Children's National Medical Center, Psychology and Behavioral Health, Washington D.C., USA.
Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 10006, Cincinnati, OH, USA.
Res Child Adolesc Psychopathol. 2021 Aug;49(8):1015-1030. doi: 10.1007/s10802-021-00815-y. Epub 2021 Mar 26.
This study investigated patterns of response to intervention in children with co-occurring attention-deficit/hyperactivity disorder (ADHD) and reading difficulties (RD), who participated in a randomized clinical trial examining the efficacy of reading intervention, ADHD treatment, or combined treatments. Growth Mixture Modeling (GMM) was used to investigate trajectories of parent and teacher academic impairment ratings and child oral reading fluency, and whether trajectories were predicted by pre-treatment covariates (ADHD severity, reading achievement, phonemic awareness, rapid letter naming, anxiety, oppositional defiant disorder), for 216 children with ADHD/RD in 2-5 grade (61.1% male; 72.2% African American; 8.8 ± 1.3 years of age). GMM revealed three trajectories for academic impairment (6.9-24.2% stable, 23.7-78.7% moderately improving, and 14.1-52.1% steeply improving) and oral reading fluency (20.8% low improving, 42.1% moderate improving, and 37.1% high improving). Children in the reading intervention were more likely to be in the stable or moderately improving trajectory than those in the ADHD and combined treatments, who were more likely to be in the steeply improving trajectory for academic impairment. Relative to the ADHD intervention, children in the reading intervention were more likely to be in the high improving trajectory than the moderate or low improving trajectory for oral reading fluency. Children without comorbid anxiety and with better reading skills showed a more positive treatment response for teacher-rated academic progress and oral reading fluency. Results highlight the importance of examining individual differences in response to reading and ADHD interventions. Intervention modality predicted differences in parent/teacher ratings of academic progress as well as reading fluency.
本研究调查了同时患有注意力缺陷/多动障碍（ADHD）和阅读障碍（RD）的儿童对干预的反应模式，这些儿童参加了一项随机临床试验，以检验阅读干预、ADHD 治疗或联合治疗的疗效。增长混合模型（GMM）用于研究父母和教师学术损伤评分以及儿童口语阅读流畅性的轨迹，以及轨迹是否可以通过治疗前的协变量（ADHD 严重程度、阅读成绩、音素意识、快速字母命名、焦虑、对立违抗性障碍）来预测，共涉及 216 名 2-5 年级的 ADHD/RD 儿童（61.1%为男性；72.2%为非裔美国人；年龄为 8.8±1.3 岁）。GMM 揭示了学术损伤的三个轨迹（6.9-24.2%稳定、23.7-78.7%中度改善、14.1-52.1%急剧改善）和口语阅读流畅性（20.8%低改善、42.1%中度改善、37.1%高改善）。阅读干预组的儿童更有可能处于稳定或中度改善的轨迹，而 ADHD 和联合治疗组的儿童更有可能处于急剧改善的轨迹。与 ADHD 干预相比，阅读干预组的儿童更有可能处于口语阅读流畅性的高改善轨迹，而不是中度或低改善轨迹。无共患焦虑且阅读技能较好的儿童在教师评定的学业进展和口语阅读流畅性方面表现出更积极的治疗反应。结果强调了检查阅读和 ADHD 干预反应个体差异的重要性。干预方式预测了父母/教师对学业进展和阅读流畅性的评价差异。
