ADHD Drugs Don’t Help Kids Perform Better in School

I blogged last April that almost 1 in 5 American high school boys are diagnosed with ADHD. According to Consumer Reports, 59% of children get prescribed medications immediately after an ADHD diagnosis. Approximately 2.7 million children were taking medication for ADHD in the U.S. as of 2007, according to the Centers for Disease Control and Prevention. Millions of children are being diagnosed and treated for a psychiatric condition that impairs their ability to function in school. This is a positive thing, right? It would be if ADHD drugs (stimulant medications like Ritalin or Adderall) actually improved school performance. But the evidence base is growing that these drugs don’t improve academic outcomes in the long term, according to a recent Wall Street Journal article.

One study examined medication usage and educational outcomes of nearly 4,000 students in Quebec.  It found that medication use was associated with increases in emotional problems among girls, and reductions in educational attainment among boys. Princeton economics professor Janet Curie, an author of the study, said that "the possibility that [medication] won't help them [in school] needs to be acknowledged and needs to be closely monitored."

The lack of long-term benefits of medication for children with ADHD is a conclusion from a major U.S. government-funded study known as the MTA. In this study, 579 children with the condition were randomized to one of three different kinds of treatment (medication alone, psychosocial/behavioral treatment alone, a combination of both) or to routine community care (control group) for 14 months.

Initial results of the study, published in 1999, indicated that 8- and 9-year old children who received medication and a combination treatment saw greater improvements in ADHD symptoms than the other two groups. Kids taking medicine also exhibited some improvement in educational outcomes in that first year.

The benefits of taking medication dissipated by the third year, however. The most recent set of assessments, the eight-year follow-up published in 2007, indicated that there were no differences in symptoms or functioning among the youths assigned to the different treatment groups as children. Some other conclusions from the follow up study were:

• Youths with ADHD had more academic, social, and conduct problems, more depression, and more hospitalizations than their peers without ADHD.
• Youths with ADHD who responded well to treatment and maintained their gains for 3 years functioned the best after 8 years.
• 61.5% of the children who were medicated at the end of 14 months had stopped taking their medication by the 8 year follow-up. The reason for so many children stopping their medication is unknown.
• Children who were no longer taking medication at the 8 year follow-up were functioning as well as children who were still medicated.

It’s interesting that more than half of the medicated children stopped taking their medication by the 8 year follow up. Is it because they outgrew their ADHD? Or is it because the families couldn't find enough of a benefit in continuing the drug? The study results showed that children who stopped taking their medication did as well as children who were still medicated. Also children who were randomized in the initial study for no medication did as well after 8 years as children who were randomized in one of the drug groups.

From the Wall Street Journal article, “One way of interpreting the findings is that the medicine proves effective on immediate classroom behaviors like sitting still and interrupting the teacher less, but it doesn't help with other factors important to successful completion of homework or test-taking, like family encouragement.”

There’s certainly no evidence in the above studies supporting the use of stimulant drugs for ADHD. Children are being exposed to dangerous side effects, and parents, insurance companies, and the taxpayers are purchasing drugs that have no proven long-term benefit.

Due to the fact that 15% to 30% of ADHD drugs end up being used by children who don’t have ADHD, do the drugs benefit these children in any way? Although children without ADHD believe that stimulants enhance their cognitive ability, a recent study that examined objective measures like episodic memory, working memory, inhibitory control, intelligence, and scholastic achievement could find very little cognitive benefit from the stimulant Adderall. These children without an ADHD diagnosis are getting high and being exposed to dangerous side effects from stimulant drugs they obtain from friends, but the drugs are not helping them perform better in school.

The burden of proof is on the drug companies and doctors to show any long-term benefit of stimulant drugs for ADHD. The evidence presented in this article clearly indicates little to no benefit. In the absence of any benefits, prescribing these drugs to children should be banned.