Attention Deficit Disorder & Poor Reading Instruction: Is There a Connection?

Medical Professionals Can’t Cure What Ails Many School Children
by James J. Campbell, M.D.
March 26, 1996

Though written in 1996 as a presentation, the information contained in this article is just as applicable today. Dr. James Campbell is a practicing pediatrician in Fulton, New York.

The number of children referred from the schools for medical evaluation and treatment of Attention Deficit Disorder (ADD) and Learning Disability (LD) has been increasing substantially each year. In assessing these children, I have become aware over the past one and one-half years, that, for a large proportion of these children, the cause of their problem is the failure of the school’s instructional program to teach reading rationally and effectively.

This astonishing conclusion is all the more tragic because authorities and teachers in the schools do not acknowledge this fact and refuse to make the appropriate changes for the individual child. Instead, there is vehement denial that the instructional program could be at fault. Corrective measures are not taken, and the child is made to suffer continuing blame and humiliation.

Parents are told that their children have disabilities which, in fact, they do not have; families are subjected to misperceptions of their children’s abil ities and behavior; they are told that they do not provide enough attention to the children, that family stresses are causing the child trouble, that the child lacks self-esteem, that psychological or social services are necessary. They are told that medications are required to correct the child’s ability to “focus,” or “stay on task.” In many instances, this is simply false. The child merely needs to be taught to read.

Let me describe some typical instances of this phenomenon:

Case Study #1

An 8-year-old boy near the end of second grade was brought into my office by his mother at the prompting of school staff, who were convinced that he had ADD. He had been generally healthy and had always been considered to be a bright, intelligent boy. His behavior at home was typical for a child his age.

In his second year in school, teachers complained that he would “not stay on task,” that “he was unruly, interrupted the class often,” and “couldn’t stay in his seat.” His performance in school got worse. He was given extra reading, at which he made “adequate progress.”

The mother was told that she did not spend enough time reading to him, although, in fact, he read together with family and relatives nearly every day. (This was greeted with skepticism by the school.) His behavior in school became very bad. He would scream at the teacher and at the principal. He pulled a book stand down. The school psychologist evaluated him. He had a very high Conners Scale rating (an index of hyperactivity, distractibility). Finally, the family was told that he must have a medical evaluation and should be put on medication. We found that he was perfectly normal and healthy. On inquiry, we learned he did enjoy reading with someone, but would quickly abandon the activity if he was expected to read to any significant extent. We then learned that much of his behavioral problems in school occurred during reading classes. It was also reported that he would often ask his mother or grandparents if they thought he was smart. He was worried that he was “dumb.”

We suspected that he could not read. The mother was shocked. He was tested outside of the school and it was determined that he was reading only at an early first-grade level. He had virtually no phonetic skills. In fact, he had been explicitly told by his teacher not to sound out words.

His reading teacher was asked what program was being used, and she answered Language Arts (Whole Language). In his remedial class, the same program was used, despite the fact that he still could not read. However, the teacher expressed satisfaction with his reading progress. When the teacher was asked if a systematic phonetic method could be used, the answer was an emphatic “no,” with the assertion that this would not be appropriate and that the school would not allow such a thing. After discussion of alternatives with the parents, a direct and systematic phonetic approach was provided by private tutoring twice weekly.

Within three months, the boy was reading at a late fourth-grade level, and all of his behavior problems were resolved. At the end of the fourth grade, he was reading at a nearly seventh-grade level. Comments on his report card rate his behavior as wonderful. His achievement in all of his subjects has improved dramatically.

School personnel were happy at his progress, but when the mother disclosed that he had had phonetic tutoring, the teacher remarked that this fact had nothing to do with the change!

Case Study #2

Another child was brought in at 9 years old, at the end of the fourth grade. He was passing in school, but not “performing to potential.” He had attention problems in school, but his behavior was not terrible. He was particularly disruptive, however, and hyperactive at home.

His mother remarked that, over the past year or two, he had developed quite a negative attitude toward adults. He was defiant to the point that there was serious family discord. The mother remarked that he was very negative about his teachers, but she could not determine why.

He liked school, but mostly the activities. When asked, “If you are in reading class, and the teacher calls upon you, how does it make you feel?” He started to cry. He left the examination bench, went over to his mother, and cried on her shoulder. He looked at her and said, “Mommy, I can’t read.”

After two months on a phonetic program, he showed marked improvement. In fifth grade, he enjoys school much more and is reading above grade level. His after-school anger and hyperactivity are totally resolved. Such cases continue to appear in my office on a regular basis. Some are more dramatic and disheartening. The general characteristics of the cases can be summarized into two large groups: (1) a younger group from kindergarten through approximately fifth grade, and (2) an older group from fifth grade to high school.

Characteristics of K-5 Non-Readers

The characteristics of the first group are: (a) usually, but not always, the child does not have serious behavior problems until after starting school; (b) the child is disruptive and does not stay on task; (c) the child has poor attention skills; (d) he often acts out; (e) the behavior problems often occur in association with reading or reading-related tasks; (f) the child usually likes school; (g) the child likes to read with others but prefers not to do the reading; (h) the child is angry at or dislikes the teacher but cannot give a good reason why; (i) the child may develop negative attitudes toward adults; (j) hyperactive behavior occurs in school and at home; (k) the child may have been identified as having trouble with reading, but the school does not think this is the problem (he “is making progress;” “there is no need to worry.”); (l) the level of reading deficiency is often not described accurately or specifically; (m) annual achievement tests results are lower than expected from the report card reading grades; (n) if tested, the child is significantly delayed in reading skills (we have seen as much as four years); (o) phonetic and decoding skills are typically absent or very poor; (p) the child has great difficulty spelling; (q) the child shows he is confused about letters; (r) some children do not understand that reading proceeds from left-to-right, or top to bottom; (s) report card ratings in reading are often ambiguous; (t) the child is often worried that he is “dumb” or “not smart enough.” (u) when asked how they feel in reading class, the child answers, “I feel sad,” “I feel dumb,” “I’m embarrassed,” “I feel mad.”

Characteristics of Grades 6-12 Non-Readers

The second group is those children from fifth grade through high school. In this group, one observes a transition from disliking the teacher to disliking reading, on to alienation from learning. The characteristics are: (a) the child has poor attention skills; (b) over time, the child becomes more oppositional rather than simply disruptive; (c) the child comes to dislike reading: he hates to read and reads very seldom on his own or with anyone else; (d) the older child in this group no longer likes school and would rather not be there or may like only a couple activities; (e) the child cannot concentrate well; (f) the child often forgets what he is reading almost immediately; (g) the child does not admit to having reading difficulties; (h) the child begins to skip school or get dismissed from classes or school; (i) the child is less and less interested in undertaking a different type of reading program because he thinks it is pointless; (j) if the child is put into a phonetic reading program, it takes him much longer than those in the first group to overcome the problems accumulated under Whole Language instruction.

The Tragic Results

These children end up in this predicament because the method of teaching reading in the schools is unsound. Children fail to learn phonetic skills because the school does not teach them these skills explicitly or systematically. Furthermore, the schools do not acknowledge these deficiencies or correct them with direct, systematic teaching. Instead, the child is promoted into higher and higher grades irrespective of the level of reading deficiency or confusion.

Each higher grade requires more efficiency in reading mechanics and comprehension. Thus, the child is put into a double-bind: his reading problems are ignored, but the demands on his reading skills continually increase. These children begin to feel that they are dumb and unable to learn. The actions of the schools and teachers convince them that this is true.

The younger children are still in the state where they believe that adults are all-powerful and all-knowing. Their perception is that the teacher “knows” that they cannot read. So the mere fact that they are called on makes them feel the teacher is being mean or picking on them.

In order to avoid public disclosure of their inability to read, these children act out, or take various measures to avoid being called upon. Since they cannot read well, they cannot follow the work in class and appear to have an attention deficit. Indeed, they are not paying attention — because they cannot!

As time goes on, or years go by, not paying attention becomes a mental habit. As the amount of reading skills required in classwork increases, these children are “lost” for a larger and larger fraction of the day. They become disruptive. (Imagine your emotional state after spending an obligatory six hours each day in an environment in which you could not “connect,” and in which you felt largely incompetent.

Finally, these children are alienated from learning and from school, and behaviors and attitudes show this quite clearly. They lose any commitment to academic activities, or they may even become truant from school as young teenagers.

The dominant approach of teaching reading in the schools is the Whole Language method, or Language Arts. Words are presented to early readers as whole visual patterns. In effect, the child is expected to memorize the English language word by word, and is not explicitly taught the phonetic principles and concepts to relate the printed text to the sounds of the language in a systematic, automatized way. Thus, the fundamental concepts underlying the English alphabet are ignored.

The child is left helpless, without any tools to decode the printed word. The primary principle of Whole Language instruction is guessing. In order to discover the reality of a printed word, the child is taught to guess, using contextual skills (initially pictures), and is told that his guess is correct if its meaning is correct. Even if in reality the word is not correct, the child is not told this fact. Instead, he is congratulated on his good guess.

In such a system of instruction, it is not surprising that many children do not understand the significance of individual letters or small groups of letters. Thus, they are usually bad spellers, or write letters backward or otherwise incorrectly. They don’t develop a habit of integrating the sound symbols from left to right, and so pronunciation and writing of words is often disordered.

Since they are taught to look all over the page, or all over the paragraph to get context clues to guess at an unknown word, they do not learn to integrate sounds, words, concepts, or meaning in an orderly left-to-right progression efficiently. Children confused in this manner will skip parts of sentences, fail to understand the meaning of a sentence or paragraph, and easily forget what they have just read. Since they are told that they have made a good guess even when their guess is wrong, confusion can also arise because, for example, the written word “house” may be stated as “home,” “dwelling,” “shelter,” etc., totally obliterating any correspondence between sound and the letters in the written word.

The Missing Link: The Ability to Decode

Thus, as children fail in this method, and have limited or no decoding skills, their confusion is manifested by: (1) a lack of knowledge of vowel sounds, (2) a lack of knowledge of some consonant sounds and sound blends, (3) poor or extremely poor spelling, (4) a lack of understanding the order in reading text, including left-to-right and top-to-bottom, (5) poor acquisition of vocabulary, (6) poor reading memory, and (7) poor comprehension.

The longer these problems in reading are allowed to persist, the more generalized the deficits become, leading to problems in thinking and conceptualization. The paucity of vocabulary alone is a serious limitation on the development of thinking ability.

As reading failure progresses, the child next begins to fail in math as well. In higher grades, the child must read a problem, and extract information from it in order to solve a math problem. Since his reading is impaired, he cannot construct the math problem correctly. This new impediment, often seen in children who seemed to be doing well in math, leads to further frustration and anger in the child. It is another evidence that his intellectual capability is lacking.

All of the self-esteem exercises practiced in the school are a hollow mockery to the child who knows — even if no one else will acknowledge it — that he cannot understand or complete the work. No amount of “special services” will solve this problem. No neurological diagnosis, behavior therapy or drugs can give the child the cognitive ability that is systematically being destroyed every day in school. He is utterly confused and demoralized by a system that loads him with self-esteem, while at the same time depriving him of the one thing he needs: rational instruction in reading.

Avoiding the Obvious

When these children are evaluated in the school, and when their problems are discussed in the schools, the one item that is never considered is that the reading instruction may be poor. The explanations offered in conference with parents are legion: “you don’t read to him enough;” “she’s not ready to read;” “some children never learn vowels;” “he’s immature;” “she’s learning at her own pace;” “just be patient;” “he’s exposed to too much violence;” “family problems are bothering, etc.” But not “we need to analyze the child’s reading problem(s), and address them specifically;” or, “we don’t teach phonetics systematically, because we think phonetics are irrelevant” (which is what the schools believe). Instead: teachers say “we teach some phonics,” or “we have an eclectic program which includes phonics.” Parents are given these and other rationalizations year after year. We have tested children in fifth grade who do not even understand the alphabet — children who are reading at a preschool or first grade level!

A case in point: a child who was in third grade was reading at an early first grade level. He was given two hours of extra reading each week. When I asked the reading teacher if the child was taught any differently in the special reading class, she answered, “no.”

I remarked, “after essentially three years of no progress, wouldn’t you try a different approach? Why not try a phonetic approach?” The answer was a vehement, “No, we wouldn’t do that. Phonetics is bad, and it is not a correct way to teach reading.”

Even when I have indicated that the child has a serious deficiency in phonetic skills, the school has refused to address this problem with a systematic phonetic teaching program. This attitude is virtually implacable. Teachers and committees who insist that a doctor put a child on drugs, or have the child undergo expensive medical evaluations refuse to react to the finding that the child cannot read without a direct, systematic program of instruction!

Thus, many families have to address these problems on their own, through home programs or private tutoring. One of the most disheartening things I have seen is the response by the school when the child improves. After one child had improved his reading skills to grade level, and was no longer exhibiting disruptive behaviors in class, the mother disclosed in a teacher’s conference that he had had private phonetic instruction for several months. She was told that this had nothing to do with the child’s improvements. She was told that he simply and coincidentally “matured into reading.”

Case Study #3

In another case, a child who had made enormous improvements was “caught” by the teacher sounding out words and was reprimanded! These reactions make if very hard for me to believe that the school teaches phonetics in a direct, systematic way, despite statements and pamphlets to the public. In many Whole Language programs today, phonetic elements are taught as “clues to guessing” in the Whole Language context, not as the key conceptual skills that they are.

These attitudes are not necessarily a reflection of the teachers’ convictions. Some teachers do not agree with the schools’ policies on reading instruction, but they are under an obligation to teach only Whole Language. If they deviate from this practice, even in the interest of a particular child, they may face discipline.

Whatever positive things that may be said about certain aspects of the Whole Language programs, it is clear to me from reviewing years of literature that the fundamental instructional concepts are fraudulent. It is astonishing that the school system would adopt and continue to use such an unproven and defective system of instruction.

After years of decline from one of the best school systems in the country to nearly the worst, the California Board of Regents last year [1996] attributed their decline substantially to their earlier adoption [1987] of Whole Language. In Massachusetts, a governor’s commission on that state’s failing education system is debating the role of Whole Language in their declining literacy.

This instructional program is manufacturing reading disorders, and creating a group of children who are so confused that they are regarded mistakenly as being disabled with attention deficit disorder, hyperactivity disorder, and other behavioral problems. They and their families are being burdened with false impressions and false accusations about themselves. The cognitive development of these children is being impaired, sometimes to an extraordinary extent.

Teach Direct, Systematic Phonics

Direct teaching of phonetics to beginning and young readers in a rational, systematic way is crucial to most children. There is ample evidence of its importance in instructional, psychological, and linguistic literature. The children described in this letter clearly show what happens when this aspect of reading instruction is neglected. And given the experiences of these children, it is likely that there are many more children who, though not as seriously impaired as these, would learn reading more easily and thoroughly, and achieve higher literacy, if they were given proper phonetic instruction.

It seems to me that the Fulton Board of Education needs to assume some responsibility and assert some authority in this matter. How is it that such a program was established in the schools in the first place? How many children are classified as disabled in the typical class? How many children are being classified as disabled when their only problem is that they are not being taught to read? How much district and community resource is being wasted or misspent on classifying, evaluating, treating, and degrading children, who, if they were taught to read properly, would not have to be classified, evaluated, treated, or degraded? Why is this reading program not under question when, across the country, it is under criticism or being abandoned by major school systems? Does the school board evaluate and approve instructional programs?

I hope that this information will stimulate the board to assure that the program in reading instruction be evaluated so that its failure in teaching phonetic skills can be rectified. There should be no child in this school system who is made to suffer the humiliation and insecurities of the current defective program.

Children who are already behind in these skills should be identified and taught properly to avoid the problems of those I have described in this article.

Reality Overcomes Skepticism

When I began to identify these cases two years ago, I was reluctant to talk about them. I was skeptical that phonetic reading failure could explain apparent attention deficit disorder. But I continue to encounter more cases, and reading about reading has made them understandable.

The response of the children to proper reading instruction is rewarding and convincing. These kinds of cases occur in other local school districts, as well. The problem is both enormous and horrible, but it is gratifying when young children resolve their problems by simply improving their phonetic and reading knowledge. It is up to the school board to assure that such children get an opportunity to solve these problems in the school with expediency, and to correct the instructional program so that the schools stop producing children with reading and behavioral disorders.

April 4, 1996
Doctor’s View “Ridiculous”
I am writing in response to Dr. Campbell’s accusations directed at the Fulton School District. I am concerned that the public, knowing Dr. Campbell as a prominent figure within the community, will believe his statements as factual. I am concerned that a medical doctor believes he has the knowledge necessary to judge educational programs. Did he receive his doctorate degree in elementary education? Are we allowed to walk into his office and criticize his medical judgment?

I am a mother of two children within the Fulton School District, at the elementary level. I can assure Dr. Campbell, though my children are in, or have been in whole language classrooms, they are both excellent readers due to their teachers’ professional instruction. I know of countless other children who are also excelling in school. Dr. Campbell’s personal stories may have some validity as individual cases, but for him to blatantly generalize that the Fulton children are at risk is ridiculous. Dr Campbell states, “The principle of Whole Language is guessing.” This statement supports his lack of knowledge. As a teacher myself, I know the components of Whole Language: reading, writing, listening, and speaking. Within each component skills (which do include phonics and spelling) are taught. Teachers know the importance of phonic instruction but it is only a part of the total reading program. Children can learn to decode a word or a sentence without learning what they mean. Is this the type of student Dr. Campbell feels is successful?

Daily students walk into our classrooms with a wide range of academic abilities and social baggage. The child who spends each afternoon and evening in front of the television will learn to read at a different rate than the child who is read to each evening. The child who is abused or heard mommy and daddy are getting a divorce will not be interested in their “phonics or whole language” lesson the next day, week or month. These are the real issues teachers face daily.

Fulton teachers, as well as all teachers, are professionals. We dedicate our lives to the education of children. Perhaps, Dr. Campbell, society as a whole needs revamping. Until that occurs however, maybe Ritalin shouldn’t be prescribed, but some old fashioned values.

Ann Ruta, Fulton, New York

April 10, 1996
Teacher Offers “Silly and Fallacious Arguments”
I would like to thank the many individuals, including teachers, former teachers, special education teachers, and leaders of local educational facilities who have written and called with positive responses to my recent article about children who appear to be hyperactive or learning disabled, but who are, in fact, unable to read because of a failure of the reading program in the schools. The primary problem for this group of children is that they do not have phonetic skills, and cannot begin to understand what they are reading.

I have received only several out of approximately 40 responses that were negative, or critical, about the article. Ann Ruta’s (Valley News, April 4) is typical of these, so I will make some comments about her letter.

In the first place, Ms. Ruta appears to have missed the whole point of the article. The article is summarized in the first paragraph of this letter. The article was about a specific group of children, which I believe is a large group. My effort is to get the schools to pay attention to this group, identify them, and actually teach them what they need to know to read. Ms. Ruta wants, instead, to bask in the glory of “countless children…who are excelling in school.” She does not address herself to any pedagogical issue about the reading program, and offers no explanation for the experiences of the children about whom I wrote.

Ms. Ruta resorts to two silly and fallacious arguments: (1) that no one but an elementary school educator can possibly understand or criticize an educational program, and (2) that phonics is only a part of the total reading program.

The first is an illogical and personal attack. It is somewhat disheartening to me that an educator does not have the confidence that human intelligence can be applied to any subject. Does Ms. Ruta want to educate children to think, or to worship authority?

With respect to the second item, I am glad that Ms. Ruta is proud that she knows that Whole Language has components: “reading, writing, listening, and spelling.” However, this achievement is irrelevant to my article. The article is concerned with phonetic reading failure and its consequences, not about any other components of Whole Language per se. Again, Ms. Ruta runs off on a tangent and fails to respond to the substance of the article. The question was not “do teachers know the importance of phonics?” but rather, “do teachers actually teach phonetics effectively?” (The answers to these questions, incidentally, are “some teachers know the importance of phonics,” and “some or many do not teach phonics effectively.”)

Ms. Ruta reaches out to blame society (is society an entity?), parents, or circumstances, for reading failures. This is merely a convenient way to get everyone off the hook and ignore some important questions. Any person or professional who works with children is faced with such issues. But is Ms. Ruta suggesting that it helps a child if another adult fails in her responsibility to the child? Teachers may, indeed, face difficult circumstances with families. But the teacher’s responsibility is to teach the child to read! Maybe if that were accomplished, some of those children would develop the confidence and ability to overcome some of their obstacles. If Ms. Ruta wants authority in addition to reasoning about the importance of phonetics, she need only read a wealth of literature on the subject over the past 40 years. The English alphabet is a phonetic, not a pictographic or sight, symbolic system. To fail to teach the basic phonetic principles thoroughly and systematically would simply be foolish and illogical. The concept of the “sight word” has been thoroughly disproved in research. To teach sight words as a fundamental concept seems also to be foolish and illogical. An excellent book on the subject of reading is Marily Jager Adams’ Beginning to Read.

I would be more convinced that phonetics were being taught effectively in all classrooms if I were not seeing the children I have described. Mr. Egan has stated that Fulton “never abandoned phonetics.” But this is hard to reconcile with these children, nor with the fact that whenever I have written that a particular child has reading failure due to phonetic ignorance, the school system has ignored it. I have been told directly by reading teachers in the district that they would not teach phonics, and that it is not a way to teach a child to read. If they have not abandoned phonetics, how do they embrace it?

Thanks again to those who have written and called. I hope the school district will deal constructively with this problem, rather than engage in defensive rhetoric or illogical and irrelevant argument.

James J. Campbell, M.D.
Fulton, New York

Reprinted by Permission

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