It’s a age-old question that seems to go round and round – is the reading hard because of attention problems or is it hard to pay attention because the reading is hard? For those of you who closely follow research, you probably know that there’s a high overlap between the symptoms of ADHD and reading disability (15-40% in research studies) and both are highly heritable.

A welcome addition to this area is a paper from Canada looking at the effect of medication for ADHD vs. different types of reading intervention for students age 7-11 years. The study had 65 students and was not powered to look at individual reading interventions (Phonological Analysis and Blending or Word Identification) or a control intervention (General Cognitive and Academic Strategy Training – including organization and metacognition), but could look at the general question of academic vs. medical intervention and its effect on reading performance. The reading interventions involved small group (2-3 students) pull out instruction of 35 hours over the course of 10 weeks. The medical group received twice a day methylphenidate with a 2-3 week titration phase.

FINDINGS:

MEDICATION: BENEFIT on teacher ratings of Hyperactivity-Impulsivity, but not Inattentiveness. BENEFIT on parent ratings of oppositional behavior.
NO BENEFIT on reading measures (word attack, word identification, keywords or test of transfer, and reading comprehension).

READING / ACADEMIC INTERVENTION: BENEFIT on parent ratings of Hyperactivity-Impulsivity for students receiving Phonological Analysis and Blending Intervention. BENEFIT on reading measures (word attack, keywords or test of transfer, and reading comprehension).

What about the effects of both medication + academic intervention? Data may be preliminary because of the small sample sizes between groups, but there were signs of increased benefit for both MPH + academic intervention, at least for the Phonological and Word Identification groups. The General Cognitive strategy group + MPH showed benefits for Arithmetic.

CONCLUSIONS:

“Overall, our main findings show that (a) stimulant medication is effective in improving (but not normalizing) some behavioral symptoms of ADHD in children with ADHD + RD, but it was not as effective as a stand-alone treatment in improving reading ability in the absence of concurrent reading remediation; and (b) intense reading remediation (in programs that emphasize phonological or word identification strategy training) had substantial beneficial effects on reading abilities in children with comorbid ADHD + RD, but scores were not normalized. Also we found that intense academic instruction also improved ADHD symptoms to some extent, as reported by parents, regardless of medication treatment…our findings suggest that intensive academic remediation may also contribute to improved behavior in elementary school-aged children with a clinical diagnosis of ADHD + RD.”

Clearly more research needs to be done, but the data have important practical implications. Regardless if ADHD students are on medication, if significant reading disability persists, they should receive appropriate reading intervention and their problems should not be simply attributed to ADHD.