By Steven Reinberg
Friday, September 21, 2007 12:00 AM
FRIDAY, Sept. 21 (HealthDay News) -- Children with attention-deficit/hyperactivity disorder (ADHD) can perform better at school if placed on long-term drug therapy, a new study suggests.
"This is the first study that shows that taking stimulants for ADHD improves long-term school performance," said lead researcher Dr. William Barbaresi, a pediatrician at the Mayo Clinic in Rochester, Minn. "This includes reading achievement, being absent from school and being retained in a grade -- stimulant treatment was associated with better outcomes," he said.
Based on the findings, stimulant medication needs to be considered for every child with ADHD, Barbaresi believes.
"We can make that recommendation now on the basis of long-term improvement in the ways children's lives turn out, not just on the desire to control ADHD behavior symptoms," he said.
A companion study by the same group of researchers finds that children with ADHD are at heightened risk of lowered reading scores, absenteeism, repeating a grade, and dropping out of school.
Both papers are published in the September edition of theJournal of Development & Behavioral Pediatrics.
Experts estimate that in the United States almost 2 million children -- or about 3 percent to 5 percent of young children in the country -- have ADHD. ADHD affects a child's ability to focus and to control impulsive behaviors.
In the first study, Barbaresi's team followed more than 5,700 children from birth until they were 18 years old. Among these children, 277 boys and 93 girls were diagnosed with ADHD.
The Mayo team found that treatment with prescription stimulants, such as Ritalin, was associated with improved long-term academic success of children with ADHD.
Children taking stimulants usually began taking them in elementary school and continued on the medication for almost three years -- about 30.4 months.
By age 13, those taking medication had improved reading scores compared with children with ADHD who didn't receive the drugs, the researchers found. Furthermore, those children taking the highest doses had the most improved reading scores, Barbaresi's group added.
Children treated with medication also were less likely to be absent from school, and the longer they took the drugs, the less absenteeism was seen. In addition, children with ADHD who received stimulants were 1.8 times less likely to be held back a grade than children with ADHD who were not receiving the treatment.
In the second study, Barbaresi's team found that school outcomes for the average child with ADHD were significantly worse compared with children without the condition.
"Reading tests among children with ADHD are almost 30 points lower, children with ADHD are absent for a significantly greater number of days, and children with ADHD are almost three times more likely to drop out of school and be retained a grade," Barbaresi said.
These poor outcomes were equally likely for boys and girls with ADHD, Barbaresi said.
"We can't simply focus on the symptoms of ADHD," Barbaresi said. "We really need to be focusing on the risk for poor outcomes in school and in other aspects of the child's life," he said. "That's why we have to recognize these children and make sure they get appropriate treatment."
The studies were funded by grants from the U.S. Public Health Service, the U.S. National Institutes of Health, the Mayo Clinic, and McNeil Consumer and Specialty Pharmaceuticals, maker of the ADHD stimulant Concerta.
One expert hailed the findings.
"This study reinforces the value and long-term benefit of treatment with stimulant medication," said Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Schneider Children's Hospital in New York City. "It also highlights the risks that ADHD patients face and indicates that those risks can be mitigated by effective treatment," he said.
Another expert had a more mixed reaction to the studies.
"This study provides reassuring evidence that medication is not just blunting hyperactivity or enhancing alertness but actually doing so in a way that protects the capacity to learn," noted Dr. David Katz, director of the Prevention Research Center at Yale University School of Medicine in New Haven, Conn.
But drugs may not be the total answer, he added.
"Ritalin works but is not a desirable alternative to recess, which could perhaps work, too, in some cases at least," Katz said. "We need more attention to the underlying reasons for the rising prevalence of ADHD. Is it lack of physical activity; the highly processed modern diet; the over-stimulation of a multimedia environment; or all of the above?" he wondered.
For more on ADHD, visit the U.S. National Institute of Mental Health.
SOURCES: William Barbaresi, M.D., pediatrician, Mayo Clinic Rochester, Minn.; Andrew Adesman, M.D., chief, developmental and behavioral pediatrics, Schneider Children's Hospital, New York City; David L. Katz, director, Prevention Research Center, Yale University School of Medicine, New Haven, Conn.; September 2007,Journal of Development & Behavioral Pediatrics