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Does Long-Term Medication Use Improve the Academic Outcomes of Youth with Attention-Deficit/Hyperactivity Disorder?

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Abstract

Youth with Attention-Deficit/Hyperactivity Disorder (ADHD) frequently experience academic impairment, including lower grades than their peers and elevated risk for grade retention and school dropout. Medication is the most commonly used treatment for youth with ADHD, and it is therefore essential to understand the extent to which medication use improves long-term academic functioning. This paper reviews the literature on the relation between long-term medication use and the academic outcomes of youth with ADHD. A systematic literature search was conducted to identify pertinent studies published since 2000 that followed youth with ADHD for 3 or more years. Academic outcomes of interest included school grades, achievement test scores, and grade retention. Nine studies were identified reporting on eight distinct longitudinal samples (N across studies = 8,721). These studies demonstrate that long-term medication use is associated with improvements in standardized achievement scores. However, the magnitude of these improvements is small and the clinical or educational significance is questionable. Evidence for long-term improvements in school grades and grade retention is less compelling. This review highlights methodological considerations in providing directions for future research. The importance of using multiple sources to gather information about medication adherence is discussed, including use of methodologies such as electronic monitors, rather than relying solely on parent report or chart review. Future research should also examine a range of medication adherence definitions in order to determine whether age of onset, duration of use, dose, and/or consistency of use moderates the relation between long-term medication use and academic outcomes.

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References

  • Allensworth, E. M., & Easton, J. Q. (2007). The on-track indicator as a predictor of High School graduation. Chicago, IL: Consortium on Chicago School Research at the University of Chicago.

    Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author.

  • Anesko, K. M., Schoiock, G., Ramirez, R., & Levine, F. M. (1987). The homework problem checklist: Assessing children’s homework difficulties. Behavioral Assessment, 9, 179–185.

    Google Scholar 

  • Balfanz, R., Herzog, L., & Mac Iver, D. J. (2007). Preventing student disengagement and keeping students on the graduation path in urban middle-grades schools: Early identification and effective interventions. Educational Psychologist, 42, 223–235.

    Article  Google Scholar 

  • Barbaresi, W. J., Katusic, S. K., Colligan, R. C., Pankratz, V. S., Weaver, A. L., & Jacobsen, S. J. (2002). How common is attention-deficit/hyperactivity disorder? Incidence in a population-based birth cohort in Rochester, Minn. Archives of Pediatrics and Adolescent Medicine, 156, 217–224.

    PubMed  Google Scholar 

  • Barbaresi, W. J., Katusic, S. K., Colligan, R. C., Weaver, A. L., & Jacobsen, S. J. (2007). Modifiers of long-term school outcomes for children with attention-deficit/hyperactivity disorder: Does treatment with stimulant medication make a difference? Results from a population-based study. Journal of Developmental and Behavioral Pediatrics, 28, 274–287. doi:10.1097/DBP.0b013e3180cabc28.

    Article  PubMed  Google Scholar 

  • Barkley, R. A. (2006). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (3rd ed.). New York: Guilford.

    Google Scholar 

  • Barkley, R. A., & Cunningham, C. E. (1978). Do stimulant drugs improve the academic performance of hyperkinetic children? A review of outcome studies. Clinical Pediatrics, 17, 85–92. doi:10.1177/000992287801700112.

    Article  PubMed  Google Scholar 

  • Barnard, L., Stevens, T., To, Y. M., Lan, W. Y., & Mulsow, M. (2010). The importance of ADHD subtype classification for educational applications of DSM-V. Journal of Attention Disorders, 13, 573–583. doi:10.1177/1087054708326433.

    Article  PubMed  Google Scholar 

  • Bhatara, V., Feil, M., Hoagwood, K., Vitiello, B., & Zima, B. (2004). National trends in concomitant psychotropic medication with stimulants in pediatric visits: Practice versus knowledge. Journal of Attention Disorders, 7, 217–226. doi:10.1177/108705470400700404.

    Article  PubMed  Google Scholar 

  • Biederman, J., Faraone, S. V., Spencer, T. J., Mick, E., Monuteaux, M. C., & Aleardi, M. (2006). Functional impairments in adults with self-reports of diagnosed ADHD: A controlled study of 1001 adults in the community. Journal of Clinical Psychiatry, 67, 524–540. doi:10.4088/JCP.v67n0403.

    Article  PubMed  Google Scholar 

  • Biederman, J., Monuteaux, M. C., Spencer, T., Wilens, T. E., & Faraone, S. V. (2009). Do stimulants protect against psychiatric disorders in youth with ADHD? A 10-year follow-up study. Pediatrics, 124, 71–78. doi:10.1542/peds.2008-3347.

    Article  PubMed  Google Scholar 

  • Bowers, A. J. (2009). Reconsidering grades as data for decision making: More than just academic knowledge. Journal of Educational Administration, 47, 609–629.

    Article  Google Scholar 

  • Bowers, A. J. (2011). What’s in a grade? The multidimensional nature of what teacher-assigned grades assess in high school. Educational Research and Evaluation, 17(3), 141–159.

    Article  Google Scholar 

  • Bussing, R., Mason, D. M., Bell, L., Porter, P., & Garvan, C. (2010). Adolescent outcomes of childhood attention-deficit/hyperactivity disorder in a diverse community sample. Journal of the American Academy of Child and Adolescent Psychiatry, 49, 595–605. doi:10.1016/j.jaac.2010.03.006.

    PubMed  Google Scholar 

  • Centers for Disease Control and Prevention. (2003). Mental health in the United States: Prevalence of diagnosis and medication treatment for attention-deficit/hyperactivity disorder: United States, 2003. MMWR. Morbidity and Mortality Weekly Report, 54, 842–847.

    Google Scholar 

  • Charach, A., Ickowicz, A., & Schachar, R. (2004). Stimulant treatment over five years: Adherence, effectiveness, and adverse effects. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 559–567. doi:10.1097/00004583-200405000-00009.

    Article  PubMed  Google Scholar 

  • Cooper, J., Hall, L., Penland, A., Krueger, A., & May, J. (2009). Measuring medication adherence. Population Health Management, 12(1), 25–30.

    Article  PubMed  Google Scholar 

  • dosReis, S., Mychailyszyn, M. P., Evans-Lacko, S. E., Beltran, A., Riley, A. W., & Myers, M. A. (2009). The meaning of attention-deficit/hyperactivity disorder medication and parents’ initiation and continuity of treatment for their child. Journal of Child and Adolescent Psychopharmacology, 19(4), 377–383.

    Article  PubMed  Google Scholar 

  • DuPaul, G. J., & Stoner, G. (2003). ADHD in the schools: Assessment and intervention strategies (2nd ed.). New York: Guilford.

    Google Scholar 

  • Epstein, J. N., Langberg, J. M., Lichtenstein, P. K., Altaye, M., Brinkman, W. B., House, K., et al. (2010). Attention-deficit/hyperactivity disorder outcomes for children treatment in community-based pediatric settings. Archives of Pediatrics and Adolescent Medicine, 164, 160–165.

    Article  PubMed  Google Scholar 

  • Epstein, J. N., Langberg, J. M., Lichtenstein, P. K., Kolb, R., Altaye, M., & Simon, J. O. (2011). Use of an Internet portal to improve community-based pediatric ADHD care: A cluster randomized trial. Pediatrics, 128, e1210–e1217. doi:10.1542/peds.2011-0872.

    Article  Google Scholar 

  • Epstein, J. N., Langberg, J. M., Lichtenstein, P. K., Mainwaring, B. A., Luzader, C. P., & Stark, L. J. (2008). Community-wide intervention to improve the attention-deficit/hyperactivity disorder assessment and treatment practices of community physicians. Pediatrics, 122, 19–27. doi:10.1542/peds.2007-2704.

    Article  PubMed  Google Scholar 

  • Evans, S. W., Pelham, W. E., Smith, B. H., Bukstein, O., Gnagy, E. M., Greiner, A. R., et al. (2001). Does-response effects of methylphenidate on ecologically valid measures of academic performance and classroom behavior in adolescents with ADHD. Experimental and Clinical Psychopharmacology, 9, 163–175. doi:10.1037/1064-1297.9.2.163.

    Article  PubMed  Google Scholar 

  • Frazier, T. W., Youngstrom, E. A., Glutting, J. J., & Watkins, M. W. (2007). ADHD and achievement: Meta-analysis of the child, adolescent, and adult literatures and a concomitant study with college students. Journal of Learning Disabilities, 40, 49–65. doi:10.1177/00222194070400010401.

    Article  PubMed  Google Scholar 

  • Gearing, R. E., Townsend, L., MacKenzie, M., & Charach, A. (2011). Reconceptualizing medication adherence: Six phases of dynamic adherence. Harvard Review of Psychiatry, 19(4), 177–189.

    Article  PubMed  Google Scholar 

  • Gresham, F. M., & Elliott, S. N. (1990). Social skills rating system manual. Circle Pines, MN: American Guidance Service.

    Google Scholar 

  • Hack, S., & Chow, B. (2001). Pediatric psychotropic medication compliance: A literature review and research-based suggestions for improving treatment compliance. Journal of Child and Adolescent Psychopharmacology, 22, 59–67.

    Article  Google Scholar 

  • Hale, J. B., Reddy, L. A., Semrud-Clikeman, M., Hain, L. A., Whitaker, J., Morley, J., et al. (2011). Executive impairment determines ADHD medication response: Implications for academic achievement. Journal of Learning Disabilities, 44(2), 196–212. doi:10.1177/002221910391191.

    Article  PubMed  Google Scholar 

  • Hansen, D. L., & Hansen, E. H. (2006). Caught in a balancing act: Parents’ dilemmas regarding their ADHD child’s treatment with stimulant medication. Qualitative Health Research, 16, 1267–1285. doi:10.1177/1049732306292543.

    Article  PubMed  Google Scholar 

  • Hechtman, L., Abikoff, H., Klein, R. G., Weiss, G., Respitz, C., Kouri, J., et al. (2004). Academic achievement and emotional status of children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 812–819. doi:10.1097/01.chi.0000128796.84202.eb.

    Article  PubMed  Google Scholar 

  • Hommel, K. A., Davis, C. M., & Baldassano, R. N. (2009). Objective versus subjective assessment of oral medication adherence in pediatric inflammatory bowel disease. Inflammatory Bowel Diseases, 15, 589–593. doi:10.1002/ibd.20798.

    Article  PubMed  Google Scholar 

  • Huang, Y.-S., Tsai, M.-H., & Guilleminault, C. (2011). Pharmacological treatment of ADHD and the short and long-term effects of sleep. Current Pharmaceutical Design, 17, 1450–1458. doi:10.2174/138161211796197179.

    Article  PubMed  Google Scholar 

  • Klapp Lekholm, A., & Cliffordson, C. (2008). Discrepancies between school grades and test scores at individual and school level: Effects of gender and family background. Educational Research and Evaluation, 14, 181–199.

    Article  Google Scholar 

  • Langberg, J. M., Arnold, L. E., Flowers, A. M., Epstein, J. N., Altaye, M., Hinshaw, S. P., et al. (2010). Parent-reported homework problems in the MTA study: Evidence for sustained improvement with behavioral treatment. Journal of Clinical Child and Adolescent Psychology, 39, 220–233. doi:10.1080/15374410903532700.

    Article  PubMed  Google Scholar 

  • Langberg, J. M., Molina, B. S. G., Arnold, L. E., Epstein, J. N., Altaye, M., Hinshaw, S. P., et al. (2011). Patterns and predictors of adolescent academic achievement and performance in a sample of children with attention-deficit/hyperactivity disorder. Journal of Clinical Child and Adolescent Psychology, 40, 519–531. doi:10.1080/15374416.2011.581620.

    Article  PubMed  Google Scholar 

  • LeFever, G. B., Villers, M. S., Morrow, A. L., & Vaughn, E. S., I. I. I. (2002). Parental perceptions of adverse educational outcomes among children diagnosed and treated for ADHD: A call for improved school/provider collaboration. Psychology in the Schools, 39, 63–71. doi:10.1002/pits.10000.

    Article  Google Scholar 

  • Loe, I. M., & Feldman, H. M. (2007). Academic and educational outcomes of children with ADHD. Ambulatory Pediatrics, 7, 82–90. doi:10.1016/j.ambp.2006.05.005.

    Article  PubMed  Google Scholar 

  • Markus, S. C., & Durkin, M. (2011). Stimulant adherence and academic performance in urban youth with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 50, 480–489. doi:10.1016/j.jaac.2011.02.007.

    Article  Google Scholar 

  • Massetti, G. M., Lahey, B. B., Pelham, W. E., Loney, J., Ehrhardt, A., Lee, S. S., et al. (2008). Academic achievement over 8 years among children who met modified criteria for attention-deficit/hyperactivity disorder at 4–6 years of age. Journal of Abnormal Child Psychology, 36, 399–410. doi:10.1007/s10802-007-9186-4.

    Article  PubMed  Google Scholar 

  • Mayes, S. D., & Calhoun, S. L. (2007a). Learning, attention, writing, and processing speed in typical children and children with ADHD, autism, anxiety, depression, and oppositional-defiant disorder. Child Neuropsychology, 13, 469–493.

    Article  PubMed  Google Scholar 

  • Mayes, S. D., & Calhoun, S. L. (2007b). WISC-IV and WISC-III predictors of academic achievement in children with ADHD. School Psychology Quarterly, 22, 234–249.

    Article  Google Scholar 

  • Mayes, S. D., Calhoun, S. L., Bixler, E. O., & Zimmerman, D. N. (2009). IQ and neuropsychological predictors of academic achievement. Learning and Individual Differences, 19, 238–241.

    Article  Google Scholar 

  • Molina, B. S. G., Hinshaw, S. P., Swanson, J. M., Arnold, L. E., Vitiello, B., Jensen, P. S., et al. (2009). The MTA at 8 years: Prospective follow-up of children treated for combined type ADHD in a multisite study. Journal of the American Academy of Child and Adolescent Psychiatry, 48, 484–500. doi:10.1097/CHI.0b013e31819c23d0.

    Article  PubMed  Google Scholar 

  • MTA Cooperative Group. (1999). A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 56, 1073–1086.

    Article  Google Scholar 

  • MTA Cooperative Group. (2004). National Institute of Mental Health Multimodal Treatment Study of ADHD follow-up: 24-month outcomes of treatment strategies for attention-deficit/hyperactivity disorder. Pediatrics, 113, 754–761.

    Article  Google Scholar 

  • Office of Juvenile Justice and Delinquency Prevention. (1995). Juvenile offenders and victims: A national report. Pittsburgh: National Center for Juvenile Justice.

  • Olfson, M., Gameroff, M. J., Marcus, S. C., & Jensen, P. J. (2003). National trends in the treatment of attention deficit hyperactivity disorder. American Journal of Psychiatry, 160, 1071–1077.

    Article  PubMed  Google Scholar 

  • Pappadopulos, E., Jensen, P. S., Chait, A. R., Arnold, L. E., Swanson, J. M., Greenhill, L. L., et al. (2009). Medication adherence in the MTA: Saliva methylphenidate samples versus parent report and mediating effect of concomitant behavioral treatment. Journal of the American Academy of Child and Adolescent Psychiatry, 48, 501–510. doi:10.1097/CHI.0b013e31819c23ed.

    Article  PubMed  Google Scholar 

  • Pelham, W. E. (1986). The effects of psychostimulant drugs on learning and academic achievement in children with attention-deficit hyperactivity disorders and learning disabilities. In J. K. Torgesen & B. Wong (Eds.), Psychological and educational perspectives on learning disabilities (pp. 259–295). New York: Academic Press.

    Google Scholar 

  • Pelham, W. E., Gnagy, E. M., Burrows-Maclean, L., Williams, A., Fabiano, G. A., Morrisey, S. M., et al. (2001). Once-a-day Concerta methylphenidate versus three-times-daily methylphenidate in laboratory and natural settings. Pediatrics, 107, e105. doi:10.1542/peds.107.6.e105.

    Article  PubMed  Google Scholar 

  • Perwien, A., Hall, J., Swensen, A., & Swindle, R. (2004). Stimulant treatment patterns and compliance in children and adults with newly treated attention-deficit/hyperactivity disorder. Journal of Managed Care Pharmacy, 10, 122–129.

    PubMed  Google Scholar 

  • Power, T. J., Werba, B. E., Watkins, M. W., Angelucci, J. G., & Eiraldi, R. B. (2006). Patterns of parent-reported homework problems among ADHD-referred and non-referred children. School Psychology Quarterly, 21, 13–33. doi:10.1521/scpq.2006.21.1.13.

    Article  Google Scholar 

  • Powers, R. L., Marks, D. J., Miller, C. J., Newcorn, J. H., & Halperin, J. M. (2008). Stimulant treatment in children with attention-deficit/hyperactivity disorder moderates adolescent academic outcome. Journal of Child and Adolescent Psychopharmacology, 18, 449–459. doi:10.1089/cap.2008.021.

    Article  PubMed  Google Scholar 

  • Randall, J., & Englehard, G., Jr. (2009). Examining teacher grades using Rasch measurement theory. Journal of Educational Measurement, 46, 1–18. doi:10.1111/j.1745-3984.2009.01066.x.

    Article  Google Scholar 

  • Rapoff, M. A. (2009). Adherence to pediatric medical regimens (2nd ed.). New York: Springer.

    Google Scholar 

  • Rapport, M. D., Quinn, S. O., DuPaul, G. J., Quinn, E. P., & Kelly, K. L. (1989). Attention deficit disorder with hyperactivity and methylphenidate: The effects of dose and mastery level on children’s learning performance. Journal of Abnormal Child Psychology, 17, 669–689. doi:10.1007/BF00917730.

    Article  PubMed  Google Scholar 

  • Reich, W., Huang, H., & Todd, R. D. (2006). ADHD medication use in a population-based sample of twins. Journal of the American Academy of Child and Adolescent Psychiatry, 45, 801–807. doi:10.1097/01.chi.0000219833.00979.c3.

    Article  PubMed  Google Scholar 

  • Rumberger, R. W. (2004). Why students drop out of school. In G. Orfield (Ed.), Dropouts in America: Confronting the graduation rate crisis (pp. 131–156). Cambridge, MA: Harvard Education Press.

    Google Scholar 

  • Rumberger, R. W., & Palardy, G. J. (2005). Test scores, dropout rates, and transfer rates as alternative indicators of high school performance. American Educational Research Journal, 42, 3–42.

    Article  Google Scholar 

  • Schachar, R., & Tannock, R. (1993). Childhood hyperactivity and psychostimulants: A review of extended treatment studies. Journal of Child and Adolescent Psychopharmacology, 3, 81–97. doi:10.1089/cap.1993.3.81.

    Article  PubMed  Google Scholar 

  • Scheffler, R. M., Brown, T. T., Fulton, B. D., Hinshaw, S. P., Levine, P., & Stone, S. (2009). Positive association between attention-deficit/hyperactivity disorder medication use and academic achievement during elementary school. Pediatrics, 123, 1273–1279. doi:10.1542/peds.2008-1597.

    Article  PubMed  Google Scholar 

  • Swanson, J. M. (1992). School-based assessments and interventions for ADD students. Irvine, CA: KC Publishing.

    Google Scholar 

  • Swanson, J. M., Cantwell, D., Lerner, M., McBurnett, K., & Hanna, G. (1991). Effects of stimulant medication on learning in children with ADHD. Journal of Learning Disabilities, 24, 219–230. doi:10.1177/002221949102400406.

    Article  PubMed  Google Scholar 

  • Swanson, H. L., Trainin, G., Necoechea, D. M., & Hammill, D. D. (2003). Rapid naming, phonological awareness, and reading: A meta-analysis of the correlation evidence. Review of Educational Research, 73, 407–440.

    Article  Google Scholar 

  • Thiruchelvam, D., Charach, A., & Schachar, R. J. (2001). Moderators and mediators of long-term adherence to stimulant treatment in children with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 922–928.

    Article  PubMed  Google Scholar 

  • van de Loo-Neus, G. H. H., Rommelse, N., & Buitelaar, J. K. (2011). To stop or not to stop? How long should medication treatment of attention-deficit hyperactivity disorder be extended? European Neuropsychopharmacology, 21, 584–599. doi:10.1016/j.euroneuro.2011.03.008.

    Article  PubMed  Google Scholar 

  • Van der Oord, S., Prins, P. J. M., Oosterlaan, J., & Emmelkamp, P. M. G. (2008). Efficacy of methylphenidate, psychosocial treatments and their combination in school-aged children with ADHD: A meta-analysis. Clinical Psychology Review, 28, 783–800. doi:10.1016/j.cpr.2007.10.007.

    Article  PubMed  Google Scholar 

  • Wagner, G. J., & Rabkin, J. G. (2000). Measuring medication adherence: Are missed doses reported more accurately then perfect adherence? AIDS Care, 12(4), 405–408.

    Article  PubMed  Google Scholar 

  • Wilens, T. E., Biederman, J., & Spencer, T. J. (2002). Attention deficit/hyperactivity disorder across the lifespan. Annual Review of Medicine, 53, 113–131. doi:10.1146/annurev.med.53.082901.103945.

    Article  PubMed  Google Scholar 

  • Wolf, L. E. (2001). College students with ADHD and other hidden disabilities. Annals of the New York Academy of Sciences, 931, 385–395. doi:10.1111/j.1749-6632.2001.tb05792.x.

    Article  PubMed  Google Scholar 

  • Zwick, R., & Greif Green, J. (2007). New perspectives on the correlation of SAT scores, high school grades and socioeconomic factors. Journal of Educational Measurement, 44, 23–45. doi:10.1111/j.1745-3984.2007.00025.x.

    Article  Google Scholar 

  • Zwick, R., & Sklar, J. C. (2005). Predicting college grades and degree completion using high school grades and SAT scores: The role of student ethnicity and first language. American Educational Research Journal, 42, 439–464. doi:10.3102/00028312042003439.

    Article  Google Scholar 

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Acknowledgments

During completion of this manuscript, the first author was supported by R305A090059 from the Institute of Education Sciences (IES) and R01MH083665 from the National Institute of Mental Health (NIMH), and the second author was supported in part by the Ohio Department of Mental Health (ODMH Grant 12.1281).

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Langberg, J.M., Becker, S.P. Does Long-Term Medication Use Improve the Academic Outcomes of Youth with Attention-Deficit/Hyperactivity Disorder?. Clin Child Fam Psychol Rev 15, 215–233 (2012). https://doi.org/10.1007/s10567-012-0117-8

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