For decades, most doctors, parents, and teachers believed that stimulant drugs helped children with Attention Deficit Hyperactivity Disorder (ADHD) learn. However, in the first study of its kind, scientists from the Center for Children and Families at Florida International University (FIU) found that the drugs had no detectable impact on how much children with the disease learned. ADHD in the classroom.
About 10 percent of children in the United States are diagnosed with ADHD. Of these, more than 90% are prescribed stimulants as their primary form of school-based treatment, as most doctors believe the drugs will result in better academic performance.
“Doctors and educators are convinced that drugs help children with ADHD learn because they do more sitting work and spend more time on the task when treated,” said William E. Pelham, Jr., lead author of the study and director of the Center. for children and families. “Unfortunately, we found that the medications had no impact on learning the actual program content.”
Researchers evaluated 173 children ages 7 to 12 with ADHD participating in the center’s Summer Treatment Program, a comprehensive eight-week summer camp program for children with ADHD and behavioral, emotional and related learning.
Children received two consecutive phases of daily 25-minute instruction on vocabulary and subject content in science and social studies. The instruction given to each pupil during the three-week phases corresponded to his or her determined grade level. Certified teachers and assistants taught the material to groups of 10-14 children in a classroom setting.
Each child was randomized to receive a sustained-release stimulant drug during the first or second phase of instruction, receiving a placebo during the other.
Contrary to expectations, the researchers found that the children learned the same amount of science content, social studies, and vocabulary whether they took the drug or the placebo.
Although the medications did not improve learning, the study showed that the medications helped the children do more seated work and improved their behavior in the classroom, as expected. When taking medication, children solved 37% more arithmetic problems per minute and committed 53% fewer violations of classroom rules per hour.
Also, consistent with previous studies, the researchers found that the drugs helped improve test scores slightly when taken on the day of a test, but not enough to improve grades for most children. For example, the drugs helped children increase by an average of 1.7 percentage points out of 100 on science and social studies tests.
Improved academic achievement is important for children with ADHD because compared to their peers, children with ADHD exhibit more off-task behaviors in the classroom, receive lower grades, and score lower on tests. They are also more likely to receive special education services, be held for a year, and drop out before graduation. Poor academic achievement is one of the most debilitating impairments associated with ADHD, often leading to the long-term work and financial difficulties that characterize ADHD in adulthood.
Previous research by Pelham, a pioneer in ADHD research and treatment, found that behavioral therapy – when used first – is less expensive and more effective than medication in treating children with ADHD. Stimulants are more effective as a complementary second-line treatment option for those who need them, and at lower doses than those typically prescribed. Additionally, the Society for Developmental and Behavioral Pediatrics (SDBP) has released new clinical guidelines that strongly recommend behavioral intervention as a first-line treatment for young people with ADHD.
“Our research has repeatedly found that behavioral intervention is best for children with ADHD because they, their teachers, and their parents learn skills and strategies that will help them succeed in school, at home and in long-term relationships,” Pelham said. “Medicating our children does not solve the problem, it only temporarily suppresses the symptoms. Instead, families should focus on behavioral interventions first and add medications only if needed.
Behavioral and academic interventions that significantly improve long-term functional impairment for youth with ADHD include parent training and classroom management tools such as a daily report card and school-specific academic achievement services such as blueprints 504 [accommodations provided under Section 504 of the Rehabilitation Act of 1973] and Individual Education Plans (IEPs) for special education.
The researchers note that the study was conducted in a controlled environment similar to a summer school and results may be different in a regular classroom setting. They would like to replicate this study in a natural classroom environment using school programs over the duration of a school year to further assess the impact of medications on learning.
Reference: “The Effect of Stimulant Medications on Learning Curriculum in Children with ADHD: A Randomized Crossover Study” by Pelham, WE III, Altszuler, AR, Merrill, BM, Raiker, JS, Macphee, FL, Ramos, M., Gnagy, EM, Greiner, AR, Coles, EK, Connor, CM, Lonigan, CJ, Burger, L., Morrow, AS, Zhao, X., Swanson, JM, Waxmonsky, JG and Pelham, WE , Jr., May 23, 2022, Journal of Consulting and Clinical Psychology.
This study was published in the Journal of Consulting and Clinical Psychology and was funded by the National Institute on Mental Health.