Attention-Deficit/Hyperactivity Disorder, School Performance, and Effect of Medication.


Attention-Deficit/Hyperactivity Disorder, School Performance, and Effect of Medication

Jangmo A, Stålhandske A, Chang Z, Chen Q, Almqvist C, Feldman I, Bulik CM, Lichtenstein P, D’Onofrio B, Kuja-Halkola R, Larsson H. J Am Acad Child Adolesc Psychiatry. 2019 Feb 1. pii: S0890-8567(19)30059-0.

Guest Commentary by Dr. Margaret Weiss: These results reflect a design which focused on academic performance rather than achievement, thus differentiating it from earlier studies. If, as the study suggests, stimulants improve academic performance that is a salient functional outcome of considerable interest.


OBJECTIVE: Individuals with Attention-Deficit/Hyperactivity Disorder (ADHD) are at increased risk of poor school performance and pharmacological treatment of ADHD may have beneficial effects on school performance. Conclusions from previous research have been limited by small sample sizes, outcome measures, and treatment follow-up. The current study analyzed school performance in students with ADHD compared to students without ADHD, and the association between pharmacological treatment of ADHD and school performance.

METHOD: A linkage of Swedish national registers covering 657,720 students graduating from year 9 of compulsory school provided measures of school performance, electronically recorded dispensations of ADHD medication, and potentially confounding background factors such as parental socioeconomic status. Primary measures of school performance included student eligibility to upper secondary school and grade point sum.

RESULTS: ADHD was associated with substantially lower school performance independent of socioeconomic background factors. Treatment with ADHD medication for 3 months was positively associated with all primary outcomes, including a decreased risk of no eligibility to upper secondary school, odds ratio of 0.80, 95% confidence interval (CI) 0.76-0.84, and a higher grade point sum (range 0.0-320.0) of 9.35 points, 95% CI=7.88-10.82; standardized coefficient of 0.20.

CONCLUSION: ADHD has a substantial negative impact on school performance while pharmacological treatment for ADHD is associated with higher levels in several measures of school performance. Our findings emphasize the importance of detection and treatment of ADHD at an early stage to reduce the negative impact on school performance.

* Dr. Margaret Weiss is Director of Clinical Research, Child Psychiatry at Cambridge Health Alliance, Harvard University. Her commentary reflects her own opinion. It is not approved or necessarily representative of the CADDRA board.

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