It's perhaps the most controversial disorder of the 21st century: opponents say it's unnecessarily medicated, while advocates call it a breakthrough. Attention deficit hyperactivity disorder (ADHD) has received even more attention lately, as one study has found that medicating a child with ADHD has almost no chance of resulting in better grades.
The most common medications used to treat ADHD are Ritalin and Adderall, two stimulants that have been proven to enhance cognitive function in the short term, including focus, memory, and attention. According to a number of studies testing for kids' academic performance with and without the drugs, over a long timeline, the effectiveness of these benefits disappears.
"The possibility that [medication] won't help them [in school] needs to be acknowledged and needs to be closely monitored," said economics professor Janet Currie, director of the Center for Health & Wellbeing, a health policy institute at Princeton University.
Currie helped author an 11-year study on 4,000 Quebec students who took ADHD medication. The study found that boys who took the drugs performed substantially worse than those who didn't. Girls reported being more emotional while taking the medication, according to a working paper published by the National Bureau of Economic Research.
"Our results are silent on the effects on optimal use of medication for ADHD," the researchers wrote, "but suggest that expanding medication use can have negative consequences given the average way these drugs are used in the community."
Currie argues that children whose performance suffers while taking the drug could simply be taking an incorrect dosage or have stopped taking it because the side effects outweigh the benefits.
The question remains, however, as to why short-term cognitive processes soar with ADHD drugs but wane in the long term.
The answer may be found in a simple review of ADHD's symptoms and the effects of its medication.
ADHD is a neurobehavioral disorder that gets diagnosed most often in children, after signs that the child has trouble paying attention and controlling impulsive behaviors. The Centers for Disease Control and Prevention (CDC) report that some 2.7 million parents, as of 2007, medicate their child in some form for ADHD.
When a child with ADHD takes Ritalin or Adderall, he or she experiences heightened focus, greater concentration, less hyperactivity, and more overall clarity. For this reason, says University of Pennsylvania cognitive neuroscientist Martha Farah, students who take the drugs must exercise more control in what they focus on. Give them the wrong stimulus, and the child is just as unproductive academically.
According to the Wall Street Journal, if one of Farah's ADHD students "keeps her head down and studies, she gets very absorbed in her work and accomplishes a tremendous amount. But if a friend stops by, she becomes equally engrossed in the chat."
This is why little evidence exists to show ADHD drugs help students perform better in school. Focus and concentration are only helpful tools when used correctly. Students who take Adderall and clean their entire bedroom are still shirking the responsibilities of their studies, even if it isn't the Internet that's distracting them.
In one major, U.S. government-funded study known as the MTA that looked at the long-term effects of ADHD treatment, 579 children with the condition were randomized to one of three different kinds of treatment or a control group for 14 months.
During the first year of the study, eight and nine year olds did perform nominally better than students with ADHD who hadn't taken the drugs. However, as the study progressed, the effects leveled off and the students became academic equals.
At the most recent set of assessments, the eight-year follow-up, there were no differences between any of the groups on symptoms or academic achievement measures, suggesting that there wasn't any long-term residual benefit of the treatments during childhood, the Wall Street Journal reports.
Farah's findings mirror these as well. When she and her colleagues gave IQ and neurocognitive tests to students with ADHD, those who were taking medication performed the same as those who weren't on the drugs.
These findings highlight the importance of fostering a well-rounded support system for children. Family encouragement, positive motivation, and structured education end up contributing more to a child's education than medication alone.
In a separate study performed by Farah, a statistical review of existing data on the topic, still unpublished, suggests there are "very small effects," she said, "not zero, but not a whole heck of a lot difference."
Source: Currie J, Stabile M, Jones L. Do Stimulant Medications Improve Education and Behavioral Outcomes for Children with ADHD? The National Bureau of Economic Research. 2013.