by David Rabiner
Attention Research Update
5 Dobbs Place
Durham, NC 27707
| Do long-acting stimulants improve academic performance? The adverse impact of ADHD has on children’s academic performance and achievement is well-established. This has been shown for a variety of outcomes, including grade point averages, grade retention, high school graduation, and transition to post secondary education. Research has shown that it is the inattentive symptoms of ADHD, rather than the hyperactive-impulsive symptoms, that are most directly related to academic struggles.What is less established is whether stimulant medication treatment promotes better academic outcomes, even though it has a substantial impact on reducing core ADHD symptoms for many children. Although it is clear that well-conducted medication treatment enhances children’s academic productivity, evidence that it promotes gains in both short- and long-term learning, as well as on important real-world academic outcomes, e.g., grades, graduation rates, etc., is somewhat more equivocal.A study published recently in the Journal of Attention Disorders [Folkins et al., (2025). Academic Outcomes in Primary and Secondary School Students Prescribed Long-Acting Stimulants for ADHD Management, https://journals.sagepub.com/doi/10.1177/10870547251378169] examines this important issue in a large, representative sample of elementary and secondary school students residing in New Brunswick, Canada.Health and educational records of students attending New Brunswick schools between 2008 and 2021 were used to identify students who had ever received an ADHD diagnosis.Then, for each year of the study, students were assigned to one of three groups: ADHD treated, ADHD untreated, and not ADHD.Those assigned to the Treated group for a given academic year had at least 150 days of continuous treatment with a long-acting stimulant during that year. It was felt that treatment for this length of time, i.e., at least half an academic year, was of sufficient duration to potentially influence academic outcomes during that year.Individuals in the Untreated group had an ADHD diagnosis but no record of receiving long-acting stimulant during the academic year of interest. Individuals were included in the No ADHD group if they had no administrative data records at any time indicating a diagnosis of ADHD.This procedure identified nearly ten thousand K-8 treated students with ADHD and over 15,000 untreated students. For grades 9-12, the number of students identified were nearly 6000 and 12,000 respectively. Students without ADHD were over 130,000 in grades K-8 and over 70,000 in grades 9-12.It is not clearly explained why the authors focused exclusively on long-acting stimulants and many students with ADHD in the sample were receiving other ADHD medications. Because these other medications could also potentially impact academic outcomes, the authors controlled for this in their analyses. Results – Data analyses tested for group differences on a range of academic outcomes including report card grades, standardized test results, attendance, graduation from high school, and transition to post-secondary education.In all analyses, the authors controlled for other factors that could potentially influence academic outcomes, including age, gender, school district, comorbid conditions, recent immigration status, and household income. As noted above, analyses also considered whether students with ADHD were receiving ADHD medication other than one of the long-acting stimulants. Report card grades K-8 students – Among grade K-8 students, average report card grades were lower for treated and untreated students compared to those without ADHD. Differences between treated and untreated students were not significantly different. High school students – For students in grades 9-12, average report card grades were significantly lower in the treated and untreated groups compared to the No ADHD group. Treated students had significantly higher grades than those not treated with a long-acting stimulant. They were also less likely to have failed one or more classes. Performance on Standardized Exams: K-8 students – Treated and untreated students scored lower on standardized exams compared to the No ADHD group; this was true both overall and across all subject areas. In contrast, results for treated and untreated groups did not differ significantly from one another. High school students – Students in the treated and untreated ADHD groups scored below the No ADHD group overall and across all subject areas. Students with ADHD who received long-acting stimulants scored significantly higher than those who did not. School attendance – For this outcome, high school and primary school students were combined. Compared to students without ADHD, absences were lower in the treated group and higher in the untreated group. Comparing treated and untreated students directly, the latter group had significantly higher absences. Graduating from High School – Compared to students without ADHD, the likelihood of not graduating from high school on the first attempt was significantly higher in the untreated group; treated students did not differ from students without ADHD and were also more likely to graduate on their first attempt compared to untreated students. Attending post-secondary education – Students in the untreated group were less likely to enter post-secondary education compared to both treated students and students without ADHD. Treated students were less likely to begin post-secondary than students without ADHD. Summary and implications – Results from this study conducted with a large sample of students drawn from the entire New Brunswick population indicate that treatment of ADHD with long-acting stimulants is linked to a number of positive academic impacts, particularly among secondary school students. Particularly noteworthy is that treatment significantly reduced school absences, enhanced the likelihood of graduating from high school on the first attempt, and also enhanced the likelihood of transitioning to post-secondary education. These are all positive outcomes and indicate that treatment with long acting stimulants may “….mitigate against the downstream consequences faced by those with untreated ADHD.”The advantage of using a large, administrative data set as was done in this study, rather than conducting a randomized clinical trial, is that it provides an opportunity to examine the impact of medication treatment in the real world. Thus, results from this study offer evidence of how treatment with long acting stimulants are likely to actually impact children in the community. However, these kinds of studies are not without limitations. For example, the accuracy with which ADHD diagnoses were established is unknown and a number of children are likely to have been misclassified. Also, while a number of factors that could influence academic outcomes were controlled for in the analyses, some potentially important individual and treatment-related factors, e.g., symptom severity, treatment adherence, availability of academic accommodations, could not be determined and were thus not accounted for. While these are important caveats, the overall pattern of results indicate that treatment with long-acting stimulants can reduce – and in some cases – eliminate significant outcome differences between students with and without ADHD. And, for most outcomes examined, students with ADHD who receive this treatment fare better than those who do not. Thus, this study contributes to the ADHD treatment literature by providing important new findings on the potential benefits of treatment with long acting stimulant medication for students with ADHD. |
| Copyright © 2025 by David Rabiner |
| Attention Research Update 5 Dobbs Place Durham, NC 27707 |
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