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Release: Nov. 30, 1999

UI study: children with ADHD may need help with memory deficits

IOWA CITY, Iowa -- Some children with Attention-Deficit Hyperactivity Disorder (ADHD) also have memory problems that need separate assessment and treatment, according to a University of Iowa study.

The memory deficits are caused by a learning disability and affect short-term memory skills used for spelling, sounding out words and other reading-related tasks, said Lynn C. Richman, Ph.D., UI professor of pediatric psychology and the study's lead investigator. However, memory lapses in children with ADHD are often attributed to the inattention associated with the disorder rather than to a separate problem.

"In children with ADHD it can be difficult to determine if certain learning difficulties are caused by inattention or by memory deficits or both," Richman said. "Many physicians appropriately diagnose the Attention-Deficit Hyperactivity Disorder but miss the memory problems."

"The bottom line is that you need to assess for learning disabilities when you assess for ADHD, and vice versa," said Brian D. Johnson, Ph.D., the paper's senior author. Johnson wrote about the study as part of his UI doctoral dissertation in counseling psychology and published it as an article in a recent issue of the journal Developmental Neuropsychology. He is now an associate professor of professional psychology at the University of Northern Colorado in Greeley.

Memory testing can help reveal whether a child has trouble learning because of poor listening skills, usually caused by ADHD, or because of difficulty remembering things, usually caused by a learning disability.

Richman added that the study helps explain why children with ADHD who receive medication for their condition may still show memory problems.

"Medication can improve attention in children with ADHD but not help solve the learning problems related to memory," Richman said. "We need to find out if other medications can treat ADHD while also addressing memory deficits, or help children get specialized memory training and other educational interventions in addition to their ADHD treatment."

Johnson said the study was unique in how it examined different types of ADHD and learning disabilities. The study examined 40 children ages 7 to nearly 14 who had ADHD and 40 children in the same age group who had Undifferentiated Attention Deficit Disorder (UADD), a subset of ADHD marked only by inattention, not by hyperactivity or impulsivity. The researchers controlled for IQ, gender and school grade and further subgrouped the children based on whether tests showed they had reading disabilities. The children were then given the Color Span Test, developed by Richman and other UI researchers to assess visual and verbal memory.

The outcomes helped reveal that children with ADHD, whether they had a learning disability or not, had significantly more memory deficits than children with UADD.

The Color Span Test requires a person to retain color names in increasingly lengthy sequences. The test includes four presentation-response variations, such as the examiner pointing to colors in a particular sequence, then asking the child to reproduce the sequence by pointing. The three other tests include a pointing presentation requiring an oral response; an oral presentation requiring a pointing response; and an oral presentation requiring an oral response.

Whether they had UADD or ADHD, the children had the most difficulty with the test variation that involved a pointing presentation and pointing response. However, compared to children with UADD, the children with ADHD had more difficulty when the presenter orally named the color sequence, and they had to respond by pointing to the colors in order.

"This information can help teachers know which ways are best for a child to learn or take a test," Richman said.

UI Health Care pediatric psychologists regularly use an ADHD and learning disability diagnostic battery that includes the Color Span Test to assess memory.

Richman says a next step would be to study how medication affects the memory of children with ADHD. He will pursue more complex memory analyses to learn how brain pathways may be affected. Johnson is studying ADHD identification in college students. Elizabeth M. Altmaier, Ph.D., UI professor of psychological and quantitative foundations, served as Johnson's dissertation advisor.

Approximately 6 percent of all people age 7 and older have ADHD. Learning disabilities are even more common, affecting nearly 15 percent of the population. Most children with learning disabilities have some type of memory deficit. Memory is not typically related to overall intelligence in children with learning disabilities.

Learning disorders and ADHD can both result in inattention, impulsivity and hyperactivity. However, children with learning disorders are more likely to show symptoms at school but not at home; children with ADHD will show problem behaviors in more than one setting.

University of Iowa Health Care describes the partnership between the UI College of Medicine and the UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide.