Children with ADHD often struggle with reading comprehension. They tend to exhibit weaknesses in decoding skills that allow translating print into speech sounds, as well as language comprehension abilities needed to construct meaning from texts.
Attention deficits may further hamper their capacity to focus on reading tasks. It is unclear whether these reading-related struggles fully explain comprehension difficulties in ADHD or if other attentional factors uniquely contribute.
Cole, A. M., Chan, E. S. M., Gaye, F., Spiegel, J. A., Soto, E. F., & Kofler, M. J. (2023). Evaluating the simple view of reading for children with attention-deficit/hyperactivity disorder. Journal of Educational Psychology, 115(5), 700–714. https://doi.org/10.1037/edu0000806
Key Points
- The study tested key predictions from the Simple View of Reading (SVR), which states that decoding skills and language comprehension together fully explain reading comprehension performance.
- Latent estimates of decoding and language comprehension accounted for 94-100% of the variance in reading comprehension in both children with ADHD and a clinical comparison group.
- The findings support the validity of the SVR even for children with ADHD who showed weaker decoding skills.
- Both decoding and language comprehension were equally necessary predictors in both groups of children.
Rationale
The Simple View of Reading (SVR) is a well-established model stating that decoding skills and linguistic comprehension fully explain reading comprehension performance across development (Gough & Tunmer, 1986; Lonigan et al., 2018). However, most SVR research has focused on typical developmental samples.
Children with ADHD exhibit reading difficulties across all SVR components – decoding, language comprehension, and reading comprehension. However, it’s unclear if the SVR fully explains their reading comprehension difficulties (Brock & Knapp, 1996; Miller et al., 2013).
One study found decoding and language comprehension explained only 38-55% of the variance in reading comprehension among adolescents with ADHD, suggesting the SVR may not be sufficient in this population (Mackenzie, 2019).
The current study addresses gaps and limitations of the prior study to test key SVR predictions in a carefully diagnosed childhood ADHD sample using latent variables and multiple indicators of each construct.
If upheld even in ADHD, it would indicate reading interventions targeting decoding and linguistic comprehension may also benefit children with attention and behavior disorders.
Method
Sample
The study included 250 children ages 8-13 years recruited from 2013-2021. Of those, 154 children met DSM-5 criteria for ADHD based on clinical interviews and parent/teacher ratings.
An additional 96 children were included as a clinical comparison group, 38.5% of whom were typically developing and 61.5% had other psychological disorders (besides ADHD).
Statistical measures
Latent variable structural equation modeling (SEM) was used to test relations between latent constructs of decoding, language comprehension, and reading comprehension.
Each latent variable consisted of 2-3 observed variable indicators from standardized achievement tests. Multigroup SEM was used to compare model fit between children with and without ADHD.
Results
A full sample measurement model showed all indicators loaded significantly onto the reading comprehension, decoding, and language comprehension latent constructs (standardized factor loadings 0.72 to 0.96, all p < .001).
In the full sample structural model, decoding and language comprehension both uniquely predicted reading comprehension (beta weights = 0.52, p < .001) and together explained 99% of its variance.
The multigroup structural model showed adequate fit constraining model pathways to equality across ADHD/non-ADHD groups. For children with ADHD, decoding and language comprehension explained 94% of the variance in reading comprehension. For non-ADHD children, 100% of reading comprehension variance was explained.
Constraining reading comprehension disturbance terms (R-squared values representing unexplained variance) to equality and then 100% across groups did not worsen model fit. This indicates decoding and language comprehension fully explain reading comprehension skills for children with ADHD similarly to other clinical groups.
In summary, consistent with SVR predictions, decoding, and language comprehension were equally necessary and together sufficient to explain reading comprehension performance across groups.
Insight
A key insight is that decoding skills and linguistic comprehension, the two components of the “simple view of reading,” fully explain variance in reading comprehension performance for children with ADHD.
Remarkably, these components were sufficient to account for over 90% of reading comprehension skills, even in children exhibiting ADHD-related weaknesses in foundational decoding abilities.
The findings contradict an assumption that additional cognitive factors like working memory or executive functions are needed to fully understand reading difficulties in ADHD. Instead, they align with a large developmental literature upholding the simple view of reading across ages and skill levels.
This suggests a root cause of ADHD reading problems may lie in the building blocks of reading itself – translating print into speech sounds and making sense of language.
On an applied level, the full explanatory power of decoding/linguistic comprehension has encouraging implications for reading interventions in ADHD. It indicates focusing training specifically on these two pillars of reading comprehension may pay dividends for real-world academic outcomes.
Emerging evidence supports this, with decoding interventions producing reading comprehension gains for children with ADHD comparable to or even exceeding typical readers.
In summary, the simple view of reading held up remarkably well in this childhood ADHD sample known to exhibit reading weakness. Latent decoding and language comprehension constructs almost fully explained their reading comprehension difficulties, reinforcing these skills as key levers for literacy interventions.
Strengths
The study had several notable methodological strengths.
The sample comprised carefully diagnosed children with and without ADHD, enabling stronger conclusions regarding processes specifically implicated in ADHD. Approximately 40% of the ADHD sample had suspected learning disorders; retaining them improved generalizability given high reading disorder comorbidity in ADHD.
The study improved upon limitations of past ADHD research by using latent variable analysis. Creating latent constructs of each simple view component based on multiple observed indicators reduces task-specific variance and better captures the breadth of each skill.
It also extended the simple view literature by testing key predictions in an understudied clinical population using the same standardized achievement tests used to identify reading disorders in schools.
As the largest investigation of the simple view of reading in childhood ADHD to date, it provided a rigorous test of longstanding theoretical assumptions.
The multigroup analysis allowed direct statistical comparisons between children with and without ADHD to quantify the veracity of the simple view of reading in ADHD specifically.
Finally, the study probed the conceptual boundaries of the simple view by testing the sufficiency of decoding and linguistic comprehension. This was done by modeling the percentage of reading comprehension variance explained rather than just predicting outcomes.
The remarkably high R-squared values reinforce decoding and language as necessary and sufficient pillars underlying reading comprehension.
Limitations
Some limitations should be considered when interpreting the results.
Measures came from a single assessment battery and testing session. Using multiple tests and occasions would reduce shared method effects. However, controlling for other academic skills measured concurrently did not alter results.
The sample spanned a large age and grade range (2nd-7th grade). Although results held for both older and younger cohorts, future research should test whether contributions of decoding versus linguistic comprehension to reading change developmentally in ADHD as found for typical readers.
The complexity of reading comprehension increases over childhood into adolescence. While this study showed the simple view explains literal understanding of texts for children with ADHD, additional higher-order comprehension skills may require updated models in older readers.
The clinical comparison group contained a spectrum of disorders (besides ADHD), improving specificity but limiting comparability to typically developing children. Replications with additional typical groups would be beneficial.
Finally, the study provided a rigorous test of key simple view of reading predictions but did not examine more complex models or additional skills hypothesized to relate to the reading difficulties seen in ADHD.
Future work should investigate which capabilities specifically enable or constrain decoding and linguistic comprehension.
Implications
This study carries meaningful implications for research and practice. On a theoretical level, the findings clearly uphold the validity of the simple view of reading for explaining reading comprehension performance in children with ADHD.
Contrary to hypotheses, decoding and linguistic comprehension were just as sufficient in accounting for variance in an ADHD sample known to exhibit reading weaknesses.
By showing the simple view holds even in ADHD, the research underscores decoding and linguistic comprehension as pivotal levers for improving academic comprehension outcomes.
It suggests skill deficits in these two reading pillars may represent a root cause of ADHD literacy difficulties, rather than solely downstream consequences of attention control or behavioral issues.
The relative importance of decoding/linguistic comprehension did not vary by ADHD diagnosis or differ across age cohorts spanning 2nd-7th grade.
On an applied level, the full explanatory sufficiency of the simple view components echoes emerging intervention research showing strong reading comprehension gains in ADHD from programs targeting decoding skills specifically.
It suggests that despite neurocognitive weaknesses, evidence-based reading interventions focused on linguistic comprehension and decoding skill-building may prove just as beneficial for children with attention/behavior disorders.
Future research should further explore which specific capabilities enable or hinder growth in the decoding and linguistic comprehension pillars to better inform the design of literacy interventions for struggling readers with ADHD.
Additional longitudinal and intervention studies are needed to flesh out developmental implications. But these initial results provide an encouraging proof of concept – the simple view’s promise likely extends to improving real-world reading outcomes even among children facing additional learning barriers.
References
Primary reference
Cole, A. M., Chan, E. S. M., Gaye, F., Spiegel, J. A., Soto, E. F., & Kofler, M. J. (2023). Evaluating the simple view of reading for children with attention-deficit/hyperactivity disorder. Journal of Educational Psychology, 115(5), 700–714. https://doi.org/10.1037/edu0000806
Other references
Brock, S. E., & Knapp, P. K. (1996). Reading comprehension abilities of children with attention-deficit/hyperactivity disorder. Journal of Attention Disorders, 1(3), 173–185. https://doi.org/10.1177/108705479600100305
Gough, P. B., & Tunmer, W. E. (1986). Decoding, reading, and reading disability. Remedial and Special Education, 7(1), 6–10. https://doi.org/10.1177/074193258600700104
Lonigan, C. J., Burgess, S. R., & Schatschneider, C. (2018). Examining the simple view of reading with elementary school children: Still simple after all these years. Remedial and Special Education, 39(5), 260–273. https://doi.org/10.1177/0741932518764833
Mackenzie, G. (2019). Using the Simple View of Reading to Examine Reading Comprehension Proficiency in Youth With and Without Attention Deficit Hyperactivity Disorder (Publication No. 13419554) [Doctoral dissertation, University of Toronto]. ProQuest Dissertations & Theses Global.
Miller, A. C., Keenan, J. M., Betjemann, R. S., Willcutt, E. G., Pennington, B. F., & Olson, R. K. (2013). Reading comprehension in children with ADHD: Cognitive underpinnings of the centrality deficit. Journal of Abnormal Child Psychology, 41(3), 473–483. https://doi.org/10.1007/s10802-012-9686-8
Keep Learning:
Here are some suggested Socratic discussion questions for a college class:
- How might deficits in working memory or executive functioning relate to the decoding and linguistic comprehension weaknesses exhibited by children with ADHD in this study? Are they separate predictors, underlying components, or both?
- Do you think these findings supporting the simple view of reading would generalize to other neurodevelopmental disorders like autism or intellectual disability? Why or why not?
- If future studies continue to show strong benefits from “simple view” reading interventions in ADHD, how might this inform education policies around resource allocation and where best to focus remedial efforts?
- If you could design a follow-up longitudinal study to this research, what key questions would you want to address regarding the simple view of reading across different ages and skill levels in ADHD?
