Purpose and Objective

1


Story Comprehension and Social Functioning in
Children with ADHD
Steven W. Evans Bebhinn M. Timmins
Zewelanji N. Serpell Elizabeth C.
Buvinger Carey E. Masse
Abstract
Research support provided by the Alvin V. Baird
Attention and Learning Disabilities Center and a
grant funded by the Virginia Tobacco Settlement
Foundation
Method Contd
Previous research by Lorch and colleagues
revealed that boys with attention-deficit/
hyperactivity disorder (ADHD) performed
significantly worse than boys without ADHD on
specific dimensions of a measure of story
comprehension. There was no difference between
the performance of boys with ADHD and comparison
boys on recall of factual information, but
significant differences were found on questions
which required reasoning skills beyond simple
recall. The current study provides a partial
replication of these findings and extends this
research by examining the data in relation to
social functioning. Results indicate a
significant relationship between two of the three
domains of story comprehension and multiple
measures of social functioning when the tasks are
performed in the presence of distracting stimuli.
After giving the participant instructions to
watch the episode the administrator turned on the
TV and VCR and then left the room to return in 23
minutes. Upon his/her return he/she removed the
toys from the table (if present) and reminded the
participant of the names of the characters based
on a picture of the family depicted in the show.
At that time the administrator began recording on
a standard audio recording device and
administered a cued recall test which consisted
of 23 items. The questions followed the
chronological presentation of events in the show
and focused on overt content. Administrators also
recorded participants responses by hand.
Interviews from the tapes were then transcribed
and scored by two raters. Participants were given
credit for items if their answers appeared in a
key provided by Lorch. Of the 23 questions asked
during the interview, 5 were factual questions, 7
were near why questions and 3 were far why
questions. The why questions involved reasoning
and the distinction between the near why and the
far why questions exist in the level of reasoning
required of the child to determine the response.
The far why questions required a higher degree of
reasoning than the near why questions. Eight
questions could constitute near why or far why
answers depending on the response and were coded
as such by the scorer. If the participant gave a
response that indicated more than one answer type
(near why or far why), they were given credit for
both. This meant that the number of possible
responses was 31. As a result, scores ranged from
0-31. Items that were discrepantly scored between
the two raters were sent to a third rater for
scoring. Raters 1 and 2 agreed on the scores for
94.51 of the items. Social Skills
Measures Social Skills Rating System The
parent report version was used in this study to
assess the social functioning of the
participants. Test-retest reliability for the
SSRS is reported in the ranges of .65 to .93,
with subscale reliabilities ranging at .48 to
.88. The coefficient alpha reliability is
reported in the ranges of .81 to .85 (Frank,
Gresham Elliott, 1990). Impairment Rating
Scale The parent report version of the IRS was
used to obtain indices of relationships with
peers and siblings. Children are rated on a 0 to
6 scale ranging from No problem/ Definitely does
not need treatment or special services to
Extreme problem/ Definitely needs treatment or
special services. Behavior Assessment System
for Children The parent report version of the
BASC was used to obtain ratings of social skills
and leadership. Both are indices of prosocial
involvement and behavior (Reynolds Kamphaus,
1992).
Discussion
These results suggest that a social comprehension
deficit may be a factor in explaining the social
impairment that so frequently accompanies
children with ADHD. If youth with ADHD are unable
to decipher the cause and effect relationships
between their behavior and the behavior of
others, and behaviors between others, then they
are unlikely to benefit from the continuous
shaping of social behavior that occurs as part of
our daily interactions and facilitates our
development of appropriate social behavior.
Rejection, criticism, ignoring and other subtle
and direct consequences of behavior will appear
random if the cause and effect relationships are
not understood. As a result, learning appropriate
social behavior is compromised and the cumulative
effect of this can be significant impairment.
These findings have implications for the
development of effective social skills
interventions for children with ADHD. It may be
that remedial training throughout childhood and
adolescence is needed to help children with ADHD
recognize and learn from the cause and effect
social relationships that occur around them. This
training would focus on strategies for obtaining
information from the social environment and
methods similar to those used to teach reading
comprehension may be warranted. Similar to the
work published by Lorch and colleagues, our most
interesting findings come from data collected in
the toys present condition. Most social contexts
for children are analogous to a toys present
condition. Since children with and without ADHD
did not differ in the toys absent condition, it
may be that children with ADHD can learn to apply
the same strategies they use when there are no
distractions to situations with significant
distraction. A recent study by Lorch and
colleagues (2004) reported that measures of
visual tracking and sustained gaze corresponded
to poor comprehension and may be a behavioral
index of the strategies needed to learn the
social contingencies operating in our
environment. Level of distraction may be tapered
to allow shaping of the desired attention
strategies to achieve social comprehension.
Purpose and Objective
Many children with ADHD experience serious social
difficulties (Bagwell, Molina, Pelham, Hoza,
2001 Fischer, Barkley, Fletcher, Smallish,
1993) and social impairment is one of the most
common presenting problems for children with ADHD
who are referred for treatment (Barkley et al.,
1991). Research that has focused on social
skills deficits has primarily measured forms of
social problem solving that appear to
differentiate children with better social
adjustment from those with poor social
functioning (Evans, Short, 1991 Richard
Dodge, 1982). Hence, many social skills
interventions place great emphasis on teaching
problem solving skills and there is evidence that
these interventions can help some children
(Kazdin, 1996). However, there is also evidence
that the current social skills interventions
available may be insufficient to make a
significant impact on socially impaired children
(Gresham, 1998), suggesting that there may be
more involved in successful social functioning
than problem solving. The work by Lorch and
colleagues suggests that in distracting
situations children with ADHD may be less able
than non-ADHD peers to recognize cause and
effect social relationships between behavior
(Lorch et al. 2000). Boys with ADHD and a control
group of boys without ADHD viewed televised
stories and were asked to answer questions about
the story. In one condition distracting toys were
present during the time the children watched the
television show, while there were no toys
present in the other condition. The two groups
did not differ in their ability to recall factual
information or in their performance when there
were no distracting toys present during their
viewing of the episode. The two groups did differ
in their ability to provide answers to questions
that required reasoning when there were toys
present, with the control group doing better
than the boys with ADHD (Lorch et al. 2000). The
current study tested a theory that proposes that
the social impairment in youth with ADHD may be
attributable to this deficit in recognizing
social cause and effect relationships. It may be
that the cumulative effect of this deficiency
over the years when social behaviors are being
shaped by the behaviors of others around us leads
to social impairment. Based on this previous
research three hypotheses were proposed.
Results

• Hypothesis One After viewing an episode of
  Growing Pains children with ADHD will recall more
  factual information than information that
  requires reasoning skills. Consistent with
  previous research, results indicate that children
  performed better on the factual dimension of the
  story comprehension measure than the reasoning
  dimensions. The factual questions asked were most
  often answered correctly, with a mean percentage
  of 71.64. This was followed by the near why
  questions with a mean percentage of 55.72 and
  then the far why questions with a mean percentage
  39.76. As the amount of reasoning required to
  answer the question increased, the percentage
  correct decreased.
• Hypothesis Two Performance on the story
  comprehension measure will differ for children
  who are placed in an environment that is
  distracting compared to children in the toys
  absent condition. Means and standard deviations
  for the group presented with toys and not
  presented with toys suggest that the presence of
  toys compromised performance on the story
  comprehension measure. An analysis of variance
  was conducted comparing the children in the toys
  present condition with those in the toys absent
  condition on each question type included on the
  story comprehension measure. According to the
  data the presence of toys significantly reduced
  performance on all question types except the far
  why questions. See table 1 .

• Hypothesis One After viewing an episode of
  Growing Pains children with ADHD will recall more
  factual information than information that
  requires reasoning skills.
• Hypothesis Two Performance on the story
  comprehension measure will differ for children
  who are placed in an environment that includes
  distracting toys than children who are in the
  toys absent condition.
• Hypothesis Three A significant relationship
  exists between story comprehension and social
  functioning, such that the better a child does on
  the story comprehension measure, the better they
  will function socially.

• Hypothesis Three A significant relationship
  exists between story comprehension and social
  functioning, such that the better an child does
  on the story comprehension measure, the better
  they function socially. To investigate the
  relationship between story comprehension measures
  and measures of social functioning, Pearsons
  correlations were computed between the story
  comprehension measures, including all three
  question types and a total score, and multiple
  measures of social functioning. Although these
  correlations were computed for both the toys
  present and toys absent conditions, only those
  results in the toys present condition are
  presented, as none of the findings in the toys
  absent condition were significant. The results in
  Table 2 suggest a significant relationship
  between story comprehension and social
  functioning as measured by the SSRS parent
  report, the IRS parent report of childs
  relationship with siblings, and the BASC social
  skills and leadership scores. It appears that the
  far why question type on the story comprehension
  measure best correlated with the social
  functioning measures. Consistent with our
  findings, it was expected that a relationship
  between the factual questions of story
  comprehension and the social skills measures
  would not exist since this does not measure the
  social reasoning thought to negatively impact
  social functioning.

Method
Participants Parents referred their children to
the study based on recruitment information
requesting children with problems related to
impulsivity, hyperactivity or inattention.
Seventy one subjects ranging in age from 10-13
years who were recruited for a larger project
completed the procedures for this study.
Exclusion criteria included a diagnosis of
bipolar disorder or schizophrenia and an IQ of
below 80. Participants received a stipend for
their time. The first 42 participants were
randomly assigned to one of two conditions (toys
present or toys absent) for their participation
in the procedures relevant to this study. The
remaining participants completed the procedures
in the toys present condition. This resulted in
46 participants in the toys present condition and
21 in the toys absent condition. The data for
four subjects could not be used due to technical
difficulties or administrator error. Procedure
Measures were administered during the initial
assessment for participants recruited for a study
of the Challenging Horizons Program (Evans,
Axelrod Langberg, 2004) . The complete
assessment consisted of 6-8 hours of
questionnaires, computer assessments and clinical
interviews given to both the child and parent by
a trained graduate or undergraduate psychology
student to assess a variety of areas including
social, emotional and behavioral functioning,
ADHD symptoms, achievement and IQ. All
participants met DSM-IV criteria for one subtype
of ADHD based on the parents answers to the
structured diagnostic interview (DISC-IV)
(McGrath, Handwerk, Armstrong, Lucas Friman,
2004), parent DBD, (Pelham, 1992) and the parent
and teacher versions of the IRS rating scales
(Fabiano Pelham, 1992). The assessment of
social comprehension procedures were completed in
accordance with procedures used in previous
studies by Lorch et al. (2000). The materials to
complete these assessments were graciously
provided by Dr. Lorch to insure accurate
replication. Participants viewed a 23 minute
episode of the ABC sitcom Growing Pains
(Sullivan, Marshall Guntzell, 1986). The name
of the episode, which was played in full without
commercial interruption was Magic Show and was
taken from the second season of the series. Each
participant was seated at a table to view the
episode. In the toys absent condition there was
nothing on the table. In the toys present
condition, toys were placed on the table in a
standard arrangement. The TV was at a 45 degree
angle from the participant.
Table 2 Correlations between story comprehension
measures and social skills in the toys present
condition
Table 1 Means and standard deviations of scores
on story comprehension measure by toy condition
and analysis of variance for toy condition
Note. TP Toys Present TA Toys Absent
p
Note. p