Inattentive Behavior in Boys with ADHD during Classroom Instruction: the Mediating Role of Working Memory Processes
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Children with ADHD exhibit clinically impairing inattentive behavior during classroom instruction and in other cognitively demanding contexts. However, there have been surprisingly few attempts to validate anecdotal parent/teacher reports of intact sustained attention during ‘preferred’ activities such as watching movies. The current investigation addresses this omission, and provides an initial test of how ADHD-related working memory deficits contribute to inattentive behavior during classroom instruction. Boys ages 8–12 (M = 9.62, SD = 1.22) with ADHD (n = 32) and typically developing boys (TD; n = 30) completed a counterbalanced series of working memory tests and watched two videos on separate assessment days: an analogue math instructional video, and a non-instructional video selected to match the content and cognitive demands of parent/teacher-described ‘preferred’ activities. Objective, reliable observations of attentive behavior revealed no between-group differences during the non-instructional video (d = −0.02), and attentive behavior during the non-instructional video was unrelated to all working memory variables (r = −0.11 to 0.19, ns). In contrast, the ADHD group showed disproportionate attentive behavior decrements during analogue classroom instruction (d = −0.71). Bias-corrected, bootstrapped, serial mediation revealed that 59% of this between-group difference was attributable to ADHD-related impairments in central executive working memory, both directly (ER = 41%) and indirectly via its role in coordinating phonological short-term memory (ER = 15%). Between-group attentive behavior differences were no longer detectable after accounting for ADHD-related working memory impairments (d = −0.29, ns). Results confirm anecdotal reports of intact sustained attention during activities that place minimal demands on working memory, and indicate that ADHD children’s inattention during analogue classroom instruction is related, in large part, to their underdeveloped working memory abilities.
KeywordsADHD Attention-deficit/hyperactivity disorder Classroom attention Working memory Classroom instruction
Compliance with Ethical Standards
This study was conducted without external funding.
Conflict of Interest
The authors declare that they have no conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent/assent was obtained from all participants included in the study.
- Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA School-age Forms & Profiles. Burlington: University of Vermont.Google Scholar
- Alderson, R. M., Rapport, M. D., Hudec, K. L., Sarver, D. E., & Kofler, M. J. (2010). Competing core processes in attention-deficit/hyperactivity disorder (ADHD): do working memory deficiencies underlie behavioral inhibition deficits? Journal of Abnormal Child Psychology, 38, 497–507.CrossRefPubMedGoogle Scholar
- Alderson, R. M., Rapport, M. D., Kasper, L. J., Sarver, D. E., & Kofler, M. J. (2012). Hyperactivity in boys with attention deficit/hyperactivity disorder (ADHD): the association between deficient behavioral inhibition, attentional processes, and objectively measured activity. Child Neuropsychology, 18, 487–505.CrossRefPubMedGoogle Scholar
- Alderson, R. M., Kasper, L. J., Patros, C. H., Hudec, K. L., Tarle, S. J., & Lea, S. E. (2015). Working memory deficits in boys with attention deficit/hyperactivity disorder (ADHD): an examination of orthographic coding and episodic buffer processes. Child Neuropsychology, 21(4), 509–530.CrossRefPubMedGoogle Scholar
- Barkley, R. A. (Ed.). (2014). Attention-deficit hyperactivity disorder: a handbook for diagnosis and treatment (5th ed.). New York: Guilford Publications.Google Scholar
- California Department of Education (2017). Recommended and required instructional minutes. Sacramento, CA. Retrieved from http://pubs.cde.ca.gov/tcsii/ch3/rdmdrqirdinstmin.aspx.
- Chronis, A. M., Fabiano, G. A., Gnagy, E. M., Onyango, A. N., Pelham, W. E., Lopez-Williams, A., et al. (2004). An evaluation of the summer treatment program for children with attention-deficit/hyperactivity disorder using a treatment withdrawal design. Behavior Therapy, 35(3), 561–585.CrossRefGoogle Scholar
- Cortese, S., Ferrin, M., Brandeis, D., Buitelaar, J., Daley, D., Dittmann, R. W., et al. (2015). Cognitive training for attention-deficit/hyperactivity disorder: meta-analysis of clinical and neuropsychological outcomes from randomized controlled trials. Journal of the American Academy of Child and Adolescent Psychiatry, 54(3), 164–174.CrossRefPubMedPubMedCentralGoogle Scholar
- Dovis, S., Van der Oord, S., Wiers, R. W., & Prins, P. J. (2012). Can motivation normalize working memory and task persistence in children with attention-deficit/hyperactivity disorder? The effects of money and computer-gaming. Journal of Abnormal Child Psychology, 40(5), 669–681.CrossRefPubMedGoogle Scholar
- DuPaul, G. J., & Stoner, G. (2014). ADHD in the schools: assessment and intervention strategies. New York: Guilford Publications.Google Scholar
- Elliott, J. G., Gathercole, S. E., Alloway, T. P., Holmes, J., & Kirkwood, H. (2010). An evaluation of a classroom-based intervention to help overcome working memory difficulties and improve long-term academic achievement. Journal of Cognitive Education and Psychology, 9(3), 227–250.CrossRefGoogle Scholar
- Friedman, L.M., Rapport, M.D., Orban, S.A., Eckrich, S.E., Calub, C.A. (2017a-online early release). Applied problem solving in children with ADHD: the mediating roles of working memory and mathematical calculation. Journal of Abnormal Child Psychology. doi: 10.1007/s10802-017-0312-7.
- Good, R. H., & Kaminski, R. A. (Eds.). (2001). Dynamic indicators of basic early literacy skills (5th ed.). Eugene: Institute for the Development of Educational Achievement.Google Scholar
- Hayes, A.F. (2014). PROCESS for SPSS (Version 2.12.1) (computer software). Columbus: The Guilford Press.Google Scholar
- Hinshaw, S.P. (2002). Is ADHD an impairing condition in childhood and adolescence? In P.S. Jensen, & J.R. Cooper (Eds.), Attention deficit hyperactivity disorder: state of the science—best practices (pp. 5-1-5-21). Kingston: Civic Research Institute.Google Scholar
- Huitt, W., Monetti, D., & Hummel, J. (2009). Designing direct instruction. In C. Reigeluth & A. Carr-Chellman (Eds.), Instructional design theories and models: Volume III, building a common knowledgebase (pp. 73–97). Mahwah: Lawrence Erlbaum Associates.Google Scholar
- Imeraj, L., Antrop, I., Sonuga-Barke, E., Deboutte, D., Deschepper, E., Bal, S., & Roeyers, H. (2013). The impact of instructional context on classroom on-task behavior: a matched comparison of children with ADHD and non-ADHD classmates. Journal of School Psychology, 51(4), 487–498.CrossRefPubMedGoogle Scholar
- Kane, M. J., Hambrick, D. Z., Tuholski, S. W., Wilhelm, O., Payne, T. W., & Engle, R. W. (2004). The generality of working memory capacity: a latent-variable approach to verbal and visuospatial memory span and reasoning. Journal of Experimental Psychology: General, 133(2), 189–217.CrossRefGoogle Scholar
- Karalunas, S. L., Geurts, H. M., Konrad, K., Bender, S., & Nigg, J. T. (2014). Annual research review: reaction time variability in ADHD and autism spectrum disorders: measurement and mechanisms of a proposed trans-diagnostic phenotype. Journal of Child Psychology and Psychiatry, 55(6), 685–710.CrossRefPubMedPubMedCentralGoogle Scholar
- Kaufman, J., Birmaher, B., Brent, D., Rao, U., Flynn, C., Moreci, P., et al. (1997). Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. Journal of the American Academy of Child and Adolescent Psychiatry, 36(7), 980–988.CrossRefPubMedGoogle Scholar
- Kofler, M. J., Rapport, M. D., Bolden, J., Sarver, D. E., & Raiker, J. S. (2010). ADHD and working memory: the impact of central executive deficits and exceeding storage/rehearsal capacity on observed inattentive behavior. Journal of Abnormal Child Psychology, 38(2), 149–161.CrossRefPubMedGoogle Scholar
- Lui, M., & Tannock, R. (2007). Working memory and inattentive behaviour in a community sample of children. Behavioral and Brain Functions, 3(12), 1–11.Google Scholar
- Molina, B.S., Hinshaw, S.P., Swanson, J.M., Arnold, L.E., Vitiello, B., Jensen, P.S., … MTA Cooperative Group. (2009). The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study. Journal of the American Academy of Child and Adolescent Psychiatry, 48(5), 484–500.Google Scholar
- Noldus Information Technology (2011). The observer XT reference manual version 10.5. Wageningen: Author.Google Scholar
- Normand, S., Schneider, B. H., Lee, M. D., Maisonneuve, M. F., Chupetlovska-Anastasova, A., Kuehn, S. M., & Robaey, P. (2013). Continuities and changes in the friendships of children with and without ADHD: a longitudinal, observational study. Journal of Abnormal Child Psychology, 41(7), 1161–1175.CrossRefPubMedGoogle Scholar
- Raiker, J. S., Rapport, M. D., Kofler, M. J., & Sarver, D. E. (2012). Objectively-measured impulsivity and attention-deficit/hyperactivity disorder (ADHD): testing competing predictions from the working memory and behavioral inhibition models of ADHD. Journal of Abnormal Child Psychology, 40(5), 699–713.CrossRefPubMedGoogle Scholar
- Rapport, M. D., Denney, C., DuPaul, G. J., & Gardner, M. J. (1994). Attention deficit disorder and methylphenidate: normalization rates, clinical effectiveness, and response prediction in 76 children. Journal of the American Academy of Child and Adolescent Psychiatry, 33(6), 882–893.CrossRefPubMedGoogle Scholar
- Rapport, M. D., Alderson, R. M., Kofler, M. J., Sarver, D. E., Bolden, J., & Sims, V. (2008). Working memory deficits in boys with attention-deficit/hyperactivity disorder (ADHD): the contribution of central executive and subsystem processes. Journal of Abnormal Child Psychology, 36(6), 825–837.CrossRefPubMedGoogle Scholar
- Rapport, M. D., Bolden, J., Kofler, M. J., Sarver, D. E., Raiker, J. S., & Alderson, R. M. (2009). Hyperactivity in boys with attentiondeficit/hyperactivity disorder (ADHD): A ubiquitous core symptoms or manifestation of working memory deficits. Journal of Abnormal Child Psychology, 37, 521–534.Google Scholar
- Rapport, M. D., Orban, S. A., Kofler, M. J., & Friedman, L. M. (2013). Do programs designed to train working memory, other executive functions, and attention benefit children with ADHD? A meta-analytic review of cognitive, academic, and behavioral outcomes. Clinical Psychology Review, 33(8), 1237–1252.CrossRefPubMedGoogle Scholar
- Riddle, M. A., Yershova, K., Lazzaretto, D., Paykina, N., Yenokyan, G., Greenhill, L., et al. (2013). The preschool attention-deficit/hyperactivity disorder treatment study (PATS) 6-year follow-up. Journal of the American Academy of Child and Adolescent Psychiatry, 52(3), 264–278.CrossRefPubMedPubMedCentralGoogle Scholar
- Roberts, W., Milich, R., & Barkley, R. (2015). Primary symptoms, diagnostic criteria, subtyping, and prevalence of ADHD. In R. Barkley (Ed.), Attention-deficit hyperactivity disorder (4th ed., pp. 50–80). New York: Guildford.Google Scholar
- Sarver, D. E., Rapport, M. D., Kofler, M. J., Scanlan, S. W., Raiker, J. S., Altro, T. A., & Bolden, J. (2012). Attention problems, phonological short-term memory, and visuospatial short-term memory: differential effects on near-and long-term scholastic achievement. Learning and Individual Differences, 22, 8–19.CrossRefGoogle Scholar
- Sergeant, J. A., Oosterlaan, J., & Van der Meere, J. (1999). Informationprocessing and energetic factors in attention-deficit/hyperactivity disorder. InH. C. Quay & A. E. Hogan (Eds.), Handbook of disruptive behavior disorders (pp. 75–104). New York: Kluwer Academic/Plenum Publishers.Google Scholar
- Shaw, M., Hodgkins, P., Caci, H., Young, S., Kahle, J., Woods, A. G., & Arnold, L. E. (2012). A systematic review and analysis of long-term outcomes in attention deficit hyperactivity disorder: effects of treatment and non-treatment. BMC Medicine, 10(99), 1–15.Google Scholar
- Skansgaard, E. P., & Burns, G. L. (1998). Comparison of DSM-IV ADHD combined and predominantly inattention types: correspondence between teacher ratings and direct observations of inattentive, hyperactivity/impulsivity, slow cognitive tempo, oppositional defiant, and overt conduct disorder symptoms. Child and Family Behavior Therapy, 20, 1–14.CrossRefGoogle Scholar
- Slavin, R. E. (2012). Educational Psychology: theory and practice: Edition 10. Boston: Allyn & Bacon.Google Scholar
- Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statistics (5th ed.). Boston: Allyn & Bacon/Pearson Education.Google Scholar
- Vanderwal, T., Eilbott, J., Finn, E.S., Craddock, R.C., Turnbull, A.G., Castellanos, F.X. (2017-online early release). Individual differences in functional connectivity during naturalistic viewing conditions. NeuroImage doi: 10.1101/084665.
- Wechsler, D. (2007). Wechsler Intelligence Scale for Children—Fifth Edition. Technical and interpretive manual. San Antonio: The Psychological Corporation.Google Scholar
- Zentall, S. S., & Zentall, T. (1983). Optimal stimulation: A model of disordered activity and performance in normal and deviant children. Psychological Bulletin, 94, 446–471.Google Scholar