Characteristics and Types of Attention Deficit Hyperactivity Disorder (ADHD)
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According to the Centers for Disease Control and Prevention (CDC), about one-half of 1.6 million elementary school-aged children diagnosed with attention deficit/hyperactivity disorder (ADHD) have also been diagnosed with a learning disability (LD) (Brown University Child and Adolescence Behavior Letter, 2001). The American Speech-Language-Hearing Association (1997) stated that ADHD affects 3 to 5 percent of all children, and boys are three times more likely to be affected by the disorder than girls. The cause of ADHD is unknown, and the disorder and its symptoms are chronic and pervasive (www.asha.org). In the Fourth Edition of the Diagnostic and Statistical Manual ADHD is categorized into three subtypes which are ADHD Predominantly Inattention Type, ADHD Predominantly Hyperactivity-Impulsive Type, and ADHD Combined Type.
The criteria for the ADHD predominantly inattention type include at least six of the following:
Makes careless mistakes in schoolwork, often has difficulty sustaining attention in tasks or play activities, often does not seem to listen when spoke to directly, often does not follow through on instructions and fails to finish schoolwork, often has difficulty organizing tasks and activities, often avoids, dislikes, or engages in tasks that require sustained mental effort, is often easily distracted by external stimuli, and is often forgetful in daily activities.
The criteria for ADHD predominantly hyperactivity-impulsive type includes a minimum of six or more of the following:
Often fidgets with hands or feet and squirms in seat, often leaves seat in classroom, often runs about or climbs excessively in situations in which it is inappropriate, often has difficulty playing or engaging in leisure activities quietly, is often on the go, often talks excessively, often blurts out answers before the question have been completed, often has difficulty awaiting turn,and often interrupts others.
The ADHD combined type demonstrates characterisitics from both subtypes (Camarata & Gibson, 1999).
Inattention, hyperactivity, and impulsivity have their effects on speech and language. McGee, Share, Moffitt, Williams, and Silva (1998) research suggested that the presence of a disruptive behavioral disorder is the most common long-term association with reading difficulties (Pisecco, Baker, Silva, & Brooke, 2001). The research examined by Ricco and Jemison (1998) stated that children with both reading disabilities and ADHD may have phonological processing deficits and linguistic deficiencies that are predictive of reading disabilities (Maynard, Tyler, & Arnold, 1999). The same study (1998) by Ricco and Jemison concluded that acquisition and the development of reading skills are affected by language and verbal abilities rather than the presence of an attention deficit.
Ricco and Jemison provided evidence in their research that the strongest cause of reading problems in children with ADD was the characteristics of specific language impairment.
Dupal and Stoner’s research (1993) proposed that ADHD leads to the manifestation of reading difficulties, while McGee and Share (1988) suggested that reading disorders lead to the development of ADHD behaviors (Pisecco et al., 2001). The research of Pennington, Grossier, and Welsh (1993) compared and contrasted groups children with only reading disabilities, only ADHD, ADHD and reading disabilities, and control groups on phonological processing and executive functioning measures. On phonological processing measures the group with only RD performed worse than the group with only ADHD. The ADHD only group performed worse on executive functioning measures than the RD only group. On measures of phonological processing and executive functioning the RD/ADHD group scored similarly to the group with only ADHD. Pennington et al. concluded that “reading disorders may cause symptoms of ADHD to manifest without the development of the full syndrome (Pisecco et al., 2001)."
Pisecco et al.’s study investigated expressive and receptive language and temperament in early childhood. A study by Purvis and Tannock (1997) stated that children with reading disabilities have problems with language at the semantic level. On the other hand, children with ADHD experience problems with the organizational tasks of language (Pisecco et al., 2001). Pisecco et al.'s data revealed that both the groups with only RD and the RD/ADHD groups scored lower on receptive language than the comparison group. On expressive language, the group with only RD and the RD/ADHD groups both scored significantly lower than the comparison group. Overall, academic difficulties are highly predictive in children when early language deficits are present with reading difficulties.
The research of Javorsky (1996) examined phonics and syntax in ADHD groups, ADHD/language learning disability (LLD) groups, and LLD groups. On measures of phonology and syntax, the ADHD group did differ from the ADHD/LLD group, but the ADHD/LLD and the LLD groups demonstrated no significant differences. The ADHD/LLD group was significantly different from the ADHD group on language measures. Javorsky's study concluded that the language strucutre of ADHD/LLD and
LLD are more alike than the ADHD group.
The main finding in a study conducted by Marshall and Hynd (1997) was math achievement differences among the two subtypes. Children with ADD without hyperactivity scored significantly lower in mathematics than children with ADHD.
Likewise, Carlson, Lahey, and Neeper (1986) and Hynd, Lorys, Semurud, Nieves, Huettner, and Lahey (1991) both reported the same findings. Students with ADD without
hyperactivity performed more poorly than students with ADHD. Dykman and Ackerman reported both students with ADHD and students ADD without hyperactivity demonstrated increased rates of reading disabilities (RD) and math disabilities (MD).
Students with ADD without hyperactivity revealed more MD than students with ADHD.
The Kaufman Test of Educational Achievement (KTEA; Kaufamn & Kaufman,1985) was given to 4 groups of children that measured reading decoding, reading
comprehension, spelling, and arithmetic computation. The groups consisted of ADHD LI (Language Impairment), ADHD, OPD (Other Psychiatric Disorder) LI, and OPD. The results revealed that children in the ADHD LI and the OPD LI groups had poorer
language skills than children in the ADHD and OPD groups. Also, the ADHD LI RD group exhibited the poorest pragmatic skills compared to the other groups. Although low achievement is closely associated with both ADHD and LI, LI accounts for a larger part of variance in achievement. While children with ADHD do have problems with working memory, they did not perform as poorly as children with LI. While there is no evidence that ADHD and LI is a unique group, they are at greater risk because they demonstrate deficits associated with both disorders. Narrative discourse is associated with LI, whether there is a reading disability present. It is important to realize that there is an overlap between structural language and pragmatic abilities. Overall, results indicated that children with LI were at the most disadvantage regardless of the psychiatric diagnosis (Cohen,Vallance, Barwick, Im, Menna, Horodezky, & Isaacson, 2000).
The data of Brown (1986) analyzed teacher ratings of children with ADD and/or ADHD. When teachers compared the two subtypes teachers rated children with ADHD more problematic than children with ADD. Teachers were also able to distinguish
between children with ADD and children with ADHD (Brown, 1986).
The study of Prater investigated the effects of self-monitoring of academic performance and on-task behaviors on children with both learning disabilites (LD) and ADD/ADHD. The students self-monitored and self-graphed their academic perfomance on reading comprehension, mathematics, and written expression. When self-monitored the students scored above 90 percent for productivity scores for reading comprehension
and mathematics. While self-monitoring assignments during independent practice, the students completed more of their assignments. Students performed relatively better in
mathematics than in the other academic areas. The students on-task behaviors improved across all academic areas. Overall, self-monitoring improved academic productivity and
accuracy as well as on-task behaviors (Prater, 1999).