Severity of emotional and behavioral problems among poor and typical readers.

Publication: Journal of Abnormal Child Psychology

Publication Date: 01-APR-05

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INTRODUCTION

Children and adolescents with poor reading skills face a variety of challenges in their lives, and may be at risk for emotional and behavioral problems. In some cases, behavioral or emotional problems may be triggered by the stress of difficulties in school, or they may be a contributing factor to poor achievement in school or to learning difficulties (Rutter & Yule, 1970). Severity of behavioral and emotional problems also may be associated with the diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) (Connor et al., 2003), which commonly co-occurs with reading problems (Willcutt & Pennington, 2000a). Nevertheless, many of the studies examining these issues have focused on youth in clinical settings, or youth receiving special educational services rather than youth who have been clearly defined as poor readers in non-clinical settings, and have focused on emotional/behavioral problems at only a single point in time, precluding closer examination of the course of symptoms over time. Many studies also have had relatively small sample size or a preponderance of males, have not matched youth with and without reading problems in terms of other relevant characteristics such as sociodemographic factors, or have not considered the presence of comorbid ADHD in contributing to emotional and behavioral problems.

Emotional Problems and Poor Reading

Some cross-sectional studies have found that there are higher than expected rates of learning disabilities among samples of depressed youth (e.g., Fristad, Topolosky, Weller, & Weller, 1992). Conversely, other studies of children and adolescents have suggested that youth with learning disabilities (LD) may have higher than expected rates of clinically significant depressive symptoms (defined by cut-offs on scales) (Goldstein, Paul, & Sanfilippo-Cohn, 1985; Maag & Behrens, 1989; Wright-Strawderman & Watson, 1992), and more depressive symptoms than comparison samples of non-LD youth (Hall & Haws, 1989; Rodriguez & Routh, 1989--for peer-nominated ratings of depression but not self-reported depression). Studies of children specifically having reading difficulties have yielded somewhat mixed results. For example, in the Pittsburgh Youth Study, Maughan, Rowe, Loeber, and Stouthamer-Loeber (2003) found that preteenage boys with poor reading reported more depressed mood than preteenage boys without reading problems; similar differences were not found among adolescent boys. Boetsch, Green, and Pennington (1996) found that children and adolescents with poor reading skills in the community, in a twin study, and in a clinic sample were more depressed than their peers without reading problems. Others have reported that girls with reading disabilities (RD) evidence more depressive symptoms than youth without reading problems, and that depressive symptoms among boys with reading problems are not as pronounced as those for girls (Willcutt & Pennington, 2000b).

Differences in anxiety symptoms likewise have been found among samples of LD youth relative to comparison youth (Margalit & Shulman, 1986; Paget & Reynolds, 1984; Rodriguez & Routh, 1989). Children and adolescents specifically with reading difficulties also have been noted to score higher on measures of anxiety symptoms than youth without reading problems (Casey, Levy, Brown, & Brooks-Gunn, 1992; Willcutt & Pennington, 2000b, particularly for girls).

Somatic complaints have not been well studied among youth with reading problems. Willcutt and Pennington (2000b) found that youth with reading disabilities had more somatic complaints than both their peers in the community and their co-twins without reading problems. They speculated that "some children with RD develop physical symptoms such as headaches or stomachaches in their response to the stress of academic work" (p. 1045). Margalit and Raviv (1984) similarly noted a higher prevalence of teacher-reported minor somatic complaints among children in special schools for learning disabilities relative to children in other schools.

Behavioral Problems and Poor Reading

Behavioral problems are commonly thought to be more prevalent among children and adolescents with poor reading, as well as among those with other types of learning disorders and language problems. For example, longitudinal community research has demonstrated that youth identified at age 5 with pervasive speech and language impairments or auditory comprehension problems evidence higher rates of teacher-rated externalizing behavioral problems at age 12 than youth with speech problems alone (Beitchman et al., 1996). Persistence of such problems was reflected in higher rates of antisocial personality disorder diagnoses at age 19 among males with language impairments relative to males with no speech or language impairment (Beitchman et al., 2001). In addition. LD youth have been described by parents as having more externalizing behaviors than peers in the community (Konstantareas & Homatidis, 1989), and have been reported to engage in violence twice as often as non-LD youth (Svetaz, Ireland, & Blum, 2000). Heiervang, Stevenson, Lund, and Hugdahl (2001) found that children with poor reading ability similarly had more parent and teacher-reported but not self-reported delinquent and aggressive behaviors than children without reading problems; in addition, boys but not girls with reading problems were found to have more teacher-reported externalizing behaviors than youth without reading problems. Willcutt and Pennington (2000b) found that both boys and girls with reading disability had more parent-reported aggressive and delinquent behaviors than youth without reading disability; however, the aggressive behaviors of reading disabled boys were more evident than those of reading disabled girls.

In longitudinal studies, Williams and McGee (1994) found that reading problems among boys was related to risk of later conduct disorders, but Maughan, Pickles, Hagell, Rutter, and Yule (1996) found that it was girls rather than boys with reading problems who developed later behavioral problems. Similar to cross-sectional findings (Willcutt & Pennington, 2000b). Fergusson and Lynskey (1997) found that the relationship over time between reading problems and behavioral problems was not apparent after controlling for confounding factors such as comorbid ADHD.

Comorbid ADHD and Reading Disabilities

The most common psychiatric disorder seen in reading disabled youth is ADHD. The rates of ADHD among children with RD have been estimated at 6-39% (Semrud-Clikeman et al., 1992; Willcutt & Pennington, 2000a), depending in part on the subtype of ADHD and gender. By contrast, estimates of the prevalence of ADHD from the general population range from approximately 2-5% (Costello et al., 1996; Shaffer et al., 1996). Conversely, the rates of RD found among children diagnosed with ADHD are estimated at 15-45% (August & Garfinkel, 1990; Dykman & Ackerman, 1991; Semrud-Clikeman et al., 1992). Although they often occur together, RD and ADHD are separate diagnostic entities as evidenced by their different patterns of cognitive correlates. Specifically, ADHD is typically associated with impaired executive functioning including inhibition deficits, whereas RD is associated with difficulties with phonological processing or phonemic awareness (Pennington, Groisser, & Welsh, 1993; Schachar, Mota, Logan, Tannock, & Klim, 2000; Willcutt et al., 2001). In a large community-based study, youth with both ADHD and RD appeared to have problems with both phonemic awareness and inhibition (Willcutt et al., 2001).

Despite the common co-occurrence of RD and ADHD, there are some indications that youth with learning disabilities may exhibit "diagnostic-specific deficits" related to attention problems (Tarnowski, Prinz, & Ney, 1986, p. 345). In addition, ADHD has been associated with various psychiatric comorbidities. Therefore, it is possible that emotional and behavioral problems thought to be associated with poor reading may in fact be a function of comorbid ADHD, rather than being a correlate of reading problems per se. Nonetheless, few studies (e.g., Willcutt & Pennington, 2000b) have examined the degree to which emotional/behavioral problems evidenced by poor reading youth are linked to the presence of comorbid ADHD.

With these considerations, the current study was designed to examine the emotional, behavioral, and attention problems from mid- to late adolescence among individuals with and without poor single word reading ability. The majority of previous data regarding the emotional and behavioral correlates of reading ability has emerged primarily from cross-sectional studies, from studies that focused on youth younger than adolescence, or from studies without independent evaluation of reading ability. This study used a longitudinal design to evaluate parent- and self-reported emotional and behavioral symptoms among adolescents with poor and typical single word reading ability as assessed in a screening assessment of non-referred high school students. The reading groups were defined in terms of their single word reading ability because it is a common outcome of a number of reading-related processes such as phonemic awareness and decoding skills, and because prior research has questioned the validity of definitions of reading disabilities based on discrepancies between intellectual functioning and reading performance (Flowers, Meyer, Lovato, Wood, & Felton, 2001; Steubing et al., 2002). Data were collected from both the adolescents and adult informants because previous research has indicated that youth tend to report more internalizing problems and fewer externalizing problems than their parents report about the youth (Kashani, Orvaschel, Burk, & Reid, 1985).

In this study we were particularly interested in the understudied transition period from mid- to late adolescence. For some youth, this may be a particularly stressful developmental period during which adolescents make decisions about whether to continue in school, consider other educational and employment choices, and begin to establish their independence. Thus, this can be a pivotal time in these lives of youth during which important life choices are made that can impact their future.

The specific hypotheses for this study were as follows:

1. Adolescents with poor single word reading ability will evidence more severe symptoms of depression and anxiety and more severe somatic complaints over time as...

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