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To improve academic outcomes, children with ADHD need both medication and non-medication treatments

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Aca­d­e­m­ic prob­lems are extreme­ly com­mon in chil­dren with ADHD, and often the issue that leads to refer­ral for an ADHD eval­u­a­tion.

Aca­d­e­m­ic out­comes can be mea­sured in 2 dif­fer­ent ways — aca­d­e­m­ic achieve­ment and aca­d­e­m­ic per­for­mance — and both are com­pro­mised in chil­dren with ADHD. Aca­d­e­m­ic achieve­ment refers to the infor­ma­tion and skills that chil­dren acquire and is typ­i­cal­ly mea­sured by stan­dard­ized tests. Aca­d­e­m­ic per­for­mance focus­es on direct mea­sures of suc­cess at school such as grades, grade reten­tion, high school grad­u­a­tion, and col­lege enroll­ment.

An impor­tant ques­tion then, for mil­lions of kids diag­nosed with ADHD and for their par­ents and edu­ca­tors, is whether long-term aca­d­e­m­ic func­tion­ing can improve with appro­pri­ate treat­ment.

The Study

A new study pub­lished online in the Jour­nal of Atten­tion Dis­or­ders [Long-term out­comes of ADHD: Aca­d­e­m­ic achieve­ment and per­for­mance] rep­re­sents a valu­able effort to answer that ques­tion.

The authors began by con­duct­ing a sys­tem­at­ic lit­er­a­ture search to iden­ti­fy all poten­tial­ly rel­e­vant stud­ies. Specif­i­cal­ly, they looked for all stud­ies pub­lished in peer reviewed jour­nals between 1980 and 2012 that exam­ined aca­d­e­m­ic out­comes asso­ci­at­ed with treat­ment over at least a 2-year peri­od. Some of these stud­ies com­pared aca­d­e­m­ic out­comes in treat­ed and non-treat­ed chil­dren; oth­ers had no com­par­i­son group but looked at achieve­ment and/or per­for­mance mea­sures before and after treat­ment, while oth­ers com­pared out­comes between treat­ed youth and youth with­out ADHD.

As a result of this search, the authors iden­ti­fied 14 stud­ies that looked at aca­d­e­m­ic achieve­ment out­comes and 12 that assessed per­for­mance out­comes were com­pared. To cre­ate a com­mon out­come met­ric across mul­ti­ple stud­ies that used vary­ing meth­ods, stud­ies were grouped into those that showed treat­ment ben­e­fits and those that did not. They then sim­ply count­ed the num­ber of stud­ies where evi­dence of treat­ment ben­e­fits was found.

For stud­ies that com­pared treat­ed vs. untreat­ed youth, or aca­d­e­m­ic func­tion­ing before and after treat­ment, ben­e­fit was defined as a sta­tis­ti­cal­ly sig­nif­i­cant gain asso­ci­at­ed with treat­ment. Where treat­ed youth were com­pared to youth with­out ADHD, ben­e­fit was assumed when aca­d­e­m­ic out­comes for youth with ADHD were not sig­nif­i­cant­ly worse than for non-ADHD con­trols.

The Results

For achieve­ment test scores, treat­ment yield­ed improve­ment in 7 of 9 stud­ies (78%) when the com­par­i­son was with pre-treat­ment base­line and in 4 of 5 stud­ies (80%) when treat­ed and untreat­ed youth were com­pared.

For aca­d­e­m­ic per­for­mance out­comes, improve­ment was found in 1 of 2 stud­ies that used pre– vs. post-treat­ment com­par­isons and in 4 of 10 stud­ies com­par­ing treat­ed and non-treat­ed youth.

Over­all, there­fore, there was greater evi­dence of treat­ment ben­e­fits on achieve­ment out­comes than on per­for­mance out­comes.

The authors also exam­ined how treat­ment out­comes var­ied for med­ica­tion, non-med­ica­tion, and treat­ments that com­bined both approach­es. Although the num­ber of stud­ies on which these com­par­isons were based is small, avail­able evi­dence sup­port­ed the val­ue of mul­ti­modal treat­ment (e.g., the com­bi­na­tion of med­ica­tion, behav­ior ther­a­py, school con­sul­ta­tion). Such treat­ment yield­ed ben­e­fits in 100% of stud­ies exam­in­ing achieve­ment out­comes and 67% of those exam­in­ing per­for­mance out­comes. For med­ica­tion treat­ment only the per­cent­ages were 75% and 33% respec­tive­ly; for non-med­ical treat­ments, the fig­ures were 75% and 50%.

Summary and Implications

The over­all mes­sage from this sum­ma­ry of research exam­in­ing how treat­ment affects long-term aca­d­e­m­ic out­comes in youth with ADHD is pos­i­tive. Many stud­ies found improve­ment with ADHD treat­ment for both achieve­ment and per­for­mance out­comes, with evi­dence sug­gest­ing that treat­ment has more con­sis­tent­ly pos­i­tive impacts on achieve­ment than on per­for­mance. As the study notes, “More achieve­ment test and aca­d­e­m­ic per­for­mance out­comes improved with mul­ti­modal (100% and 67%, respec­tive­ly) than phar­ma­co­log­i­cal (75% and 33%) or non-phar­ma­co­log­i­cal (75% and 50%) treat­ment alone.”

This is con­sis­tent with the gen­er­al­ly held view that most youth for ADHD should receive mul­ti-modal treat­ment as opposed to med­ica­tion or non-med­ica­tion approach­es alone. How­ev­er, as recent­ly found in anoth­er study that exam­ined treat­ment prac­tices in a large num­ber of pedi­a­tri­cians (Study finds large gaps between research and prac­tice in ADHD diag­no­sis and treat­ment) while med­ica­tion treat­ment was rec­om­mend­ed for over 90% of youth diag­nosed with ADHD, behav­ioral treat­ment was rec­om­mend­ed few­er than 15% of the time. Thus, many chil­dren may not be receiv­ing mul­ti­modal treat­ment in com­mu­ni­ty care.

It is impor­tant to place these find­ings in the con­text of the lim­it­ed data base on which they were drawn. First, despite sys­tem­at­i­cal­ly search­ing the rel­e­vant research over a 32-year peri­od, the authors iden­ti­fied only 5 stud­ies that specif­i­cal­ly com­pared long-term aca­d­e­m­ic out­comes in treat­ed vs. non-treat­ed youth. And, these stud­ies were not nec­es­sar­i­ly ran­dom­ized-con­trolled tri­als, which makes it impos­si­ble to con­clude that pos­i­tive out­comes asso­ci­at­ed with treat­ment can be attrib­uted specif­i­cal­ly to treat­ment itself.

In the years ahead, we hope that the research need­ed to bet­ter address these impor­tant issues will become more avail­able. We need bet­ter data to inform deci­sions as to how to best help each child suc­ceed at school, and at home.

In the mean­time, as we will out­line in our upcom­ing online course, we need to ensure chil­dren with atten­tion deficits access appro­pri­ate non-med­ica­tion treat­ments, com­ple­ment­ing the more com­mon phar­ma­co­log­i­cal ones.

Dr. David Rabin­er is a child clin­i­cal psy­chol­o­gist, Direc­tor of Under­grad­u­ate Stud­ies in the Depart­ment of Psy­chol­ogy and Neu­ro­science at Duke Uni­ver­sity, and founder of the Atten­tion Research UpdateAlvaro Fer­nan­dez, named a Young Glob­al Leader by the World Eco­nomic Forum, is the co-author of The Sharp­Brains Guide to Brain Fit­ness: How to Opti­mize Brain Health and Per­for­mance at Any Age.Child-Brain They have part­nered to offer the upcom­ing online course How to Nav­i­gate Con­ven­tional and Com­ple­men­tary ADHD Treat­ments for Healthy Brain Devel­op­ment. (May 2015; reg­is­tra­tion open)

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Categories: Attention and ADD/ADHD, Cognitive Neuroscience, Education & Lifelong Learning, Health & Wellness

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