How effective are drug treatments for children with ADHD at improving on-task behaviour and academic achievement in the school classroom? A systematic review and meta-analysis
- 6k Downloads
- 55 Citations
Abstract
Attention-deficit hyperactivity disorder (ADHD) has a significant impact on children’s classroom behaviour, daily functioning and experience of school life. However, the effects of drug treatment for ADHD on learning and academic achievement are not fully understood. This review was undertaken to describe the effects of methylphenidate, dexamfetamine, mixed amfetamine salts and atomoxetine on children’s on-task behaviour and their academic performance, and to perform a meta-analysis to quantify these effects. Nine electronic databases were systematically searched for randomized controlled trials comparing drug treatment for ADHD against (i) no drug treatment, (ii) baseline (in crossover trials), or (iii) placebo; reporting outcomes encompassing measures of educational achievement within the classroom environment. Forty-three studies involving a pooled total of 2,110 participants were identified for inclusion. Drug treatment benefited children in the amount of school work that they completed, by up to 15 %, and less consistently improved children’s accuracy in specific types of academic assignments, such as arithmetic. Similar improvements were seen in classroom behaviour, with up to 14 % more of children’s time spent “on task”. Methylphenidate, dexamfetamine and mixed amfetamine formulations all showed beneficial effects on children’s on-task behaviour and academic work completion. Atomoxetine was examined in two studies, and was found to have no significant effect. These review findings suggest that medication for ADHD has the potential to improve children’s learning and academic achievement.
Keywords
ADHD Attention-deficit hyperactivity disorder Medication Education AchievementNotes
Acknowledgments
KS is partly funded by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Nottinghamshire, Derbyshire, Lincolnshire. VP is funded by the NIHR as a Doctoral Research Fellow and was previously funded by the NIHR as an In-Practice Fellow.
Conflict of interest
None.
Supplementary material
References
- 1.The MTA Cooperative Group (1999) A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal Treatment Study of Children with ADHD. Arch Gen Psychiatry 56(12):1073–1086CrossRefGoogle Scholar
- 2.Polanczyk G, Silva de Lima M, Horta BL, Biederman J, Rohde LA (2007) The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry 164(6):942–948PubMedCrossRefGoogle Scholar
- 3.Taylor E et al (2004) European clinical guidelines for hyperkinetic disorder—first upgrade. Eur Child Adolesc Psychiatry 13(Suppl 1):I7–I30PubMedGoogle Scholar
- 4.American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington, DCGoogle Scholar
- 5.DuPaul GJ, Stoner G (2003) ADHD in the schools: assessment and intervention strategies, 2nd edn. Guilford Press, New YorkGoogle Scholar
- 6.Fergusson DM et al (1997) Attentional difficulties in middle childhood and psychosocial outcomes in young adulthood. J Child Psychol Psychiatry 38(6):633–644PubMedCrossRefGoogle Scholar
- 7.Klassen AF et al (2004) Health-related quality of life in children and adolescents who have a diagnosis of attention-deficit/hyperactivity disorder. Pediatrics 114:e541PubMedCrossRefGoogle Scholar
- 8.Harpin VA (2005) The effect of ADHD on the life of an individual, their family, and community from preschool to adult life. Arch Dis Child 90(Suppl I):i2–i7PubMedCrossRefGoogle Scholar
- 9.Barkley RA (2002) Major life activity and health outcomes associated with attention-deficit/hyperactivity disorder. J Clin Psychiatry 63(Suppl 12):10–15PubMedGoogle Scholar
- 10.Manuzza S et al (1998) Adult psychiatric status of hyperactive boys grown up. Am J Psychiatry 155:4Google Scholar
- 11.Frazier TW et al (2007) ADHD and achievement : meta-analysis of the child, adolescent, and adult literatures and a concomitant study with college students. J Learn Disabil 40:49PubMedCrossRefGoogle Scholar
- 12.Biederman J et al (2012) An examination of the impact of ADHD on IQ: a large, controlled, family based analysis. Biol Psychiatry 71:1S–316S Abstract no. 773CrossRefGoogle Scholar
- 13.Duric NS, Elgen IB (2011) Norwegian children and adolescents with ADHD—a retrospective clinical study: subtypes and comorbid conditions and aspects of cognitive performance and social skills. Adolesc Psychiatry 1:349–354Google Scholar
- 14.Bridgett DJ, Walker ME (2006) Intellectual functioning in adults with ADHD: a meta-analytic examination of full scale IQ differences between adults with and without ADHD. Psychol Assess 18(1):1–14PubMedCrossRefGoogle Scholar
- 15.Barry TD, Lyman RD, Klinger LG (2002) Academic underachievement and attention-deficit/hyperactivity disorder: the negative impact of symptom severity on school performance. J Sch Psychol 40(3):259–283CrossRefGoogle Scholar
- 16.Loe IM, Feldman HM (2007) Academic and educational outcomes of children with ADHD. Ambul Pediatr 7(1):82–90PubMedCrossRefGoogle Scholar
- 17.Massetti GM 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. J Abnorm Child Psychol 36(3):399–410PubMedCrossRefGoogle Scholar
- 18.Polderman TJC, Boomsma D, Bartels M, Verhulst FC, Huizink AC (2010) A systematic review of prospective studies on attention problems and academic achievement. Acta Psychiatr Scand 122(4):271–284PubMedCrossRefGoogle Scholar
- 19.Wigal SB, Wigal TL (2006) The laboratory school protocol: its origin, use, and new applications. J Atten Disord 10:92PubMedCrossRefGoogle Scholar
- 20.National Institute for Health and Clinical Excellence (2008) Attention deficit hyperactivity disorder: Diagnosis and management of ADHD in children, young people and adults (National Clinical Practice Guideline Number 72) National Institute for Health and Clinical Excellence: LondonGoogle Scholar
- 21.Swanson JM et al (1993) Effect of stimulant medication on children with attention deficit disorder: a “review of reviews”. Except Child 60(2):154–162Google Scholar
- 22.Jadad AR et al (1999) Treatment of attention-deficit/hyperactivity disorder. Evid Rep Technol Assess 11(i–viii):1–341Google Scholar
- 23.Schachar R et al (2002) Attention-deficit hyperactivity disorder: critical appraisal of extended treatment studies. Can J Psychiatry Revue Canadienne De Psychiatrie 47(4):337–348Google Scholar
- 24.Backman J, Firestone P (1979) A review of psychopharmacological and behavioral approaches to the treatment of hyperactive children. Am J Orthopsychiatry 49(3):500–504PubMedCrossRefGoogle Scholar
- 25.Carlson JS et al (2007) Methylphenidate, atomoxetine, and caffeine: a primer for school psychologists. J Appl Sch Psychol 24(1):127–146CrossRefGoogle Scholar
- 26.Murray DW et al (2011) Effects of OROS methylphenidate on academic, behavioral, and cognitive tasks in children 9 to 12 years of age with attention-deficit/hyperactivity disorder. Clin Pediatr 50:308CrossRefGoogle Scholar
- 27.Scheffler RM et al (2009) Positive association between attention-deficit/hyperactivity disorder medication use and academic achievement during elementary school. Pediatrics 123:1273PubMedCrossRefGoogle Scholar
- 28.Hale JB et al (2011) Executive impairment determines ADHD medication response: implications for academic achievement. J Learn Disabil 44:196PubMedCrossRefGoogle Scholar
- 29.Semrud-Clikeman M et al (2008) Executive functioning in children with attention-deficit/hyperactivity disorder: combined type with and without a stimulant medication history. Neuropsychology 22(3):329–340PubMedCrossRefGoogle Scholar
- 30.Barkley RA, Murphy KR, Fischer M (2008) ADHD in adults: what the science says. Guilford Press, New YorkGoogle Scholar
- 31.Biederman J et al (2006) Young adult outcome of attention deficit hyperactivity disorder: a controlled 10-year follow-up study. Psychol Med 39:167–179CrossRefGoogle Scholar
- 32.Molina BSG et al (2009) MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study. J Am Acad Child Adolesc Psychiatry 48:5CrossRefGoogle Scholar
- 33.Biederman J, Faraone SV (2006) The effects of attention-deficit/hyperactivity disorder on employment and household income. Medscape Gen Med 8(3):12Google Scholar
- 34.The Cochrane Collaboration (2008) Cochrane handbook for systematic reviews of interventions version 5.0.1. Higgins JPT, GS (editors). The Cochrane CollaborationGoogle Scholar
- 35.The Cochrane Collaboration (2008) Review Manager Version 5.0. The Nordic Cochrane Centre, CopenhagenGoogle Scholar
- 36.Biederman J et al (2007) Lisdexamfetamine dimesylate and mixed amphetamine salts extended-release in children with ADHD: a double-blind, placebo-controlled, crossover analog classroom study. Biol Psychiatry 62(9):970–976PubMedCrossRefGoogle Scholar
- 37.McCracken JT et al (2003) Analog classroom assessment of a once-daily mixed amphetamine formulation, SLI381 (ADDERALL XR), in children with ADHD. J Am Acad Child Adolesc Psychiatry 42(6):673–683PubMedCrossRefGoogle Scholar
- 38.Pelham WE et al (1999) A comparison of morning-only and morning/late afternoon Adderall to morning-only, twice-daily, and three times-daily methylphenidate in children with attention-deficit/hyperactivity disorder. Pediatrics 104(6):1300–1311PubMedCrossRefGoogle Scholar
- 39.Pelham WE et al (1999) A comparison of Ritalin and Adderall: efficacy and time-course in children with attention-deficit/hyperactivity disorder. Pediatrics 103(4):e43PubMedCrossRefGoogle Scholar
- 40.Swanson JM et al (1998) Analog classroom assessment of Adderall in children with ADHD. J Am Acad Child Adolesc Psychiatry 37(5):519–526PubMedCrossRefGoogle Scholar
- 41.Ajibola O, Clement PW (1995) Differential effects of methylphenidate and self-reinforcement on attention-deficit hyperactivity disorder. Behav Modif 19(2):211–233PubMedCrossRefGoogle Scholar
- 42.Balthazor MJ, Wagner RK, Pelham WE (1991) The specificity of the effects of stimulant medication on classroom learning-related measures of cognitive processing for attention-deficit disorder children. J Abnorm Child Psychol 19(1):35–52PubMedCrossRefGoogle Scholar
- 43.Barkley RA, Dupaul GJ, McMurray MB (1991) Attention-deficit disorder with and without hyperactivity—clinical response to 3 dose levels of methylphenidate. Pediatrics 87(4):519–531PubMedGoogle Scholar
- 44.Brams M et al (2008) A randomized, double-blind, crossover study of once-daily dexmethylphenidate in children with attention-deficit hyperactivity disorder: rapid onset of effect. CNS Drugs 22(8):693–704PubMedCrossRefGoogle Scholar
- 45.Carlson CL et al (1992) Single and combined effects of methlyphenidate and behavior—therapy on the classroom performance of children with attention-deficit hyperactivity disorder. J Abnorm Child Psychol 20(2):213–232PubMedCrossRefGoogle Scholar
- 46.Chacko A et al (2005) Stimulant medication effects in a summer treatment program among young children with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 44(3):249–257PubMedCrossRefGoogle Scholar
- 47.Dopfner M et al (2004) Comparative efficacy of once-a-day extended-release methylphenidate, two-times-daily immediate-release methylphenidate, and placebo in a laboratory school setting. Eur Child Adolesc Psychiatry 13:I93–I101PubMedGoogle Scholar
- 48.Douglas VI et al (1986) Short-term effects of methylphenidate on the cognitive, learning and academic-performance of children with attention-deficit disorder in the laboratory and the classroom. J Child Psychol Psychiatry 27(2):191–211PubMedGoogle Scholar
- 49.Dupaul GJ, Rapport MD (1993) Does methylphenidate normalize the classroom performance of children with attention-deficit disorder? J Am Acad Child Adolesc Psychiatry 32(1):190–198PubMedCrossRefGoogle Scholar
- 50.Elia J et al (1993) Classroom academic-performance—improvement with both methlyphendiate and dextroamphetamine in ADHD boys. J Child Psychol Psychiatry 34(5):785–804PubMedCrossRefGoogle Scholar
- 51.Evans SW, Pelham WE (1991) Psychostimulant effects on academic and behavioral measures for ADHD junior-high school students in a lecture format classroom. J Abnorm Child Psychol 19(5):537–552PubMedCrossRefGoogle Scholar
- 52.Evans SW et al (2001) Dose-response effects of methylphenidate on ecologically valid measures of academic performance and classroom behavior in adolescents with ADHD. Exp Clin Psychopharmacol 9(2):163–175PubMedCrossRefGoogle Scholar
- 53.Fabiano GA et al (2007) The single and combined effects of multiple intensities of behavior modification and methylphenidate for children with attention deficit hyperactivity disorder in a classroom setting. Sch Psychol Rev 36(2):195–216Google Scholar
- 54.Gorman EB et al (2006) Effects of methylphenidate on subtypes of attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 45(7):808–816PubMedCrossRefGoogle Scholar
- 55.James RS et al (2001) Double-blind, placebo-controlled study of single-dose amphetamine formulations in ADHD. J Am Acad Child Adolesc Psychiatry 40(11):1268–1276PubMedCrossRefGoogle Scholar
- 56.McGough JJ et al (2006) A randomized, double-blind, placebo-controlled, laboratory classroom assessment of methylphenidate transdermal system in children with ADHD. J Atten Disord 9(3):476–485PubMedCrossRefGoogle Scholar
- 57.Pelham WE et al (1985) Methylphenidate and children with attention deficit disorder—dose effects on classroom academic and social behavior. Arch Gen Psychiatry 42(10):948–952PubMedCrossRefGoogle Scholar
- 58.Pelham WE et al (1987) Sustained release and standard methlyphenidate effects on cognitive and social-behavior in children with attention-deficit disorder. Pediatrics 80(4):491–501PubMedGoogle Scholar
- 59.Pelham WE et al (1990) Relative efficacy of long-acting stimulants on children with attention-deficit hyperactivity disorder—a comparison of standard methylphenidate, sustained-release methylphenidate, sustained-release dextroamphetamine, and pemoline. Pediatrics 86(2):226–237PubMedGoogle Scholar
- 60.Pelham WE et al (1993) Separate and combined effects of methylphenidate and behavior-modification on boys with attention-deficit hyperactivity disorder in the classroom. J Consult Clin Psychol 61(3):506–515PubMedCrossRefGoogle Scholar
- 61.Pelham WE Jr et al (2005) A dose-ranging study of a methylphenidate transdermal system in children with ADHD. J Am Acad Child Adolesc Psychiatry 44(6):522–529PubMedCrossRefGoogle Scholar
- 62.Rapport MD et al (1985) Methylphenidate in hyperactive-children—differential effects of dose on academic, learning and social behavior. J Abnorm Child Psychol 13(2):227–243PubMedCrossRefGoogle Scholar
- 63.Rapport MD et al (1994) Attention-deficit disorder and methylphenidate—normalization rates, clinical effectiveness, and response prediction in 76 children. J Am Acad Child Adolesc Psychiatry 33(6):882–893PubMedCrossRefGoogle Scholar
- 64.Silva RR et al (2006) Efficacy and duration of effect of extended-release dexmethylphenidate versus placebo in schoolchildren with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol 16(3):239–251PubMedCrossRefGoogle Scholar
- 65.Tannock R et al (1989) Dose-response effects of methylphenidate on academic-performance and overt behavior in hyperactive children. Pediatrics 84(4):648–657PubMedGoogle Scholar
- 66.Vyse SA, Rapport MD (1989) The effects of methylphenidate on learning in children with ADDH: the stimulus equivalence paradigm. J Consult Clin Psychol 57(3):425–435PubMedCrossRefGoogle Scholar
- 67.Wigal SB et al (2009) A 13-hour laboratory school study of lisdexamfetamine dimesylate in school-aged children with attention-deficit/hyperactivity disorder. Child Adolesc Psychiatry Mental Health 3:17CrossRefGoogle Scholar
- 68.Silva R et al (2005) Efficacy of two long-acting methylphenidate formulations in children with attention-deficit/hyperactivity disorder in a laboratory classroom setting. J Child Adolesc Psychopharmacol 15(4):637–654PubMedCrossRefGoogle Scholar
- 69.Swanson JM et al (2004) A comparison of once-daily extended-release methylphenidate formulations in children with attention-deficit/hyperactivity disorder in the laboratory school (The Comacs Study). Pediatrics 113(3 Part 1):e206–e216PubMedCrossRefGoogle Scholar
- 70.Ballinger C, Varley C, Nolen P (1984) Effects of methylphenidate on reading in children with attention deficit disorder. Am J Psychiatry 141(12):1590–1593PubMedGoogle Scholar
- 71.Klein RG (1991) Effects of high methylphenidate doses on the cognitive performance of hyperactive children. Bratisl Med J 92(11):534–539Google Scholar
- 72.Pelham WE et al (1989) Comparative effects of methylphenidate on ADD girls and ADD boys. J Am Acad Child Adolesc Psychiatry 28(5):773–776PubMedCrossRefGoogle Scholar
- 73.Rapport MD et al (1986) Comparing classroom and clinic measures of attention deficit disorder: differential, idiosyncratic, and dose-response effects of methylphenidate. J Consult Clin Psychol 54(3):334–341PubMedCrossRefGoogle Scholar
- 74.Rapport MD et al (1987) Attention deficit disorder and methylphenidate: group and single-subject analyses of dose effects on attention in clinic and classroom settings. J Clin Child Psychol 16(4):329–338CrossRefGoogle Scholar
- 75.Richardson E et al (1988) Effects of methylphenidate dosage in hyperactive reading-disabled children: II. Reading achievement. J Am Acad Child Adolesc Psychiatry 27(1):78–87PubMedCrossRefGoogle Scholar
- 76.Worrall A (1993) Evaluating the effects of methylphenidate on the cognitive, behavioural and academic performance of A.D.D. children in the classroom. S Afr J Child Adolesc Mental Health 5(2):96–101CrossRefGoogle Scholar
- 77.Brown RT et al (2006) Atomoxetine in the management of children with ADHD: effects on quality of life and school functioning. Clin Pediatr 45(9):819–827CrossRefGoogle Scholar
- 78.Wietecha LA et al (2009) Atomoxetine treatment in adolescents with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol 19:6CrossRefGoogle Scholar
- 79.Swanson JM (1992) School-based assessments and interventions for ADD students. K.C. Publishing, IrvineGoogle Scholar
- 80.Murray DW et al (2009) Psychometric properties of teacher SKAMP ratings from a community sample. Assessment 16(2):193–208PubMedCrossRefGoogle Scholar