In the Journals

ADHD medication may improve school test scores in ADHD

ADHD medication use was associated with better performance on higher education entrance tests among individuals with ADHD, according to recent findings.

“Clinical trials have shown that ADHD medications are efficacious at reducing the core symptoms of ADHD and are generally tolerated in children, adolescents and adults, although recent Cochrane systematic reviews graded this evidence as low-quality,” Yi Lu, PhD, of Karolinska Institutet, Stockholm, and colleagues wrote. “It is, however, less clear whether such improvement in behavior translates into better academic outcomes. Results from previous studies are mixed; more important, it is difficult to evaluate the educational significance of the measured outcomes.”

To assess associations between ADHD medication use and performance on higher education entrance tests among individuals with ADHD, researchers analyzed records of pharmacologic treatment from Swedish national registers and data from the Swedish Scholastic Aptitude Test for 61,140 individuals diagnosed with ADHD.

Overall, 930 individuals completed multiple entrance tests and used ADHD medications intermittently.

When adjusting for age and practice effects, mean test scores were 4.8 points higher (95% CI, 2.26-7.34; P < .001) during periods of medication use, compared with nonmedicated periods.

Sensitivity analyses indicated similar associations, according to researchers.

“Although these are encouraging findings with clear clinical effect, some caution is required,” Luis Augusto Rohde, MD, PhD, of Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil, wrote in an accompanying editorial.

According to Rohde, there are methodological issues inherent to large population samples like the one used by Lu and colleagues, not all participants took the entrance test, and Swedish Medical Registers included only individuals being treated for ADHD.

“There are also uncertainties about the magnitude of the clinical effect because the use of medication increased test scores by a mean of 4.8 points (95% CI, 2.26-7.34 points) on a scale from 0 to 200,” Rodhe wrote. “Do these methodological issues diminish clinical interest in the findings? Clearly not. Science is a construction in which we need to put one brick at a time in the wall of knowledge. One major problem in the clinical work with patients with ADHD is their adherence to pharmacologic interventions. The field needs data on functional outcomes that matter for patients... The work done by this group of investigators provides the kind of information that we all need to stimulate compliance with pharmacologic interventions in our discussions with patients.” – by Amanda Oldt

Disclosure: Lu reports no relevant financial disclosures. Rohde reports receiving honoraria, serving on the speakers bureau or advisory board, and/or serving as a consultant for Eli Lilly, Janssen-Cilag, Novartis, Medice, and Shire; receiving authorship royalties from Oxford Press and ArtMed; receiving travel awards from Shire for taking part in 2014 American Psychiatric Association and 2015 World Federation of ADHD meetings; and receiving unrestricted educational and research support from Eli Lilly, Janssen-Cilag, Novartis, and Shire for the ADHD and Juvenile Bipolar Disorder Outpatient Programs that he chaired. Please see the study for a full list of relevant financial disclosures.

ADHD medication use was associated with better performance on higher education entrance tests among individuals with ADHD, according to recent findings.

“Clinical trials have shown that ADHD medications are efficacious at reducing the core symptoms of ADHD and are generally tolerated in children, adolescents and adults, although recent Cochrane systematic reviews graded this evidence as low-quality,” Yi Lu, PhD, of Karolinska Institutet, Stockholm, and colleagues wrote. “It is, however, less clear whether such improvement in behavior translates into better academic outcomes. Results from previous studies are mixed; more important, it is difficult to evaluate the educational significance of the measured outcomes.”

To assess associations between ADHD medication use and performance on higher education entrance tests among individuals with ADHD, researchers analyzed records of pharmacologic treatment from Swedish national registers and data from the Swedish Scholastic Aptitude Test for 61,140 individuals diagnosed with ADHD.

Overall, 930 individuals completed multiple entrance tests and used ADHD medications intermittently.

When adjusting for age and practice effects, mean test scores were 4.8 points higher (95% CI, 2.26-7.34; P < .001) during periods of medication use, compared with nonmedicated periods.

Sensitivity analyses indicated similar associations, according to researchers.

“Although these are encouraging findings with clear clinical effect, some caution is required,” Luis Augusto Rohde, MD, PhD, of Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil, wrote in an accompanying editorial.

According to Rohde, there are methodological issues inherent to large population samples like the one used by Lu and colleagues, not all participants took the entrance test, and Swedish Medical Registers included only individuals being treated for ADHD.

“There are also uncertainties about the magnitude of the clinical effect because the use of medication increased test scores by a mean of 4.8 points (95% CI, 2.26-7.34 points) on a scale from 0 to 200,” Rodhe wrote. “Do these methodological issues diminish clinical interest in the findings? Clearly not. Science is a construction in which we need to put one brick at a time in the wall of knowledge. One major problem in the clinical work with patients with ADHD is their adherence to pharmacologic interventions. The field needs data on functional outcomes that matter for patients... The work done by this group of investigators provides the kind of information that we all need to stimulate compliance with pharmacologic interventions in our discussions with patients.” – by Amanda Oldt

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Disclosure: Lu reports no relevant financial disclosures. Rohde reports receiving honoraria, serving on the speakers bureau or advisory board, and/or serving as a consultant for Eli Lilly, Janssen-Cilag, Novartis, Medice, and Shire; receiving authorship royalties from Oxford Press and ArtMed; receiving travel awards from Shire for taking part in 2014 American Psychiatric Association and 2015 World Federation of ADHD meetings; and receiving unrestricted educational and research support from Eli Lilly, Janssen-Cilag, Novartis, and Shire for the ADHD and Juvenile Bipolar Disorder Outpatient Programs that he chaired. Please see the study for a full list of relevant financial disclosures.