Attention Problems Lead to Reading Difficulties, Not Vice Versa

From the WebMD Archives

July 21, 2000 -- Many children with attention problems also have difficulties with reading. But which causes which: Does poor reading ability shorten a child's attention span in the classroom, or does failure to pay attention hamper the ability to read?

New research from Duke University suggests it's the latter: Young schoolchildren with attention problems were likely to later develop reading difficulties, regardless of their IQs, their earlier reading achievements, and the level of their parents' involvement in their education. By the same token, poor reading ability -- even in children as old as 12 -- did not affect a child's ability to pay attention.

"The basic conclusion is that during kindergarten and, especially, first grade, significant attention problems can contribute to a child failing to acquire early reading skills to the same extent as their peers," researcher David Rabiner, PhD, tells WebMD. "When these important skills are not acquired during first grade, it significantly increases the likelihood that they will struggle with reading in the grades ahead." Rabiner is a child clinical psychologist and senior research scientist at the Center for Child and Family Policy and the department of psychology at Duke University in Durham, N.C.

Children who have problems staying focused, or are disruptive, are sometimes categorized as having attention deficit hyperactivity disorder (ADHD). From 4% to 12% of all school-age children have ADHD, according to the American Academy of Pediatrics (AAP), making it the most common childhood neurobehavioral disorder. Problems that can result from ADHD include difficulties in school, troubled relationships with family members and peers, and behavioral problems, the AAP says.

The American Psychiatric Association lists 14 characteristics that are found in children with ADHD. For a diagnosis of the disorder, at least eight of these characteristics must be present, beginning before age 7, and must be present for at least six months. Your child may have ADHD if he or she:

  • Often fidgets or squirms
  • Has difficulty remaining seated
  • Is easily distracted
  • Has difficulty waiting his or her turn in games or group situations
  • Often blurts out answers to questions before they have been completed
  • Has difficulty following through on instructions from others
  • Has difficulty sustaining attention in tasks or play activities
  • Often shifts from one uncompleted activity to another
  • Has difficulty playing quietly
  • Often talks excessively
  • Often interrupts or intrudes on others
  • Often does not seem to listen to what is being said to him or her
  • Often loses things
  • Often engages in physically dangerous activities without considering possible consequences, and not simply for the purpose of thrill-seeking

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In the Duke study, which was published in the Journal of the American Academy of Child and Adolescent Psychiatry, researchers used periodic standardized tests to monitor the behavior and reading ability of nearly 400 children from kindergarten through fifth grade in Durham; Nashville, Tenn.; Seattle; and rural Pennsylvania. Half the children were male, and half were minorities, including 43% who were black.

The researchers discovered that among those children with large differences between their IQs and their reading achievement -- which is one of the criteria used to identify children as having a reading disability -- the percentage who were highly inattentive doubled between kindergarten and first grade. And inattentive first graders were almost three times as likely as their peers to have a discrepancy between IQ and reading ability.

Since attention problems play such an important role in the development of reading difficulties, early screening for attention problems may help identify the children most at risk of developing reading problems, Rabiner says. But sometimes it's not that easy, as not all children with attention problems behave disruptively.

"Too often, a child who is quietly inattentive in class may not be identified by teachers as having a problem, so no one may be aware that the child is not mastering these skills and needs additional help," he says.

This includes children who have the inattentive type of ADHD, which often goes undiagnosed until they are further along in school and their work has already suffered, he says. "Perhaps identifying these children earlier -- and working to make sure that their inattention is not interfering with the mastery of critical academic skills -- could be a cost-effective intervention," says Rabiner.

In recent years, there has been growing interest in ADHD, as well as concerns about possible overdiagnosis of the disorder. In its surveys of pediatricians and family physicians across the country, the American Academy of Pediatrics has found wide variations in diagnostic criteria and treatment methods for ADHD.

Several previous studies have documented a link between attention problems and difficulties in reading achievement. The Duke study offers a new wrinkle: Since the researchers followed children from kindergarten through the end of fifth grade, they were able to show that attention problems actually precede reading difficulties for many children.

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"This suggests that attention problems play a role in the reading underachievement, although this cannot be concluded with certainty," says Rabiner. Still, since the researchers also measured symptoms of hyperactivity and other emotional and behavioral problems, they were able to show more conclusively that it is inattention -- and not these other issues -- that is most clearly linked to the development of reading difficulties, he says.

The next step would be to see whether screening first graders for attention problems, followed by additional reading help for those who are highly inattentive, results in long-term gains in these children's reading achievements, Rabiner says. "We need to explore whether a little extra help for inattentive kids in first grade helps them acquire skills they would otherwise miss and promote better reading skills that can help throughout their schooling."

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