Delinquency, Hyperactivity, and Phonological Awareness: A Comparison of Adolescents With ODD and ADHD

Copyright by Elizabeth Diane Palacios 2002

The Dissertation Committee for Elizabeth Diane Palacios Certifies that this is the approved version of the following dissertation:

DELINQUENCY, HYPERACTIVITY, AND PHONOLOGICAL AWARENESS: A COMPARISON OF ODD AND ADHD

Committee:

Margaret Semrud-Clikeman, Supervisor

Diane Schallert

Frank Wicker

Penny Seay

Roger Kirk

DELINQUENCY, HYPERACTIVITY, AND PHONOLOGICAL AWARENESS: A COMPARISON OF ODD AND ADHD

by Elizabeth Diane Palacios, B.A., M.S. Ed.

Dissertation Presented to the Faculty of the Graduate School of The University of Texas at Austin in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy

The University of Texas at Austin May 2002

Dedication

To my precious family, Robert, René, Aaron, and Michelle. I love you.

Acknowledgements

I would like to acknowledge those who have contributed immensely to the completion of this dissertation. Without their substantial gifts of knowledge, expertise, patience, guidance, and love, this endeavor would not have been possible. It was certainly a community project! I give special thanks to my mentor and advisor, Dr. Margaret SemrudClikeman for her unwavering support, encouragement, and inspiration. My admiration grew as I was constantly challenged academically as well as personally to strive toward excellence. Thank you for believing in me. I also would like to express my gratitude to such an exceptional dissertation committee; Dr. Penny Seay, Dr. Diane Schallert, and Dr. Frank Wicker whose academic mastery and yet down-to-earth demeanor were immeasurable and to Dr. Roger Kirk for his guidance as well! A special thanks to my graduate assistants who volunteered their time during a hectic schedule: Melinda Williams, Nicole Melton, Allison Alexander, and Ashley Ayub. I would like to acknowledge La Vega ISD, Waco ISD, and McLennan County Challenge Academy for making their students available for this study. The principals, teachers, counselors, staff, and parents demonstrated v

both professionalism and passion for their students and this study. I would also like to recognize the community of Robinson, Texas, for their willingness to volunteer their resources and community network as well as Waco businesses and restaurants for providing great incentives for the children. I offer deep gratitude for all the support from my administration, colleagues, and students at Baylor University who made my years of commuting to Austin and teaching in Waco both bearable and enjoyable. To my dear friends on campus, I give special thanks. I wish to thank my colleagues in the School of Education and in the Department of Educational Psychology for the constant support, encouragement, and high expectations set for me. I look forward to giving more of my time and expertise to this excellent institution. I must also take time to express gratitude to all those who contributed to this endeavor during the “long haul.” Thanks to my mother-in-law, Elvira, and to my neighbor, Sylvia Brown, for their countless (and delicious) meals for my family while I was away, my father-in-law, Genaro, who would not let me quit, Dr. Lyle C. Brown, for his tireless editing during the wee hours of the night, my mom, Minerva, the prayer warrior, my sister, Marianne, who always asked how my “little book” was going, my dad, Edward, and brothers, Eddie and Mark, who earnestly tried to remember what I was studying in school. I’m finally finished! Finally, I give all my appreciation and gratitude to my family. Robert, you were relentless in smoothing out the turbulence, calming the chaos, and bringing laughter and love to my life. You are my rock and my soul mate. To my children, I want to say how proud I am of how you have become young adults.

vi

Time goes swiftly, but your love is constant. Thank you René for making it so easy and fun to be a mom. Your leadership for your sister and brother is extraordinary. You always kept me assured that all was well (even when it wasn’t). Aaron, thanks for your humor and wit. You kept things high-spirited around the house with never a dull moment. Michelle, your warm, caring, and loving spirit has touched my life. Keep your light shining! I’m blessed to have each of you! Most of all, I give thanks to God who led me through the winding paths even when I couldn’t see the destination. Thank you Lord!

vii

Delinquency, hyperactivity, and phonological awareness: A comparison of ODD and ADHD

Publication No._____________

Elizabeth Diane Palacios, Ph.D. The University of Texas at Austin, 2002

Supervisor: Margaret Semrud-Clikeman

Most parents and educators agree that reading is the foundation for success in the classroom. However, many children fall short of the necessary reading level, resulting in an array of classroom problems. Reading disability and behavior problems are the two most common childhood disorders observed in the classroom (Smart, Swanson, & Prior, 1996). Depending on the definition used, it is estimated that 10-15% of school-aged children have learning problems, with most research directed at reading difficulties (Smart et al., 1996). Similarly, behavior problems, such as hyperactivity and oppositional disorder, are also evident in the classroom. The high level of overlap between reading difficulties and behavior problems, especially the externalizing types, has been consistently reported (Cornwall & Bawden, 1992; McGee, Williams, Share, Anderson, & viii

Silva, 1986; Pisecco, Baker, Silva, & Brooke, 1996). Without successful early intervention, both disorders commonly lead to costly and long-term negative outcomes for both the child and society. The purpose of this study was to explore the relationship between reading skills, specifically reading comprehension and phonological awareness, and externalizing behaviors--hyperactivity (ADHD) and oppositional defiant disorder (ODD). Children with ADHD have been found to have a comorbidity of reading disabilities at a higher proportion than would be expected by chance. Hyperactivity and impulsivity have been noted to be the most contributing factors in these studies. In this study, children with only ADHD-combined type of hyperactivity and inattentiveness, ODD only, a combination of ADHD and ODD, and children without either ADHD or ODD were invited to participate. Participants in the study included approximately 100 boys between the ages of 1115 in grades 6-8.

They were selected from Central Texas area alternative

education schools. Parents completed behavior rating scales that measured their child's adaptive and problem behaviors in the community as well as at home. Teachers also completed behavior rating scales that measured these same behaviors in the school setting. Group differences were explored in the areas of reading comprehension and phonological awareness. Results indicated that there were no significant differences among the four groups. These findings raise the question as to whether the groups were truly homogeneous or if group differences were not identified because of inappropriate reading measures. While all four groups performed in the average range in phonological awareness and reading

ix

comprehension, most of the ODD and ADHD/ODD students are reading below grade level. Further investigation is warranted in this area.

x

Table of Contents List of Tables ........................................................................................................xiv List of Figures........................................................................................................xv Chapter 1 Introduction.............................................................................................1 Research Questions................................................................................6 Chapter 2 Review of Literature ...............................................................................7 Academic Problems ........................................................................................8 Learning Disabilities (LD)............................................................8 Assessment of Learning Disabilities ............................................9 Reading Disabilities (RD)...........................................................10 Assessment of Reading Disabilities............................................13 Reading Comprehension (RC)....................................................14 Assessment of Reading Comprehension ....................................15 Phonological Awareness (PA)....................................................15 Assessment of Phonological Awareness ....................................16 Externalizing Behavior Problems .................................................................17 Attention-Deficit/Hyperactivity Disorder-Combined Type (ADHD-C) ..................................................................................18 Assessment of ADHD-C.............................................................20 Oppositional -Defiant Disorder (ODD) ......................................27 Assessment of ODD ...................................................................29 Comorbidity of Learning Disabilities and Externalizing Behaviors ............29 Comorbidity of Reading Problems and ADHD-C ........................................ 31 Comorbidity of ADHD-C and ODD............................................................. 35 Gender Differences .......................................................................................36

366

Summary ....................................................................................................... 37

xi

Chapter 3 Methodology ........................................................................................40 Recruitment Sources.....................................................................................40 Participants ...................................................................................................41 Classification Of Participation......................................................................46 ADHD-C.....................................................................................47 ODD............................................................................................49 ADHD-C and ODD ....................................................................49 Control Group (CON).................................................................49 Instrumentation .............................................................................................49 Wechsler Abbreviated Scale Of Intelligence (WASI)................49 Socio-Economic Status (SES) ....................................................50 Behavior Assessment System For Children (BASC) .................50 Attention-Deficit/Hyperactivity Disorder Test (ADHDT) .........51 Outcome Measures .......................................................................................52 Woodcock Diagnostic Reading Battery (WDRB) ......................52 Procedure ......................................................................................................55 Experimental Design and Analyses ..............................................................57 Designs and Analyses for Study Hypotheses .............................57 Sample Size and Power ................................................................................63 Chapter 4 Results..................................................................................................64 Descriptive Analyses ....................................................................................64 Sample Population ......................................................................64 Group Comparisons ....................................................................68 Research Analysis.........................................................................................74 Preliminary Analyses..................................................................74 Primary Analyses........................................................................74 Secondary Analyses....................................................................78

xii

Chapter 5 Discussion ............................................................................................81 ADHD-C and Subtests of Phonological Awareness............................93 ADHD-C And Subtests of Reading Comprehension...........................93 Integration with Literature...................................................................94 Contribution to Literature ....................................................................97 Limitations.........................................................................................100 Conclusions........................................................................................102 Directions for Research .....................................................................103 Appendix..............................................................................................................107 References............................................................................................................114 Vita ....................................................................................................................128

xiii

List of Tables Table 1:

DSM-IV Diagnostic Criteria for Attention-Deficit/Hyperactivity Disorder-Combined Type .................................................................21

Table 2:

DSM-IV Diagnostic Criteria for 313.81 Oppositional Defiant Disorder ............................................................................................27

Table 3:

Sample Population Demographics Data ...........................................43

Table 4:

Classification of ADHDT Quotient Scores and Group Levels.........48

Table 5:

Classification of Phonological Awareness Group Levels.................54

Table 6:

Means and Standard Deviations for Measures on IQ, ADHDT, and WDRB Reading Measures for the Total Sample .......................65

Table 7:

Comparisons Between Teacher and Parent BASC Rating Scales ....67

Table 8:

Means and Standard Deviations of Age and Grade for Each Group ................................................................................................69

Table 9:

Group Comparisons on Variables.....................................................73

Table 10:

Group Comparisons on Outcome Measures .....................................77

xiv

List of Figures Figure 1:

Causal Path Models for Reading Disabilities and Behavior Problems ............................................................................................4

Figure 2:

Causal Path Models: Hypotheses for the Co-Occurrence of LD and ODD ………..............................................................................30

Figure 3:

Causal Path Models: Hypotheses for Occurrence of Comorbidity Of RD and ADHD ............................................................................33

Figure 4:

Ethnicity of Sample Population ........................................................45

Figure 5:

Group Comparisons by Ethnicity .....................................................71

Figure 6:

Group Comparisons by Socio-Economic Status (SES) ....................72

Figure 7:

Reading Comprehension and Phonological Awareness Cluster Scores................................................................................................75

xv

Chapter 1: Introduction School success appears to come easier to some children than to others. Most children begin their first year with high aspirations of beginning an adventure into unknown territory. But all too soon, for some, those dreams are shattered and the reality of successive failures takes its toll. Children have the need to belong and the need to experience academic success, personal growth, and a positive self-identity. During the early years, however, some students begin to experience academic failure that often results in behavior problems, disconnectedness, frustration, and/or apathy (McWhirter, J., McWhirter, B, McWhirter, A., & McWhirter, E., 1998). The regular education classroom environment most often supports learning for students “in the middle of the road,” excluding those students on the fringes of the intellectual and behavioral spectrum. Gifted children, along with academic underachievers, sometimes are left to “sink or swim.” With literally hundreds of studies on classroom effectiveness and efficiency, there is still much to be learned about empowering students who do not readily attain academic success. Since the 1970’s, federal laws have addressed the needs of exceptional children and have set the standards for special education. The Individuals with Disabilities Education Act (Public Law 94-142) mandates guidelines for prereferrals, early modifications, referrals, assessments, classroom interventions, and effective placements. Early detection of learning problems has enabled teachers,

1

parents, and school staff to work together to develop effective learning programs tailored to the child’s individual needs both in the classroom and at home (Mastropieri & Scruggs, 2000). With the growing number of children diagnosed with some form of learning disability, more attention has been placed on empirical research and its classroom implications. During recent years, however, researchers, as well as teachers and parents, have noticed that many children with learning disabilities also display behavior problems (Hinshaw, 1992; McGee et al., 1986). Reading disabilities are the most frequently diagnosed learning disability (Cornwall & Bawden, 1992). Because of the importance of literacy to our society and to academic success, reading has been selected for this study. The two major components of reading are reading comprehension and decoding. Decoding is built upon phonological awareness, which refers to an ability to make use of "spelling-to-sound" relationship (Aaron, 1991). There is a substantial body of evidence indicating that phonological awareness is a critical skill in learning to read (Lundberg, Frost, & Petersen, 1988; Stanovich, 1986). There is a long-standing debate as to whether learning disabilities (LD) lead to the development of behavior problems or vice versa, which is known as the Learning Disability/Juvenile Delinquency Link (LD/JD). This study examines the “greater than chance” overlap between reading disabilities and externalizing behaviors. Three hypotheses have been offered to explain causal paths of the comorbidity of reading disabilities and behavior problems: (1) behavior problems (BP) precede and lead to reading disability (RD) by disrupting the learning

2

process; (2) reading difficulties and the frustration and failure experiences they encompass lead to “acting out” disruptive behavior, anxiety, and other problems; and (3) there are common precursors (e.g., intelligence, social disadvantage) that contribute to the development of both disorders (see Figure 1). Hinshaw (1992) poses a fourth hypothesis of bidirectional paths between both disorders (Smart et al., 1996).

3

Hypothesis 1:

BP

RD

Hypothesis 2:

RD

BP

Hypothesis 3:

Common Etiology

RD BP

Hypothesis 4:

BP

RD

Figure 1. Causal path models for the occurrence of reading disabilities (RD) and behavior problems (BP).

4

The ramifications of reading and behavior problems are evident in various domains. First, in terms of prevalence rates of the overlap of reading problems and externalizing behavior problems, children continue to experience “personal and societal suffering” and resistance to most intervention strategies in the classroom (p. 127, Hinshaw, 1992). Second, reading problems and behavior problems each strongly predict later maladjustment (Cornwall & Bawden, 1992). Third, it is widely believed that understanding the underlying causes of these difficulties may yield theoretical insights into behavior-cognition links (Hinshaw, 1992). Fourth, the association of reading problems and behavior problems has implications for future policy (as evidenced in the efforts toward modifying U.S. law to include Attention-Deficit/Hyperactivity Disorder as a distinct category deserving special education services) (Hinshaw, 1992). Several studies examining the comorbidity of reading problems and behavior problems have found that Attention-Deficit/Hyperactivity Disorder (ADHD) type behavior problems significantly differentiated children with comorbid problems from children with behavior problems alone (Smart et al., 1996). Studies found that children with both reading problems and ADHD also exhibited significantly more antisocial behaviors than groups of children with reading disabilities only, ADHD only, and the control group (Pisecco et al., 1996). The lack of consensus concerning the definition of learning disabilities, specifically reading disabilities, add further to the complexity of examining externalizing behaviors and reading difficulties.

5

RESEARCH QUESTIONS This study will investigate the relationship between hyperactivity and externalizing behavior as it relates to reading comprehension as well as phonemic awareness.

Students with Attention-Deficit/Hyperactivity Disorder-Combined

Type (ADHD-C) will be compared to students with Oppositional Defiant Disorder (ODD), and the relationship to reading ability will be examined. The following general research questions guide the hypotheses of this study: 1.

Do reading measures discriminate among groups of children with ADHD plus ODD compared to those of either disorder and control group? If they do, do measures of phonological awareness deficits underlie those differences?

2.

Do children with a sole diagnosis of ADHD perform more poorly than those with a diagnosis of ODD? If they do, will these differences be most pronounced on measures of phonological awareness?

6

Chapter 2: Review of the Literature Learning disabilities and behavior problems are the two most common childhood disorders (Frick, Lahey, Kamphaus, Loeber, Christ, Hart, & Tannenbaum, 1991; Hinshaw, 1992; Smart et al., 1996).

Depending on the

definitional criteria utilized, it is estimated that 10%−15% of school-age children have learning problems, most specifically in the area of reading. Many variables have been examined to find possible correlations to these two disorders, including hyperactivity, externalizing behaviors, IQ, SES, etc. In this study, the purpose is to explore the relationship between students who exhibit externalizing behaviors and symptoms of hyperactivity and their effect on measures of phonological awareness and reading comprehension. This chapter reviews the literature in several areas of investigation pertinent to the study of learning disabilities, reading disabilities, Attention-Deficit/Hyperactivity Disorder-Combined Type (ADHD-C), and Oppositional Defiant Disorder (ODD). The literature review includes theoretical perspectives on the development of both reading disability and ADHD from neuropsychological, psychological, and cognitive perspectives. In addition, various studies demonstrating the social and behavioral problems of children with reading disabilities and/or ADHD are reviewed. ACADEMIC PROBLEMS Learning Disabilities (LD) In 1963, Samuel Kirk and others coined the term, learning disabilities (LD), at a meeting of parents and professionals (Smith & Luckasson, 1995). 7

National attention was brought to individuals with disabilities through implementation of Section 504 of the Vocational Rehabilitation Act of 1973 and provisions of the Education for all Handicapped Children Act (P.L. 94-142). As amended in 1990, the title of the law was changed to Individuals with Disabilities Education Act (IDEA); this legislation strengthened the concept of related services (e.g., counseling, developmental, and corrective services; transportation) for individuals with disabilities (Friend & Bursuck, 1999). Nationally, two definitions are most often used.

One is the federal

government's definition included in IDEA; the other has been adopted by a coalition of professional and parent organizations concerned with learning disabilities. The federal definition states: Specific learning disability means a disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, that may manifest itself in an imperfect ability to listen, think, speak, read, write, spell, or to do mathematical calculations. The term includes such conditions as perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia. The term does not apply to children who have learning problems that are primarily the result of visual, of hearing, of motor disabilities, of mental retardation, of emotional disturbance, or of environmental, cultural, or economic disadvantages (p. 245, Smith & Luckasson, 1995). The National Joint Committee on Learning Disabilities' definition is basically the same, but it differs in the orientation concerning causes of the

8

disability. The federal definition is older and reflects a medical orientation (e.g., brain damage). Earlier work in this field focused on individuals with brain injury. The National Joint Committee on Learning Disabilities, however, attributes LD to a central nervous system dysfunction and/or neurodevelopmental differences and does not mention the term brain injury or dyslexia, although the definition allows for other dysfunctions.

Other definitions have emerged and differ in

philosophical orientations concerning causes, identification, and treatment of learning disabilities (Smith & Luckasson, 1995). Assessment of Learning Disabilities Identification and assessment of students with learning disabilities vary from state to state (McLeskey, 1992; Smith & Luckasson, 1995; Vaughn, Bos, & Schumm, 2000), but common features include the following: (a) a significant discrepancy between a child's potential and actual academic achievement; (b) intelligence scores within the normal range; and (c) a disability that is neither the result of visual, hearing, motor disabilities, mental retardation, or emotional disturbance, nor of environmental, cultural, or economic disadvantage (Smith & Luckasson, 1995). LD difficulties can occur in academic areas such as math, reading and/or writing, along with additional difficulties in inadequate social skills, self-concept, self-control, or behavior (Cronin, 1996; Durrant, Voelker, & Cunningham, 1990; Wenz-Gross, 1997).

The broad definition of learning

disabilities accompanied by differing assessment techniques has precluded a consensus among researchers as to the prevalence of LD.

9

While various classification and subtyping systems have been proposed for learning disabilities, there is a common element of both language-based disabilities that are associated primarily with difficulties in reading and spelling and a nonverbal type of disability associated with problems in arithmetic. These disabilities are most often referred to as nonverbal learning disabilities (NLVD) but have also been described as “nonverbal perceptual-organization-output disorders,” left hemisyndrome, and social-emotional learning disabilities (Beitchman & Young, 1997).

Consistent with results of other studies, one

particular study found that 1.3% of a sample of 9- and 10-year-olds showed specific (arithmetic only) difficulties and 2.3% had difficulties in both arithmetic and reading. Specific reading difficulties were most common (3.9%). Reading Disabilities (RD) Reading disabilities, also known as dyslexia, is one of the most significant problems experienced by children with learning disabilities. The inability to read affects all aspects of a child’s life. Much attention has been given to reading disabilities among children and adolescents. Reading experts argue that not all reading disabilities are alike because of the nature of etiology, the method of diagnosis, and definition itself

(Aaron, Joshi, & Williams, 1999).

Some

researchers question whether the term is even necessary. Willcutt and Pennington (2000) define a reading disability as a "developmental disorder characterized by significant underachievement on standardized tests of single-word reading, reading fluency, and reading comprehension, usually resulting from impaired phonological processing" (p. 179). Although there are various definitions, most 10

reading experts agree on four points, Dyslexia: (1) has a biological basis and is due to a congenital neurological condition, (2) persists into adolescence and adulthood, (3) has perceptual, cognitive, and language dimensions, and (4) often leads to difficulties in many areas of life as the individual matures (Hynd, 1992). These individuals are often intelligent in other areas such as mathematics and art. Children with dyslexia often continue to display symptoms as adolescents (Richek, Caldwell, Jennings, & Lerner, 2002; Shaywitz, Fletcher, Holahan, Shneider, Marchione, Stuebing, Francis, Pugh & Shaywitz., 1999). Recent neuroimaging studies have demonstrated that the cognitive deficit is related to a pattern of brain organization different than those seen in readers without dyslexia. The neural manifestation of dyslexia is the underactivation in posterior brain regions (particularly the angular gyrus) and the overactivation in anterior brain regions as dyslexic readers engage in phonologic analysis (Shaywitz et al., 1999). Experimental, neuropsychological, and developmental studies on reading suggest that the two major components of reading are comprehension and decoding (Aaron, 1991). The essence of reading is comprehension. It is defined as the active construction of meaning to what is being read or heard. Good readers are able to construct a text in their mind as they read or hear a passage (Richek, Caldwell, Jennings, Lerner, 2000).

Decoding refers to ability to

pronounce the written word by relating graphemes to phonemes. Decoding is one of the two strategies for word recognition; the other is sight word reading (Aaron et al., 1999). Sight-word reading develops as children learn to read at a faster rate

11

than decoding. In fact, sight-word reading depends on the acquisition of adequate decoding skills (Aaron et al., 1999). Several researchers (Siegel & Ryan, 1988; Stanovich & Siegel, 1994) agree that the “purest definition of reading disabilities appears to involve difficulty with reading nonwords" (p. 284). Stanovich and Siegel (1994) state, "virtually all poor readers have a phonological deficit" (p. 28). Children who have been identified with a reading disability have been typically referred to as dyslexic, reading disabled, or specific reading retarded (SRR). These poor readers have been thought to be qualitatively different from the garden-variety poor readers (Beitchman & Young, 1997). Children with SRR show a discrepancy between their measured IQ’s and level of reading ability. Children who are reading consistent with their age and IQ level (that is, children with below-average IQ scores) are considered to have general reading backwardness (GRB) or to have a garden variety poor reading. These children tend to demonstrate poor academic performance. Both groups of poor readers are similar on a variety of cognitive variables, neuropsychological profiles, and sociodemographic and family characteristics (Beitchman & Young, 1997). However, despite similarities, the SRR group has been shown to have better language skills than the GRB group. Reports by authors Jorm, Share, Matthews, and Maclean (1986) and McGee et al. (1986) suggest that behavior problems are strongly related to GRB rather than SRR. This study attempted to differentiate the specific types of behavior problems as they relate to poor readers.

12

Assessment of Reading Disabilities Similar to the definition of learning disabilities, it is also a common practice to define reading disabilities on the basis of intellectual discrepancies. A significant discrepancy between a child’s learning potential (Intelligence Quotient score) and his or her actual achievement (reading achievement score) has been considered to be the most important criterion in making eligibility and diagnostic decisions concerning reading disabilities.

However, some concern has been

expressed about using discrepancy formulas derived from IQ in making these types of decisions (Aaron, 1991). Again, similar to the controversies concerning the use of LD discrepancy formulas, reading disabilities were also thought to be more than just a matter of points between the IQ and achievement scores. Other researchers have asked if IQ is even necessary in the definition (Kavale & Forness, 2000). In response, it is argued that IQ is irrelevant because four basic assumptions about IQ-achievement discrepancy are not valid. These include "(a) IQ tests measure intelligence; (b) intelligence and achievement are independent, and the presence of LD will not affect IQ scores; (c) IQ scores predict reading and/or arithmetic scores; and (d) students with reading disabilities with different IQ levels have different cognitive processes and information-processing skills” (Kavale & Forness, 2000, p. 249). Stanovich (1999) argues that the concept of intelligence does not provide an accurate gauge for poor reading, thus should not be used to assess reading ability. He describes IQ-achievement discrepancy as “IQ Fetishism.” Despite empirical support, he accuses the LD field of endorsing

13

the theory that society has an obligation to raise the achievements of individuals who fall short of their intellectual potential instead of raising the skills of those with low skills (Stanovich, 1999). Children with low skills should be the focus of reading interventions. Too many times, numbers are manipulated in order to find the largest possible discrepancy between IQ and achievement scores by using various combinations of standardized assessments. Reading Comprehension (RC) Comprehension is the heart of reading. Good readers share four important elements of comprehension: “(1) the purpose of reading is comprehension, (2) comprehension is an active and accurate process, (3) readers use their background knowledge to comprehend, and (4) comprehension requires higher-level thinking (Richek et al., 2002). Good readers enjoy and learn from reading. Poor readers, however, view reading simply as recognizing words on a page. These readers often lack “fix-up” strategies guided by metacognitive awareness with which the reader monitors comprehension of the text just read (Richek et al., 2002). Ability to construct meaning and apply it to background knowledge is also an area of concern. Poor readers often lack the background knowledge needed to facilitate comprehension. This may be due to a number of reasons including the lack of exposure to information, personal schemas, frame of references, cultural experiences, etc. Higher-level comprehension takes place when the student can organize what is read and draw inferences.

Unfortunately, poor readers are

unable to connect and reason from text in a logical manner. The difficulty of

14

reading only serves to exacerbate the resistance to read more. Students soon learn to despise reading and avoid it at all costs. (Richek et al., 2002). Assessment of Reading Comprehension Most standardized tests of reading contain at least one subtest of measuring reading comprehension. Reading experts warn against assuming that a student is poor reader just because of low scores. The low score may be due to problems with word recognition. However, if the student scores high on the vocabulary (word recognition) and low on the comprehension subtest, then it is most probable that the student indeed has comprehension problems.

Some

methods of measuring comprehension include having the student retell a story, asking questions concerning a passage, and having the student fill in the blank after reading a passage silently. This study will measure the student’s ability to read passages silently and provide the correct word that would make the blank in a sentence consistent with the passage. Phonological Awareness (PA) When applied to reading, phonological awareness refers to the “ability to make use of spelling-to-sound relationship for converting the written word into its corresponding phonological representation” (Aaron, 1991, p. 179). There appears to be ample evidence that phonological awareness is critical in the acquisition of reading (Lundberg et al., 1988; Marshall, Snowling, & Baily, 2001; Shaywitz et al., 1999). Phonological awareness has repeatedly been described as one of the most "powerful predictors of subsequent word-reading ability” (McBride-Chang, 1995; Stanovich, 1999). 15

Assessment of Phonological Awareness Most investigators agree that phonological awareness is among the most powerful predictors of subsequent reading ability in longitudinal studies but few agree on how to measure phonological awareness. Some researchers may ask children to complete nursery rhymes, tap out the number of syllables in a nonsense word, or change a phoneme for another in a word (e.g., go to no). Children may also be asked to blend up to five or six phonemes into words (McBride-Chang, 1995).

There is little standardization in the assessment of

phonological awareness, but the three essential components shared by virtually all phonological awareness assessment tools are the following: (1) The participant must initially listen to one or more orally-presented words or nonsense words. Often the student is asked to repeat the stimulus so that the examiner can ensure that the stimulus was correctly perceived. (2) The participant is asked to operate on that stimulus or set of stimuli. For instance, an older individual may be required to identify a single phoneme in the stimulus or to repeat the stimulus after having removed a single phoneme from it. (3) The participant is required to express responses to the given stimuli. Other researchers have their own criteria. Snider (1997) lists tasks from easiest to hardest, as follows: (a) Rhyme (recognize pairs of rhyming words) (b) Sound oddity tasks (identify words that are the same or different in terms of beginning, middle, or ending sounds)

16

(c) Blending tasks (identify a word when each syllable or phoneme is pronounced separately) (d) Phoneme segmentation (pronounce each separate phoneme in a onesyllable word) (e) Phoneme manipulation (identify the word left when phonemes are added, deleted, or moved) By its very nature, any phonological awareness task requires that the responses be verbally derived (McBride-Chang, 1995).

Most phonological

studies include children, but little has been researched on dyslexia in adolescence. When adolescent readers are examined, it is evident that deficits in phonological awareness continue to characterize dyslexic readers even during their teen and early adult years (Shaywitz et al., 1999). For the purpose of this study, the child will be asked to identify (1) words with missing phonemes (incomplete words) and (2) words presented in parts (sound blending) on audiotape. EXTERNALIZING BEHAVIOR PROBLEMS The link between academic underachievement and externalizing behaviors has been adamantly discussed, resulting in much evidence that the overlap clearly exists (Hinshaw, 1992). Reasons for the great interest in reading and behavior problems include the following: first, the prevalence rates, personal and societal suffering, and resistance to intervention strategies; second, both reading problems and behavior problems predict later maladjustment because externalizing problems often lead to antisocial behavior and reading problems (Hinshaw, 1992). Childhood behaviors marked by defiance, impulsivity, disruptiveness, aggression, 17

antisocial features, and overactivity are characteristics of externalizing behaviors. Differences of such features from behaviors considered internalizing--evidenced by withdrawal, dysphoria, and anxiety--have been thoroughly discussed. Once established, externalizing behaviors are more stable than internalizing behaviors and carry a worse prognosis and higher resistance to most forms of interventions (Hinshaw, 1992).

Evidence has been presented that there exists a common

behavioral syndrome of children who not only manifest overactivity, difficulty in concentrating, and impulsivity, but also manifest aggression, disobedience, and antisocial behaviors (Stewart, Cummings, Singer, & DeBlois, 1981). Researchers have reported that the presence of behavior problems is often accompanied by reading difficulties (Pisecco et al., 1996). Although some argue that aggressive conduct disorder is correlated with poor reading, when hyperactivity is added to the equation, researchers have found that the correlation of behavior problems and reading problems is even stronger (Frick et al., 1991; Hinshaw, 1992) with conservative comorbidity estimates of approximately 23% (Semrud-Clikeman, Biederman, Sprich-Buckminister, Lehaman, Faraone, & Norman, 1992). Attention-Deficit/Hyperactivity Disorder-Combined Type (ADHD-C) ADHD is estimated to be present in 3%−5% of all school-age children (APA, 1994), and it is diagnosed in a heterogeneous group of children that vary with regard to psychiatric comorbidities (Biederman, Newcorn, & Sprich, 1991; Semrud-Clikeman et al., 1992). ADHD has undergone three different diagnostic nomenclatures since 1980 (Morgan, Hynd, Riccio, & Hall, 1996). Inevitably 18

these changes caused much confusion and controversy. The first DSM (APA, 1957) did not recognize ADHD, but DSM-II (APA, 1968) introduced ADHD as a "hyperkinetic reaction to childhood (or adolescence)" (Morgan et al., 1996). In DSM-III (APA, 1980) the disorder was renamed as Attention Deficit Disorder (ADD) and was subdivided into two types: ADD with hyperactivity (ADD/H) and ADD without hyperactivity (ADD/WO). ADD/WO has been used in community, school, and clinic-based samples to describe children with inattention problems, but not hyperactivity (Lahey & Carlson, 1991; Szatmari, Boyle, & Offord, 1989). Studies comparing ADD/WO and ADD/H children on behavioral, social, and intellectual measures further demonstrate differences other than hyperactivity. Behavioral comparisons have shown children with ADD/H tend to exhibit more externalizing behavior problems (Barkley, DuPaul, & McMurray, 1990; Cantwell & Baker, 1991; Edelbrock & Achenbach, 1984; Hynd, Lorys, Semrud-Clikeman, Nieves, Huettner, & Lahey, 1991; King & Young, 1982; Lahey, Schaughency, Strauss, & Frame, 1984; Lahey, Schaughency, Hynd, Carlson, & Nieves, 1987), to be more impulsive (Cantwell & Baker, 1991; Lahey et al., 1984; 1987), and to experience more academic problems (August & Garfinkel, 1990; Boudreault, Thivierge, Cote, Boutin, Julien, & Berberon, 1988; Cantwell & Baker, 1991; Fergusson & Horwood, 1992; Frick et al., 1991; McGee & Share, 1988). In DSM-III-R (APA, 1987), the disorder was perceived as unidimensional and was given the term Attention-Deficit/Hyperactivity Disorder (ADHD). Another category, Undifferentiated Attention Deficit Disorder (UADD) for children with inattention only, was also included in DSM-III-R. This change was

19

due primarily to the lack of empirical data supporting the DSM-III nomenclature (Cantwell & Baker, 1991). DSM-IV (APA, 1994) has evolved into differentiating the categories into ADHD-Combined Type (ADHD-C), ADHD-Predominantly Inattentive (ADHD-PI), and ADHD-Predominantly Hyperactive-Impulsive (ADHD-PH). Assessment of ADHD According to Barkley (1998), the three fundamental components of diagnosing ADHD are the clinical interview, the medical examination, and the completion and scoring of behavior ratings scales by both parent and teacher. Because ADHD is a behavioral syndrome, a child suspected of ADHD should be systematically observed in several different environments (e.g., home, school, and playground). The diverse settings rule out the effects of a specific environment on the child's behavior. The severity of ADHD is also a concern for this study and can be assessed by several measures. To

be

diagnosed

with

Attention-Deficit/Hyperactivity

Disorder,

predominantly inattentive type, a child must have six of nine inattention symptoms but not have the specified number of hyperactivity/impulsivity symptoms. To be diagnosed with ADHD-predominantly hyperactive-impulsive type, the child must have four of six hyperactivity/ impulsivity symptoms but not have the specified number of inattention symptoms. Finally, a child who meets the criteria for both inattention and hyperactivity/ impulsivity symptoms will receive the diagnosis of ADHD-combined type (see Table 1 for criteria for diagnosis). 20

Table 1 DSM-IV Diagnostic Criteria for Attention-Deficit/ Hyperactivity DisorderCombined Type A. Either (1) or (2): (1)

six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

INATTENTION (a)

often fails to give close attention to details or makes careless mistakes in schoolwork or other activities

(b)

often has difficulty sustaining attention in tasks or play activities

(c)

often does not seem to listen when spoken to directly

(d)

often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)

(e)

often has difficulty organizing tasks and activities

(f)

often avoids, dislikes, or is reluctant to engage in tasks that require

(g)

often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools) (table continues)

21

Table 1 (continued)

DSM-IV Diagnostic Criteria for Attention-Deficit/ Hyperactivity Disorder

(2)

(h)

is often easily distracted by extraneous stimuli

(i)

is often forgetful in daily activities

six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level

Hyperactivity (a)

often fidgets with hands or feet or squirms in seat

(b)

often leaves seat in classroom or in other situations in which remaining seated is expected

(c)

often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)

(d)

often has difficulty playing or engaging in leisure activities quietly

(e)

is often "on the go" or often acts as if "driven by motor"

(f)

often talks excessively

Impulsivity (g)

often blurts out answers before questions have been completed

(h)

often has difficulty awaiting turn (table continues)

22

Table 1 (continued)

DSM-IV Diagnostic Criteria for Attention-Deficit/ Hyperactivity Disorder (i)

often interrupts or intrudes others (e.g., butts into conversations or games)

B. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years. C. Some impairment from symptoms is present in two or more settings (e.g., at school [or work] and at home). D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning. E. The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder). 314.01 Attention-Deficit/Hyperactivity Disorder, Combined Type: if both Criteria A1 and A2 are met for the past 6 months 314.00 Attention-Deficit/Hyperactivity disorder, Predominantly Inattentive Type: if Criterion A1 is met but Criterion A2 is not met for the past 6 months

23

314.01 Attention-Deficit/Hyperactivity disorder, Predominantly HyperactiveImpulsive Type: if Criterion A2 is met but Criterion A1 is not met for the past 6 months. Note. (pp. 83-85; APA, 1994).

The parent interview is crucial to understanding the child in the home. No other adult has greater breadth of knowledge of the child than the parent. According to Semrud-Clikeman and Hynd (1991), clinical interviews provide an excellent source of chronological framework for parents' concerns and the child's behaviors. However, there is some question as to the reliability and subjectivity of interviews. A review of various structured clinical interviews finds that some of the clinical interviews do an adequate job in not identifying children, in this case, with symptoms of depression when, in fact, they are not depressed (false positive), but do a poor job in identifying children with depression when, in fact, they are depressed (false negative) (Semrud-Clikeman & Hynd, 1991). Their concerns with clinical interviews are, namely, their moderate sensitivity (false positive), poor specificity (false negative), as well as the great variability among different clinical interviews to measure severity, duration, and frequency (Semrud-Clikeman & Hynd, 1991). It is considered essential that a pediatric physical examination be completed. However, such evaluations are often brief, relatively superficial, and consequently, unreliable for achieving a diagnosis of ADHD. Too often, this is

24

the result of failure to incorporate a thorough clinical interview and behavior rating scales (Barkley, 1998). In addition to the clinical interview and medical examination, both the parent and the teacher usually complete behavior rating scales. There are a variety of scales with excellent reliable and valid normative data on children within a wide range of ages. It is useful to have these scales mailed out to parents and teachers before the clinical interview in order to be able to elaborate on vague or unclear information provided on the rating scales. Again, although this type of information may be subjective, it provides invaluable information about the child that may take months or even years for the evaluator to gather. These scales provide a wealth of information in a small amount of time (Barkley, 1998). Behavior scales also provide a means of collecting qualitative information and comparing scores to norms collected on large groups of children. Nonetheless, because of the nature of behavior scales, responses are still personal opinions and subject to the oversights, prejudices, and limitations on reliability and validity that such opinions may have (Barkley, 1998). The Behavior Assessment System for Children (BASC) (Reynolds & Kamphaus, 1998) is often used as part of an assessment to determine ADHD. Both the Teacher Rating Scale (TRS) and the Parent Rating Scale (PRS) help identify behaviors that encompass ADHD, such as hyperactivity and attention problems. This instrument is able to differentiate between ADHD-Predominantly Hyperactive-Impulsive Type and ADHD-Predominantly Inattentive Type with moderate reliability.

The authors recognize that unlike children with

25

hyperactivity, children with attention problems may not display externalizing behavior problems, thus they are not included in the same composite. Hyperactivity is included in the Externalizing Problems composite whereas the Attention Problems Scale is included in the School Problems composite. The ADHDT is also a form of a behavior rating scale. Unlike others, however, it is a standardized, norm-referenced behavior checklist used to identify children with ADHD based on the DSM-IV definition of ADHD (Gilliam, J. E., 1995). This test is comprised of 36 items describing behaviors and characteristics that are divided into three subtests: Hyperactivity, Impulsivity, and Inattention. It is one of the few tests normed entirely on persons with ADHD. Oppositional-Defiant Disorder (ODD) Oppositional defiant disorder (ODD) is defined as "a pattern of negativistic, hostile, and defiant behaviors" (Frick et al., 1991). Some researchers question the validity of ODD being distinct from conduct disorder (CD) "involving a pattern of behavior in which the basic rights of others and important age-appropriate societal rules or norms are violated" (Frick et al., 1991). Because of the lack of consensus, ODD and CD are sometimes grouped together in empirical studies (Cadesky, Mota, & Schachar, 2000; Kuhn, Schachar, & Tannock, 1997; Schachar & Tannock, 1995). However, factor analytic literature bears the validity of the distinction between ODD and CD (Biederman, Faraone, Milberger, Garcia-Jetton, Chen, Mick, Green, & Russell, 1996; Frick et al., 1991). Most often, ODD is thought to be a less severe or more juvenile form of CD (Frick et. al., 1991). (See Table 2 for criteria for diagnosis). 26

Table 2

DSM-IV Diagnostic Criteria for 313.81 Oppositional Defiant Disorder A.

A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which four (or more) of the following are present:

(1)

often loses temper

(2)

often argues with adults

(3)

often actively defies or refuses to comply with adults' requests or rules

(4)

often deliberately annoys people

(5)

often blames others for his or her mistakes or misbehavior

(6)

is often touchy or easily annoyed by others

(7)

is often angry and resentful

(8)

is often spiteful or vindictive

Note. Consider a criterion met only if the behavior occurs more frequently than is typically observed in individuals of comparable age and developmental level. B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning C. The behaviors do not occur exclusively during the course of a Psychotic or Mood Disorder D. Criteria are not met for Conduct Disorder, and, if the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder. Note. (pp. 93-94 APA, 1994)

27

Assessment of ODD Like ADHD, information used to diagnose ODD is gathered through clinical interviews and behavior checklists. Parents and teachers are important contributors of such information.

It is important to gather information that

describes the child in a variety of environments. The Behavior Assessment System for Children (BASC) (Reynolds & Kamphaus, 1998) is also used for diagnosing oppositional defiant disorder. Both the Teacher Rating Scale (TRS) and the Parent Rating Scale (PRS) help identify externalizing behaviors that encompass ODD such as aggression and conduct problems. COMORBIDITY OF LEARNING DISABILITIES AND EXTERNALIZING BEHAVIORS For the past three decades, the link between specific learning disabilities and aggression, antisocial behavior, and delinquency has been a topic of much controversy (Broder, Dunivant, Smith, & Sutton, 1981; Keilitz & Dunivant, 1986; Lane, 1980; Larson, 1988; Waldie & Spreen, 1993). The overlap of academic difficulties and externalizing behaviors continue to be discussed in current literature (Frick et al., 1991; Mayes, Calhoun, & Crowell, 2000; Pisecco et al., 1996). According to some researchers, two major types of externalizing behaviors−impulsivity and hyperactivity on one end of the continuum and aggression and conduct problems on the other end−are, in fact, considered two distinct disorders in relation to academic underachievement (Hinshaw, 1992).

28

Studies based solely on incarcerated juveniles have led to the belief that learning disabilities cause juvenile delinquency. There has been much debate regarding plausible theories, faulty methodology, and questionable links (Bachara & Zaba, 1978; Jacobsen, 1983; Keilitz & Dunivant, 1986). Dominant theories explaining the link between learning disabilities and delinquency include (a) the School Failure Hypothesis, which states that a lack of educational success results in low self-esteem, frustration, and acting out behavior (Grande, 1988); (b) the Differential Treatment Hypothesis, which proposes that youth with learning disabilities engage in the same amount of antisocial acts as youngsters without learning disabilities but they are treated differently from non learning-disabled youth by the justice system, possibly because of their poor school performance (Keilitz & Dunivant, 1986); and (c) the Susceptibility Hypothesis, which states that learning disabilities are accompanied by personality characteristics that predispose the individual to delinquent behavior (Larson, 1988). Figure 2 lists the three hypotheses.

29

(a) School Failure Hypothesis:

(b) Differential Treatment Hypothesis:

LD

ODD

Differential Treatment

LD

ODD

(c) Susceptibility Hypothesis: Personality Characteristics e.g., impulsivity, hyperactivity

+

LD

ODD

Figure 2. Causal path models: Hypotheses for the co-occurrence of learning disabilities (LD) and oppositional defiant disorder (ODD).

30

There are a disproportionately large segment of individuals with learning disabilities in juvenile detention centers. Empirically derived prevalence rates have ranged from 12%−73% and greater (Brier, 1989; Broder et al., 1981; Larson, 1988).

Of course, the use of differing definitions of learning disability,

accompanied with the use of varied assessment criteria, techniques, and instruments underscore the disagreement among researchers.

However, the

concern is still valid; there seems to be some correlation between learning disabilities and aggression, behavior problems, and delinquency (Brier, 1989). COMORBIDITY OF READING PROBLEMS AND ADHD-C Much research has been conducted examining the high comorbidity of learning disabilities (LD) and ADHD. It is estimated to range from 15%−50% specifically for reading (August & Garfinkel, 1990; Barkley et al., 1990; Lambert & Sandoval, 1980; Livingston, Dykman, & Ackerman, 1990; Semrud-Clikeman et al., 1992) and is more prevalent among boys than among girls (Willcutt & Pennington, 2000). The co-occurance is so frequent that some researchers have questioned the nature of the relationship (Hinshaw, 1992; Jorm et al., 1986; McGee & Share, 1988; McGee et al., 1986) and have suggested that ADHD may even be a precursor to the manifestation of reading difficulties. In contrast, others have proposed that ADHD, in fact, leads to reading difficulties (DuPaul & Stoner, 1994). There are five competing hypotheses for the occurrence of comorbidity of reading disabilities (RD) and ADHD as shown on Figure 3: (a) Disorder A causes Disorder B 31

(b) Disorder B causes Disorder A (c) a third factor causes both disorders in all cases (common etiology) (d) a third factor causes both disorders in an etiologic subtype, but the two disorders are otherwise etiologically independent (e) there is no causal basis for the observed association, rather it is an artifact of some kind (Pennington, 1993).

32

Figure 3. Causal path models: Hypotheses for the occurrence of comorbidity of reading disabilities (RD) and Attention-Deficit/Hyperactivity Disorder (ADHD).

33

In some cases, the first disorder could replicate a complete copy of the second. In other cases, one disorder could replicate only the symptoms of the second disorder, not the full syndrome (Pennington, Groisser, & Welsch, 1993). This phenomena is called the phenocopy hypothesis because only the symptoms rather than the characteristics of the disorder are produced, e.g., hyperactivity. Pennington and associates (1993) found evidence to support the phenocopy hypothesis, proposing that children with comorbidity ADHD and RD do not have the core cognitive deficits of ADHD, but rather have only behavioral symptoms that develop as a secondary consequence of their learning problems. Other researchers (Hinshaw, 1992; Szatmari, Boyle, & Offord, 1989) credit inattention for the reading problems experienced among ADHD children. In these studies, characteristics of RD/ADHD groups are defined by deficits in memory and verbal skills (McGee, Williams, Moffitt, & Anderson, 1989); phonological, attentional, and linguistic deficits (August & Garfinkel, 1990; McGee et al., 1989); poor visual-motor integration and planning (August & Garfinkel, 1990; Robins, 1992); poor verbal fluency (Anderson, Williams, McGee, & Silva, 1987); and poor verbal processing abilities (Dykman & Ackerman, 1991). Although many studies have found differences in various areas, other researchers did not find significant differences between ADHD children, with and without RD, in specific domains such as executive functions (Bonafina, Newcorn, McKay, Koda & Halperin, 2000). In some literature it is suggested that children with reading disabilities more commonly have phonological weaknesses and ADHD children have attentional deficits. Although

34

the two groups demonstrate weaknesses in both domains, there are still discrepant findings (Klorman, Hazel-Fernandez, Shaywitz, Fletcher, Marchione, Holahan, Stuebing, & Shaywitz, 1999). At the same time, Willcutt and Pennington (2000) support the hypothesis that RD and ADHD co-occur much more frequently than would be expected by mere chance. Based on their twin studies, the authors speculate that there may exist a genetic overlap or a shared predisposition toward developing characteristics of both RD and ADHD. The diversity of results across studies is due to the variations of methodology (teacher vs. parent reports of behavior problems), differing definitions of reading disability (discrepancy formula vs. regression equations), differing time periods (early grades vs. later grades), the relatively small size of the RD group samples, exclusion vs. inclusion of girls, and the types of specific behaviors studied (ADHD vs. non-ADHD characteristics) (Smart et al., 1996). One of the most consistent conclusions in childhood psychopathology research is that children with reading disabilities frequently have additional psychiatric disorders (Hinshaw, 1992; Semrud-Clikeman et al., 1992; Williams & McGee, 1994). An association has specifically been established between reading disabilities (especially general reading backwardness) and externalizing difficulties (Beitchman & Young, 1997; Hinshaw, 1992; McGee et al. 1986; Smart et al., 1996; Pisecco et al., 1996). COMORBIDITY OF ADHD-C AND ODD ADHD children frequently have conduct, depressive, oppositional, and anxiety disorders (Faraone, Biederman, Lehman, Spencer, Norman, Seidman, 35

Kraus, Perrin, Chen, & Tsuang, 1993). When these two disorders coexist, studies of cognitive abilities are confounded. One does not know which disorder caused the cognitive disability. Some researchers have investigated the possibilities that ADHD may be a precursor to ODD (Paternite, Loney, & Roberts, 1995); others claim high comorbidity of academic underachievement, juvenile delinquency, substance abuse, etc., as well (Schachar & Tannock, 1995). Prior and Sanson (1986) argue that ADHD should be classified as "conduct disorder with hyperactivity," because the overlap between the two is so great (McGee et al., 1989). GENDER DIFFERENCES Both RD and ADHD have been found to be more prevalent among boys than girls, especially when samples were recruited from clinics. The boy/girl ratio in clinical samples is higher (ranging from 4:1 to 9:1) when compared to schoolbased or community samples where the boy/girl ratio is nearly equal (ranging from 1.2:1.5 to 3:1) (Barkley, 1998; McGee, Feehan, Williams, Partridge, Silva, & Kelly, 1990; Pennington, 1991; S. E. Shaywitz, B. A. Shaywitz, Fletcher, & Escobar, 1990; Szatmari et al., 1989; Willcutt & Pennington, 2000). A metaanalysis of gender differences indicated that the differences among boys and girls were moderated by the effect of referral source (Gaub & Carlson, 1997). It was also suggested that girls with ADHD found in treatment settings represented the most severely affected of the girls (Carlson, Tamm, & Gaub, 1997).

Other

studies, however, show little to no significant differences in the rates of reading disabilities between the sexes, thus challenging the commonly held view that 36

reading disabilities prevalence rates are greater among boys than girls (Flynn & Rahbar, 1994; Pennington, 1991; Shaywitz et al., 1990; Wadsworth, De Fries, Stevenson, Gilger, & Pennington, 1992; Willcutt & Pennington, 2000). Previously reported differences may be due to biased referral practices by teachers in which boys with disruptive behaviors are more readily referred for assessment. Girls with similar reading problems, but without behavior problems, are often overlooked. It is not until the girls are severely impaired that they are finally identified for services (Shaywitz et al., 1990). In a study examining gender differences in children with ADHDCombined, ODD, and a co-occurring ADHD-C/ODD, children in the ADHDC/ODD group received the poorest ratings. In the ADHD-C and ODD groups, ratings of aggression were higher in boys than girls. Girls with ODD were rated with more appropriate behavior and less attention problems, but unhappier and more socially impaired than boys with ODD. In the ADHD-C only group, boys showed more severe ratings on failing to listen. In the ODD only group, boys demonstrated more severe ratings on controlling temper, arguing with adults, defiance, and blaming others. Thus, girls from both ADHD-C only and ODD only groups were less impaired than boys in the severity of symptoms in aggressiveness and inappropriate behaviors (Carlson et al., 1997). SUMMARY Academic underachievement and behavior problems have a long history of being associated with each other (Hinshaw, 1992). Children with behavior problems also tend to suffer from learning disabilities. 37

The most prevalent

learning disability among children is in the area of reading, which is composed of two major components: reading comprehension and decoding. decoding is phonological awareness.

The core of

Because of the "greater-than-chance"

comorbidity of externalizing behavior and reading problems, there have been many studies examining the causes, pathways, and finally, effectiveness of interventions (Broder et al., 1981; Lane, 1980; Mayes et al., 2000; Pisecco et al., 1996; Semrud-Clikeman et al., 1992). Among externalizing behaviors, the two most common domains are hyperactivity and aggressiveness. These behaviors have often been blamed for the overrepresentation of poor readers among children with behavior problems. In past studies, groups of children with ADHD and/or ODD have been carefully examined as to how their behaviors interact as well as how behaviors affect reading abilities.

There is consensus that children with comorbidity of

hyperactivity and aggression have more problems in various psychological, intellectual, academic, and behavioral domains. However, the lack of common methodologies, definitions, levels of severity, and gender confound findings. The purpose of this study is to explore the effects of hyperactivity and externalizing behaviors on reading abilities, both reading comprehension as well as phonological awareness. Various studies have proposed that ADHD and ODD are distinct groups, and others have argued that they are not. The ultimate goal of this study is to better understand children with both externalizing behavior problems and reading problems and, consequently, how to help them in the classroom.

Understanding the strengths and weakness of these children can

38

facilitate the development of both preventive and interventive programs. Thus, by meeting the needs of these children, school failure can be replaced with school success.

39

Chapter 3: Method Investigators have suggested that children with learning disabilities are more likely to experience behavioral problems than children without learning disabilities (Brier, 1989; Broder et al., 1981; Keilitz & Dunivant, 1986; Larson, 1988; Waldie & Spreen, 1993).

Comorbidity with Attention-Deficit/

Hyperactivity Disorder-Combined Type (ADHD-C) and Oppositional Defiance Disorder (ODD) further confound this relationship (Smart et al., 1996). The purpose of this study is to determine whether boys who demonstrate a combination of ADHD and ODD differ significantly on measures of general reading abilities and/or phonological awareness from boys who have a sole diagnosis of ADHD, ODD, or neither. In this chapter, the research design for implementation of the study is described. Specifically, (1) the participants are described, (2) the instruments of assessment are discussed, (3) the procedures used in data collection are outlined, and (4) the statistical treatment of the data is delineated. RECRUITMENT SOURCES The approval of the study by the Institutional Research Board (IRB) at UT at Austin was contingent upon recruiting boys already diagnosed with ADHD and/or ODD. The IRB permitted only the control group to come from public schools. With the IRB approval, students from alternative schools were recruited, because they were most likely to carry one or both diagnoses. However, because of the nature of students found at the alternative schools, students with only 40

ADHD were difficult to find without a diagnosis of ODD as well. To compensate for the small number of students with a sole diagnosis of ADHD at the alternative schools, a small network of parents of boys diagnosed only with ADHD was recruited from the Central Texas area. The control group included boys that were not diagnosed ADHD or ODD. The other three groups were made up of boys already diagnosed with ADHD and/or ODD. PARTICIPANTS Participants in this study included 113 boys between the ages of 11−15 years. Various studies have found gender differences in studies concerning reading disabilities and externalizing behaviors (Pisecco et al., 1996; Smart et al., 1996; Willcutt, & Pennington, 2000). Reading problems, externalizing behavior problems, and ADHD are more prevalent among boys than among girls in both clinical and community samples (Fletcher, & Escobar, 1990; Willcutt et al., 2000). More boys than girls meet the criteria for ADHD in both community and clinical samples; however, the ratio is consistently higher among boys than girls (Barkley, 1998; McGee, Feehan, Williams, Partridge, Silva, & Kelly, 1990; Szatmari et al., 1989; Willcutt et al., 2000).

Some argue that the

overrepresentation of boys is a result of girls being underreferred by teachers. Girls identified with ADHD in the community displayed lower levels of inattention, less internalizing behavior, and less peer aggression than boys with ADHD. However, girls identified in clinical settings were as impaired as their counterparts.

In examining gender differences among children with reading

difficulties, again, boys were identified 2−4 times more often than girls. Because 41

of the difficulty in recruiting females and the overwhelming prevalence of boys with ADHD and/or ODD, only males were recruited for the purpose of finding significant differences between the groups with hyperactivity, behavior problems, and a combination of both as they relate to general reading ability as well as phonological awareness. The children were in grades 6−8 and were selected from Central Texas schools with a similar socioeconomic status (SES) and ethnicity makeup. The SES of each participant was determined by the family’s participation in the school’s “free and reduced lunch” program. Based on family income and size, this government-funded program is provided for low-income families. Descriptive information regarding the ages, ethnicity, grades, SES, and special education status of the participants is provided in Table 3. The sample consisted of 6% eleven-year-olds, 15% twelve-year-olds, 29% thirteen-year-olds, 36% fourteen-year-olds, and 13% fifteen-year-olds. The mean age was 13.35 years and mean grade was 7.23. Twenty-six percent of the sample was in the sixth grade, 25% was in the seventh grade, and 56% was in the eighth grade.

42

Table 3 Sample Population Demographic Data (N=113) N

Percent (%)

Age 11

7

6.1

12

17

15.1

13

33

29.2

14

41

36.3

15

15

13.3

6

29

25.7

7

28

24.7

8

56

49.6

Ethnicity Caucasian

52

46.1

Hispanic

28

24.7

African-American

33

29.2

Receives Free or Reduced Lunch

68

60.0

Receives Special Education

27

24.0

Grade

Note: Free or reduced lunch indicates that participants are in lower socioeconomic status (SES).

43

The sample consisted of 46% Caucasian, 25% Hispanic, and 29 % African-American (representative of community) as shown in Figure 4. Most of the participants were on free and/or reduced lunch (60%) program, and a small number was in the special education program at their respective schools (24%). Students who attended ESL classes or who spoke predominantly Spanish were excluded from the study due to the nature of this study.

44

Ethnicity of Ethnicity ofSample SamplePopulation Population 50.00% 40.00% 30.00% 20.00% 10.00% 0.00%

Caucasian

Hispanic

AfricanAmerican

Figure 4. Breakdown of ethnicity percentages for total sample population.

45

C

LASSIFICATION OF PARTICIPATION

Those students who were being served by their campus’s special education program were predominantly being served under the Other Health Impairment (OHI) category for ADHD. Many of the children who were enrolled in the alternative schools had already been diagnosed with ODD and/or ADHD, and the scores on the Parent and Teacher Rating Scales (BASC) validated the diagnoses. Most of the students in the alternative schools that met the criteria for ADHD also demonstrated high scores on the externalizing behaviors, which resulted in a comorbidity of ADHD/ODD.

It appeared that by the time students reached

middle school and were placed in alternative schools, a presence of ADHD without ODD was rare to find. The participants were placed in the appropriate groups according to diagnoses and BASC results from independent consensus from parents and teachers (N=26 each group): (1) Attention Deficit/Hyperactivity Disorder-Combined Type only (ADHD-C)−children with comorbidity of ODD were excluded from this group; (2) Oppositional Defiant Disorder only (ODD)−children with comorbidity of ADHD-C were excluded; (3) a combination of ADHD-C and ODD (ADHD-C/ODD); and (4) a control group (CONT)− children who did not meet the criteria for either ADHD or ODD. Any child whose estimated Full Scale IQ was less than 80 or who showed evidence of a neurological

disorder,

poor

physical

health,

uncorrected

sensorimotor

impairments, or a history of psychosis were excluded from this study.

46

Attention-Deficit/Hyperactivity Disorder-Combined Type (ADHD-C) Parents and teachers of students already diagnosed with ADHD were asked to complete the BASC rating scales. A student qualified for this group only if both the parent and teacher Behavior Assessment System for Children (BASC) (Reynolds & Kamphaus, 1992) rating scales had a T score of 60 or greater on the subscales−Hyperactivity and/or Attention Problems. The student’s parents and/or teachers were also asked to complete the Attention-Deficit/Hyperactivity Disorder Test (ADHDT) (Gilliam, 1995).

The ADHDT has an ADHD Quotient that

indicates the probability of ADHD in a child as Very High, High, Above Average, Below Average, Low, or Very Low. If the student's ADHD Quotient is 90 or above, the child qualified for the ADHD-C group. For Hypothesis 7, the ADHD groups were classified according to their score: Low Level Group = ADHD Quotient of 89 and below; Medium Level Group = ADHD Quotient range of 90−110; High Level Group = ADHD Quotient of 111 and above (see Table 4). Children with comorbidity of ODD were excluded from this group.

47

Table 4 Classification of ADHDT Quotient Scores and Group Levels ADHDT Quotient Score

Level of ADHD Groups

111 and above

High Level

90−110

Medium Level

89 and below

Low Level

Note. ADHDT−Attention-Deficit/Hyperactivity Disorder Test (PRO-ED, 1995).

48

Oppositional Defiant Disorder Only Group (ODD) Parents and teachers of students already diagnosed with ODD were asked to complete the BASC rating scales. A student with a T score of 60 or greater on the Aggression and/or Conduct Problems subscales on both the parents’ and teacher’s checklist qualified for the ODD group. Children with comorbidity of ADHD were excluded from this group. Combination Group (ADHD/ODD) Children who met the criteria for both ADHD-C and ODD were included in this group. Control Group (CON) The control group was comprised of participants from La Vega ISD who were not diagnosed with ADHD/ODD, did not meet the criteria for either ADHD or ODD, and were free from any other handicapping condition. INSTRUMENTATION For the purpose of this study, several measures were used to determine both group classification and group differences. Wechsler Abbreviated Scale Intelligence (WASI) Intelligence was measured using the WASI. This scale (Wechsler, 1999) is an individually administered clinical instrument for assessing the intellectual ability of individuals ages 6−89 years. The WASI is nationally standardized and is summarized in three composite standard scores: the Verbal, Performance, and

49

Full Scale (M=100, SD=15). The scale is also linked to the Wechsler Intelligence Scale for Children-Third Edition (WISC-III).

The WASI consists of four

subtests: Vocabulary, Block Design, Similarities, and Matrix Reasoning. This scale shows excellent technical characteristics in terms of standardization and reliability as well as correlation with other measures of aptitude and academic achievement. Socio-Economic Status The socio-economic status of participants was determined by participation in the free-lunch program at their respective school. This dependent variable was examined to see whether or not it confounded between-group differences. Behavior Assessment System for Children (BASC) The BASC is a multimethod, multidimensional approach to assessing the behavior of children age 4−18 years. It is designed to facilitate the differential diagnosis and educational classification of a variety of emotional and behavioral disorders of children. Two rating scales, one for teachers and one for parents, gather information concerning the child's observable behaviors. The Teacher Rating Scales (TRS) is a comprehensive measure of both adaptive and problem behaviors in the school setting. The form contains descriptors of behaviors that the respondent rates on a four-point scale of frequency, ranging from Never to Almost Always. The TRS takes 10−20 minutes to complete. The Parent Rating Scale (PRS) measures a child's adaptive and problem behaviors in the community and home settings. The PRS has the same four-choice response format as the

50

TRS and takes 10−20 minutes to complete. Both the TRS and the PRS contain a Hyperactivity scale which assesses two aspects of the ADHD (hyperactivity and impulsivity), and the Attention Problem scale, which assesses inability to maintain attention and the tendency to be easily distracted.

Item behaviors

focusing on hyperactivity include tapping foot or pencil, leaving seat during meals, and being overactive. Impulsivity item behaviors include acting without thinking, hurrying through assignments, and being unable to wait to take a turn in games. The Attention Problems scale includes items such as failure to complete homework from start to finish without taking a break, forgetting things, short attention span, easily distracted from classwork, and trouble concentrating. Items on the Aggression scale include behaviors such as arguing, name calling, criticizing, blaming, verbally threatening others, breaking others' possessions, hitting others, and being cruel to animals. The Conduct Problems scale includes behaviors such as cheating in school, stealing, truancy, lying, and running away from home. The TRS reliability coefficients for adolescent boys are .95 for the Aggression subscale, .82 for the Conduct Problems subscale, and .94 for Hyperactivity. The PRS reliability coefficients for adolescent boys are .84 for the Aggression subscale, .73 for the Conduct Problems subscale, and .76 for the Hyperactivity subscale. Interrater reliability is strong between the TRS and PRS (Reynolds & Kamphaus, 1998). Attention-Deficit/Hyperactivity Disorder Test (ADHDT) The ADHDT is a standardized, norm-referenced behavior checklist used to identify children with ADHD based on the DSM-IV definition of ADHD 51

(Gilliam, J. E., 1995). This test is comprised of 36 items describing behaviors and characteristics that are divided into three subtests: Hyperactivity, Impulsivity, and Inattention. The Hyperactivity subtest consists of behaviors such as excessive running, jumping, and climbing; excitability; fidgetiness; and restlessness. The Impulsivity subtest includes behaviors such as acting before thinking, interrupting conversations, and blurting out answers.

The Inattention subtest includes

behaviors such as poor concentration, disorganization, and absentmindedness. The ADHDT can be completed in approximately 5−10 minutes. The internal consistency and reliability of the subtests were determined to be in the .80s and .90s. Studies of both test-retest and interrater reliability confirm the utility of the ADHDT as a diagnostic instrument. It is one of the few tests normed entirely on persons with ADHD. Outcome Measures Woodcock Diagnostic Reading Battery (WDRB) The WDRB is a comprehensive set of individually administered tests that measure dimensions of reading achievement and related abilities. This battery is comprised of tests selected from several parts of the Woodcock-Johnson PsychoEducational Battery-Revised (WJ-R) (Woodcock & Johnson, 1989, 1990a; 1989, 1990b). Normative data consisting of 6,026 individuals, ranging in ages 4−96 years, are based on a single sample that was administered all tests in the battery. This battery yields derived scores as well as age and grade equivalents. The subscale Reading Comprehension cluster was used to measure the student’s ability to read and understand the passages. This is made up of Reading 52

Vocabulary and Passage Comprehension. The first test, Reading Vocabulary, consists of words that are read out loud by the student. Two sections of this test consist of finding synonyms and antonyms for each word.

The second test

measures the student’s ability to read passages silently and provide the correct word that would make the blank in a sentence consistent with the passage. The median reliability for Reading Vocabulary is .92 in the age 5−18 range. The median reliability for Passage Comprehension is .88 in the age 5−18 range. The median reliability for the overall Reading Comprehension cluster is .95 in the age 5−18 range. The Phonological Awareness cluster was used to measure the student’s ability to analyze and synthesize phonemic information. This cluster is comprised of two tests: Incomplete Words and Sound Blending. The first task, Incomplete Words, has the child hear a recorded word that has one or more phonemes missing and has the child identify the complete word. The second task, Sound Blending, has the student integrate and say whole words after hearing parts (syllables and/or phonemes of the words) on audiotape. For the purpose of grouping students for Hypothesis 7, students with a PA cluster standard score of 89 and below were classified in the Low Level reading group. Students with a standard score in the range of 90−110 were placed in the Medium Level, and students with a standard score of 111 and above were placed in the High Level group (see Table 5).

53

Table 5 Classification of Phonological Awareness (PA) Group Levels Standard Score

PA Group Level

111 and above

High Level

90−110

Medium Level

89 and below

Low Level

54

The median test reliability for Incomplete Words is .72 in the age 5−18 range. On the Sound Blending subtest, the median reliability is .86 in the age 5−18 range.

The overall median reliability for the Phonological Awareness

Cluster is .88 for ages 5−18. PROCEDURE With the approval and support of each campus principal, a cover letter (signed by both the principal and researcher) and a consent form were sent to the parents of all male students, ages 11−15 in grades 6−8, explaining the nature of the study and the need for volunteers (see Appendix A for the IRB approved cover letter and consent form). Campus teachers were contacted individually to explain how they could help in providing parent information, collecting consent forms, distributing candy to the students with signed consent forms, and finally, completing the BASC Teacher Rating Scale form for each participant from their class. Parents who returned the parental consent form were then contacted and asked to complete background information concerning the behavior of their child (BASC Parent Rating Scale; and for those children diagnosed with ADHD, the ADHDT rating scale). As consent forms were returned, student records were examined to identify whether or not a student was diagnosed with ADHD and/or ODD and to gather additional background information. Only diagnosed students at the alternative schools and non-diagnosed students from the public school were included in the study. To compensate for the lack of students with ADHD only, a small network of parents of children already diagnosed with ADHD was contacted about participating in the study. The parents followed the same 55

procedure of completing consent forms and rating scales, and of providing the necessary information from a selected teacher as well as information from their student’s record. Approximately 150 students from all three campuses and the community network were contacted, with a return of 113 eligible students for the study. To maximize the response rate, all students were given candy for the return of their parental consent forms and a bag of “goodies” (such as candy, pens, pencils, and coupons) upon the completion of all assessments. At the end of data collection on each campus, a drawing was held for restaurant coupons, movie tickets, bowling and skating coupons, and $25 for their voluntary participation in the study. Teachers were also given tokens of appreciation including candy, coupons, and small gifts. All the prizes were donated by Waco community businesses and organizations. Each participating student was asked to complete an assent form to indicate his informed consent (see Appendix B) and understanding that he could discontinue at any time without any repercussions. Confidentiality and the nature of the study were carefully explained.

None of the students declined

participation. Each student was tested on the school campus in areas provided by the school principal or staff. The students from the community network were tested at their homes. Each student was individually administered the WASI and WDRB Reading Comprehension and Phonological Awareness subtests by the principal researcher and/or Master’s level, school psychology graduate students

56

trained in testing. Results were made available to the parents and the appropriate school staff unless otherwise specified by the parents. EXPERIMENTAL DESIGNS AND ANALYSES Designs and Analyses for Study Hypotheses The study is a CRAC-4 design used to compare reading skills of the four groups of participants based on behavioral functioning. Stratified sampling was used to assign participants to groups based on existing diagnoses of ADHD/ODD and the results of the BASC and ADHDT. These groups were then compared on the basis of each of the dependent variables: reading comprehension and phonological awareness. Preliminary Analyses Group membership for Hypotheses 1−3 serves as the independent variable in these analyses. The Reading Vocabulary Cluster and Passage Comprehension Cluster on the Woodcock Diagnostic Reading Battery

(WDRB) were the

outcome measures. IQ serves as a covariate since a significant relationship was found with the dependent variable (Reading Comprehension Cluster composite score). Univariate ANCOVA was performed on Hypotheses 1−4 to determine whether there were any differences between the groups on reading measures. Alpha was set at the .05 level.

Hypothesis 1: Students with either ADHD or behavior problems will perform more poorly than the control group on reading comprehension. 57

(a) The ADHD-C group will perform more poorly than the control group on reading comprehension. (b) The ODD group will perform more poorly than the control group on reading comprehension. Hypothesis 2: Students with ADHD will perform more poorly than students with behavior problems on reading comprehension. Analysis No differences were found by the preliminary ANCOVA.

Further

analyses were unnecessary. Rationale Researchers credit inattention for the reading problems experienced among ADHD children. In other studies, characteristics of RD/ADHD groups are defined by deficits in memory and verbal skills (McGee et al., 1989); phonological, attentional, and linguistic deficits (August & Garfinkel, 1989; McGee et al., 1989); poor visual-motor integration and planning (August & Garfinkel, 1990; Robins, 1992); poor verbal fluency (Anderson & Silva, 1986); and poor verbal processing abilities (Dykman & Ackerman, 1991). Reading disabilities and aggression, antisocial behavior, and delinquency have been thoroughly examined because of their consistent overlap (Broder et al., 1981; Frick, Lahey et al., 1986; Lane, 1980; Larson, 1988; Mayes, Calhoun, & Crowell, 2000; Pisecco et al., 1996; Waldie & Spreen, 1993). This study will look at each externalizing behavior group separately and combined as it relates to general reading abilities. 58

Hypothesis 3: Students with a combination of ADHD and behavior problems will perform more poorly on reading comprehension. (a) The ADHD-C/ODD group will perform more poorly than the control group on reading comprehension. (b) The ADHD-C/ODD group will perform more poorly than the ADHDC (no ODD) group on reading comprehension. (c) The ADHD-C/ODD group will perform more poorly than the ODD (no ADHD) group on reading comprehension. Analysis No differences were found by the preliminary ANCOVA.

Further

analyses were unnecessary. Rationale Comorbidity of learning disabilities (LD) and ADHD is estimated to range from 15%−50% specifically for reading and is more prevalent among boys than among girls (Willcutt & Pennington, 2000). In order to explain the relationship between ADHD and reading disabilities, as well as externalizing behavior and reading disabilities, various researchers have examined groups of ADHD only, ODD only, groups of students with only reading disabilities, and various forms of combination groups, e.g., ADHD/ODD, ADHD/RD, etc. A review of various studies (August & Garfinkel, 1989; Barkley, 1990; Klorman et al., 1999; Lambert & Sandoval, 1980; Livingston et al., 1990; McGee et al., 1989; Semrud-Clikeman et al., 1992) indicate that comorbidity of any of these disorders puts the child at

59

greater risk for more severe difficulties as well as greater resistance to intervention. The prevalence of reading disabilities is over represented in samples of children with ADHD falling between 25% and 40% (e.g., Dykman & Ackerman, 1991; McGee & Share, 1988; Semrud-Clikeman et al., 1992; Willcutt & Pennington, 2000).

Some studies even go so far as to suggest that reading

problems and attention problems "are on a continuum, are interrelated, and usually coexist" (Mayes et al., 2000). Group membership for Hypotheses 4−6 will serve as the independent variable. The outcome measure used in these analyses will be taken from the Phonological Awareness Cluster score on the WDRB. The two subtests included in this cluster are Incomplete Words and Sound Blending. If there is a significant correlation with the results from the Phonological Awareness Cluster composite score and IQ, the IQ will serve as a covariate. Hypothesis 4: Students with either ADHD or behavior problems will perform more poorly than the control group on phonological awareness measures. (a) The ADHD-C group will perform more poorly than the control group on phonological awareness measures. (b) The ODD group will perform more poorly than the control group on phonological awareness measures. Hypothesis 5: Students with ADHD will perform more poorly than students with behavior problems on phonological awareness measures.

60

Analysis No differences were found by the preliminary ANCOVA.

Further

analyses were unnecessary. Rationale As noted above, both groups of children with ADHD and behavioral problems have been found with "greater-than-chance" presence of reading disabilities. Not many studies have been done with ODD/RD, but rather with externalizing behaviors and reading disabilities.

Many studies have used a

combination of ODD and its more severe manifestation, conduct disorder. This study will attempt to separate the two disorders and examine any differences as they relate to phonological awareness. Inattentiveness has been the strongest predictor of reading disabilities. Several studies indicated that 15% and 26% of individuals with reading disabilities also met criteria for ADHD (Gilger, Pennington, & DeFries, 1992; Shaywitz, Fletcher, & Shaywitz, 1995). In addition, the continuum of reading disabilities and attention problems has been demonstrated to be significantly associated in three additional samples (Boetsch, Green, & Pennington, 1996; Fergusson & Horwood, 1992; McGee & Share, 1988), providing further evidence for the phenotypic overlap of RD and ADHD (Willcutt & Pennington, 2000). Hypothesis 6: Students with a combination of ADHD and behavior problems will perform more poorly on phonological awareness measures. (a) The ADHD-C/ODD group will perform more poorly than the control group on phonological awareness measures. 61

(b) The ADHD-C/ODD group will perform more poorly than the ADHD (no ODD) group on phonological awareness measures. (c) The ADHD-C/ODD group will perform more poorly than the ODD (no ADHD) group on phonological awareness measures. Analysis No differences were found by the preliminary ANCOVA.

Further

analyses were unnecessary. Rationale The literature generally suggests that children with reading disabilities more commonly have phonological weaknesses (Purvis & Tannock, 2000). As reading disabilities relate to behavior and attentional problems, research results have been mixed. Some support has been found for the phenocopy hypothesis where it is believed that ADHD/RD children do not have core deficits of ADHD but rather manifest only behavioral symptoms, which develop as a secondary consequence. In studies examining behavior problems and reading problems, again, results are mixed. However, most studies do agree that comorbidity of behavior problems, hyperactivity, and reading difficulties, in fact, exist. Hypothesis 7: ADHDT Quotients will increase as phonological awareness (PA) scores decrease.

62

Analysis The Pearson's Correlation Coefficient Analysis was conducted to describe the strength of the linear relationship between a student’s ADHDT Quotient and phonological awareness score. Rationale Very few studies have examined the level of severity when comparing their functioning in domains such as externalizing behaviors, reading difficulties, hyperactivity, etc. This comparison between levels of ADHD and phonological awareness will enable correlations to be explored. SAMPLE SIZE AND POWER Between-group differences in social and behavioral research are usually modest, with effect sizes not exceeding 0.5. Using the Cohen guidelines for estimating the sample size, a medium effect size of 0.25 was used for the index f for the p = 4 treatment levels, alpha was set at 0.05 and the acceptable power was set at .80. According to Table E.13 (Kirk, 1995) the sample size should be at least 26 participants per group with a sample population of 104 participants. Al l of the groups exceeded this number with the exception of the ADHD-C group (N=18). The total sample size was 113 boys.

63

CHAPTER 4: Results This chapter discusses the results of the analyses presented in Chapter 3. The first section focuses on descriptive data with regard to each of the variables in the research study for both the overall sample and group comparisons. This section is followed by the results for each of the research hypotheses. Based on the results of the primary analyses, further analyses were computed. The last section of this chapter provides a summary of the results from the hypotheses and analyses. DESCRIPTIVE ANALYSES Sample The sample used in this dissertation study includes 113 male participants ranging from ages 11−15 years. The sample population has an overall mean IQ score of 97. The range of IQ scores falls between 80 and 132, with most of the scores falling in the lower average range of the WASI. Descriptive information regarding scores on the IQ, ADHDT, and the outcome measures-WDRB Reading Comprehension and Phonological Awareness clusters- are presented in Table 6. The sample group scored in the low average range on both reading measures and performed in the low average range of intelligence. One factor may be that majority of students attend alternative schools where school failure is rampant.

64

Table 6

Means and Standard Deviations for Measures on IQ, ADHDT, and WDRB Reading Measures for the Total Sample (N=113)

Variable

M

SD

IQ (WASI)

97.66

11.71

ADHDT Quotient

59.27

41.74

Reading Comprehension

95.28

13.08

Phonological Awareness

90.05

11.76

WDRB Clusters

Note. IQ = Intelligent Quotient; WASI = Wechsler Abbreviated Scale of Intelligence (Psychological Corp., 1999); ADHDT = Attention Deficit/ Hyperactivity Disorder Test (PRO-ED, 1995); WDRB = Woodcock Diagnostic Reading Battery (Riverside, 1997).

65

The parents’ ratings on the BASC subtests included Hyperactivity and Attention Problems to identify ADHD behaviors. In the subscales identifying ODD behaviors, Aggression and Conduct Problems were utilized.

Teacher

ratings resulted in Hyperactivity, Attention Problems, Aggression, and Conduct Problems (see Table 7). A Paired Samples Test was conducted to find differences between parent and teacher rating scales on the BASC for the total sample. Using a t-test with alpha = .0125 to control for type 1 error (Bonferroni), significant differences were found.

Parents rated their own child higher than the child’s teacher on the

hyperactivity (t = 2.763, r = 0.007), attention problems (t = 4.975, r < 0.001) and conduct problems (t = 6.775, r < 0.001) subscales. However, on the aggression subtest, there were no significant differences (t = 352, r = 0.725).

66

Table 7

Comparisons Between Teacher and Parent BASC Rating Scale for the Total Sample (N=113)

Measure and Variable

Parents

Teacher

t

p

ADHD Behaviors Hyperactivity

59.07

55.50

2.763

0.007*

Attention Problems

59.30

54.05

4.975

< 0.001*

Aggression

57.27

56.99

0.352

0.725

Conduct Problems

70.73

60.50

6.775

< 0.001*

ODD Behaviors

Note. BASC = Behavior Assessment System for Children (American Guidance Service, Inc., 1992); ADHD = Attention-Deficit/Hyperactivity Disorder; ODD = Oppositional Defiant Disorder; * Significant difference.

67

Group Comparisons The mean score on each demographic variable is presented in terms of the four diagnostic groups: ADHD-C, ODD, ADHD/ODD, and Control (see Table 8). The assumption of a chi-square test was not met, thus not reliable because the predicted frequency in some of cells was less than five. An informal observation of the groups reveals that the ADHD and ADHD/ODD groups did not differ. However, the ODD group had the oldest members and the Control group had the youngest participants. In terms of grade levels, the ADHD group had participants in the highest grade level compared to the other groups.

68

Table 8 Means and Standard Deviations of Age and Grade for Each Group

Variables Age Grade

Note.

ADHD-C

ODD

ADHD/ODD

(N = 18)

(N = 36)

M

SD

M

13.44

.86

13.86

.99

7.60

.85

7.36

.79

SD

Control

(N = 25)

(N = 34)

M

SD

M

13.44

1.08

12.71

1.00

7.2

.81

6.91

.87

SD

ADHD-C = Attention-Deficit/Hyperactivity Disorder-Combined Type;

ODD = Oppositional Defiant Disorder; ADHD/ODD = combined group

69

When ethnicity was observed across the groups, the ADHD group was made up of 78% Caucasian, 11% Hispanic, and 11% African-American. The ODD group was made up of 31% Caucasian, 42% Hispanic, and 27% AfricanAmerican.

The ADHD/ODD group was made up of 12% Caucasian, 28%

Hispanic, and 60% African-American. The Control group was comprised of 71% Caucasian, 12% Hispanic, and 17% African-American (see Figure 5). Socioeconomic status also appeared to have observable differences across the groups (see Figure 6). Mean and standard deviations for IQ scores and the results of the BASC parent and teacher rating scales are presented on Table 9.

70

Ethnicity

Ethnicity

25 20

Caucasian Hispanic

15

African-American

10 5 0

ADHD

ODD

ADHD/ODD

Figure 5. Group comparisons made by ethnicity.

71

Control

SES Status Socio-Economic 30 25 20 Low Income

15

High Income

10 5 0

ADHD

ODD

ADHD/ODD

Control

Figure 6. Group comparisons made by socio-economic status (SES).

72

Table 9 Group Comparisons on Variables ODD

ADHD/ODD

Control

(N = 18)

(N=36)

(N=25)

(N=34)

SD

M

IQ score 104.06 14.12 Parent BASC HYP

Variables

M

ADHD-C

SD

M

SD

M

SD

93.81

11.19

90.88

7.46

103.35

9.08

58.89

15.12

57.39

12.85

70.72

18.86

52.38

11.13

ATT PR 62.06

9.67

58.83

9.90

62.24

11.21

56.18

12.34

49.28

7.78

58.86

15.78

72.80

18.53

48.41

11.42

CON PR 50.28

6.72

82.42

17.11

89.32

20.74

55.50

12.23

62.00

11.27

53.31

5.42

67.16

13.59

46.21

6.61

ATT PR 64.50

5.91

52.83

3.73

61.28

11.92

45.12

6.99

52.81

8.38

58.28

9.13

72.04

15.70

46.53

4.46

CON PR 49.13

6.21

66.89

11.38

77.80

19.27

46.35

3.55

AGG

Teacher BASC HYP

AGG

Note: BASC = Behavior Assessment System for Children (American Guidance Service, Inc., 1992); HYP = hyperactivity; ATT PR = attention problems; AGG = aggression; CON PR = conduct problems

73

RESEARCH ANALYSIS Preliminary Analyses To examine whether there were significant distinctions on SES and IQ variables between groups, chi-square tests of independence were conducted. All statistical tests were defined at a .05 level of significance. SES was not able to be tested reliability due to the lack of sufficient predicted frequencies in each cell. However, significant differences among the four groups were found for IQPhonological Awareness, χ2 (3) = 15.72, ρ = 0.0034 and IQ-Read Comprehension χ2 (3) = 40.68, ρ < .0001. IQ was used as a covariant in subsequent tests. Primary Analyses To examine specific reading skills that comprise the Reading Comprehension Cluster, a series of 4 (groups) X 2 (task) repeated measures of analysis of covariance procedures were performed, F(3,112) = 1.13, ρ = .34. Hypotheses one, two, and three predicting students with ADHD or behavior problems would have difficulty on measures of reading comprehension were not confirmed.

Although no significant difference was present, the trend was

consistent with what was predicted by the hypotheses.

74

Reading Measures

Reading Comprehension & Phonological Awareness

2

Control ADHD/ODD ODD ADHD

1

0

50

100

150

(1) RC (2) PA

Mean MeanScore Scores

Figure 7.

1 = Reading Comprehension Cluster score; 2 = Phonological

Awareness Cluster score

75

Phonological awareness was the author’s main interest in comparing the four groups. The predictions in hypotheses four, five, and six stated that students with ADHD or behavior problems would have difficulty on phonological measures.

When the Phonological Awareness (PA) Cluster scores were

compared, however, no significant differences were found among the groups F(3,112) = 1.73, ρ = 0.17.

Again, the trend was consistent with what was

predicted by the hypotheses with the exception of the ADHD group performing the best. Although not significantly, the ADHD group performed better than the other groups, including the control group on this measure (see Table 10).

76

Table 10

Group Comparisons on Outcome Measures

WDRB

ADHD-C

ODD

ADHD/ODD

Control

(N = 18)

(N = 36)

(N = 25)

(N = 34)

M

SD

M

SD

M

SD

M

SD

RCC

98.94

14.15

91.61

13.51

88.72

8.63

102.06 11.30

RV

101.89

15.32

93.25

14.33

90.00

9.89

104.59 10.68

PC

97.06

12.95

91.19

13.84

89.00

7.82

99.44 11.35

PAC

94.78

12.03

89.19

11.01

82.80

9.21

93.79 11.72

IW

91.28

8.24

89.69

11.10

90.36 10.73

93.21 12.03

SB

98.72

20.72

87.17

16.64

87.16 14.60

96.74 14.84

Note WDRB=Woodcock Diagnostic Reading Battery (Riverside, 1997); RCC=Reading Comprehension Cluster; RV=reading vocabulary; PC=passage comprehension; PAC-Phonological Awareness Cluster; IW=incomplete words; SB=sound blending.

77

In summary, Hypothesis 7 predicting that ADHDT quotients would increase as phonological awareness (PA) scores decreased was confirmed. The Pearson’s Correlation Coefficient Analysis was conducted to describe the strength of the linear relationship between a student’s ADHDT quotient and phonological awareness score. The results indicated that the correlation between ADHDT quotients and phonological awareness scores were significantly different than zero, r = -.234, ρ = .013. Using a two-tailed t-test, the correlation was found to be significant at the .05 level. It can be concluded that there is a significant, but low, negative linear relationship between ADHD quotients and phonological awareness scores. As the level of ADHD behaviors increase (indicated by high quotients), the phonological awareness skills tended to decrease. Secondary Analyses. The Phonological Awareness cluster is comprised of two subtests, Incomplete Words and Sound Blending. The four groups were compared using an analysis of covariance to validate distinctions. Results yielded no significant differences between groups when compared by both subtests, Incomplete Words, F(3,112) = .45, ρ = .72 and Sound Blending, F(3,112) = .91, ρ = 0.44. In relation to mean score comparisons on Incomplete Words subtest, the students in the ODD group (M = 89.69) performed the poorest, followed by ADHD/ODD (M = 90.36), ADHD (M = 91.28), and the Control group (M = 93.21). The ODD group, rather than the combination group, experienced the most difficulty in this task.

On the

Sound Blending subtest, when mean scores were compared, the ADHD group (M 78

= 98.72) performed the best, followed by the Control group (M = 96.74). The ODD (M = 87.17) and ADHD/ODD (M = 87.16) were similar in mean scores. The Reading Comprehension cluster yielded a stronger negative linear correlation (r = -.347, r = .000) compared to the Phonological Awareness cluster. Using a two-tailed t-test, the correlation between ADHD and reading comprehension was significant at the .01 level. It may be concluded that there is a low, but significant negative linear relationship between ADHD quotients and reading comprehension. Within the Reading Comprehension Cluster (Reading Vocabulary and Passage Comprehension), the Reading Vocabulary subtest was most correlated with levels of ADHD (r = -.341, r = .000). Using a two-tailed ttest, the correlation between ADHD and Reading Vocabulary was low, but significant at the .01 level. The Reading Vocabulary subtest consists of two sections of finding synonyms and antonyms for each word. In order to see whether there was a specific reading task more difficult than the other, additional analyses of covariance were performed. The Reading Comprehension subtests, Reading Vocabulary and Passage Comprehension, were examined for any possible group differences using analysis of covariance. The results indicated that there were no significant differences among groups in Reading Vocabulary scores, F(3,112) = 1.33, r = 0.27. In comparison to each other in Reading Vocabulary, the trend was that the ADHD/ODD performed the poorest followed by ODD, ADHD, and the Control group.

Passage

Comprehension, F(3, 112) = 0.52, ρ = .67) was not significantly different as well.

79

The same trend resulted where the ADHD/ODD group performed the poorest followed by ODD, ADHD, and Control groups. Summary This chapter reported the statistical results of analyses completed for this study. The chi-square analyses revealed that there were differences between groups in SES, ethnicity, age, and grade level. However, these results were found unreliable due to insufficient predicted frequencies in various cells. IQ, however, was found to be significantly different between groups using both chi-square and analyses of variance. IQ was then used as a covariant for the remaining analyses. Analyses of covariance were performed to assess significant differences among groups in relation to reading comprehension and phonological awareness. The results yielded no significant differences. Because of possible differences in subtest within each cluster, each subtest was also assessed using analyses of covariance. Again, no significant differences were found across groups.

80

Chapter 5: Discussion

Comorbidity of juvenile delinquency and learning disabilities has been heavily debated for many years by several researchers (Grande, 1988; Hinshaw, 1992; Keilitz & Dunivant, 1986; Larson, 1988; McGee & Share, 1988; Rourke, 1989; Rutter, 1989; Zimmerman et al., 1981). The overlap between juvenile delinquency and learning disabilities is coined the “JD/LD Link”. When research was conducted on juvenile delinquency in the past, however, all types of behaviors were included.

Researchers addressed externalizing or delinquent

behaviors as if there were one single type of disruptive behavior, when in fact, various types of behavior problems existed.

These behaviors include

inattention/hyperactivity, impulsivity, aggression, oppositional defiance disorders, conduct disorders, and antisocial impairment. As researchers began studying externalizing behaviors individually, it was becoming difficult to ascertain specifically what types of behaviors were contributing to what types of learning disabilities or vice versa. Eventually researchers began disentangling causes and correlates of disorders and their outcomes.

Delinquent behaviors are now

commonly addressed as distinct types of behaviors, and learning disabilities are classified into specific areas such as reading, mathematics, and spelling/written language. Additionally, studies of the comorbidity of these behaviors (ADHD, ODD, CD) and learning problems (RD) have emerged into the LD/JD arena.

81

There is little contention that reading is fundamental to the educational process of children and adolescents. School success depends heavily on the acquisition of reading skills; thus, barriers to typical developmental pathways have attracted the attention of researchers. A reading disability is characterized by significant underachievement on standardized tests of single-word reading, reading fluency, and reading comprehension, usually due to impaired phonological processing (Aaron et al., 1999; Felton & Wood, 1989; Light, Pennington, Gilger, & Defries, 1995; Shaywitz et al., 1999; Stanovich & Siegel, 1994; Wagner & Torgesen, 1987; Wilcutt & Pennington, 2000). However, since children with reading disabilities have a “greater than chance” possibility of being diagnosed with ADHD and ODD/CD, further investigation is merited. Researchers began to investigate the relationships between ADHD, ODD, and reading disabilities (Biederman et al., 1991; Faraone et al., 1993; SemrudClikeman et al., 1991). Their findings consistently support the theory that a significant relationship exists between behavior problems and reading disabilities and that behavior problems are more prevalent among poor readers with belowaverage IQ scores (Jorm et al. 1986; McGee et al., 1986). These children are considered to have general reading backwardness (GRB).

Children with

comorbidity ADHD and ODD have each been linked to reading problems, but authors argue (Pisecco et al., 1996) that the ADHD and reading problems may exacerbate behavior problems. However, children with pure ADHD may exhibit externalizing behaviors as a result of their inattentive, impulsive, and hyperactive tendencies.

82

One method of disentangling the relationship between ADHD and ODD with reading disabilities is called the multiple comparison approach. This method addresses two hypotheses regarding the nature of the association of two disorders (Purvis & Tannock, 2000). The phenocopy hypothesis states that one disorder is primary and the other is secondary. The etiological subtype hypothesis proposes additive effects or greater than additive effects of the two disorders.

By

conducting a classic double dissociation (Shallice, 1988), evidence for cognitive separability of two disorders is provided. To test for a double dissociation, there must be previous studies supporting different core cognitive deficits in each disorder. The phenocopy hypothesis predicts that the comorbid group’s profile will be similar to the profile of one of the pure groups, rather than exhibiting the deficits of both groups. If the latter pattern were found, either the common etiology or etiologic subtype hypotheses would be supported, because both imply that a single etiology can sometimes produce both full syndromes in the same individual. The overlap of ADHD and reading disabilities has been explored more often than ODD and reading problems. Some studies estimate rates of overlap between ADHD and LD ranging from 15%−45% (Biederman et al., 1991; Faraone et al., 1993; Semrud-Clikeman et al., 1992; Shaywitz & Shaywitz, 1993). ODD has been strongly associated with reading problems, particularly with children who have general reading backwardness (GRB) or garden-variety poor reading. ODD/CD has been found to coexist in as many as 30%−50% of children with ADHD (Kuhne et al., 1997). Previous research has focused on either ADHD

83

or ODD, but rarely on both as they relate to reading abilities, specifically reading comprehension and phonological awareness. The purpose of this study was to investigate the relationship between externalizing behaviors and reading problems. In particular, it was expected that hyperactivity and/or behavior problems would distinguish children with reading problems from those without reading problems (Barkley, 1997; Frick, Lahey, & Applegate, 1994; Pennington & Ozonoff, 1996; Tannock & Schachar, 1996). Additionally, it was hypthosized that the comorbidity of ADHD and ODD would exacerbate reading problems for children when compared to children with a sole diagnosis of ADHD or ODD (Hinshaw, Lahey, & Hart, 1993). The correlation between the level of hyperactivity and phonological awareness was also examined. Significant differences were found across groups for SES, ethnicity, age, and grade levels. The probability of significance was found to be unreliable due to a lack of predicted frequencies necessary for a valid chi-square analysis. Several confounding sources made interpretation very difficult. First, there was not enough variety of levels in terms of SES, ethnicity, age, and grade. The restriction of range precluded using SES as a covariate as there were not enough participants in the middle- and upper middle-income level.

Most of the

ADHD/ODD and ODD group members were minorities and all of them were enrolled in alternative educational programs. The limitation of using children in a predominantly low-income, low achieving, and poor behavior setting failed to provide a full range in which to adequately compare the four groups. Intelligence

84

was found to be different significantly among the four groups and used as a covariate for the remainder of the analyses. Results of the study failed to support the 1st hypothesis that students with either ADHD or behavior problems would perform more poorly than the control group on reading comprehension. Between-group differences on the reading comprehension cluster variable yielded no significant differences using univariate analysis of covariance (ANCOVA) controlling for IQ. The presence of either ADHD or ODD did not appear to affect the reading measures of the participants when compared to the control group. This finding is contradictory to the large body of literature that has found a “greater than chance” relationship between behavior problems, ADHD, and reading problems. The current results imply there are no differences between groups on measures of reading comprehension when ADHD and/or ODD symptoms are present. The lack of significant group differences for reading abilities may be partly due to socioeconomic status variables.

Lonigan et al., (1999) found

differences between middle-income and low-income groups when investigating the association of ADHD and reading skills.

Although the relationship was

significant for both groups in Lonigan’s study, the relationship between ADHD and reading problems was stronger for the middle-income group and weaker for the low-income group. Significant associations have also been documented between delinquent behaviors and reading disabilities. In fact, by adolescence, a strong correlation between delinquent behavior and variables related to verbal deficits (Moffitt, 1993) and underachievement (Williams & McGee, 1994) has

85

been found. In the current study, children with hyperactivity and/or oppositional disorders did not differ on measures or reading. Although ADHD has been more strongly linked to poor reading ability (Lonigan et al., 1999; Schachar et al., 1995), the current study did not find a difference between the groups on the measures for reading comprehension. Children with ADHD have been found to underachieve, and underachieving children also show increased rates of ADHD (Halperin, Gittelman, Klein, & Rudel, 1984). About 20%−25% of reading-disabled children have ADHD and 10%−50% of children with ADHD have concurrent reading disabilities (Hinshaw, 1992). However, these findings were not substantiated in this study. Children with low to below average intelligence scores performed commensurate with their ability. The pure ADHD also performed at the level of their potential; however, this group demonstrated the largest discrepancy between IQ scores and reading comprehension. Although the ADHD group was mostly from a middle-class environment, and by theory, was expected to have a stronger correlation to reading problems, no significant differences were found.

The failure to

differentiate the groups may not be due to the level of socio-economic class alone, but also the methodology of measuring reading comprehension.

The cloze

technique was used in this study and may have contributed to the findings. Students were required to complete sentences with missing words. This is called the cloze procedure. However, this type of measurement may not have been sensitive enough to differentiate reading comprehension abilities among the four groups. The fact that many of the students in the ADHD and ODD groups

86

demonstrated average IQ scores and reading scores does not explain why these students are currently functioning at least two years below grade level in the classroom. The 3rd hypothesis predicted that students with ADHD plus ODD would perform more poorly on reading measures than the pure ADHD and ODD groups as well as the control group.

The findings did not support this hypothesis.

Although the combination groups performed more poorly than the other groups on the reading measures, the differences were not significant. These results were inconsistent with previous studies that predicted that comorbidity exacerbates reading problems (McGee et al., 1988; Smart et al., 1996). According to Frick et al. (1991), the association between aggression and learning problems among early school-age children is best understood through its comorbidity with ADHD. Forehand et al. (1991) report that the CD plus ADHD group from their sample population had a lower verbal IQ and lower reading grade level than the pure ODD group. Methodological inconsistencies in other studies, such as failing to distinguish ADHD from ODD, have resulted in inconsistent findings. In this study, the two variables were addressed separately.

Other comparisons of

children with ADHD plus ODD on academic measures have resulted in the combination group performing better (Stewart et al., 1981), similar (Mateir, Halperin, Sharma, Newcorn, & Sathaye, 1992) and worse (Moffitt & Henry, 1989) than that of children of “pure” ADHD. Another factor that may contribute to this perplexing outcome is the failure to differentiate between ODD and conduct disorder (CD). Some studies contribute reading problems more to CD

87

rather than ODD. In this sample, most of the children in the ODD groups qualified for CD at different levels of severity. Again, the groups may not have been distinctive enough to produce reliable conclusions. All participants were diagnosed with ADHD and/or ODD, but the level of severity of ODD versus CD was not always available to this investigator. Psychologists, psychiatrists, and educational professionals made diagnoses for all the children participating in this study. To address the variability of professionals and criteria for diagnoses, however, parent and teacher rating scales were used to rate each child. Although each boy had a diagnosis of ADHD and/or ODD, (excluding the control group), he also had to obtain a score of 60 or greater in the appropriate category on the parent/teacher behavior rating scales to be included in this study. The 4th hypothesis stated that either pure ADHD or ODD groups would perform more poorly than the control group on phonological awareness measures. The results failed to differentiate between groups. According to the results of this study, children with either or both behavior disorders performed just as well as the control group. This finding supports the theory that phonological awareness is a deficit of reading disabilities but not ADHD (Nigg, Hinshaw, Carte, & Treuting, 1998; Pennington et al., 1993). Although there were no significant differences, the pure ADHD group actually performed better than the other three groups. This finding may be attributed to the higher mean IQ scores of that group. Regardless of the lack of significant differences, all of the mean phonological awareness scores were in the low-average range. However, both the Control and the ADHD

88

only groups had a 10-point discrepancy where both ODD groups were commensurate with their IQ mean scores. The 5th hypothesis that students with ADHD would perform more poorly than students with ODD on phonological awareness measures was not supported with the results of this study. All groups in this study were in the low-income range except for the ADHD group. This finding might explain the higher scores by the ADHD group compared to the other groups.

In this case, ADHD

symptoms did not appear to be as great a factor as SES. Many

researchers

propose

that

young

children

with

ADHD

overwhelmingly suffer from reading disabilities defined by phonological processing (August & Garfinkel, 1989; McGee et al., 1989; Pennington et al., 1993). High levels of inattention has consistently been linked to poor readers (Hinshaw, 1992).

However, Pennington et al. (1993) failed to support the

argument that children with pure ADHD also demonstrated impairment in phonological awareness (Pennington et al., 1993). Lonigan et al. (1999) suggest that ADHD children are not at risk for reading problems because of deficits in phonological awareness but rather the manifestations of inattention in their reading developmental pathways. In studies differentiating between children with ADHD and children with reading problems, those children with reading disabilities demonstrated deficits on phonological awareness while the ADHD only group did not. Lonigan et al. (1999) investigated the overlap between reading disabilities and ADHD in children.

They found that there were

significant differences between the low-income and middle-income samples. For

89

both groups, higher levels of teacher-reported inattention were predictive of emergent literacy skills. Children in the low-income sample generally scored lower than the children from the middle-income sample on measures of phonological awareness. In this dissertation study, although not significant, the children in groups predominantly in a low SES (both ODD groups and the control group) performed more poorly than the ADHD group predominantly from a middle-income background. The 6th hypothesis that students with a combination of ADHD and behavior problems would perform more poorly than the control group on phonological awareness measures was not supported. No differences between ADHD and ODD were substantiated. As in Hypothesis 3, although literature has suggested that comorbidity of ADHD and ODD exacerbates reading problems, this effect was not supported by this study. The combination group performed the poorest of all four groups, but they performed commensurate with their IQ mean scores. The ADHD and Control groups yielded the highest mean scores, but they had the biggest disparity between their mean IQ scores and the phonological mean scores (ten points difference opposed to two or three points). The 7th hypothesis that the severity of phonological awareness scores would decrease as the severity of ADHD increased was supported by this study. The final analysis was a Pearson Correlation to examine the relationship between the level of ADHD symptoms and phonological awareness scores. A significant negative linear relationship was found as a result of the analysis. This significant, but low correlation supports the theory that as attention problems increase, so do

90

academic problems (Mayes et al., 2000). High levels of inattention in children may place them at risk for delays in the development of skilled reading. Practical implications may suggest that teachers and school psychologist test children with severe ADHD for reading skills. Interventions could be put in place for children with ADHD who are just learning to read. In the Lonigan et al. (1999) study, higher levels of inattention were associated with lower levels of language skills and phonological memory, whereas, for children from lower-income levels, inattention was associated with specifically phonological sensitivity. Children who have trouble attending to their schoolwork and focusing on their teachers do poorly in most academic areas, including reading (Rutter, 1974).

Carlson et al. (1997) propose that in

comparison to children with ODD, children with ADHD suffer greater academic failure. In the present study, both parent and teacher rating scales had to demonstrate scores of 60 and above to meet the criteria for ODD and/or ADHD. This method prevented the “halo effect” that may occur with students from different backgrounds. Lonigan (2001) found in his study that a greater frequency of behavior problems were reported by teachers of the middle-income students opposed to students from a low-income background. He speculated that it was not necessarily greater relative to a prevalence of behavior problems, but a difference in teacher expectations for these children. In this dissertation study, both ODD groups and the control group (low SES) were rated higher in overall behavior problems by the parents rather than the teachers. However, teachers

91

rated the pure ADHD group (middle-income) higher in both ADHD and ODD symptoms. As in Lonigan’s study, teachers may have had higher expectations for middle-income students in contrast to lower-income students. Pennington et al. (1993) concluded that children with reading problems sometimes manifested ADHD symptomatology in reaction to their reading problems. Their conclusion implies that these children do not exhibit ADHD characteristics but rather ADHD-like behavior exacerbated by their frustration and consistent school failure.

This phenocopy hypothesis suggested by

Pennington et al. (1993) was also supported in findings by both Pisecco et al. (1996) and McGee and Share (1988). The absence of a significant relationship between reading abilities and behavior problems may be due to the narrow range of reading scores among the participants. There were not enough high scores to make a comparison. Most of the participants were involved in an alternative education program that included children who had been removed from home campuses and placed in structured and sometimes residential school environments. By the nature of this population, school failure was pervasive and IQ’s were in the low average range. This study reveals that the children in this alternative education setting had a lower average IQ score than those children not in the alternative program. Mean IQ scores for both the ADHD and the Control groups were approximately ten points higher than those of both ODD groups. The children in both ODD groups also had more participants in low SES than the ADHD and Control groups. If IQ had not been controlled, there would have been significant differences, but not due to chance.

92

If the Control and pure ADHD groups would have been more comparable in IQ scores, SES, and ethnicity, valid comparisons might have been conducted. ADHD AND SUBTESTS OF PHONOLOGICAL AWARENESS Because the ADHD group performed relatively better than the other groups in the Phonological Awareness measure, a second series of analyses of covariance were conducted with the subtests, Incomplete Words and Sound Blending.

The participants with pure ADHD performed relatively, but not

significantly, better on the sound blending tasks than the other groups. The Sound Blending subtest requires the student to integrate and say whole words after hearing parts (syllables and/or phonemes of the words) on audiotape. This task requires a working memory that is most difficult for children with inattention than children with hyperactivity/impulsivity deficit (Willcutt et al., 2000). On the Incomplete Words subtest, the Control group performed relatively better than the other groups. However, ADHD relatively outperformed overall on phonological awareness. None of the groups were significantly different, however.

ADHD AND SUBTESTS OF READING COMPREHENSION To further investigate the low but significant correlation between the severity of ADHD and phonological awareness, the correlation of ADHD and the other reading components were analyzed. The secondary analyses actually discovered a stronger relationship with reading comprehension rather than 93

phonological awareness (Mayes et al., 2000).

The Passage Comprehension

subtest measures the student’s ability to read passages silently and provide the correct word that would make the blank in a sentence consistent with the passage. This method of assessment is considered a cloze procedure. Although the reading comprehension cluster demonstrated a stronger correlation with the level of ADHD than phonological awareness cluster, it may have methodological concerns. The cloze procedure is one of the most common type of assessment for reading comprehension used by school psychologists.

However, experts in

reading have argued that the cloze procedure does not adequately measure reading comprehension (Neville & Searls, 1985; Fusaro, 1992).

Many researchers

consider this procedure as inappropriate, because of its inability to assess passage integration

or

“intersentential”

(across-sentence

information

integration)

comprehension (McKenna & Layton, 1990, p. 372). The importance of this issue lies in the widespread use of the cloze procedure as a global measure of reading comprehension. Using the cloze procedure in this dissertation study may account for the disparity between the student’s reading comprehension score and his below grade level of reading (often as much as two years below).

INTEGRATION WITH THE LITERATURE Juvenile delinquency and reading disabilities have been the focus of much research in years past and continue to challenge researchers today. It is agreed 94

that there is a greater probability that children with behavior problems will also have reading problems. The question is what type of behaviors affects what type of reading disabilities or vice versa. Children in alternative educational settings pervasively read below grade level.

Although the participants in this study

obtained average scores, they were in the low average range. The lower scores clustered around the participants in the alternative education setting. The higher scores were found in the ADHD group that was recruited predominantly from a community network and the control group that was recruited from a low SES public school.

The ODD and ODD/ADHD group members are attending

alternative schools because of truancy, behavior problems, and/or illegal activities. The common thread that runs throughout this population is the low level of reading skills as well as externalizing behaviors. McGee et al. (1988) suggest that the presence of behavior problems is the most common and long-term association with reading disabilities (Pisecco, Baker, Silva & Brooke, 2001). This study supports findings by Anderson et al. (1987) that there is no significant relationship between behavior problems and poor reading.

However, a

relationship was established when there was a co-diagnosis of ADHD (Pisecco et al., 2001). The negative correlation between ADHD symptoms and phonological awareness is consistent with other research that implicate the association of reading disabilities and ADHD (Frick et al., 1991; Hinshaw, 1992; Schachar & Tannock, 1995; Semrud-Clikeman et al., 1992) The question remains as to the nature and direction of this relationship (Jorm et al., 1986; McGee & Share, 1988; McGee et al., 1986; Williams, Anderson, McGee, & Silva, 1990; Williams &

95

McGee, 1994). McGee and Share (1988) suggest that reading disorders lead to the development of ADHD behaviors, while others argue that ADHD leads to the manifestation of reading problems. Some researchers define a reading disability as below-average achievement in reading comprehension as assessed by a standardized test. Others state that the purest definition includes problems with reading non-words. Still, other definitions focus specifically on phonological deficits.

The common

practice of diagnosing reading disabilities on the basis of an IQ-achievement discrepancy is still an unresolved issue.

This approach often excludes poor

readers with lower IQ’s who invariably have poor comprehension skills. In testing whether children with a reading disability share common etiology or constitute heterogeneous groups, four types of poor readers were identified by Aaron et al. (1999):

(1) decoding only, (2) comprehension only, (3) a

combination of decoding and comprehension, and (4) a combination of orthographic processing and reading speed. This study concentrated on reading comprehension and phonological awareness and questions whether ADHD and/or ODD would manifest the same kinds of reading problems.

The findings

demonstrated a stronger negative linear correlation with reading comprehension rather than phonological awareness. Again, these findings may be skewed in that the measure may not have appropriately assessed reading comprehension. Within the reading comprehension measure, the vocabulary subtest was more associated with the level of ADHD than passage comprehension. Phonological awareness was also strongly correlated with the levels of ADHD. However, specific tasks

96

such as the blending or completion of word were not significantly correlated. Studies have observed ADHD and reading problems as well as ODD and reading problems, but few studies have examined ADHD controlling for ODD. CONTRIBUTION TO LITERATURE The results of this study provide additional information concerning a population of adolescent boys with behavior symptoms of both ADHD and ODD. The effect of ADHD and/or ODD was tested by examining the profile of the comorbid group in relationship to those of the pure groups.

Understanding

comorbidities is a fundamental issue in the study of developmental psychopathologies, because each different possible explanation has different implications not only for clinical practice but also for developmental theories. A priori empirical and theoretical research has associated learning disabilities (LD) with externalizing behaviors, often resulting in juvenile delinquency. Certain explanations for this causal relationship include: (1) school failure, which states that academic deficits result in acting out behaviors; (2) differential treatment, which proposes that children with and without LD engage in the same number of antisocial behaviors but are treated differently by the judicial system; and (3) susceptibility hypothesis, which states that children with LD also possess personality characteristics that predispose them to delinquent behavior.

This

study specifically observed the most common behavior problems, ADHD and ODD, with the most common reading disability, phonological awareness. Previous studies support the contention that behavior problems are more closely related to low IQ and phonological deficits. Some research supports the 97

theory that aggressive behavior does not lead to reading difficulties and that reading disabilities do not necessarily lead to behavior problems (Cornwall & Bawden, 1992).

However, reading difficulties may worsen with preexisting

externalizing behaviors (McGee et al., 1986). Failure to complete classroom and homework assignments, tardiness, truancy, negative attitudes, and other oppositional behaviors could be responsible for the academic difficulties that children with behavior problems experience. Research studies have examined potential relationships between reading disabilities (RD), behavior problems, and ADHD in terms of reading abilities and deficits. This study used the comorbid group ADHD/ODD to determine which disorder was primary and which was secondary. Causal pathways of ADHD and./or ODD were not the focus of this study. The results did not indicate large enough differences to be significant; however, the mean score of the combination group was more similar to the pure ODD group mean score than the pure ADHD group mean score. The ADHD/ODD group relatively performed poorer on mean scores than the other groups on reading comprehension yet performed quite similar to the ODD group in phonological awareness. This study does not support the findings by Carlson et al. (1997) that children with ADHD tend to exhibit more severe learning problems than their peers. In the study by Nigg et al. (1998), CD but not ODD was associated with lower verbal ability. The sample population in this study was diagnosed with ODD in most cases, but qualified for CD (as defined by DSM-IV criteria for conduct disorder) by the nature of placement in an alternative educational setting.

98

Most of the students were placed on their campus for assault, possession of a weapon, robbery, sexual assault, property damage, etc. Students were rated high on externalizing behaviors scales (BASC) by both parents and teachers. Parents rated their children higher than did the teachers. However, these differences may be due to the fact that teachers in alternative schools work with a smaller ratio of students and are trained in behavior management. The structure of the classroom is specifically designed for children with behavior problems. The curriculum is self-paced and individualized for each student. With special training and staff support, the teachers may feel better able to work with these children than the parents who may not have parenting skills or support. This study differs from other studies in that ADHD and ODD were separated into different groups and evaluated for distinction using reading measures (reading comprehension and phonological awareness). When ADHD behavior (hyperactivity, inattention, and impulsivity) levels were correlated with phonological awareness and reading comprehension cluster, a significant negative linear correlation resulted.

The strong correlation of ADHD symptoms and

phonological awareness may be due to the “snowball effect” hypothesis (Halperin et al. (1984), which suggests that young pure hyperactive children go on to develop reading problems. But the overlap of ADHD and reading disabilities is greater than chance and should not be taken lightly. The ADHDT Quotient indicates the level of severity of ADHD behaviors (hyperactivity, inattention, and/or impulsiveness). This study supported the theory that as the severity of

99

ADHD symptoms increases, phonological skill decreases, thus affecting reading success. Significant differences between groups were not found on measures of reading comprehension, although the students were functioning two years below grade level in some groups and not in others.

Some explanation for this

incongruity may be the methodology used to measure reading comprehension. The cloze procedure is frequently used for global comprehension measures. However, there is some discrepancy between reading test scores and reading levels in the classroom.

For practical implications, the measures that are

commonly used in assessing reading comprehension may not be accurately measuring what the tests purport to measure. As a result, children are not being accurately identified for special services when indeed they may possess reading difficulties in reading comprehension not identified by the cloze procedure. Reading specialists have long used other measurements that are lengthy and tedious to administer. Many school psychologists continue to use measures that may not fully measure reading comprehension. LIMITATIONS The sample population for the ADHD/ODD and the ODD groups were recruited from the alternative education settings. By definition, these students were unsuccessful in the mainstream classroom. Many of the students shared common characteristics such as low average IQ, low-income backgrounds, behavioral problems, and poor reading skills. Generalizability to public school students would be inappropriate. 100

Although participants were diagnosed with ODD, most of these children qualified for CD by the nature of their placement. For that reason, the distinction was not made between ODD and CD in this study. Another limiting factor was that students with a sole diagnosis of ADHD also demonstrated severe symptoms of ODD/CD. Ratings from both parents and teachers indicated high levels of aggression and/or conduct problems on the BASC rating scales, thus disqualifying students from the pure ADHD group.

The four groups were significantly

different in SES, ethnicity, age, and grade levels. But the difference was not to chance. The lack of sufficient predictive frequencies in some of the categories precluded valid chi-square test results. Both ODD groups and the control group were made up of predominantly low-income participants.

Both ODD group

participants attended alternative education schools. IQ was used as covariant because of significant difference among groups. Income and IQ are known correlates of reading ability and behavior problems. Both the IQ and reading scores of the ODD and combination groups were in the lower average range. There were not enough scores in the higher range to make significant differences possible.

The participants reflected the reading

characteristics of children with general reading backwardness or the gardenvariety poor reading skills. This is where children perform consistent to their IQ level. The tests used to diagnose phonological and reading comprehension may have limited the findings as well. A popular reading instrument, which is both quick and easy, was used to measure reading disabilities. Perhaps more thorough

101

and extensive reading tests would have accurately differentiated reading abilities between groups. Because this study only included boys, the findings of this investigation may not be generalized to children other than boys ages 11 through 15 due to gender differences and significant developmental changes occurring prior to and after this period. In addition, this study examined externalizing behaviors rather than including internalizing behaviors. This study may not adequately address cultural, ethnic, or individual differences that may impact reading abilities or behavior problems. CONCLUSION In summary, the results of this study provide additional information that may lead to the early identification of specific problem behaviors. Earlier and more appropriate forms of intervention are vital for children at risk of developing later behavior or reading problems. There have been tremendous advances in the field of learning disabilities (specifically, reading disabilities) in the last ten years. We continue to understand the core deficits of externalizing behaviors and how they affect emergent literacy.

For young children, there may be specific

intervention to prevent a child from experiencing reading difficulties that may lead to behavior problems later down the line. However, when working with adolescents, the interventions must by intense and consistent before results are realized.

By addressing behavior problems, perhaps children can learn, or

perhaps teaching children to read may deter their acting out later.

What is

important is to distinguish which behaviors are neurological and/or genetic and 102

which symptoms are environmental. Research must also continue to differentiate between ADHD with ODD/CD when developing interventions, treatment, and academic instruction. DIRECTIONS FOR RESEARCH Although this study failed to find significant differences between the ADHD, ODD, ADHD/ODD, and Control groups, an abundance of research validates the impact of externalizing behaviors (ADHD and ODD) on the acquisition of reading skills. Due to this high coexistence of behavior problems and reading problems, assessment of a child suspected of reading disabilities should also include assessment for social-emotional functioning. This holistic approach is imperative because successful intervention with reading difficulties may preclude the development of antisocial, aggressive, and ADHD-like behaviors.

Likewise, children with behavior problems should be given a

psychoeducational functioning assessment. Regardless of the causal pathways of ADHD, ODD, and reading disabilities, the “greater than chance” comorbidity merits early intervention. In this case, adolescents with low average IQ scores and reading abilities, intervention may take a different course. Well-designed follow-up studies have repeatedly indicated that reading disabilities persist into late adolescence and young adulthood (Beitchman & Young, 1997). Comprehension skills may improve, but the progress of poor readers is often slower than that of their normal reading peer. IQ scores and initial severity of the reading disability are the most consistent predictors of early adult reading levels. Reading skills can improve well into adulthood, but this depends on the extent of 103

practice and experience with literary activities. The most consistent finding is that those children diagnosed early in their academic years continue to have problems with phonological awareness into adolescence (Bruck, 1985; Pennington et al., 1991). However, with adequate support, children can make academic progress, but at a slower pace than their normal reading peers. Not all disabilities are alike, so further research should explore the relationship between behavior problems and certain components. Numerous studies that have provided phonological training to children with decoding deficits have reported success in the child’s decoding skills.

For children with comprehension deficits,

comprehension-strategy training has enabled those who can decode the written language, but cannot comprehend it well, to improve their reading abilities. This study attempted to investigate comprehension and phonological awareness. The sample population did not include a sufficiently broad range of readers.

Most importantly, the type of measure used to assess reading

comprehension (cloze procedure) may not have adequately assessed how well the student comprehends what he is reading. This imprecise measure of reading comprehension may explain the puzzling fact that the students functioning below grade level demonstrated average scores on reading comprehension. Using other means of reading comprehension assessment might result in significant differences between groups. It would be interesting to see, if any, the association between ODD and learning problems (opposed to reading scores) as defined by the parent- and teacher-rating scales. The Learning Problems subtest in the BASC allows for

104

teachers and parents to rate the student in the academic setting where reading problems would be measured differently and more practically. Using another measure of academic skills might give a more accurate description of the student as it relates to his externalizing behaviors. Because reading difficulties are not alike, neither are externalizing behaviors. Past studies had mixed ADHD, ODD, CD without learning the effect of each on reading abilities. This study attempted to separate ADHD and ODD, although most students, by the nature of their educational environment, qualified for CD. Thus, ODD and CD were not distinguished in this study. Future studies should continue to explore differences in ages (early childhood vs. adolescence) for the acquisition of reading skills. Would different reading programs be more beneficial at certain developmental stages?

The

problem with prevalent illiteracy among our juvenile delinquents warrants the search for solutions that deal with providing timely and effective interventions. The relationship between ADHD and ODD should also be further investigated. Too many children are failing as they attempt to juggle the task of acquiring literacy skills while managing behaviors of hyperactivity, impulsivity, and/or inattention. While researchers continue to debate “which come first, the chicken or the egg?” the comorbidity of behavior problems and reading difficulties should continue to be scrutinized. If findings continue to attribute externalizing behaviors (that may resemble ADHD) to reading problems, academic failure, and delinquency, then intervention is critical. If etiological causes were found to contribute to reading and behavior problems, then

105

interventions should be early. Regardless of the causes, if untreated the outcome is the same, a frustrated and dysfunctional child.

Understanding distinctive

characteristics of ADHD, ODD, and CD as well as individual differences, the development of comprehensive and multidisciplinary assessments can facilitate effective interventions and follow-up for children at risk.

106

APPENDIX

107

APPENDIX A Parent/Guardian Consent Form (COVER LETTER AND PERMISSION SLIP)

108

Consent Form Cover Letter (date) Dear Parent/Guardian: You and your son are invited to participate in a research study that will look at how hyperactivity and behavior problems affect the reading abilities of boys between the ages of 11-14. Children with and without these behaviors will help answer this question. My name is Liz Palacios and this study is being conducted as part of my dissertation work in the School Psychology program at the University of Texas at Austin. Your son was selected to be one of the approximately 200 students asked to be in this study because he attends the McLennan County Challenge Academy and may show some of the behaviors in which we are interested. If you and your son choose to participate in this study, he will be administered two 10-minute tests to measure reading ability as it relates to naming words. You will be asked to complete a rating scale of your child's behavior at home that will take about 10 minutes. One of your child's teachers will also be asked to fill out a brief rating scale that asks for information about his behavior in school. If your child has been diagnosed with attention deficit/ hyperactivity disorder (ADHD) or oppositional defiant disorder (ODD), a second parent rating scale and short interview with you will follow. This interview will take approximately 20 minutes. All interviews will be scheduled at your convenience. In addition, I will also need your permission to have access to your child’s school records for additional data such as his scores on standardized tests. All information that is collected in connection with this study is strictly confidential and will be used only for the purpose of this study. All published results of the study will consist only of grouped data. Neither your or your son’s name will be associated with the study information in any published document. As a token of my appreciation, I would like to compensate you and your son for your time and participation with prizes including restaurant coupons, store coupons, candy, etc. in a drawing. When your child returns this consent form, he will automatically get a small prize as well. If you agree to participate in this study, please sign the permission form and return it to your teacher. Keep this form for your records. Your signature indicates that you have read the information provided above and have agreed to participate. You may withdraw at any time after having signed this form should you choose to 109

discontinue participation in this study. Your decision whether or not to participate will not affect your for your son’s present or future relations with the University of Texas at Austin or the Challenge Academy. If you have any questions, please contact me at (254) 710-4683 or my research advisor, Professor Margaret Semrud-Clikeman, Ph.D. at the University of Texas at Austin. Sincerely,

Liz Palacios, M.S. Ed., Doctoral Candidate, School Psychology, UT at Austin

110

Permission Slip I agree to participate in this study on behavior and reading and to allow my son to participate. I understand that it is completely voluntary and I may withdraw from the study at any time. I give Ms. Liz Palacios permission to access my child's school records. I understand that I will have access to the assessment results as well as a summary of the study if I choose to do so.

Son’s Name (please print)

Parent/Guardian's Name (please print)

Phone Number

Parent/Guardian's Signature

Date

PLEASE HAVE YOUR CHILD RETURN THIS FORM IN THE ENCLOSED ENVELOPE TO HIS TEACHER FOR HIS PRIZE. THANK YOU! 111

APPENDIX B Child Assent Form

112

STUDY ON BEHAVIOR AND READING Student Assent Form I agree to be in a study about behavior and reading. I understand that this study has been explained to my parents or guardians and they have given permission for me to participate. As part of the study, I understand that I will meet with the researcher to do some tests involving hearing and repeating single words that will take about 15-20 minutes. I may also be asked to take another test. I understand that my participation is up to me. I may refuse to answer any of the questions at any time. I understand that it's all right if I decide to stop participating in this study at any time. Nobody at my school will be told about what I say or do in this study. As a thank you for my participation, I will receive a small token of appreciation such as candy. Writing my name on this page means that I read this page and that I agree to be in the study. I know what will happen to me. If I decide to quit the study, all I have to do is tell the person in charge. This person’s name is Ms. Liz Palacios and her telephone number is (254) 710-4683.

_____________________________________ Student Participant

__________________ Date

_____________________________________ Researcher

__________________ Date

_____________________________________ __________________ Liz Palacios, M.S.Ed. , Doctoral Student, UT at Austin Date 113

REFERENCES

Aaron, P.G. (1991). Can reading disabilities be diagnosed without using intelligence tests? Journal of Learning Disabilities, 24(3), 178-186. Aaron, P.G., Joshi, M., & Williams, K. A. (1999). Not all reading disabilities are alike. Journal of Learning Disabilities, 32(2), 120-141. American Psychiatric Association (1957). Diagnostic and statistical manual of mental disorders. Washington, DC: American Psychiatric Association. American Psychiatric Association (1968). Diagnostic and statistical manual of mental disorders (2nd ed.). Washington, DC: American Psychiatric Association. American Psychiatric Association (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: American Psychiatric Association. American Psychiatric Association (1987). Diagnostic and statistical manual of mental disorders (3rd Rev.ed.). Washington, DC: American Psychiatric Association. American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association. Anderson, J., Williams, S., McGee, R., & Silva, P. A. (1987). The prevalence of DSM-III disorders in a large sample of pre-adolescent children from the general population. Archives of General Psychiatry, 44, 69-81. August, G. J., & Garfinkel, B. D. (1989). Behavioral and cognitive subtypes of ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 739-748.

114

August, G. J., & Garfinkel, B. D. (1990). Comorbidity of ADHD and reading disability among clinic-referred children. Journal of Abnormal Child Psychology, 18(1) 29-45. Bachara, G. H., & Zaba, J. N. (1978). Learning disabilities and juvenile delinquency. Journal of Learning Disabilities, 11(4), 58-62. Barkley, R. A. (1997). Behavioral inhibition, sustained attention, and executive functions constructing a unifying theory of ADHD. Psychology Bulletin, 121, 65-94. Barkley, R. A. (1998). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (2nd ed.). New York: Guilford Press. Barkley, R. A., DuPaul, G. J., & McMurray, M. B. (1990). Comprehensive evaluation of attention deficit disorder with and without hyperactivity as defined by research criteria. Journal of Consulting and Clinical Psychology, 58(6), 775-789. Beiderman, J., Faraone, T. V., Milberger, S., Jetton, J., Chen, L., Mick, E., et al. (1996). Is childhood oppositional defiant disorder a precursor to adolescent conduct disorder? Findings from a four-year follow-up study of children with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 35(9), 1193-1204. Biederman, J., Newcorn, J., & Sprich, S. (1991). Comorbidity of attention deficit hyperactivity disorder with conduct, depressive, anxiety, and other disorders. American Journal of Psychiatry, 148(5), 564-577. Beitchman, J. H., & Young, A. R. (1997). Learning disorders with a special emphasis on reading disorders: A review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry, 36(8), 10201033. Block, J. (1995). On the relation between IQ, impulsivity, and delinquency: Remarks on the Lynam, Moffitt, and Stouthamer-Loeber (1993) interpretation. Journal of Abnormal Psychology, 103, 328-338. Boetsch, E. A., Green, P. A., & Pennington, B. F. F. (1996). Psychosocial correlates of dyslexia across the lifespan. Development and Psychopathology, 8, 539-562. 115

Bonafina, M. A., Newcorn, J. H, McKay, K. E., Koda, V.H., & Halperin, J. M. (2000). ADHD and reading disabilities: A cluster analytic approach for distinguishing subgroups. Journal of Learning Disabilities, 33(3), 297301. Boudreault, M., Thivierge, J., Cote, R., Boutin, E., Julien, Y., & Bergeron, S. (1988). Cognitive development and reading achievement in pervasive ADD, situational ADD and control children. Journal of Child Psychology and Psychiatry, 29, 611-619. Brier, N. (1989). The relationship between learning disability and delinquency: A review and reappraisal. Journal of Learning Disabilities, 22, 546-553. Broder, P. K., Dunivant, N., Smith, E. C., & Sutton, L. P. (1981). Further observations on the link between learning disabilities and juvenile delinquency. Journal of Educational Psychology, 73, 838-850. Bruck, M. (1985). The adult functioning of children with specific learning disabilities: A Follow-up study. In I. Siegel (Ed.), Advances in applied developmental psychology (pp. 91-129). Norwood, NJ: Ablex. Cadesky, E. B., Mota, V. L., & Schachar, R., J. (2000). Beyond words: How do children with ADHD and/or conduct problems process nonverbal information about affect. Journal of the American Academy of Child & Adolescent Psychiatry, 39(9), 1160-1167. Cantwell, D. P. (1995). Child psychiatry: Introduction and overview. In Kaplan, H. I., & Sadock, B. J. (Eds.), Comprehensive Textbook of Psychiatry/VI. Baltimore: Williams & Wilkins. Cantwell, D. P., & Baker, L. (1991). Association between attention deficit hyperactivity disorder and learning disorder. In S. E. Shaywitz & B. A. Shaywitz (Eds.), Attention deficit disorder comes of age: Toward the twenty-first century. Austin, TX: Pro-ed. Carlson, C., Tamm, L, & Gaub, M. (1997). Gender differences in children with ADHD, ODD, and co-occurring ADHD/ODD identified in a school population. Journal of the American Academy of Child and Adolescent Psychiatry, 36(12), 1706-1715.

116

Cornwall, A. & Bawden, H. N. (1992). Reading disabilities and aggression: A critical review. Journal of Learning Disabilities, 25(5), 281-288. Cronin, M. E. (1996). Life skills curricula for students with learning disabilities: A review of the literature. Journal of Learning Disabilities, 29 (1), 53-68. DuPaul, G. T., Stoner, G. (1994). ADHD in the schools: Assessment and intervention strategies. New York: Guilford. Durrant, J. E., Cunningham, C. E., & Voelker, S. (1990). Academic, social, and general self-concepts of behavioral subgroups of learning disabled children. Journal of Educational Psychology, 82(4), 657-663. Dykman, R. A., & Ackerman, P. T. (1991). ADD and specific reading disability: Separate but often overlapping disorders. Journal of Learning Disabilities, 24, 96-103. Edelbrock, C. S., & Achenbach, T. M. (1984). The teacher version of the Child Behavior Profile: I. Boys aged 6-11. Journal of Consulting and Clinical Psychology, 52, 207-217. Faraone, S. V., Biederman, J., Krifcher Lehman, B., Spencer, T., Norman, D., Seidman, L. J., Kraus, I., Perrin, J., Chen, W. J., & Tsuang, M, T. (1993). Intellectual performance and school failure in children with attention deficit hyperactivity disorder and their siblings. Journal of Abnormal Psychology, 102(4), 616-623. Felton, R. H., & Wood, F. B . (1989). Cognitive deficits in reading disability and attention deficit disorder. Journal of Learning Disabilities, 22, 3-13. Fergusson, D. M., & Horwood, L. (1992). Attention deficit and reading achievement. Journal of Child Psychology and Psychiatry, 33, 375-385. Flynn, J. M., & Rahbar, M. H. (1994). Prevalence of reading failure in boys compared with girls. Psychology Sch, 31, 66-71. Forehand, R., Wierson, M., Frame, C., Kempton, T., & Armistead, L. (1991). Juvenile delinquency entry and persistence: Do attention problems contribute to conduct problems? Development & Experimental Psychiatry, 22(4), 261-264.

117

Frick, P. J., Lahey, B. B., Applegate B. (1994). DSM-IV field trials for the disruptive behavior disorders: Symptom utility estimates. American Academy of Child and Adolescent Psychiatry, 33, 529-539. Frick, P. J., Lahey, B. B., Kamphaus, R. W., Loeber. R., Christ, M.A.G., Hart, E., et al. (1991). Academic underachievement and the disruptive behavior disorders. Journal of Consulting and Clinical Psychology, 59(2), 289-294. Frick, P. J., Lahey, B.B., Loeber, R., Southamer-Loeber, M., Green, S., Hart, E., & Christ, M. A. (1991). Oppositional defiant disorder and conduct disorder in boys: Patterns of behavioral covariation. Journal of Clinical Child Psychology, 20, 202-208. Friend, M., & Bursuck, W. D. (1999). Including students with special needs: A practical guide for classroom teachers. Boston: Allyn & Bacon. Fusaro, J. A. (1992). Meta-Analysis of the effect of sentence-combining on reading comprehension when the criterion measure is the test of reading comprehension. Perceptual & Motor Skill, 74, 331-333. Gilger, J. W. Pennington, B. F., & DeFries, J. C. (1992). A twin study of the etiology of comorbidity: Attention deficit hyperactivity disorder and dyslexia. Journal of American Academy of Child and Adolescent Psychiatry 31, 343-348. Gilliam, J. E. (1995). Attention-deficit/hyperactivity disorder test (ADHDT). Austin, TX: Pro-ed. Grande, C. G. (1988). Delinquency: The learning disabled student’s reaction to academic school failure? Adolescence, 223(89), 209-219. Guab, M., & Carlson, C. L. (1997). Gender differences in ADHD: A metaanalysis and critical review. Journal of American Academy of Child and Adolescent Psychiatry, 36, 1036-1045. Halperin, J. M., Gittelman, R., Klein, D. F., & Rudel, R. G. (1984). Readingdisabled hyperactive children: A distinct group of attention-deficit disorder with hyperactivity. Journal of Abnormal Psychology, 12, 1-14. Hinshaw, S.P. (1987). On the distinction between attentional deficits/ hyperactivity and conduct problems/aggression in child psychopathology. Psychology Bulletin, 101, 443-463. 118

Hinshaw, S.P. (1992). Externalizing behavior problems and academic underachievement in childhood and adolescence: Causal relationships and underlying mechanisms. Psychological Bulletin, 111(1), 127-155. Hinshaw, S. P., Lahey, B. B., & Hart, E. L. (1993). Issues of taxonomy and comorbidity in the development of conduct disorder. Development and Psychopathology, 5, 31-50. Hynd, G. (1992). Neurological aspects of dyslexia: Comment on the balance. Journal of Learning Disabilities, 25, 110-113. Hynd, G. W., Lorys, A. R., Semrud-Clikeman, M., Nieves, N., Huettner, M. I. S., & Lahey, B. B. (1991). Attention deficit disorder without hyperactivity: A distinct behavioral and neurocognitive syndrome. Journal of Child Neurology, 6, S37-S43. Jacobsen, J. J. (1983). Learning disabilities and juvenile delinquency: Where are we today? Journal for Special Educators, 19(2), 65-73. Jorm, A. F., Share, D. L., Matthews, R., & Maclean, R. (1986). Behaviour problems in specific reading retardeded and general reading backward children: A longitudinal study. Journal of Child Psychology and Psychiatry, 27(1), 33-43. Kavale, K. A., & Forness, S. R. (2000). What definitions of learning disability say and don't say. Journal of Learning Disabilities, 22(3), 239. Keilitz, I., & Dunivant, N. (1986). The relationship between learning disability and juvenile delinquency: Current state of knowledge. Remedial and Special Education, 7(3), 18-26. King, C., & Young, R. (1982). Attentional deficits with and without hyperactivity: Teacher and peer perceptions. Journal of Abnormal Child Psychology, 10, 483-496. Kirk, R. E. (1995). Experimental design : Procedures for the behavioral sciences. Pacific Grove, CA : Brooks/Cole. Klorman, R., Hazel-Fernandez, L., Shaywitz, S., Fletcher, J., Marchione, K., Holahan, J., et al. (1999). Executive functioning deficits in attentiondeficit/hyperactivity disorder are independent of oppositional defiant or 119

reading disorder. American Academy of Child and Adolescent Psychiatry, 38(9), 1148-1156. Kuhne, M., Schachar, R., & Tannock, R. (1997). Oppositional defiant: Impact of comorbid oppositional or conduct problems on attention-deficit hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 36(12), 1715-25. Lahey, B. B., & Carlson, C. (1991). Validity of the diagnostic category of attention deficit disorder without hyperactivity: A review of the literature. Journal of Learning Disabilities, 24(2), 110-120. Lahey, B. B., Schaughency, E. A., Hynd, G. W., Carlson, C. L., & Nieves, N. (1987). Attention deficit disorder with and without hyperactivity: Comparison of behavioral characteristics of clinic-referred children. Journal of the American Academy of Child and Adolescent Psychiatry, 26, 718-723. Lahey, B. B., Schaughency, E. A., Strauss, C. C., & Frame, C. L. (1984). Are attention deficit disorders with and without hyperactivity similar or dissimilar disorders? Journal of the American Academy of Child Psychiatry, 23, 302-309. Lambert, N. M., & Sandoval, J. (1980). The prevalence of learning disabilities in a sample of children considered hyperactive. Journal of Abnormal Child Psychology, 8, 33-50. Lane, B. A. (1980). The relationship of learning disabilities to juvenile delinquency: current status. Journal of Learning Disabilities 13(8), 20-29. Larson, K. A. (1988). A research review and alternative hypothesis explaining the link between learning disability and delinquency. Journal of Learning Disabilities, 21(6), 357-369. Light, J. G., Pennington, B. F., Gilger, J. W., Defries, J. C. (1995). Reading disability and hyperactivity disorder: Evidence for common genetic etiology. Developmental Neuropsychology 11, 323-335. Livingston, R. L., Dykman, R. A., & Ackerman, P. T. (1990). The frequency and significance of additional self-reported psychiatric diagnoses in children

120

with attention deficit disorder. Journal of Abnormal Child Psychology, 18, 465-478. Lonigan, C. J., Bloomfield, B. G., Anthony, J. L., Bacon, K. D., Phillips, B. M., & Samwel, C. S. (1999). Relations among emergent literacy skills, behavior problems and social competence in preschool children from low-and middle-income backgrounds. Early Childhood Special Education, 19, 4066. Lundberg, I., Frost, J., & Petersen, O.P. (1988). Effects of an extensive program for stimulating phonological awareness in preschool children. Reading Research Quarterly, 23(3) 263-284. Lynam, D., Moffitt, T. E., & Stouthamer-Louber, M. (1993). Explaining the relation between IQ and delinquency: Class, race, test motivation, school failure, or self-control? Journal of Abnormal Pscychology, 102, 197-96. Marshall, C. M., Snowling, M. J., & Bailey, P. J. (2001). Rapid auditory processing and phonological ability in normal readers and readers with dyslexia. Journal of Speech, Language, and Hearing Research, 44(4), 925-939. Mastropieri, M. A., & Scruggs, T. E. (2000). The inclusive classroom: Strategies for effective instruction. Upper Saddle River, NJ: Merrill/Prentice-Hall, Inc. Mateir, K., Halperin, J. M., Sharma, V., Newcorn, J. H., & Sathaye, N. (1992). Methylphenidate response in aggressive and nonaggressive ADHD children: Distinctions on laboratory measure of symptoms. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 219-225. Mayes, S. D., Calhoun, S. L., & Crowell, E. W. (2000). Learning disabilities and ADHD: Overlapping spectrum disorders. Journal of Learning Disabilities, 33(5), 417-424. McBride-Chang, C. (1995). What is phonological awareness? Journal of Educational Psychology, 87(2), 179-192. McGee, R., Feehan, M., Williams, S., Partridge, E., Silva, P. A., & Kelly, J. (1990). DSM-III disorders in a large sample of adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 611-61 121

McGee, R., & Share, D. L. (1988). Attention deficit disorder-hyperactivity and academic failure: Which comes first and what should be treated? Journal of the American Academy of Child and Adolescent Psychiatry, 27, 318325. McGee, R., Share, D., Moffitt, T. E., Williams, S., & Silva, P. A. (1988). Reading disability, behaviour problems and juvenile delinquency. In D. Saklofske & S. Eysenck (Eds.), Individual differences in children and adolescents: International research perspective (pp.158-172). London: Hodder & Stoughton. McGee, R., Williams, S., Moffitt, T., & Anderson, J. (1989). A comparison of 13year-old boys with attention deficit and/or reading disorder on neuropsychological measures. Journal of Abnormal Child Psychology, 17(1), 37-53. McGee, R., Williams, S., Share, D., Anderson, J., & Silva, P. (1986). The relationship between specific reading retardation, general reading backwardness and behavioural problems in a large sample of Dunedin boys: A longitudinal study from five to eleven years. Journal of Child Psychology and Psychiatry, 27(5), 597-610. McLeskey, J. (1992). Students with learning disabilities at primary, intermediate, and secondary grade levels: Identification and characteristics. Learning Disability Quarterly, 15(1), 13-19. McWhirter, J. J., McWhirter, B. T., McWhirter, A. M., & McWhirter, E. H. (1998). At-risk youth: A comprehensive response for counselolrs, teachers, psychologists, and human service professionals. Pacific Grove: Brooks/Cole Publishing Company. Moffit, T. E., (1993). “Life-course-persistent” and “adolescent-limited” antisocial behavior: A developmental taxonomy. Psychology Review, 100, 679-701. Moffit, T. E., & Henry, B. (1989). Neuropsychological assessment of executive functions in self-reported delinquents. Development and Psychopathology, 1, 105-118. Morgan, A. E., Hynd, G. W., Riccio, C. A., & Hall, J. (1996). Validity of 'DSMIV' ADHD predominantly inattentive and combined types: Relationship to

122

previous 'DSM' diagnoses/subtype differences. Journal of the American Academy of Child and Adolescent Psychiatry, 35(3), 325-334. Neville, D. D., & Searls, E. F. (1985). The effect of sentence-combining and kernel-identification training of the syntactic component of reading comprehension. Research in the Teaching of English, 19, 37-61. Nigg, J. T., Hinshaw, S. P., Carte, E. T., & Treuting, J. J. (1998). Neuropsychological correlates of childhood attention-deficit/hyperactivity disorder: Explainable by comorbid disruptive behavior or reading problems? Journal of Abnormal Psychology, 107(3), 468-481. Paternite, C., Loney, J., & Roberts, M. (1995). External validation of oppositional disorder and attention deficit disorder with hyperactivity. Journal of Abnormal Child Psychology, 23(4), 453-472. Pennington, B. F. (1991 Diagnosing learning disabilities. New York: Guilford Press. Pennington, B. F. (1997). Dimensions of executive functions in normal and abnormal development. In N. Krasnegor, R. J. Lyon, & P. Goldman-Rakic (Eds.), Development of the prefrontal cortex: Evolution, neurobiology, and behavior (pp. 265-281). Baltimore: Brookes. Pennington, B. F., Groisser, D., & Welsh, M. (1993). Contrasting cognitive deficits in attention deficit hyperactivity disorder versus reading disability. Developmental Psychology, 29(3), 511-523. Pennington, B. F., & Ozonoff, S. (1996). Executive functions and developmental psychopathology. Journal of Child Psychology and Psychiatry, 37, 51-87. Pisecco, S., Baker, D. B., Silva, P. A., & Brooke, M. (1996). Behavioral distinctions in children with reading disabilities and/or ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 35(11), 14771478. Pisecco, S., Baker, D. B., Silva, P. A., & Brooke, M. (2001). Boys with reading disabilities and/or ADHD: Distinctions in early childhood. Journal of Learning Disabilities, 34(2), 98-106. Prior, M., & Sanson, A. (1986). Attention deficit disorder with hyperactivity: A critique. Journal of Child Psychology and Psychiatry, 27, 307-319. 123

Purvis, K. L., & Tannock, R. (2000). Phonological processing, not inhibitory control, differentiates ADHD and reading disability. Journal of the American Academy of Child and Adolescent Psychiatry, 39(4), 485-494. Reynolds, C. R., & Kamphaus, R. W. (1998). Behavior Assessment System for Children (BASC). Circle Pines, MN: American Guidance Service. Richek, M. A., Caldwell, J. S., Jennings, J. H., & Lerner, J. W. (2002). Reading problems: Assessment and teaching strategies (4th ed.). Boston: Allyn & Bacon. Richman, N., Stevenson, J., & Graham, P., (1982). Preschool to school: A behavioural study. San Diego, CA: Academic Press. Robins, P. M. (1992). A comparison of behavioral and attentional functioning in children diagnosed as hyperactive or learning-disabled. Journal of Abnormal Child Psychology, 20, 65-82. Rourke, B. P. (1989). Nonverbal learning disabilities: The syndrome and the model. New York: Guilford Press. Rutter, M. (1974). Emotional disorder and educational underachievement. Archives of Disease in Childhood, 49, 249-256. Rutter, M. (1989). Isle of Wright revisited: Twenty-five years of child psychiatric epidemiology. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 633-653. Schachar, R., & Tannock, R. (1995). Test of four hypotheses for the comorbidity of attention-deficit hyperactivity disorder and conduct disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 34(5), 639649. Semrud-Clikeman, M., Biederman, J., Sprich-Buckminster, S., Lehman, B. K., Faraone, S. V., & Norman, D. (1992). Comorbidity between ADDH and learning disability: A review and report in a clinically referred sample Journal of the American Academy of Child and Adolescent Psychiatry, 31(3), 439-447. Semrud-Clikeman, M., & Hynd, G. (1991). Review of issues and measures in childhood depression. School Psychology International, 12, 275-298. 124

Shallice, T. (1988). From neuropsychology to mental structure. Cambridge, England: Cambridge University Press. Shaywitz, B. A., Fletcher, J. M., & Shaywitz, S. E. (1995). Defining and classifying learning disabilities and attention-deficit/hyperactivity disorder. Journal of Child Neurology, 10, 50-57. Shaywitz, S. E., Fletcher, J. M., Holahan, J. M., Shneider, A. E., Marchione, K. E., Stuebing, K. K., Francis, D. J., Pugh, K. R., & Shaywitz, B. A. (1999). Persistence of dyslexia: The Connecticut longitudinal study at adolescence. Pediatrics, 104(6), 1351-1361. Shaywitz, S. E., & Shaywitz, B. A. (1993). Learning disabilities and attention deficits in the school setting. In Lynn J. Meltzer (Ed.), Strategy assessment and instruction for student with learning disabilities: From theory to practice (pp. 221-245). Austin, TX:PRO-ED. Shaywitz, S. E., Shaywitz, B. A., Fletcher, J. M., & Escobar, M. D. (1990). Prevalence of reading disability in boys and girls. Journal of the American Medical Association, 264, 998-1002. Siegel, L. S., & Ryan, E. B. (1988). Development of grammatical-sensitivity, phonological, and short-term memory skills in normally achieving and learning disabled children. Developmental Psychology, 24(1), 28-37. Smart, D., Swanson, A., & Prior, M. (1996). Connections between reading disability and behavior problems: Testing temporal and causal hypotheses. Journal of Abnormal Child Psychology, 24(3), 363-384. Smith, E., & Luckasson, R. (1995). Introduction to special education: Teaching in an age of challenge. Boston, MA: Allyn & Bacon. Stanovich, K. E. (1986). Matthew effects in reading: Some consequences of individual differences in the acquisition of literacy. Reading Research Quarterly, 21, 360-406. Stanovich, K. E. (1999). The sociopsychometrics of learning disabilities. Journal of Learning Disabilities, 32(4), 350-361. Stanovich, K. E., & Siegel, L. S. (1994). Phenotypic performance profile of children with reading disabilities: A regression-based test of the 125

phonological-core variable-difference model. Journal of Education Psychology, 86(1), 24-53. Stewart, M. A., Cummings, C., Singer, S., & DeBlois, C.S. (1981). The overlap between hyperactive, and unsocialized aggressive children. Journal of Child Psychology and Psychiatry, 22, 35-45. Szatmari, P., Boyle, M., & Offord, D. (1989). ADHD and conduct disorder: Degree of diagnostic overlap and differences among correlates. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 865-872. Tannock, R., & Schachar, R. (1996). Executive dysfunction as an underlying mechanism of behavior and language problems in attention deficit hyperactivity disorder. In Beitchman, J. H., Cohen, N. J., Konstantatareas, M. M., & Tannock, R. (Eds.), Language, Learning and Behavior Disorders: Developmental, Biological, and Clinical Perspectives. New York: Cambridge University Press. Vaughn, S., Bos, C., & Schumm, J. S. (2000). Teaching exceptional, diverse, and at-risk students in the general education classroom. Boston: Allyn & Bacon. Wadsworth, S., DeFries, J., Stevenson, J., Gilger, J., & Pennington, B. (1992). Gender ratios among reading-disabled children and their siblings as a function of parental impairment. Journal of Child Psychology and Psychiatry, 7, 1229-1239. Wagner, R., K., & Torgesen, J. K. (1987). The nature of phonological processing and its causal role in the acquisition of reading skills. Psychological Bulletin, 101(2), 192-212. Waldie, K., & Spreen, O. (1993). The relationship between learning disabilities and persisting delinquency. Journal of Learning Disabilities, 26, 417-423. Wechsler, D. (1999). Wechsler Abbreviated Scale of Intelligence. San Antonio, TX: Psychological Corporation. Wenz-Gross, M., & Siperstein, G. N. (1997). Importance of social support in the adjustment of children with learning problems. Exceptional Children, 63(2), 183-194.

126

Willcutt, E. G., & Pennington, B. F. (2000). Comorbidity of reading disability and attention-deficit/hyperactivity disorder: Differences by gender and subtype. Journal of Learning Disabilities, 33(2), 179. Williams, S., Anderson, J., McGee, R., & Silva, P. A. (1990). Risk factors for behavioral and emotional disorder in preadolescent children. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 413-419. Williams, S., & McGee, R. (1994). Reading attainment and juvenile delinquency. Journal of Child Psychology and Psychiatry, 35(3), 441-459. Woodcock, R. W., & Johnson, M. B. (1989, 1990a). Woodcock-Johnson PsychoEducational Battery-Revised: Tests of Achievement. Itasca, IL: Riverside. Woodcock, R. W., & Johnson, M. B. (1989, 1990b). Woodcock-Johnson PsychoEducational Battery-Revised: Tests of Cognitive Ability. Itasca, IL: Riverside. Zimmerman, J., Rich, W. D., Keilitz, I., & Broder, P. K. (1981). Some observations on the link between learning disabilities and juvenile delinquency. Journal of Criminal Justice, 9, 1-17.

127

VITA Elizabeth Diane Palacios, daughter of Edward Gonzalez and Minerva Gonzalez, was born in San Antonio, Texas. Elizabeth graduated from Harlandale High School in 1976 and attended San Antonio College during the following summer. In the fall of 1976, she entered Baylor University in Waco, Texas, and received the degree of Bachelor of Arts in Business Administration in 1980. Elizabeth married Robert Palacios in 1979, and has two sons, René and Aaron, and a daughter, Michelle. Elizabeth served as the Assistant to the Dean of Graduate Studies and Research/Coordinator for Graduate Minority Recruitment at Baylor University from 1981-1991. She transferred to the Department of Student Activities where she coordinated community service in the Waco community for the following five years. Elizabeth completed her Master of Science in Education in the Student Personnel Services in Higher Education and Licensed Professional Counseling programs through the Department of Educational Psychology at Baylor University in 1991. In the fall of 1995, she was admitted to the University of Texas at Austin to pursue a degree of Doctor of Philosophy in the School Psychology program. From 1995 to the present, Elizabeth has been a lecturer at Baylor University in the Department of Educational Psychology as well as a consultant for educational programs in the Waco area schools.

Permanent Address: 157 Nogal Lane, Waco, Texas, 76706 This dissertation was typed by the author.

128