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Letter Reversals and ADHD

Letter Reversals and ADHD

The Journal of Attention Disorders published a large study on 1109 children with possible ADHD to examine the relationship of static reversals, handedness and gender to reaction time variability (RTV).  If ADHD was present, the child was rated as mild, moderate or severe. Using parent report and observation, the age at which the children were still manifesting static reversals and handedness was recorded.   The results indicated that:

  • letter reversals were still present in 40.8% of the 3 to 6 year olds, 42.9% of the 7-8 year olds and 16.3% of the 9-11 year olds.
  • both-handed girls had longer RTs but were less variable in their RTs (12 out of 208 females were both handed)
  • the age of letter reversal continuation was significantly associated with RTV for male and female children.

Previous research indicates increased RTV is associated with occasional lapses in attention which is linked to intrusions of task negative brain network activity during task performance.  In addition, some studies of the default mode network (DMN) found increased activity in posterior cingulate, precuneus, and middle temporal gyrus during RT trials. The DMN is a network of interacting brain regions known to have activity highly correlated with each other and distinct from other networks in the brain. Normally, the DMN is active when a person is day dreaming or mind wandering.

It is hypothesized that RTV is possibly from: a temporal processing deficit, the inability to modulate very low frequency neural fluctuations, inefficient executive control and/or difficulties with regulation of energetic state.  The researchers concluded that a failure of suppression of visually symmetrical information and/or a failure of default mode suppression may also be associated with RTV in children with ADHD.


Buckner, R. L.; Andrews-Hanna, J. R.; Schacter, D. L. (2008). “The Brain’s Default Network: Anatomy, Function, and Relevance to Disease”. Annals of the New York Academy of Sciences. 1124 (1): 1–38. doi:10.1196/annals.1440.011. PMID 18400922

Levy, F., & Young, D. (2016). Letter Reversals, Default Mode, and Childhood ADHD. Journal of attention disorders, 1087054715624229.

Reversal Repair Letter Reversals

Reversal Repair is a multisensory intervention that includes twelve sequenced research-based activities to help students with persistent letter reversals. This program builds automaticity of oral, phonological, and written use of these frequently confused letters.  FIND OUT MORE INFORMATION

Read more about Letter Reversals.