Drug Treatment Improves Long-Term School Success, Study Shows
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Reviewed By Louise Chang, MD
Sept. 19, 2007 -- Kids with attention deficit hyperactivity disorder (ADHD) who take Ritalin or other prescription stimulants are more likely to achieve long-term academic success than children with ADHD who don't take drugs.
That is the finding from the longest and most comprehensive follow-up study of school performance among children with ADHD ever conducted.
Researchers from the Mayo Clinic had unprecedented access to the medical and school records of an entire population of children living in a school district in Rochester, Minn. As a result, they were able to follow the children's progress from birth to age 18.
The results showed that compared with kids without ADHD, children with the disorder were at higher risk for poor long-term academic outcomes, including lower reading scores, more school absenteeism, and having to repeat a grade.
Among children with ADHD, treatment with prescription stimulants was found to significantly lower the risk of these outcomes.
Stimulants and School Performance
Earlier studies have linked treatment with stimulants to short-term improvements in school performance. But the study is the first to show long-term benefits even after drug treatment has been stopped.
The children in the study who took Ritalin or other stimulants typically began treatment in elementary school, and they took the drugs for an average of 2.5 years. Many kids took the drugs for five years or more.
"Long-term school outcomes seem to be improved when children are treated with appropriate stimulant medication therapy for ADHD," researcher William J. Barbaresi, MD, of the Mayo Clinc, tells WebMD.
"This finding should prompt us to make every effort to ensure that all children with ADHD are identified and have an opportunity to receive appropriate treatment."
The Mayo researchers compared outcomes among 370 children in the population cohort diagnosed with ADHD between 1976 and 1982 and 740 children without ADHD living in the same Minnesota school district. The groups were matched for sex and age.
Among the major findings from the study:
- Children with ADHD were 1.8 times less likely to be held back a grade if they were treated with stimulant medications.
- Girls were as likely as boys to have worse school outcomes when their ADHD was not treated with drugs.
- Children with ADHD who also had other psychiatric or learning disorders were at greater risk for poor academic performance than other children with ADHD.
Not Just Controlling Behavior
Nearly 2 million children in the United States have ADHD, but many children with the disorder remain undiagnosed and many more do not get treatment.
Barbaresi says the Mayo research offers some of the first evidence that treatment with stimulant medications can have a lasting impact on quality of life into adulthood.
The research appears in the August issue of the Journal of Developmental and Behavioral Pediatrics.
"The criticism [of stimulant drugs] has been that we are treating children just to control behavior and other undesirable symptoms," he says. "But these findings show a real impact in terms of life outcome."
Pediatric psychologist Ronald Brown, PhD, of the Medical University of South Carolina, says it is clear that Ritalin and other stimulant drug treatments can positively affect school performance and other life outcomes in children with ADHD.
But he adds that too many health providers rely on drugs alone, ignoring other effective treatments like psychotherapy, special education, and behavioral interventions.
"Pediatricians have to treat many kids in a short period of time, so it is hard for them to provide any other type of treatment," he says. "And many insurance companies don't pay for additional services for children with ADHD."
Brown chaired a recent American Psychological Association (APA) task force examining the use of drugs in children with mental disorders.
The group concluded that a combination of behavioral therapy and drug treatment can often be more effective than either treatment alone in the treatment of ADHD.
"The message to parents of children with ADHD is that there are treatments that work, and stimulants are just one of those treatments," Brown says. "If parents don't feel comfortable with medication there are other options."
SOURCES: Barbaresi, W.J. Journal of Developmental and Behavioral Pediatrics, August 2007; vol 28: pp 265-287. William J. Barbaresi, MD, department of pediatric and adolescent medicine, Mayo Clinic. Ron Brown, PhD, pediatric psychologist and professor of pediatrics, Medical University of South Carolina; and spokesman, American Psychological Association.
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