Relationship between reading–writing performance and executive functions, neurocognitive profile and functionality in children with SLD and comorbid ADHD

This study examined the relationship between reading–writing performance and mental health problems, executive dysfunctions, neurocognitive deficits, and functional impairment in children diagnosed with specific learning disorder (SLD) with comorbid attention-deficit/hyperactivity disorder (ADHD), and compared them with children diagnosed with ADHD only. In addition, risk factors predicting reading–writing performance and functional impairment were investigated.

SLD was diagnosed through DSM-5 and supported by the Reading–Writing Assessment Battery (OYAB), grade-appropriate calculation performance tests, and the Bender–Gestalt Test. ADHD diagnosis was determined using DSM-5, Conners’ Parent Rating Scales, and teacher report forms. The study sample consisted of 106 children, including 71 diagnosed with SLD with comorbid ADHD and 35 diagnosed with ADHD only. Based on OYAB composite scores, the SLD with comorbid ADHD group was divided into “very low performance” (n = 36) and “low performance” (n = 35) subgroups. Psychiatric disorders were assessed using K-SADS-PL; reading–writing performance was assessed using OYAB; and cognitive profiles were evaluated with WISC-IV. Parent-report measures included the Conners Parent Rating Scale–Revised Short Form (CPRS-R:S), the Revised Child Anxiety and Depression Scale–Parent Version (RCADS-P), the Behavior Rating Inventory of Executive Function–Parent Form (BRIEF-P), and the Weiss Functional Impairment Rating Scale–Parent Report (WFIRS-P). Statistical analyses included group comparisons, post-hoc analyses, and regression analyses.

According to K-SADS-PL, threshold and subthreshold anxiety symptoms were more frequently observed in the very low performance subgroup. On OYAB reading, writing, comprehension, and total composite scores, the ADHD-only group performed significantly better than the SLD with comorbid ADHD group. Overall performance was highest in the ADHD-only group, followed by the low-performance SLD with comorbid ADHD subgroup, and lowest in the very low-performance SLD with comorbid ADHD subgroup. For comprehension scores, no significant difference was observed between the ADHD-only group and the low-performance SLD with comorbid ADHD subgroup; both groups performed significantly better than the very low-performance subgroup. WISC-IV results demonstrated that perceptual reasoning, working memory, processing speed, and full-scale IQ scores were significantly lower in the SLD with comorbid ADHD group compared with the ADHD-only group; however, these scores were not significantly associated with reading–writing performance levels. No significant group differences were observed in executive function behaviors. Children in the very low performance subgroup exhibited greater functional impairment, particularly in school and learning domains. Functional impairment was significantly predicted by behavioral regulation (an executive function indicator), inattention symptoms, and total anxiety and depression scores. Regression analyses indicated that impairments in working memory and processing speed constitute significant risk factors for learning difficulties and poor reading–writing performance in the comorbid presentation of SLD and ADHD; however, longitudinal studies are required to clarify the direction of these associations.

In conclusion, among children with SLD and comorbid ADHD, low reading–writing performance is associated with increased psychiatric symptoms and more pronounced functional impairment, especially in academic domains. Executive dysfunctions, inattention symptoms, and internalizing symptoms emerge as key risk factors exacerbating functional difficulties. These findings emphasize that early diagnosis and intervention should target not only academic skills but also psychiatric and cognitive processes to support long-term adaptation and quality of life.

References

No references