Attention deficit disorder and specific reading disability: separate but often overlapping disorders

Within a large (N = 182) heterogeneous sample of clinic-referred children with DSM-III-diagnosed attention deficit disorder (ADD), three behavioral subgroups were identified via cluster analysis of teacher ratings: 40% of the children had ADD with hyperactivity (ADDH), 30% had ADD with hyperactivity and aggressivity (ADDHA), and 31% had ADD without hyperactivity or aggressivity. Proportionally more girls were in the ADD-only subgroup. Over half the sample (n = 94) were poor readers, with 82 meeting discrepancy criteria for specific reading disability (RD). Proportionately more boys than girls met the RD criteria (9.2:1.0), whereas the sex ratio of males to females for the whole sample was 5.1 to 1.0. Focusing just on white males, the three behavioral subgroups were significantly different on convergent validity measures, such as other teacher ratings, parent ratings, and interview-elicited ratings of externalizing behavior, but were not different on such divergent validity measures as IQ and achievement scores, self-ratings, and laboratory performance tasks. Boys in the ADD sample who did not meet criteria for RD had significantly higher IQs than those who did, but subgroups with and without RD still differed significantly on WRAT-R reading and spelling scores with IQ covaried out. Both groups with and without RD could be differentiated from a control group on laboratory measures of sustained attention and impulse control. Methylphenidate benefited all subgroups equally, whether RD or not, and whether given a low (0.3 mg/kg) or high (0.6 mg/kg) dose.