Examining the Co-morbidity of Behavioral Problems and Reading Difficulties Among Elementary School Children

1. American Indian of Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Is. White 4% 4% 12% 1% 49% English Spanish Other English and Spanish Equally English and Other Equally 49% 35% 11% 5% 1% Examining the Co-morbidity of Behavioral Problems and Reading Difficulties Among Elementary School Children A. Wechsler1, M. Pierce2, T. Katzir2, M. Wolf3, G. Noam1 1McLean Hospital, 2Harvard University, 3Tufts University INTRODUCTION RESULTS: Continued 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. 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 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. 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. RESEARCH QUESTIONS • What is the prevalence of specific problem behaviors among at-risk readers who exhibit maladaptive behaviors in the classroom? • Do struggling readers who exhibit problem behaviors in school show different literacy profiles than struggling readers who do not exhibit problem behaviors? • 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] PARTICIPANTS • 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 • Table 1. Percentage of children identified by parents as belonging to race categories Figure 6. Means on literacy measures* for groups with elevated and non-elevated scores on the Social Problems Dimension of the CTRS-S. • 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] Table 2. Percentage of children identified by parents as belonging to first language categories Figure 3. Means on literacy measures* for groups with elevated and non-elevated scores on the Hyperactivity Dimension of the CTRS-S. Other languages: Portuguese, Vietnamese, Cambodian, Armenian, Russian, Swahili, Tagalog • Social Problems • Students with elevated T scores for Social Problems performed significantly lower than non-elevated counterparts on: • Expressive Vocabulary (Word-R) [F(1,138)=5.2, p=.024] MEASURES • 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) 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] • 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 non-elevated 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 non-elevated counterparts only on expressive vocabulary. RESULTS: Prevalence of Problem Behaviors Figure 1. Number of subjects exhibiting elevated and non-elevated scores on the CTRS-S. Figure 4. Means on literacy measures* for groups with elevated and non-elevated scores on the Conners’ ADHD Index of the CTRS-S. 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. . • Conners’ ADHD Index • Students with elevated T scores for Conners’ ADHD performed significantly lower than non-elevated 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] • 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 Email: wechsler@post.harvard.edu