Richard Mattison, MD and Susan Dickerson Mayes, PhD Describe Relationships among Learning Disability, Executive Function and Psychopathology in Children with ADHD

In an article published in the February 2012 edition of the Journal of Attention Disorders, Richard Mattison, MD and Susan Dickerson Mayes, PhD described relationships among learning disability, executive function and psychopathology in a clinical sample of children with ADHD. They found that problems with executive function were associated with learning disabilities but not with psychopathology, and reflected on the implications of their findings for clinical practice. 

Several studies have shown that children with ADHD are at increased risk for learning disabilities. This is explained in part by the fact that problems with attention, working memory, processing speed, and other executive function skills are characteristic of both learning disabilities and ADHD. It is also known that many children with ADHD have other co-occurring psychiatric disorders, including anxiety disorders, major depressive disorders and conduct disorders. The prevalence of these psychiatric disorders in children with learning disabilities has not been extensively studied. Nor was it known how the presence of learning disabilities is associated with the risk of other psychiatric disorders in children with ADHD.

A statistical analysis of the records of 595 children with ADHD revealed that the presence of learning disabilities was not significantly associated with the presence or type of psychiatric illness in these children. And while the presence of learning disabilities was not predictive of Full Scale IQ scores, it was associated with differences in specific measures of executive function, including indices of working memory and processing speed. An analysis of academic performance scores showed, as expected, that children with ADHD who also had learning disabilities scored lower on all measures of achievement than children without learning disabilities.

Based on these findings, the researchers concluded that the core deficits in executive function appear to be more closely associated with learning disabilities and problems with academic achievement than with psychopathology in children with ADHD.

Reflecting on their findings, the researchers suggested that clinicians assess all patients with ADHD for the presence of learning disabilities, since over 73% of the participants in their study had a co-occurring learning disability. The authors also advised clinicians to avoid reliance on abbreviated IQ measures or on Full Scale IQ scores, since these fail to reveal the executive function deficits that characterize children with ADHD and learning disabilities.

Richard Mattison is Professor of Psychiatry in the Division of Child and Adolescent Psychiatry at Stony Brook University. Susan Mayes, Ph.D., is Chief Psychologist and Professor in the Department of Psychiatry at Penn State College of Medicine.