Interventions for Children With Attention and Reading Disorders (ICARD)

The purpose of this research was to learn about the best treatment approaches for children who have both Attention Deficit Hyperactivity Disorder (ADHD) and serious reading difficulties (RD).  ADHD and RD are common childhood disorders and frequently co-occur. A number of studies suggest that students who have both disorders have even more severe academic and social difficulties and higher school dropout rates than students who have only RD or only ADHD. Nevertheless, there has very little research on interventions for students with both conditions. Educators, physicians, clinicians, and parents need to know:

• Whether it is sufficient to provide these students with supplemental reading interventions without directly treating the ADHD
• Whether students’ reading outcomes will improve with ADHD treatments alone, without supplemental reading intervention
• Whether students need treatments for both ADHD and RD. This study is comparing student outcomes when students receive treatment for ADHD only, RD only, or the combination of the two

Both the ADHD and RD treatments have already been found to be effective for students who have a single disorder, and it is not our purpose to test a new experimental approach. We provided these effective treatments either alone or in combination to find out whether students with both RD and ADHD need to be treated for both conditions or whether they will respond well to reading intervention or ADHD treatment alone.

Children who have both ADHD (either inattentive or combined type) and serious reading difficulties (RD) were identified at participating schools. If their parents agreed to participate in the study, these children were randomly assigned to receive either:

• ADHD treatment alone
• RD treatment alone
• Both ADHD and RD treatment

Children’s inattention, reading performance, and other related outcomes were assessed before and after the intervention to compare the effects of the three treatment approaches.  The interventions were provided for 16 weeks.

• ADHD Treatment.  Children who were assigned to the ADHD treatment group received two kinds of treatment. The first was medication that was fully approved by the FDA for the treatment of ADHD.  The medication prescribed and carefully monitored by the study physicians. Using frequent feedback from parents and teachers about the students’ ADHD symptoms and any side effects they experienced, the doctors found the best medication and the optimal dose of the medication to support each child.  The second component of the ADHD treatment was a parent class designed to help parents understand ADHD and provide them with strategies for working with their children at home. The classes were provided by project psychologists. Parents were asked to attend nine sessions, including one joint meeting with the psychologist, parents, and the child’s classroom teacher to discuss home-school communication strategies.
• Reading Treatment. Children who were assigned to receive the reading treatment were provided with small-group intensive reading instruction four days per week for 45 minutes per day, either individually or in groups of two students with one teacher.  The intervention included a focus on (a) phonemic awareness, phonics and word reading; (b) reading fluency; and (c) reading comprehension. The amount of time the teacher spent working on each area depended on the need of each child.  The programs used in the intervention were all supported by scientific reading research, which has found that they are generally effective for students with reading difficulties and disabilities.
• Combined Treatment. Children who were assigned to the combined treatment group received both the ADHD and reading treatments described above.

CLI Faculty:

Linda Ewing-Cobbs, Ph.D., Mary Prasad, Ph.D.

Principal Investigator:

Carolyn Denton, PhD, University of Texas Health Science Center at Houston (UTHealth Houston)

Co-Investigator:

Jeff Epstein, PhD, Cincinnati Children’s Hospital Medical Center, Leanne Tamm, PhD, Cincinnati Children’s Hospital Medical Center, Aaron Vaughn, PhD, Cincinnati Children’s Hospital Medical Center, Linda Ewing-Cobbs, PhD, University of Texas Health Science Center at Houston (UTHealth Houston), Anson Koshy, MD, University of Texas Health Science Center at Houston (UTHealth Houston), Mary Prasad, PhD, University of Texas Health Science Center at Houston (UTHealth Houston), Heather Taylor, PhD, University of Texas Health Science Center at Houston (UTHealth Houston)

Participating Sites:

The study was conducted in the greater Houston and Cincinnati areas. In Houston, participating schools included private schools and independent charter schools, as well as schools in the Alvin and Fort Bend school districts.

Results:

Data collection and data analyses has concluded.

DISES 2018 Denton & Tamm ADHD + RD

Publications:

Denton, C.A., Tamm, L., Schatschneider, C., & Epstein, J.N. (2020). The effects of ADHD treatment and reading intervention on the fluency and comprehension of children with ADHD and word reading difficulties: A randomized clinical trial. Scientific Studies of Reading, 24, 72-89. DOI: 10.1080/10888438.2019.1640704.PMCID: PMC7518569

Mano, Q. R., Jastrowski Mano, K. E., Tamm, L., Denton, C. A., & Esptein, J. N. (2017). Gender moderates association between emotional-behavioral problems and text comprehension in children with both reading difficulties and ADHD.  Psychology in the Schools, 54.5 (2017): 504-518. PMCID: PMC5526612

Tamm, L., Denton, C.A., Epstein, J.N., Schatschneider, C., Taylor, H., Arnold, L.E., Bukstein, O., Anixt, J., Koshy, A., Newman, N.C., Maltinsky, J., Brinson, P., Loren, R.E.A., Prasad, M.R., Ewing-Cobbs, L., & Vaughn, A. (2017). Comparing treatments for children with ADHD and word reading difficulties: A randomized clinical trial. Journal of Consulting and Clinical Psychology, 85, 434-446. PMCID: PMC5398

Tamm, L., Epstein, J.N., Denton, C.A., Vaughn, A., Peugh, J., & Willcutt, E. (2014). Reaction time variability associated with reading skills in poor readers with ADHD. Journal of the International Neuropsychological Society, 20, 292-301. PMCID: PMC3963392