Studies: ADHD drugs don’t necessarily improve academic performance

14 Jul

Moi wrote in ADHD coaching to improve a child’s education outcome:
The American Academy of Child and Adolescent Psychiatry discusses the primary symptoms of ADHD in the article, What Is ADHD:

The primary symptoms of ADHD are hyperactivity, impulsivity, and inattention.
Hyperactive children always seem to be in motion. A child who is hyperactive may move around touching or playing with whatever is around, or talk continually. During story time or school lessons, the child might squirm around, fidget, or get up and move around the room. Some children wiggle their feet or tap their fingers. A teenager or adult who is hyperactive may feel restless and need to stay busy all the time.
Impulsive children often blurt out comments without thinking first. They may often display their emotions without restraint. They may also fail to consider the consequences of their actions. Such children may find it hard to wait in line or take turns. Impulsive teenagers and adults tend to make choices that have a small immediate payoff rather than working toward larger delayed rewards.
Inattentive children may quickly get bored with an activity if it’s not something they really enjoy. Organizing and completing a task or learning something new is difficult for them. As students, they often forget to write down a school assignment or bring a book home. Completing homework can be huge challenge. At any age, an inattentive person may often be easily distracted, make careless mistakes, forget things, have trouble following instructions, or skip from one activity to another without finishing anything.
Some children with ADHD are mainly inattentive. They seldom act hyperactive or impulsive. An inattentive child with ADHD may sit quietly in class and appear to be working but is not really focusing on the assignment. Teachers and parents may easily overlook the problem.
Children with ADHD need support to help them pay attention, control their behavior, slow down, and feel better about themselves.
What Is Not ADHD?
Many children and adults are easily distracted at times or have trouble finishing tasks. To be ADHD, however, the behaviors must appear before age 7 and continue for at least six months. The symptoms must also create a real handicap in at least two areas of the child’s life—in the classroom, on the playground, at home, in the community, or in social settings.
If a child seems too active on the playground but not elsewhere, the problem might not be ADHD. It might also not be ADHD if the behaviors occur in the classroom but nowhere else. A child who shows some symptoms would not be diagnosed with ADHD if his or her schoolwork or friendships are not impaired by the behaviors.
Even if a child’s behavior seems like ADHD, it might not actually be ADHD. Many other conditions and situations can trigger behavior that resembles ADHD. For example, a child might show ADHD symptoms when experiencing
A death or divorce in the family, a parent’s job loss, or other sudden change.
Undetected seizures.
An ear infection that causes temporary hearing problems.
Problems with schoolwork caused by a learning disability.
Anxiety or depression. 

ADHD News has a synopsis of the ADHD diagnosis in the article by Mark Domoto, M.Ed. In the section, Diagnosing ADHD
https://drwilda.com/2012/03/31/adhd-coaching-to-improve-a-childs-education-outcome/

Julia Lawrence of Education News reports about a Quebec study in the article, Study: ADHD Drugs Don’t Improve Academic Performance in Kids:

Shirley S. Wang of The Wall Street Journal writes about one such study published in June which looked at academic outcomes of Quebec students prescribed ADHD drugs like Ritalin and Adderall over a span of 11 years. Researchers concluded that boys who were taking drugs academically underperformed peers with the same symptoms who were not medicated. The working paper published by the National Bureau of Economic Research also reported that girls who took ADHD drugs had higher incidence of emotional problems than ones who did not.
“The possibility that [medication] won’t help them [in school] needs to be acknowledged and needs to be closely monitored,” says economics professor Janet Currie, an author on the paper and director of the Center for Health & Wellbeing, a health policy institute at Princeton University. Kids may not get the right dose to see sustained benefits, or they may stop taking the medication because side effects or other drawbacks outweigh the benefits, she says.
Why drugs that claim to improve concentration, focus and emotional control don’t lead to academic improvement is a question that has puzzled researchers for some time — and answering the question could be the key to effective ADHD treatment in children. Finding an effective treatment regime could help a lot of kids; according to Centers for Disease Control and Prevention, there are 2.7 million children currently on ADHD drugs of some kind in the United States alone.
http://www.educationnews.org/parenting/study-adhd-drugs-dont-improve-academic-performance-in-kids/#sthash.HkASci3N.dpuf

This study is in accord with research from Yale University.

Geneva Pittman of Reuters writes in the article, Be cautious of mind-altering drugs for kids: doctors:

Focusing on stimulants typically used to treat attention deficit hyperactivity disorder, or ADHD, researchers said the number of diagnoses and prescriptions have risen dramatically over the past two decades.
Young people with the disorder clearly benefit from treatment, lead author Dr. William Graf emphasized, but the medicines are increasingly being used by healthy youth who believe they will enhance their concentration and performance in school.
According to the National Institute on Drug Abuse, 1.7 percent of eighth graders and 7.6 percent of 12th graders have used Adderall, a stimulant, for nonmedical reasons.
Some of those misused medicines are bought on the street or from peers with prescriptions; others may be obtained legally from doctors.
“What we’re saying is that because of the volume of drugs and the incredible increase… the possibility of overdiagnosis and overtreatment is clearly there,” said Graf, from Yale University in New Haven, Connecticut.
In their statement, published in the journal Neurology, he and his colleagues say doctors should not give prescriptions to teens who ask for medication to enhance concentration against their parents’ advice. http://www.reuters.com/article/2013/03/13/us-medications-kids-idUSBRE92C17H20130313

Here is the press release from Yale:

No attention-boosting drugs for healthy kids, doctors urge
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Wednesday, March 13, 2013

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Read this article on YaleNews
 
Doctors at Yale School of Medicine and the American Academy of Neurology (AAN) have called upon their fellow physicians to limit or end the practice of prescribing memory-enhancing drugs to healthy children whose brains are still developing. Their position statement is published in the March 13 online issue of the journal Neurology, the medical journal of the AAN.
The statement was written to address the growing trend in which teens use “study drugs” before tests and parents request attention deficit hyperactivity disorder (ADHD) drugs for children who don’t meet the criteria for the disorder. The AAN spent several years analyzing all of the available research and ethical issues to develop this official position statement on the topic.
“Doctors caring for children and teens have a professional obligation to always protect the best interests of the child, to protect vulnerable populations, and to prevent the misuse of medication,” said first author of the statement, Dr. William Graf, professor of pediatrics and neurology at Yale School of Medicine. “The practice of prescribing these drugs, called neuroenhancements, for healthy students is not justifiable.”
Graf and a group of child neurologists provide evidence that points to dozens of ethical, legal, social, and developmental reasons why prescribing mind-enhancing drugs, such as those used to treat ADHD, for healthy people is viewed differently in children and adolescents than it would be in functional, independent adults with full decision-making capacities.
Some of the reasons not to prescribe neuroenhancements include: the child’s best interest; the long-term health and safety of neuroenhancements, which has not been studied in children; kids and teens may lack complete decision-making capacities while their judgments and cognitive abilities are still developing; maintaining doctor-patient trust; and the risks of over-medication and dependency.
“A physician should talk to the child about the request, as it may reflect other medical, social, or psychological motivations such as anxiety, depression, or insomnia,” said Graf, who notes that there are alternatives to neuroenhancements available, including maintaining good sleep, nutrition, study habits, and exercise regimens.
Other authors on the position statement include Saskia K. Nagel, Dr. Leon G. Epstein, Dr. Geoffrey Miller, Dr. Ruth Nass, and Dr. Dan Larriviere.
Citation: Neurology 80 (March 13, 2013)

Citation:
Pediatric neuroenhancement Ethical, legal, social, and neurodevelopmental implications
1.William D. Graf, MD,
2.Saskia K. Nagel, PhD,
3.Leon G. Epstein, MD,
4.Geoffrey Miller, MD,
5.Ruth Nass, MD and
6.Dan Larriviere, MD, JD
+Show Affiliations
| + Show Full Disclosures
1.Correspondence to Dr. Graf: william.graf@yale.edu
1.Published online before print March 13, 2013, doi: 10.1212/WNL.0b013e318289703b Neurology March 26, 2013 vol. 80 no. 13 1251-1260
2.
Abstract
Full Text
Full Text (PDF)
1.Also available:
2.CME Course
3.Data Supplement
Abstract
The use of prescription medication to augment cognitive or affective function in healthy persons—or neuroenhancement—is increasing in adult and pediatric populations. In children and adolescents, neuroenhancement appears to be increasing in parallel to the rising rates of attention-deficit disorder diagnoses and stimulant medication prescriptions, and the opportunities for medication diversion. Pediatric neuroenhancement remains a particularly unsettled and value-laden practice, often without appropriate goals or justification. Pediatric neuroenhancement presents its own ethical, social, legal, and developmental issues, including the fiduciary responsibility of physicians caring for children, the special integrity of the doctor–child–parent relationship, the vulnerability of children to various forms of coercion, distributive justice in school settings, and the moral obligation of physicians to prevent misuse of medication. Neurodevelopmental issues include the importance of evolving personal authenticity during childhood and adolescence, the emergence of individual decision-making capacities, and the process of developing autonomy. This Ethics, Law, and Humanities Committee position paper, endorsed by the American Academy of Neurology, Child Neurology Society, and American Neurological Association, focuses on various implications of pediatric neuroenhancement and outlines discussion points in responding to neuroenhancement requests from parents or adolescents. Based on currently available data and the balance of ethics issues reviewed in this position paper, neuroenhancement in legally and developmentally nonautonomous children and adolescents without a diagnosis of a neurologic disorder is not justifiable. In nearly autonomous adolescents, the fiduciary obligation of the physician may be weaker, but the prescription of neuroenhancements is inadvisable because of numerous social, developmental, and professional integrity issues

Increasingly, some families find that an education coach improves their child’s chance of success at school.
Jean Enersen’s King5 News story,  ADHD coaches help students tackle academic goals tells the about the success one family has had with an ADHD coach:

Middle school is all about keeping track of schedules, and getting assignments in on time. It can be complicated.
“I have eight teachers,” said 7th grade student Marcus Wesley.
When his mother asked, “Have you started writing your story?” Marcus could only tell her, “No, but I have all my outline and stuff.” The story was pivotal to his grade.
Keeping a handle on all his upcoming assignments is hard for Marcus. He was recently diagnosed with ADHD.
“I’m a little more hyper than other kids. So they give me the medicine to calm me down,” he explained.
But medicine is only part of the answer said his mother. Alone, it won’t assure his success in school.
“I personally think every student deserves a coach,” said ADHD coach Naomi Zemont.
Since last September, Zemont has been Marcus Wesley’s ADHD coach.
“Last time around, you really wanted to make up this work in humanities,” she reminded Marcus.
Zemont helps the 7th grader develop a plan to achieve his goals. He sets the goals himself, and decides the actions it will take to complete them. In doing so, Marcus is learning to break tasks into parts he can manage. http://www.king5.com/health/childrens-healthlink/ADHD-coaches-help-students-tackle-academic-goals–144024376.html

Before deciding what is the most appropriate therapy, the diagnosis of ADHD must be made by a competent health care provider.

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