Mohamed Ali Saad Baraka, Eman Roshdy El-Safy Dalia, Sherif Kamel Bahaa El-Dine and Maha Mahmoud Rabie*
Department of Phoniatrics - Zagazig University Hospitals, Egypt
Received: 23 October, 2017; Accepted: 01 November, 2017; Published: 02 November, 2017
Maha Mahmoud Rabie – Physician of Phoniatrics- Zagazig University Hospitals, Egypt, E-mail:
Saad Baraka MA, El-Safy Dahlia ER, El-Dine SKB, Rabie MM (2017) The Effectiveness of Rehabilitation Programs of Learning Disabilities on Children with Attention Deficit Hyperactivity Disorder. Arch Otolaryngol Rhinol 3(4): 115-120. DOI: 10.17352/2455-1759.000061
© 2017 Saad Baraka MA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Rehabilitation programs; Learning disabilities; Attention deficit hyperactivity disorder
Objective: The aim of this work is to evaluate the role of rehabilitation programs of learning disabilities on children with attention deficit hyperactivity disorder (ADHD) children, and compare the effect of pharmacological treatment, rehabilitation program of learning disabilities, and both together on children with attention deficit hyperactivity disorder (ADHD) children.
Design: A prospective study.
Setting: Zagazig University Hospitals.
Patients and methods: This study was conducted on a sample of 30 ADHD children between the ages of 6.5 to 8.5 years, attending the Units of Phoniatrics in Ain Shams University Hospital and Zagazig University Hospital. These children demonstrated skills below the performance range expected for their age on pretest measures and school assessments.
Results: After testing the control groups with age ranged (5.5-8.5y) (mean =7) with dividing them in to 3 equal groups in age , and recording their testing as normal, the ADHD children tested per/ post study. The 1st group exposed for pharmacological treatment; their pretest was low in comparison for same age groups. There were increased result of posttest by about 10-30% (mean=20) in their tests in group 2 children remediated by rehabilitation program and pretests were done and were low for normal control group in same age. The posttests were elevated by about 20-30% (mean=25%) In group 3 children remediated by rehabilitation program and pretests were done and were low for normal control group in same age.
The posttests were elevated by about 30-40% (mean=30%) After comparing the results of 3 groups; there were no significant deference in pretests result. There was high significant difference in post-tests result except in Stanford Binnet Intelligence Scale “4th Arabic version”. There were no significant deference between male and female children.
Conclusion: ADHD affects learning globally and compromises all cognitive functions, rather than just one or two. There were good the role of rehabilitation programs of learning disabilities on children with attention deficit hyperactivity disorder (ADHD) children, and by adding pharmacological treatment the better results were produced.
ADHD is considered to be a disorder that interfere with a child’s ability to do well at school. The National Institute of Mental Health indicates that 20%-30% of children with ADHD have a learning disability. Learning Disabilities can appear in preschool children as problems in understanding sounds or words or having a hard time using words to express themselves. School age children with learning disabilities can have difficulty in reading, spelling, writing and/or arithmetic. One of the most well-known learning disability is dyslexia, a reading disability .
A student with a learning disability has a deficit in one or two areas while performing at or above average in other areas. For example, a student with a reading disability will usually have no trouble with mathematics unless they have a disability in that area. In schools, students are diagnosed with a learning disability when there is a significant discrepancy between their IQ and performance on achievement tests. These tests are usually given by the school psychologist and are different from the standardized tests that are given to the entire school .
In contrast, ADHD affects learning globally and compromises all cognitive functions, rather than just one or two. This is not measurable on tests, unless the tests were given incorrectly (for example, if the tests were done while the student was distracted). Although learning disabilities are diagnosed by the school system, ADHD cannot be. ADHD is a medical condition and the diagnosis can only be made by medical professionals .
The best explanation of the differences between the two, Darcy, 2008, has found is this: Imagine the "normal" brain as a room with all the lights on. A learning disability will turn off one or two of the lamps in the room, leaving some areas dark while others are still bright. However, ADHD dims all the lights in the room; it affects the person all the time not just when they performing specific cognitive functions (like reading). A student with both ADHD and a learning disability will have the lights dim throughout the room, with one or two areas significantly darker. Students with ADHD should always be screened for learning disabilities, if for no other reason that an undiagnosed learning disability can mimic the symptoms of ADHD. Knowing what exactly is going on is essential in order to decide on an effective course of action .
Patients and Methods
A group of 30 children in the same age range was served as a normal comparison group. These children had normal cognitive abilities, average literacy development, and no history of speech or language difficulties. They were divided as 10 children in the age range 5.5 to 6.5 years, 10 children in the age range 6.5 to 7.5 years, and 10 children in the age range 7.5 to 8.5 years.
The ADHD children were divided as follows:
• 10 children were received pharmacological treatment.
• 10 children were received the language-based training program.
• 10 children were received both the language-based training program and pharmacological treatment.
They were trained or treated or both for 6 months then the result was compared.
Patients meet the DSM-IV criteria for ADHD (American Psychiatric Association, 1994).
*The research approach was a pre/posttest study. Every case was subjected to the following protocol of assessment:
Complete history taking, including the latest score of Arabic exam for school students.
General, Vocal tract, Ear and nose and Neurological examination.
Clinical diagnostic aids
• Psychometric evaluation using:
o Stanford Binnet Intelligence Scale “4th Arabic version” (Melika, 1998), for determination of mental age. Only children with an IQ 90 or more participated in the study.
o Vienland social maturity scale (Doll, 1965) for determination of social age.
o Conner's test of ADHD.
• Audiological assessment to exclude patients with hearing impairment.
• The following assessment measures were used at both pre- and post-test: Language assessment using the Standardized Arabic Language Test .
• Dyslexia Screening Test “Arabic version”  was applied for the suitable age. The test was composed of eleven items. These are:
o Rapid naming test.
o Bead threading.
o One minute reading.
o Postural stability.
o Phonemic segmentation.
o Two minute spelling.
o Backward digit span.
o Nonsense passage reading.
o One minute writing.
o Verbal fluency.
o Semantic fluency.
• Illinois test of psycholinguistic abilities “Arabic version” (El-Sady et al., 1996). It includes the following subtests:
-At the represential level:
-At the automatic level:
*Auditory sequential memory.
*Visual sequential memory.
• Phonological awareness assessment.
• Sound production assessment was done by applying Mansoura Arabic Articulation Test  in addition to testing the production of multisyllabic words.
• Word finding difficulty was outlined in a quasi-objective way through the results of the following subtests of the Dyslexia Screening Test  and Illinois test : Rapid naming, backward digit span, Semantic fluency and Verbal fluency subtests of Dyslexia Screening Test. Auditory association and Grammatic closure subtests of Illinois test.
• Assessment of semantics at both the receptive and expressive levels can be obtained from the Standardized Arabic Language Test . A more detailed assessment of semantics was constructed and was applied on normal comparison group prior to its application on the patients.
• Assessment of syntax at both the receptive and expressive levels can be obtained from the Standardized Arabic Language Test .
• The memory state of the patients was evaluated through the results of the auditory sequential memory and visual sequential memory subtests of the Illinois test.
*The above mentioned protocol of assessment was administered to each child prior to undergoing twice weekly 40 minutes training sessions for 6 months. The training program is an Arabic language-based program developed . It focuses on remediation of both lower order and higher order process disorders in addition to attention and memory training, as follow:
A-Remediation of lower order process disorders:
1-Remediation of phonological awareness deficit:
Sentence division into words.
Bisyllabic word division.
Monosyllabic word division.
*Phoneme grapheme correspondence.
2-Remediation of sound production deficit: mainly through syllable by syllable attack and consonant exaggeration.
B-Remediation of higher order process disorders:
1-Remediation of vocabulary deficit: by condensed repetitive semantic training under hold attention to yield automatic retrieval.
2-Remediation of semantic and syntactic deficits:
For semantic deficit: synonyms, antonyms and hyponyms are taught.
For syntactic deficit: morphology, surface and deep structures are taught.
C-Remediation of attention and memory deficits:
Mainly through improving auditory and visual sequential memories, using different activities that are graduated in difficulty. Attention control will follow the developmental stages of attention.
*The treatment plan was tailored according to each child’s deficit, based on his/her performance in the pretests.
Upon completion of sessions, post testing would be administered using the post-test assessment measures. In addition, the student’s score of scholastic monthly Arabic exam would be used as indicator to the progress in academic achievement.
After testing the control groups with age ranged (5.5-8.5y) (mean =7) with dividing them in to 3 equal groups in age , and recording their testing as normal , the ADHD children tested per/ post study.
The 1st group exposed for pharmacological treatment; their pretest was low in comparison for same age groups.
There were increased result of posttest by about 10-30% (mean=20) in their tests (Figure 1).