Skip to main content

Advertisement

SpringerLink
Log in

How effective are drug treatments for children with ADHD at improving on-task behaviour and academic achievement in the school classroom? A systematic review and meta-analysis

  • Review
  • Published:
European Child & Adolescent Psychiatry Aims and scope Submit manuscript

Abstract

Attention-deficit hyperactivity disorder (ADHD) has a significant impact on children’s classroom behaviour, daily functioning and experience of school life. However, the effects of drug treatment for ADHD on learning and academic achievement are not fully understood. This review was undertaken to describe the effects of methylphenidate, dexamfetamine, mixed amfetamine salts and atomoxetine on children’s on-task behaviour and their academic performance, and to perform a meta-analysis to quantify these effects. Nine electronic databases were systematically searched for randomized controlled trials comparing drug treatment for ADHD against (i) no drug treatment, (ii) baseline (in crossover trials), or (iii) placebo; reporting outcomes encompassing measures of educational achievement within the classroom environment. Forty-three studies involving a pooled total of 2,110 participants were identified for inclusion. Drug treatment benefited children in the amount of school work that they completed, by up to 15 %, and less consistently improved children’s accuracy in specific types of academic assignments, such as arithmetic. Similar improvements were seen in classroom behaviour, with up to 14 % more of children’s time spent “on task”. Methylphenidate, dexamfetamine and mixed amfetamine formulations all showed beneficial effects on children’s on-task behaviour and academic work completion. Atomoxetine was examined in two studies, and was found to have no significant effect. These review findings suggest that medication for ADHD has the potential to improve children’s learning and academic achievement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

Similar content being viewed by others

References

  1. The MTA Cooperative Group (1999) A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal Treatment Study of Children with ADHD. Arch Gen Psychiatry 56(12):1073–1086

    Article  Google Scholar 

  2. Polanczyk G, Silva de Lima M, Horta BL, Biederman J, Rohde LA (2007) The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry 164(6):942–948

    Article  PubMed  Google Scholar 

  3. Taylor E et al (2004) European clinical guidelines for hyperkinetic disorder—first upgrade. Eur Child Adolesc Psychiatry 13(Suppl 1):I7–I30

    PubMed  Google Scholar 

  4. American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington, DC

    Google Scholar 

  5. DuPaul GJ, Stoner G (2003) ADHD in the schools: assessment and intervention strategies, 2nd edn. Guilford Press, New York

    Google Scholar 

  6. Fergusson DM et al (1997) Attentional difficulties in middle childhood and psychosocial outcomes in young adulthood. J Child Psychol Psychiatry 38(6):633–644

    Article  PubMed  CAS  Google Scholar 

  7. Klassen AF et al (2004) Health-related quality of life in children and adolescents who have a diagnosis of attention-deficit/hyperactivity disorder. Pediatrics 114:e541

    Article  PubMed  Google Scholar 

  8. Harpin VA (2005) The effect of ADHD on the life of an individual, their family, and community from preschool to adult life. Arch Dis Child 90(Suppl I):i2–i7

    Article  PubMed  Google Scholar 

  9. Barkley RA (2002) Major life activity and health outcomes associated with attention-deficit/hyperactivity disorder. J Clin Psychiatry 63(Suppl 12):10–15

    PubMed  Google Scholar 

  10. Manuzza S et al (1998) Adult psychiatric status of hyperactive boys grown up. Am J Psychiatry 155:4

    Google Scholar 

  11. Frazier TW et al (2007) ADHD and achievement : meta-analysis of the child, adolescent, and adult literatures and a concomitant study with college students. J Learn Disabil 40:49

    Article  PubMed  Google Scholar 

  12. Biederman J et al (2012) An examination of the impact of ADHD on IQ: a large, controlled, family based analysis. Biol Psychiatry 71:1S–316S Abstract no. 773

    Article  Google Scholar 

  13. Duric NS, Elgen IB (2011) Norwegian children and adolescents with ADHD—a retrospective clinical study: subtypes and comorbid conditions and aspects of cognitive performance and social skills. Adolesc Psychiatry 1:349–354

    Google Scholar 

  14. Bridgett DJ, Walker ME (2006) Intellectual functioning in adults with ADHD: a meta-analytic examination of full scale IQ differences between adults with and without ADHD. Psychol Assess 18(1):1–14

    Article  PubMed  Google Scholar 

  15. Barry TD, Lyman RD, Klinger LG (2002) Academic underachievement and attention-deficit/hyperactivity disorder: the negative impact of symptom severity on school performance. J Sch Psychol 40(3):259–283

    Article  Google Scholar 

  16. Loe IM, Feldman HM (2007) Academic and educational outcomes of children with ADHD. Ambul Pediatr 7(1):82–90

    Article  PubMed  Google Scholar 

  17. Massetti GM et al (2008) Academic achievement over 8 years among children who met modified criteria for attention-deficit/hyperactivity disorder at 4–6 years of age. J Abnorm Child Psychol 36(3):399–410

    Article  PubMed  Google Scholar 

  18. Polderman TJC, Boomsma D, Bartels M, Verhulst FC, Huizink AC (2010) A systematic review of prospective studies on attention problems and academic achievement. Acta Psychiatr Scand 122(4):271–284

    Article  PubMed  Google Scholar 

  19. Wigal SB, Wigal TL (2006) The laboratory school protocol: its origin, use, and new applications. J Atten Disord 10:92

    Article  PubMed  Google Scholar 

  20. National Institute for Health and Clinical Excellence (2008) Attention deficit hyperactivity disorder: Diagnosis and management of ADHD in children, young people and adults (National Clinical Practice Guideline Number 72) National Institute for Health and Clinical Excellence: London

  21. Swanson JM et al (1993) Effect of stimulant medication on children with attention deficit disorder: a “review of reviews”. Except Child 60(2):154–162

    Google Scholar 

  22. Jadad AR et al (1999) Treatment of attention-deficit/hyperactivity disorder. Evid Rep Technol Assess 11(i–viii):1–341

    Google Scholar 

  23. Schachar R et al (2002) Attention-deficit hyperactivity disorder: critical appraisal of extended treatment studies. Can J Psychiatry Revue Canadienne De Psychiatrie 47(4):337–348

    Google Scholar 

  24. Backman J, Firestone P (1979) A review of psychopharmacological and behavioral approaches to the treatment of hyperactive children. Am J Orthopsychiatry 49(3):500–504

    Article  PubMed  CAS  Google Scholar 

  25. Carlson JS et al (2007) Methylphenidate, atomoxetine, and caffeine: a primer for school psychologists. J Appl Sch Psychol 24(1):127–146

    Article  Google Scholar 

  26. Murray DW et al (2011) Effects of OROS methylphenidate on academic, behavioral, and cognitive tasks in children 9 to 12 years of age with attention-deficit/hyperactivity disorder. Clin Pediatr 50:308

    Article  Google Scholar 

  27. Scheffler RM et al (2009) Positive association between attention-deficit/hyperactivity disorder medication use and academic achievement during elementary school. Pediatrics 123:1273

    Article  PubMed  Google Scholar 

  28. Hale JB et al (2011) Executive impairment determines ADHD medication response: implications for academic achievement. J Learn Disabil 44:196

    Article  PubMed  Google Scholar 

  29. Semrud-Clikeman M et al (2008) Executive functioning in children with attention-deficit/hyperactivity disorder: combined type with and without a stimulant medication history. Neuropsychology 22(3):329–340

    Article  PubMed  Google Scholar 

  30. Barkley RA, Murphy KR, Fischer M (2008) ADHD in adults: what the science says. Guilford Press, New York

    Google Scholar 

  31. Biederman J et al (2006) Young adult outcome of attention deficit hyperactivity disorder: a controlled 10-year follow-up study. Psychol Med 39:167–179

    Article  Google Scholar 

  32. Molina BSG et al (2009) MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study. J Am Acad Child Adolesc Psychiatry 48:5

    Article  Google Scholar 

  33. Biederman J, Faraone SV (2006) The effects of attention-deficit/hyperactivity disorder on employment and household income. Medscape Gen Med 8(3):12

    Google Scholar 

  34. The Cochrane Collaboration (2008) Cochrane handbook for systematic reviews of interventions version 5.0.1. Higgins JPT, GS (editors). The Cochrane Collaboration

  35. The Cochrane Collaboration (2008) Review Manager Version 5.0. The Nordic Cochrane Centre, Copenhagen

  36. Biederman J et al (2007) Lisdexamfetamine dimesylate and mixed amphetamine salts extended-release in children with ADHD: a double-blind, placebo-controlled, crossover analog classroom study. Biol Psychiatry 62(9):970–976

    Article  PubMed  CAS  Google Scholar 

  37. McCracken JT et al (2003) Analog classroom assessment of a once-daily mixed amphetamine formulation, SLI381 (ADDERALL XR), in children with ADHD. J Am Acad Child Adolesc Psychiatry 42(6):673–683

    Article  PubMed  Google Scholar 

  38. Pelham WE et al (1999) A comparison of morning-only and morning/late afternoon Adderall to morning-only, twice-daily, and three times-daily methylphenidate in children with attention-deficit/hyperactivity disorder. Pediatrics 104(6):1300–1311

    Article  PubMed  CAS  Google Scholar 

  39. Pelham WE et al (1999) A comparison of Ritalin and Adderall: efficacy and time-course in children with attention-deficit/hyperactivity disorder. Pediatrics 103(4):e43

    Article  PubMed  CAS  Google Scholar 

  40. Swanson JM et al (1998) Analog classroom assessment of Adderall in children with ADHD. J Am Acad Child Adolesc Psychiatry 37(5):519–526

    Article  PubMed  CAS  Google Scholar 

  41. Ajibola O, Clement PW (1995) Differential effects of methylphenidate and self-reinforcement on attention-deficit hyperactivity disorder. Behav Modif 19(2):211–233

    Article  PubMed  CAS  Google Scholar 

  42. Balthazor MJ, Wagner RK, Pelham WE (1991) The specificity of the effects of stimulant medication on classroom learning-related measures of cognitive processing for attention-deficit disorder children. J Abnorm Child Psychol 19(1):35–52

    Article  PubMed  CAS  Google Scholar 

  43. Barkley RA, Dupaul GJ, McMurray MB (1991) Attention-deficit disorder with and without hyperactivity—clinical response to 3 dose levels of methylphenidate. Pediatrics 87(4):519–531

    PubMed  CAS  Google Scholar 

  44. Brams M et al (2008) A randomized, double-blind, crossover study of once-daily dexmethylphenidate in children with attention-deficit hyperactivity disorder: rapid onset of effect. CNS Drugs 22(8):693–704

    Article  PubMed  CAS  Google Scholar 

  45. Carlson CL et al (1992) Single and combined effects of methlyphenidate and behavior—therapy on the classroom performance of children with attention-deficit hyperactivity disorder. J Abnorm Child Psychol 20(2):213–232

    Article  PubMed  CAS  Google Scholar 

  46. Chacko A et al (2005) Stimulant medication effects in a summer treatment program among young children with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 44(3):249–257

    Article  PubMed  Google Scholar 

  47. Dopfner M et al (2004) Comparative efficacy of once-a-day extended-release methylphenidate, two-times-daily immediate-release methylphenidate, and placebo in a laboratory school setting. Eur Child Adolesc Psychiatry 13:I93–I101

    PubMed  Google Scholar 

  48. Douglas VI et al (1986) Short-term effects of methylphenidate on the cognitive, learning and academic-performance of children with attention-deficit disorder in the laboratory and the classroom. J Child Psychol Psychiatry 27(2):191–211

    PubMed  CAS  Google Scholar 

  49. Dupaul GJ, Rapport MD (1993) Does methylphenidate normalize the classroom performance of children with attention-deficit disorder? J Am Acad Child Adolesc Psychiatry 32(1):190–198

    Article  PubMed  CAS  Google Scholar 

  50. Elia J et al (1993) Classroom academic-performance—improvement with both methlyphendiate and dextroamphetamine in ADHD boys. J Child Psychol Psychiatry 34(5):785–804

    Article  PubMed  CAS  Google Scholar 

  51. Evans SW, Pelham WE (1991) Psychostimulant effects on academic and behavioral measures for ADHD junior-high school students in a lecture format classroom. J Abnorm Child Psychol 19(5):537–552

    Article  PubMed  CAS  Google Scholar 

  52. Evans SW et al (2001) Dose-response effects of methylphenidate on ecologically valid measures of academic performance and classroom behavior in adolescents with ADHD. Exp Clin Psychopharmacol 9(2):163–175

    Article  PubMed  CAS  Google Scholar 

  53. Fabiano GA et al (2007) The single and combined effects of multiple intensities of behavior modification and methylphenidate for children with attention deficit hyperactivity disorder in a classroom setting. Sch Psychol Rev 36(2):195–216

    Google Scholar 

  54. Gorman EB et al (2006) Effects of methylphenidate on subtypes of attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 45(7):808–816

    Article  PubMed  Google Scholar 

  55. James RS et al (2001) Double-blind, placebo-controlled study of single-dose amphetamine formulations in ADHD. J Am Acad Child Adolesc Psychiatry 40(11):1268–1276

    Article  PubMed  CAS  Google Scholar 

  56. McGough JJ et al (2006) A randomized, double-blind, placebo-controlled, laboratory classroom assessment of methylphenidate transdermal system in children with ADHD. J Atten Disord 9(3):476–485

    Article  PubMed  Google Scholar 

  57. Pelham WE et al (1985) Methylphenidate and children with attention deficit disorder—dose effects on classroom academic and social behavior. Arch Gen Psychiatry 42(10):948–952

    Article  PubMed  CAS  Google Scholar 

  58. Pelham WE et al (1987) Sustained release and standard methlyphenidate effects on cognitive and social-behavior in children with attention-deficit disorder. Pediatrics 80(4):491–501

    PubMed  Google Scholar 

  59. Pelham WE et al (1990) Relative efficacy of long-acting stimulants on children with attention-deficit hyperactivity disorder—a comparison of standard methylphenidate, sustained-release methylphenidate, sustained-release dextroamphetamine, and pemoline. Pediatrics 86(2):226–237

    PubMed  Google Scholar 

  60. Pelham WE et al (1993) Separate and combined effects of methylphenidate and behavior-modification on boys with attention-deficit hyperactivity disorder in the classroom. J Consult Clin Psychol 61(3):506–515

    Article  PubMed  Google Scholar 

  61. Pelham WE Jr et al (2005) A dose-ranging study of a methylphenidate transdermal system in children with ADHD. J Am Acad Child Adolesc Psychiatry 44(6):522–529

    Article  PubMed  Google Scholar 

  62. Rapport MD et al (1985) Methylphenidate in hyperactive-children—differential effects of dose on academic, learning and social behavior. J Abnorm Child Psychol 13(2):227–243

    Article  PubMed  CAS  Google Scholar 

  63. Rapport MD et al (1994) Attention-deficit disorder and methylphenidate—normalization rates, clinical effectiveness, and response prediction in 76 children. J Am Acad Child Adolesc Psychiatry 33(6):882–893

    Article  PubMed  CAS  Google Scholar 

  64. Silva RR et al (2006) Efficacy and duration of effect of extended-release dexmethylphenidate versus placebo in schoolchildren with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol 16(3):239–251

    Article  PubMed  Google Scholar 

  65. Tannock R et al (1989) Dose-response effects of methylphenidate on academic-performance and overt behavior in hyperactive children. Pediatrics 84(4):648–657

    PubMed  CAS  Google Scholar 

  66. Vyse SA, Rapport MD (1989) The effects of methylphenidate on learning in children with ADDH: the stimulus equivalence paradigm. J Consult Clin Psychol 57(3):425–435

    Article  PubMed  CAS  Google Scholar 

  67. Wigal SB et al (2009) A 13-hour laboratory school study of lisdexamfetamine dimesylate in school-aged children with attention-deficit/hyperactivity disorder. Child Adolesc Psychiatry Mental Health 3:17

    Article  Google Scholar 

  68. Silva R et al (2005) Efficacy of two long-acting methylphenidate formulations in children with attention-deficit/hyperactivity disorder in a laboratory classroom setting. J Child Adolesc Psychopharmacol 15(4):637–654

    Article  PubMed  Google Scholar 

  69. Swanson JM et al (2004) A comparison of once-daily extended-release methylphenidate formulations in children with attention-deficit/hyperactivity disorder in the laboratory school (The Comacs Study). Pediatrics 113(3 Part 1):e206–e216

    Article  PubMed  Google Scholar 

  70. Ballinger C, Varley C, Nolen P (1984) Effects of methylphenidate on reading in children with attention deficit disorder. Am J Psychiatry 141(12):1590–1593

    PubMed  CAS  Google Scholar 

  71. Klein RG (1991) Effects of high methylphenidate doses on the cognitive performance of hyperactive children. Bratisl Med J 92(11):534–539

    CAS  Google Scholar 

  72. Pelham WE et al (1989) Comparative effects of methylphenidate on ADD girls and ADD boys. J Am Acad Child Adolesc Psychiatry 28(5):773–776

    Article  PubMed  Google Scholar 

  73. Rapport MD et al (1986) Comparing classroom and clinic measures of attention deficit disorder: differential, idiosyncratic, and dose-response effects of methylphenidate. J Consult Clin Psychol 54(3):334–341

    Article  PubMed  CAS  Google Scholar 

  74. Rapport MD et al (1987) Attention deficit disorder and methylphenidate: group and single-subject analyses of dose effects on attention in clinic and classroom settings. J Clin Child Psychol 16(4):329–338

    Article  Google Scholar 

  75. Richardson E et al (1988) Effects of methylphenidate dosage in hyperactive reading-disabled children: II. Reading achievement. J Am Acad Child Adolesc Psychiatry 27(1):78–87

    Article  PubMed  CAS  Google Scholar 

  76. Worrall A (1993) Evaluating the effects of methylphenidate on the cognitive, behavioural and academic performance of A.D.D. children in the classroom. S Afr J Child Adolesc Mental Health 5(2):96–101

    Article  Google Scholar 

  77. Brown RT et al (2006) Atomoxetine in the management of children with ADHD: effects on quality of life and school functioning. Clin Pediatr 45(9):819–827

    Article  Google Scholar 

  78. Wietecha LA et al (2009) Atomoxetine treatment in adolescents with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol 19:6

    Article  Google Scholar 

  79. Swanson JM (1992) School-based assessments and interventions for ADD students. K.C. Publishing, Irvine

    Google Scholar 

  80. Murray DW et al (2009) Psychometric properties of teacher SKAMP ratings from a community sample. Assessment 16(2):193–208

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

KS is partly funded by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Nottinghamshire, Derbyshire, Lincolnshire. VP is funded by the NIHR as a Doctoral Research Fellow and was previously funded by the NIHR as an In-Practice Fellow.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. University of Nottingham, Nottingham, Nottinghamshire, UK

    Vibhore Prasad, Ellen Brogan, Caroline Mulvaney, Matthew Grainge, Wendy Stanton & Kapil Sayal

Authors
  1. Vibhore Prasad
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ellen Brogan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Caroline Mulvaney
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Matthew Grainge
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wendy Stanton
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kapil Sayal
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vibhore Prasad.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Cite this article

Prasad, V., Brogan, E., Mulvaney, C. et al. How effective are drug treatments for children with ADHD at improving on-task behaviour and academic achievement in the school classroom? A systematic review and meta-analysis. Eur Child Adolesc Psychiatry 22, 203–216 (2013). https://doi.org/10.1007/s00787-012-0346-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00787-012-0346-x

Keywords

Search

Navigation