Drug treatment for children diagnosed with attention-deficit/hyperactivity disorder (ADHD) often results in improvements in inattention, hyperactivity, and impulsivity. But whether such treatment can help academic performance in children with the disorder remains a question. A study appearing today in Pediatrics suggests delaying drug treatment may be associated with a decline in math skills in children with ADHD.
The finding is based on a study of all 236 children born between 1994 and 1996 in Iceland who began treatment primarily with Ritalin (methylphenidate) for ADHD at some time between their fourth and seventh grades. The researchers were able to assess these children’s academic performance over a 3-year period, as measured by standardized tests in mathematics and language arts that the Icelandic school system administers to all children in fourth and seventh grades.
Children in the nonmedicated general school population demonstrated consistent grade-appropriate performance between fourth and seventh grades. However, those diagnosed with ADHD had a 60% greater risk of academic decline in mathematics compared with the general population and a 30% greater risk of decline in language arts, although the decline was less among those who began drug treatment earlier.
Children with ADHD who began drug treatment within 12 months of their fourth-grade tests experienced a 0.3 percentile point decline in their math scores compared with a drop of 9.4 percentile points in children who began taking medication 25 to 36 months after their fourth-grade test. Drug therapy appeared to have no effect on scoring in language arts.
The study indicated that earlier drug treatment for girls with ADHD was clearly associated with a benefit only in mathematics performance; earlier treatment initiation provided marginal benefits in both math and language arts for boys. The researchers cautioned, however, that because of the small number of girls (71) in the study, these differences could be due to chance, or they might reflect actual sex differences. Girls with ADHD present predominantly with symptoms of inattention and have lower levels of hyperactivity than boys with ADHD, which may play a role in how early the disorder is detected and when treatment starts.