Self-regulated strategy development for written expression with students with attention deficit/hyperactivity disorder.

Writing is a difficult and demanding task requiring attention to multiple processes. Children need both to learn the mechanics of writing and to develop effective and efficient composition skills (Graham & Harris, 2003). Writing involves planning, generating content, organizing the composition, translating content into written language, and revising and improving the writing. Writing also requires self-regulation and attention to the composing process. Skilled writers use strategies to plan, write, and revise their compositions, as well as strategies to self-regulate performance (Graham & Harris, 2003).

Many students experience difficulties mastering writing. Data from the National Assessment of Educational Progress shows three out of every four 4th-, 8th-, and 12th-grade students demonstrated only partial mastery of necessary writing skills and knowledge at their respective grade levels, and only 1 in 100 students demonstrated "advanced" writing skills (Persky, Daane, & Jin, 2003). Negotiating and coordinating basic skills, knowledge, strategies, and conventions of written language can be difficult even for skilled writers. Often children are not equipped with appropriate strategies to overcome obstacles presented in the composition process (Graham & Harris, 2003).

Children with attention deficit/hyperactivity disorder (ADHD) may be at particular risk for difficulties with written expression. ADHD is one of the most commonly diagnosed psychiatric disorders of childhood (Barkley, 1997) with a prevalence typically reported as between 3% and 7% (American Psychiatric Association, 2000) and is estimated to affect approximately 2 million school-age children (Forness & Kavale, 2002). Research indicates students with ADHD are generally more likely to achieve academically at a level below what would be predicted by their intellectual ability (Barry, Lyman, & Klinger, 2002; DuPaul & Eckert, 1997, 1998; Riccio, Gonzales, & Hynd, 1994; Zentall, 1993). Up to 80% of children with ADHD have been found to exhibit academic performance and/or learning problems (Barkley, 1998).

Transcription problems are well documented among children with ADHD. The handwriting of these children is less mature than their non-ADHD peers (Hoza & Pelham, 1993; Tucha & Lange, 2004; Whalen, Henker, & Finck, 1981). Imhof (2004) evaluated the handwriting quality of 44 boys with ADHD, and 44 non-ADHD controls. Children completed a copying task, and were evaluated on measures of letter formation, alignment, slant, spacing, and neatness. Data demonstrated that children with ADHD performed significantly below their nondisabled peers on letter formation, alignment, and neatness. Spelling is also a problem. For example, the MTA Cooperative Group study (1999) reported that students with ADHD were approximately one-third to one-half standard deviation below the mean on standardized spelling measures. Transcription skills problems and spelling problems are serious because they can influence perceptions of how well a student writes, and interfere with the execution of composition processes (Graham, 1999).

Although transcription problems are well documented, there has been very little research on children with ADHD in other aspects of writing. We were able to locate only two studies that reported data on the level of composition skills among children with ADHD. Mayes, Calhoun, and Crowell (2000) reported data on a sample of 86 students with ADHD. Students were 8 to 16 years old and had been referred to a university-affiliated department of psychiatry. Students were diagnosed with ADHD based on research criteria that included multiple measures (i.e., rating scales, behavior checklists, diagnostic interviews) across both parents and teachers. Students were divided into two groups: ADHD with LD and ADHD without LD. Written expression was assessed using the Wechsler Individual Achievement Test (Psychological Corporation, 1992); IQ was assessed using the Wechsler Intelligence Scale for Children-III (Wechsler, 1991). On average, the students in the ADHD with LD group had a 26-point discrepancy between IQ and written expression achievement. Based on the IQ/achievement discrepancy, 65% of the ADHD with LD group would qualify as disabled in written expression. The ADHD without LD group demonstrated 7-point discrepancy between IQ and written expression achievement. This also suggested some degree of impairment.

Similarly, Resta and Eliot (1994) reported data on 21 students with ADHD. Students were ages 8 to 13 and were clinic-referred. The ADHD diagnosis was made using parent and teacher rating scales. Written expression was assessed using the Written Language Assessment (Grill & Kirwin, 1989). Prior to testing, children who were prescribed stimulant medication underwent a 48-hour period in which no medication was administered. The results showed that the children with ADHD were significantly below controls in terms of word complexity, written language, productivity, and general writing ability. The authors concluded that many children with ADHD are limited in their composition skills, and are at a distinct disadvantage for successfully mastering writing skills.

The results of these studies suggest that written expression is a problem among children with ADHD. Moreover, other research also suggests that there are additional reasons to suspect that children with ADHD might be at increased risk for difficulties in written expression because of problems with factors critical to successful writing--namely planning and organization--as well as language.