Drugs alone do not improve children’s classroom learning – new research

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William E. Pelham, Jr., Florida International University

(THE CONVERSATION) For decades, many doctors, parents and teachers have believed that stimulant drugs help children with ADHD learn because they are able to focus and behave better when medicated.

After all, an estimated 6.1 million children in the United States are diagnosed with attention deficit/hyperactivity disorder, and more than 90% are prescribed stimulants as their primary form of school-based treatment.


However, in a peer-reviewed study that several colleagues and I published in the Journal of Consulting and Clinical Psychology, we found that the drugs had no detectable effect on how much children with ADHD learned. in class. This is at least the case when learning – defined as the acquisition of skills or knowledge attainable through teaching – is measured in terms of tests intended to assess improvements in current academic knowledge or skills. a student over time.

Compared to their peers, children with ADHD exhibit more distracted and disruptive academic behavior, achieve lower grades, and perform lower on tests. They are more likely to receive special education services and be held for a year, and less likely to graduate from high school and enter college – two educational milestones associated with significant increases in earnings.

Just as children with ADHD struggle more than their peers in school, adults with a history of ADHD struggle to hold steady jobs.

Learning measures

In this study, funded by the National Institute of Mental Health, we evaluated 173 children aged 7 to 12 years. They were all participating in our summer treatment program, a comprehensive eight-week summer camp for children with ADHD and behavioral, emotional and learning challenges.

Children received grade-level instruction in vocabulary, science, and social studies. Classes were led by certified teachers. The children received medication for the first half of the summer and a placebo for the other half. They were tested at the start of each academic teaching 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 that parents and teachers have been operating for a long time, we found that children learned the same amount of science, social studies, and vocabulary content whether they were on medication or a placebo.

Yes. We were also shocked by this discovery.

Many published studies show that drugs help children focus and behave better in class. The theory is that if stimulant drugs help a child stay focused on their schoolwork and improve their behavior in class, it should also improve their learning.

In our study, the drugs helped the children complete more schoolwork and improve their behavior in class, as expected. When taking medication, children solved 37% more arithmetic problems per minute and had 53% fewer classroom rule violations per hour.

Unfortunately, doing more schoolwork and behaving better in class did not lead to higher test scores, which strongly determine overall class grades. These results support the findings of other research that has found that there is no long-term beneficial effect of medications on standardized test scores.

This is an important finding because stimulant medications are by far the most common treatment for children with ADHD, and the majority only receive medication. Other treatments available for children with ADHD include behavioral therapy, including parent training, and a combination of therapy and medication.

A new understanding

Almost 40 years ago, my research lab published the first-ever study looking at the effects of stimulant drugs on learning in children with ADHD in the classroom. Back then, we measured learning by how quickly and accurately children completed worksheets and how well they behaved in class.

Researchers in my lab found that medicated children concentrated more and behaved better, and we hypothesized that the drugs helped them learn more. Since then, stimulant medications have been the most common treatment for ADHD.

Having published nearly 500 scientific studies on the subject over the past 40 years, we have learned a lot about the most effective treatments for children with ADHD.

ADHD is not something kids will outgrow

Our most recent long-term study from the National Institute of Mental Health found that an adult with a history of childhood ADHD is expected to earn $1.25 million less than an adult without a history of ADHD in lifetime, potentially reaching retirement with up to 75% less net worth.

In this study, we found that people with ADHD fared worse in almost every aspect of work and financial well-being. This included income, savings, employment status, and dependency on parents or other adults.

Nearly half of adults with childhood ADHD regularly received money from parents, other adults, or the government.

To improve long-term financial outcomes and reduce dependence on parents and government, people with ADHD can benefit from educational supports and interventions that help them complete high school and earn a bachelor’s degree. .

Because the children in our study were 7 to 12 years old, we don’t know if our findings would extend to adolescents or adults with ADHD. As children grow, the way they learn changes: teenagers or young adults may gain more knowledge through independent study than from classroom instruction. It is therefore important to determine whether the drugs help learning outside the classroom.

How to help kids with ADHD thrive

There are ways for children to improve their academic performance through effective classroom strategies, rather than just taking medication to begin with. Behavioral and academic strategies that significantly help youth with ADHD include parent training and classroom management tools like a daily report card. A child with ADHD may also receive effective behavioral services at school that are specific to academic success, such as 504 and Individual Education Plans, also known as IEPs, for students in special education.

Our previous research has shown 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. In other words, drugs should only be added if children still need additional support after behavioral and school interventions have been tried.

Additionally, in 2020, the Society for Developmental and Behavioral Pediatrics released new clinical guidelines that strongly recommend behavioral intervention as first-line treatment for young people with ADHD and medication as second-line treatment, if needed.

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 to be more focused and behaves better in class doesn’t mean they’ll get better grades. What we have found time and time again is 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.

To give children with ADHD the best chance of thriving, I believe families, healthcare professionals, and educators should focus on behavioral and academic interventions first and add medications only when necessary.

This article is republished from The Conversation under a Creative Commons license. Read the original article here: https://theconversation.com/adhd-medication-alone-doesnt-improve-classroom-learning-for-children-new-research-183714.

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