Use of ADHD drugs tied to higher test scores.(BEHAVIORAL PEDIATRICS)(Clinical report)

Children treated with medication for attention-deficit/hyperactivity disorder during their elementary school years score higher on standardized tests for mathematics and reading, compared with their ADHD peers who are not medicated, data from a longitudinal study of 594 children show.

However, the gains did not close the test-score gap between children with and without the condition, Richard M. Schemer, Ph.D., of the University of California, Berkeley, and his colleagues reported.

They also noted that children who were medicated for a longer time had reading scores of just over 5 points higher than those of their unmedicated peers. And although they did not find a significant interaction with sex, they did find that the medication-reading association was lower in children with an individualized education program than it was for those with no such program.

ADHD affects about 8% of school-aged children in the United States, of whom about 56% are treated with a prescription medication. The condition is marked by inattention and impulsivity, and by atypical levels of physical activity. This population often also grapples with lower academic achievement, compared with non-ADHD peers, as well as higher grade retention, special education placement, and dropout rates. However, the association between medication use and academic achievement is "largely unknown," the investigators wrote (Pediatrics 2009; 123:1272-9).

The investigators drew on data from the Early Childhood Longitudinal Study-Kindergarten Class of 1998-1999 (ECLS-K), which tracks the academic progress of a nationally representative sample of children who attended kindergarten in the United States during that period. The full ECLS-K sample was 8,370, of whom 594 were diagnosed with ADHD. Of those with ADHD, 75% were boys, 71.6% were white, 12.2% black, 11.0% Hispanic, and 1.4% Asian/Pacific islander. The data were collected in five waves between kindergarten and fifth grade--in the fall and spring of kindergarten and in the spring of the first, third, and fifth grades, over a 6-year period. The data set included information about whether a child was diagnosed with ADHD and was being medicated for the condition.

The mean mathematics score in medicated children was 2.9 points higher than that of the unmedicated children, comparable with the gains achieved in 0.19 school years. In regard to reading scores, only children who had been medicated from the spring of kindergarten onward had a significantly different score--5.4 points higher than their unmedicated peers, which was comparable with 0.29 school years. Neither of these improvements in the medicated children narrowed the gap between children with and without ADHD, the investigators noted.

Dr. David Fassler, who was not involved with the study, said in an interview that the results are consistent with general clinical experience. However, because of the methodology used, he said, the results should be "'interpreted with caution.

"For example, the authors rely on the parents' reports of both diagnosis and medication," said Dr. Fassler, a child and adolescent psychiatrist in Burlington, Vt. "Also, they did not collect data on treatments other than medication, such as behavioral interventions. "Nonetheless, I expect the findings will prove interesting and somewhat reassuring to parents and physicians evaluating treatment options for children with ADHD.'"

The authors reported that they had no relevant financial disclosures.

The study was funded by a grant from the National Institute of Mental Health.

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