Differences Between Children With Attention Deficit

Disorder, Children With Specific Learning

Disabilities, and Normal Children
Cheryl Kuehne
Primary Children’s Medical Center, Salt Lake City

Thomas ). Kehle
University of Utah

William McMahon
Primary Children’s Media/ Center, Salt Lake City

The study investigated the power of live measures to differentiate between children
with Attention Deficit Disorder (ADD), 1 ren with Specific Learning Disabilities
c h’ld
(SLD), and normal children. The measut-es employed were the Canners Parent Ques-
tionnaire (CPQ), the Canners Teacher Questionnaire (CTQ, the Matching Familiar
Figures Test (MFFT), the Portrus Mazes Test (PMT), and the Jumbled Numbrrs
Game fJNG). Thr results indicated that the Canners Parent Questionnaire, Canners
Teacher Questionnaire, Matching Familiar Figures Test, and the Porteus Mazes Test
significantly discriminated between groups. The Canners Questionnaires were able to
discriminate between all three groups and the MFFT and PMT were able to discrirni-
natr between ADD and normal children. A discriminant analysis indicated that the
CPQ was the best predictor of group membership, followed in order by the CTQ
PMT. and MFFT.

Although the components of a diagnostic evaluation for both Attention Deficit Disor-
der with Hyperactivity (ADD) and Specific Learning Disabilities (SLD) have been
specified by numerous researchers and clinicians, specific instruments and procedures
are not ordinarily included in the diagnostic criteria. This is especially true in the case
of ADD. As a result, there remains a need for the determination of objective measures
that would enhance the clinical diagnosis of ADD based on the criteria of the current
Dkzgnosticand Statistical Manual ofMental Di.wrders (DSM III) (American Psychiatric Asso-
ciation, 1980). Also, an investigation of the extent to which these measures can dis-
criminate between ADD and SLD would be useful because even though it is assumed
that the primary disorders of these two groups of children differ, as depicted in the
DSM III criteria, school psychologists and other clinicians often fail to distinguish
between the two groups.
In addition to detecting possible differences among the groups, the present study
addressed the efficacy of specific measures in predicting group membership. In corre-
spondence with the DSM III criteria for ADD, measures of attention span, restless-
ness, and impulsivity were employed.

Address correspondence and reprint requests to Thomas J. Kehle, Department of Educational

Psychology, University of Utah, 327 Milton Bennion Hall, Salt Lake City, UT 84112.

161
162 Journal of School Psychology

METHODS

Subjects and Procedure

There were 90 male subjects (three groups of 30 children) involved in the study. All of
the children were from the same city. The first group consisted of 30 boys between the
ages of 6 and 12 years who were referred to the Learning Problems Clinic (LPC) at the
University of Utah Medical Center for evaluation of learning and/or behavior prob-
lems. All of these children met the DSM III criteria for ADD, as determined by a
complete evaluation. The evaluation consisted of a detailed developmental history;
psychological, educational, and neurological testing; behavioral observations and clini-
cal interview; and physical examination. Each evaluation was conducted by a multidis-
ciplinary team in psychology, pediatrics, and child psychiatry. None of these children
met the DSM III or Utah criteria for Specific Developmental Disorders or Specific
Learning Disabilities. In summary, all of the students in the first group demonstrated
an ADD; however, they demonstrated no significant academic deficits. Parents who
agreed to let their children participate in the study also agreed to take them off any
stimulant medications (e.g., Ritalin, Dexedrine) that had been prescribed for 48 hr
prior to testing. This period of time was judged sufficient to eliminate the effects of
medication inasmuch as the half-life of methylphenidate is approximately 2.5 hr
(Winsberg et al., 1982). Each of the parents signed the approved consent form at a
follow-up appointment and the Matching Familiar Figures Test (MFFT), the Porteus
Mazes Test, (PMT), the Jumbled Numbers Game UNG), and the Peabody Picture
Vocabulary Test-Revised (PPVTR) were administered in a random order. The Con-
ners Parent Questionnaire (CPQ), with Hollingshead data, and the Canners Teacher
Questionnaire (CTQ) were not administered at this time, as both had recently been
completed during the initial LPC evaluation.
The second group consisted of 30 boys who were enrolled in a local school district’s
resource program for children with SLD for one or two academic periods a day. All of
these children met the DSM III criteria for SLD and the Utah criteria for SLD, as
determined by a complete psychoeducational evaluation administered by school per-
sonnel. The Utah criterion is a 40% discrepancy between individual academic skill
levels and intellectual ability. Interviews with the classroom teachers of each of the SLD
students were conducted to rule out the possibility of ADD. In summary, each of the
students in the second group demonstrated SLD; however, interviews with their teach-
ers indicated that they displayed no significant evidence of ADD. These students were
matched with the ADD group on age and intelligence. Parents who signed approved
consent forms were sent a CPQ(with Hollingshead data) to complete. After receipt of
the completed CPQ each child was administered the MFFT, PMT, JNG, and PPVTR
in random order. The regular classroom teachers of each of these SLD students were
also asked to complete a CTQ.
The third group consisted of 30 boys selected from the regular classrooms of the SLD
children who made up the second group. These children were chosen because there
was no evidence of learning or behavioral problems in teachers’ reports. None of these
children met the criteria for ADD or SLD. These students constituted the control
group and were also matched with the ADD and SLD groups on age and intelligence.
After receipt of parent consent forms and CPQ and Hollingshead data, the dependent
 Kuehne et al. 163

measures were administered in random order. The regular classroom teachers com-
pleted the CTQ.

Measures

The measures selected for the present study have been found to discriminate between
hyperactive children and normal peers in previous studies (Douglas & Peters, 1979;
Homatidis & Konstantareas, 1981; Messer, 1976). Their ability to discriminate be-
tween children with ADD, SLD, and normal controls has not been explored. In
selecting tests, care was taken to obtain information over short time periods that would
allow for optimal performance, considering evidence on the importance of boredom
and fatigue in the ADD and SLD population. All of the measures selected required
about equal administration time, so that differences could not be attributed to the time
factor involved in completion.
The observational measures used in this study were the Revised Conners Parent
Questionnaire (Conners, 1978) and the Revised Canners Teacher Questionnaire (Con-
ners, 1978), which have been used extensively in hyperactivity research. The three
psychometric measures employed were the Matching Familiar Figures Test (Kagan et
al., 1964), the Porteus Maze Test (Porteus, 1959), and the Jumbled Numbers Game
(Homatidis & Konstantareas, 1981).
The subjects in each group were matched as to age, receptive vocabulary, and social
class. The Peabody Picture Vocabulary Test-Revised (Dunn & Dunn, 1981) was used
to assess receptive vocabulary, and the Hollingshead Two Factor Index of Social Posi-
tion (Hollingshead, 1957) was used to assess social class. An ANOVA showed no
significant differences on any of the three measures (see Table 1).

RESULTS

The data include (a) hyperkinesis index scores on the CPQ (b) hyperkinesis index
scores on the CTQ (c) total error scores on the MFFT, (d) age scores on the PMT, and
(e) total time on the JNG.
The means and standard deviations for the live dependent variables as a function of
group membership are presented in Table 1. A multivariate analysis of variance
(MANOVA) was completed, Wilk’s lambda serving as the criterion for testing signifi-
cance. The live dependent variables were considered simultaneously. The results indi-
cated significant differences among the three groups (F= 18.81, p< ,001).
Separate univariate tests showed significant differences on all but one of the depen-
dent measures. The greatest differences between groups were noted on the CPQ [F(2,
87) = 95.6, p<.OOOl] and the CTQ [F(2, 87) = 77.6, p< .OOOl]. In addition, signili-
cant differences were also noted on the MFFT [F(2, 87) = 13.5, p< .OOOl] and the
PMT [F(2, 87) = 5.9, p< .004].
The Tukey test indicated that the three groups significantly differed from one anoth-
er on the CPQ. The ADD children manifested significantly higher scores on the
hyperkinesis index of the CPQ than the children with SLD @< .Ol). Further, the
children with SLD scored significantly higher than the normal controls (#< .Ol).
In addition, the Tukey test indicated that the ADD, SLD, and normal control
groups significantly differed from one another on the CTQ criterion. The ADD group
scored significantly higher on the hyperkinesis index of the CTQ than the SLD chil-
164 Journal of School Psychology

Table 1
Means and Standard Deviations for Matching Variables and
Dependent Measures as a Function of Group Membership

Attention Speckfic
Lklicit Ixarning Normal
Disorder Disabilities controls

Matching variable~~
Ase M 106.70 107 83 108.37
SD 18.16 13.89 20.07
PPVT-R M 106.47 104 40 108.83
SD 15.38 8 81 15.84
Holhngshead M 32.17 29.60 28.90
SD 15.43 11.67 16.85

Dependent mrasurrs
CPQ M 21.10 11.23 5.83
SD 3.36 5.12 4.35
CTQ M 19.50 9.00 4.57
SD 4.35 4.89 .5.04
MFFT M 12.60 8.00 6.30
SD 5.67 5.41 3.04
PMT M 122.00 132.00 140.40
SD 20.62 21.60 19.97
JNG M 79.47 76.37 61.57
SD 42.45 28.18 20.34

‘Abbreviations: PPVT-R, Rabody Picture Vocabulary ‘I&-Rr-

vised; CPQ, Canners Parent Questionnaire: CTQ, Canners
Teacher Questionnaire; MFFT, Matching Familiar Figur-cs Test;
PM?; Porteus Mazes ‘Test; JNG, Jumblrd Numbers Game.

dren ($< .Ol), who in turn scored significantly higher than the normal controls
(p< .Oi).
The MFFT score, which measures reflection-impulsivity, differentiated the ADD
children from the SLD children (p< .Ol) and the ADD children from the normal
control group ($ < .Ol). The ADD children made significantly more errors than both
the SLD and normal control children; however, there was no significant difference
between the SLD and the normal control groups.
The PMT score, which is a measure of planning and foresight, discriminated be-
tween the ADD and normal control children (p< .Ol). The ADD children scored
significantly lower than the normal control children. There was no significant differ-
ence between the ADD and SLD children or the SLD and the normal control children.
In addition, the data were subjected to discrirninant analysis to explore the efficacy
of the variables in classifying the children into the three groups. The discriminant
analysis indicated that four variables were selected that maximized the difference
between the diagnostic groups. The main predictor was the CPQ(Wilk’s lambda = .31,
p< .OOOl). In addition, the variab!es of CTQ (Wilk’s lambda = .25, p< .OOOl), PMT
(Wilk’s lambda = .23, p< .OOOl), andMFFT(Wilk’slambda= .22,p<.Ol)weresignif-
icant; however, the JNG failed to contribute to the differentiation between the groups.
The classification ability of the variables entered into discriminant analysis was
 Kuehne et al. 165

96.7% for the ADD group. No ADD child was misclassified as normal, and only one
ADD child was misclassified as SLD. The ability to classify the SLD students into the
correct group was 60%. Approximately 27% of the students in the SLD group were
misclassified into the normal control group and 13.3 % were misclassified as ADD.
The ability to classify the normal controls into the correct group was 86.7 % Of the
students misclassified, three normal control children were misclassified as SLD and
one was misclassified as ADD.

DISCUSSION

Three issues were addressed in the present study: (a) the power of the live single
measures to significantly differentiate between ADD, SLD, and normal children; (b)
the combination of variables that maximizes the differences between ADD, SLD, and
normal children; and (c) the ability to predict group membership on the basis of these
measures.
With respect to the first issue, four of the live measures employed significantly
discriminated between the groups. The results suggest that ADD children demonstrate
substantially more problems with attention span, impulsivity, and overactivity than
SLD and normal children. Also, the ADD children had more problems with foresight
and planning than normal children.
With respect to the question of maximal differentiation, the hyperkinesis index of the
Conners Parent Questionnaire was the single best predictor. The parents’ observations
of their children’s attention span, impulsivity, and activity level, based on long-term
observations in the home, proved to be the most powerful data for classification pur-
poses. This was followed by the hyperkinesis index of the Conners Teacher Question-
naire, which was the second-best discriminator and significantly increased the classifi-
cation ability of the discriminant analysis. The results suggest that parent and teacher
observational measures are critical components in the evaluation of ADD and SLD
children.
With respect to the third issue, the discriminant analysis was most successful at
predicting group membership for the ADD children. Of the 30 ADD children 29
(96.7%) were correctly classified on the basis of these four observational and psycho-
metric measures. The four measures were extremely accurate in differentiating ADD,
SLD, and normal children. This makes sense, given that they were designed to assess
attention span, impulsivity, and overactivity, which are the same criteria DSM III uses
to make the diagnosis of ADD. The combination of observational and psychometric
measures was least successful in predicting group membership for the SLD group. The
classification errors tended to be in the direction of viewing SLD children as normal
children, rather than ADD children. Although some SLD children demonstrate some
degree of difficulty with attention span, impulsivity, and overactivity, more appear to
be like normal children in this regard. This is consistent with the Douglas and Peters
(1979) model, in that these children have mild attentional deficits, the primary prob-
lem being learning. As to implications for diagnosis, these results suggest that although
measures of attention, impulsivity, and overactivity are useful in the evaluation of
SLD, they are not sufficient. Additional measures designed to assess visual and audito-
ry processing, integration, sequencing memory, and output ability, as well as individu-
al academic skill levels, are necessary. Failure to combine cognitive, observational, and
academic measures in the evaluation of SLD children may result in inadequate diagnosis,
166 Journal of School Psychology

In summary, the results of’ this study indicate that the CPQ CTQ. PMT, and
MFFT discriminate between ADD, SLD, and normal children. The data indicate that
ADD children demonstrate more attentional problems than SLD and normal children
and that SLD children demonstrate more attentional problems than normal children,
The utility of these measures is encouraging; they are inexpensive and easy to adminis-
ter and score. As current DSM III and Public Iaw 94-142 criteria for these disorders
do not designate specific instruments and procedures for diagnosis, the results of this
study indicate that school psychologists and other clinicians can use the CPQ CTQ
PMT, and MFFT to provide useful information for the diagnosis and treatment of
ADD. The data also indicate that these measures, combined with intellectual and
academic measures, can provide useful information for the diagnosis and treatment of
SLD. The accurate diagnosis of these two disorders is critical to insuring the imple-
mentation of appropriate individualized interventions.

REFERENCES

American PsychiatricAssociation. (1980). D uz,<moslic and rlal~r&tcnlmanual ojmmpnkd disordm (3rd cd.).
Washington, Author
DC:
Canners, C. K. (1978). Normative data on revised Canners Pwent and Teacher Rating Scales.
Journal ojAbnorml Chdd Psych&u, 6, 221-236.
Dnuglas, V. I , & Peters, K. G. (1979). Toward a clearer definition of the attention deficit of
hyperactive children. In G. A. Hale & M. Ixwis (Eds.), ,4/l&zon ana’ the deoelopmnt ufrqnt~ir~~
skilLr (pp. 173-147). New York: Plenum.
Dunn, C. M., & Dunn, I,. M. (1981). Pmbody Pzcture Vbcabula~ 7k-Reuued manual. Circle Pints,
MN: American Guidance Service.
Hollingshead, A. B. (1957). 7iuo F&or In&x ofSocial Position. New Haven, CT: Privately printed.
Homatidis, S., 81 Konstantareas, M. M. (1981). .4ssessment of hyprractivity: Isolating measures
of high discriminant ability.,/ournai q~JConsulltn~~and Climcai Prycholqq, 49, 533-541.
Kagan, ,J., Rosman, B. L., Day D.. Albert, ,J., & Phillips, W. (1964). Information processing in
the child: Significance of analytic and reflective attitudes. PJ2’cholo,~ica/Mono~raphJ, it?, l-3i.
Messer, S. B. (1976). Reflection-impulsiwty: A Review. Psycholo,q&l Rullettn, 83, 1026-1052.
Porteus, S. D. (1959). 7&Mar~ Test andcllnzcalpsychoio~. Palo Alro, CA. Pacific Books.
Winsberg, B. G , Kupietz, S. S.. Sverd, .J., Hungund, B. I,., & Young, N. L (1982). Meth-
ylphenidate oral dose plasma concentration and behaworal responw in children. P~ychophmme
Colored,76. 329-332.

Manuscript reccivrd: March 21, 1986

Final revision accepted August 30. 1986