Study: ADHD meds may provide little academic benefit

New research suggests medication alone isn’t enough to increase academic performance for kids with attention-deficit/hyperactivity disorder (ADHD). Published May 23 in the Journal of Consulting and Clinical Psychology, the study from Florida International University’s Center for Children and Families found ADHD medication did not affect the amount of subject material students absorbed during a treatment program.

While experts agree that the study’s findings provide some clarity to the issue of ADHD and education, they caution against downplaying the role of either medication or behavioral treatments.

Almost 10 percent of children in the United States between the ages of 2 and 17 have been diagnosed with ADHD, according to the Centers for Disease Control and Prevention. Of those, the CDC in 2016 estimated 62 percent were on medication.

Health experts describe ADHD as a neurodevelopmental disorder that causes increased difficulty focusing, controlling impulses, and following instructions. Children with ADHD on average receive lower grades than their peers and struggle to engage and focus in classroom settings. Teachers and parents often resort to various stimulant medications to help them settle down and focus on tasks. But these stimulants can also cause problematic side effects, including crankiness, loss of appetite, trouble sleeping, and more.

The Florida researchers observed 173 children ages 7 to 12 with ADHD enrolled in FIU’s Summer Treatment Program. Each child underwent two consecutive 25-minute instruction periods and received methylphenidate, a stimulant commonly prescribed for ADHD, during one period and a placebo during the other. Methylphenidate (often marketed under the brand name Ritalin, among others) acts on the central nervous system by increasing levels of dopamine, a hormone involved in the motivational process.

The researchers evaluated how much students learned based on test scores and daily assessments. They reported no significant increase in the amount of subject material kids learned when medicated. When taken on the day of a test, medication slightly increased students’ scores, but not enough to boost their overall grades.

That’s not to say the medication had no effect: Students completed more assignments when medicated, evidenced by a 37 percent uptick in arithmetic problems solved per minute. It also seemed to significantly improve classroom behavior. Students who had taken methylphenidate committed 53 percent fewer classroom rule violations per hour.

“Medicating our children doesn’t solve the problem—it only takes away the symptoms temporarily,” said lead author William Pelham Jr. in FIU’s news release. “Instead, families should focus on behavioral interventions first and add medications only if needed.”

Parents and teachers use behavioral interventions to help kids with ADHD focus and better manage daily tasks. Consistency is key to these interventions, which can include giving specific positive feedback, intentionally ignoring undesirable behaviors, and making daily report cards that award privileges when the child meets certain behavioral goals.

Joel Nigg, director of Oregon Health and Science University’s Center for ADHD Research, said the role of medication versus alternative treatments is nuanced. For most kids with ADHD, he believes a combination of medication and behavioral treatments makes sense. But if the symptoms are mild, it’s possible to correct them with behavioral interventions alone, he said. And if the symptoms are uncomplicated—for example, a child has trouble focusing but doesn’t act out in the classroom—medication alone might be sufficient.

Nigg emphasized that medications act very quickly, while the benefits of behavioral interventions may take years to manifest: “If a clinician sees a child who’s on fire with problems and difficulties and can’t stay in school and so on, then it makes sense that they might start medication and get that behavior under control, and then work on the functional outcomes.”

Dr. Rosemary Stein, director of the International Family Clinic in Burlington, N.C., and a member of the Christian Medical and Dental Associations, sometimes sees dramatic differences after putting a patient diagnosed with ADHD on stimulant medication. She said kids will often lose self-confidence, but adding a stimulant can help them focus enough to see major improvements in school performance.

But Nigg and Stein expressed concern about the high percentage of U.S. children diagnosed with ADHD. The number of diagnoses nearly doubled between 1997 and 2016. Nigg wouldn’t pin the blame on any specific factor, but he noted the potential effect of performance pressure, environmental toxins, diet, and other societal changes on children’s mental health. “There’s not a simple answer,” he said.

Stein thinks the root of the problem is easier to pinpoint: “We are overdiagnosing what is normal childhood because we cannot deal with it.” She said she sees many kids exhibiting ADHD symptoms not because they have the disorder, but because their parents are too stressed and busy to focus on correcting these behaviors.

That’s why Stein tries behavioral modifications with her patients before prescribing stimulants. “A poorly behaved child is not ADHD,” she said. “Most children have some difficulty focusing.”

For children who have ADHD, Stein said parental engagement is a game-changer. When parents approach their kid’s diagnosis as a top priority without blaming the child, it can boost self-confidence and enable the child to focus and excel at school.