ADHD Medications and Learning Outcomes

A recent study reviewed at (link below) has concluded that the earlier you start children on medications for ADHD, the better off they fare in class. This was based on a comparison of children who were required to take a general test of knowledge and skills at the end of Grade 4, then again at the end of Grade 7.

The findings showed that children who began drug treatment within 12 months of their fourth-grade test declined 0.3 percent in math by the time they took their seventh-grade test, compared with a decline of 9.4 percent in children who began taking medication 25-to-36 months after their fourth-grade test. In other words, if you have a child who is struggling with attention problems at the end of grade 4, they will do worse in class at the end of Grade 7, regardless of whether they are medicated or not. Those who started on drugs sooner seemed to do ‘less worse’.

“Children who began taking medications immediately after their fourth-grade standardized tests showed the smallest declines in academic performance,” said the study’s lead author. “The effect was greater in girls than boys and also greater for children who did poorly on their fourth grade test”, she continues.

My own research has yet to uncover any evidence to support the use of ADHD medications as a means of improving academic performance for children who are already struggling. However, there is a fair bit of evidence to suggest that such medications do have real and significant risk profiles, including the possibility of abuse. There is also a terrific black market built around these medications: As a class of drug, they are the number one off-prescription drug of choice on university and college campuses in the US, even more popular than marijuana. We have taught children that it is not only OK to take drugs to enhance performance, we have made it easy to access them.

The use of these medications is predicated on a child’s apparent trouble paying attention and sitting still as directed by parents and teachers. It so happens that many children with ‘hidden’ visual problems will also display the same sorts of behaviors until their difficult vision is corrected.

Difficult vision not simply a matter of blurred vision, it is felt by the child in a variety of ways ranging from physical illness and headache, muscle strain, and a need to adopt odd head postures. The effects are experienced by the child as double vision, difficulty concentrating, or intolerance to near tasks. Visual impediments to learning (VIL) may not be noticed outside of the classroom context where there is a great reliance upon small detailed print, and a lot of near work. Most VIL will not present overtly to the family physician or teacher, but can be easily measured by optometrists with training in developmental vision diagnosis and management. In some cases, however, VIL are so severe that some children appear to have other developmental concerns, even autism. Either way, VIL can and do have significant impact on a child’s behaviour.

Still, it is quite rare for medical doctors to recommend vision assessments before prescribing potentially dangerous drugs to control what often can and probably should be controlled through other means. My own clinical experience and research shows that proper management of vision as a starting point in therapy leads to great improvements in behavior and achievement for most children. Not all children need vision help, but most who have learning and reading trouble do. Addressing vision problems at the start will most often reduce the need for other interventions and assist with anything that follows.

Experience also shows that in some rare cases, medication can and does provide reliable and helpful assistance in focusing attention. Stimulants of this class have been known to have this effect for many years, and this is of course the reason it is so popular among university and college students. It is also the reason why for some parents it’s a godsend. There is no question that drugs can ‘calm’ a child and focus their attention, but there is no indication that they will fix vision problems, nor will they fix any underlying problems associated with learning and reading. This is likely partly due to the fact that the child is unsure ‘what’ to focus his attention on at an early age, that is, they haven’t learned to learn through books yet, and prefer to learn by manipulation and interaction. Older students know the rules and how to glean information from text, so the boost in attention accelerates their performance.

If the parent or teacher is concerned about academic outcomes, then the first best to look is vision because it is so fundamental to how a child manages the classroom. Then, it makes sense to look at other key elements like exercise, diet, and sleep. Directed learning therapy is also beneficial. If the concern is primarily about hyperactivity, then medications might be a good option. These do not address any other underlying learning problems, however, but for some children, it can help to open the door to start to address them.

In the end, management of learning and reading disabilities is complex and requires a broad view of what might be causing a child to be unable to perform to our expectations. It also requires a broad arsenal of tools to help. When it come to managing children’s behaviour by potentially harmful means, we must always proceed with caution, be honest about why we are doing so, and then proceed only as part of a more comprehensive solution. We also owe it to the children and parents to look for other likely causes first.

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