Attention Deficit Hyperactivity Disorder, Reading Disabilities
Conditions
Brief summary
The objective of this randomized clinical trial is to address unanswered questions about the relative effectiveness of treatments for children with both Attention Deficit Hyperactivity Disorder (ADHD) and significant reading difficulties (RD). The study evaluates attentional and word reading outcomes for students with both conditions when provided with either (a) ADHD treatment alone, (b) RD treatment alone, or (c) the combination of ADHD and RD treatment.
Detailed description
The objective of this randomized clinical trial is to address unanswered questions about the relative effectiveness of treatments for children with both Attention Deficit Hyperactivity Disorder (ADHD) and significant reading difficulties (RD). The study evaluates attentional and word reading outcomes for students with both conditions when provided with either (a) disorder-specific ADHD treatment (carefully managed medication + parent training), (b) disorder-specific RD treatment (intensive, individualized reading instruction), or (c) the combination of ADHD and RD treatment. The study aims to address the relative benefits of providing either disorder-specific ADHD or RD treatment alone and providing the combined treatment. The investigators hypothesize that the combined treatment approach will result in better outcomes in terms of both word reading/decoding and a reduction in ADHD symptoms than either of the disorder-specific treatments alone. Treatment will last for 16 weeks, with assessment prior to and following treatment and some measures collected regularly throughout the intervention periods.
Interventions
DRUGMethylphenidate
Appropriate dosage to be individually determined; daily for 16 weeks
BEHAVIORALIntensive reading instruction
Individualized phonologically-based instruction delivered 4 days per week for 45 min. per day by a highly trained tutor.
BEHAVIORALParent Training
Nine sessions on parenting a child with ADHD
DRUGMixed Salt Amphetamine
Appropriate dosage to be individually determined; daily for 16 weeks; prescribed only if child does not show a beneficial treatment response to Concerta
DRUGAtomoxetine
Appropriate dosage to be individually determined; daily for 16 weeks
DRUGGuanfacine
Appropriate dosage to be individually determined; daily for 16 weeks
Sponsors
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Children's Hospital Medical Center, Cincinnati
The University of Texas Health Science Center, Houston
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
7 Years to 12 Years
Healthy volunteers
No
Inclusion criteria
1. Meet criteria for ADHD, Combined Type or ADHD, Predominantly Inattentive Type based on the Diagnostic Interview Schedule for Children, 4.0 (DISC) parent interview, Teacher baseline Swanson Nolan and Pelham Rating Scale (SNAP) endorses additional non-overlapping Inattentive symptoms with the parent DISC, which when combined with the parent ratings result in endorsement of 6 or more symptoms required for diagnosis by the Diagnostic and Statistical Manual. 2. Have at least 4 symptoms of inattention rated Often or Very Often on the teacher version of the SNAP-IV. 3. Have a standard score of 90 or lower on either the Woodcock-Johnson III Tests of Achievement Letter-Word Identification or Word Attack Subtests, or on the Basic Reading Skills Cluster 4. Attend a participating school in Grades 2-5 5. Have at least one parent or guardian who understands English well enough to participate in the behavioral parent training intervention. 6. Have a Full Scale OR Non-Verbal Intelligence Quotient (IQ) estimate higher than 70 based on the IQ Composite and Non-Verbal IQ estimate of the Kaufman Brief Intelligence Test (KBIT-2).
Exclusion criteria
1. Any documented or suspected bipolar disorder, severe psychosis, or other severe emotional disturbance, developmental disability, or autism. 2. Receipt of primary school reading instruction in a language other than English. 3. A history or presence of cardiovascular problems that would contraindicate stimulant treatment. 4. Chronic vocal tics. 5. Children will be excluded if they are taking a concomitant medication that has the potential to significantly affect their ADHD symptoms, that would be contraindicated to take along with the study medication, or if they have not been on a stable dose of a psychotropic medication long enough to fully assess the clinical outcome or tolerability.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Wechsler Individual Achievement Test-III (WIAT-III) Pseudoword Decoding Subtest | Week 16 (End of Active Treatment Phase) and Follow-Up | The WIAT-III is an individually-administered test of academic achievement. In the Pseudoword Decoding subtest students read a list of increasingly difficult nonsense words as a test of their ability to use phonics to decode unknown words. Scores reported here are standardized scores with a mean of 100 and standard deviation of 15. Higher scores represent a better outcome. |
| Swanson, Nolan, and Pelham Checklist for DSM-IV (SNAP)- Parent Rating of Inattention | 16 weeks (end of Active Treatment phase), and follow-up | Rating Scale of ADHD symptomology completed by parents and teachers. Raters evaluate how well each DSM-IV (Diagnostic and Statistical Manual) ADHD symptom describes a child on a four-point Likert scale (0=Not at all, 1=Just a little, 2=Quite a bit, 3=Very much). The measure shows adequate internal consistency (.94) and test-retest reliability (Bussing et al., 2008; Gau et al., 2008). |
| Swanson, Nolan, and Pelham Checklist for DSM-IV (SNAP)- Parent Rating of Hyperactivity-impulsivity | 16 weeks (end of Active Treatment phase), and follow-up | Rating Scale of ADHD symptomology completed by parents and teachers. Raters evaluate how well each DSM-IV (Diagnostic and Statistical Manual) ADHD symptom describes a child on a four-point Likert scale (0=Not at all, 1=Just a little, 2=Quite a bit, 3=Very much). The measure shows adequate internal consistency (.94) and test-retest reliability (Bussing et al., 2008; Gau et al., 2008). |
| Swanson, Nolan, and Pelham Checklist for DSM-IV (SNAP)- Teacher Rating of Inattention | Week 16 (End of Active Treatment Phase) and Follow-Up | Rating Scale of ADHD symptomology completed by parents and teachers. Raters evaluate how well each DSM-IV ADHD symptom describes a child on a four-point Likert scale (0=Not at all, 1=Just a little, 2=Quite a bit, 3=Very much). The measure shows adequate internal consistency (.94) and test-retest reliability (Bussing et al., 2008; Gau et al., 2008). |
| Swanson, Nolan, and Pelham Checklist for DSM-IV (SNAP)- Teacher Rating of Hyperactivity-impulsivity | Week 16 (End of Active Treatment Phase) and Follow-Up | Rating Scale of ADHD symptomology completed by parents and teachers. Raters evaluate how well each DSM-IV ADHD symptom describes a child on a four-point Likert scale (0=Not at all, 1=Just a little, 2=Quite a bit, 3=Very much). The measure shows adequate internal consistency (.94) and test-retest reliability (Bussing et al., 2008; Gau et al., 2008). |
| Wechsler Individual Achievement Test-III (WIAT-III) Word Reading Subtest | Week 16 (End of Active Treatment Phase) and Follow-Up | The WIAT-III is an individually-administered test of academic achievement. In the Word Reading subtest students read a list of increasingly difficult words. Scores reported here are standardized scores with a mean of 100 and standard deviation of 15. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Dynamic Indicators of Basic Early Literacy Skills Oral Reading Fluency Subtest (DIBELS ORF) | Week 16 (End of Active Treatment Phase) and Follow-Up | DIBELS ORF measures oral reading fluency in connected text. Students are presented with a passage on their grade level to read orally, and the score is the number of words of the passage read correctly in a one-minute period. Students in this study read two passages at each test administration, and the mean score for the two passages was the dependent variable analyzed. A research synthesis of studies reporting psychometric properties for DIBELS ORF determined that reliability coefficients in these studies exceeded .80 and that the measure demonstrated moderate to high concurrent and predictive validity across studies (Goffreda & DiPerna, 2010). |
| Test of Word Reading Efficiency (TOWRE) - Sight Word Efficiency | Week 16 (End of Active Treatment Phase) and Follow-Up | The TOWRE Sight Word Efficiency subtest measures fluency of reading words in lists. The raw score is the number of words or nonwords identified correctly in 45 seconds. Standard scores with a mean of 100 and standard deviaion of 15 are reported here. Higher scores represent a better outcome. |
| Test of Word Reading Efficiency (TOWRE) - Phonemic Decoding Efficiency | Week 16 (End of Active Treatment Phase) and Follow-Up | The TOWRE Phonemic Decoding Efficiency measures the student's fluent decoding of nonsense words that follow the spelling rules of the English language. The raw score is the number of nonwords identified correctly in 45 seconds. Standardized scores with a mean of 100 and standard deviaion of 15 are reported here. Higher scores represent a better outcome. |
| Test of Silent Reading Fluency and Comprehension (TOSREC) | Week 16, End of Active Treatment Phase | The TOSREC measures sentence-level comprehension and silent reading fluency. It is a sentence verification task; children are presented with a list of sentences and must tell whether they are true or false. Items are based on common knowledge (e.g., All apples are blue). The raw score is the number of items answered correctly in 3 minutes. Standardized with a mean of 100 and standard deviation of 15 are reported here. Higher scores represent a better outcome. |
| Wechsler Individual Achievement Test-III (WIAT-III) Reading Comprehension Subtest | Week 16, End of Active Treatment Phase | The WIAT-III is an individually-administered test of academic achievement. This subtest involves reading sentences and longer passages and then answering a set of literal and inferential comprehension questions about the text. Scores reported here are standardized scores with a mean of 100 and standard deviation of 15. Higher scores represent a better outcome. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| ADHD Treatment Carefully-managed medication and behavioral parent training. Children began with a trial of extended release methylphenidate; if there was no benefit or the side effects were intolerable, this was followed by a trial of mixed salt amphetamine. if side effects of stimulants were intolerable, atomoxetine or guanfacine could be prescribed. Parent training was nine sessions provided by a psychologist addressing ADHD and its treatment, principles of behavior modification, and evidence-supported practices for managing behavior. | 77 |
| Intensive Reading Instruction Specialized phonologically-based reading instruction provided by well-trained tutors either individually (one-on-one) or to groups of two students for 45 minutes, four days per week, for 16 school weeks. Instruction was explicit and systematic, with extended opportunities to practice and apply skills in connected text with feedback. Interventionists used an individualized combination of published and unpublished programs targeting word reading and decoding, reading fluency, and reading comprehension, depending on students' needs documented in ongoing assessment. | 73 |
| Combined ADHD Treatment and Reading Instruction All interventions described in Reading Instruction and ADHD treatment arms: Phonologically-based reading instruction provided for 45 minutes, four days per week, for 16 school weeks provided concurrently with carefully-managed medication (methylphenidate, mixed salt amphetamine, atomoxetine or guanfacine) and behavioral parent training. | 66 |
| Total | 216 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Active Treatment Phase (Weeks 1-16) | Withdrawal by Subject | 5 | 1 | 3 |
| Follow-Up Phase | Lost to Follow-up | 1 | 3 | 7 |
Baseline characteristics
| Characteristic | ADHD Treatment | Intensive Reading Instruction | Combined ADHD Treatment and Reading Instruction | Total |
|---|---|---|---|---|
| Age, Categorical <=18 years | 77 Participants | 73 Participants | 66 Participants | 216 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Region of Enrollment United States | 77 participants | 73 participants | 66 participants | 216 participants |
| Sex: Female, Male Female | 25 Participants | 24 Participants | 35 Participants | 84 Participants |
| Sex: Female, Male Male | 52 Participants | 49 Participants | 31 Participants | 132 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — |
| other Total, other adverse events | 3 / 71 | 1 / 74 | 5 / 68 |
| serious Total, serious adverse events | 0 / 71 | 0 / 74 | 0 / 68 |
Outcome results
Primary
Swanson, Nolan, and Pelham Checklist for DSM-IV (SNAP)- Parent Rating of Hyperactivity-impulsivity
Rating Scale of ADHD symptomology completed by parents and teachers. Raters evaluate how well each DSM-IV (Diagnostic and Statistical Manual) ADHD symptom describes a child on a four-point Likert scale (0=Not at all, 1=Just a little, 2=Quite a bit, 3=Very much). The measure shows adequate internal consistency (.94) and test-retest reliability (Bussing et al., 2008; Gau et al., 2008).
Time frame: 16 weeks (end of Active Treatment phase), and follow-up
Population: Six excluded from analyses (1 from ADHD Treatment , 1 from Intensive Reading Instruction , 4 from Combined ) because upon ex post-facto review of records, they did not meet inclusion criteria and had been included in error. Other reductions in numbers analyzed on this variable were due to missing data.
| Arm | Measure | Group | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|---|
| ADHD Treatment | Swanson, Nolan, and Pelham Checklist for DSM-IV (SNAP)- Parent Rating of Hyperactivity-impulsivity | 16-Week Outcomes | 0.8 units on a scale | Standard Error 0.1 |
| ADHD Treatment | Swanson, Nolan, and Pelham Checklist for DSM-IV (SNAP)- Parent Rating of Hyperactivity-impulsivity | Follow-up Outcomes | 0.9 units on a scale | Standard Error 0.1 |
| Intensive Reading Instruction | Swanson, Nolan, and Pelham Checklist for DSM-IV (SNAP)- Parent Rating of Hyperactivity-impulsivity | 16-Week Outcomes | 1.3 units on a scale | Standard Error 0.1 |
| Intensive Reading Instruction | Swanson, Nolan, and Pelham Checklist for DSM-IV (SNAP)- Parent Rating of Hyperactivity-impulsivity | Follow-up Outcomes | 1.4 units on a scale | Standard Error 0.1 |
| Combined ADHD Treatment and Reading Instruction | Swanson, Nolan, and Pelham Checklist for DSM-IV (SNAP)- Parent Rating of Hyperactivity-impulsivity | 16-Week Outcomes | 0.6 units on a scale | Standard Error 0.1 |
| Combined ADHD Treatment and Reading Instruction | Swanson, Nolan, and Pelham Checklist for DSM-IV (SNAP)- Parent Rating of Hyperactivity-impulsivity | Follow-up Outcomes | 0.7 units on a scale | Standard Error 0.1 |
Primary
Swanson, Nolan, and Pelham Checklist for DSM-IV (SNAP)- Parent Rating of Inattention
Rating Scale of ADHD symptomology completed by parents and teachers. Raters evaluate how well each DSM-IV (Diagnostic and Statistical Manual) ADHD symptom describes a child on a four-point Likert scale (0=Not at all, 1=Just a little, 2=Quite a bit, 3=Very much). The measure shows adequate internal consistency (.94) and test-retest reliability (Bussing et al., 2008; Gau et al., 2008).
Time frame: 16 weeks (end of Active Treatment phase), and follow-up
Population: Six excluded from analyses (1 from ADHD Treatment , 1 from Intensive Reading Instruction , 4 from Combined ) because upon ex post-facto review of records, they did not meet inclusion criteria and had been included in error. Other reductions in numbers analyzed on this variable were due to missing data.
| Arm | Measure | Group | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|---|
| ADHD Treatment | Swanson, Nolan, and Pelham Checklist for DSM-IV (SNAP)- Parent Rating of Inattention | 16-Week Outcomes | 1.1 Units on a scale | Standard Error 0.1 |
| ADHD Treatment | Swanson, Nolan, and Pelham Checklist for DSM-IV (SNAP)- Parent Rating of Inattention | Follow-up Outcomes | 1.3 Units on a scale | Standard Error 0.1 |
| Intensive Reading Instruction | Swanson, Nolan, and Pelham Checklist for DSM-IV (SNAP)- Parent Rating of Inattention | 16-Week Outcomes | 1.7 Units on a scale | Standard Error 0.1 |
| Intensive Reading Instruction | Swanson, Nolan, and Pelham Checklist for DSM-IV (SNAP)- Parent Rating of Inattention | Follow-up Outcomes | 1.6 Units on a scale | Standard Error 0.1 |
| Combined ADHD Treatment and Reading Instruction | Swanson, Nolan, and Pelham Checklist for DSM-IV (SNAP)- Parent Rating of Inattention | 16-Week Outcomes | 1.0 Units on a scale | Standard Error 0.1 |
| Combined ADHD Treatment and Reading Instruction | Swanson, Nolan, and Pelham Checklist for DSM-IV (SNAP)- Parent Rating of Inattention | Follow-up Outcomes | 1.0 Units on a scale | Standard Error 0.1 |
Primary
Swanson, Nolan, and Pelham Checklist for DSM-IV (SNAP)- Teacher Rating of Hyperactivity-impulsivity
Rating Scale of ADHD symptomology completed by parents and teachers. Raters evaluate how well each DSM-IV ADHD symptom describes a child on a four-point Likert scale (0=Not at all, 1=Just a little, 2=Quite a bit, 3=Very much). The measure shows adequate internal consistency (.94) and test-retest reliability (Bussing et al., 2008; Gau et al., 2008).
Time frame: Week 16 (End of Active Treatment Phase) and Follow-Up
Population: Six excluded from analyses (1 from ADHD Treatment , 1 from Intensive Reading Instruction , 4 from Combined) because upon ex post-facto review of records, they did not meet inclusion criteria and had been included in error. Other reductions in numbers analyzed on this variable were due to missing data.
| Arm | Measure | Group | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|---|
| ADHD Treatment | Swanson, Nolan, and Pelham Checklist for DSM-IV (SNAP)- Teacher Rating of Hyperactivity-impulsivity | 16-Week Outcomes | 0.7 Units on a scale | Standard Error 0.1 |
| ADHD Treatment | Swanson, Nolan, and Pelham Checklist for DSM-IV (SNAP)- Teacher Rating of Hyperactivity-impulsivity | Follow-up | 0.8 Units on a scale | Standard Error 0.1 |
| Intensive Reading Instruction | Swanson, Nolan, and Pelham Checklist for DSM-IV (SNAP)- Teacher Rating of Hyperactivity-impulsivity | 16-Week Outcomes | 1.1 Units on a scale | Standard Error 0.1 |
| Intensive Reading Instruction | Swanson, Nolan, and Pelham Checklist for DSM-IV (SNAP)- Teacher Rating of Hyperactivity-impulsivity | Follow-up | 1.1 Units on a scale | Standard Error 0.1 |
| Combined ADHD Treatment and Reading Instruction | Swanson, Nolan, and Pelham Checklist for DSM-IV (SNAP)- Teacher Rating of Hyperactivity-impulsivity | 16-Week Outcomes | 0.8 Units on a scale | Standard Error 0.1 |
| Combined ADHD Treatment and Reading Instruction | Swanson, Nolan, and Pelham Checklist for DSM-IV (SNAP)- Teacher Rating of Hyperactivity-impulsivity | Follow-up | 0.8 Units on a scale | Standard Error 0.1 |
Primary
Swanson, Nolan, and Pelham Checklist for DSM-IV (SNAP)- Teacher Rating of Inattention
Rating Scale of ADHD symptomology completed by parents and teachers. Raters evaluate how well each DSM-IV ADHD symptom describes a child on a four-point Likert scale (0=Not at all, 1=Just a little, 2=Quite a bit, 3=Very much). The measure shows adequate internal consistency (.94) and test-retest reliability (Bussing et al., 2008; Gau et al., 2008).
Time frame: Week 16 (End of Active Treatment Phase) and Follow-Up
Population: Six excluded from analyses (1 from ADHD Treatment , 1 from Intensive Reading Instruction , 4 from Combined ) because upon ex post-facto review of records, they did not meet inclusion criteria and had been included in error. Other reductions in numbers analyzed on this variable were due to missing data.
| Arm | Measure | Group | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|---|
| ADHD Treatment | Swanson, Nolan, and Pelham Checklist for DSM-IV (SNAP)- Teacher Rating of Inattention | 16-week Outcomes | 1.2 Units on a scale | Standard Error 0.1 |
| ADHD Treatment | Swanson, Nolan, and Pelham Checklist for DSM-IV (SNAP)- Teacher Rating of Inattention | Follow-Up | 1.5 Units on a scale | Standard Error 0.1 |
| Intensive Reading Instruction | Swanson, Nolan, and Pelham Checklist for DSM-IV (SNAP)- Teacher Rating of Inattention | 16-week Outcomes | 1.7 Units on a scale | Standard Error 0.1 |
| Intensive Reading Instruction | Swanson, Nolan, and Pelham Checklist for DSM-IV (SNAP)- Teacher Rating of Inattention | Follow-Up | 1.9 Units on a scale | Standard Error 0.1 |
| Combined ADHD Treatment and Reading Instruction | Swanson, Nolan, and Pelham Checklist for DSM-IV (SNAP)- Teacher Rating of Inattention | 16-week Outcomes | 1.4 Units on a scale | Standard Error 0.1 |
| Combined ADHD Treatment and Reading Instruction | Swanson, Nolan, and Pelham Checklist for DSM-IV (SNAP)- Teacher Rating of Inattention | Follow-Up | 1.5 Units on a scale | Standard Error 0.1 |
Primary
Wechsler Individual Achievement Test-III (WIAT-III) Pseudoword Decoding Subtest
The WIAT-III is an individually-administered test of academic achievement. In the Pseudoword Decoding subtest students read a list of increasingly difficult nonsense words as a test of their ability to use phonics to decode unknown words. Scores reported here are standardized scores with a mean of 100 and standard deviation of 15. Higher scores represent a better outcome.
Time frame: Week 16 (End of Active Treatment Phase) and Follow-Up
Population: Six excluded from analyses (1 from ADHD Treatment , 1 from Intensive Reading Instruction , 4 from Combined ) because upon ex post-facto review of records, they did not meet inclusion criteria and had been included in error. Other reductions in numbers analyzed on this variable were due to missing data.
| Arm | Measure | Group | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|---|
| ADHD Treatment | Wechsler Individual Achievement Test-III (WIAT-III) Pseudoword Decoding Subtest | 16-Week Outcomes | 78.3 standardized scores | Standard Error 1 |
| ADHD Treatment | Wechsler Individual Achievement Test-III (WIAT-III) Pseudoword Decoding Subtest | Follow-Up | 77.1 standardized scores | Standard Error 1 |
| Intensive Reading Instruction | Wechsler Individual Achievement Test-III (WIAT-III) Pseudoword Decoding Subtest | 16-Week Outcomes | 83.8 standardized scores | Standard Error 1 |
| Intensive Reading Instruction | Wechsler Individual Achievement Test-III (WIAT-III) Pseudoword Decoding Subtest | Follow-Up | 82.6 standardized scores | Standard Error 1.1 |
| Combined ADHD Treatment and Reading Instruction | Wechsler Individual Achievement Test-III (WIAT-III) Pseudoword Decoding Subtest | 16-Week Outcomes | 83.0 standardized scores | Standard Error 1.1 |
| Combined ADHD Treatment and Reading Instruction | Wechsler Individual Achievement Test-III (WIAT-III) Pseudoword Decoding Subtest | Follow-Up | 81.9 standardized scores | Standard Error 1.2 |
Primary
Wechsler Individual Achievement Test-III (WIAT-III) Word Reading Subtest
The WIAT-III is an individually-administered test of academic achievement. In the Word Reading subtest students read a list of increasingly difficult words. Scores reported here are standardized scores with a mean of 100 and standard deviation of 15.
Time frame: Week 16 (End of Active Treatment Phase) and Follow-Up
Population: Six excluded from analyses (1 from ADHD Treatment , 1 from Intensive Reading Instruction , 4 from Combined ) because upon ex post-facto review of records, they did not meet inclusion criteria and had been included in error. Other discrepancies in numbers are due to missing data.
| Arm | Measure | Group | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|---|
| ADHD Treatment | Wechsler Individual Achievement Test-III (WIAT-III) Word Reading Subtest | 16-Week Outcomes | 76.9 standardized scores, M=100, SD = 15 | Standard Error 0.7 |
| ADHD Treatment | Wechsler Individual Achievement Test-III (WIAT-III) Word Reading Subtest | Follow-Up | 77.1 standardized scores, M=100, SD = 15 | Standard Error 0.8 |
| Intensive Reading Instruction | Wechsler Individual Achievement Test-III (WIAT-III) Word Reading Subtest | 16-Week Outcomes | 79.0 standardized scores, M=100, SD = 15 | Standard Error 0.7 |
| Intensive Reading Instruction | Wechsler Individual Achievement Test-III (WIAT-III) Word Reading Subtest | Follow-Up | 78.1 standardized scores, M=100, SD = 15 | Standard Error 0.8 |
| Combined ADHD Treatment and Reading Instruction | Wechsler Individual Achievement Test-III (WIAT-III) Word Reading Subtest | 16-Week Outcomes | 79.9 standardized scores, M=100, SD = 15 | Standard Error 0.7 |
| Combined ADHD Treatment and Reading Instruction | Wechsler Individual Achievement Test-III (WIAT-III) Word Reading Subtest | Follow-Up | 78.8 standardized scores, M=100, SD = 15 | Standard Error 0.8 |
Secondary
Dynamic Indicators of Basic Early Literacy Skills Oral Reading Fluency Subtest (DIBELS ORF)
DIBELS ORF measures oral reading fluency in connected text. Students are presented with a passage on their grade level to read orally, and the score is the number of words of the passage read correctly in a one-minute period. Students in this study read two passages at each test administration, and the mean score for the two passages was the dependent variable analyzed. A research synthesis of studies reporting psychometric properties for DIBELS ORF determined that reliability coefficients in these studies exceeded .80 and that the measure demonstrated moderate to high concurrent and predictive validity across studies (Goffreda & DiPerna, 2010).
Time frame: Week 16 (End of Active Treatment Phase) and Follow-Up
Population: Six excluded from analyses (1 from ADHD Treatment , 1 from Intensive Reading Instruction , 4 from Combined ) because upon ex post-facto review of records, they did not meet inclusion criteria and had been included in error. Other reductions in numbers analyzed on this variable were due to missing data.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| ADHD Treatment | Dynamic Indicators of Basic Early Literacy Skills Oral Reading Fluency Subtest (DIBELS ORF) | 16-Week Outcomes | 53.67 words read correctly per minute | Standard Deviation 30.3 |
| ADHD Treatment | Dynamic Indicators of Basic Early Literacy Skills Oral Reading Fluency Subtest (DIBELS ORF) | Follow-Up | 63.06 words read correctly per minute | Standard Deviation 31.97 |
| Intensive Reading Instruction | Dynamic Indicators of Basic Early Literacy Skills Oral Reading Fluency Subtest (DIBELS ORF) | 16-Week Outcomes | 50.71 words read correctly per minute | Standard Deviation 31.94 |
| Intensive Reading Instruction | Dynamic Indicators of Basic Early Literacy Skills Oral Reading Fluency Subtest (DIBELS ORF) | Follow-Up | 57.40 words read correctly per minute | Standard Deviation 31.06 |
| Combined ADHD Treatment and Reading Instruction | Dynamic Indicators of Basic Early Literacy Skills Oral Reading Fluency Subtest (DIBELS ORF) | 16-Week Outcomes | 53.83 words read correctly per minute | Standard Deviation 33.5 |
| Combined ADHD Treatment and Reading Instruction | Dynamic Indicators of Basic Early Literacy Skills Oral Reading Fluency Subtest (DIBELS ORF) | Follow-Up | 59.05 words read correctly per minute | Standard Deviation 31.97 |
Secondary
Test of Silent Reading Fluency and Comprehension (TOSREC)
The TOSREC measures sentence-level comprehension and silent reading fluency. It is a sentence verification task; children are presented with a list of sentences and must tell whether they are true or false. Items are based on common knowledge (e.g., All apples are blue). The raw score is the number of items answered correctly in 3 minutes. Standardized with a mean of 100 and standard deviation of 15 are reported here. Higher scores represent a better outcome.
Time frame: Week 16, End of Active Treatment Phase
Population: Six excluded from analyses (1 from ADHD Treatment , 1 from Intensive Reading Instruction , 4 from Combined ) because upon ex post-facto review of records, they did not meet inclusion criteria and had been included in error. Other reductions in numbers analyzed on this variable were due to missing data.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| ADHD Treatment | Test of Silent Reading Fluency and Comprehension (TOSREC) | 17.40 standardized scores | Standard Error 0.7 |
| Intensive Reading Instruction | Test of Silent Reading Fluency and Comprehension (TOSREC) | 17.70 standardized scores | Standard Error 0.7 |
| Combined ADHD Treatment and Reading Instruction | Test of Silent Reading Fluency and Comprehension (TOSREC) | 18.57 standardized scores | Standard Error 0.75 |
Secondary
Test of Word Reading Efficiency (TOWRE) - Phonemic Decoding Efficiency
The TOWRE Phonemic Decoding Efficiency measures the student's fluent decoding of nonsense words that follow the spelling rules of the English language. The raw score is the number of nonwords identified correctly in 45 seconds. Standardized scores with a mean of 100 and standard deviaion of 15 are reported here. Higher scores represent a better outcome.
Time frame: Week 16 (End of Active Treatment Phase) and Follow-Up
Population: Six excluded from analyses (1 from ADHD Treatment , 1 from Intensive Reading Instruction , 4 from Combined ) because upon ex post-facto review of records, they did not meet inclusion criteria and had been included in error. Other reductions in numbers analyzed on this variable were due to missing data.
| Arm | Measure | Group | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|---|
| ADHD Treatment | Test of Word Reading Efficiency (TOWRE) - Phonemic Decoding Efficiency | 16-Week Outcomes | 80.4 standardized scores | Standard Error 0.79 |
| ADHD Treatment | Test of Word Reading Efficiency (TOWRE) - Phonemic Decoding Efficiency | Follow-Up | 81.49 standardized scores | Standard Error 0.83 |
| Intensive Reading Instruction | Test of Word Reading Efficiency (TOWRE) - Phonemic Decoding Efficiency | 16-Week Outcomes | 83.4 standardized scores | Standard Error 0.79 |
| Intensive Reading Instruction | Test of Word Reading Efficiency (TOWRE) - Phonemic Decoding Efficiency | Follow-Up | 84.50 standardized scores | Standard Error 0.86 |
| Combined ADHD Treatment and Reading Instruction | Test of Word Reading Efficiency (TOWRE) - Phonemic Decoding Efficiency | 16-Week Outcomes | 82.9 standardized scores | Standard Error 0.84 |
| Combined ADHD Treatment and Reading Instruction | Test of Word Reading Efficiency (TOWRE) - Phonemic Decoding Efficiency | Follow-Up | 84.32 standardized scores | Standard Error 0.92 |
Secondary
Test of Word Reading Efficiency (TOWRE) - Sight Word Efficiency
The TOWRE Sight Word Efficiency subtest measures fluency of reading words in lists. The raw score is the number of words or nonwords identified correctly in 45 seconds. Standard scores with a mean of 100 and standard deviaion of 15 are reported here. Higher scores represent a better outcome.
Time frame: Week 16 (End of Active Treatment Phase) and Follow-Up
Population: Six excluded from analyses (1 from ADHD Treatment , 1 from Intensive Reading Instruction , 4 from Combined ) because upon ex post-facto review of records, they did not meet inclusion criteria and had been included in error. Other reductions in numbers analyzed on this variable were due to missing data.
| Arm | Measure | Group | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|---|
| ADHD Treatment | Test of Word Reading Efficiency (TOWRE) - Sight Word Efficiency | 16-Week Outcomes | 80.8 standardized scores | Standard Error 0.82 |
| ADHD Treatment | Test of Word Reading Efficiency (TOWRE) - Sight Word Efficiency | Follow-Up | 83.57 standardized scores | Standard Error 0.82 |
| Intensive Reading Instruction | Test of Word Reading Efficiency (TOWRE) - Sight Word Efficiency | 16-Week Outcomes | 82.7 standardized scores | Standard Error 0.82 |
| Intensive Reading Instruction | Test of Word Reading Efficiency (TOWRE) - Sight Word Efficiency | Follow-Up | 85.04 standardized scores | Standard Error 0.84 |
| Combined ADHD Treatment and Reading Instruction | Test of Word Reading Efficiency (TOWRE) - Sight Word Efficiency | 16-Week Outcomes | 83.5 standardized scores | Standard Error 0.87 |
| Combined ADHD Treatment and Reading Instruction | Test of Word Reading Efficiency (TOWRE) - Sight Word Efficiency | Follow-Up | 84.15 standardized scores | Standard Error 0.9 |
Secondary
Wechsler Individual Achievement Test-III (WIAT-III) Reading Comprehension Subtest
The WIAT-III is an individually-administered test of academic achievement. This subtest involves reading sentences and longer passages and then answering a set of literal and inferential comprehension questions about the text. Scores reported here are standardized scores with a mean of 100 and standard deviation of 15. Higher scores represent a better outcome.
Time frame: Week 16, End of Active Treatment Phase
Population: Six excluded from analyses (1 from ADHD Treatment , 1 from Intensive Reading Instruction , 4 from Combined ) because upon ex post-facto review of records, they did not meet inclusion criteria and had been included in error.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| ADHD Treatment | Wechsler Individual Achievement Test-III (WIAT-III) Reading Comprehension Subtest | 88.27 standardized scores | Standard Error 0.9 |
| Intensive Reading Instruction | Wechsler Individual Achievement Test-III (WIAT-III) Reading Comprehension Subtest | 84.70 standardized scores | Standard Error 0.9 |
| Combined ADHD Treatment and Reading Instruction | Wechsler Individual Achievement Test-III (WIAT-III) Reading Comprehension Subtest | 86.35 standardized scores | Standard Error 1 |