Stimulant medications are widely used to improve the core symptoms of attention-deficit/hyperactivity disorder (ADHD) in children, including inattention, hyperactivity and impulsivity.
But there is less evidence that the medications improve academic performance over the long term.
Researchers studied the prescription drug use and performance on standardized tests of a group of children born over a three-year period. Children without ADHD performed at a consistent level on the fourth grade and seventh grade tests.
But in contrast, children taking ADHD medications had lower scores on the seventh-grade tests, especially in math. Children who began taking medications soonest after their fourth-grade test showed the smallest declines.
It makes sense that if a child is not able to pay attention during the early years when basic skills are being taught, that he or she could be at a disadvantage down the line. “If a child is not paying attention to the information presented from kindergarten through 7th grade,” says Robin K. Blitz, MD, “then it is likely that they have not learned the basic math skills that are the foundation for higher math abilities.”
The effect was greater in girls than boys and also greater for children who did poorly on their fourth grade test.
ADHD becomes more of an impairment as children grow, says Blitz, developmental director of Barrow Neurological Institute of Phoenix Children’s Hospital and an AzAAP member.
Most children can sit and pay attention in kindergarten to a certain degree, but expectation increases along the way. As the frontal lobe matures, says Blitz, the abilities related to executive function increases. That means that the brain is better able to regulate emotions and control urges to act impulsively or become distracted or hyperactive.
Distractibility impairs the ability to pay attention to instructions, pay attention to details, and complete tasks.
“The child with ADHD does not ‘want’ to have bad behavior or not listen or not pay attention to instructions,” says Blitz. “They just can’t, without significant extra work effort. If a child is not paying attention, it is very difficult to learn material.”
Blitz says there are three parts to learning. The first is to pay attention to the information provided. Then, the brain has to process, or interpret, the information. Then, the brain has to remember the information processed.
If there is a deficit in attention, she adds, then the information never enters the brain in the first place to be processed and remembered. That’s how ADHD can impair learning.
Early intervention, identification and treatment can lead to improved academic performance, increased likelihood that a child will graduate from high school and attend college, and gain the ability to obtain and maintain a job. improved peer relations, and improved family function. “We all want the best for our children,” says Blitz, who is also mother to two adult sons with ADHD. “We should give them every opportunity for success.”