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By Dennis Miller, BHC Senior Writer

A recent study has revealed that schoolchildren with attention deficit hyperactivity disorder (ADHD) who take medication achieve superior academic performance over students with unmedicated ADHD. The study, which surveyed children five times over the years between kindergarten and fifth grade, found that students who took ADHD medications achieved on average math scores 2.9 points higher and reading scores 5.4 points higher than unmedicated students with ADHD. The NIMH-funded study’s results were published in the May 2009 issue of Pediatrics, and a full PDF is available here.

The study was led by Richard Scheffler, Ph.D., who is the Director of The Nicholas C. Petris Center on Health Care Markets and Consumer Welfare at the University of California Berkeley. Dr. Scheffler says the study provides important new information that should inform the sometimes contentious debate over ADHD medications. “We’re not suggesting or saying that the clinicians need to think that medication is the only way to treat attention deficit,” says Dr. Scheffler. “We know there’s a range of treatments including counseling, behavioral therapy and the like, and also involving the family and the school. But for a significant number of children, medication should also be part of that package of treatment.”

Dr. Scheffler emphasizes that this study was not a controlled clinical trial. Rather, it was an analysis of the academic records of a sample of 594 children diagnosed with ADHD who were enrolled in the national Early Childhood Longitudinal Study, Kindergarten Class of 1998-1999, underaken by the U.S. Department of Education. This analysis showed gains equivalent to the progress typically made in one-fifth of a school year in math, and one-third of a school year in reading.

While the gains noted did not elevate students with medicated ADHD to the same performance level as students without ADHD, and while they were not major gains, the researchers noted that any academic improvement during these early school years is critical, as early academic success often predicts later school progress. Children with ADHD tend to have lower grades, lower math and reading scores, and are more likely to repeat a year or drop out of school altogether than students without ADHD.

Dr. Scheffler and his colleagues plan additional research with the aim of bringing further clarity to the sometimes controversial debate over ADHD medication. “We hope to put this current study and do more on it, and also to write a book which lays out all the evidence on both sides of the issue, and tries to make sense of a lot of disparate articles written by different people, and try to bring some clarity, so parents and clinicians can have a better sense of what the issues are in treating attention deficit and what the best alternatives are for improving the functioning of these children in school and society as a whole.”

In recognition of ADHD Awareness Week (Spetember 13 – 19th), Behavioral Health Central contacted Dr. Scheffler this week to discuss the study and what it found. To listen to our interview, click the audio icon above. The following is a written transcript of our conversation:

BHC: This is Dennis Miller of Behavioral Health Central. With me today is Dr. Richard Scheffler, Director of the Nicholas C. Petris Center on Healthcare Markets and Consumer Welfare at the University of California, Berkeley. Dr. Scheffler is the lead author of a recent study funded by the National Institute of Mental Health which found that students with ADHD who took medication had math scores that were on average 2.9 points higher and reading scores 5.4 points higher than their unmedicated peers with ADHD. The study was published in the May 2009 issue of Pediatrics.

Dr. Scheffler thank you for joining us today.

Richard Scheffler: Happy to be here.

BHC: Tell us a little bit more about the study and what it found.

RS: Well, this is a study of following children from the kindergarten through the fifth grade. It’s a national sample cohort of children and it’s probably the most comprehensive study of its type.

What we were able to look at was children, all of whom had ADHD diagnosed. And we have an idea of when they started to take medications. But the important part about the study is, we had their standardized math and reading scores from each of the years. So with that, we were able to take a look at the association between medication and their test scores the following year. We found out that children on average who received medication scored better on math and reading scores.

BHC: And what is the significance of this news, do you feel, for clinicians?

RS: Well, this is a controversial area and I think clinicians need to look at the total range of evidence. Let me say what we’re not saying: We’re not suggesting or saying that the clinicians need to think that medication is the only way to treat attention deficit. We know there’s a range of treatments, including counseling, behavioral therapy and the like, and also involving the family and the school. But for a significant number of children, medication should also be part of that package of treatment. And so we’re presenting this as additional evidence.

This is not a controlled clinical trial. So that still needs to be done, but the associations are quite strong and they hold up quite well. And so, we think medication is a promising treatment for a number of children with attention deficit and clinicians need to look at our study as another piece of evidence that suggests that.

BHC: Did you find that the medications put the children on an equal performance level with their non-ADHD afflicted peers or simply above those with ADHD who were not medicated?

RS: That’s an excellent question. There was still a gap between those children who were non-ADHD and those with ADHD, even with the medication. This narrowed the gap but did not remove it.

BHC: Were the gains in the math and reading identical in nature or were there differences that suggest something about how ADHD affects the processing of information in the brain?

RS: There seemed to be a little bit better results I recall on the reading scores and they were a little bit more delayed. The reading score improvements happened further on than the math score improvements, but these were not that strong. But the overall effect was about a third or a quarter of a school year on average and that’s quite significant for the overall population.

BHC: Did your study look at any particular medications or was the criteria simply that they were on some recommended medication for ADHD?

RS: It was the latter. We didn’t test for specific types of medication. We do know what medication they took, but we did not investigate that in the current study.

BHC: I see. Is there any further research planned in this area?

RS: Oh yes, there is, of course. We have a funded grant by the Robert Wood Johnson Foundation. Steve Hinshaw and I — Hinshaw is my colleague; he’s chairman of the Psychology Department here at Berkeley —  he and I are writing a book on this topic supported by a grant from the Robert Wood Johnson Foundation. And so, we hope to put this current study, to do more on it, but also to write a book which lays out all the evidence on both sides of the issue and tries to make sense of a lot of disparate articles written by different people and try to bring some clarity, so parents and clinicians can have a better sense of what the issues are in treating it attention deficit and what are the best alternatives for improving the functioning of these children in school and society as a whole.

BHC: Well, great! Dr. Scheffler, anything else that you’d like to add that we haven’t covered so far?

RS: No, just thank you for the opportunity and we’re looking forward to presenting more findings quite soon in this area, which is important and we know also quite controversial.
 

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