For decades, many physicians, parents, and educators have believed that stimulant medications help children with ADHD learn because they are able to focus and behave better when taking the drug.
After all, an estimated 6.1 million children in the US are diagnosed with attention-deficit/hyperactivity disorder, and more than 90% are prescribed stimulant medications as the main form of treatment in school settings.
However, in a peer-reviewed study that several colleagues and I published in the Journal of Consulting and Clinical Psychology, we found that medication has no detectable effect on how much children with ADHD learn in the classroom. At least this is the case when learning – defined as the acquisition of demonstrable skills or knowledge through instruction – in the context of tests to assess improvements in a student’s current academic knowledge or skills over time Is measured.
Compared to their peers, children with ADHD display more off-task, disruptive classroom behavior, earn lower grades and score lower on tests. They are more likely to receive special education services and retain for grades, and less likely to finish high school and enter college — two educational milestones that have been linked to significant increases in income.
Just as children with ADHD have more difficulty in school than peers, adults with a history of ADHD have a harder time keeping a steady job.
In this study, funded by the National Institute of Mental Health, we evaluated 173 children between the ages of 7 and 12. They were all participating in our Summer Treatment Program, a comprehensive eight-week summer camp for children with ADHD and related behavioral, emotional and learning challenges.
Children received grade level education in vocabulary, science and social studies. Classes were led by certified teachers. The children were given the drug in the first half of the summer and a placebo during the second half. They were tested at the beginning of each academic instruction block, which lasted about three weeks. They then took the same test at the end to determine how much they had learned.
Contrary to conventional wisdom, under which parents and teachers have long operated, we found that children learned similar amounts of science, social studies and vocabulary material, whether taking medication or a placebo.
Yes. We were also surprised by this discovery.
Several published studies show that the drug helps children focus and behave better in the classroom. The theory has been that if stimulant medication helps a child stay on task with their schoolwork and improves their behavior in the classroom, it should also improve their learning.
In our study, the drug helped children complete more schoolwork and improve their classroom behavior, as expected. While taking the drug, the children completed 37% more arithmetic problems per minute and demonstrated 53% fewer classroom rule violations per hour.
Unfortunately, completing more schoolwork and behaving better in the classroom did not lead to higher grades on tests, which determine the overall class grade too much. These results support the findings of other research that has found that the drug has no long-term beneficial effect on standardized test scores.
This is an important finding because stimulant medication is by far the most common treatment for children with ADHD, and most receive only medication. Other treatments available for children with ADHD include behavioral therapy, which includes training for parents, and a combination of therapy and medication.
a new understanding
About 40 years ago, my research lab published the first study looking at the effects of stimulant medication on learning for children with ADHD in a classroom setting. During that time, we measured learning by how quickly and accurately children completed worksheets and how they behaved in the classroom.
Researchers in my lab found that medicated children focused more and behaved better, and we assumed that the drug helped them learn more. Since then, stimulant medications have been the most common treatment for ADHD.
After publishing nearly 500 scientific studies on the topic over the past 40 years, we’ve learned a great deal about the most effective treatments for children with ADHD.
ADHD Isn’t Something Kids Will Outgrow
Our most recent National Institute of Mental Health long-running study found that an adult with a history of childhood ADHD is expected to earn US$1.25 million less in their lifetime than adults without a history of ADHD, Potentially reducing net worth by up to 75% by the time you reach retirement.
In that study, we found that people with ADHD performed worse in almost every aspect of work and financial well-being. This included income, savings, employment status and dependence on parents or other adults.
About half of adults with childhood ADHD were regularly receiving funding from parents, other adults, or the government.
To improve long-term financial outcomes and reduce dependence on parents and the government, people with ADHD can benefit from educational support and interventions that help them finish high school and earn a bachelor’s degree.
Since the children in our study were 7–12 years old, we do not know whether our findings will extend to adolescents or adults with ADHD. As children grow, how they learn changes: Adolescents or young adults may gain more knowledge from independent study than from classroom teaching. That’s why it’s important to determine whether medication helps with learning outside the classroom.
How to help children with ADHD thrive
There are ways for children to improve academic achievement with effective classroom strategies, rather than just taking medication initially. Behavioral and educational strategies that greatly help youth with ADHD include parenting training and classroom-based management tools such as daily report cards. A child with ADHD can also receive effective behavioral services at school that are specific to academic achievement, such as 504 and individualized education plans for students in special education, also known as IEPs.
Our previous research has found that behavioral therapy – when first used – is less expensive and more effective than medication in treating children with ADHD. Stimulants are most effective as a complementary, second-line treatment option for those who need it and at lower doses than usually prescribed. In other words, medication should be added only if children still need additional support after behavioral and educational interventions have been tried.
Additionally, in 2020, the Society for Developmental and Behavioral Pediatrics published new clinical guidelines that strongly recommend behavioral interventions as first-line treatment for youth with ADHD and second-line if necessary. Medicine as a treatment.
So while it’s true that medication helps with focus and behavior, so do behavioral and academic strategies in the classroom. And just because a child seems more focused and behaves better in class doesn’t mean he or she will get better grades. We have repeatedly found that behavioral interventions are best for children with ADHD because they, their teachers, and their parents learn the skills and strategies that will help them succeed in the long run at school, at home, and in relationships. .
To give children with ADHD the best chance of growing up, I believe that families, medical professionals, and teachers should focus on behavioral and academic interventions first and add medication only when needed.