Gifted Issues Discussion homepage Forums Twice Exceptional How does ADHD impact reading? Any experts?

I'm about to delve into the research, but I know this site is full of expert parents advocating for their twice exceptional learners. So I thought I'd ask here…

I'd like to take my research to the district because they keep telling us to "have her read 20 minutes a day" and she'll catch up. Sorry, that hasn't been working for years.

Lindamood-Bell is the only thing that worked and we don't want to continue to pay for that service out of pocket. I'm hunting for evidence that she has a learning disability that explains why Lindamood-Bell is the intervention that works.

A recent learning disability evaluation from the district showed "attention" problems, but DD7 did not meet criteria for a learning disability because she scored in the average range.

So off I go to explore the research on ADHD and reading, but any direction from someone who has been down this road already would be greatly appreciated. Thank you ~

Here a kid could qualify for an IEP for ADHD if their learning is being significantly affected by it. And once you have the IEP, services in various areas are possible (like reading). An advocate told me to look at other disability categories than SLD because they may be more flexible about what constitutes not making academic progress. Here they would put ADHD in the "Other Health Impairments" category. You would need an ADHD medical diagnosis though. ADHD can affect processing speed and therefore fluency in various area, like math, writing, and reading fluency. Did she take the WISC and get a low processing speed score? You can make the argument that the processing/attentional issues are directly related to her reading. DD has what I would consider fairly severe ADHD and her math and writing fluency are affected but not reading fluency for whatever reason. She is always very quick and focused when reading, but not while doing other things. Anyway, not sure if that answers your questions or not...

blackcat, thank you!

DD7 didn't qualify for an OHI :-(
On her WISC-IV her processing speed was 23rd percentile. Her VCI and PRI were high, so there was a huge gap… but… no one is diagnosing her with a reading disability yet.

She does have a medical dx of ADHD - that is strong and clear and "impressively so" according to her team of UCLA pediatricians. Although female, DD7 has hyperactive/impulsive type and can focus her mind and her ears and is organized, but cannot concentrate her eyes very well. It actually seems like it's a motor issue with keeping her eyes on the page.

This showed up with her Woodcock Johnson test when she kept making simple errors on the math portion, switching addition and subtraction symbols, but solving higher order math problems easily. She also skipped over 10 questions at a time, getting all 10 "wrong," which figured into her score. Ah, me.

I did find this Johns Hopkins research:

The Effects of ADHD (Beyond Decoding Accuracy) on Reading Fluency and Comprehension

Dr. E. Mark Mahone, Ph.D., ABPP
Director of Neuropsychology at the Kennedy Krieger Institute, Baltimore, Maryland
Associate Professor of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine

http://education.jhu.edu/PD/newhorizons/Journals/Winter2011/Mahone

seablue,

I really know absolutely nothing about the impact of ADHD on reading, but have a few random thoughts for you -

First, if her eyes are "skipping around" when she reads, I'd suggest a developmental optometrist evaluation if you haven't already had one. This sounds so much like a tracking issue - and if she is having difficulty with focus or tracking then that could be the reason her processing speed subtest scores are so low on the WISC, and why she seems to skip over questions when doing math etc. This is not the type of issue that a regular optometrist would check for (it's related to how the eyes work together, not to the actual vision in each eye independent of the other).

"I'd like to take my research to the district because they keep telling us to "have her read 20 minutes a day" and she'll catch up. Sorry, that hasn't been working for years. "

Which type of "catching up" are you asking about? Catching up as in progressing with reading ability, or catching up on knowledge she's losing out or falling behind on because she can't keep up with reading? (Both are extremely important!)

What do the Lindamood Bell tutors think your dd needs going forward? More LB? How much longer? How intense and how long has your dd already been in LB? She obviously made progress, but did she progress as quickly as originally expected? Have you tried whatever reading program the school district is offering, and if not, what are the reasons you'd expect it not to be helpful? If your dd has been through it before and she didn't make progress, what did happen? Those are things that I would want to try to have a good handle on understanding in making a decision about "what's next".

Re advocating at school, I would not put the focus so much on what the disability is and how it impacts your dd, I'd try to focus on demonstrating that there is an impact. I'm not saying that understanding why she's having difficulty isn't important - it is really important! But the school wants to see how she's impacted academically more than they want to be reading research evidence of how ADHD specifically impacts ability to read etc.

I am sure you've spent so much time with her that you see obvious issues with her reading - but to advocate it would be helpful to somehow try to quantify what you are seeing. I'm also curious what types of specific reading assessments she's had through LB (or through other providers). I have a 2e dd who struggles tremendously with reading, but many of her reading assessment categories test out as squarely average and don't appear to be anything to worry about. There's one specific issue that impacts her, and you basically have to run the "right" set of subtests/tests to have that extremely low # pop up.

In the meantime, while you try to sort through how to deal with school, I'd recommend having your dd listen to audiobooks - at her intellectual/cognitive level, not only at the level she's reading at currently. That way you can help prevent her from falling behind in vocabulary acquisition and you can keep her brain stimulated

Also, fwiw, if you ultimately find out it's a vision issue and you're able to remediate/correct it, I suspect your dd will catch up quickly with reading skills - that's what happened with our dd who has a vision challenge - she went from being about 2 grade levels behind to being way ahead of grade level in no time at all without any specific reading instruction or intervention - just getting her eyesight issues corrected was the key.

Best wishes,

polarbear

Thanks, polar bear! To answer some of your questions, so is falling behind on keeping up with progressing her reading. She blew her LB goals out of the water: their intervention worked beautifully. That's why I tend to think it's not eyesight, but more likely dyslexia. Of course I could be completely wrong.

I don't completely understand what you mean about approaching the district. Although I understand the importance of bringing up the challenges my daughter faces, so far that is met with "gee, that sounds frustrating, but our tests show she's not eligible for services." The LB tutoring (4 hours/day, 5 days/week for the month just prior to school starting) catapulted her into the normal range.

So I want to bring them more evidence that there is a relationship between ADHD and reading disability, so they will help me document whatever needs to be documented to provide DD7 services. The special ed teacher totally gets it, but the rest of the staff doesn't believe she has any reading issues.

I await the final written report from LB...

The final written report from LB should help!

"Although I understand the importance of bringing up the challenges my daughter faces, so far that is met with 'gee, that sounds frustrating, but our tests show she's not eligible for services.' "

The rules set out for minimum bars to fall under etc in terms of numbers are supposed to be interpreted as *suggestions* - not hard and fast rules that prevent kids from receiving services. I totally understand where the district is probably coming from re this in terms of good intentions, and I've also seen how a school district can use this as a way of running over a parent by making them think they can't advocate past a specific set of policy guidelines to get services. The way the system is supposed to work is that the decision is a *team* decision - and if you've got a sped teacher who agrees that your dd should be receiving help, you've got a great start toward your goal of receiving services through the district.

I don't know how you'd' go about convincing them that LB is the only way to go re remediation though - my guess is that if the remediation came through a LB center, they are going to see a report advocating more work as potentially biased. Did a psych who evaluated your dd originally recommend the LB? If it was written in a psych report it would be useful in advocating. LB worked well for my dd who has a reading challenge too - but she didn't go through a LB-only center, she worked with a reading tutor center that had several different approaches and picked programs based on individual student needs. I can potentially see the district arguing that any program might work if a child is attending 4 hours/day 5 days/week for a full month (just playing devil's advocate here… that's how I always approached my advocacy - thinking through every danged argument the school could throw at us!).

Anyway, I'd still consider looking into the vision - or at least ask the LB tutor if your dd's eyes still appear to jump around when focusing on reading. Or can you see it? If you can see it, I'd run screaming to a DO! But that's just me It doesn't mean she's not dyslexic, just means that there might be potentially something that would help in addition to her LB/etc work. Our school district has actually paid for DO work for one of the kids I knew back in elementary - but she also had a grandmother who was a special ed teacher and really knew how to navigate around the school district's brick walls.

polarbear

seablue, did your DD not qualify under OHI because the team (which includes the parents) decided that she does not need SPED services? Without IEP, at the moment, I can't really think of a way to get a school district to pay for outside services. (Even with an IEP, it may be a big challenge to make that happen but at least it is possible).

Well there is a known tendency toward co-morbidity of ADHD with other issues (dyslexia, other specific LDs and tourettes being things that immediately come to mind). So yes there IS a known connection.

Is your daughter taking medication for her ADHD? Medication had a profound impact on my DDs ability to read (she does not have dyslexia, she's just much more able to do the work, any work, on medication), even more so on her handwriting and I think on her eye tracking (she has age appropriate eye teaming & tracking but a DYS FSIQ, the behavioural optometrist didn't want to address the issue because she met age norms but did acknowledge that there was a massive gap between her ability to read mentally and what her eyes could manage). She also has glasses for her eye teaming/tracking issues so it's hard to say for sure if the glasses or the meds help the eye issues the most, but even with glasses and meds she really needs books with a larger size font, good quality font, well laid out text and lower density text than what generally comes in books at her reading level.

So, I am not an expert here - but I have two kids w/o attention issues and one with - this is what I noticed in terms of reading:

a)my ADHD dd7 learned to read by "whole word" reading. She simply did not have the focus to say in her head : cuh - ahh- tuh and then put it all together... (wait.. what was the first sound again?). It was much easier for her to just "see" that this was "cat"

b)I worked with her on "sight" word reading.. this was easy. I would write notes on post it notes and stick them on the wall by the kitchen table... This way they could be looked at frequently, but it only needed a few seconds of attention at a time. For a younger child just starting out this way I would stick with words that are visually distinct from one another "go" and "the"

c)The harder part was "comprehension" - she could read every word in a whole book now and you would get to the end and ask her to summarize it... and it would be like - ummmm I don't remember what happened at the beginning. For this, we worked with a reading tutor since she would get all pouty when I would ask her to recall - it is still not perfect - but I think she has definitely gotten better.

Reading alone for 20 minutes can be a waste of time in terms of making progress if you are not working towards a specific goal.

I think I would want more information about where exactly she is having difficulty with her reading. Decoding, comprehension, re-tell?

Clarifying question: does she have a diagnosis of ADHD, or just vague "attentional weaknesses"?

As to ADHD and reading: many children with ADHD are slow to learn to read, most likely because of the executive function/working memory/automaticity side. Once they learn to decode, the usual long-term difficulty is with comprehension, and then later with inferential comprehension in particular. The corollary is difficulty with spelling (working memory/automaticity, as well as poor self-monitoring), and then later with (lengthy) written expression (especially initiation, organization, and using writing for literary analysis).

At age 7, you are a ways away from the higher-level deficits that usually crop up (and often are not identified at first glance, because of the length of reading selections and writing samples used in many standardized assessments). Not that these are not an issue now, but that expectations are so low for reading comprehension in 2nd graders that it will be a challenge to document even her personal weaknesses, let alone normative weaknesses.

For documentation of dyslexic-type decoding deficits, I would suggest an assessment for phonological processing (CTOPP-2, PAL-II, some supplementary subtests of WISC-V and WJ-IV (latest editions only)), with an emphasis on the later-developing PA skills, that involve phoneme manipulation, rather than the early, surface PA skills. Often one sees discrepancies between real word naming (letter-word ID, word reading) and nonsense word decoding (word attack, pseudoword reading) in children who have learned a bunch of words by sight, sufficient to look average, yet don't really have solid underlying decoding skills for novel vocabulary.

Even if the district qualifies her as dyslexic/SLD in reading (which is what IEPs typically call dyslexia), it is highly unusual for a school to pay for outside decoding/encoding intervention. Most school systems have an inside person with similar training, though rarely Lindamood. More typically, you will see other systematic multi-sensory instruction in decoding/encoding skills, such as Orton-Gillingham or Wilson. Both are effective, btw. If they have OG or Wilson and you strongly prefer LB, plan to pay for LB privately.

Thanks aeh - I had not sent his kind of specific description of the impact of ADHD on reading; it's very helpful. I can certainly see why it's challenging to untangle the ADHA vs dyslexia effects if both seem to be present.

Are there remediation strategies for reading that are supposed to help get at some of these problems when AHDH is the culprit? If I am understanding you, it sounds like maybe O-G-type training might help at the front end with automating decoding, but still leave weaknesses in comprehension, especially as reading complexity increases?

OG is excellent for decoding, but there are other programs that help take a student to the next level in fluency, once they've completed OG, such as Read Naturally. Comprehension is yet another level, usually helped most by learning active reading strategies--so more cognitive and executive functioning strategies than anything else. Comprehension also naturally improves as decoding becomes automatic, because this frees up cognitive and EF functions for comprehending, rather than decoding. Some active reading strategies include KWL (know-want to know-learned) and SQ3R (Survey-Question-Read-Retell-Review).

aeh, you are a font of knowledge I don't seem to be able to find anywhere else. I've ordered the first couple levels of All About Reading/ Spelling to get us started, and now I have a sense for the longer term trajectory too. Thanks, yet again.