Intragroup differences and similarities in performance on rapid automatized naming tasks in children with ADHD symptoms, children with reading disabilities, and controls

Abstract

Introduction  Rapid automatized naming (RAN) is the ability to name, as fast as possible, symbols such as letters, digits and figures. The present study aimed to investigate intragroup performance patterns on RAN tasks in children with attention deficit hyperactivity disorder (ADHD) symptoms alone, children with reading disability (RD) alone and controls with typical development.

Methods  A total of 216 Brazilian children between 8 to 11 years old were selected from public schools located in two Brazilian capitals, namely Porto Alegre and Belo Horizonte, to participate in the study. Mixed 3 (participant group: ADHD symptoms, RD or control group) × 3 (type of stimulus: letters, numbers or figures) ANOVAs were performed using response time and number of errors as dependent variables. Only intragroup comparisons are described in this paper.

Results  The groups with ADHD symptoms and RD showed similar performance results on naming speed. There were no differences between letters and numbers within each group, but we found slower responses in figure naming compared to the other tasks for both groups. Concerning accuracy, children with ADHD symptoms showed a similar number of errors in all three tasks. These patterns were distinct from the performance of the control group.

Conclusion  Results suggest a shared deficit in naming speed of alphanumeric stimuli in children with ADHD symptoms and those with RD, and impairments in naming digits correctly in children with ADHD symptoms.

Attention deficit hyperactivity disorder; reading; language tests; children; neuropsychology

Introduction

Rapid automatized naming (RAN) is the ability to name, as fast as possible, visually presented familiar symbols such as letters, digits, figures or colors.¹ Several studies have revealed RAN to be a strong longitudinal predictor of reading development, especially reading fluency.¹ - ³ Furthermore, deficits in this skill are common to different neurodevelopmental disorders, such as attention deficit hyperactivity disorder (ADHD)³ , ⁴ and reading disability (RD).⁵

Performing RAN tasks requires several cognitive processes such as attentional and visual processes, integration of visual patterns and orthographic information (letters as stimuli) and recovery of phonological labels. These processes are often impaired in children with ADHD and/or RD, translating into an increased number of errors and decreased naming speed in these tasks.⁴ , ⁶ Authors also claim the potential usefulness of RAN in the diagnosis of reading and attentional problems, particularly in children aged from 5 to 9.⁶

There is also evidence that the development of RAN color and object may diverge from RAN letter and digit, suggesting that different cognitive processes may be involved in these different subtasks.⁷ Letters and digits engage largely automated decoding processes, whereas objects and colors do not, and as such, the latter would consume more resources relating to attention.⁶ In this sense, children with ADHD tend to present lower performance rates specifically on tasks composed of figures and colors compared with controls.⁴ , ⁶

Within groups, adolescents and adults with ADHD have demonstrated significantly quicker naming of letters/digits compared with colors and objects; the RD group has shown significantly quicker naming of letters compared with digits, and both did not differ from object naming.⁸ However, that study had some limitations: it considered only naming speed of each task as a RAN score and it did not include a control group to compare the performance of others to the pattern expected.⁸

Thus, it is important to investigate the differences and similarities in performance on RAN tasks according to type of stimulus between children with ADHD and those with RD, especially due to the high comorbidity of both disorders.⁶ Establishing execution performance profiles for these groups has crucial clinical relevance for both assessment and intervention designs.⁵ The current study sought to compare differences in performance (response time – RT and number of errors) between RAN of letters, numbers and figures in children with ADHD symptoms alone, in children with RD alone, and in controls with typical development.

Method

This was a quasi-experimental contrasting groups study⁹ that evaluated 216 children (55.1% girls) attending public schools, aged between 8 and 11 years (mean ± standard deviation = 8.94±0.71), from the 3rd (n = 62) and 4th grades (n = 154) of elementary schools located in Porto Alegre, state of Rio Grande do Sul (n = 66), and Belo Horizonte, state of Minas Gerais (n = 150).

The exclusion criteria were: uncorrected auditory or visual impairments (reported by parents/guardians); non-verbal intelligence quotient (IQ) below the 15th percentile on the Raven Colored Progressive Matrices Test (CPM),¹⁰ , ¹¹ which measures non-verbal intelligence; and meeting the criteria for comorbidity between ADHD and RD symptoms (n = 6). The following criteria were used to define the groups:

1. Group with ADHD symptoms alone (n = 20, 50% male/female): children who scored at least 6 items as either “quite a bit” or “very much” in questions 1 to 9 (inattention symptoms) of the Multimodal Treatment Study for ADHD (MTA) version of the Swanson, Nolan, and Pelham, Version IV (MTA-SNAP-IV) scale,¹² - ¹⁴ and/or who scored at least 6 items as either “quite a bit” or “very much” in questions 10 to 18 (hyperactivity/impulsivity symptoms), and with performance above the 16th percentile on the Word and Pseudoword Reading Test (LPI).¹⁵

2. Group with RD alone (n = 37, 64.9% female): children who scored below the cut-off point described above on the MTA-SNAP-IV scale¹³ and with performance below the 16th percentile on LPI.¹⁵

3. Control group (without ADHD symptoms or RD) (n = 159, 53.5% female): children who scored below the cut-off point described above on the MTA-SNAP-IV scale¹³ and with performance above the 16th percentile on LPI.¹⁵

The Contingency Naming Speed Task (CNS)¹⁶ consists of four RAN trials of letters (D, A, O, S), numbers (1, 2, 3, 4) and figures (square, circle, triangle and rhombus). Performance was measured based on RT (speed) and number of errors (accuracy) in each CNS task. The scores that assess inhibition and flexibility¹⁶ were not analyzed in the present study (for more details about the task, see van der Sluis et al.¹⁶ ).

This study was approved by the research ethics committees of both Universidade Federal de Minas Gerais (UFMG; protocol 939.562) and Instituto de Psicologia, Universidade Federal do Rio Grande do Sul (UFRGS; protocol 1.023.371). Two evaluation sessions (a group session and an individual session with each child) were conducted with children whose parents had signed the informed consent term. The CPM¹⁰ was administered in the group session; the CNS,¹⁶ the LPI¹⁵ and other neuropsychological tasks were administered individually. Here we report on CNS¹⁶ and LPI¹⁵ performance only. The parents/guardians completed the MTA-SNAP-IV scale.¹³

Mixed 3 (group: ADHD symptoms, RD, or control group) × 3 (type of stimulus: letters, digits or figures on CNS) analyses of variance (ANOVAs) were performed. We used the group as a between-subjects factor and the CNS task as a within-subjects factor. However, in this study, only intragroup comparisons are described (intergroup comparisons have already been published¹⁷ ).

Results

As shown in Table 1 , ADHD symptoms and RD groups exhibited similar RT performance in CNS tasks with letters and numbers (p > 0.05) and slower RT performance in the CNS task with figures (p < 0.05). In contrast, the control group named letters significantly faster than numbers, and the latter faster than figures (p < 0.05, F _2,212 = 3.9, p < 0.022, Wilk’s Λ = 0.037, η ² = 0.03).

Table 1
Mixed ANOVA intragroup comparisons between each CNS measure and each CNS task (n = 216)

	RAN Letters	RAN Digits	RAN Figures	F	Wilk’s Λ	p
Response time (milliseconds)
Controls (n = 159)	20813.23 ± 4355.49a	22721.39 ± 5666.98b	52920.13 ± 17813.67c	3.9	0.03	0.022*
ADHD symptoms (n = 20)	22655.00 ± 5079.37a	23860.00 ± 6089.46a	56022.56 ± 19935.232b	3.9	0.03	0.022*
RD (n = 37)	24781.03 ± 6626.67a	26059.73 ± 5833.22a	64448.92 ± 17717.10b	3.9	0.03	0.022*
Number of errors
Controls (n = 159)	0.11 ± 0.4a	0.12 ± 0.52a	0.67 ± 1.69b	2.69	0.95	0.03*
ADHD symptoms (n = 20)	0.10 ± 0.44a	0.20 ± 0.41a	0.70 ± 1.12a	2.69	0.95	0.03*
RD (n = 37)	0.32 ± 0.62a	0.24 ± 0.68a	1.86 ± 2.64b	2.69	0.95	0.03*

• Data presented as mean ± standard deviation.
• ADHD = attention deficit hyperactivity disorder; RAN = rapid automatized naming; RD = reading disability.
• * p < 0.05.
• Different letters indicate differences among tasks.

Regarding accuracy, children with ADHD symptoms showed a similar number of errors in the three CNS tasks. In contrast, children with RD and controls made more errors when naming figures than letters and digits (p < 0.05). These two groups did not differ significantly from each other (p > 0.05, F _4,422 = 2.696, p < 0.03, Wilk’s Λ = 0.951, η ² = 0.02; Table 1 ).

Discussion

The present study investigated similarities and differences between performance in different RAN tasks in participants with ADHD symptoms, participants with RD, and control children with typical development. We discuss the results in order to provide possible explanations and directions for future investigations with RAN.

The ADHD symptoms and RD groups showed similar temporal performance in RAN tasks with letters and numbers, and lower performance with figures (when compared to letters and numbers). Children with typical development performed differently. They named letters significantly faster than numbers, and the latter faster than figures. Thus, there is probably a shared common difficulty in letter and digit (alphanumeric tasks) speeded naming in children with ADHD symptoms and those with RD, compared to control children.

The relationship between RAN and reading might be explained by the fact that both tasks require serial processing and retrieval of specific names¹⁸: good readers access word representations stored in the mental lexicon¹⁹ faster and more efficiently. In this sense, rapid naming of digits and letters has a strong predictive relationship with early word recognition processes.²⁰ In addition, RAN interventions seem to enhance word reading speed and, consequently, improve reading fluency.²¹

In children with ADHD, a deficit in executive control or failure to automatize working memory maintenance processes underlies the speed naming deficits observed in RAN tasks. In order to name a list of symbols, the child must plan, control and monitor the visual processing time for each stimulus; inhibit distractors to retrieve the representation of the next symbol; and implement sequential processing efficiently. This is probably the reason why RAN performance is also related to executive functions, especially inhibitory control, working memory and shifting. Commonly, the executive function components mentioned above are impaired in children with ADHD.²² It can also be argued that a more general underlying cognitive process, such as processing speed, is impaired in children with ADHD symptoms and also in those with RD. Thus, the lower performance observed in naming speed in RAN tasks, especially with alphanumeric stimuli, might be explained by a common deficit in processing speed in children with RD and those with ADHD.²³ , ²⁴

Concerning accuracy (number of errors), children often have more difficulty in naming figures than letters or numbers, since the former task is less common in everyday life.²⁵ Therefore, we expected children with ADHD symptoms to make a significantly higher number of errors in figure naming when compared to the two other categories, as opposed to the control group. However, no significant differences were observed in performance between naming letters, digits or figures in children with ADHD symptoms. One possible explanation for this absence of statistically significant differences is that children with ADHD symptoms showed a larger mean number of errors in digit naming in a qualitative comparison with the number of errors made by the control group. This result indicates that the accuracy of digit naming can be impaired in children with ADHD symptoms, even in the absence of comorbid RD.

Finally, to corroborate the hypotheses discussed in this brief communication concerning RAN effects in children with ADHD symptoms and RD, we suggest that future studies include other RAN tasks, such as discrete naming (naming isolated stimuli – we only tested serial naming, in which all the stimuli are presented simultaneously). It would also be interesting to study samples with comorbid symptoms (i.e., children with both ADHD and RD), as well as to perform multivariate statistical analyses to include multiple dependent measures. In addition, it is important to emphasize that, in order to compare RAN performances across groups, stimulus type must be taken into consideration (i.e., letters, numbers, figures or colors), as each task demands different cognitive processes.

Acknowledgements

This study received financial support from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), via a PhD grant awarded to Gabriella Koltermann (research productivity grant, Jerusa Salles, call CNPq/MCTI nº 25/2015).

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Publication Dates

• Publication in this collection
  05 June 2020
• Date of issue
  Apr-Jun 2020

History

• Received
  10 May 2019
• Accepted
  22 July 2019