Developmental Changes in Attention and Comprehension among Children with

Attention Deficit Hyperactivity Disorder

Author(s): Ursula L. Bailey, Elizabeth P. Lorch, Richard Milich and Richard Charnigo
Source: Child Development , Nov. - Dec., 2009, Vol. 80, No. 6 (Nov. - Dec., 2009), pp.
1842-1855
Published by: Wiley on behalf of the Society for Research in Child Development

Stable URL: https://www.jstor.org/stable/25592112

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 Child Development, November/December 2009, Volume 80, Number 6, Pages 1842-1855

Developmental Changes in Attention and Comprehension Among Children

With Attention Deficit Hyperactivity Disorder

Ursula L. Bailey, Elizabeth P. Lorch, Richard Milich, and Richard Charnigo

University of Kentucky

Changes in visual attention and story comprehension for children (N = 132) with attention deficit hyperactiv
ity disorder (ADHD) and comparison peers were examined. Between the ages of 7 and 9 (Phase 1) and
approximately 21 months later (Phase 2), children viewed 2 televised stories: 1 in the presence of toys and 1
in their absence. Both groups of children showed developmental increases in visual attention and stable group
differences over time. Deficits in comprehension among children with ADHD, however, increased over time.
Whereas comparison children's recall of factual and causal information increased over time in both viewing
conditions, children with ADHD showed no developmental improvement in recall of factual information in
the toys-present condition and no improvement in recall of causal relations in either viewing condition.

Considerable research has been directed toward Longitudinal studies do exist that have examined
understanding the nature of the core symptoms developmental changes in symptom patterns and
that define attention deficit hyperactivity disorder academic performance among children with ADHD
(ADHD). Based on this body of research, theoretical (e.g., Barkley et al., 1990; Fischer, Barkley,
models have been proposed to explain the atten Edelbrock, & Smallish, 1990). Thus, it has been
tional and inhibitory problems exhibited by chil documented that as children with ADHD get older
dren with ADHD (e.g., Barkley, 1997; Nigg, 2006). they demonstrate declines in the primary symp
In contrast, much less research has examined toms (i.e., attention problems, hyperactivity, impul
higher order cognitive processing skills of these sivity) of the disorder, but in adolescence or young
children, such as skills that are necessary for effec adulthood they still are significantly more symp
tive story comprehension, and no study has exam tomatic than their age mates (Barkley, 2006). For
ined developmental changes in such skills among example, Barkley et al. (1990) found that in adoles
children with ADHD. An understanding of story cence 70%-80% of children with ADHD still
comprehension abilities is important given the rec display age-inappropriate symptoms. Although
ognized role of story comprehension in academic declines in the primary symptoms are observed as
success (Kendeou et al., 2005; Low & Durkin, 1998) children with ADHD get older, their academic
and the well-documented academic problems problems persist and may even increase, resulting
exhibited by children with ADHD (Barkley, 2006). in more school failure, higher dropout rates, and
Because these academic difficulties start in the early lower occupational success (Barkley, 2006). For
grades and persist over time (Barkley, Fischer, example, Fischer et al. (1990) found that adolescents
Edelbrock, & Smallish, 1990), a developmental with ADHD scored significantly below matched
examination of the story comprehension abilities of controls on standardized tests of achievement.
children with ADHD is particularly desirable. To Despite the wealth of follow-up studies examin
achieve this goal, this study uses a longitudinal ing symptom patterns and academic achievement,
design to examine developmental changes in story these studies are limited in the extent to which they
comprehension processes among children with offer insights into developmental changes among
ADHD and their comparison peers. children with ADHD. Although these longitudinal
studies offer valuable data on changes in overall
This research was funded by Grant MH47386 from the symptom patterns and on academic achievement as
National Institute of Mental Health and Grant DA005312 from
the National Institute on Drug Abuse.
Correspondence concerning this article should be addressed to
Richard Milich, Department of Psychology, University of ? 2009, Copyright the Author(s)
Kentucky, Lexington, KY 40506-0044. Electronic mail may be sent Journal Compilation ? 2009, Society for Research in Child Development, Inc.
to milich@email.uky.edu. All rights reserved. 0009-3920/2009/8006-0018

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 Developmental Changes in ADHD 1843

an outcome, they generally do not address the comprehension beyond the contributions of tradi
higher order cognitive processes that may influence tional indicators of literacy, such as word identifica
academic success. To begin to address questions tion and vocabulary. Finally, Feagans and
about such processes, this study investigates longi Applebaum (1986) reported that relatively strong
tudinal changes in patterns of visual attention, first-grade narrative skills, beyond syntactic and
memory for story events, and how attention pat semantic skills, predicted fewer academic problems
terns may relate to story memory for both children 3 years later.
with ADHD and their comparison peers. In studying story comprehension among chil
dren with ADHD, there are several benefits to
using a television-viewing method similar to that
Story Comprehension
used by Kendeou et al. (2005). First, television
One approach to understanding the higher order viewing provides a familiar and enjoyable setting
cognitive processing skills of children with ADHD for children while allowing the presentation of
is to investigate their comprehension of complex complex story structures. Second, reading is not a
stories. As Low and Durkin (1998, p. 202) argue, requirement in this task, so that valid assessment of
story comprehension abilities are regarded as story comprehension abilities of children with
"fundamental organizational processes which ADHD can be obtained despite the reading prob
underpin representational development, the con lems common in this group. Third, the measure
struction of knowledge bases and problem-solving ment of visual attention in the television-viewing
strategies." Investigating story comprehension skills methodology permits investigation of the direct
allows us insight into many aspects of children's relation between attention and story comprehen
cognitive functioning, including the strategic sion. Most importantly, measures of comprehension
allocation of attention; the selection, encoding, and of televised stories should prove informative in
interpretation of important information; the use of understanding the difficulties in academic achieve
story structure; the retrieval of relevant background ment among children with ADHD given that early
information; the generation of inferences that allow comprehension of televised stories was a good pre
interpretation of presented information; the moni dictor of later reading achievement (Kendeou et al.,
toring of comprehension; and the use of retrieval 2005).
skills (Lorch, Berthiaume, Milich, & van den Broek,
2007). Furthermore, story comprehension abilities
Attention and Comprehension in Children With ADHD
are not specific to reading alone but instead appear
to represent general narrative comprehension pro A number of studies have used a television
cesses (Lorch & Sanchez, 1997; Oakhill & Cain, viewing methodology to understand the story com
2007a). For example, Milch-Reich, Campbell, prehension among children with ADHD and its
Pelham, Connelly, and Geva (1999) demonstrated relation to visual attention (Lorch et al., 2000; Lorch
that differences in the inferential and causal under et al., 2004). In this methodology, attention to televi
standing of children with ADHD may have impor sion is manipulated by having children watch two
tant implications for their representations of social programs: one in the presence of toys and one in
relations. their absence. The children are videotaped continu
Several models of reading development propose ously to enable coding of visual attention to the
that skills such as narrative comprehension and program. At the end of each program, children are
skills associated with word decoding represent sep asked cued recall questions testing both factual
arate processes and that each makes an indepen events and the causal relations that connect story
dent and unique contribution to the development events.
of reading comprehension (Shatil & Share, 2003; The results of a number of studies (Landau,
Storch & Whitehurst, 2002). For example, Lynch Lorch, & Milich, 1992; Lorch et al., 2000, Studies 1
et al. (2008), in their sample of 4- and 6-year-olds, and 2; Lorch et al., 2004) have been quite consistent
found interrelations among skills associated with in documenting the nature of the attention to and
word decoding and among skills associated with comprehension of televised stories among children
narrative comprehension but little relation between with ADHD. Specifically, these studies reveal that
the two sets of skills. Furthermore, Kendeou et al. in the absence of toys, there are no significant
(2005) tracked children from ages 6 to 8 and found differences in visual attention or story recall for
that early comprehension of stories presented on older elementary-school-aged children with ADHD
television or audiotape predicted later reading and their comparison peers. In contrast, in the

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1844 Bailey, Lorch, Milich, and Charnigo

presence of toys, children with ADHD show a stee form a more coherent representation of the rela
per decrease in visual attention than do comparison tions among story events, thereby accounting for
children. In terms of story recall, children with group differences when toys are present. For exam
ADHD show no deficit in the recall of factual infor ple, total time spent in long looks, but not total time
mation in either viewing condition and no differ spent in short looks, was a significant mediator of
ence in the recall of causal relations when toys are group differences in recall of causal relations. Con
absent. However, when toys are present during sistent with this finding, the results of all three sets
viewing, children with ADHD exhibit significantly of analyses lead to the conclusion that reduced cog
poorer performance than comparison children on nitive engagement with the material among chil
questions testing causal relations. In fact, compari dren with ADHD produces less coherent story
son children show no drop in recall of causal rela representations and thus poorer understanding of
tions information when toys are present despite a causal connections among story events.
significant decrease in their visual attention. Thus, These studies of the attention to and comprehen
in three studies (Lorch et al., 2000, Studies 1 and 2; sion of television among children with ADHD have
Lorch et al., 2004), differences in story comprehen offered important insights into specific difficulties
sion between ADHD and comparison groups these children experience in comprehending stories.
emerged when tasks tapped the understanding of However, these studies share a common limitation
specific causal relations between story events but in that they fail to examine these issues from a
only in the presence of toys. This indicates that chil developmental perspective, instead collapsing
dren with ADHD do not necessarily have a gener across the entire elementary school age range.
alized deficit in understanding causal relations. Research on story comprehension of typically
Instead, their ability to understand how story developing children has revealed substantial
events are connected is more easily disrupted when improvements over the elementary school years in
their attention is distracted than is that of compari children's appreciation of story structure and
son children. understanding of causal relations (van den Broek,
How might the attentional problems of children 1997). In addition, during the elementary school
with ADHD impair their understanding of causal years story comprehension skills become increas
relations, but not factual events, in the presence of ingly important for academic success (Kendeou
toys? One possibility is that children with ADHD et al., 2005; Oakhill & Cain, 2007a, 2007b). There
engage in shorter looks at the television during the fore, an examination of how story comprehension
toys-present condition, thus impeding their con develops across this age range among children with
struction of a coherent story representation. Indeed, ADHD is needed.
the studies just reviewed consistently found that
the average length of looks at the television is sig
The Current Study
nificantly shorter for children with ADHD than for
comparison children. One viable explanation for The primary purpose of this study is to use a
the problems children with ADHD have in under longitudinal design and the television-viewing
standing causal relations may stem from evidence methodology to investigate and compare patterns
that long looks at the television (i.e., > 15 s) reflect of developmental change in story comprehension
greater cognitive engagement and deeper process among elementary-school-aged children with
ing of story content (Anderson, Choi, & Lorch, ADHD and comparison children. In addition,
1987; Burns & Anderson, 1993). Children with developmental changes in attention and their rela
ADHD may have difficulty in answering causal tion to comprehension will be examined for the
relations questions when their attention is divided two groups of children. Given the lack of develop
because these children spend less time engaged in mental research in this area, specific hypotheses
long looks at the television and thereby are less about changes over time are not offered. Instead,
likely to make connections among events. three major patterns of developmental change in
Lorch et al. (2004) tested the hypothesis that dif group differences should be considered. First, from
ferences in cognitive engagement accounted for the perspective of a developmental delay, early
group differences in recall of causal relations in the group differences may attenuate or even disappear
toys-present condition. The results of three sets of as the children mature. A second possibility is that
analyses offered compelling support for the early group differences persist and remain stable
hypothesis that the increased time spent in long throughout childhood. Finally, consistent with the
looks by the comparison children enables them to reading literature, early deficits in basic skills

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 Developmental Changes in ADHD 1845

may limit mastery of more complex processes as son) did not return for Phase 2 for the following
children mature, thereby leading to greater group reasons: eight children (3 ADHD, 5 comparison)
differences over time (Torgesen & Burgess, 1998). moved away, 8 children (5 ADHD, 3 comparison)
As the first longitudinal investigation of story com could not be located, and 8 children (8 ADHD) dis
prehension among children with ADHD, the design continued participation (most often due to timing
of this study allows us to assess supporting evi difficulties in scheduling). A total of 32 children
dence for each of these possible patterns of devel with ADHD (27 males, 5 females) and 57 compari
opmental change. son children (36 males, 21 females) completed both
Phases 1 and 2. The distribution of ethnic groups
included 86.5% Caucasian, 9% African American,
and 4.5% from other ethnic groups. The groups did
Method not differ in average age at either phase. Mothers of
children with ADHD reported having significantly
Participants
fewer years of education than mothers of compari
A total of 132 children (57 ADHD, 75 compari son children (Table 1).
son) ranging in age from 7 to 9 years, was initially The children with ADHD were recruited from
recruited to participate in the longitudinal study the Hyperactive Children's Clinic in the School of
during Phase 1. The data for 19 children were Medicine at the University of Kentucky. A three
excluded from analyses for the following reasons: step process was developed to ensure that each
low IQ (5 ADHD), inappropriate symptoms for child had an appropriate diagnosis of ADHD. First,
group placement (1 ADHD, 6 comparison), speech children were only considered if they had been
problems or epilepsy (1 ADHD, 1 comparison), on assessed at the psychiatric clinic and received a
medication that could not be suspended during diagnosis of ADHD based on the DSM-IV (Diagnos
testing (1 ADHD, 1 comparison), and other reasons tic and Statistical Manual of Mental Disorders, 4th ed.;
(1 ADHD, 2 comparison). The exclusions resulted American Psychiatric Association, 1994) criteria.
in a Phase 1 sample of 48 children with a diagnosis The diagnosticians were a team consisting of a
of ADHD and 65 comparison peers. child psychiatrist and another mental health profes
Approximately 21 months after the initial session sional. The diagnosis was made by the team using
of Phase 1, children participated in Phase 2 of the standard measures, including child and parent
study. A total of 24 children (16 ADHD, 8 compari interviews, child observations, Conners' Parent and

Table 1
Comparison of Two Diagnostic Groups on Relevant Demographic Variables

ADHD Comparison
(n = 32; 84%) (n = 57; 63%)

Factor (% male) M SD M SD

Age (years)
Phase 1 8.46 0.92 8.42 0.85 0.05 .831
Phase 2 10.25 1.01 10.14 0.87 0.27 .606
CBCL attention problems 71.3 8.2 51.0 2.5 302.8 <.001
DSM-IV interview
Inattention 6.84 1.78 0.21 0.53 690.04 <.001
Hyperactivity-impulsivity 5.97 1.82 0.16 0.41 536.99 <.001
Oppositionality 3.16 2.53 0.25 0.61 69.00 <.001
Mother's education 14.07 2.07 15.67 2.29 10.22 <.001
Vocabulary scaled score 9.22 3.94 13.32 3.50 25.67 <.001
Conners' Parent Ratings9
Oppositional 64.03 12.75 47.77 7.08 55.36 <.001
Inattention 70.30 13.91 46.92 5.11 157.58 <.001
Hyperactivity 76.83 11.40 48.98 5.68 218.03 <.001
ADHD index 72.93 9.18 47.31 5.62 246.71 <.001

Note. ADHD = attention deficit hyperactivity disorder; CBCLChild

= Behavior Checklist; DSM-IV = Diagnostic and Statistical Manual of
Mental Disorders-Fourth Edition.

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1846 Bailey, Lorch, Milich, and Charnigo

Teacher Rating Scales (Conners, 1997), and when achieved interrater reliabilities for the number of
possible, psychological test results. The clinic ADHD symptoms endorsed by the parent to be
diagnosed the children based on a convergence of above 95% (e.g., Lorch et al, 1999). Only the chil
evidence from these data, ensuring that the child dren whose parental interviews supported a diag
was significantly impaired in at least two settings. nosis of ADHD were retained and contributed data
From the clinic diagnoses, a pool of potential for this study.
participants was identified. In the second step of The group of comparison children was recruited
the diagnostic process, parents of identified chil using advertisements in a local newspaper. The eli
dren were asked for consent for the research team gibility of each child began with a screening
to review their children's files. If consent was assessed via a telephone interview with a parent to
granted, clinic files were examined by one of the ascertain that the child was free from any
authors to assess eligibility for participation in the behavioral problems and referrals or learning dis
study. This process allowed the research team to abilities, but the child could have some symptoms.
obtain additional information concerning potential An on-site structured interview with the parent
exclusionary criteria, such as children who had an confirmed the results of the phone interview, such
IQ below 80, significant sensory impairment, epi that only children free of behavioral problems and
lepsy, or a psychotic disorder. Children who were learning disabilities were included in the study.
prescribed a medication that could not be sus Data for comparison children who met criteria for
pended for testing sessions were excluded from three or more symptoms of inattention, hyperactiv
the study but children being treated with a psy ity-impulsivity, or ODD were excluded from the
chostimulant medication were eligible to partici study. As previously stated, comparison children
pate. Of the children with ADHD participating in were not required to be symptom free, but as indi
the study, 91% normally received a psychostimu cated in Table 1, they exhibited significantly less
lant medication. Of these children, 52% received symptomatology than children with ADHD for
Adderall, 31% Concerta, and 17% Ritalin. Chil inattentive, hyperactivity-impulsivity, and ODD
dren were not excluded if they had comorbid symptoms. Both groups of parents further rated
psychological disorders or learning disability. their children using the Child Behavior Checklist
Children who met criteria for ADHD-inattentive (CBCL; Achenbach, 1991). As indicated in Table 1,
subtype were excluded from the study due to the children with ADHD were rated significantly
increasing evidence that impulsivity-hyperactivity higher on the CBCL attention problems scale than
is a core deficit of ADHD and that the ADHD were the comparison children. As further valida
inattentive subtype may be a distinct disorder tion of the diagnostic categories, scores from
and not a subtype of ADHD (Barkley, 2001; the Conners' Parent Rating Scale-Revised-Short
Milich, Balentine, & Lynam, 2001). Version (CPRS-R: S; Conners, 1997) were available
Finally, if the previous criteria were met, the par from Phase 2 conducted approximately 21 months
ent and child were invited to participate in the later. Children with ADHD scored significantly
study. The third step in the diagnostic process was higher than comparison children on all scales from
an on-site standardized interview with the parent this measure, providing evidence of the stability of
to confirm the diagnosis of ADHD. The interview the diagnostic categories (Table 1).
was similar to the Children's Interview for Psychi In addition to diagnostic measures, the Wechsler
atric Syndromes-Parent Version (P-ChIPS; Weiler, Intelligence Scale for Children-Third Edition
Weller, Rooney, & Fristad, 1999) but was limited to (WISC-III; Wechsler, 1991) vocabulary subtest was
verbatim DSM-IV criteria for ADHD and opposi collected during Phase 1 as an estimate of verbal
tional defiant disorder (ODD). In this interview, intelligence. As indicated in Table 1, children with
parents were asked to respond whether each ADHD had significantly lower scores than did
DSM-IV criterion was true for his or her child, give comparison children. Because of the significant
behavioral examples, and indicate whether they group difference that emerged on this measure of
thought the behavior was age inappropriate and intelligence, this study includes IQ as a covariate in
how it affected their child's academic and social the analyses.
functioning. The research team only considered For the children with ADHD who were pre
responses that indicated age-inappropriate behavior scribed psychostimulant medication, during both
and impairment to meet diagnostic criteria. This phases of the study children were medication free
interview procedure has been used successfully by on the day of testing. Medication-free status was
this research group in previous studies and has ensured by making reminder calls to parents and

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 Developmental Changes in ADHD 1847

verifying compliance on the day of study. The 24 he or she could play with the toys during the pro
hr time period free from medication provided an gram. Before leaving, the experimenter reminded
acceptable wash-out period for the drug to be the child that he or she would be asked questions
passed out of the children's systems (see Greenhill, about the program when it was over. The experi
2001; Pelham et al, 1999). All children were paid menter started the program and then left the room.
$15 and given two small toys during each session. The viewing session was videotaped and observed
by the experimenter in a nearby control room.
Materials When the program was over, the experimenter
returned to the room, removed the toys (if present),
During each phase of the study, children viewed and showed the child a picture card with all the
two different 13-min episodes of the Rugrats car major characters of the Rugrats program. Then the
toon television program, one with toys present and child was asked to give a free recall of the events of
one with toys absent. For each child, four of six pos the story, followed by a series of cued recall ques
sible episodes were randomly selected and counter tions. The cued-recall assessment consisted of 35-38
balanced across phases and viewing conditions. factual and causal relations questions that followed
Rugrats episodes were chosen both because of the the sequence of the show. The child's answers were
wide appeal of this animated program across the recorded on audiotape, transcribed, and later
age range tested in this study and because episodes scored as correct or incorrect.
could be identified that followed a goal-driven To obtain an estimate of interrater reliability for
story structure; that is, a protagonist is presented coding of the answers to the recall questions, 20%
with a problem that gives rise to a goal that leads to of the responses were scored twice, with correla
attempts to achieve the goal, often encountering tions of .99 for Phase 1 responses. The interrater
obstacles that create subgroups. Early comprehen reliability for coding the recall questions was > .92
sion of Rugrats episodes successfully predicted later for both viewing conditions and both types of ques
reading comprehension (Kendeou et al., 2005). tions. Coders were kept blind both to the study
hypotheses and to the group status of the children.
Procedure The videotapes were coded to determine the
child's percent visual attention to the television.
Children were brought to the home-like labora Visual attention ratings were done using a synchro
tory at the university by a parent for the first time nization of the Rugrats episode with a computer pro
in Phase 1 and a second time in Phase 2, approxi gram, which allowed raters to code a child's onset
mately 21 months later. The procedure for both and offset of each look to the television. To obtain an
phases was the same. Upon arrival, the child spent estimate of interrater reliability for coding, 20% of
about 5 min getting acquainted with the experi the tapes were scored twice, with correlations > .95
menter and picking out which toys he or she would for ratings of visual attention and > .96 for time
receive at the end of the session. During this time spent in long looks for both viewing conditions.
in Phase 1 informed consent was obtained from the
parent and assent from the child.
Dependent Variables
The viewing room contained a 121.92 x 77.47 cm
table on which were placed the toys during the The primary dependent variables of visual atten
toys-present viewing condition. A 91.44-cm cart tion were percent visual attention to the television
was situated at a 45? angle to the right edge of the and time spent in long looks (> 15 s) at the televi
table. The video camera was located in the left sion. Measures of comprehension were percentage
upper corner of the room, which allowed for of factual questions answered correctly and per
recording the child's attention toward and away centage of causal recall questions answered cor
from the television. rectly. For factual questions, analyses focused on
An experimenter blind to group status (i.e., children's recall of information high in importance
ADHD vs. comparison children) tested the child. to the plots of the televised stories. Questions also
The child was seated at the table (with or without were asked that assessed recall of information
toys, depending on the viewing condition) and told judged to be low in importance. By definition, this
that a television program would be coming on to information is not crucial to understanding the
watch. The child was told that he or she would be overall story. Therefore, to simplify the analyses
asked questions about the program when it was only recall of information high in importance was
over. If toys were present, the child was told that included.

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 1848 Bailey, Lorch, Milich, and Charnigo

Results whether the volume of missing data may have

hindered statistical inference, we conducted sec
The primary purpose of this study was to use the ondary analyses entailing multiple imputation (MI).
television-viewing methodology and a longitudinal More specifically, we applied PROC MI to replace a
design to investigate and compare patterns of child's missing values with five sets of randomly
developmental change in attention, cognitive drawn values that were compatible with the child's
engagement, and comprehension among children nonmissing values. This yielded five imputed data
with ADHD and comparison children. Because per sets, each with 452 observations (4 per child for 113
cent attention and percent of time in long looks children). We refit the mixed model for each depen
exhibited significant skewness, a logistic transfor dent variable five times, once with each of the five
mation was performed to reduce skewness to imputed data sets. PROC MIANALYZE then was
acceptable levels. The formula is as follows: new applied to combine the five refits into a single set of
score = log(old score/[C - old score]), where C is parameter estimates with accompanying standard
the ceiling for the old score. An old score of 0 or C errors. For ease of presentation, the F values, p val
is treated as if it were 1/2 or C - 1/2 to ensure that ues and effect sizes (d) are provided for both AC
the new score is well defined. The dependent vari and MI analyses in Tables 2-5. The effect size is
ables of percentage correct on factual and causal defined as the appropriate linear combination of
questions did not exhibit marked skewness; there estimated means based on the mixed model
fore, no transformations were applied to these divided by the estimated standard deviation based
variables. on the mixed model.
The primary analyses consisted of linear mixed Because the questions addressed in this study
models to relate each dependent measure to the concern differences between groups, especially as
independent variables of group, viewing condition, the groups may differentially change across phases,
and phase, as well as the interactions of these vari only effects that involve diagnostic group are
ables. In addition, the child's gender, mother's reported. For each dependent variable, focused con
years of education, and the child's vocabulary score trasts examined whether there were differences in
were entered into the model as control variables. developmental changes for children in the two
We applied PROC MIXED in Version 9.1 of SAS to diagnostic groups. Additional analyses addressed
fit the mixed model. PROC MIXED uses all avail whether variation in cognitive engagement contrib
able cases (AC) to estimate model parameters. uted to variation in factual recall and causal recall.
Thus, if a child had missing values on a dependent
variable during Phase 2 but not Phase 1 (n = 16,
Developmental Changes in Attention
ADHD, 8 comparison), PROC MIXED still used
that child's observations from Phase 1. Percent attention. The results regarding patterns
Only 81% of the intended data were available for of transformed visual attention were in line with
estimating mixed model parameters. To examine previous studies (i.e., Landau et al., 1992; Lorch

Table 2
Summary of Significant Effects for the Dependent Variable of Visual Attention

Available cases Multiple imputatio

Effect df F p d F p d
Group 4,278 3.58 .0072 0.45 2.93 .0220 0.40
View 4,264 190.95 < .0001 2.43 196.76 < .0001 2.49
Group x View 2, 264 3.73 .0253 0.50 3.27 .0443 2.49
Group?TA 2, 248 0.72 .4900 0.20 3.27 .6397 0.47
Group?TP 2, 247 6.33 .0021 0.70 5.14 .0091 0.63
Phase 4,274 5.18 .0005 0.31 4.47 .0016 0.29
Phase?TP 2, 264 6.19 .0023 0.48 5.74 .0040 0.48
Phase-Comp?TP 1, 272
14.09 .0002 0.59 12.03 .0005 0.53
Phase-ADHD?TP 1, 276 6.17 .0136 0.52 6.09 .0181 0.53

Note. TA = toys absent; TP = toys present; Comp = comparison group; AD

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 Developmental Changes in ADHD 1849
Table 3
Summary of Significant Effects for the Dependent Variable of Cognitive Engagement

Available cases Multiple imputation

Effect df
Group 4,269 4.90 .0008 0.40 3.26 .0126 0.34
View 4,264 138.37 < .0001 2.16 136.22 < .0001 2.14
Group x View 2,264 6.64 .0015 0.67 4.30 .0174 0.54
Group?TA 2,245 0.05 .9518 0.06 0.09 .9112 0.07
Group?TP 2,245 7.95 .0005 0.73 5.40 .0070 0.61
Phase 4,275 5.61 .0002 0.34 4.20 .0024 0.31
Phase?TP 2,264 6.27 .0022 0.61 5.64 .0044 0.44
Phase-Comp?TP 1,273 10.20 .0016 0.52 7.18 .0073 0.43
Phase-ADHD?TP 1,277 12.11 .0006 0.76 8.48 .0052 0.62

Note. TA = toys absent; TP = toys present; Comp = comparison group; ADHD = attention deficit hyperactivity disorder group.

Table 4
Summary of Significant Effects for the Dependent Variable of Factual Recall

Available cases Multiple imputation

Effect df
Phase 4,284 8.02 < .0001 0.48 7.14 < .0001 0.45
Group 4,249 5.06 .0006 0.41 3.44 .0087 0.29
Group x View 2,273 7.67 .0006 0.45 4.06 .0205 0.44
Group?TA 2,258 0.86 .4241 0.19 0.14 .8688 0.07
Group?TP 2,257 8.43 .0003 0.64 7.42 .0006 0.51
Phase-Comp?TA 1,283 4.47 .0353 0.37 5.86 .0158 0.41
Phase-ADHD?TA 1,288 10.28 .0015 0.75 5.20 .0272 0.53
Phase-Comp?TP 1,282 17.38 < .0001 0.72 17.47 < .0001 0.72
Phase-ADHD?TP 1,286 0.06 .8063 0.06 0.50 .4796 0.14

Note. TA = toys absent; TP = toys present; Comp = comparison group; ADHD = attention deficit hyperactivity disorder group.

Table 5
Summary of Significant Effects for the Dependent Variable of Causal Recall

Available cases Multiple imputation

Effect df
Phase 4,284 7.86 < .0001 0.47 7.25 < .0001 0.46
Group 4,252 3.37 .0104 0.45 4.08 .0030 0.51
Phase-Comp 2,282 14.11 < .0001 0.65 12.85 < .0001 0.61
Phase-ADHD 2,286 1.59 .2065 0.29 2.44 .0959 0.30

Note. Comp = comparison group; ADHD = attention deficit hyperactivity disorder group.

et al., 2000, Studies 1 and 2; Lorch et al., 2004), in higher visual attention than the children with
that significant effects of group and viewing condi ADHD. Children showed a developmental increase
tion were qualified by a significant Group x View in visual attention from Phases 1 to 2, primarily due
ing Condition interaction (Table 2). With toys absent to an increase in visual attention when toys were
there was no significant group difference in visual present. Both the children with ADHD and the com
attention toward the television. However, with toys parison children showed similar patterns of devel
present, comparison children showed significantly opmental increase when toys were present.

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1850 Bailey, Lorch, Milich, and Charnigo

Cognitive engagement. The results for trans

formed time spent in long looks were similar to
that reported for overall attention (Table 3). Signifi
cant effects of group and viewing condition were
qualified by a significant Group x Viewing Condi X 60 -
tion interaction. With toys absent there was no sig A Comparison
nificant group difference in time spent in long - -ADHD
looks toward the television. However, with toys
present, comparison children showed significantly
more time in long looks than the children with
Phase One Phase Two
ADHD. Children showed a developmental increase
Time of Measurement
in time spent in long looks from Phases 1 to 2, pri
marily due to an increase in time spent in long Figure 1. Mean percent high important factual informat
looks when toys were present. Both the children recalled correctly as a function of diagnostic group and ph
with ADHD and the comparison children showed toys-present condition only.
similar patterns of developmental increase when
toys were present. Additional mixed models were fit relating
dependent variables of factual recall and cau
recall to transformed time in long looks. Th
Developmental Changes in Recall of Story Events mixed models also included the control variables
Factual recall. Analyses focused on children's child's gender, mother's years of education, an
recall of factual information high in importance to child's vocabulary score.
the plots of the televised stories. Children answered Time spent in long looks was a significant p
more questions correctly at Phase 2 than at Phase 1, dictor of causal recall, AC: ?347) = 4.21, p < .00
and comparison children answered more questions d = 0.34; MI: p = .0009, d = 0.29, but not a sign
correctly than did children with ADHD (Table 4). cant predictor for recall of factual information, A
The latter effect was qualified by a Group x View ?346) = 1.67, p = .0952, d = 0.13; MI: p = .10
ing Condition interaction. Both groups of children d = 0.16. These findings corroborate those of Lo
performed similarly in their recall of highly impor et al. (2004), who found that greater time spen
tant factual information when toys were absent, but long looks was indicative of greater cognit
comparison children recalled more of this informa engagement and resulted in better recall of cau
tion than did children with ADHD when toys were information. There was limited evidence that t
present. Both the children with ADHD and the in long looks partially accounted for group dif
comparison children showed significant improve ences in recall of causal information (AC: chang
ment with development when toys were absent. In p value from .0104 to .0691; change in d from 0
contrast, when toys were present comparison chil to 0.35), although effects involving group remaine
dren showed developmental improvement, significant in the MI analysis (MI: change in p valu
whereas the children with ADHD showed little
improvement in recall of highly important factual
information from Phases 1 to 2 (Figure 1).
Causal recall. Children answered more questions
correctly at Phase 2 than at Phase 1, and compari
son children answered more questions correctly
than did children with ADHD (Table 5). In addi
tion, comparison children showed significant - -ADHD
improvement from Phase 1 to Phase 2, whereas ^*- Comparison
children with ADHD failed to show significant
improvement across phases (Figure 2).
Phase One Phase Two
Developmental Changes in the Relation Between Time of Measurement
Attention Patterns and Comprehension
Figure 2. Mean percent causal relations questions answer
The final purpose of this study was to investigate correctly as a function of diagnostic group and phase, acr
the relations between visual attention and recall. viewing conditions.

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 Developmental Changes in ADHD 1851

from .0030 to .0119; change in d from 0.51 to 0.45). dren with ADHD showed no deficit relative to their
The difference between the AC and MI analyses comparison peers in recalling plot-relevant factual
may reflect an influence of attrition in the AC information either at Phase 1 or at Phase 2. In con
analysis. trast, in the presence of toys, children with ADHD
showed no improvement in recalling this informa
tion across phases, resulting in a substantial deficit
at Phase 2 when attention was divided between the
Discussion
television and toy play. For questions testing
A major goal of this study was to investigate and understanding of causal relations, children with
compare patterns of developmental change in story ADHD showed no developmental advance and a
comprehension among children with ADHD and deficit relative to comparison children at Phase 2,
comparison children. Although previous research regardless of viewing condition and associated
has documented deficits in story comprehension level of attention.
among children with ADHD and has linked these One way to interpret these patterns of findings is
deficits to group differences in attention patterns to consider how they relate to the distinction
(Lorch et al., 2000; Lorch et al., 2004), no study has between skills necessary to encode important story
examined developmental change in these group events and skills necessary for effective allocation
differences. As noted earlier, three major patterns of attention. Specifically, the results of the present
of developmental change are possible. First, early and earlier studies (e.g., Lorch et al., 2004) support
group differences may attenuate or even disappear the interpretation that children with ADHD have
as the children mature. Second, early group differ the skills necessary to comprehend important
ences may persist and remain stable throughout factual information. Thus, under optimal viewing
childhood. Finally, early deficits in basic skills may conditions (i.e., toys absent), and with explicit
limit mastery of more complex processes as chil questions to cue recall (i.e., as opposed to unstruc
dren mature, thereby leading to greater group tured free recall; see Flake, Lorch, & Milich, 2007),
differences over time. children with ADHD are as successful as compari
The results of this study can be discussed with son children in encoding and recalling important
respect to each of these three possible patterns of factual information. The current longitudinal study
developmental change. For no measures were ini adds a unique contribution to this interpretation in
tial group differences reduced across phases, thus that the two groups of children show the same
providing no support for the hypothesis of a devel developmental progression in their recall of impor
opmental delay in attention and comprehension tant factual information, provided that children
among children with ADHD. The results for the with ADHD maintain high levels of attention.
attention measures generally were consistent with Although children with ADHD possess skills
the hypothesis that early group differences persist necessary for successful recall of factual informa
and remain stable throughout the elementary tion, the opportunity for toy play disrupted the
school years. Although children's percent attention processing of high-important factual information
to the television and time spent in long looks during Phase 2. In fact, the children with ADHD
increased for both groups of children across phases, did not show any improvement across phases
the magnitude of group differences remained when toys were present. In contrast, from Phase 1
constant. In contrast, for the comprehension mea to Phase 2, comparison children showed an
sures, not only did the group differences generally increased ability to identify and encode the most
increase over time, but this was almost entirely important information even when their attention
accounted for by the absence of improvement was divided between the television program and
among the children with ADHD. toy play. Notably, although both groups of children
To best understand the nature of the develop showed similar increases in their overall levels of
ment of story comprehension deficits among chil visual attention from Phases 1 to 2 when toys were
dren with ADHD, it is necessary to consider the present, only the comparison children showed an
viewing condition under which attention is increase in their recall of important factual informa
assessed as well as the type of information probed tion. There are several reasons why the children
by the questions. For questions tapping highly with ADHD may fail to show progress in this area.
important factual information, group differences in One possibility is that comparison children have
recall over time depended on the conditions for increased total processing resources over time,
viewing. Specifically, in the absence of toys chil whereas children with ADHD have not developed

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1852 Bailey, Lorch, Milich, and Charnigo

more resources that are suitable for this task. events and connect them to previously encoded
Another possibility is a lack of progress among events, allowing children to establish causal links
children with ADHD in the ability to effectively among story events that are relatively distant in
apply skills needed to divide their processing time. Thus, long looks may help children con
resources for successful story comprehension. struct a more coherent story representation, which
Because children's academic and social environ may in turn allow children to infer connections
ments typically present demands for divided among events.
attention, the results of this study suggest that chil Given that time spent in long looks did not
dren with ADHD may be at a developmental disad entirely account for group differences in develop
vantage in acquiring important factual information ment of the understanding of causal relations, addi
in day-to-day settings. tional explanations must be considered. It may be
Whereas the children with ADHD did demon that comparison children have achieved better mas
strate improvement over time in their recall of fac tery of story comprehension strategies that increas
tual information when attention was undivided, ingly are required as children proceed through the
these children's performance on questions testing elementary school years and encounter more
causal relations revealed a different pattern. Specifi demanding tasks. Such strategies may include inte
cally, children with ADHD showed no develop grating details to form a main idea, anticipating
mental improvement in their understanding of upcoming story events, and inferring characters'
causal relations regardless of whether toys were motivations. A related explanation for these group
present during viewing. In contrast, comparison differences concerns resource limitations that may
children showed developmental gains that were be important to developing and executing such
similar for both conditions. In this study, even story comprehension strategies. Cognitive resource
when children with ADHD achieved high levels of limitations that have been found among children
attention and recall of important factual informa with ADHD include deficits in planning and in
tion, they showed no developmental improvement working memory (Barkley, 1997), both of which
in their ability to understand the causal connections may restrict the ability to make connections among
among these events. Thus, differences in levels of events. Finally, understanding causal relations
attention do not explain the group differences in requires relatively effortful processing. Comparison
developmental patterns. Similarly, group differ children, as they develop, may be more able and/or
ences in development of the understanding of cau willing to exert the effort necessary for an inte
sal relations occurred even in the condition in grated understanding of the story. The failure to
which children with ADHD showed a good under exert sufficient effort on complex tasks is a problem
standing of discrete story events. that has been documented among children with
These group differences in developmental pat ADHD (Barkley, 1997).
terns appear to relate to differences in processes The results of this study may have important
required to recall factual information versus those implications both for understanding and ameliorat
processes needed to answer causal relations ques ing the academic problems experienced by children
tions. Unlike performance on questions testing with ADHD. Current treatments, such as stimulant
factual information, correctly answering questions medication and behavior modification, have proven
testing causal relations requires integration of effective for increasing rates of attention and pro
story events. One component that enables children ductivity for children with ADHD but are less
to connect story events is more sustained atten effective in producing long-term academic gains
tion to the television program, as indexed by the (Barkley, 2006). Because of the dependence of fac
measure of time spent in long looks. For both tual recall on visual attention, the results of this
groups, time spent in long looks predicted perfor study suggest that traditional treatments may be
mance on causal relations questions. More impor beneficial in improving cued recall of important
tantly, the group difference in recall of causal factual events. However, the findings also indicate
relations was partially accounted for by group dif that treatments specifically targeting children's cog
ferences in cognitive engagement. This finding is nitive processing may be an important addition in
consistent with results reported by Lorch et al. improving children's understanding of causal con
(2004), although in the latter case time spent in nections among events. In this study, children with
long looks completely accounted for group differ ADHD failed to show any developmental improve
ences. As argued in Lorch et al. (2004), long looks ment even when attention was optimal (i.e., toys
may give children more time to encode ongoing absent condition) and they were asked structured

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 Developmental Changes in ADHD 1853

questions to cue the relevant information. Children cal of children's programs and can be entertaining
with ADHD may need educational interventions even if the plot lines are not well understood.
focused specifically on making connections among Thus, children could find value in these episodes
events and building coherent story representations even if not processing at the deeper levels associ
(Berthiaume, 2006; Lorch et al., 2007), in addition toated with more time in long looks. This may help
the traditional treatments that may help implement explain why the percentage of time children spent
and maintain these new skills. Developing and in long looks in this study was considerably lower
testing such interventions for children with ADHD than that found in previous studies (Lorch et al.,
seem particularly important because making causal 2000; Lorch et al., 2004). Despite this limitation,
connections is a fundamental skill that takes on time spent in long looks predicted performance on
added importance as children get older and need to causal relations questions and still partially
apply this skill to a wider range of academic sub accounted for group differences in understanding
jects (Oakhill & Cain, 2007b; Snyder & Downey, of causal relations. In addition, the findings of all
1991). these studies converge on the conclusion that the
One limitation of the present study is that the major difficulty children with ADHD have in story
sample was too small to examine the possible mod comprehension pertains to the understanding of
erating effects of comorbid conditions in explaining causal relations. Furthermore, these difficulties
differences between children with ADHD and com were detected in a task that required no reading.
parison children. In particular, it was not possible As such, these difficulties are independent of any
to examine potential effects of comorbid learning reading problems, which are common among chil
disabilities in accounting for the results because of dren with ADHD (Barkley, 2006).
the absence of comprehensive IQ and achievement A fourth limitation of this study is the generaliz
test data. Future research can examine more sys ability of the findings to actual performance in the
tematically the potential moderating role of rele classroom. Because the purpose of the study was to
vant comorbid factors. investigate the impact of ADHD symptomatology
A second limitation, common to many longitudi on story comprehension, the children with ADHD
nal studies, is that there was some attrition from were off medication while doing the story compre
Phases 1 to 2. This attrition, which often is not ran hension tasks. However, many of these children
dom, introduces the possibility that findings across normally were on medication during the school
phases may be influenced to some degree by attri day. It is unknown what impact medication would
tion. A comparison of the AC and MI analyses does have on story comprehension performance,
suggest a tendency for some MI effect sizes to be although the one previous study in this area
slightly smaller than AC effect sizes. However, with suggests only a limited effect of medication
one exception, the pattern of significant findings (Francis, Fine, & Tannock, 2001), and this study did
was the same for the AC and MI analyses, suggest not examine medication's impact on understanding
ing that attrition did not change the major conclu of causal relations. In addition, as argued earlier,
sions drawn from this study. the difficulties in understanding causal relations
A third potential limitation in this study was demonstrated by children with ADHD in this study
the choice of television programming, which dif were observed even when these children were
fered from that employed in previous studies (e.g., attending at high rates, suggesting that medication
Lorch et al., 2004). Differences in programs across may not affect this deficit.
studies may help to explain why the recall find In addition to the potential effects of medication,
ings for the present study differed in a couple of other differences between a classroom and this
respects from those obtained in the earlier studies. study may limit the generalizability of the findings.
In the earlier studies the situation comedies had Obviously, the child is not alone in a classroom,
formal features (e.g., live action, more verbal than material is rarely presented on television, classroom
visual humor) characteristic of general audience distractions are quite different from the toys-pres
programming and relatively elaborate plot struc ent condition employed in this study, and testing is
tures (e.g., multiple subplots), suggesting that the not routinely done in a one-to-one setting. These
entertainment value of the programs would be differences suggest that the present results actually
enhanced by fuller comprehension of the stories. may underestimate the story comprehension defi
In contrast, the Rugrats episodes are characterized cits experienced by children with ADHD in typical
by formal features (e.g., animation, physical school settings. Nevertheless, the degree to which
humor, child characters with peculiar voices) typi the story comprehension measures used in the

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1854 Bailey, Lorch, Milich, and Charnigo

present study predict academic achievement activity disorder: What is the connection? School
remains to be investigated. In addition, the impact Psychology Review, 35, 309-323.
of distractions more typical of classroom settings Burns, J. J., & Anderson, D. R. (1993). Attentional inertia
needs to be examined more systematically. and recognition memory in adult television viewing.
Communication Research, 20, 777-799.
The final limitation of the study concerns the fact
that teacher data were not available for all children Conners, C. K. (1997). Conners' Parent Rating Scales
Revised-Short Version. North Tonawanda, NY: Multi
in the clinic group to further confirm the diagnosis Health Systems.
of ADHD. Thus, the only standardized information Feagans, L., & Applebaum, M. I. (1986). Validation of lan
we are able to report comes from parents, in the guage subtypes in learning disabled children. Journal of
form of the structured interview at Phase 1 and the
Educational Psychology, 78, 358-364.
rating scales completed at both Phases 1 and 2. Fischer, M., Barkley, R. A., Edelbrock, C. S., & Smallish,
However, it is important to note that all of the chil L. (1990). The adolescent outcome of hyperactive chil
dren with ADHD were clinic referred and had dren diagnosed by research criteria, II: Academic,
received a diagnosis after a comprehensive evalua attentional, and neuropsychological status. Journal of
tion that included information from multiple Consulting and Clinical Psychology, 58, 580-588.
sources. Flake, R. A., Lorch, E. P., & Milich, R. (2007). The effects
of thematic importance on story recall among children
In closing, this study has extended the previous
with attention deficit hyperactivity disorder and com
research by examining the development of parison
attenchildren. Journal of Abnormal Child Psychology,
tion and comprehension abilities in children35,with
43-53.
ADHD. It is well established that children with
Francis, S., Fine, J., & Tannock, R. (2001). Methyl
ADHD have significant academic difficulties,phenidate
but selectively improves storyretelling in chil
few treatments have proven successful in address
dren with attention deficit hyperactivity disorder.
ing these problems. By documenting key areas inof Child and Adolescent Psychopharmacology, 11,
Journal
217-228.
which children with ADHD do not show develop
Greenhill, L. L. (2001). Clinical effects of stimulant medi
mental progress, this study may provide insight
into the types of interventions that may be cation
mostin ADHD. In M. V. Solanto, A. F. T. Arnsten, &
beneficial. F. X. Castellanos (Eds.), Stimulant drugs and ADHD basic
and clinical neuroscience (pp. 31-71). New York: Oxford
University Press.
References Kendeou, P., Lynch, J. S., van den Broek, P., Espin, C,
White, M., & Kremer, K. E. (2005). Developing success
Achenbach, T. M. (1991). Child Behavior Checklist forful readers: Building early comprehension skills
ages
4-18. Burlington: Department of Psychiatry, University
through television viewing and listening. Early Child
of Vermont. hood Education Journal, 33, 91-98.
American Psychiatric Association (1994). Diagnostic Landau,
andS., Lorch, E. P., & Milich, R. (1992). Visual atten
tion to and comprehension of television in attention
statistical manual of mental disorders (4th ed.). Washing
ton, DC: Author. deficit hyperactivity disordered and normal boys. Child
Anderson, D. R., Choi, H. P., & Lorch, E. P. (1987). Development,
Atten 63, 928-937.
Lorch, E. P., Berthiaume, K., Milich, R., & van den Broek,
tional inertia reduces distractibility in young children's
TV viewing. Child Development, 58, 798-806. P. (2007). Story comprehension impairments in children
Barkley, R. A. (1997). ADHD and the nature of self-control.
with attention-deficit/hyperactivity disorder. In K. Cain
New York: Guilford. & J. Oakhill (Eds.), Children's comprehension problems in
Barkley, R. A. (2001). The inattentive type of ADHD
oralas
anda written language: A cognitive perspective (pp.
distinct disorder: What remains to be done? Clinical
128-156). New York: Guilford.
Psychology, Science and Practice, 8, 489-493. Lorch, E. P., Eastham, D., Milich, R., Lemberger, C. C,
Sanchez, R. P., & Welsh, R. (2004). Difficulties in com
Barkley, R. A. (2006). Attention-deficit hyperactivity disorder:
A handbook for diagnosis and treatment (3rd ed.). prehending
New causal relations among children with
York: Guilford. ADHD: The role of cognitive engagement. Journal of
Barkley, R. A., Fischer, M., Edelbrock, C. S., & Smallish,
Abnormal Psychology, 113, 56-63.
L. (1990). The adolescent outcome of hyperactive Lorch, E. P., Milich, R., Sanchez, R. P., Baer, S., Hooks, K.,
children diagnosed by research criteria: H?rtung, I. An C, et al. (2000). Comprehension of televised
stories in boys with attention deficit/hyperactivity dis
8-year prospective follow-up study. Journal of the Ameri
can Academy of Child and Adolescent Psychiatry, 29, 546
order and nonreferred boys. Journal of Abnormal Psy
557. chology, 109, 321-330.
Berthiaume, K. S. (2006). Story comprehension and aca Lorch, E. P., & Sanchez, R. P. (1997). Children's memory
demic deficits in children with attention deficit hyper for televised events. In P. den van Broek, P. J. Bauer, &

This content downloaded from

154.59.125.115 on Tue, 09 Jan 2024 11:26:39 +00:00
All use subject to https://about.jstor.org/terms
 Developmental Changes in ADHD 1855

T. Bourg (Eds.), Developmental spans in event comprehen Pelham, W. E., Aronoff, H. R., Midlam, J. K., Shapiro, C.
sion and representation: Bridging fictional and actual events J., Gnagy, E. M., Chronis, A. M., et al. (1999). A com
(pp. 271-291). Mahwah, NJ: Erlbaum. parison of Ritalin and adderall: Efficacy and time
Lorch, E. P., Sanchez, R. P., van den Broek, P., Milich, R., course in children with attention-deficit/hyperactivity
Murphy, E. L., Lorch, R. F., et al. (1999). The relation of disorder. Pediatrics, 103,1-14.
story structure properties to recall of television stories Shatil, E., & Share, D. L. (2003). Cognitive antecedents of
in young children with attention-deficit hyperactivity early reading ability: A test of modularity hypothesis.
disorder and nonreferred peers. Journal of Abnormal Journal of Experimental Child Psychology, 86,1-31.
Child Psychology, 27, 293-309. Snyder, L. S., & Downey, D. M. (1991). The language
Low, J., & Durkin, K. (1998). Structure and causal connec reading relationship in normal and reading-disabled
tions in children's on-line television narratives: What children. Journal of Speech and Hearing Research, 34, 129
develops? Cognitive Development, 13, 201-225. 140.
Lynch, J. S., van den Broek, P., Kremer, K. W., Kendeou, Storch, S. A., & Whitehurst, G. J. (2002). Oral language
P., White, M. J., & Lorch, E. P. (2008). The development and code-related precursors to reading: Evidence from
of narrative comprehension and its relation to other a longitudinal structural model. Developmental Psychol
early reading skills. Reading Psychology, 29, 327-365. ogy, 38, 934-947.
Milch-Reich, S., Campbell, S. B., Pelham, W. E., Connelly, Torgesen, J. K., & Burgess, S. R. (1998). Consistency of
L. M., & Geva, D. (1999). Developmental and individ reading-related phonological processes throughout
ual differences in children's online representations of early childhood: Evidence from longitudinal-correla
dynamic social events. Child Development, 70, 413^131. tional and instructional studies. In J. Metsala & L. Ehri
Milich, R., Balentine, A., & Lynam, D. R. (2001). ADHD (Eds.), Word recognition in beginning reading (pp. 161?
combined type and inattentive type are distinct and 188). Mahwah, NJ: Erlbaum.
unrelated disorders. Clinical Psychology: Science and van den Broek, P. W. (1997). Discovering the cement of
Practice, 8, 463^188. the universe: The development of event comprehension
Nigg, J. T. (2006). What causes ADHD? Understanding what from childhood to adulthood. In P. W. van den Broek,
goes wrong and why. New York: Guilford. P. J. Bauer, & T. Bourg (Eds.), Developmental spans in
Oakhill, J., & Cain, K. (2007a). Introduction to compre event comprehension and representation (pp. 321-342).
hension development. In K. Cain & J. Oakhill (Eds.), Mahwah, NJ: Erlbaum.
Children's comprehension problems in oral and written lan Wechsler, D. (1991). Wechsler Intelligence Scale for Chil
guage (pp. 3-40). New York: Guilford. dren (3rd ed.). San Antonio, TX: Psychological
Oakhill, J., & Cain, K. (2007b). Issues of causality in Corporation.
children's reading comprehension. In D. S. McNamara Weiler, E. B., Weiler, R. A., Rooney, M. T., & Fristad, M.
(Ed.), Reading comprehension strategies: Theories, interven A. (1999). Children's Interview for Psychiatric Syndromes
tions, and technologies (pp. 47-71). Mahwah, NJ: Parent Version (P-ChIPS). Washington, DC: American
Erlbaum. Psychiatric Press.

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