvement in reading age following the training period. Of the students who continued to improve their level of comprehension, one improved by one year and six months on reading age, while another improved by two years. The remaining students improved by three to nine months on reading age. Again these improvements were noted by teachers, either through observation or both observation and the analysis of running records taken as part of class testing. Parents regularly involved in hearing their children read also reported noticing these on-going improvements, as did all students.

Measurements of sight vocabulary taken after the training period showed that all students, except one had increased their sight vocabulary. Two students improved by more than two years' reading age, three improved by more than one year and the remaining students improved by six to seven months of reading age. One further student had a sight vocabulary that was too great to measure to a reading age with the instrument used for this study, both before and after the training period, but had increased the number of words read correctly by four words.

Results of post-testing following the maintenance phase showed that all students, except two, had increased their sight vocabulary score again. It is interesting to note that the student who did not show an increase in sight vocabulary score after the training period, had an increased score following the maintenance period. Of the two who did not improve, one was the student who began with an extremely high sight vocabulary and he was able to maintain the increase made during the training period. The other student who did not continue to improve reduced the score of the previous test. Those who improved their sight vocabulary score increased in reading age by one to seven months.

Analysis of oral reading after the initial training period indicated that the pattern of strategy use had changed for all students with students now using a range of strategies and being more effective and flexible in the way they used the reading strategies. Their concern for making meaning from what they were reading had also increased with many more meaning-changing errors detected and corrected. Towards the end of the training period trainers noted that their student was becoming more automatic in his/her strategy use and while he/she was continuing to use the full range of strategies, had stopped being aware of each strategy used.

By the end of the maintenance phase students were continuing to use the full range of strategies more effectively. When interviewed all students reported that the strategies were "in their heads" and that they used them whenever they were reading. This change in reading behaviour was noted by the classroom teachers and those parents who regularly heard their children read.

As with comprehension and sight word vocabulary student motivation to engage in reading increased to varying degrees. All students became more willing to engage in reading in the classroom and most increased the amount of reading they were doing in the home. The year eight student, Mark, (pseudonyms have been used) reported that he had read all that was available to him at home and had joined the local library during the maintenance phase. The need for external motivation reduced for all students with most students no longer requiring this form of motivation to encourage them to use reading strategies or engage in reading in the classroom.

At the beginning of the training period all of the students were reluctant readers who avoided reading where possible, except for one primary student who reported that she loved reading. Mark was particularly averse to reading and reported in his initial interview that "reading was stupid" and that he got other people to read for him.

Despite this reluctance all students were willing to be withdrawn for the training program and reported that "earning points and prizes was fun" and made them look forward to the reading sessions. The one exception to this was Colleen, the year eleven student, who was willing to go to the training sessions, but was not impressed by the idea of rewards. From the beginning Colleen was motivated by the desire to improve her reading.

For all other students both using strategies and monitoring them was driven by the desire to earn points and so 'prizes'. Trainers reported instances where students asked to keep reading because they only needed to earn one more sticker before they could claim a prize. This behaviour was also noted at times during post-testing.

Interviews conducted at the end of the training period indicated that all except two students had increased the amount of reading they were choosing to do both at home and in the classroom whether or not they were earning points and rewards.

This was further evidenced during the maintenance phase when some teachers and students reported that students were monitoring their strategies during silent reading but had chosen not to collect their rewards from the classroom teacher. Some teachers also reported that students were volunteering to read aloud in front of the class. This represented a significant change in behaviour as previously these students had actively avoided reading and had refused to read aloud in class.

The degree of attitudinal changes towards reading also varied between students. While all students identified an improvement in their reading, and all reported that they now felt more positive about reading, not all of them demonstrated the same increase in enthusiasm for reading. For some the way they perceived reading changed altogether and they began seeing it as something that was for pleasure as well as useful. Others began to see reading as less of a chore and useful for being able to complete school assignments.

In the interview following the training period Mark reported that over the recent school holidays he had read a book for the first time and that he thought "it was cool". He said that before he had started on the training program he thought that reading was just saying words. He couldn't work out why people read and what was so good about reading. His mother reported that Mark had "read everything in the house" and that she was "shocked" by the change in his attitude to reading.

Another parent reported in an interview following the maintenance phase that her daughter Kate had started teaching her younger sister how to read using the strategies and methods from the intervention. The parent went on to say that the younger child had now started to improve in her reading. This parent also reported that Kate was now quite enthusiastic about getting her homework done and to do the projects set in class.

The changes in the students' reading behaviour and pattern of strategy use was not limited to isolated reading events where they were either working with a trainer or using the intervention during silent reading. Students reported that they used the strategies every time they read. Teachers also reported that the students' ability to research and write project reports had been enhanced.

Mark reported that he had improved in other subjects as well because he were able to read and understand the notes on the blackboard and the text-books he had to read. Mark had moved from a special class to a regular class just as he had finished the training period and was reported by his new English teacher to be the best reader in the class, with the best comprehension. He also reported in the interview after the maintenance phase that he had recently completed an assignment in English that required research on the Internet and a written report. Mark had earned an A+ for this work and said that he believes he wouldn't have achieved this grade before he worked on the reading program.

As mentioned previously all classroom teachers attended a session that included training in the use of the intervention and general information about ADHD. At the end of the training phase teachers also met with myself and the trainer who had worked with their student/s to discuss the student's progress and test results. The teachers also observed the trainer working with their student/s. Most were willing to attend these sessions though one teacher did not stay long enough to either observe or discuss the student's results even though her class was being taken by the deputy principal to allow her to attend this session.

Of the eight teachers involved, only one teacher, Mary, actively supported her student in the use of the intervention during the maintenance phase. Mary provided regular silent reading sessions, reminded Stephen to use the necessary materials and introduced the intervention to Stephen's reading group. Mary was able to be released from the classroom to work as a trainer during the first few weeks of the training phase before a teacher aide assumed this role. She witnessed first hand the changes that took place in Stephen's reading and became very excited about his progress.

Other teachers supported the students to varying degrees ranging from little provision of silent reading to provision of regular silent reading but without reminding students to use the materials. One teacher did not provide reading material suitable for the student's ability level stating in the final interview that there wasn't enough time to gather books to suit individual students. Mark's new English teacher was not asked to maintain the intervention in any way as Mark did not want to use the intervention in his new class.

This paper briefly outlined findings from a follow-up study into the efficacy of a new reading intervention for students with ADHD. The intervention was based on Barkley's theory of ADHD and current understanding of the reading process. It included the cognitive training components of self-instruction, self-monitoring and self-reinforcement; training in the use of reading strategies, and visual memory prompts. Early data analysis indicates that ADHD students from early primary through to senior high school are able to benefit from the intervention with findings demonstrating improvement in reading comprehension, sight vocabulary, motivation to engage in reading and attitude to reading. These findings are particularly heartening considering the results of the second post-tests which showed that most students continued to improve with minimal input from classroom teachers during the maintenance phase.