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Stimulants have no demonstrable impact on how much children with ADHD learn in the classroom, new research finds.
For decades, most doctors, parents, and teachers have believed that stimulants help children with attention-deficit hyperactivity disorder (ADHD) learn. However, in the first study of its kind, researchers at Florida International University’s (FIU) Center for Children and Families found that medication had no demonstrable effect on how much children with ADHD learn in school.
About 10 percent of children in the US are diagnosed with ADHD. Of these, more than 90 percent are prescribed stimulants as the main form of treatment at school, because most doctors believe that drugs lead to better academic performance.
“Physicians and educators believe that medication helps children with ADHD learn because they do more sitting tasks and spend more time on tasks when treated with medication,” said William E. Pelham, Jr., senior author of the study and Director of the Center for Children and Families. “Unfortunately, we found that medication had no impact on learning actual curriculum content.”
The researchers evaluated 173 children between the ages of 7 and 12 with ADHD who were enrolled in the center’s Summer Treatment Program, a comprehensive eight-week summer camp program for children with ADHD and related behavioral, emotional, and learning problems.
The children completed two consecutive phases of daily 25-minute classes in vocabulary and subject matter in science and social studies. The instruction provided to each student during the three-week phases corresponded to their designated grade level. Certified teachers and assistants taught the material to groups of 10-14 children in the classroom.
Each child was randomized to receive a sustained-release stimulant in either the first or second phase of instruction and a placebo in the other phase.
Contrary to expectations, the researchers found that children learned the same amount of science, social science, and vocabulary content whether they took the drug or the placebo.
While medications did not improve learning, the study showed that medications did help children do more sitting tasks and improve their classroom behavior, as expected. When taking medication, children did 37 percent more arithmetic problems per minute and committed 53 percent fewer classroom rule violations per hour.
In addition, consistent with previous studies, the researchers found that when medication was taken on the day of a test, medication slightly helped improve test scores, but was insufficient to improve most children’s grades. For example, medication helped children improve an average of 1.7 percentage points out of 100 on science and social science tests.
Improving school performance is important for children with ADHD because children with ADHD behave more outside of class, receive lower grades, and perform lower on tests than their peers. They are also more likely to receive special education, be retained for a class, and drop out before graduation. Poor school performance is one of the most debilitating impairments associated with ADHD and often leads to the long-term professional 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 most effective as a second-line supplemental treatment option for those who need them and at lower doses than would normally be prescribed. In addition, the Society for Developmental and Behavioral Pediatrics (SDBP) has published new clinical guidelines strongly recommending behavioral intervention as the first-line treatment for adolescents with ADHD.
“Our research has consistently found that behavioral intervention is best for children with ADHD because they, their teachers, and their parents are learning skills and strategies that will help them be successful in school, at home, and in relationships over the long term,” said Pelham. “Medicating our children doesn’t solve the problem – it only temporarily eliminates the symptoms. Instead, families should focus on behavioral interventions first, adding medication only when needed.”
Behavioral and school-based interventions that make meaningful long-term improvements to functional impairment in adolescents with ADHD include parent education and classroom-based management tools, such as a daily report card, and school services specifically for school achievement, such as 504 plans [accommodations provided under Section 504 of the Rehabilitation Act of 1973] and Individualized Special Education Plans (IEPs).
The researchers note that the study was conducted in a controlled summer school-like setting and results may be different in a regular classroom setting. They wish to replicate this study in a natural classroom setting using academic curricula over the duration of a school year to further assess the effects of medication on learning.
Reference: “The Effect of Stimulant Drugs on Academic Curriculum Learning in Children with ADHD: A Randomized Crossover Trial” 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, & Pelham, WE, Jr , May 23, 2022, Journal of Counseling and Clinical Psychology.
DOI: 10.1037/ccp0000725
This study was published in the Journal of Consulting and Clinical Psychology and funded by the National Institute on Mental Health.
