Medication Doesn’t Help Kids With ADHD Learn

Summary: Study reports medications for ADHD have little detectable impact on how much a child with attention deficit hyperactivity disorder learns in the classroom. However, the medications helped children retain attention, improve classroom behavior, and improve seat-time work.

Source: Florida International University

For decades, most physicians, parents and teachers have believed that stimulant medications help children with attention deficit hyperactivity disorder (ADHD) learn.

However, in the first study of its kind, researchers at the Center for Children and Families at FIU found medication has no detectable impact on how much children with ADHD learn in the classroom.

Approximately 10% of children in the U.S. are diagnosed with ADHD and more than 90% of them are prescribed stimulant medication as the main form of treatment in school settings because most physicians believe that medication will result in better academic achievement.

“Physicians and educators have held the belief that medication helps children with ADHD learn because they complete more seatwork and spend more time on-task when medicated,” said William E. Pelham, Jr., senior author of the study and director at the Center for Children and Families. “Unfortunately, we found that medication had no impact on learning of actual curriculum content.”

Researchers evaluated 173 children between the ages of 7 and 12 with ADHD participating in the center’s Summer Treatment Program, a comprehensive eight-week summer camp program for children with ADHD and related behavioral, emotional and learning challenges.

Children completed two consecutive phases of daily, 25-minute instruction in vocabulary and subject-area content in science and social studies. The instruction provided to each student during the three-week phases was at their determined grade level. Certified teachers and aides taught the material to groups of 10–14 children in a classroom setting.

Each child was randomized to be medicated with a sustained-release stimulant medication during either the first or second of the instructional phases, receiving a placebo during the other.

Contrary to expectations, researchers found that children learned the same amount of science, social studies, and vocabulary content whether they were taking the medication or the placebo.

While medication did not improve learning, the study showed that medication helped children complete more seatwork and improve their classroom behavior, as expected. When taking medication, children completed 37% more arithmetic problems per minute and committed 53% fewer classroom rule violations per hour.

Additionally, consistent with previous studies, researchers found that medication slightly helped to improve test scores when medication is taken on the day of a test, but not enough to boost most children’s grades. For example, medication helped children increase on average 1.7 percentage points out of 100 on science and social studies tests.

Improving academic achievement is important for children with ADHD because compared to their peers, children with ADHD exhibit more off-task classroom behavior, receive lower grades, and obtain lower scores on tests. They also are more likely to receive special education services, be retained for a grade and drop out before graduation.

Poor academic achievement is one of the most debilitating impairments associated with ADHD, often leading to the long-term vocational and financial difficulties that characterize ADHD in adulthood.

Previous research conducted by Pelham, an ADHD research and treatment pioneer, has found that behavioral therapy—when used first—is less expensive and more effective in treating children with ADHD than medication.

This shows a light bulb and math symbols
While medication did not improve learning, the study showed that medication helped children complete more seatwork and improve their classroom behavior, as expected. Image is in the public domain

Stimulants are most effective as a supplemental, second-line treatment option for those who need it and at lower doses than typically prescribed. Additionally, the Society for Developmental and Behavioral Pediatrics (SDBP) has published new clinical guidelines that strongly recommend behavioral intervention as the first-line treatment for youth with ADHD.

“Our research has found time and time again 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 at school, at home and in relationships long-term,” said Pelham.

“Medicating our children doesn’t solve the problem—it only takes away the symptoms temporarily. Instead, families should focus on behavioral interventions first and add medication only if needed.”

Behavioral and academic interventions that meaningfully improve functional impairment long-term for youth with ADHD include parent training and classroom-based management tools like a daily report card, and school services specific to academic achievement such as 504 plans [accommodations provided under Section 504 of the Rehabilitation Act of 1973] and special education individualized education plans (IEPs).

Researchers note that the study was conducted in a controlled summer school-like environment and results may be different in a regular classroom setting. They would like to replicate this study in a natural classroom environment using academic curricula over the duration of a school year to further evaluate the impact of medication on learning.

About this ADHD and learning research news

Author: Press Office
Source: Florida International University
Contact: Press Office – Florida International University
Image: The image is in the public domain

Original Research: Closed access.
The effect of stimulant medication on the learning of academic curricula in children with ADHD: A randomized crossover study” by William E. Pelham III et al. Journal of Consulting and Clinical Psychology


Abstract

The effect of stimulant medication on the learning of academic curricula in children with ADHD: A randomized crossover study

Objective: Evaluate whether stimulant medication improves acquisition of academic material in children with attention deficit hyperactivity disorder (ADHD) receiving small-group, content-area instruction in a classroom setting.

Method: Participants were 173 children between the ages of 7 and 12 years old (77% male, 86% Hispanic) who met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for ADHD and were participating in a therapeutic summer camp. The design was a triple-masked, within-subject, AB/BA crossover trial. Children completed two consecutive phases of daily, 25-min instruction in both (a) subject-area content (science, social studies) and (b) vocabulary. Each phase was a standard instructional unit lasting for 3 weeks. Teachers and aides taught the material to small groups in a summer classroom setting. Each child was randomized to be medicated with daily osmotic-release oral system methylphenidate (OROS-MPH) during either the first or second of the instructional phases, receiving placebo during the other.

Results: Medication had large, salutary, statistically significant effects on children’s academic seatwork productivity and classroom behavior on every single day of the instructional period. However, there was no detectable effect of medication on learning the material taught during instruction: Children learned the same amount of subject-area and vocabulary content whether they were taking OROS-MPH or placebo during the instructional period.

Conclusions: Acute effects of OROS-MPH on daily academic seatwork productivity and classroom behavior did not translate into improved learning of new academic material taught via small-group, evidence-based instruction.

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  1. Great, it is all about school work and not about it being a neurodevelopment disorder, in which case some kids like mine have a difficult time controlling their impulsivity controlling their emotions, and wish to die or do something to get them seriously injuried. It is all about school work and not behavior issues controlling their emotions. i get sick and tired of these stories and the actual kids who are not looking for stimulants but a med that works on controlling their emotions, which is, by the way, the way the primary reason the REAL kids with ADHD get the diagnosis. It costs taxpayers money in behavioral health or emergency room and hospital bills when these kids get hurt. It is not all about the school work.

  2. This is a flawed study not taking into account other variables. I want to know the testing, the type of teaching, the adjustment for learning, measurement of Mood as these variables influence outcome and how it was controlled for. Also since the environment can influence a person with ADHD, was it new or strange, routine or novel, were the children naive to medication? as this is all part of learning. Without medication I was a 4.0 A student as long as I took one course at a time. Did I retain the information no not unless an emotion and continued use of it was required (repetitive). I memorized it spit it out on the test and then if not needed I did not keep it readily available. The issues here also include the type of medication selected (Concerta XL ) OROS-Methylphenidate which for each person may not be appropriate ,and the dosing was not titrated to the best dose for the child. I want to know who subsidized this study as the study is not available for the general public and the article does not address this issue. The bias is evident and the facts are sparse. Since ADHD and retention includes needing to have an emotion attached to the learning meaning I am interested and I want to learn it. The strength of the person with ADHD was not addressed for learning. “173 children between the ages of 7 and 12 years old (77% male, 86% Hispanic) who met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for ADHD and were participating in a therapeutic summer camp.” Selection does not specify other comorbid learning or mental health issues.Concur w/previous commentors.

  3. Medication only adjusts the ‘temporal lensing’ that ADD & ADHD diagnoses use to meter and regulate the flow of incoming events, allowing them to narrow down their attentive bandwidth and hold it in place for increased periods of time. This is unfortunately not going to impact the style or methodology of teaching being delivered. Those ‘suffering’ from attention disorders often process information using analogous context; comparison of input to recollection of reality sort of thing. This makes learning styles that focus on rote memorization less effective, which implies the need for differential studies that account not just for learning rates, but for teaching approaches.

  4. 8 weeks and they decided there was no difference in the amount of learning that took place? Seriously? Heaving lived with unmedicated ADHD all my life I can assure you that when you can NOT focus and pay attention you can NOT learn. Therefore you eventually fall behind, you really don’t see that in a short 8 week span, but by the time I was in high school I was failing regularly because of what I had missed thru the years.My daughter on the other hand also has ADHD, and has been medicated since kindergarten. She taught herself to read in kindergarten, has maintained mostly A’s her entire school career.. Won top level reading, awards & math awards. She just graduated with a 4.2 GPA. Yet, Without her medicine she can barely read 3 words put together. Medication may not be what makes the information stay in a persons brain so that they can remember and learn it. However, it is the tool that slows the brain down and allows a person to be able to fofocus and open their brain to what they are learning. I wish I had the opportunity of having the proper medication when I was in school as my daughter has had. Maybe I could have done more with my life. Regardless, I fear this article will set things back to the stone age for those with ADHD.

  5. ADHD is just a byproduct of the evolution of our brains. The brains are more connected in certain areas, but not in others. In a few generations, we’ll be elderly and the new generations will be able to focus on 50 things at once.

  6. ADHD isn’t a learning disability in the first place, though people can have learning disabilities as co-morbidities. My son is a straight A student. I was a straight A student. We still have ADHD. Girls internalize our symptoms at an early age due to different social expectations so we don’t present with behavior problems as children as often but our ADHD has lasting negative impacts especially if we slip through the cracks without identification. This is based on some outdated stereotype of the misbehaving boy.

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