By Denise Mann
MONDAY, April 27, 2009 (Health.com) — New York City mom Nancie Steinberg recently received some great news at a parent-teacher conference for her 11-year-old son. The medication that her fifth grader takes to treat his attention deficit hyperactivity disorder (ADHD) seemed to be making a difference in the classroom. “The teachers always had to have him by their right kneecap to keep him focused, but now they feel that he is very focused, an active participant and overall his academics are better,” she says, breathing a sigh of relief.
Now, if a new study is correct, these improvements may actually spill over to his performance on standardized math and reading tests. Elementary school-aged children with ADHD who take medication seem to do better on such standardized tests than their non-medicated peers with ADHD, according to a study in the May issue of Pediatrics.
“Previous research has shown that when children are medicated for ADHD, they get better grades, their teachers like them more, they are less impulsive and they stay focused longer, but we have never been able to say that they learn more, until now,” says lead study author Richard M. Scheffler, PhD, the distinguished professor of health economics and public policy in the School of Public Health and Goldman School of Public Policy at the University of California at Berkeley.
The gains seen in test scores, however, do not erase the test score gap seen between children with ADHD and their peers who do not have the behavioral disorder, the researchers say. About 4.4 million children in the United States have ADHD, which is marked by impulsivity, hyperactivity, and difficulty focusing.
In the study, the researchers looked at survey data from more than 21,000 children who entered kindergarten in 1998 and were followed through fifth grade. They took a closer look at 594 children diagnosed with ADHD who had survey data from all five years. The children with ADHD who took medication scored 2.9 points higher in mathematics tests and 5.4 points higher in reading tests than their peers with ADHD who were not taking medication.
What does this equate to in the classroom setting? In general, all children gained 90.2 points in average math scores between kindergarten and fifth grade. So the 2.9-point difference in math scores was the equivalent of the gains achieved in about two months of a school year, and the 5.4-point difference in reading scores was roughly equal to three months of schooling. Now, the researchers plan to follow these kids through middle school and beyond to see whether continued medication use has lasting effects on academic achievements.
Still, taking ADHD drugs alone was not enough to close the gap in test scores between kids with ADHD and their ADHD-free peers, the study showed.
“Medication improved math and reading scores, but it did not bring these kids up to the average of kids without ADHD, so other things are necessary,” Scheffler says. “Treating a child for this disorder is a team sport, and medication, if appropriate, is one player.”
Study co-author Stephen P. Hinshaw, PhD, the chair and professor of psychology at the University of California at Los Angeles at Berkeley, agrees. “Medication alone is hardly ever an adequate treatment for ADHD,” he says. “In the realm of academic achievement, it usually takes a team approach—behavioral strategies consistently practiced by parents, teacher [involvement and] direct tutoring before major gains are seen,” he says. Parents can help by giving children more structure, including regular schedules and set bedtimes.
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Stephen Grcevich, MD, a child and adolescent psychiatrist in Chagrin Falls, Ohio, says parents can also help their children “by turning off the TV and the computer, reading together with their child, taking an interest in their schoolwork, developing a positive collaboration with their child’s teacher and advocating with their child’s school for appropriate evaluation and testing of possible learning disabilities when academic achievement lags behind academic ability.”
More than half of kids with ADHD do take prescription medications to control the symptoms, but this is not a decision that parents like Steinberg enter into lightly. Some parents may fear that there is a stigma attached to taking drugs for behavioral issues, while others may worry about the potential side effects, including poor appetite. In the study, 90% of the children taking ADHD medication were taking stimulants, which may cause poor appetite, weight loss, and sleeplessness.
“It is a balancing act,” Scheffler explains. "Children with untreated ADHD have serious problems in school, they are more likely to drop-out of school, become substance abusers, and they don’t get along well with their peers, but these drugs do have side effects,” he says.
Hinshaw says the “study should allay concerns that the medications act only to make children more compliant and docile.” He adds, “the medication is linked to improvements in reading and math as well.”
The study does suggest that ADHD is a serious condition that has a negative impact on learning, says Dr. Grcevich. “Amidst all the media hype about medication safety and side effects, this study helps demonstrate that there are real risks to the decision to not use medication as a component of a comprehensive ADHD treatment plan.”
The National Institute of Mental Health funded the study.