Story comprehension in children with ADHD

A Story Mapping Intervention to Improve Narrative Comprehension Deficits in Adolescents with ADHD

The current study examined the effects of an 8-week Story Mapping Intervention (SMI) to improve narrative comprehension in adolescents with ADHD. Thirty 12 - 16 year-old adolescents with ADHD who were participating in a summer treatment program for adolescents with ADHD received the SMI instruction ten times and completed SMI homework ten times in a structured environment with teacher feedback. Recall of fables and story creation were assessed before and after the SMI. At post-test, fable recalls included more of the most important events, were more coherent, and included a greater number of plausible inferences than pre-test fable recalls. SMI homework scores accounted for increases in recall of important events and plausible inferences, suggesting that consistent practice and feedback with story mapping could contribute to important recall gains. In contrast, the inclusion of goal-based events and the rated coherence of created stories did not improve, suggesting that more explicit instruction in applying story mapping to story creation may be required.

A 10-year longitudinal fMRI study of narrative comprehension in children and adolescents

Comprehension of spoken narratives requires coordination of multiple language skills. As such, for normal children narrative skills develop well into the school years and, during this period, are particularly vulnerable in the face of brain injury or developmental disorder. For these reasons, we sought to determine the developmental trajectory of narrative processing using longitudinal fMRI scanning. 30 healthy children between the ages of 5 and 18 enrolled at ages 5, 6, or 7, were examined annually for up to 10 years. At each fMRI session, children were presented with a set of five, 30s-long, stories containing 9, 10, or 11 sentences designed to be understood by a 5 year old child. fMRI data analysis was conducted based on a hierarchical linear model (HLM) that was modified to investigate developmental changes while accounting for missing data and controlling for factors such as age, linguistic performance and IQ. Performance testing conducted after each scan indicated well above the chance (p<0.002) comprehension performance. There was a linear increase with increasing age in bilateral superior temporal cortical activation (BAs 21 and 22) linked to narrative processing. Conversely, age-related decreases in cortical activation were observed in bilateral occipital regions, cingulate and cuneus, possibly reflecting changes in the default mode networks. The dynamic changes observed in this longitudinal fMRI study support the increasing role of bilateral BAs 21 and 22 in narrative comprehension, involving non-domain-specific integration in order to achieve final story interpretation. The presence of a continued linear development of this area throughout childhood and teenage years with no apparent plateau, indicates that full maturation of narrative processing skills has not yet occurred and that it may be delayed to early adulthood.

A spectral graphical model approach for learning brain connectivity network of children's narrative comprehension

Narrative comprehension is a fundamental cognitive skill that involves the coordination of different functional brain regions. We develop a spectral graphical model with model averaging to study the connectivity networks underlying these brain regions using fMRI data collected from a story comprehension task. Based on the spectral density matrices in the frequency domain, this model captures the temporal dependency of the entire fMRI time series between brain regions. A Bayesian model averaging procedure is then applied to select the best directional links that constitute the brain network. Using this model, brain networks of three distinct age groups are constructed to assess the dynamic change of network connectivity with respect to age.

Getting clued in: inferential processing and comprehension monitoring in boys with ADHD

OBJECTIVE

The present study examines the ability of children with ADHD to make inferences and monitor ongoing understanding of texts, to shed light on their academic difficulties.

METHOD

A total of 29 boys with ADHD and 41 comparison boys between the ages of 7 and 12 participated. Three tasks measure how boys create and evaluate inferences, particularly explanatory inferences, and how they monitor their understanding of story events and the connections among them.

RESULTS

Boys with ADHD are less able than their comparison peers to make appropriate inferences, particularly explanatory inferences. They also have more trouble identifying text inconsistencies.

CONCLUSIONS

Findings suggest that difficulties in making inferences and monitoring ongoing comprehension among children with ADHD may contribute to story comprehension problems and in turn to academic difficulties experienced by these children. Interventions specifically focusing on understanding causal connections, creating inferences, and monitoring ongoing understanding of stories need to be investigated.

Speed of language comprehension is impaired in ADHD

OBJECTIVE

Children with ADHD have an increased risk of poor academic performance. It is important to identify cognitive processes that may be related to this academic failure. In Western schooling systems, especially language processing skills may be of relevance. The present study, therefore, compares the ability to comprehend complex sentences of individuals with and without ADHD.

METHOD

Fifteen children (aged 8-11) and 15 adolescents (aged 12-16) with ADHD combined subtype are matched for age, gender, and parental level of education to 30 control subjects. Language comprehension is measured using the neuropsychological procedure proposed by Luria and an adapted version of the Token Test.

RESULTS

Compared with the control group, children and adolescents with ADHD perform significantly slower on language comprehension tasks. Differences in accuracy are limited. No interaction between age and ADHD is found.

CONCLUSIONS

Children and adolescents with ADHD are slower and less efficient than matched control subjects with regard to complex sentence comprehension.

Preliminary evidence of beneficial effects of methylphenidate on listening comprehension in children with attention-deficit/hyperactivity disorder

OBJECTIVE

The effect of methylphenidate (MPH) on listening comprehension for information passages, and on working memory, was examined in a clinical sample of 16 children with attention-deficit/hyperactivity disorder (ADHD).

METHOD

Drug effects on comprehension of spoken language at the levels of single sentences and passages, and on verbal and visual-spatial working memory (WM) skills were assessed over a 4-day placebo-controlled, double-blind, crossover treatment trial of MPH at low, medium, and high doses. Concurrent behavior ratings were also completed. Data were analyzed at both group and individual levels; individual improvements using average change scores were analyzed to explore interrelationships among comprehension, WM, and behavioral responses to MPH.

RESULTS

There was a significant effect of drug on comprehension of inferences from challenging listening passages (F = 3.1, p ,0.05), and on visual-spatial working memory performance (F = 3.3, p ,0.05), with significant linear dose-response relationships evident for both domains. Individual improvements in comprehension using averaged placebo-dose change scores were not related to improvements in behavior with MPH, or to improvements in WM in this sample.

CONCLUSIONS

Findings provide preliminary evidence that MPH affects higher-level language comprehension skills, which require sustained attention and mental effort. If generalizable to classroom listening skills, these findings have implications for clinicians and teachers involved with children with ADHD.

The effects of thematic importance on story recall among children with attention deficit hyperactivity disorder and comparison children

This study examined the recall of televised stories for younger (4-6 years) and older (7-9 years) children with and without attention deficit hyperactivity disorder (ADHD) under two different viewing conditions (toys present/toys absent). Each child watched two Rugrats television programs, once with toys present and once with toys absent. Immediately after viewing a program, the child completed a free recall of the observed story. Comparison children's recall increased more than ADHD children's as importance level increased, and comparison children recalled more information overall than children with ADHD. When toys were present, children with ADHD retold less coherent stories than comparison children, as indexed by smaller correlations between the story units recalled and the order of these units in the story. In summary, children with ADHD demonstrated multiple difficulties in story comprehension. These findings add to our understanding of the differences in higher-order cognitive processing abilities between children with ADHD and comparison children, and suggest important areas of focus in designing more effective academic interventions for children with ADHD.

Age-related connectivity changes in fMRI data from children listening to stories

The way humans comprehend narrative speech plays an important part in human development and experience. A group of 313 children with ages 5-18 were subjected to a large-scale functional magnetic resonance imaging (fMRI) study in order to investigate the neural correlates of auditory narrative comprehension. The results were analyzed to investigate the age-related brain activity changes involved in the narrative language comprehension circuitry. We found age-related differences in brain activity which may either reflect changes in local neuroplasticity (of the regions involved) in the developing brain or a more global transformation of brain activity related to neuroplasticity. To investigate this issue, Structural Equation Modeling (SEM) was applied to the results obtained from a group independent component analysis (Schmithorst, V.J., Holland, S.K., et al., 2005. Cognitive modules utilized for narrative comprehension in children: a functional magnetic resonance imaging study. NeuroImage) and the age-related differences were examined in terms of changes in path coefficients between brain regions. The group Independent Component Analysis (ICA) had identified five bilateral task-related components comprising the primary auditory cortex, the mid-superior temporal gyrus, the most posterior aspect of the superior temporal gyrus, the hippocampus, the angular gyrus and the medial aspect of the parietal lobule (precuneus/posterior cingulate). Furthermore, a left-lateralized network (sixth component) was also identified comprising the inferior frontal gyrus (including Broca's area), the inferior parietal lobule, and the medial temporal gyrus. The components (brain regions) for the SEM were identified based on the ICA maps and the results are discussed in light of recent neuroimaging studies corroborating the functional segregation of Broca's and Wernicke's areas and the important role played by the right hemisphere in narrative comprehension. The classical Wernicke-Geschwind (WG) model for speech processing is expanded to a two-route model involving a direct route between Broca's and Wernicke's area and an indirect route involving the parietal lobe.

Attention-deficit disorder (attention-deficit/ hyperactivity disorder without hyperactivity): a neurobiologically and behaviorally distinct disorder from attention-deficit/hyperactivity disorder (with hyperactivity)

Most studies of attention-deficit/hyperactivity disorder (ADHD) have focused on the combined type and emphasized a core problem in response inhibition. It is proposed here that the core problem in the truly inattentive type of ADHD (not simply the subthreshold combined type) is in working memory. It is further proposed that laboratory measures, such as complex-span and dual-task dichotic listening tasks, can detect this. Children with the truly inattentive type of ADHD, rather than being distractible, may instead be easily bored, their problem being more in motivation (underarousal) than in inhibitory control. Much converging evidence points to a primary disturbance in the striatum (a frontal-striatal loop) in the combined type of ADHD. It is proposed here that the primary disturbance in truly inattentive-type ADHD (ADD) is in the cortex (a frontal-parietal loop). Finally, it is posited that these are not two different types of ADHD, but two different disorders with different cognitive and behavioral profiles, different patterns of comorbidities, different responses to medication, and different underlying neurobiologies.

Attention-deficit disorder (attention-deficit/ hyperactivity disorder without hyperactivity): a neurobiologically and behaviorally distinct disorder from attention-deficit/hyperactivity disorder (with hyperactivity)

Most studies of attention-deficit/hyperactivity disorder (ADHD) have focused on the combined type and emphasized a core problem in response inhibition. It is proposed here that the core problem in the truly inattentive type of ADHD (not simply the subthreshold combined type) is in working memory. It is further proposed that laboratory measures, such as complex-span and dual-task dichotic listening tasks, can detect this. Children with the truly inattentive type of ADHD, rather than being distractible, may instead be easily bored, their problem being more in motivation (underarousal) than in inhibitory control. Much converging evidence points to a primary disturbance in the striatum (a frontal-striatal loop) in the combined type of ADHD. It is proposed here that the primary disturbance in truly inattentive-type ADHD (ADD) is in the cortex (a frontal-parietal loop). Finally, it is posited that these are not two different types of ADHD, but two different disorders with different cognitive and behavioral profiles, different patterns of comorbidities, different responses to medication, and different underlying neurobiologies.

Cognitive modules utilized for narrative comprehension in children: a functional magnetic resonance imaging study

The ability to comprehend narratives constitutes an important component of human development and experience. The neural correlates of auditory narrative comprehension in children were investigated in a large-scale functional magnetic resonance imaging (fMRI) study involving 313 subjects ages 5-18. Using group independent component analysis (ICA), bilateral task-related components were found comprising the primary auditory cortex, the mid-superior temporal gyrus, the hippocampus, the angular gyrus, and medial aspect of the parietal lobule (precuneus/posterior cingulate). In addition, a right-lateralized component was found involving the most posterior aspect of the superior temporal gyrus, and a left-lateralized component was found comprising the inferior frontal gyrus (including Broca's area), the inferior parietal lobule, and the medial temporal gyrus. Using a novel data-driven analysis technique, increased task-related activity related to age was found in the components comprising the mid-superior temporal gyrus (Wernicke's area) and the posterior aspect of the superior temporal gyrus, while decreased activity related to age was found in the component comprising the angular gyrus. The results are discussed in light of recent hypotheses involving the functional segregation of Wernicke's area and the specific role of the mid-superior temporal gyrus in speech comprehension.

Story comprehension and the impact of studying on recall in children with attention deficit hyperactivity disorder

This study examined the impact of studying on story comprehension and recall among children with attention deficit hyperactivity disorder (ADHD). Participants in the study were 36 children with ADHD and 43 nonreferred comparison children ages 7 to 11. The participants listened to 1 of 2 folktales and recalled the story both before and after studying a written version of the story for up to 10 min. The stories had been divided into individual events, and each event was coded for the number of causal connections it had to other story events. Each event was presented on a separate page of the study booklet so that time spent on each event could be recorded. All of the transcribed recalls were coded for which story events the participant correctly recalled. For both groups, recall increased as the number of causal connections increased, but the effect of the number of causal connections on recall was stronger for comparison children than for children with ADHD. The results revealed no group differences in studying behavior. However, when recall before studying was included as a predictor of recall after studying, studying was found to be more effective for higher IQ comparison children than for higher IQ children with ADHD, especially at the highest levels of causal connections. The results offer important leads for the development of academic interventions that are specific to the story-comprehension deficits of children with ADHD.

Difficulties in comprehending causal relations among children with ADHD: the role of cognitive engagement

The present study examined whether time spent in long looks (i.e., >or=15 s), an index of cognitive engagement, would account for differences between children with attention deficit hyperactivity disorder (ADHD) and comparison children in understanding causal relations. Children viewed two televised stories, once in the presence of toys and once in their absence. Dependent variables were visual attention and questions tapping factual information and causal relations. Comparison children answered significantly more causal relations questions than did the children with ADHD, but only in the toys-present condition. Four lines of evidence revealed that the difficulties children with ADHD had in answering causal relations questions in the toys-present condition could be linked specifically to this group's decreased time spent in long looks.

Listening comprehension and working memory are impaired in attention-deficit hyperactivity disorder irrespective of language impairment

This study investigated listening comprehension and working memory abilities in children with attention-deficit hyperactivity disorder (ADHD), presenting with and without language impairments (LI). A 4-group design classified a community sample (n = 77) of boys aged 9-12 into ADHD, ADHD + LI, LI, and Normal groups. Children completed tests of basic language and cognitive skills, verbal and spatial working memory, and passage-level listening comprehension. Multivariate analyses and post hoc comparisons indicated that ADHD children who did not have co-occurring LI comprehended factual information from spoken passages as well as normal children, but were poorer at comprehending inferences and monitoring comprehension of instructions. ADHD children did not differ from normal children in verbal span, but showed significantly poorer verbal working memory, spatial span, and spatial working memory. The ADHD + LI and LI groups were most impaired in listening comprehension and working memory performance, but did not differ from each other. Listening comprehension skills were significantly correlated with both verbal and spatial working memory, and parent-teacher ratings of inattention and hyperactivity/impulsivity. Findings that children with ADHD but no LI showed subtle higher-level listening comprehension deficits have implications for both current diagnostic practices and conceptualizations of ADHD.

The relation of story structure properties to recall of television stories in young children with attention-deficit hyperactivity disorder and nonreferred peers

In this study, the authors examined memory for televised stories to gain insight into similarities and differences in story comprehension between young children with attention-deficit hyperactivity disorder (ADHD) and their typical peers. In particular, the authors investigated the extent to which 4- to 6-year-old children's free recall of story events is predicted by several structural properties of story events (number of causal connections, whether an event is on or off the story's causal chain, story-grammar category, and position in the story's hierarchical structure), whether differences exist between children with ADHD and nonreferred comparison children in their sensitivity to structural features of stories, and whether age differences in sensitivity to structural features are similar for both groups. For both groups, recall of story events was predicted by all four structural properties, but the effects of the two causal properties was stronger for comparison children than for children with ADHD. Further examination revealed that this difference was observed only when a competing activity was available during television viewing. These findings indicate that both groups of preschool children are able to benefit from causal structure when recalling television stories, but that children with ADHD lose this benefit when attention is divided. Consistent with previous findings for nonreferred children (P. W. van den Broek, E. P. Lorch, & R. Thurlow, 1996), in both diagnostic groups the effects of causal properties increased across age, and older children were more likely to include causally important protagonists' goals in their recalls than younger children.