Medication treatment for children with attention-deficit/hyperactivity
disorder (ADHD) is associated with moderately higher math and reading scores
than those earned by their peers with ADHD not taking medications, a five-year
naturalistic, observational study has found.
The study authors, led by Richard Scheffler, Ph.D., a professor of health
economics and public policy at the University of California at Berkeley School
of Public Health and School of Public Policy, analyzed data from a
longitudinal survey of more than 21,000 children throughout the United States
who were in kindergarten in 1998 and 1999. The findings are reported in the
The children were followed through fifth grade and had five assessments
that included standardized math and reading tests in the fall and spring of
kindergarten and in the spring of first, third, and fifth grades. Nearly 600
children had a diagnosis of ADHD as reported by their parents, and about
two-thirds of these children were taking medications at the assessment in the
spring of fifth grade. Those not taking medications for ADHD in fifth grade
were assumed to be unmedicated throughout the study period.
Compared with unmedicated children with ADHD, those who took medications
had math scores that were 2.9 points higher, which was statistically
significant and represented an academic gain of 0.19 of a school year
(equivalent to approximately two months) over the six-year period from the
fall of kindergarten to spring of fifth grade.
The general difference in reading scores between medicated and unmedicated
children with ADHD was not statistically significant. However, the subgroup of
children who had been medicated for a year or longer had a 5.4-point gain in
mean reading score over unmedicated children, which was statistically
significant and equivalent to a gain of 0.29 school years (equivalent to
slightly over three months).
"The effect size would be considered on the moderate side,"
Stephen Hinshaw, Ph.D., chair and a professor of psychology at the University
of California at Los Angeles, told Psychiatric News. He is one of the
The researchers pointed out in the article that despite the academic
performance gains in the medicated children with ADHD, they still fell
substantially behind their peers without ADHD in both math and reading test
"Medication use was associated with gains compared with kids who did
not get medicated, but the gains were only about 40 percent of the amount
needed to bridge the gap [between children with and without ADHD],"
Hinshaw said. "The clear implication is that combination
treatments—medication plus home-based behavioral treatments, teacher
consultation, or, when indicated, tutoring or direct academic
instruction—are needed for academic remediation for children with
"The results of this study are consistent with general clinical
experience," David Fassler, M.D., a child psychiatrist and clinical
professor of psychiatry at the University of Vermont medical school, commented
to Psychiatric News. "Without treatment, children with ADHD
have difficulties at home, in school, and with their peers. With treatment,
they tend to do better across all settings," he noted.
Despite the study's encouraging findings, he noted, "the results
should be interpreted with caution due to the methodology employed. For
example, the authors rely on the parents' reports of both diagnosis and
medication history [and] did not collect data on treatments other than
medication, such as behavioral interventions."
Fassler concurred with the authors' conclusion that more long-term clinical
studies are needed to better understand the effects of medication use on
academic achievement in children with ADHD.
Hinshaw said, "If used consistently and monitored well, medication
may be linked not only to attention and behavioral improvement but gains in
actual reading and math skills." However, "despite the
potential ... enhancement of achievement [associated with medication use], a
multimodal or team approach is almost certainly necessary to show important
and lasting academic benefits for youths with ADHD," he emphasized.
The study was funded by the National Institute of Mental Health.
An abstract of "Positive Association Between
Attention-Deficit/Hyperactivity Disorder Medication Use and Academic
Achievement During Elementary School" is posted at<pediatrics.aappublications.org/cgi/content/abstract/123/5/1273>.▪