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Revista CEFAC

Print version ISSN 1516-1846On-line version ISSN 1982-0216

Rev. CEFAC vol.20 no.6 São Paulo Nov./Dec. 2018 


Profile of reading difficulties in children with attention deficit hyperactivity disorder: a literature review

Erica Moraes Silva de Paula1 

Ana Luiza Navas1 

1Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, São Paulo, Brasil.



to characterize the reading alterations in individuals with attention deficit hyperactivity disorder.


PubMed and SciELO platforms from 2006 to 2016 with the keywords "reading" and "attention deficit hyperactivity disorder", with their equivalents in Portuguese, were searched.


seven hundred ninety articles were found in the two databases, of which 119 were relevant. After a full reading, twenty five articles were selected for the analysis, according to relevance and other exclusion/inclusion criteria. In 21 of the studies, individuals with attention deficit hyperactivity disorder presented worse performance in reading, as compared with their peers. Of these, 14 studies identified a delay in some skills that are important for reading: processing speed, reading accuracy, phonological awareness, comprehension and/or orthographic processing.


these results corroborate other studies that have verified the presence of a deficit in academic performance, especially in reading skills, in individuals with attention deficit hyperactivity disorder, that may persist in their adulthood.

Keywords: Reading; Attention deficit hyperactivity disorder; Language


Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by a persistent pattern of inattention, hyperactivity and impulsivity, not expected in typical development, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V)1.

Different studies, especially with twins, have shown the presence of genetic inheritance in ADHD2. Genetic vulnerability to ADHD appears to be mediated by several small-effect genes, but further studies are needed to precisely identify what these effects are, as well as which phenotypes are specific for subtypes and comorbidities of the disorder3.

In respect of the biological aspects, some studies have shown that individuals with ADHD present a possible failure in the activation of the striated nucleus, a brain region with a high concentration of dopamine linked to the reward system. In one study, individuals in a control group had striated nucleus activation and dopamine release as soon as they were told about a reward, while individuals with ADHD had the release only after actually receiving it. This delay in reward circuit response may explain the inattention and impulsivity present in individuals with ADHD4. These characteristics persist in adolescence and adulthood, but may be less pronounced5.

ADHD may be accompanied by comorbidities, the most frequent being written language disorders that appear in 14% of children with ADHD. These findings highlight the importance of the attentional factor in relation to the domain of the language, and emphasize the importance of attention for any type of learning.

In many cases of ADHD, the family and school only refer children to specialists when they are already behind in terms of school performance. Therefore, it is important to look out for reading and writing difficulties that may be due to the inattention, impulsivity or hyperactivity that are associated with ADHD. As the symptomatology of ADHD can affect several areas that impair school performance, it is necessary to identify how this can have an impact on the specific skills necessary for the good development of reading and writing. It is, therefore, important to include both oral and written language assessments to complete the performance profile and assist in the diagnosis of ADHD. This study aimed to identify, through a review of the literature, the reading disorders present in children with ADHD in order to better inform professionals from different areas, as well as to qualify the process of evaluation and intervention for children and adolescents with ADHD. In addition, it was intended to verify the hypothesis that as a result of the attention deficit, there may be decoding errors due to excessive reading guess, reading fluency deficits, which consequently affect reading comprehension.


PubMed and SciELO databases were searched for articles published between 2006 and 2016 in Portuguese or English, using a combination of the terms "leitura" and "Transtorno do Deficit de Atenção e Hiperatividade (TDAH)" and their equivalents in English, "reading" and "attention deficit hyperactivity disorder (ADHD)”. The databases were selected for their thematic scope and for including open access articles. The search was performed using the advanced search function in both databases, with items classified by relevance, according to the criteria of the database chosen. The choice to only include articles published in Portuguese and English was based on the idea that any scientific community should have access to articles published in their own language, as well as those published in English, the access language of international science.

Selection Criteria

The selection criteria were complete, original articles, published between the years 2006 and 2016, published in Portuguese or English. General studies on ADHD with specific reading disorders as comorbidities were included. Duplicate articles, articles not relevant to the subject, reviews, genetic studies, studies with illiterate/pre-school subjects, case studies, treatment studies, and surveys containing other comorbidities were excluded. Table 1 shows the excluded articles.

Data Analysis

Initially, the first 100 articles were selected according to relevance in each database. The first inspection for the criteria was based on the reading of the titles and abstracts of articles with open access. All duplicate articles were excluded as well as those that did not meet established selection criteria. The same procedure was done for articles with restricted access. When there was doubt about the exclusion criteria, a second judge analyzed the article. The author and the advisor of this study were considered the judges for the inclusion or exclusion of the articles. Upon completion of the collection of the database for analysis, all articles were read completely in order to record all relevant details for further analysis. The studies were organized by journal, year of publication, age of population studied, diagnosis, language spoken, the main purpose of the study, the experimental approach, measures used, and conclusions. For the present study, it focused on the discussion of participants' reading characteristics.

Literature Review

From the survey of the literature, 790 articles were found (771 in PubMed and 19 in Scielo), of which the 100 most relevant were selected from PubMed and all 19 from Scielo.

After reading the titles and abstracts we selected 34 articles for the complete analysis. A summary of the selection process is shown in Figure 1.

Figure 1: Organization Chart used for the Systematic Review Process 

Exclusion and inclusion criteria were used to select the articles. The ones excluded were duplicates or did not fit in the criteria. Review articles or Case reports were also excluded. Table 1 shows the articles excluded.

Table 1: Distribution of articles excluded according to the exclusion criterion 

Category PubMed Scielo Total
Restricted access 2 0 2
Duplicate 3 1 4
Case report 0 1 1
Genetics 8 0 8
Language 4 2 6
Non related with the topic 48 9 57
Literature review 2 1 3
Other psychiatric/neurologic disorders 4 0 4
Preschoolers/illiterates 2 0 2
Treatment 6 1 7
Total 79 15 94

Examining the geohistorical distribution of the articles, in terms of the year of publication, country of origin and language of the publication, may help to understand the interest in this area of research around the world in recent years. Most of the studies analyzed were published in the last 3 years (2014 to 2016) of the period investigated. Of the 25 articles, 6 (24%) were published in 2016, 4 (16%) were published in 2015, 6 (24%) in 2014, 4 (16%) in 2013, 1 in 2012 (4%), 3 (12%) in 2011, and 1 (4%) in 2008. Most of the studies were conducted in the United States of America (10), followed by Brazil (5), Germany (2), Australia (2), Canada (2), Israel (2), Belgium (1) and Spain (1). Of the 25 articles, 21 (84%) were published in English and 4 (16%) in Portuguese.

Figures 2 and 3 show details of each study such as date of publication, authorship, country, goal of the study, sample description, and main findings of the 25 studies analysed6-30.

Figure 2: Identification and description of the selected articles, in chronological order of publication 

Figure 3: Sample characterization and results of changes in written language, according to the chronological order of publication 

The academic deficits present in ADHD may persist until adult life, even if reduced in severity or the associated symptoms are controlled, as demonstrated in the research of Voigt et al.6. The study conducted by Whipple and Nelson7, which also included and tracked the performance of adults, showed difficulty in naming tasks in both the ADHD group and the comorbid group. These data are compatible with other findings that report that the incidence rate of ADHD symptoms in adults who showed symptoms in childhood is between 30 and 70%, with the same difficulties persisting in respect of academic performance8.

Most of the studies found and analyzed showed that individuals with ADHD had worse academic performance compared to their peers. This data corroborates other studies31 that evaluated the academic performance of children without ADHD, with ADHD and, with ADHD and a concomitant learning disorder, and identified performance deficits, especially in reading and writing, both in the ADHD+learning disorder group and in the group with only ADHD 20-23.

Deficits in Phonological and Orthographic Processing Skills

Among all the studies selected for review, 2 articles showed significant differences between individuals with ADHD and their control group pairs in phonological awareness tasks. In one study, the ADHD group with no comorbidity had a worse performance in phonological awareness, and in the other study, only the group with ADHD and with a specific learning disorder as comorbidity had worse performance in phonological awareness compared to the non-ADHD , and ADHD without learning disorder groups.

There was 1 article with a study in respect of orthographic processing in individuals with ADHD. This study reported that individuals with ADHD demonstrated worse performance in rules knowledge and in orthographic memory. None of the participants in the ADHD group had a specific learning disorder as a comorbidity.

Changes in phonological awareness and orthographic rules are often more severe in learning disorders than in ADHD, due to the presence of common phonological and orthographic processing deficits in individuals with reading disorders. Considering that the development of this ability depends on stimulation and correct learning from the preschool stage, it is not uncommon for children with ADHD to present deficits in phonological and orthographic processing as a possible consequence of the presence of ADHD symptoms, such as inattention and impulsivity9,13.

Deficit in Reading Performance

Regarding the analysis of reading performance, the majority of the studies showed that there was a significant difference in performance in reading tasks between children with ADHD and the control group (Table 2). Twenty-one studies (84%) found that individuals with ADHD, with or without reading difficulty as a comorbidity, performed significantly worse in reading tests compared to their non-ADHD peers. The other studies analyzed did not find significant differences in the reading performance of children with ADHD or did not aim to identify the reading profile in this group, although they did examine academic performance.

Table 2: Study summaries according to the reading skills investigated 

Related Reading Skills Number of studies
Word reading rate 9
Word reading accuracy 9
Pseudoword reading rate 3
Pseudoword reading rate 3
Phonological awareness 2
Comprehension (passage, texts) 6
Orthographic processing 3

Of the 21 publications whose results showed poor reading performance in subjects with ADHD, 14 specified different reading-related skills and their characterization in subjects with ADHD. Twelve studies showed a worse performance, specifically in fluency and accuracy of word reading and 3 studies showed worse performance related to pseudoword fluency and accuracy.

The area that showed the greater deficits in the groups with ADHD or groups with a comorbidity (ADHD and learning disabilities) were speed and accuracy of reading6,7,9-17. Fluency and reading accuracy are important elements, since they allow monitoring of possible changes in the development of reading32. These results are compatible with other studies19 that showed reduced speed of reading of words and of non-words in individuals with ADHD.

The understanding of texts, passages, and online comprehension was worse in ADHD groups with or without comorbidity of learning disorder, as shown in six studies9,11,16,20-22. The symptoms of individuals with ADHD, such as impulsivity, deficit in inhibitory control, hyperactivity, along with the difficulties in reading present seem to interfere indirectly in reading comprehension, although the etiology of comprehension difficulties in ADHD is not very clear16. This study showed deficits in different aspects of reading comprehension (textual, sentential, inferential) in individuals with ADHD.


The present study aimed to characterize the reading profile of children with ADHD and identify which abilities are more commonly affected. According to the reviewed literature between 2006 and 2016, these difficulties are present at the phonological level and in orthographic processing, which contribute to difficulties in reading accuracy and fluency, and as a consequence, affect reading comprehension.


1. American Psychiatry Association. DSM-V. Diagnostic and Statistical Manual of Mental disorders. 5th.ed. Washington: American Psychiatric Association, 2013. [ Links ]

2. Williams NM, Franke B, Mick E, Anney RJ, Freitag CM, Gill M et al. Genome-wide analysis of copy number variants in attention deficit hyperactivity disorder: the role of rare variants and duplications at 15q13.3. Am J Psychiatry. 2012;169(2):195-204. [ Links ]

3. Faraone SV, Mick E. Molecular genetics of attention deficit hyperactivity disorder. Psychiatr Clin North Am. 2010;33(1):159-80. [ Links ]

4. Furukawa E, Bado P, Tripp G, Mattos P, Wickens JR, Bramati IE et al. Abnormal striatal bold responses to reward anticipation and reward delivery in ADHD. PLoS ONE. 2014;9(2):e89129. [ Links ]

5. Marx I, Hubner T, Herpertz SC, Berger C, Reuter E, Kircher T et al. Cross sectional evaluation of cognitive functioning in children, adolescents and young adults with ADHD. J Neural Transm. 2010;117(3):403-29. [ Links ]

6. Voigt RG, Katusic SK, Colligan RC, Killian JM, Weaver AL, Barbaresi WJ. Academic achievement in adults with a history of childhood attention-deficit/ hyperactivity disorder: a population-based prospective study. Dev Behav Pediatr. 2016;38(1):1-11. [ Links ]

7. Whipple BD, Nelson JM. Naming speed of adolescents and young adults with attention deficit hyperactivity disorder: differences in alphanumeric versus color/object naming. Archives of Clinical Neuropsychology. 2016;31(1):66-78. [ Links ]

8. Czamara D, Tiesler CMT, Kohlboeck G, Berdel D, Hoffmann B, Bauer CP et al. Children with ADHD symptoms have a higher risk for reading, spelling and math difficulties in the GINIplus and LISAplus cohort studies. PLoS ONE. 2013;8(5):e63859. doi:10.1371/journal.pone.0063859 [ Links ]

9. Lobo PAS, Lima LAM. Comparação do desempenho em leitura de palavras de crianças com e sem transtorno de déficit de atenção/ hiperatividade. Rev. CEFAC. 2008;10(4):471-83. [ Links ]

10. Silva C, Cunha VLO, Capellini SA. Desempenho cognitivo-linguístico e em leitura de escolares com Transtorno de Déficit de Atenção e Hiperatividade. Rev Bras. de Cresc. Des. Humano. 2011;21(3):849-58. [ Links ]

11. Albuquerque G, Maia M, Franca A, Mattos P, Pastura G. Processamento da linguagem no transtorno do déficit de atenção e hiperatividade (TDAH). D.E.L.T.A. 2012;28(2):245-80. [ Links ]

12. Jacobson LA, Ryan M, Denckla MB, Mostofsky SH, Mahone EM. Performance lapses in children with attention-deficit/hyperactivity disorder contribute to poor reading fluency. Archives of Clinical Neuropsychology. 2013;28(7):672-83. [ Links ]

13. Cunha VLO, Silva C, Lourencetti MD, Padula NAMR, Capellini SA. Performance of students with attention deficit disorder and hyperactivity in metalinguistic and reading tasks. Rev. CEFAC. 2013;15(1):40-50. [ Links ]

14. Stubenrauch C, Freund J, Flers SA, Scharked W, Braun M, Jacobs AM et al. Nonword reading and Stroop interference: What differentiates attention-deficit/hyperactivity disorder and reading disability? J. of Clinical and Exp. Neuropsych. 2014;36(3):244-60. [ Links ]

15. Sciberras E, Mueller KL, Efron D, Bisset M, Anderson V, Schilpzand EJ et al. Language problems in children with ADHD: a community-based study. Pediatrics. 2014;133(5):793-800. [ Links ]

16. Friedman LM, Rapport MD, Raiker JS, Orban SA, Eckrich SJ. Reading comprehension in boys with ADHD: the mediating roles of working memory and orthographic conversion. J Abnorm Child Psychol. 2016;45(2):273-87. [ Links ]

17. Alves LM, Siqueira CM, Ferreira MCM, Alves JFM, Lodi DF, Bicalho L et al. Rapid naming in brazilian students with dyslexia and attention deficit hyperactivity disorder. Front. Psychol. 2016;7:21. doi: 10.3389/fpsyg.2016.00021 [ Links ]

18. Rogers M, Hwang H, Toplak P, Weiss M, Tannock R. Inattention, working memory, and academic achievement in adolescents referred for attention deficit/hyperactivity disorder (ADHD). Child Neuropsychology. 2011;17(5):444-58. [ Links ]

19. Stern P, Shalev L. The role of sustained attention and display medium in reading comprehension among adolescents with ADHD and without it. Res. Dev. Disab.: A Multidisciplinary Journal. 2013;34(1):431-9. [ Links ]

20. Yeari M, Avramovich A, Schiff R. Online inferential and textual processing by adolescents with attention-deficit/hyperactivity disorder during reading comprehension: evidence from a probing method. J. of Clinical and Exp. Neuropsych. 2016;39(5):1-17. [ Links ]

21. McGrath LM, Pennington BF, Shanahan MA, Santerre-Lemmon LE, Barnard HD, Willcutt EG et al. A multiple deficit model of reading disability and attention-deficit/hyperactivity disorder: searching for shared cognitive deficits. J Child Psychol Psychiatry. 2011;52(5):547-57. Doi:10.1111/j.1469-7610.2010.02346.x. [ Links ]

22. DuPaul GJ, Morgan PL, Farkas G, Hillemeier MM, Maczuga S. Academic and social functioning associated with attention-deficit/hyperactivity disorder: latent class analyses of trajectories from kindergarten to fifth grade. Journal of Abnormal Child Psychology. 2016;44(7):1425-38. [ Links ]

23. Efron D, Sciberras E, Anderson V, Hazell P, Ukoumunne OC, Jongeling B et al. Functional status in children With ADHD at age 6;8: a controlled community. Pediatrics. 2014;134(4):e992-e1000. [ Links ]

24. Kibby MY, Dyer SM, Vadnais SA, Jagger AC, Casher GA, Stacy M. Visual processing in reading disorders and attention-deficit/hyperactivity disorder and its contribution to basic reading ability. Front. Psychol. 2015;6:1635. doi: 10.3389/fpsyg.2015.01635 [ Links ]

25. Martinussen R, Mackenzie G. Reading comprehension in adolescents with ADHD: exploring the poor comprehender profile and individual differences in vocabulary and executive functions. Research in Dev. Disab. 2015;38:329-37. [ Links ]

26. Miranda A, Colomer C, Mercader J, Fernández M, Presentación MJ. Performance-based tests versus behavioral ratings in the assessment of executive functioning in preschoolers: associations with ADHD symptoms and reading achievement. Front. Psychol. 2015;6:545. doi: 10.3389/fpsyg.2015.00545 [ Links ]

27. Owens J, Jackson H. Attention-deficit/hyperactivity disorder severity, diagnosis, & later academic achievement in a national sample. Soc Sci Res. 2016;61:251-65. doi: 10.1016/j.ssresearch.2016.06.018 [ Links ]

28. Rennie B, Beebe-Frankenberger M, Swanson HL. A longitudinal study of neuropsychological functioning and academic achievement in children with and without signs of attention deficit/hyperactivity disorder. J of Clinical and Exp Neuropsychology. 2014;36(6):621-35. DOI: 10.1080/13803395.2014.921284 [ Links ]

29. Tamm l, Epstein JN, Denton CA, Vaughn AJ, Peugh J, Willcutt EG. Reaction time variability associated with reading skills in poor readers with ADHD. J Int Neuropsychol Soc. 2014;20(3):292-301. doi:10.1017/ S1355617713001495 [ Links ]

30. Van de Voorde S, Roeyers H, Verté S, Wiersema JR. The influence of working memory load on response inhibition in children with attention-deficit/hyperactivity disorder or reading disorder. J of Clinical and Exp Neuropsychology. 2014;33(7):753-64. [ Links ]

31. Willcutt E, Pennington B, Olson R, Chhabildas N, Hulslander J. Neuropsychological analyses of comorbidity between reading disability and attention deficit hyperactivity disorder: in search of the common deficit. Dev. Neuropsych. 2005;27(1):35-78. [ Links ]

32. Francis DJ, Santi KL, Barr C, Fletcher JM, Varisco A, Foorman BR. Form effects on the estimation of students' oral reading fluency using DIBELS. J School Psychol. 2008;46(3):315-42. [ Links ]

Received: April 24, 2018; Accepted: September 11, 2018

Corresponding address: Ana Luiza Navas, Rua Cesário Motta Jr. 61, 10º. andar, Vila Buarque, CEP 01221-020 - São Paulo, São Paulo, Brasil, Email:

Conflict of interests: Nonexistent

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