V.4 #3 Counseling/School Psychology - Verbal Working Memory Deficits in Attention-Deficit Hyperactiv

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Attention deficit hyperactivity disorder (ADHD) is known to the general population of consisting of difficulties with attention, poor impulse control and hyperactivity. However, learning disabilities (LD) and learning deficits that co-occur with ADHD are less known. According to Barkley (2006), prevalence rates of a reading disability in children with ADHD occur at 21 percent, and for mathematics at 28 percent. This is not referring to a failure simply due to class work, but represents a significant discrepancy between one’s aptitude or learning potential (generally defined as an IQ score) and a specific area or areas in academic achievement (mathematics, reading or writing). This article will focus on core cognitive deficits that can be found in children with ADHD that can often be seen in children who also have LD.

Working Memory (WM)

Traditional measures of long-term storage and retrieval have failed to confirm deficits in children with ADHD (Barkley, 2006). However, measures that assess a person’s working memory have confirmed deficits. “Working memory (WM) has been defined as the capacity to hold information actively in mind that will be used to guide a subsequent response” (Barkely, 2006, p. 136). WM can be broken down into nonverbal and verbal working memory. This article will focus on verbal WM and a future article will explore nonverbal WM.

Verbal Working Memory

There is ample research supporting deficits in verbal working memory in children with ADHD. Tasks that assess verbal WM generally consist of the retention and oral repetition of numbers, arithmetic, and the retention of verbal material for a period of time. This latter task requires the child to restate the content in their own words which necessitates a reorganization of the material. Academic content material is presented in a complex manner consisting of several sequential tasks to be completed which requires the material to be held, processed, and manipulated, children with ADHD often have complications in this matter. For example, a teacher may ask a class to open up their math book to page 85 and to complete problems 1 through 10. Then turn over their paper and complete problems 20-25, but only after the first part of the work has been shown to the teacher; a child with ADHD may have difficulty holding that information in their mind in order to complete the task correctly. This is not due to an attention problem but is actually a working memory deficit. In addition, when strategies are needed to organize academic material that enable the child or adolescent to encode the information to be remembered, people with ADHD are significantly less effective than people without LD or ADHD. Barkley (2006) clearly states that these deficits do not lie only with children with ADHD but also with children who have a specific reading disability.

Story Comprehension Deficits Due to Poor WM

A particular area that may frustrate all who are involved in the classroom working with children who have ADHD, LD, or both, is story comprehension (listening, watching, or reading). This task requires good verbal working memory along with the ability to effectively organize the content for later retention. Studies have shown that children who have working memory deficits (i.e., ADHD and LD) have significant impaired recall of story content after watching televised stories (Barkley, 2006). Interestingly, it does not affect their cued-recall ability, such as when a teacher provides cues to retrieve the information from long-term memory and place it into working memory. The difficulty primarily affects unassisted recall especially in areas that require a deeper knowledge of causal relationships. This may explain why individuals with ADHD may not have any difficulties recalling simple story details. However, when required to hold more information together at once while understanding the relationships and causal variables from the story content, a significantly greater detrimental impact is observed on their capabilities.

Interventions

1. Directions need to be stated in a clear manner, briefly, and often to children with ADHD and LD. It is often beneficial to have the children repeat the directions back before moving onto the task at hand as a means to give corrective feedback if something was not understood correctly. Moreover, if a task is required to be completed in a sequence, it would be prudent for teachers to break up the task into more manageable components and steps. State each sequence separately and only after the previous one was completed correctly.

2. Display rules and procedures along with other physical prompts in the classroom. For example, “stop signs, big eyes, big ears for ‘stop, look, and listen’ reminders” (Pfiffner, Barkely, & DuPaul, 2006, p. 554).

3. Due to WM deficits in children with ADHD and LD, it is incumbent upon a teacher to provide more external cues about their performance on academics and, of course, their behavior. This requires that the teacher monitor academic and behavioral functioning and provide specific feedback to enhance behavioral control and academic goal attainment.

It is important to remember that the child with a disability is quite possibly processing information in a very different way than the other children without disabilities in the classroom as evidenced by documented working memory deficits in children with ADHD and LD. Teachers should not hesitate to contact their school psychologist to discuss additional interventions that will facilitate better academic and behavioral performance.

References

Barkley, R. A. (2006). Associated cognitive, developmental, and health problems. In R. Barkley (Ed.), Attention deficit hyperactivity disorder (pp. 122-183). New York: Guilford Press.

Pfiffner, L. J., Barkley, R. A., & DuPaul, G. J. (2006). Treatment of ADHD in school settings. In R. Barkley (Ed.), Attention deficit hyperactivity disorder (pp. 547-589). New York: Guilford Press.

Michael David Benhar, Ph.D. is an Assistant Professor in the Social Sciences Department at Suffolk County Community College. Dr. Michael David Benhar teaches undergraduate and graduate courses in Developmental Psychology, Exceptional Child, Classroom Management, and Assessment. He has co-authored a chapter on students with disabilities. In addition, he has worked as a school psychologist in a preschool for children with special needs.