& Reading Comprehension and

Reading Related Abilities in

Adolescents with Reading
Disabilities and Attention-
Deficit/Hyperactivity
Disorder
Karen Ghelani1,2, Robindra Sidhu1, Umesh Jain3 and
Rosemary Tannock2,*
1
Ontario Institute for Studies in Education, The University of Toronto, Toronto, Canada
2
Brain and Behavior Research Program, Research Institute, The Hospital for Sick Children,
Toronto, Canada
3
The Centre for Addiction and Mental Health, Toronto, Canada

Reading comprehension is a very complex task that requires

different cognitive processes and reading abilities over the life span.
There are fewer studies of reading comprehension relative to
investigations of word reading abilities. Reading comprehension
difficulties, however, have been identified in two common and
frequently overlapping childhood disorders: reading disability (RD)
and attention-deficit/hyperactivity disorder (ADHD). The nature of
reading comprehension difficulties in these groups remains unclear.
The performance of four groups of adolescents (RD, ADHD,
comorbid ADHD and RD, and normal controls) was compared on
reading comprehension tasks as well as on reading rate and
accuracy tasks. Adolescents with RD showed difficulties across
most reading tasks, although their comprehension scores were
average. Adolescents with ADHD exhibited adequate single word
reading abilities. Subtle difficulties were observed, however, on
measures of text reading rate and accuracy as well as on silent
reading comprehension, but scores remained in the average range.
The comorbid group demonstrated similar difficulties to the RD
group on word reading accuracy and on reading rate but
experienced problems on only silent reading comprehension.
Implications for reading interventions are outlined, as well as the

*Correspondence to: R. Tannock, Brain and Behavior Research Program, The Hospital for
Sick Children, 555 University Ave., Toronto, Ontario, Canada M5G 1X8. E-mail:
[email protected]

Copyright # 2004 John Wiley & Sons, Ltd. DYSLEXIA 10: 364–384 (2004)
Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/dys.285
Reading Disability in Adolescents 365

clinical relevance for diagnosis. Copyright # 2004 John Wiley &

Sons, Ltd.
Keywords: reading disability; attention deficit hyperactivity disorder; adolescence; reading
comprehension

INTRODUCTION

R
eading comprehension is multifaceted and requires the synchrony of a
number of reading related processes in order to derive meaning from
text. Research on reading development has focused overwhelmingly on
the acquisition of basic decoding skills while the development of comprehension
has been relatively neglected. As a result, there is little research to explain why
the harmonious relationship between decoding and reading comprehension
sometimes becomes dissonant.
Reading comprehension difficulties have been documented in two very
common childhood disorders: reading disability (RD) and attention-deficit/
hyperactivity disorder (ADHD). Reading disability (RD) is a language-based
disorder characterized by the failure to acquire rapid, context-free, word
identification skills (Stanovich & Siegel, 1994) while ADHD is a developmental
disorder comprised of difficulties with inattention, impulsivity, and hyperactivity
(Barkley, 1997; DSM-IV-TR, APA, 2000). Both of these disorders are pervasive
across the life span (Barkley, 1997; Shaywitz & Shaywitz, 2003). Reading
Disability and ADHD co-occur more frequently than expected by chance
(Fawcett & Nicolson, 2001; Fletcher, Shaywitz, & Shaywitz, 1999; Willcutt,
Pennington, & DeFries, 2000) which makes the investigation of unique and
shared reading abilities challenging.
Reading Disability is a very heterogeneous disorder which may or may not be
accompanied by reading comprehension failure (Cain, Oakhill, & Bryant, 2000;
Ransby & Swanson, 2003; Simmons & Singleton, 2000; Snowling, 2001). When
comprehension difficulties occur, they are usually traced to a ‘bottleneck’ at the
word level which leaves few attentional processes available for interpreting text
(LaBerge & Samuels, 1974; Perfetti, 1985).
Few studies have examined reading comprehension difficulties in individuals
with ADHD. Results of one study indicated that the performance of children
with ADHD, without comorbid language impairments, declined as the length of
the passage increased (Cherkes-Julkowski et al., 1995). Results from another
study revealed that, in spite of generally average word reading accuracy and
word reading rate, children with ADHD were more impaired in the reporting of
main ideas from expository passages than normal controls (Brock & Knapp,
1996). Group differences were attributed to greater demands for effortful
processing on longer passages and, therefore, greater demands on attentional
capacity. Reading disabilities and medication effects in the ADHD group,
however, were not adequately controlled for in these two studies. Therefore,
although the literature suggests reading comprehension failure in individuals
with ADHD, the results remain equivocal.
The literature on reading processes proposes several critical predictors of
reading comprehension performance. The most robust predictor is that of

Copyright # 2004 John Wiley & Sons, Ltd. DYSLEXIA 10: 364–384 (2004)
366 K. Ghelani et al.

phonological processing. Individuals with reading disabilities have a deficit at

the phonological module level which impedes their ability to discern and
manipulate the distinctive sound elements that constitute language (Shaywitz &
Shaywitz, 2003). Because of the nature of the ‘phonological core-deficit’
(Stanovich, 2000), other abilities necessary for adequate comprehension (i.e.
cognitive and linguistic functions) may remain intact (Shaywitz & Shaywitz,
2003). Another component thought to be important for reading comprehension
abilities is reading fluency. Wolf and Katzir-Cohen (2001) have suggested a
definition of reading fluency that incorporates reading comprehension ability:
‘. . . reading fluency refers to a level of accuracy and rate where decoding is
relatively effortless; where oral reading is smooth and accurate with correct
prosody; and where attention can be allocated to comprehension’ (p. 219).
Evidence for slower and more laborious word reading has been reported in
individuals with RD (e.g. Young & Bowers, 1995) but not in individuals with
ADHD (Brock & Knapp, 1996).
Reading rate has typically been measured by tasks requiring the rapid naming
of visual stimuli such as letters, digits, colors, and objects (Denckla & Rudel,
1974). Individuals with RD generally have slower naming speed across tasks
with particular difficulties naming letters and digits (e.g. Wolf, 1999). For
individuals with ADHD, there is growing evidence to support specific naming
deficits for objects (e.g. Carte, Nigg, & Hinshaw, 1996) and colors (e.g. Tannock,
Martinussen, & Frijters, 2000). It has been reported that letter- and digit-naming
speed best predict the speed of reading passages in text (Young & Bowers, 1995)
while the semantic properties inherent in object-naming are a better predictor of
reading comprehension (Wolf & Obrego! n, 1992).
Previous investigations of reading comprehension have generally focused on a
younger age group, neglecting other age groups, such as adolescents. Different
reading skills, however, are required of adolescents than children. For example,
adolescents are required to read a variety of text genres (e.g. expository and
narrative) that are increasingly complex and lengthy. Also, adolescents generally
read silently and yet many standardized assessments of reading comprehension
require the adolescent to read aloud (i.e. Gray Oral Reading Test).
Accordingly, there were two primary objectives of this study. The primary
objective was to examine reading comprehension in adolescents with a reading
disability and/or ADHD using both oral and silent reading passages. The second
objective was to investigate the characteristics of reading component skills in
these disorders. It was predicted that both the RD group and the ADHD group
would show more difficulties on reading comprehension tests relative to the
normal controls. It was further predicted that the RD group would be more
impaired on reading component tasks than either the normal controls or the
ADHD group. It was not expected that the ADHD group would differ from
normal controls on reading component skills. It was predicted that the RD group
would show slower naming speed across rapid naming tasks and the ADHD
group would show specific difficulties with naming objects and colors relative to
the normal controls.
Four groups were used (RD, ADHD, ADHD+RD, and normal controls (NC)) to
better understand the specific deficits associated with each clinical group. The
inclusion of a comorbid group (ADHD+RD) allowed us to determine whether
these adolescents shared the deficits associated with either RD or ADHD (or

Copyright # 2004 John Wiley & Sons, Ltd. DYSLEXIA 10: 364–384 (2004)
Reading Disability in Adolescents 367

both) or whether they exhibited a unique profile. Evidence of the latter situation
would suggest that ADHD+RD is a distinct clinical condition that needs to be
differentiated from both ADHD and RD.

METHOD

Participants
A total of 96 adolescents (aged 14–17 years) participated in this study: 32 ADHD
(26 males and 6 females), 20 RD (10 males and 10 females), 19 ADHD+RD (15
males and 4 females), and 25 Normal Controls (NC) (15 males and 10 females).
The clinical groups were recruited from several sources including referrals from
mental health facilities, community referrals, and advertisements in the Learning
Disability Association of Ontario (LDAO) newsletter. The normal comparison
group was recruited through a newsletter advertisement in a large metropolitan
hospital (Hospital for Sick Children) looking for adolescents without reading or
attentional disorders to volunteer for a research study. Many of the adolescents in
the normal control group were children of hospital staff (i.e. nurses, research
technologists, social workers) and many of these adolescents brought along a
same-aged peer.
Adolescents in the three clinical groups were interviewed using the Schedule
for Affective Disorders and Schizophrenia for School-Age Children-Present and
Lifetime Version (K-SADS-PL) which generates a DSM-IV diagnosis (Kaufman
et al., 1997). The K-SADS-PL has been used extensively to make diagnostic
decisions based on DSM criteria and has been validated with children aged 6–17.
Separate interviews were conducted with parents and adolescents by a PhD level
clinical psychologist or a supervised PhD Candidate in clinical psychology (KG).
When the information provided by parent and adolescent was inconsistent, the
parent information superceded the adolescent report for the presence of
externalizing symptoms. A Screening Interview, in addition to the Behavioral
Disorders supplement, was used with participants in the normal control group,
unless concerns were raised by the parent, in which case, the entire interview was
used. This situation occurred for two adolescents in the control group. Parents
and teachers were also required to complete the Conners’ Parent Rating Scale-
Revised: Long Form (Conners, 1997) and the Conners’ Teacher Rating Scale-
Revised: Long Form (Conners, 1997), respectively. To be eligible for the study,
participants were required to have an estimated Full Scale IQ (FSIQ) between 80
and 130 (as determined by a composite of the Vocabulary and Matrix Reasoning
subtest on the Wechsler Abbreviated Scale of Intelligence), English as their first
language, and no evidence of neurological dysfunction, uncorrected sensory
impairments, or a history or current presentation of psychosis. Maternal
education was used as a proxy measure of SES and was obtained from the
family and developmental history questionnaires (revised Ontario Health Child
Study) (Boyle et al., 1993) completed by parents. These data are reported as the
proportion (in percentages) of mothers from each group who had at least
completed high school. The percentages of mothers obtaining at least high school
education were 94 and 85% for the ADHD group and the RD group, respectively.
All mothers in the normal control and comorbid ADHD+RD group reported at
least high school education.

Copyright # 2004 John Wiley & Sons, Ltd. DYSLEXIA 10: 364–384 (2004)
368 K. Ghelani et al.

The majority of the adolescents in the study were in either Grade 10 or 11 and
attending an urban secondary school. Most of the adolescents in the clinical
groups were receiving, at least, part-time resource withdrawal for language arts
and mathematics.
Inclusion for the ADHD Group: The ADHD group had a confirmed diagnosis
based on the following algorithm: The adolescent (1) met current diagnosis based
on the summary of DSM-IV symptoms on the K-SADS-PL (Kaufman et al., 1997);
(2) met clinical criteria on both the Conners’ Parent and Teacher questionnaires in
order to establish pervasiveness of clinical problems across settings; (3) had a
developmental history establishing the onset of symptoms prior to age 7; and (4)
had reading scores above the 25th percentile (Standard Score 90) on both the
Word Identification and the Word Attack subtests of the Woodcock Reading
Mastery Test-Revised-Normative Update (WRMT-R/NU) (Woodcock, 1998).
Previous school report cards, clinical reports and/or psychoeducational assess-
ments were requested to verify the childhood diagnosis of Inattentive and
Hyperactive/Impulsive subtypes. Psychiatric consultation and differential
diagnosis was provided for all ADHD adolescents by a child and adolescent
psychiatrist who confirmed past and current diagnosis. Further psychiatric
follow-up was offered to those who required reassessment of medication or to
those who would benefit from further counselling around ADHD symptoms.
Inclusion for the RD Group: A reading disability diagnosis was defined by a
standard score below the 25th percentile (SS 90) on one of the following subtests:
Word Identification or Word Attack subtests of the Woodcock Reading Mastery
Test-Revised (WRMT-R/NU) (Woodcock, 1998). A cut off of SS 90 has been used
previously in the research literature (Bruck, 1992; Fletcher et al., 1998;
Frankenberger & Fronzaglio, 1991; Siegel & Heaven, 1986). It should be noted
that this criterion is not as rigorous as that currently used to make a diagnosis of
Learning Disability within the school system. A discrepancy between IQ and
achievement was not required as the literature has generally found that there are
no qualitative differences in component reading skills between discrepancy-
based-and low-achievement-based RD children (Fletcher et al., 1994). Adolescents
in the RD group did not meet criteria for a diagnosis of ADHD based on the
K-SADS-PL. Individuals in the RD group had a formal diagnosis of childhood
Reading Disorder or a history of severe reading difficulties.
Inclusion for the ADHD+RD Group: Participants with a comorbid condition were
required to meet diagnostic criteria for both ADHD and RD.
Inclusion for the Normal Control Group: The normal controls (NC) were
screened for RD and ADHD using the Word ID and the Word Attack subtests
from the WRMT-R/NU, the Interview Screener and Behavioral Disorder
Supplement on the K-SADS-PL, and the Conners’ Parent and Teacher Rating
Scales. Adolescents with scores below the 25th percentile on the reading
subtests of the WRMT-R/NU or with T-Scores above 60 on either the Parent
or Teacher Conners’ Rating Scales were not included in the control group
for this study.

Group differences on standardized and diagnostic measures

Table 1 presents demographic variables, as well as variables used for diagnostic
purposes. The four groups of adolescents did not differ on age or in terms of
the relative proportion of females (w2 ð3, N ¼ 96Þ ¼ 7:00, p ¼ 0:07). A multivariate

Copyright # 2004 John Wiley & Sons, Ltd. DYSLEXIA 10: 364–384 (2004)
 Table 1. Diagnostic characteristics of the ADHD, RD, ADHD+RD and control groups
ADHD RD ADHD + RD Controls

(1) (2) (3) (4)

M SD n M SD n M SD n M SD n df F Z2 sig. Post-hoca

Age 15.3 1.0 32 15.6 1.28 20 15.3 1.2 19 15.0 1.24 25 3, 92 0.7 0.02 n.s.
WASI Scores
Vocabulary scaled 11.0 1.7 32 9.5 2.54 20 9.7 2.0 19 12.3 2.20 25 3, 92 9.1 0.23 * * *
1, 4 > 2, 3
Score
Matrix reasoning 10.6 1.88 32 10.1 3.75 20 10.9 1.5 19 11.4 1.90 25 3, 92 1.4 0.04 n.s.
Scaled score
Estimated FSIQ 103.4 7.35 32 96.8 10.18 20 101.7 7.9 19 110.6 9.4 25 3, 92 10.0 0.25 * * *
4 > 1 > 2, 3
Reading Disability in Adolescents

WRMT-R/NU
Multivar. effect 6, 182 22.9 0.43 * * *
(Word ID, attack)
Word ID 101.3 6.49 32 82.1 7.89 20 86.8 7.1 19 106.9 10.60 25 3, 92 47.2 0.61 1, 4 > 2, 3

Copyright # 2004 John Wiley & Sons, Ltd.

* * *
Standard score
Word attack
Standard score 102.1 8.56 32 86.0 5.30 20 85.4 5.3 19 105.2 10.80 25 3, 92 41.1 0.57 * * *
1, 4 > 2, 3

ADHD Subtypes (% of clinical sample)

Inattentive subtype 67.4% N/A 68.4% N/A
Hyperactive/ 3.6% N/A 0.0% N/A
Impulsive subtype
Combined subtype 29.0% N/A 31.6% N/A

Conners’ Rating Scales

Parent inattention
T-Score 72.8 10.3 28 57.4 12.90 16 73.8 8.9 18 45.6 3.50 17 3, 75 37.8 0.60 * * *
1, 3 > 2 > 4
Parent hyperactive/ 71.1 13.7 28 57.3 14.70 16 73.0 14.3 18 47.2 5.10 17 3, 75 17.2 0.41 * * *
1, 3 > 2 , 4
Impulsive T-score
Teacher inattention 73.2 12.70 28 65.9 17.48 16 75.6 13.3 18 44.2 2.10 17 3, 75 23.8 0.48 * * *
1, 2, 3 > 4
T-score
Teacher hyperactive/ 61.8 16.17 28 58.4 18.67 16 67.8 16.8 18 46.5 4.40 17 3, 75 6.1 0.20 * * *
1, 3 > 4
Impulsive T-score

Note: **p50.01, ***p50.001. ADHD¼attention deficit hyperactivity disorder, RD¼reading disabled, ADHDþRD¼attention deficit hyperactivity disorder and reading disabled,
multivar.¼multivariate, T-Scores: T ¼ 61–65 mildly atypical; T ¼ 66–70 moderately atypical; T ¼> 70 markedly atypical.
a
Tukey HSD.
369

DYSLEXIA 10: 364–384 (2004)

370 K. Ghelani et al.

analysis of variance (MANOVA) revealed a main Group effect for the T-Scores on
the Inattentive and Hyperactive/Impulsive Indices of the Conners’ Parent and
Teacher Rating Scales. Tukey Honestly Significant Difference (HSD) post hoc
contrasts indicated that the adolescents in the three clinical groups were rated by
parents and teachers as being significantly more inattentive than their peers in
the normal control group. Only the adolescents in the ADHD group and the
comorbid group were seen by parents and teachers as having more hyperactive
and impulsive symptoms.
The participants completed a number of standardized measures of intellectual,
academic, and language functioning. The short form of the WASI (Wechsler
Abbreviated Scale of Intelligence, Wechsler, 1999) (i.e. Vocabulary and Matrix
Reasoning) was used to provide an estimate of intellectual ability. With respect to
cognitive functioning, there was a main Group effect for Vocabulary but not for
Matrix Reasoning. Post hoc analyses revealed that the RD groups (RD only and
ADHD+RD) had significantly lower scores on the WASI Vocabulary subtest than
the normal control group. All adolescents in the clinical groups had significantly
lower scores on estimated FSIQ when compared to adolescents in the normal
control group. By design, the RD groups (RD only and ADHD+RD) were
significantly more impaired on measures of isolated word reading and decoding
than either the ADHD only group or the normal control group. The ADHD group
did not differ from the normal controls on word reading and decoding.

Dependent Measures
Reading comprehension and reading components were measured using the
following tasks:

(1) Reading comprehension: Both oral and silent reading comprehension abilities
were measured. The measures included the Comprehension subtest of the Gray
Oral Reading Tests-Fourth Edition (GORT-4) (Wiederholt & Bryant, 2001) and the
Gray Silent Reading Tests (GSRT) (Wiederholt & Blalock, 2000). On the
Comprehension subtest, the adolescent is asked to read passages orally. After
each passage, the adolescent is requested to turn over the page to the
comprehension questions that are read by the examiner. The adolescent then
orally answers the five multiple-choice questions. The reader is not allowed to
reread the story when answering the five multiple-choice questions. The
Comprehension score is a measure of the accuracy of the adolescent’s responses
to questions about the content of each story that had been read. The GSRT yields a
Silent Reading Quotient (SRQ) which is an indication of the adolescent’s overall
silent reading comprehension; however it does not provide a measure of reading
rate or accuracy. The GSRT is a self-paced task in which the adolescent reads the
story and is allowed to refer back to the passage to answer the five multiple-
choice questions on a response sheet. The GORT-4 and the GSRT have a similar
content and format as both contain short narrative passages and five multiple-
choice questions.
(2) Text reading rate and accuracy: The Rate and Accuracy subtests from the Gray
Oral Reading Tests (GORT-4) were used. Rate measures the amount of time taken
by the adolescent to read a story aloud. Accuracy measures the adolescent’s
ability to pronounce each word in the story correctly.

Copyright # 2004 John Wiley & Sons, Ltd. DYSLEXIA 10: 364–384 (2004)
Reading Disability in Adolescents 371

(3) Rapid word reading: Rapid word reading efficiency was measured by
subtests on the Test of Word Reading Efficiency (TOWRE) (Wagner, Torgesen, &
Rashotte, 1999a). Sight Word Efficiency (SWE) assesses the number of real words
that can be accurately read orally and Phonemic Decoding Efficiency (PDE)
measures the number of pseudowords (i.e. nonwords) that can be accurately
decoded orally. Both tests require the individual to read lists (columns) of words
from top to bottom as quickly and accurately as possible for 45 seconds.
(4) Rapid naming speed: The Letters, Digits, Colors, and Objects subtests from
the Comprehensive Test of Phonological Processing (CTOPP) (Wagner, Torgesen,
& Rashotte, 1999b) were administered. Each subtest requires the individual to
name the stimuli as quickly as they can. The individual’s score is the total
number of seconds taken to name all of the items on two stimulus pages. Each
subtest has a total of 72 items (36 items per stimulus page). Each stimulus page
has four rows and nine columns of six randomly arranged items measured by the
subtest (i.e. letters, digits, colors, objects). The composites of these subtests were
used in the analyses. The Rapid Naming Composite Score (RNCS) is a measure of
naming speed for letters and digits while the Alternate Rapid Naming Composite
Score (ARNCS) is a measure of naming speed for colors and objects. Letters and
digits were chosen as they have proven to be better predictors of reading
performance in the RD population (Denckla & Rudel, 1974). Colors and objects
were chosen as they have been shown to be more difficult for the ADHD group
(Semrud-Clikeman et al., 2000; Tannock, Martinussen, & Frijters, 2000). In
addition, a relationship has been found between object naming speed and
reading comprehension (Wolf & Goodglass, 1986; Wolf & Obreg!on, 1992).

Measures and Procedures

The testing was completed in one day at the Hospital for Sick Children. Informed
written consents and assents were obtained from parents and from adolescents
who were 14 or 15 years of age. Adolescents aged 16 years and over provided
written consents. All adolescents were asked to be off psychostimulant
medication for at least 24 hours prior to testing. This required 25 of the 32
adolescents in the ADHD group and 6 of the 19 adolescents in the comorbid
group who were on stimulant medication to be off medication for the day of
testing. Only one adolescent with ADHD who was receiving a non-stimulant
medication (Amitriptoline, an antidepressant medication) was assessed while on
medication. The testing was administered by the first author (K. G.) and by two
other PhD level psychology students who were trained in administering the
standardized tasks. Adolescents were reimbursed $20 for their participation. All
clinical participants received verbal feedback as well as a written clinical
assessment of their results. A consulting psychiatrist (U. J.) was involved in the
verbal feedback sessions with the ADHD participants to confirm and interpret
any clinical diagnoses.
Statistical Analyses: Prior to conducting statistical analyses, the data was
examined for outliers. Tabachnick and Fidell’s (2001, p. 71) most conservative
score changing option was selected for only those tasks on which these
individuals deviated extremely. This option calls for assigning the outlying
case a raw score on the offending variable that is one unit larger (or smaller) than
the next most extreme score in the distribution. This procedure was applied on

Copyright # 2004 John Wiley & Sons, Ltd. DYSLEXIA 10: 364–384 (2004)
372 K. Ghelani et al.

the standard scores for the rapid composite naming measures with scores being
adjusted downwards: RNCS (n ¼ 1, ADHD; n ¼ 1, RD) and ARNCS (n ¼ 1,
ADHD). Univariate analyses of variance (ANOVA) were used to examine group
differences on measures. If the omnibus F test was significant ðp ¼ :05Þ, Tukey
HSD tests were performed to determine which groups were significantly
different from each other. Eta square (Z2) effect sizes were computed. Eta square
ranges in value from 0–1. A higher value reflects a stronger effect size (Green,
Salkind, & Akey, 2000, p. 151).
Covariates: The finding that the clinical groups differed from the normal control
group on estimated FSIQ and vocabulary poses a methodological quandary.
Some researchers (e.g. Werry, Elkind, & Reeves, 1987) argue that IQ should be
included as a covariate to ensure that deficits cannot be attributed more
parsimoniously to group differences in intellectual functioning (Willcutt et al.,
2001). Others (e.g. Mariani & Barkley, 1997) argue that the presence of ADHD
may give rise to lower scores on tests of intelligence and controlling for IQ
removes the portion of the variance associated specifically with ADHD. A recent
study by Kuntsi et al. (2004) documented a genetic basis for lower intelligence
scores (9 points lower, on average, than comparison group) in the ADHD
population. A similar argument has been presented for the reading disabled
population when covarying IQ estimates that contains a vocabulary measure
(Stanovich & Siegel, 1994). Since this issue remains unresolved, results for
reading component and naming speed tasks have been reported with and
without controlling for group differences on estimated FSIQ and Vocabulary.

RESULTS

Dependent Variables
Table 2 reports the means, standard deviations, and F values on all of the reading
measures:

(1) Performance on oral and silent reading comprehension: there was a main effect
for Group on both oral and silent reading comprehension tasks (GORT-4
Comprehension subtest and the GSRT). Post hoc analyses for these measures
suggested that only the adolescents in the RD group had more difficulty in their
ability to answer questions correctly on the oral reading comprehension measure
compared to the normal group. On the silent reading passages, all clinical groups
had scores that were significantly lower than the normal control group. The
means for the clinical groups remained in the average range on these tasks and
the scores for the RD groups (RD only and ADHD+RD) were the lowest.
(2) Performance on text reading rate and accuracy: there was a main Group effect
for text reading rate and accuracy measures. Post hoc analyses indicated that the
clinical groups had significantly lower scores on text reading rate and accuracy
as compared to the normal control group. Only the mean scores for the RD
groups (RD only and ADHD+RD), however, were within the more severe
range. Post hoc comparisons revealed significantly lower scores on text reading
rate and accuracy for the RD groups (RD only and ADHD+RD) relative to
the ADHD group.

Copyright # 2004 John Wiley & Sons, Ltd. DYSLEXIA 10: 364–384 (2004)
 Table 2. Reading abilities of the ADHD, RD, ADHD+RD and control groups
ADHD RD ADHD + RD Controls

(1) (2) (3) (4)

M SD n M SD n M SD n M SD n df F Z2 sig Post-hoca

Reading comprehension
***
GSRT SRQ 103.7 12.7 31 91.3 16.7 20 93.7 21.1 18 115.0 12.8 25 3, 90 10.9 0.27 4 > 1, 3;
Standard score 4 > 2; 1 > 2
**
GORT-4 comprehension 9.4 2.0 31 8.2 2.5 20 9.3 2.1 18 10.8 2.6 25 3, 90 5.1 0.15 4>2
Scaled score

Text reading rate and accuracy

Reading Disability in Adolescents

***
GORT rate 9.5 2.3 32 5.3 1.8 20 6.1 1.6 19 12.0 2.4 25 3, 92 50.3 0.62 4 > 1 > 2, 3
Scaled score
***
GORT-4 accuracy 10.7 6.2 32 5.5 2.5 20 5.6 2.6 19 12.7 2.8 25 3, 92 37.3 0.55 4 > 1 > 2, 3
Scaled score

Copyright # 2004 John Wiley & Sons, Ltd.

Rapid word reading
***
Multivar. effect 6, 182 25.5 0.46
(SWE, PDE)
***
TOWRE SWE 96.8 9.0 32 77.1 8.1 20 81.8 7.7 19 107.1 8.1 25 3, 92 61.9 0.67 4 > 1 > 2, 3
Standard score
***
TOWRE PDE 96.7 11.4 32 75.0 7.3 20 78.5 8.0 19 105.5 10.1 25 3, 92 50.9 0.62 4 > 1 > 2, 3
Standard score
***
TOWRE composite 97.0 9.9 32 70.8 8.5 20 77.6 6.3 19 107.2 9.6 25 3, 92 61.9 0.67 4 > 1 > 2, 3
Standard Score

Rapid naming speed

***
Multivar. effect 6, 178 14.5 0.33
(RNCS, ARNCS)
***
CTOPP RNCS comp. 101.7 11.7 31 79.3 11.7 19 81.4 13.5 19 108.6 12.1 25 3, 90 31.7 0.51 1, 4 > 2, 3
Standard score
***
CTOPP ARNCS comp. 93.5 13.6 31 83.9 13.5 19 79.7 15.8 19 104.9 16.4 25 3, 90 12.7 0.30 4 > 1 > 3;
Standard score
4>2

Note: **p50.01, ***p50.001. multivar.¼multivariate; comp.¼composite, GSRT¼gray silent reading tests; SRQ¼silent reading quotient; GORT-4¼gray oral reading tests, TOWRE=test of
word reading efficiency; SWE¼sight word efficiency; PDE¼phonemic decoding efficiency; CTOPP¼comprehensive test of phonological processing; RNCS¼rapid naming composite score
(letters, digits); ARNCS¼alternate rapid naming composite score (colors, objects).
373

DYSLEXIA 10: 364–384 (2004)

374 K. Ghelani et al.

In order to assess the impact of word reading on text reading rate, a one-way
analysis of covariance (ANCOVA) was conducted using Word Identification and
GORT-4 Accuracy as separate covariates. A preliminary analysis evaluating the
homogeneity-of-slopes assumption indicated that the relationship between the
covariates and reading rate did not differ significantly as a function of group. The
main effect of Group and group comparisons remained significant which
suggests that group differences on text reading rate are not explained by group
differences on Word Identification and GORT-Accuracy.
(3) Performance on rapid word reading efficiency: main group effects were obtained
on the rapid word reading efficiency tasks. Post hoc analyses indicated that the
clinical groups were significantly slower on both sight word and nonword
reading efficiency tasks compared to the normal control group. However, as on
the text reading rate and accuracy measures, the scores for the ADHD group
remained within the average range.
The analyses were rerun separately covarying for Word Identification and for
GORT-4 Accuracy to assess the impact of single word reading on rapid word
reading efficiency. The main effect of Group and group comparisons remained
significant for rapid sight word reading efficiency (SWE) after controlling for
these two variables suggesting that group differences on rapid word reading
efficiency are not entirely explained by differences on isolated word reading or
by reading accuracy.
Comparable results were obtained for rapid nonword reading efficiency (PDE).
The main effect of Group remained significant after covarying Word Identifica-
tion. Pairwise comparisons, however, revealed that the scores for the ADHD
group were only marginally significant on rapid nonword reading efficiency
ðp ¼ 0:068Þ when covarying for isolated word reading and nonsignificant when
covarying for text reading accuracy.
(4) Performance on rapid naming speed: a main Group effect was found for rapid
naming across both the RNCS (i.e. letters and digits) and the ARNCS (colors and
objects) composites. Post hoc analyses showed that the RD groups (RD only and
ADHD+RD) were significantly impaired on both naming composites compared
to the normal group ðp ¼ :001Þ. The ADHD group, on the other hand, displayed
significantly lower scores relative to the normal control group ðp ¼ 0:05Þ when
naming colors and objects (but not when naming letters and digits). Paired
sample t-tests were performed to compare the magnitude of the difference
between the two Composite scores for the RD group and the ADHD group.
The results indicated that the difference between the Composite scores was
significant for the ADHD group, tð30Þ ¼ 4:975, p ¼ 0:000, and marginally
significant for the RD group, tð19Þ ¼
2:087, p ¼ 0:052. A one-way analysis of
covariance (ANCOVA) was performed with ARNCS as the dependent variable
and RNCS as the covariate. All group differences were eliminated with this
analysis. When groups were compared on the basis of the number of errors
made, the RD groups (RD only and ADHD+RD) made significantly more errors
on digits and letters. There were no differences between the groups on color and
object naming errors.
Analyses controlling for estimated FSIQ and Vocabulary: the ANOVAs and
MANOVAs were rerun as ANCOVAs using Bonferroni adjustment for multiple
comparisons (Fleiss, 1999) to test whether the results on the dependent measures
would be different when adjusting for estimated FSIQ and Vocabulary.

Copyright # 2004 John Wiley & Sons, Ltd. DYSLEXIA 10: 364–384 (2004)
Reading Disability in Adolescents 375

The original pattern of results remained the same for reading rate for
text, rapid sight word reading efficiency, and the letters and digits composite
when covarying for estimated FSIQ. There were differences in results, how-
ever, on other variables. Only significant differences remained between the
RD groups (RD only and ADHD+RD) and the normal controls on measures
of silent reading comprehension ðFð3,89Þ ¼ 4:197, p ¼ 0:008, Z2 ¼ 0:12Þ, accuracy
ðFð3,91Þ ¼ 25:20, p ¼ 0:000, Z2 ¼ 0:45Þ, and rapid nonword reading efficiency
ðFð3,91Þ ¼ 34:76, p ¼ 0:000, Z2 ¼ 0:53Þ with the group differences between the
ADHD group and the normal controls being eliminated.
When controlling for the effects of Vocabulary, the pattern of group differences
was similar to the results when controlling for estimated FSIQ, with two
exceptions. On silent reading comprehension only the scores for the RD only
group remained significantly lower than those of the normal controls. Significant
differences remained between the ADHD group and normal controls on
nonword reading efficiency ðFð3,91Þ ¼ 33:55, p ¼ 0:000, Z2 ¼ 0:53Þ when covary-
ing Vocabulary.

DISCUSSION

The objectives of the present study were to examine reading comprehension

abilities and reading component processes in adolescents with RD, ADHD, and
comorbid ADHD+RD.
As predicted, the results showed that the RD only group had lower scores on
both oral and silent reading comprehension measures compared to the normal
controls and the ADHD group. However, these scores were within the average
range. These results are consistent with other studies that have found differences
between individuals with reading disabilities and controls on reading compre-
hension tasks (e.g. Simmons & Singleton, 2000). The ADHD group had lower
scores on silent reading comprehension relative to the normal controls but their
scores were also within the average range. Our findings for the ADHD group are
similar to those of a recent study (e.g. Willcutt et al., in press) that reports lower
scores for the ADHD group (albeit still within the average range) than for a
normal control group on silent reading comprehension. As expected, the
comorbid group performed similarly to the RD group on the silent reading
comprehension task, although demonstrating slightly higher scores than the RD
group on the oral reading comprehension.
The lower scores for the RD groups (RD only and ADHD+RD) on these
comprehension measures, relative to the ADHD group and normal controls, are
reflective of the difficulties experienced by the RD group at the basic word
reading level. These results are consistent with the theory that efficient sight
word reading and decoding skills are necessary for attentional resource
allocation to higher reading processes such as comprehension (LaBerge &
Samuels, 1974).
The results for reading comprehension for the clinical groups are based on
fairly brief narrative passages. Although self-paced silent reading is fairly
commonplace in the secondary classroom, the text genre and length may not
represent the same reading demands as when the student is required to read a
chapter in a biology textbook. The scores, therefore, obtained on the standardized

Copyright # 2004 John Wiley & Sons, Ltd. DYSLEXIA 10: 364–384 (2004)
376 K. Ghelani et al.

comprehension measures used in this study may be higher than those obtained
on curriculum-based assessments. The reading difficulties of the RD groups and
the milder difficulties observed in the ADHD group may become exacerbated in
situations requiring increased cognitive load (i.e. when required to reading
expository passages).
The findings, indicating persistent difficulty for the RD groups (RD only and
ADHD+RD) across reading accuracy and reading rate measures, are not
surprising. The results highlight the significant challenges some adolescents
with reading disabilities face.
Subtle difficulties were evident for adolescents with ADHD on measures of
text reading accuracy and reading rate for words and text. That is, their scores on
these measures were within the average range although lower than those of the
normal controls and, in some cases, lower than the normative sample mean (i.e.
Mean ¼100, SD ¼ 15). These results were maintained for the ADHD group after
controlling for reading accuracy, with one exception: rapid nonword reading
efficiency scores were no longer significantly different. The latter result is
consistent with previous reports of intact phonological processing in the ADHD
group (Purvis & Tannock, 1997, 2000; Rucklidge & Tannock, 2002; Willcutt et al.,
2001) which remains even with the addition of a speed component.
Slower response times on naming tasks for visual stimuli were evident for both
the RD group and the ADHD group, although a differential profile of results
emerged. The RD group showed a generalized naming deficit for letters, digits,
colors, and objects whereas the ADHD group showed impairment only when
naming colors and objects. Ancillary analyses indicated that the difference
between the two RAN Composites was significant for the ADHD group and
marginally significant for the RD group. These results are consistent with
previous studies that have identified generalized longer response latencies across
naming tasks in the RD group (Wolf & Bowers, 1999; Wolf et al., 2002) and longer
response latencies on colors and objects for the ADHD group (Carte, Nigg, &
Hinshaw, 1996; Tannock, Martinussen, & Frijters, 2000; Semrud-Clikeman et al.,
2000).
The literature has highlighted the methodological quandaries that confront the
researcher when assessing the effect of IQ (e.g. Kuntsi et al., 2004; Stanovich &
Siegel, 1994) on performance, particularly in clinical groups. When the analyses
were rerun controlling for IQ, an intriguing differential pattern of results was
found for each group. When IQ was controlled, the effect of reading disabilities
on most reading tasks (i.e. silent reading comprehension, accuracy, rate, and
reading efficiency) remained. This finding is consistent with the literature that
indicates that neurocognitive deficits (i.e. reading and language skills) (Willcutt
et al., in press) in the RD group cannot be completely explained by individual
differences in IQ. When examining whether the original results were upheld for
the ADHD group, however, differences between the ADHD group and the
normal controls were eliminated when covarying for IQ with two exceptions:
reading rate and sight word reading efficiency.
The findings that estimated FSIQ did not explain performance on many of the
rapid reading tasks for the RD group are similar to those reported by Wolf et al.
(2002) for naming speed and IQ. Wolf et al. reported that IQ level is significantly
correlated only with phonological measures and not with naming-speed
variables. Of note, the differences for the ADHD group on color and object

Copyright # 2004 John Wiley & Sons, Ltd. DYSLEXIA 10: 364–384 (2004)
Reading Disability in Adolescents 377

naming were no longer significant after controlling for IQ. Color and object
naming have been differentiated in the naming speed literature as being
semantically rather than phonologically based (e.g. Wolf & Obrego! n, 1992). The
finding for the ADHD group is consistent with a study suggesting that the
lexical-semantic demands of rapid naming of colors may require more effortful
processing than word reading (Stuss et al., 2001).
Recently, evidence has been accumulating suggesting slower processing
speeds in individuals with ADHD/IA (Predominantly Inattentive Subtype)
(Berninger, Abbott, Billingsley, & Nagy, 2001; Chhabildas, Pennington, &
Willcutt, 2001; Rucklidge & Tannock, 2002; Weiler, Bernstein, Bellinger, & Waber,
2000, 2002; Willcutt et al., in press). Results of a recent study suggest that
individuals with ADHD/IA process visual information more slowly, particularly
in the context of increased cognitive load and a requirement for integrating
multiple component operations (Weiler et al., 2000).
The clinical sample in this study had a high proportion of inattentive
individuals both in the RD groups (RD only and ADHD+RD) and in the ADHD
group. The clinical groups experienced varying degrees of naming speed
difficulties, with the RD groups (RD only and ADHD+RD) performing more
poorly than either the ADHD group or the normal controls. These findings may
provide some evidence for naming speed deficits and inattention as potential
zones of overlap between these two groups (i.e. RD only and ADHD+RD). These
findings may have relevance for our understanding of the reading process.
Selective attention is required to effectively perform an operation in the presence
of conflicting information (Posner, 1988). Posner and Peterson (1990) theorized
that attention is guided, as if it were a spotlight. In order for this guiding to occur,
the spotlight must be disengaged, moved, and then re-engaged. The slower and
less efficient performance of the ADHD/IA group on measures of naming speed
could reflect differences in these operations (Weiler et al., 2000). The process of
reading also requires the ability to rapidly shift focus (i.e. from one unit of print
to the next; from decoding to comprehension) (LaBerge & Samuels, 1974).
Several longitudinal studies have contributed to growing evidence for the link
between inattention and reading abilities. McGee, Prior, Williams, Smart, and
Sanson (2002) examined outcomes for adolescents who had been diagnosed with
hyperactivity early in school. They found that early inattentive behaviors were
associated with later inattention and poor reading outcomes in adolescence.
Other studies have also documented a pathway from inattentive behavior to poor
reading skills (Rabiner & Coie, 2000; Warner-Rogers, Taylor, Taylor, & Sandberg,
2000). In the current study, many of the adolescents with ADHD had previously
been diagnosed as having the Combined subtype of ADHD (i.e. both Inattentive
and Hyperactive/Impulsive symptoms were elevated) but their restless and
impulsive symptoms had diminished over the years.
Although still undetermined, the milder reading rate difficulties in the ADHD
group may also be reflective of the slower processing speed that has been
documented in the ADHD Predominantly Inattentive type (ADHD/IA), and the
fact that the majority of our sample belong to this group. The relevance of milder
difficulties in reading rate to lower scores in reading comprehension in the
ADHD group is unknown. It is unclear whether these mild differences would
become exaggerated under other reading conditions (i.e. lengthier passages and
expository genre). The current literature suggests that both listening comprehen-

Copyright # 2004 John Wiley & Sons, Ltd. DYSLEXIA 10: 364–384 (2004)
378 K. Ghelani et al.

sion for expository text may be difficult for the ADHD group (McInnes,
Humphries, Hogg-Johnson, & Tannock, 2003). Further research is needed to
assess whether different reading conditions produce different patterns of results
for this population.

Clinical Relevance
Findings from the present study have important clinical and educational
implications for assessment and intervention, particularly for adolescents with
a reading disability (RD only and RD+ADHD) who were impaired across reading
measures. This investigation highlights the need to include a number of different
reading skill measures when conducting psychoeducational assessments rather
than relying solely on measures of untimed isolated sight word reading and
decoding. Reading problems for adolescents with reading rate deficiencies are
frequently missed on psychoeducational assessments. Reading comprehension
tasks that assess reading rate, oral decoding, and prosody, as well as silent
reading tasks that reflect classroom reading, should be included in the
assessment. There are also limitations to the current standardized reading
comprehension measures, however. For example, although the presentation
format (i.e. silent reading, multiple-choice questions) of the GSRT is common
within the secondary classroom, the content of the GSRT may not be. The
narrative passages that are used are relatively short compared to typical passages
that are required reading in secondary school texts. In addition, the questions
may draw on the reader’s background knowledge and allow the reader to infer
the correct answers without actually reading the passage.
Standardized tests introduce a number of confounds. For example, on the silent
reading task, the reader is allowed to refer back to the passage in order to answer
the multiple-choice questions unlike the oral reading condition where the text is
not available for referral. There is less demand on working memory in the silent
passage format. Working memory, which is important for complex cognitive
activities (Gathercole & Pickering, 2000), has been documented as being
problematic in both RD and ADHD populations (Barkley, 1997; de Jong, 1998;
Mariani & Barkley, 1997; Martinussen, Hayden, Hogg-Johnson, & Tannock, in
press). A critical lens is necessary to differentiate the cognitive processes required
by the various reading tests.
A slower reading rate, as evident in the RD groups (RD only and ADHD+RD),
presents a severe challenge for the adolescent who is required to read longer
passages and increasingly difficult text. Expository passages (i.e. scientific text)
demand different cognitive abilities (McInnes et al., 2003) and may place
increased demands on working memory and attentional processes, which may, in
turn, have a detrimental impact on reading rate. Some adolescents may not be
identified as having reading comprehension difficulties in the early grades but, as
they face increasingly complex text, their rate inefficiencies may prevent them
from keeping pace with the amount of required reading.
Slower processing speed has implications for classroom accommodations,
particularly the provision of extra time allotments. Extra time provisions are
routinely granted to adolescents with learning difficulties as they require more
time to decipher print. For the ADHD group, this recommendation has been
based on considerations of behavioral symptoms (i.e. the adolescent is easily

Copyright # 2004 John Wiley & Sons, Ltd. DYSLEXIA 10: 364–384 (2004)
Reading Disability in Adolescents 379

distracted and therefore needs more time to accomplish his work). For students
who have both inattention and reading difficulties, being provided with
additional time is important.

Recommendations for Intervention

The National Reading Panel (NRP, 2000) formed by the National Institute of
Child Health and Human Development (NICHD) in the United States rigorously
examined the scientific basis for instruction of text comprehension. The report
that followed recommended a number of strategies that have been found to be
effective in improving reading comprehension. These strategies include
approaches such as: comprehension monitoring; teaching metacognitive skills;
providing relevant prior knowledge; using graphic organizers to decrease
memory requirements; question answering, generation, and summarization;
and the use of multiple strategies. The report also emphasized the need for
teachers to use an active and directive approach when introducing these
strategies.
Although there is exciting data indicating that significant improvement can be
made in ameliorating phonological reading deficits (Lovett et al., 1994; Lovett,
Barron, & Benson, 2003), fluency is often more difficult to remediate (Meyer &
Felton, 1999; Wolf & Katzir-Cohen, 2001). Torgesen et al. (2001) found that
individuals with reading disorders who have ‘remediated’ decoding abilities
continue to be very slow, nonfluent readers. Chard, Vaughn, and Tyler (2002)
conducted a meta-analysis of interventions for increasing reading rate and found
that repeated oral reading was critical to improving reading comprehension.
Their study also suggested the importance of having a teacher model reading
fluency by reading aloud and also the importance of providing the opportunity
for rereading text many times to many different people. Reading progressively
more difficult text, with feedback and correction for missed words, is essential for
improving fluency. Increased practice in fluency can also be supplemented
through innovative software programs such as the Kurzweil 3000TM (Kurzweil
Educational Systems, 2000) which allows the struggling reader the opportunity to
hear high-interest, low vocabulary material while reading along silently. The
benefit of using Kurzweil 3000TM with post-secondary students with ADHD has
been described by Hecker, Elkind, Elkind, and Katz (2002).

Study Limitations
The authors of this investigation recognize that reading comprehension is a
complex activity and that several important cognitive processes that can impact
on reading comprehension such as attention, working memory, and linguistic
processes were not included in this study. Furthermore, this study did not use
reading comprehension measures that might have reflected actual classroom
reading tasks such as longer expository passages.
This study did not control for comorbid language impairments in the RD
group. These impairments may possibly explain this group’s pervasive
impairment on reading measures. Reading Disability is a very heterogeneous
disorder with different subtypes that may or may not include higher order

Copyright # 2004 John Wiley & Sons, Ltd. DYSLEXIA 10: 364–384 (2004)
380 K. Ghelani et al.

linguistic processing deficits. Another limitation of this study is that most of the
sample of ADHD adolescents belonged to the Inattentive type. Many of these
adolescents received a childhood diagnosis of Combined subtype but no longer
met criteria for that diagnosis. Therefore, our results may not be generalizable to
adolescents who are currently diagnosed with the Combined subtype. It would
be important to include a larger sample of this subtype in future research to
assess whether there are differences in cognitive processing abilities between the
Inattentive subtype and the Combined subtype of ADHD.
An additional limitation of this study is that many of the normal controls were
recruited through referrals from hospital employees. Therefore, the normal
comparison group may not be as representative as perhaps a group of
adolescents recruited through the same local schools as the clinical groups.
Unfortunately many struggling adolescent readers fall further and further
behind their normal reading peers. The tragic outcome is that many of
these adolescents become completely uninterested in the reading process and
may eventually drop out of school. Continued investigation and understan-
ding of the cognitive processes required for reading at this age is critical for
the design of appropriate interventions to specifically target areas of weakness. It
is only through building a bridge from research to the classroom application that
we can hope to help these adolescents become ‘enabled’ rather than ‘disabled’
readers.

ACKNOWLEDGEMENTS

This research was completed as part of a doctoral dissertation by Karen Ghelani,

University of Toronto, Toronto, Ontario, Canada. This research was supported by
the International Dyslexia Association Research Grant Award 2002 to K. G. and
R. T. We would like to acknowledge the contribution of the families who
participated in this study.

References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental
Disorders, 4th edition- text revision. Washington, DC: American Psychiatric Association.
Barkley, R. (1997). ADHD and the nature of self-control. New York: Guilford Press.
Berninger, V., Abbott, R., Billingsley, F., & Nagy, W. (2001). Processes underlying timing
and fluency in reading: Efficiency, automaticity, coordination, and morphological
awareness. In M. Wolf (Ed.), Dyslexia, fluency, and the brain (pp. 383–414). Timonium,
Maryland: York Press, Inc.
Bowers, P., & Newby-Clark, E. (2002). The role of naming speed within a model of reading
acquisition. Reading and Writing: An Interdisciplinary Journal, 15, 109–126.
Boyle, M. H., Offord, D. R., Racine, Y., Fleming, J. E., Szatmari, P., & Sanford, M. (1993).
Evaluation of the Revised Ontario Child Health Study Scales. Journal of Child Psychology
and Psychiatry, 34, 189–213.
Bruck, M. (1992). Persistence of dyslexic’s phonological awareness deficits. Developmental
Psychology, 28, 874–886.
Brock, S., & Knapp, P. (1996). Reading comprehension abilities of children with attention-
deficit/hyperactivity disorder. Journal of Attention Disorders, 1, 173–186.

Copyright # 2004 John Wiley & Sons, Ltd. DYSLEXIA 10: 364–384 (2004)
Reading Disability in Adolescents 381

Cain, K., Oakhill, J., & Bryant, P. (2000). Phonological skills and comprehension failure: A
test of phonological processing deficit hypothesis. Reading and Writing: An Interdisciplinary
Journal, 13, 31–56.
Carte, E., Nigg, J., & Hinshaw, S. (1996). Neuropsychological functioning, motor speed,
and language processing in boys with and without ADHD. Journal of Abnormal Child
Psychology, 24, 481–498.
Chard, D., Vaughn, S., & Tyler, B. (2002). A synthesis of research on effective interventions
for building fluency with elementary students with learning disabilities. Journal of Learning
Disabilities, 35, 386–406.
Cherkes-Julkowski, M., Stolzenberg, J., Hatzes, N., & Madaus, J. (1995). Methodological
issues in assessing the relationship among ADD, medication effects and reading
performance. Learning Disabilities: A Multidisciplinary Journal, 6, 21–30.
Chhabildas, N., Pennington, B., & Willcutt, E. (2001). A comparison of the neuropsycho-
logical profiles of the DSM-IV subtypes of ADHD. Journal of Abnormal Child Psychology, 29,
529–540.
Conners, C. K. (1997). Conners’ rating scales-revised: Technical manual. New York: Multi-
Health Systems Inc.
Denckla, M., & Rudel, R. (1974). Rapid ‘automatized’ naming of pictured objects, colors,
letters and numbers by normal children. Cortex, 10, 186–202.
de Jong, P. (1998). Working memory deficits of reading disabled children. Journal of
Experimental Child Psychology, 70, 75–96.
Fawcett, A., & Nicolson, R. (2001). Speed and temporal processing in dyslexia. In M. Wolf
(Ed.), Dyslexia, fluency, and the brain (pp. 23–40). Timonium, Maryland: York Press, Inc.
Fleiss, J. (1999). Design and analysis of clinical experiments. New York: John Wiley and Sons.
Fletcher, J., Francis, D., Shaywitz, S., Lyon, G., Foorman, B., Stuebing, K., & Shaywitz, B.
(1998). Intelligent testing and the discrepancy model for children with learning disabilities.
Learning Disabilities Research & Practice, 13, 186–203.
Fletcher, J., Shaywitz, S., Shankweiler, D., Katz, L., Liberman, I., Stuebing, K., Francis,
D., Fowler, A., & Shaywitz, B. (1994). Cognitive profiles of reading disability: Comparisons
of discrepancy and low-achievement definitions. Journal of Educational Psychology,
86, 6–23.
Fletcher, J., Shaywitz, S., & Shaywitz, B. (1999). Comorbidity of learning and attention
disorders. Separate but equal. Pediatric Clinical North America, 46, 885–897.
Frankenberger, W., & Fronzaglio, K. (1991). A review of states’ criteria for identifying
children with learning disabilities. Journal of Learning Disabilities, 24, 495–500.
Gathercole, S., & Pickering, S. (2000). Working memory deficits in children with low
achievements in the national curriculum at 7 years of age. British Journal of Educational
Psychology, 70, 177–194.
Green, S., Salkind, N., & Akey, T. (2000). Using SPSS for windows. NJ: Prentice-Hall.
Hecker, L., Elkind, J., Elkind, K., & Katz, L. (2002). Benefits of assistive reading software for
students with attention disorders. Annals of Dyslexia, 52, 2002.
Kaufman, J., Birmaher, B., Brent, D., Rao, U., Flynn, C., Moreci, P., Williamson, D., & Ryan,
N. (1997). Schedule for affective disorders and schizophrenia for school-age children-
present and lifetime version (K-SADS-PL): Initial reliability and validity data. Journal of the
American Academy of Child and Adolescent Psychiatry, 36, 980–988.
Kuntsi, J., Eley, T., Taylor, A., Hughes, C., Asherson, P., Caspi, A., & Moffitt, T. (2004).
Co-occurrence of ADHD and low IQ has genetic origins. American Journal of Medical
Genetics Part B (Neuropsychiatric Genetics), 124B, 41–47.
Kurzweil Educational Systems. (2002). Kurzweil 3000TM . Burlington, MA: Kurzweil
Educational Systems.
LaBerge, D., & Samuels, S. (1974). Toward a theory of automatic information processing in
reading. Cognitive Psychology, 6, 293–323.

Copyright # 2004 John Wiley & Sons, Ltd. DYSLEXIA 10: 364–384 (2004)
382 K. Ghelani et al.

Lovett, M. W., Barron, R. W., & Benson, N. J. (2003). Effective remediation of word
identification and decoding difficulties in school-age children with reading disabilities.
In H. L. Swanson, K. R. Harris, & S. Graham (Eds.), Handbook of learning disabilities
(pp. 273–292). New York: Guilford Press.
Lovett, M. W., Borden, S. L., Deluca, T., Lacerenza, L., Benson, N. J., & Brackstone, D.
(1994). Treating the core deficits of developmental dyslexia: Evidence transfer of learning
after phonologically and strategy-based reading training programs. Journal of Develop-
mental Psychology, 30(6), 805–822.
Mariani, M. A., & Barkley, R. A. (1997). Neuropsychological and academic functioning in
preschool boys with attention deficit hyperactivity disorder. Developmental Neuropsycho-
logy, 13, 111–129.
Martinussen, R., Hayden, J., Hogg-Johnson, S., & Tannock, R. (in press). A meta-analysis of
working memory impairments in children with attention-deficit hyperactivity disorder.
Journal of the American Academy of Child and Adolescent Psychiatry.
McGee, R., Prior, M., Williams, S., Smart, D., & Sanson, A. (2002). The long-term
significance of teacher-rated hyperactivity and reading ability in childhood: Findings from
two longitudinal studies. Journal of Child Psychology and Psychiatry, 43, 1004–1017.
McInnes, A., Humphries, T., Hogg-Johnson, S., & Tannock, R. (2003). Listening
comprehension and working memory are impaired in attention-deficit hyperactivity
disorder irrespective of language impairment. Journal Abnormal Child Psychology, 31,
427–443.
Meyer, M., & Felton, R. (1999). Repeated reading to enhance fluency: Old approaches and
new directions. Annals of Dyslexia, 49, 283–306.
National Reading Panel. (2000). Reports of the subgroups. Washington, DC: National
Institute of Child Health and Human Development Clearing House.
Perfetti, C. (1985). Reading ability. New York: University Oxford Press.
Posner, M. (1988). Structures and function of selective attention. In T. Boll, & D. Bryant
(Eds.), Clinical neuropsychology and brain function: Research, assessment, and practice (pp. 173–
203). Washington, DC: American Psychiatry Association.
Posner, M., & Peterson, S. (1990). The attention system of the human brain. Annual Review
of Neuroscience, 13, 25–42.
Purvis, K. L., & Tannock, R. (1997). Language abilities in children with attention deficit
hyperactivity disorder, reading disabilities, and normal controls. Journal of Abnormal Child
Psychology, 25, 133–134.
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, 485–494.
Rabiner, D., & Coie, J. (2000). Early attention problems and children’s reading
achievement: A longitudinal investigation. Journal of the American Academy of Child and
Adolescent Psychiatry, 39, 859–867.
Ransby, M., & Swanson, H. (2003). Reading comprehension skills of young adults with
childhood diagnoses of dyslexia. Journal of Learning Disabilities, 36(6), 538–555.
Rucklidge, J., & Tannock, R. (2002). Neuropsychological profiles of adolescents with
ADHD: Effects of reading difficulties and gender. Journal of Child Psychology and Psychiatry,
43, 988–1003.
Semrud-Clikeman, M., Guy, K., Griffin, J., & Hynd, G. (2000). Rapid naming deficits in
children and adolescents with reading disabilities and attention deficit hyperactivity
disorder. Brain and Language, 74, 70–83.
Shaywitz, S. E., & Shaywitz, B. A. (June 2003). The science of reading and dyslexia. Journal
of American Association for Pediatric Ophthalmology and Strabismus, 7(3), 158–166.
Siegel, L., & Heaven, R. (1986). Categorization of learning disabilities. In S. J. Ceci (Ed.),
Handbook of cognitive, social, and neuropsychological aspects of learning disabilities, Vol. 1
(pp. 95–121). Hillsdale, N.J.: Erlbaum.

Copyright # 2004 John Wiley & Sons, Ltd. DYSLEXIA 10: 364–384 (2004)
Reading Disability in Adolescents 383

Simmons, F., & Singleton, C. (2000). The reading comprehension abilities of dyslexic
students in higher education. Dyslexia, 6, 178–192.
Snowling, M. (2001). From language to reading and dyslexia. Dyslexia, 7, 37–46.
Stanovich, K. (2000). Progress in understanding reading. New York: Guilford Press.
Stanovich, K., & Siegel, L. (1994). The phenotypic performance profile of reading-disabled
children: A regression-based test of the phonological-core variable-difference model.
Journal of Educational Psychology, 86, 24–53.
Stuss, D., Floden, D., Alexander, M., Levine, B., & Katz, D. (2001). Stroop performance in
focal lesion patients: Dissociation of processes and frontal lobe lesion location.
Neuropsychologia, 39, 771–786.
Tabachnick, B., & Fidell, L. (2001). Using multivariate statistics (4th edn). Toronto: Allyn and
Bacon.
Tannock, R., Martinussen, R., & Frijters, J. (2000). Naming speed performance and
stimulant effects indicate effortful, semantic processing deficits in attention-deficit/
hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 28,
237–252.
Torgesen, J., Alexander, A., Wagner, R., Rashotte, C., Voeller, K., & Conway, T. (2001).
Intensive remedial instruction for children with severe reading disabilities. Journal of
Learning Disabilities, 34, 33–58.
Wagner, R., Torgesen, J., & Rashotte, C. (1999a). Test of Word Reading Efficiency: Examiner’s
manual. Austin, Texas: Pro-Ed.
Wagner, R., Torgesen, J., & Rashotte, C. (1999b). Comprehensive test of phonological processing:
Examiner’s manual. Austin, Texas: Pro-Ed.
Warner-Rogers, J., Taylor, A., Taylor, E., & Sandberg, S. (2000). Inattentive behavior in
childhood: Epidemiology and implications for development. Journal of Learning Disabilities,
33, 520–536.
Wechsler, D. (1999). Wechsler abbreviated scale of intelligence. New York: Psychological
Corporation.
Wiederholt, J., & Blalock, G. (2000). Gray silent reading tests. Austin, Texas: Pro-ed.
Wiederholt, J., & Bryant, B. (2001). Gray oral reading tests. Austin, Texas: Pro-ed.
Weiler, M., Bernstein, J., Bellinger, D., & Waber, D. (2000). Processing speed in children
with attention deficit/hyperactivity disorder, inattentive type. Child Neuropsychology, 6,
218–234.
Weiler, M., Bernstein, J., Bellinger, D., & Waber, D. (2002). Information processing deficits
in children with attention-deficit/hyperactivity disorder, inattentive type, and children
with reading disability. Journal of Learning Disabilities, 35, 448–461.
Werry, J., Reeves, J., & Elkind, G. (1987). Attention deficit, conduct, oppositional, and
anxiety disorders in children: I. A review of research differentiating characteristics. Journal
of the American Academy of Child and Adolescent Psychiatry, 26, 133–143.
Willcutt, E., Pennington, B., Boada, R., Ogline, J., Tunick, R., Chhabildas, N., Olson, R.
(2001). A comparison of the cognitive deficits in reading disability and attention deficit/
hyperactivity disorder. Journal of Abnormal Psychology, 110, 157–172.
Willcutt, E., Pennington, B., & DeFries, J. (2000). Etiology of inattention and hyperactivity/
impulsivity in a community sample of twins with learning difficulties. Journal of Abnormal
Child Psychology, 28, 149–159.
Willcutt, E. G., Pennington, B. F., Olson, R. K., Chhabildas, N., & Hulslander, J. (in press).
Neuropsychological analyses of comorbidity between reading disability and attention-deficit/
hyperactivity disorder: In search of the common deficit. Developmental Neuropsychology.
Wolf, M., & Bowers, P. (1999). The double-deficit hypothesis for the developmental
dyslexias. Journal of Educational Psychology, 91(3), 415–438.
Wolf, M. (1999). What time will tell: Towards a new conceptualization of developmental
dyslexia. Annals of Dyslexia, 49, 3–28.

Copyright # 2004 John Wiley & Sons, Ltd. DYSLEXIA 10: 364–384 (2004)
384 K. Ghelani et al.

Wolf, M., & Goodglass, H. (1986). Dyslexia, dysnomia, and lexical retrieval. Brain and
Language, 27, 360–379.
Wolf, M., & Katzir-Cohen, T. (2001). Reading fluency and its intervention. Scientific Studies
of Reading, 5(3), 211–239.
Wolf, M., & Obrego! n, M. (1992). Early naming deficits, developmental dyslexia, and a
specific deficit hypothesis. Brain and Language, 42, 219–247.
Wolf, M., O’Rourke, Gidney, C., Lovett, M., Cirino, P., & Morris, R. (2002). The second
deficit: An investigation of the independence of phonological and naming-speed deficits in
developmental dyslexia. Reading and Writing: An Interdisciplinary Journal, 15, 43–72.
Woodcock, R. (1998). Woodcock reading mastery tests-revised/NU. American Guidance
Service. Minnesota: Circle Pines.
Young, A., & Bowers, P. (1995). Individual difference and text difficulty determinants of
reading fluency and expressive. Journal of Experimental Child Psychology, 60, 428–454.

Copyright # 2004 John Wiley & Sons, Ltd. DYSLEXIA 10: 364–384 (2004)