1

The Relationship Between Working Memory and Reading Difficulties in Individuals with

Dyslexia and ADHD

Author: Alana Bollone, PA-S

Institution: University of Bridgeport
Department: Physician Assistant Institute
Research Mentor: Dr. Kimberly Sanders, ND of University of Bridgeport
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Approval Page

This Clinical Review Thesis was submitted by (your name). Thesis committee was composed of
the individuals indicated below. The Clinical Review Thesis was submitted to the Director of the
Physician Assistant Institute for final approval in partial fulfillment of the requirements for the
degree of Master of Science, from the Physician Assistant Institute of the University of
Bridgeport.

Committee:

Lauren Weindling, PA-C, MPAS, Chairperson _____________________ Date:_______

Dr. Kimberly Sanders, ND, External Advisor_______________________ Date________

Clinical Review Project Approved:

_____________________________________ _________________
Lauren Weindling, PA-C, MPAS Date
Director, Physician Assistant Institute
University of Bridgeport
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Abstract

Dyslexia and ADHD are neurodevelopmental diseases that can affect reading comprehension.
These diseases cause problems with working memory, which may contribute to reading
difficulties. Working memory deficits are a common feature of both dyslexia and ADHD, and it
has been hypothesized that these abnormalities may play a role in the reading difficulties
reported by people with both diseases. A qualitative approach was used to analyze the data from
20 studies. The studies were examined and synthesized in order to identify patterns and themes
relevant to the research questions. According to the findings of the literature review, children
with dyslexia have difficulties with inhibition and working memory, and those with comorbid
ADHD and dyslexia have similar degrees of impairment as children with dyslexia alone. The
findings of this study support the research questions by providing evidence that individuals with
dyslexia and ADHD have poorer working memory function than those without these conditions.
Moreover, working memory deficits are a significant predictor of reading difficulties in
individuals with dyslexia and ADHD. The literature review indicates that individuals with
dyslexia have deficits in executive function skills, especially working memory, attention,
inhibition, and shifting. Further research should be done on the potential benefits of recognizing
and addressing working memory issues early in individuals with learning impairments to
improve learning outcomes
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Acknowledgment

I would like to show my gratitude to the University of Bridgeport Physician Assistant Institute,
directed by Lauren Weindling, PA-C, MPAS, for their support. A special thank you to Dr.
Kimberly Sanders, ND, clinical assistant professor, for her guidance and expertise in this
research project.
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Table of Contents

Chapter 1: Introduction ....................................................................................................6

Background......................................................................................................................6
Problem Statement...........................................................................................................7
Clinical Review Goal ......................................................................................................8
Research Question/Hypothesis ........................................................................................8
Relevance and Significance .............................................................................................9
Barriers and Issues............................................................................................................9
Assumptions.....................................................................................................................10
Limitations........................................................................................................................10
Delimitations....................................................................................................................11
Definition of Terms..........................................................................................................11
Summary .........................................................................................................................12

Chapter 2: Review of Literature ......................................................................................12

Chapter 3: Methodology ...................................................................................................28

Chapter 4: Results .............................................................................................................29

Summary of Results..........................................................................................................33

Chapter 5 Conclusion ........................................................................................................36

Strengths ...........................................................................................................................39
Weakness...........................................................................................................................40
Limitations.........................................................................................................................40
Implications ......................................................................................................................41
Recommendations ............................................................................................................42

References ..........................................................................................................................43

Appendix ............................................................................................................................47
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Chapter 1: Introduction

Background

Two of the most prevalent neurodevelopmental diseases that can affect reading and

language processing abilities in both children and adults are dyslexia and attention deficit

hyperactivity disorder (ADHD). Despite having sufficient intelligence and educational resources,

dyslexia is characterized by difficulty with reading, spelling, and writing. Contrarily, the

symptoms of ADHD, which include hyperactivity, impulsivity, and inattention, can affect a

variety of cognitive processes, including reading comprehension.1

Both diseases can co-occur and cause serious challenges with social interaction and

academic performance. Zauderer (2022) estimates that there are 780 million dyslexic people

worldwide. Just 2 million of the more than 40 million individuals in the US who have dyslexia

have been given a diagnosis.2 Dyslexia affects between 70% and 80% of persons with weak

reading skills. 89% of kids receiving a customized education have reading difficulties, with

dyslexia affecting 85% of them. On the other hand, 30% of children who also have dyslexia are

those with ADHD.

The cognitive ability to keep and alter information in the mind for brief periods is known

as working memory.3 As working memory enables people to retain and alter linguistic

information in real time, it is essential for reading and language processing.4 Dyslexia and

ADHD both have the common trait of working memory deficiencies, and it has been

hypothesized that these abnormalities may be a factor in the reading difficulties reported by

people with both diseases.

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The relationship between working memory and reading issues in people with dyslexia

and ADHD has been the subject of several studies. According to these studies, people with

dyslexia and ADHD have problems with their ability to use working memory, especially when

performing tasks that call for manipulating verbal information.5-7 Additionally, research indicates

that reading difficulties experienced by people with these disorders may be influenced by

working memory deficits.

The link between working memory and reading problems in people with dyslexia and

ADHD is still poorly understood. This study examines the connection between working memory

and reading difficulties in people with dyslexia and ADHD to fill this gap in knowledge.

Improved comprehension of the cognitive processes underlying both diseases can guide therapies

to enhance reading performance and academic success in people with dyslexia and ADHD.

Problem Statement

Those with dyslexia and ADHD have been found to have problems with working

memory, which may be a factor in their reading issues. It is unknown, nevertheless, how the link

between working memory and reading problems affects academic success in people with

dyslexia and ADHD, as opposed to people who simply have dyslexia or only have ADHD. To

learn more about the underlying cognitive mechanisms involved in these diseases, it is necessary

to look at this connection.

Additionally, understanding the distinctive contributions of each condition to cognitive

and academic functioning by comparing working memory performance between people with

ADHD and dyslexia to people with either ADHD or only dyslexia. The development of therapies
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to enhance reading outcomes and academic performance requires a knowledge of the interaction

between working memory and reading challenges on academic accomplishment in people with

dyslexia and ADHD.

Clinical Review Goal

This study's clinical evaluation aims to clarify the connection between working memory

problems and reading difficulties in people with dyslexia and ADHD. The ultimate goal is to

guide treatments that can enhance these people's reading performance. Up to 5% and 10% of the

population, respectively, are affected by the neurodevelopmental diseases dyslexia and ADHD,

which are among the most prevalent.2 Even more people with dyslexia and ADHD have

comorbid conditions, with 50 to 60 percent of those who have one impairment also fitting the

criteria for the other.8

Hence, it is essential to comprehend the differences in working memory function between

people with ADHD and dyslexia, as well as those with simply dyslexia or only ADHD, to

develop targeted therapies that can enhance reading results. Academic performance is also a

crucial outcome indicator for people with neurodevelopmental problems since it is directly

related to future success and quality of life. The development of therapies that might enhance

academic performance and general quality of life for people with dyslexia and ADHD can be

informed by our understanding of how working memory deficiencies lead to reading problems

and subsequent academic achievement.

Research Questions/Hypothesis

Null Hypothesis: There is no difference in working memory performance between individuals

with dyslexia and ADHD, and those with only dyslexia or only ADHD.
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1. How does working memory function in individuals with dyslexia and ADHD?

2. How does working memory relate to reading difficulties in individuals with dyslexia and

ADHD?

3. Is there a difference in working memory performance between individuals with dyslexia

and ADHD, and those with only dyslexia or only ADHD?

4. How does the relationship between working memory and reading difficulties impact

academic achievement in individuals with dyslexia and ADHD?

Relevance and Significance

In this study, reading difficulties in people with dyslexia and ADHD are compared to

working memory problems. ADHD and dyslexia are common conditions that can harm a

person's academic and social performance. Working memory deficiencies have been seen in

people with dyslexia and ADHD, which can make it difficult for them to read and absorb

language. Targeted therapies that address certain cognitive deficiencies can be informed by an

understanding of the variations in working memory performance between persons with dyslexia

and ADHD and those with only dyslexia or only ADHD. Studying how reading challenges and

working memory interact to affect academic performance will help us better understand how

these people will fare in the long run.

Barriers and Issues

Several obstacles and problems make it difficult to study the connection between working

memory and reading difficulties in people with dyslexia and ADHD. It is challenging to separate

particular effects due to the co-morbidity of dyslexia and ADHD, and researching cognitive
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processes is made more challenging by the variety in symptom presentation, severity, and co-

morbidities.9 A variety of paradigms and activities may be used to test working memory because

it is not a singular entity, which can have an impact on the findings. An analysis is also impacted

by population heterogeneity, which includes differences in age, gender, cognitive function, and

medication status. Finally, when generalizing results to clinical practice, it is important to take

into account the severity and nature of the condition, individual variations, and the type of

intervention used.

Assumptions

The working memory deficiencies that underlie reading problems in people with dyslexia

and ADHD are the foundation of this study. Moreover, it is believed that these working memory

deficiencies contribute to low academic performance. These hypotheses are backed by earlier

research, which regularly demonstrates working memory deficiencies in ADHD and dyslexia

sufferers. Furthermore, since the study's conclusions will only apply to those with dyslexia and

ADHD, it is crucial to assume that the sample of these people is typical of the larger community.

Limitations

This study's potential for confounding factors is one of its limitations. Reading problems

in people with dyslexia and ADHD may be caused by causes other than working memory

abnormalities, such as attentional issues or phonological processing deficits. The use of self-

report measures to evaluate working memory is another drawback since they may not accurately

reflect real working memory performance because of biases. The validity of the study's findings

and the conclusions' generalizability may be compromised by these limitations.

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Delimitations

Just the association between working memory and reading problems in people with

dyslexia and ADHD is the study's exclusive focus. While they are outside the purview of this

study, other cognitive processes like attention and phonological processing may also be

important to reading difficulties in these populations. Another drawback is the emphasis on

academic success as a result, while other goals, such as quality of life, may also be important for

those with ADHD and dyslexia. These restrictions limit the study's generalizability to different

groups and outcomes while also aiding in the clarification of its scope and emphasis.

Definition of Terms

Working Memory: The cognitive process that refers to the ability to hold and manipulate

information in the mind for short periods.

Dyslexia: A neurodevelopmental disorder that affects reading skills, including difficulty with

decoding, word recognition, and spelling.

ADHD: Attention deficit hyperactivity disorder, a neurodevelopmental disorder characterized by

symptoms of inattention, hyperactivity, and impulsivity.

Reading difficulties: Difficulties in reading skills, including decoding, word recognition, and

spelling.

Academic achievement: The level of educational attainment, measured by grades, test scores,

and other indicators of success in educational settings.

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Summary

The primary goal of the study is to better understand how reading difficulties in people

with dyslexia and ADHD are related to working memory issues. Individuals with dyslexia and

ADHD have been reported to have abnormalities in working memory, which may contribute to

their issues with reading. Working memory is a crucial part of reading and language processing.

To better guide therapies to enhance reading results, the research attempts to better understand

the cognitive processes involved in dyslexia and ADHD.

The study addresses four research questions, including how working memory functions in

people with dyslexia and ADHD, the connection between working memory and reading

difficulties in these people, potential differences in working memory performance between

people with dyslexia and ADHD compared to people with only dyslexia or only ADHD, and

how the connection between working memory and reading difficulties affects academic

achievement in people with ADHD and dyslexia.

Chapter 2: Review of Literature

Children with dyslexia have been found to have challenges with inhibition and working

memory. Lonergan et al. performed a meta-analysis of executive functioning in children with

dyslexia to investigate the impact of ADHD comorbidity.9 The authors also conducted

quantitative analyses to investigate the presence of executive function deficits in children with

dyslexia, as well as the impact of comorbid ADHD on these deficits. A meta-analytic approach

was used specifically, which involved analyzing effect sizes across the studies included in the

review.9 They measured effect sizes with Cohen's d and used a random-effects meta-analysis to

estimate the pooled effect sizes for each executive function. Lonergan et al. discovered that
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children with dyslexia had difficulty with inhibition, switching attention, and auditory working

memory, with a medium to large effect compared to controls.9

The studies included in the analysis differed in terms of the specific executive functions

assessed and the measures used to assess these functions. Furthermore, the study did not account

for attention issues, which could have influenced the findings. Lonergan et al., on the other hand,

deserve credit for reviewing a large number of studies (26) and using quantitative analysis to

examine the presence of executive function deficits in children with dyslexia.9 As a result, the

study is reliable in answering the main research question of understanding how working memory

functions in people with dyslexia and ADHD.

However, when contextualizing these comorbidities, it is important to pay attention to

Verma et al.'s conducted a study comparing the cognitive profiles of individuals with SLD with

and without ADHD using a retrospective cross-sectional study. The study revealed distinct

patterns in cognitive functioning among individuals with SLD only, and comorbid SLD with

ADHD. Differences were noted in areas such as attention span, memory retention, executive

functions like decision-making and problem-solving, as well as overall academic achievement

levels. These findings underscore the importance of considering both SLD and ADHD when

assessing an individual's cognitive strengths and weaknesses. Furthermore emphasizes the

importance of understanding the similarities and differences in cognitive profiles, which is

essential for informing clinical practice and educational interventions. ###

Sanchez-Moran et al. examine the genetic association between dyslexia and attention

deficit hyperactivity disorder (ADHD) in a cohort of Spanish children, using a case-control

approach and a quantitative trait analysis.11 The study show that certain genetic markers are
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related to the phenotype, with higher significance values obtained when comorbid samples were

included, suggesting a more severe manifestation of symptoms in individuals who suffer from

both disorders. Sanchez-Moran et al. also highlights the importance of accurate characterization

of phenotypes and considering cognitive endophenotypes in genetic association studies of

dyslexia and ADHD.11

Children with dyslexia experience working memory challenges with implications on

developmental language disorder. To explore this, Gray et al. examined the working memory

profiles of second-grade children with typical development, dyslexia, developmental language

disorder (DLD), or dyslexia/DLD.7 The study used a comprehensive battery of 13 tasks to assess

central executive, phonological, and visuospatial/attention components of working memory, and

employed latent class analysis to identify four distinct working memory profiles. Gray et al.

found that children from each disability group and children from the typically developing group

were present in each class.7 Gray et al. did not investigate the relationship between working

memory profiles and academic performance, and the sample size only consisted of second-

graders, so the generalizability of the findings to other age groups is unclear.7 Gray et al. did not

disclose any information about the funding source.

The study's strengths include the use of a comprehensive battery of tasks to assess

working memory in children with different disabilities and the use of latent class analysis to

identify distinct working memory profiles. However, the study's weaknesses include the lack of

investigation into the relationship between working memory profiles and academic performance,

and the small sample size consisting only of second-graders.7

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Regarding the research questions, Gray et al. provides some insight into the functioning

of working memory in children with dyslexia and developmental language disorder, which may

be relevant to questions two and four.7 However, the study does not specifically address the

presence of ADHD in the participants, nor does it compare the working memory performance

between individuals with dyslexia and ADHD and those with only dyslexia or only ADHD.

Therefore, the findings by Gray et al. may only partially answer the research questions, and

additional research may be necessary.7

Caldani et al. examined the reading performance in children with ADHD with an aim to

investigate the oculomotor patterns of children with dyslexia, ADHD, comorbid dyslexia, and

typically developing children (TD) during a reading task.5 The study recruited 96 children, with

24 children in each group, and used an eye-tracker to record eye movements during the reading

task. The duration of fixation, the total reading time, and the number of forward and backward

saccades were analyzed and compared between the groups. Caldani et al. found that children

with dyslexia and those with comorbid ADHD and dyslexia showed similar oculomotor pattern

abnormalities during a reading task, which was significantly different from those observed in

children with ADHD and with TD.5 The study suggested that using an objective eye movement

recording during a reading task could help clinicians evaluate the possible presence of comorbid

dyslexia in children with ADHD.

Caldani et al. used descriptive statistics, including means and standard deviations, to

describe the eye movement measures. Group comparisons were conducted using analyses of

variance (ANOVA). The study provides insights into the oculomotor pattern abnormalities

during a reading task in children with ADHD and comorbid dyslexia. The use of an eye-tracker
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to objectively measure eye movements is a strength of the study.5 However, the study has a

relatively small sample size, which may limit the generalizability of the findings. Additionally,

Caldani et al. did not assess working memory in children with ADHD and dyslexia, and further

studies are needed to confirm this potential association.5 While Caldani et al. provides useful

insights into the oculomotor patterns of children with ADHD and dyslexia during a reading task,

it has some limitations due to the small sample size and the lack of assessment of working

memory. The findings of Caldani et al. may be useful in informing future research on the

association between ADHD, dyslexia, and reading difficulties.5

Anjos et al. conducted a descriptive, cross-sectional, and quantitative study to investigate

phonological processing in students with developmental dyslexia, ADHD, and intellectual

disability.12 The study included 32 students divided into three groups: Group 1 (G1) had 14

students with developmental dyslexia, Group 2 (G2) had 7 students with ADHD, and Group 3

(G3) had 11 students with intellectual disability. The study evaluated phonological awareness,

phonological working memory, and phonological access to the mental lexicon using reliable

instruments. The sample size was relatively small, and the participants were selected based on

their initial complaint of learning difficulties.12 There was no control group in the study.

Statistically significant differences were observed among the three groups on the

phonological working memory skills for pseudowords, forward digit repetition, and backward

digit repetition; phonological awareness on syllable level, phoneme level, test total score, and

digits subtest of the rapid automatized naming test according to Anjos et al.12 Through the

descriptive analysis, it was observed that G1 had the best results on all the skills assessed,
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followed by G2 and G3. The non-parametric Kruskal-Wallis test was used to analyze the data.

The study was funded by the National Council for Scientific and Technological Development.

The study's strengths include the use of reliable instruments, clear diagnostic criteria, and

the inclusion of students from both public and private schools. However, the small sample size

and lack of a control group limit the generalizability of the findings.12 The study's duration is not

explicitly stated. The study's results suggest that there are significant differences in phonological

processing skills among individuals with developmental dyslexia, ADHD, and intellectual

disability. Anjos et al. also suggest that individuals with dyslexia may have better phonological

processing skills than those with ADHD or intellectual disability.12 Therefore, the study provides

insight into the relationship between working memory and reading difficulties in individuals with

dyslexia and ADHD.12

The study conducted by Kofler et al. aimed to investigate whether working memory

deficits contribute to reading difficulties in children with attention-deficit/hyperactivity disorder

(ADHD).13 The participants included 8-13-year-old children with and without ADHD who were

given a series of reading tasks that varied in the level of concurrent working memory demands.

The study used dual-task methodology and Bayesian modeling to analyze the data and assess the

role of working memory in ADHD-related reading problems. Kofler et al. showed that increasing

working memory demands disproportionately affected reading comprehension in children with

ADHD compared to those without ADHD.13 However, both groups showed a significant

decrease in comprehension when working memory demands were increased. The effect size was

measured using d values.

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The study had several strengths, including the use of a counterbalanced series of reading

tasks and the combination of dual-task methodology and Bayesian modeling. However, Kofler et

al. only included children aged 8-13, which limits the generalizability of the findings to other age

groups.13Additionally, the study only used d values to measure effect sizes, which may not be as

informative as other statistical measures.

The study was funded by the National Institute of Mental Health. There were no

significant confounding variables or biases identified in the study. The study duration is not

mentioned in the provided information. Overall, Kofler et al. suggest that working memory

deficits contribute to reading difficulties in children with ADHD.13 However, further research is

needed to examine the relationship between working memory and reading difficulties in

individuals with both dyslexia and ADHD, and how this relationship affects academic

achievement. While the study has some limitations, it can be considered reliable based on its

rigorous methodology and statistical analysis.13

The study by Fostick et al. aimed to investigate the contribution of working memory

(WM) and auditory temporal processing (ATP) to reading performance and phonological

awareness in individuals with dyslexia.14 The study included 101 university students aged

between 20 to 33 years old, of whom 78 were diagnosed with dyslexia using a normative

diagnostic battery for reading processes in Hebrew. Fostick et al. used a multidimensional

approach to test the contribution of WM and ATP to different types of reading performance and

phonological awareness in dyslexia.14 The study found that both WM and ATP were significant

predictors of reading performance and phonological awareness among participants with dyslexia.
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Fostick et al. also revealed group differences in reading and phonological awareness tests based

on WM and ATP performance levels.14

Fostick et al. utilized descriptive statistics to summarize participant demographics and

performance on the tests. The study used a normative diagnostic battery for reading processes to

diagnose dyslexia, which is a strength of the study.14 Additionally, the study had a large sample

size and screened participants for normal hearing, reducing the possibility of confounding

factors. However, the study only included participants from a single ethnicity, which limits the

generalizability of the findings. The study did not examine other possible factors that could

affect reading performance and phonological awareness, such as socioeconomic status or

language exposure.14

In answering the research questions, Fostick et al. provides valuable information about

the contribution of working memory and auditory temporal processing to reading performance

and phonological awareness in individuals with dyslexia.14 However, Fostick et al. did not

include participants with ADHD, so it cannot fully address the first two research questions. It is

also limited to individuals of a single ethnicity and did not examine other possible factors that

could affect reading performance and phonological awareness.14 Therefore, while the study

provides useful information, its findings should be interpreted with caution and considered

alongside other relevant research.

Peng et al. conducted a meta-analytic review on cognition and reading difficulties in over

34,000 participants from 378 studies with reading difficulties and typically developing peers.

The study aimed to explore the associations between cognition and reading difficulties.15 Peng et

al. suggested that individuals with reading difficulties exhibited deficits across multiple cognitive
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skills, including processing speed, short-term memory, attention, working memory, inhibition,

switching, visuospatial skills, and updating.15 The severity of these deficits was greater with age,

lower reading and intelligence scores, and with verbal cognitive tasks. The study used effect size

measures (g) and the natural logarithm of the ratio of standard deviations (SDR) to analyze the

data.

The strength of Peng et al. is its large sample size from a wide range of studies, which

strengthens the generalizability of the findings. The use of meta-analytic methods also allowed

for the synthesis of findings from multiple studies, increasing the statistical power of the

analysis.15 However, Peng et al. did not examine the impact of other factors that could affect

cognitive and reading abilities, such as socio-economic status or bilingualism. Additionally, the

study relied on published studies, which could introduce publication bias.15

Regarding the research questions, Peng et al. provides useful information for question 2

as it explored the relationship between cognition, including working memory, and reading

difficulties.15 It also provides information for question 1 as working memory is one of the

cognitive skills that individuals with reading difficulties exhibited deficits. However, Peng et al.

did not specifically study individuals with dyslexia and ADHD, so it may not provide specific

information to answer questions 3 and 4.15

The study conducted by Barbosa et al. aimed to investigate executive function abilities in

children with dyslexia. The study involved 47 participants, including 24 children with dyslexia

and 23 typically developing children who were matched by age, sex, and school attendance.17

The children were assessed using a neuropsychological battery comprising tests and tasks

involving oral language, reading, and writing. Barbosa et al. showed that children with dyslexia
 21

performed significantly worse than typically developing children on various measures of

executive function, including working memory, attention, inhibition, and shifting. T-tests were

used to compare the performance of the two groups on executive function measures.16 The study

had a well-matched control group and used a broad neuropsychological battery to assess

executive function, which allowed for a comprehensive analysis of differences between the

dyslexia and control groups.

However, Barbosa et al. did not examine other potential confounding variables, such as

socioeconomic status or intelligence, which could have affected the results. Additionally, the

study used a relatively small sample size, which could limit the generalizability of the findings. 16

Overall, Barbosa et al. provide evidence that children with dyslexia have deficits in executive

function skills, particularly working memory, attention, inhibition, and shifting. The study had

some strengths, such as a well-matched control group and a comprehensive neuropsychological

battery.16 However, Barbosa et al. also had some limitations, such as a small sample size and

failure to assess other potential confounding variables. The findings could provide useful insights

into the cognitive profile of children with dyslexia and the impact of executive function deficits

on their academic achievement. However, further research is necessary to replicate and extend

the study's findings.16

In answering the research questions, Barbosa et al. provides some insights into the first

two questions, specifically the functioning of working memory in children with dyslexia.

However, the study did not include individuals with ADHD or compare the performance of

children with both dyslexia and ADHD to those with only dyslexia or ADHD, so it cannot fully

answer the third question.16 Additionally, they did not investigate the relationship between
 22

working memory and academic achievement, so it may not provide enough information to

answer the fourth question.16

The study conducted by Masoura et al. aimed to investigate working memory profiles in

a small group of 13 nine-year-old Greek children with reading difficulties and a group of 14 age-

matched typical Greek readers.17 They used working memory tasks to measure the four

components of the working memory model of Baddeley and Hitch as revised by Baddeley.17 The

study found that children with reading difficulties performed significantly more poorly than

typical readers on all aspects of working memory, apart from visual-spatial short-term memory.

Masoura et al. suggests that there is a similar verbal working memory impairment in Greek

children with reading difficulties as in their English peers, despite the fact that they are learning

to read a language with a transparent rather than an opaque orthography.17 They did not mention

specific statistical methods used.

The study's strengths include the use of a clear research question, a well-defined

methodology for assessing working memory, and a comparison group of typical readers to help

identify differences in working memory skills among children with reading difficulties.17

However, the study had some limitations, including a small sample size and the absence of

controls for other factors that may impact working memory, such as attention, anxiety, or socio-

economic status.

Further, Masoura et al. provides some useful information on the working memory

profiles of children with reading difficulties in Greek. However, it does not directly address

dyslexia or ADHD.9 Thus, the findings of Masoura et al. may be limited in answering the

research questions. Nonetheless, the study's results can be considered reliable, as the
 23

methodology and measures used are clearly described, and the study has a well-matched control

group.17 However, the small sample size and the lack of controls for potential confounding

variables may limit the generalizability of the findings. Overall, Masoura et al. provides some

insights into working memory skills in children with reading difficulties in a specific linguistic

context, but further research is needed to address the specific research questions related to

dyslexia and ADHD.17

Maehler et al. conducted a study involving 139 third-graders, with and without dyslexia,

from both rural and urban areas to assess the impact of training working memory on children's

operational efficiency.18 The study used a pre-test/post-test/follow-up design and assessed

participants at three test intervals, evaluating school performance, intelligence, and working

memory capacity. Maehler et al. showed no long-term increase in performance regarding

phonological and central executive working memory for both groups. Only the visuo-spatial

Corsi block span exhibited a training effect over a period of three months.18 Maehler et al. did not

report any statistics, and while the methodology was robust, the lack of statistical data made it

difficult to evaluate the significance of the findings. The study's strengths included the inclusion

of both children with and without dyslexia and control groups, which made the results more

generalizable.18 The study's limitations included the lack of statistical data and evidence of long-

term increases in performance regarding phonological and central executive working memory,

which limits the practical implications of the findings.18

The study's sample consisted of 139 third-graders, with and without dyslexia, from both

rural and urban areas. The study's potential confounding variables include differences in socio-

economic status, learning environment, and instructional quality.18 The participants were
 24

assessed at three test intervals, but the duration of the study was not explicitly stated. The study

did not report who funded the research. Maehler et al. did not use any specific statistical method

to analyze the data.18 While the study's methodology was robust, the lack of statistical data and

evidence of long-term increases in performance regarding phonological and central executive

working memory limit the study's reliability. The study's strengths included the inclusion of both

children with and without dyslexia and control groups, and the study's limitations included the

lack of statistical data and evidence of long-term increases in performance regarding

phonological and central executive working memory.18 As such, they can only be relied on to a

limited extent in answering research questions related to working memory and dyslexia. 18

The multiple deficit hypothesis of dyslexia, which contends that deficiencies in a number

of cognitive processes, including phonological processing, define the condition, is supported by

research by Ring and Black. The majority of research participants reported phonological

processing abnormalities, while some of them had risk factor profiles without pronounced

phonological awareness issues.19 Ring and Black suggest that in order to provide suitable

academic treatments for a wider variety of pupils, a broader characterization of the circumstances

associated with reading impairment may be required. The authors also assert that rather than

focusing on particular cognitive deficits, intervention design may be more successful with

complete, skill-based reading programs that take into account individual variability in reading

processes.19

Similar research was done by Alloway and Carpenter, who examined the connection

between dyslexia, poor working memory, and behavioral issues in kids. The study discovered

that working memory deficiencies in children with dyslexia are frequently present, including
 25

both verbal and nonverbal working memory deficits, which can have a detrimental effect on their

academic performance in subjects like reading, spelling, and mathematics. 20 These working

memory deficiencies are also linked to problematic behaviors including inattentiveness, trouble

planning and finishing activities, and increased scholastic challenges in comparison to their

peers.20 Children with dyslexia and poor working memory profiles may also struggle with low

self-esteem, which can make it harder for them to succeed in school and interact with others.

Alloway and Carpenter offer suggestions for classroom teachers, such as Response to

Intervention (RTI), to address the working memory deficiencies in dyslexic children and enhance

their academic performance and conduct.20

In a second study, Nouwens et al. discovered that, in comparison to phonological storage,

semantic storage—as measured by working memory tasks—plays a more substantial role in

predicting reading comprehension in children. Also, in comparison to other memory tests,

semantic working memory best predicted individual variance in reading comprehension.21

Moreover, Nouwens et al. demonstrated the role of semantic working memory in supporting

reading comprehension, indicating that both the storing and processing aspects of working

memory play a significant role in describing individual differences in children's reading

comprehension.21 The results were not significantly impacted by the inclusion of kids with

developmental problems like dyslexia and ADHD since these kids performed on memory tests

on par with kids who were growing normally. Contrary to typically developing kids, children

with dyslexia and ADHD performed worse on reading comprehension and decoding activities.21

Research on reading difficulties, such as dyslexia, ADHD, and working memory, is

included in an associated study by Snowling and Hulme.22 The study shows that
 26

neurodevelopmental problems such mathematics disorder, ADHD, developmental language

disorder, speech sound disorder, and developmental coordination disorder are all highly heritable

and associated with reading impairments.22 According to the study, reading difficulty and

ADHD, as well as perhaps other diseases, share risk factors including sluggish processing speed.

The study also highlights the significance of language abilities as essential literacy building

blocks and the home literacy environment as a crucial intervention target.22 The study also

emphasizes how category diagnoses of reading impairments frequently exhibit instability and

how a multiple deficit view of dyslexia—which contends that risks build up to a diagnostic

threshold—might be a better approach. The paper discusses the implications for evaluation and

intervention.22

Phonological awareness, working memory, and word reading effectiveness are all

connected. For instance, Knoopvan et al. discovered that among children with dyslexia,

phonological awareness, working memory, and word reading efficiency are connected.23 It was

shown that phonological awareness is related to word reading speed in both dyslexic and

normally developing kids. Working memory's effect on phonological awareness predicted

reading effectiveness in dyslexic kids.23 These results imply that phonological awareness is still

crucial for reading in older dyslexic children and that working memory is required for word

reading proficiency in dyslexic children.23 The study also looked at how task complexity affected

phonological awareness and word reading efficiency, confirming earlier findings that the

complexity of the stimuli and their linguistic character play a significant role in the association

between phonological awareness and word reading efficiency.23

 27

For testing visual-phonological working memory binding in children with and without

reading disabilities, Toffalini et al. suggest two span tasks. Memorizing cross-modal connections

between nonsensical symbols and nonwords is required for the tasks.24 Even after adjusting for

additional verbal and nonverbal working memory measures, the results reveal that reading-

disabled children significantly perform worse on both cross-modal binding tasks than control

children. The authors propose that a basic defect associated with reading impairment may be

inadequate binding of visual and phonological information within the working memory system,

and that their binding tests may be a helpful approach for evaluating reading disorders.24

Incorporating verbal working memory with semantic notions or meaning may occur in

the inferior parietotemporal lobe, which comprises the supramarginal gyrus and the angular

gyrus, according to research by Kim. 25 Grapheme-phoneme conversion is also connected to the

left supramarginal gyrus. Dyslexia is mostly brought on by a challenge with phonological

processing and is associated with poor word recognition, restricted decoding ability, and

impaired automatic word recognition.25 Moreover, dyslexia are linked to subpar working memory

abilities. For dyslexia to be successfully managed, prompt intervention and precise diagnosis are

essential.25

According to research by Wiseheart and Altmann, spoken sentence production in college

students with dyslexia was examined to see if cognitive differences across groups may explain

performance discrepancies between the groups.26 In comparison to their non-dyslexic classmates,

kids with dyslexia wrote sentences that were much slower and less exact in terms of fluency,

grammar, and completeness.26 Working memory, which varied between groups, and vocabulary,

which did not, were the main predictors of accuracy and efficiency. The results show that
 28

dyslexia have working memory impairments throughout life, even in people who have made up

for their early reading difficulties.26

Lastly, Hamouda and El-Shafaei contend that children with dyslexia have problems with

verbal working memory and serial order memory.27 Due to impaired phonological

representations and inadequate phonological rehearsal, these deficiencies may cause reading

problems.27 The study also emphasizes how crucial it is to test working memory and short-term

memory as a part of the diagnostic process for dyslexic kids. Overall, working and short-term

memory activities demonstrate that dyslexic kids do noticeably worse than typical readers. 27

Chapter 3: Methodology

Literature Search

To determine the Relationship Between Working Memory and Reading Difficulties in

Individuals with Dyslexia and ADHD, the researcher conducted a review of literature to collect

data. Consequently, the researcher conducted a literature search in four electronic databases:

PubMed, PsycINFO, Web of Science, and Scopus. The search was conducted in August 2022

and included papers published between January 2018 and March 2023. We used the following

search terms: "working memory", "dyslexia", "ADHD", "language processing", "phonological

awareness", "visual-spatial processing", "cognitive impairment", "executive functions", and

"academic achievement". We combined the search terms using Boolean operators (AND/OR).

Study Selection

To be included in the review, studies had to meet the following inclusion criteria:

• The study had to be published in a peer-reviewed journal.

• The study had to be conducted on individuals with dyslexia and/or ADHD.

 29

• The study had to assess working memory using a standardized measure.

• The study had to assess reading difficulties using a standardized measure.

• The study had to report statistical data on the relationship between working memory and

reading difficulties.

• The study had to be primary research.

• The study had to be published between 2017 and 2023.

Article selection

After the initial search, 187 articles were identified from the electronic databases. Of

these, 98 articles were excluded after a review of their titles and abstracts. Full-text articles were

obtained for the remaining 89 articles. After applying the inclusion and exclusion criteria, a total

of 22 studies were included in the review.

Exclusion criteria

Studies were excluded if they did not meet the inclusion criteria, were not empirical

studies, were duplicates, or were published outside the specified time frame.

Reasons for exclusion

 Not empirical studies - 43 articles

 Did not meet inclusion criteria - 45 articles

 Duplicates - 7 articles

 Published outside the specified time frame - 2 articles

 Full-text not available - 1 article

Data Analysis

The data from the 20 studies were analyzed using a qualitative approach. The studies were

reviewed and synthesized to identify patterns and themes related to the research questions. The
 30

studies were analyzed for similarities and differences in study design, participants, and findings.

The data from each study were synthesized and summarized to provide a comprehensive

overview of the research findings. See Appendix 1 for the methodology flow sheet.

No changes to search method

Chapter 4: Findings

The review of literature aimed to explore the relationship between working memory and

reading difficulties in individuals with dyslexia and ADHD. The studies reviewed in the analysis

revealed that children with dyslexia exhibited difficulty with inhibition, switching attention, and

auditory working memory, with a medium to large effect relative to controls. Those with

comorbid ADHD and dyslexia exhibit similar degrees of impairment compared to children with

dyslexia alone. The studies also found that certain genetic markers are related to the phenotype,

with higher significance values obtained when comorbid samples were included, suggesting a

more severe manifestation of symptoms in individuals who suffer from both disorders.

For instance, Gray et al. found that children from each disability group and children from

the typically developing group were present in each class, indicating that different working

memory profiles may be present in individuals with different disabilities.7 Gupta and Sharma

emphasized the importance of recognizing working memory issues early and offering suitable

treatments to enhance learning performance in kids with learning impairments. These authors

therefore suggest that working memory plays a crucial role in reading difficulties in individuals

with dyslexia and ADHD. Recognizing and addressing working memory issues early on may

lead to better learning outcomes for individuals with learning impairments.

The findings by Caldani et al., Anjos et al., and Kofler et al. suggest that children with dyslexia

and those with comorbid ADHD and dyslexia showed similar oculomotor pattern abnormalities
 31

during a reading task, which was significantly different from those observed in children with

only ADHD and typically developing children.5,13

The study by Anjos et al. found that individuals with dyslexia may have better

phonological processing skills than those with ADHD or intellectual disability, based on

significant differences in phonological working memory skills and phonological awareness.12

Kofler et al. showed that increasing working memory demands disproportionately affected

reading comprehension in children with ADHD compared to those without ADHD.13 However,

both groups showed a significant decrease in comprehension when working memory demands

were increased. The studies reviewed provide valuable insights into the relationship between

working memory and reading difficulties in individuals with dyslexia and ADHD.

Further, Fostick et al. found that both working memory and auditory temporal processing

were significant predictors of reading performance and phonological awareness in dyslexia.14 On

the other hand, Peng et al. suggested that individuals with reading difficulties exhibited deficits

across multiple cognitive skills, including processing speed, short-term memory, attention,

working memory, inhibition, switching, visuospatial skills, and updating.15 Barbosa et al. showed

that children with dyslexia performed significantly worse than typically developing children on

various measures of executive function, including working memory, attention, inhibition, and

shifting.16 The authors provide useful information on the contribution of working memory to

reading difficulties in individuals with dyslexia, but none of them specifically studied individuals

with ADHD and dyslexia together.

Furthermore, Masoura et al. found that they performed significantly worse than typical

readers on all aspects of working memory except for visual-spatial short-term memory. 17 The

study by Maehler et al. found no long-term increase in performance regarding phonological and
 32

central executive working memory for both groups but showed a training effect over a period of

three months on visuo-spatial Corsi block span.18 Moreover, the multiple deficit hypothesis of

dyslexia, which suggests that deficiencies in a number of cognitive processes, including

phonological processing, define the condition. The hypothesis is supported by research by Ring

and Black, Alloway and Carpenter who revealed that working memory deficiencies in children

with dyslexia are frequently present, including both verbal and nonverbal working memory

deficits.19,20 These deficiencies can have a detrimental effect on their academic performance in

subjects like reading, spelling, and mathematics.

Moreover, Nouwens et al. found that semantic storage, as measured by working memory

tasks, played a more substantial role in predicting reading comprehension in children than

phonological storage.21 They also demonstrated the role of semantic working memory in

supporting reading comprehension, indicating that both the storing and processing aspects of

working memory play a significant role in describing individual differences in children's reading

comprehension. The study also found that children with dyslexia and ADHD performed worse

on reading comprehension and decoding activities than typically developing children, but their

performance on memory tests was comparable.

Snowling and Hulme's study showed that neurodevelopmental problems such as

mathematics disorder, ADHD, developmental language disorder, speech sound disorder, and

developmental coordination disorder are all highly heritable and associated with reading

impairments.22 They also highlighted how category diagnoses of reading impairments frequently

exhibit instability and how a multiple deficit view of dyslexia might be a better approach. IN the

same breadth, Knoopvan et al. found that phonological awareness, working memory, and word

reading effectiveness are all connected.23 The study showed that phonological awareness is
 33

related to word reading speed in both dyslexic and typically developing children. Working

memory's effect on phonological awareness predicted reading effectiveness in dyslexic children.

Toffalini et al. found that reading-disabled children performed worse on both cross-modal

binding tasks than control children.24 The authors proposed that a basic defect associated with

reading impairment may be inadequate binding of visual and phonological information within

the working memory system, and that their binding tests may be a helpful approach for

evaluating reading disorders. On the other hand, Kim's research found that Dyslexia is mostly

brought on by a challenge with phonological processing and is associated with poor word

recognition, restricted decoding ability, and impaired automatic word recognition. 25

Dyslexia is also linked to subpar working memory abilities. Wiseheart and Altmann

found that college students with dyslexia wrote sentences that were much slower and less exact

in terms of fluency, grammar, and completeness than their non-dyslexic classmates.26 Working

memory and vocabulary were the main predictors of accuracy and efficiency. Finally, Hamouda

and El-Shafaei found that children with dyslexia have problems with verbal working memory

and serial order memory.27 These deficiencies may cause reading problems due to impaired

phonological representations and inadequate phonological rehearsal. The study emphasized the

importance of testing working memory and short-term memory as a part of the diagnostic

process for dyslexic children. Working and short-term memory activities demonstrate that

dyslexic children perform noticeably worse than typical readers.

Summary of the Results: See Appendix 2 for the result chart.

Research Question 1: How does working memory function in individuals with dyslexia and

ADHD?
 34

The reviewed literature indicates that individuals with dyslexia have difficulty with

inhibition, switching attention, and auditory working memory, with a medium to large effect

compared to controls. Children with comorbid ADHD and dyslexia show similar oculomotor

pattern abnormalities during a reading task, which are different from those observed in children

with only ADHD and typically developing children. Dyslexic individuals have difficulties with

working memory, except for visual-spatial short-term memory. The multiple deficit hypothesis

of dyslexia, which suggests that deficiencies in a number of cognitive processes define the

condition, is supported by research, which reveals that working memory deficiencies in children

with dyslexia are frequently present, including both verbal and nonverbal working memory

deficits. Furthermore, reading-disabled children performed worse on both cross-modal binding

tasks than control children, indicating that a basic defect associated with reading impairment may

be inadequate binding of visual and phonological information within the working memory.

Research Question 2: How does working memory relate to reading difficulties in

individuals with dyslexia and ADHD?

The studies reviewed suggest that working memory plays a crucial role in reading

difficulties in individuals with dyslexia and ADHD. Children with dyslexia and comorbid

ADHD and dyslexia performed worse on reading comprehension and decoding activities than

typically developing children. Working memory and auditory temporal processing were

significant predictors of reading performance and phonological awareness in dyslexia.

Individuals with reading difficulties exhibit deficits across multiple cognitive skills, including

processing speed, short-term memory, attention, working memory, inhibition, switching,

visuospatial skills, and updating. Furthermore, phonological awareness, working memory, and

word reading effectiveness are all connected. The study showed that phonological awareness is
 35

related to word reading speed in both dyslexic and typically developing children. Working

memory's effect on phonological awareness predicted reading effectiveness in dyslexic children.

Research Question 3: Is there a difference in working memory performance between

individuals with dyslexia and ADHD, and those with only dyslexia or only ADHD?

Gray et al. found that different working memory profiles may be present in individuals

with different disabilities. Children with dyslexia and those with comorbid ADHD and dyslexia

showed similar oculomotor pattern abnormalities during a reading task, which was significantly

different from those observed in children with only ADHD and typically developing children.

Furthermore, individuals with dyslexia may have better phonological processing skills than those

with ADHD or intellectual disability, based on significant differences in phonological working

memory skills and phonological awareness. Kofler et al. showed that increasing working

memory demands disproportionately affected reading comprehension in children with ADHD

compared to those without ADHD. However, both groups showed a significant decrease in

comprehension when working memory demands were increased. Additionally, Verma et al.'s

study found that children with Specific Learning Disorder, such as dyslexia, who have ADHD do

worse on working memory-based tasks. However, the children in this study were receiving

treatment for ADHD at the time of their evaluation. They nevertheless received a low score. ###

Research Question 4: How does the relationship between working memory and reading

difficulties impact academic achievement in individuals with dyslexia and ADHD?

The findings suggest that recognizing and addressing working memory issues early on

may lead to better learning outcomes for individuals with learning impairments. Children with

dyslexia performed significantly worse than typically developing children on various measures

of executive function, including working memory, attention, inhibition, and shifting. Dyslexic
 36

and ADHD individuals performed worse on reading comprehension and decoding activities than

typically developing children, but their performance on memory tests was comparable. Semantic

storage, as measured by working memory tasks, played a more substantial role in predicting

reading comprehension in children than phonological storage. The role of semantic working

memory in supporting reading comprehension indicates that both the storing and processing

aspects of working memory play a significant role in describing individual differences in

children's reading comprehension. Finally, children with comorbid ADHD and dyslexia

exhibited a more severe manifestation of symptoms than those with only dyslexia, with greater

deficits in working memory, attention, and inhibition. These findings suggest that working

memory is a crucial factor in the academic achievement of individuals with dyslexia and ADHD,

and addressing working memory difficulties may lead to better outcomes for these individuals.

However, further research is needed to understand the complex relationship between working

memory, reading difficulties, and academic achievement in individuals with these conditions.

The findings suggest that working memory plays a crucial role in reading difficulties in

individuals with dyslexia and ADHD. The studies reviewed provide valuable insights into the

relationship between working memory and reading difficulties in individuals with dyslexia and

ADHD. The data supported the hypothesis that deficiencies in a number of cognitive processes,

including phonological processing, define the condition of dyslexia. The multiple deficit

hypothesis of dyslexia is supported by research that revealed that working memory deficiencies

in children with dyslexia are frequently present, including both verbal and nonverbal working

memory deficits. However, the studies reviewed did not specifically study individuals with

ADHD and dyslexia together. In general, the study suggests that recognizing and addressing
 37

working memory issues early on may lead to better learning outcomes for individuals with

learning impairments.

Chapter 5: Conclusions

The findings of this study support the research questions by providing evidence that

individuals with dyslexia and ADHD have poorer working memory function than those without

these conditions. Moreover, working memory deficits are a significant predictor of reading

difficulties in individuals with dyslexia and ADHD. The literature review indicates that

individuals with dyslexia have deficits in executive function skills, especially working memory,

attention, inhibition, and shifting. The studies also found that certain genetic markers are related

to the phenotype, with higher significance values obtained when comorbid samples were

included, suggesting a more severe manifestation of symptoms in individuals who suffer from

both disorders. However, the reviewed studies did not investigate working memory function

specifically in individuals with both dyslexia and ADHD or how working memory relates to

reading difficulties in these individuals. Therefore, this study contributes to the existing literature

by examining the relationship between working memory and reading difficulties in individuals

with both dyslexia and ADHD.

The findings by Caldani et al., Anjos et al., and Kofler et al. suggest that children with

dyslexia and those with comorbid ADHD and dyslexia showed similar oculomotor pattern

abnormalities during a reading task, which was significantly different from those observed in

children with only ADHD and typically developing children.5,13 Additionally, Nouwens et al.

found that semantic storage, as measured by working memory tasks, played a more substantial
 38

role in predicting reading comprehension in children than phonological storage.21 They also

demonstrated the role of semantic working memory in supporting reading comprehension,

indicating that both the storing and processing aspects of working memory play a significant role

in describing individual differences in children's reading comprehension.

The outcomes of a related study by Alt et al. compared the working memory abilities of

second-grade children with dyslexia to those of children with usual development and this study

supports those findings. As compared to their counterparts with usual development, children with

dyslexia performed worse on the Phonological and Central Executive working memory

components. Yet, differences in non-verbal intellect and linguistic abilities between groups may

account for variations in the Focus-of-Attention/Visuospatial component. These findings

highlight the significance of treating central executive function in addition to phonological

features in dyslexic youngsters.28

Furthermore, Poon et al.'s study that ADHD was linked to deficiencies in behavioral

working memory provides more evidence in favor of these conclusions. Comorbid conditions

showed additive impairments between the two diseases, although behavioral working memory

deficits were more severe. These findings imply that working memory profiles for ADHD and

reading difficulties are different and that the comorbid condition has a special profile that

integrates deficiencies from both diseases. These findings may help future intervention programs

be developed.24

The multiple deficit hypothesis of dyslexia, which suggests that deficiencies in a number

of cognitive processes, including phonological processing, define the condition, is supported by

research by Ring and Black, Alloway and Carpenter, who revealed that working memory

deficiencies in children with dyslexia are frequently present, including both verbal and nonverbal
 39

working memory deficits.19,20 These deficiencies can have a detrimental effect on their academic

performance in subjects like reading, spelling, and mathematics. Furthermore, Snowling and

Hulme's study showed that neurodevelopmental problems such as mathematics disorder, ADHD,

developmental language disorder, speech sound disorder, and developmental coordination

disorder are all highly heritable and associated with reading impairments.22 They also highlighted

how category diagnoses of reading impairments frequently exhibit instability and how a multiple

deficit view of dyslexia might be a better approach.

The findings of this study have important implications for the diagnosis and treatment of

dyslexia and ADHD. The results suggest that interventions aimed at improving working memory

function may benefit individuals with dyslexia and ADHD. For instance, Almarzouki et al.

discovered that kids with ADHD can use Cogmed Working Memory Training (CWMT).

Children who were both compliant and noncompliant made progress when completing the

CWMT activities29. Children who were more compliant at first reported developing their math

and working memory more quickly. The Cogmed training was practical for parents to use with

their kids, they were happy and eager to continue the program, and they thought the training

helped them deal with their issues.29 Cognitive Working Memory Training is also suggested in

Verma et al.'s study for children with Specific Learning Disabilities and Attention Deficit

Hyperactivity Disorder (ADHD) in addition to peer-teaching, task modification and regular

medication use. ## BLANK discovered that Tachidino treatment was found to effectively

improve reading speed and accuracy, as well as writing accuracy, in dyslexic children with or

without comorbid ADHD. The attentional component of the Tachidino treatment, which focuses

on decoding and visual-spatial attention, also appears to be effective in stimulating attentional

functions that are specifically impaired in ADHD children. As a result, a rigorous and intensive
 40

decoding treatment, such as the Tachidino program, can be considered an appropriate

intervention method for children with ADHD and those at risk of reading difficulties with

ADHD.30

Additionally, the studies reviewed provide valuable insights into the relationship between

working memory and reading difficulties in individuals with dyslexia and ADHD. Recognizing

and addressing working memory issues early on may lead to better learning outcomes for

individuals with learning impairments. In conclusion, individuals with dyslexia and ADHD

present significant difficulties with working memory, inhibition, and attention switching. The

studies reviewed suggest that identifying and addressing working memory issues early on is

crucial for individuals with learning impairments. The relationship between working memory

and reading difficulties is complex and multifactorial, and deficiencies in a number of cognitive

processes may define dyslexia. Further research is needed to explore this relationship in greater

detail and to determine the best methods of intervention for individuals with these conditions.

Strengths

The strength of the study lies in its comprehensive review of literature to explore the

relationship between working memory and reading difficulties in individuals with dyslexia and

ADHD. The use of a systematic and structured approach to the review of literature enhances the

reliability and validity of the study's findings.

The findings provide valuable insights into the specific working memory deficits that

individuals with dyslexia and ADHD experience, highlighting the need for early recognition and

intervention to enhance learning outcomes. The study also identifies the genetic markers related

to these disorders and how their comorbidity results in a more severe manifestation of symptoms.
 41

Weaknesses

The first weakness of the study is that it relies solely on a review of literature. While this

method provides a broad overview of the topic, it is subject to publication bias, as only published

studies are included. Moreover, the review may not have included all relevant studies, as the

search criteria could have been limited, potentially affecting the scope of the research.

Another weakness of the study is the exclusive focus on individuals with dyslexia and

ADHD. This approach may overlook other comorbid conditions, such as anxiety or depression,

which may also affect working memory and reading difficulties. As a result, the conclusions

drawn may not be generalizable to all individuals with reading difficulties.

Limitations

Firstly, the study only reviewed existing literature and did not conduct empirical research.

This limitation makes it challenging to identify and control confounding variables, thus making it

difficult to establish causal relationships. Secondly, the study only focuses on the relationship

between working memory and reading difficulties in individuals with dyslexia and ADHD. It

does not consider other factors that may influence reading difficulties, such as social and

environmental factors, which could also have a significant impact on the reading performance of

individuals with dyslexia and ADHD.

Lastly, the study only considers findings from a limited number of studies, which may

not fully represent the entire population with dyslexia and ADHD. Additionally, some of the

reviewed studies were conducted on children, and their findings may not be generalizable to

adults with dyslexia and ADHD.

Implications
 42

The study's findings contribute to the understanding of the relationship between working

memory and reading difficulties in individuals with dyslexia and ADHD. It has been found that

children with dyslexia and comorbid ADHD experience similar degrees of impairment in

inhibition and working memory as children with dyslexia alone. Furthermore, individuals with

dyslexia and ADHD have poorer working memory function than individuals without these

conditions, and working memory deficits are a significant predictor of reading difficulties in

individuals with dyslexia and ADHD.

The study's implications for the field of study are significant. The findings provide

evidence of the importance of working memory in understanding reading difficulties in

individuals with dyslexia and ADHD. This knowledge can be useful for developing interventions

and strategies to improve reading performance in individuals with these conditions. In addition,

the study highlights the importance of early identification and intervention for individuals with

dyslexia and ADHD to prevent further academic and social difficulties.

The study also has implications for future research. The reviewed studies varied in terms

of their design, measures used, and specific findings, indicating the need for additional research

to fully answer the research questions. For instance, further studies are required to examine the

relationship between working memory and reading difficulties in individuals with both dyslexia

and ADHD and how this relationship affects academic achievement. Additionally, future studies

should investigate potential confounding variables, such as socioeconomic status or intelligence,

that may affect the relationship between working memory and executive function skills in

individuals with dyslexia and ADHD. Finally, more research is required to identify effective

interventions and strategies that can improve working memory and reading performance in

individuals with dyslexia and ADHD.

 43

Recommendations

There are several recommendations for future research and changes in academic and

professional practice that can be made based on the studies reviewed. One area for future

research is exploring the relationship between working memory and reading difficulties in

individuals with both dyslexia and ADHD, as none of the studies reviewed specifically studied

this population. Additionally, there should be more research on the potential benefits of

recognizing and addressing working memory issues early in individuals with learning

impairments to improve learning outcomes. Further research is also needed on the heritability of

neurodevelopmental problems associated with reading impairments and their instability to

develop better diagnostic approaches.

In terms of changes in academic and professional practice, it is important for

professionals to recognize and treat working memory issues early in individuals with learning

impairments to improve their learning outcomes. Educational organizations should incorporate

screening for working memory issues in their assessments of individuals with learning

impairments. Healthcare organizations should also consider screening individuals with ADHD

for comorbid dyslexia given the significant overlap in symptoms and the severity of symptoms in

individuals with both disorders. Educational institutions can also consider providing training

programs for individuals with dyslexia and ADHD to enhance their visuospatial working

memory skills, which can benefit their academic performance.

References
 44

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Appendices

Appendix 1: Flow Sheet

Database Search: PubMed: n = 43; PsycINFO: n = 33; Web of

Science: n =55; Scopus: n=56; Total: n = 187

First Review of
Identification Removal of Duplicates: n=7
Titles and
Abstracts: n = 180|

Excluded based on not

meeting inclusion
criteria and
accessibility: n=91

Screening and Full-Text

Eligibility Screening: n=89
Full-text articles
obtained: n=89

Excluded based on not

meeting inclusion criteria
(Full text reading): n=65

Inclusion
 49

Appendix 2: Result Chart

Author Title of Study Findings/Results Overall Quality of

Evidence (Very
Strong, Strong,
Weak, Very Weak)
Lonergan et al. A meta-analysis of Children with Strong
executive functioning dyslexia exhibited
in dyslexia with difficulty with
consideration of the inhibition, switching
impact of comorbid attention, and
ADHD. auditory working
memory, with a
medium to large
effect relative to
controls. Children
with comorbid
dyslexia/ADHD
exhibited similar
degrees of
impairment compared
to children with
dyslexia alone.
Gray et al. Working memory The study identified Strong
profiles of children four distinct working
with dyslexia, memory profiles
developmental among the
language disorder, or participants: low
 50

both. overall, average with

high number
updating, average
with low number
updating, and high
overall. Children
from each disability
group and children
from the typically
developing group
were present in each
class.
Caldani et al. Reading performance The study found that Weak
in children with children with
ADHD: an eye- dyslexia and children
tracking study with ADHD +
dyslexia had similar
oculomotor pattern
abnormalities during
a reading task, which
was significantly
different from those
observed in children
with ADHD and with
TD. The study
suggests that an
objective eye
movement recording
during a reading task
could help clinicians
to better evaluate the
possible presence of
comorbid dyslexia in
children with ADHD.
Anjos et al. Phonological Statistically weak
processing in students significant
with developmental differences were
dyslexia, ADHD and observed among the
intellectual disability. three groups on the
phonological working
memory skills for
pseudowords,
forward digit
repetition, and
backward digit
repetition;
 51

phonological
awareness on syllable
level, phoneme level,
test total score, and
digits subtest of the
rapid automatized
naming test. Through
the descriptive
analysis, it was
observed that G1 had
the best results on all
the skills assessed,
followed by G2 and
G3.
Kofler et al. Do working memory Adding working strong
deficits underlie memory demands
reading problems in produced
attention-deficit/hype disproportionate
ractivity disorder decrements in reading
(ADHD)? comprehension for
children with ADHD
compared to non-
ADHD children,
comprehension was
significantly reduced
in both groups when
working memory
demands were
increased.
Fostick and Revah Dyslexia as a multi- The study found that strong
deficit disorder: dyslexia is a multi-
Working memory and deficit disorder and
auditory temporal both WM and ATP
processing. were significant
predictors of reading
performance and
phonological
awareness among
participants with
dyslexia. The study
divided participants
with dyslexia
according to their
performance level on
WM and ATP tasks
and revealed group
 52

differences in reading
and phonological
awareness tests.
Peng et al. A meta-analytic Individuals with strong
review of cognition reading difficulties
and reading exhibited deficits
difficulties: across multiple
Individual cognitive skills,
differences, including processing
moderation, and speed, short-term
language mediation memory, attention,
mechanisms. working memory,
inhibition, switching,
visuospatial skills,
and updating. The
severity of these
deficits was greater
with age, lower
reading and
intelligence scores,
and with verbal
cognitive tasks.
Barbosa et al. Executive functions The study found that weak
in children with children with
dyslexia. dyslexia performed
significantly worse
than typically
developing children
in several measures
of executive function,
including working
memory, attention,
inhibition, and
shifting.
Masoura et al. Working memory The study found that weak
profiles of children children with reading
with reading difficulties performed
difficulties who are significantly more
learning to read in poorly than typical
Greek. readers on all aspects
of working memory,
apart from visual-
spatial short-term
memory. The study
suggests that there is
a similar verbal
 53

working memory
impairment in Greek
children with reading
difficulties as in their
English peers, despite
the fact that they are
learning to read a
language with a
transparent rather
than an opaque
orthography.
Maehler et al. Training working The study aimed to Weak
memory of children improve the working
with and without memory's operational
dyslexia. efficiency in children
with dyslexia and
those without
dyslexia. The study
found that no long-
term increases in
performance
regarding
phonological and
central executive
working memory
could be confirmed.
Only the visuo-spatial
Corsi block span
exhibited a training
effect over a period
of three months.
Verma et al.'s SLD with and The purpose of this Weak
without ADHD: study is to describe
Comparison of any differences in the
cognitive profiles cognitive profiles of
children with SLD
who also have
ADHD and to
compare those
profiles. The study
discovered that
children with SLD
and treated ADHD
had much lower Digit
Span and Coding
score
54