Examining the Co-morbidity of Behavioral Problems and Reading Difficulties
Among Elementary School Children RESULTS: Continued
INTRODUCTION
Current research on the co-morbidity of reading disabilities and behavioral problems is surprisingly
sparse. Studies have shown that trouble with reading often goes hand in hand with Attention
Deficit Hyperactivity Disorder, oppositional behavior, juvenile delinquency, and anxiety. However,
little is known about the prevalence of specific problem behaviors among poor readers.
The Conners’ Teacher Rating Scale – Revised (CTRS-S) is widely used in the diagnosis of ADHD
and other problem behaviors in school children (Conners, 1997). The CTRS-S rates the incidence
of specific problem behaviors thought to interfere with learning. This study seeks to determine
whether struggling readers who exhibit specific behaviors show different literacy profiles than
struggling readers who do not show specific behavioral problems.
A. Wechsler1, M. Pierce2, T. Katzir2, M. Wolf3, G. Noam1
McLean Hospital, 2Harvard University, 3Tufts University
1
Figure 5. Means on literacy measures* for groups with elevated and non-elevated scores on the
Anxious / Shy Dimension of the CTRS-S.
RESULTS: One-way ANOVA
100
90
Oppositional Behaviors
The literacy profiles of children with elevated T scores for Oppositional behaviors were not
significantly different from the literacy profiles of children without elevated T scores.
80
70
1. What is the prevalence of specific problem behaviors among at-risk readers who exhibit
maladaptive behaviors in the classroom?
2. Do struggling readers who exhibit problem behaviors in school show different literacy
profiles than struggling readers who do not exhibit problem behaviors?
90
80
Cog E
Cog N
60
50
4%
12%
1%
49%
GORTcmp
4%
GORTrt
GORTacc
White
MforD
Native Hawaiian
or Other Pacific Is.
Elision
PPVT
Black or African
American
WordR
PIAT
Asian
WordAtk
American Indian
of Alaska Native
WordID
PDE
Table 1. Percentage of children identified by parents as belonging to race categories
40
SWE
• 140 second and third graders who attended afterschool programs in two metropolitan U.S. cities
• Selection criteria: 2/3 or more SD below the mean on a subtest or composite of the Test of Word
Reading Efficiency (TOWRE); a T score more than one SD above the mean (>60) on one or
more indexes of the CTRS-S
• Subjects come from primarily low SES families
• 60% identified as Hispanic/Latino; 40% identified as Non-Hispanic/Latino
40
100
70
PARTICIPANTS
50
Cognitive Problems / Inattention
Students with elevated T scores for Cognitive Problems / Inattention performed significantly lower
than their non-elevated counterparts on:
• Timed word reading (TOWRE-SWE) [F(1,138)=14.0, p=.000]
• Untimed word reading (WRMT-Word ID) [F(1,138)=8.8, p=.004]
• Timed non-word reading (TOWRE-PDE) [F(1,138)=8.2, p=.005]
• Elision (CTOPP) [F(1,138)=4.9, p=.029]
• Passage comprehension (GORT) [F(1,138)=9.6, p=.002]
Anxious / Shy
Students with elevated T scores for Anxious / Shy performed significantly lower than non-elevated
counterparts on:
• Receptive Vocabulary (PPVT) [F(1,137)=9.3, p=.003]
• Expressive Vocabulary (Word-R) [F(1,137)=16.2, p=.000]
• Memory for Digits (CTOPP) [F(1,137)=4.5, p=.035]
• Untimed word reading (WRMT-Word ID) [F(1,137)=4.1, p=.045]
Figure 6. Means on literacy measures* for groups with elevated and non-elevated scores on the
Social Problems Dimension of the CTRS-S.
100
90
80
70
Other
English and
Spanish Equally
English and
Other Equally
35%
11%
5%
1%
Other languages: Portuguese, Vietnamese, Cambodian, Armenian, Russian, Swahili, Tagalog
90
70
50
Prevalence
GORTcmp
GORTrt
GORTacc
MforD
Elision
PPVT
WordR
60
46
87
Figure 4. Means on literacy measures* for groups with elevated and non-elevated scores on the
Conners’ ADHD Index of the CTRS-S.
51
53
90
82
A one-way between-groups ANOVA compared mean performance on literacy measures of children
with elevated scores on each CTRS-S dimension to children with average scores on each
dimension.
• Students with elevated T scores for Cognitive Problems / Inattention, Hyperactivity and ADHD
showed similar reading profiles, performing lower than non-elevated counterparts on real word
reading tasks and passage comprehension.
• In addition, students with elevated T scores for Cognitive Problems / Inattention performed
significantly lower than non-elevated counterparts on timed phonemic decoding and Elision.
• Students with elevated T scores for Anxious / Shy performed significantly lower than nonelevated counterparts on receptive and expressive vocabulary, Memory for Digits, and untimed
word reading.
• Students with elevated T scores for Social Problems performed significantly lower than nonelevated counterparts only on expressive vocabulary.
80
57
42
32
Elevated
70
Non
Elevated
60
ADHD E
ADHD N
50
20
Social Problems
Anxious / Shy
Conners' ADHD
Index
Hyperactivity
Cognitive
Problems /
Inattention
Deficit Group
Prevalence
• The most prevalent behavior problem reported was Cognitive Problems / Inattention
• 41% of children exhibited Anxious / Shy behaviors
• The fewest children showed Oppositional behaviors, representing only 23% of the sample
GORTcmp
GORTrt
GORTacc
MforD
Elision
PPVT
WordR
PIAT
WordAtk
WordID
PDE
SWE
40
Oppositional
0
PIAT
89
40
WordAtk
98
96
80
Social Problems
Students with elevated T scores for Social Problems performed significantly lower than nonelevated counterparts on:
• Expressive Vocabulary (Word-R) [F(1,138)=5.2, p=.024]
SUMMARY
Hyperactivity
Students with elevated T scores for Hyperactivity performed significantly lower than non-elevated
counterparts on:
• Timed Word Reading (TOWRE-SWE) [F(1,138)=5.2, p=.024]
• Untimed Word Reading (WRMT-Word ID) [F(1,138)=6.2, p=.014]
• Passage Comprehension (GORT) [F(1,138)=12.0, p=.001]
100
108
100
WordID
120
PDE
Figure 1. Number of subjects exhibiting elevated and non-elevated scores on the CTRS-S.
SWE
40
RESULTS: Prevalence of Problem Behaviors
.
Hyp E
Hyp N
60
• Conners’ Teacher Rating Scale – Revised (CTRS-S, 1997)
• Test of Word Reading Efficiency (TOWRE, 1999)
• Comprehensive Test of Phonological Processing (CTOPP, 1999)
• Peabody Individual Achievement Test (PIAT, 1989): Spelling Subtest
• The Woodcock Reading Mastery Test (WRMT, 1998)
• Gray Oral Reading Test, 4th Ed. (GORT, 2001)
• The Peabody Picture Vocabulary Test, Third Edition (PPVT-III, 1997)
• The Word-R (1990)
40
100
80
MEASURES
50
Figure 3. Means on literacy measures* for groups with elevated and non-elevated scores on the
Hyperactivity Dimension of the CTRS-S.
GORTcmp
GORTrt
GORTacc
MforD
Elision
PPVT
WordR
PIAT
WordAtk
WordID
PDE
SWE
Spanish
49%
Soc E
Soc N
60
Table 2. Percentage of children identified by parents as belonging to first language categories
English
GORTcmp
GORTrt
GORTacc
MforD
Elision
PPVT
WordR
PIAT
WordAtk
WordID
PDE
SWE
RESEARCH QUESTIONS
Anx E
Anx N
60
Figure 2. Means on literacy measures* for groups with elevated and non-elevated scores on the
Cognitive Problems / Inattention Dimension of the CTRS-S.
*The scaled scores for GORT and CTOPP were multiplied by 10.
Conners’ ADHD Index
Students with elevated T scores for Conners’ ADHD performed significantly lower than nonelevated counterparts on:
• Timed Word Reading (TOWRE-SWE) [F(1,138)=3.9, p=.050]
• Untimed Word Reading (WRMT-Word ID) [F(1,138)=5.6, p=.019]
• Passage Comprehension (GORT) [F(1,138)=6.7, p=.01]
CONCLUSIONS
These results indicate that the types of behavioral problems a child exhibits may be related to their
specific strengths and weaknesses on literacy tasks. Specifically, students who display inattentive
and anxious behaviors may have greater difficulty on tasks requiring extended attention and
strategic mental searching. These results also suggest that children who struggle with expressive
language skills may be more likely to exhibit anxious behaviors and social problems. Finally, these
results suggest that teachers are more likely to rate children as exhibiting cognitive and attentive
difficulties if they show deficits in word reading and passage reading rate and accuracy.
Email: wechsler@post.harvard.edu