Based on a synthesis of existing studies, James M. Swanson and researchers at the University of California/Irvine ADD Center, state that a consensus exists on the effects of stimulant medication on children with Attention Deficit Disorder (ADD) and hyperactivity. In their report, they describe what educators and parents should and should not expect from the use of stimulant medication with ADD children.
It is generally agreed, Swanson et al.write, that stimulant medication temporarily reduces the symptoms of overactivity, inattention and impulsivity in many children identified as having ADD. Temporary behavioral improvements can include increased compliance and effort, a decrease in negative social behaviors and physical and verbal hostility, and sometimes an increase in the amount and accuracy of work completed.
Even so, 25 to 40 percent of ADD children who receive medication do not experience these benefits. In addition, many students receiving placebos in double-blind studies have shown similar improvement in behavior. Unfortunately, for most children with ADD, medication appears to do little to improve overall academic achievement. No significant improvement should be expected in reading skills, athletic skills or positive social skills. Learning or achievement improves only to the extent that behavior or attention improves.
Moreover, the medication can produce side effects. Infrequently, children develop tics but very frequently, they experience eating and sleeping problems. Some researchers speculate that high doses may affect cognition; impairing learning.
Many researchers cite overuse of stimulant medication and urge greater caution in labeling children and a more restricted use of stimulants. These researchers argue that diagnosing ADD and separating it from other learning and behavior problems is difficult. Many professionals are concerned that stimulants simply mask symptoms and may postpone or prevent the use of other interventions that could be more effective in the long term.
Though researchers stress that stimulants should always be used in combination with educational and behavioral interventions, only a few controlled studies have been conducted that support this common-sense recommendation. And Swanson et al. report that major flaws in these studies make it difficult to accurately assess the impact of combined treatment.
Research is continuing. The National Institute of Mental Health is currently studying:
1) why no long-term effects are seen from the use of stimulants,
2) why a significant number of children do not respond to stimulants in the short term,
3) if high doses impair learning,
4) if the learning that occurs is dependent on the medicated state of the child,
5) if effects of stimulants depend on age and I.Q.,
6) if stimulant effects depend on co-existing conditions,
7) whether the effects of different stimulants are the same,
8) why the links to biological factors are not well established, and
9) why the length of treatment has been so limited (an average of two years).
These researchers stress that, so far, no intervention strategy either by itself or in combination with others, has proved clinically sufficient and long-lasting for dealing with the problems of ADD. Empirical evidence in favor of non-drug interventions that promote positive educational outcomes is still weak. Few studies have been conducted in regular classrooms. Swanson et al. state that this population of students is still inadequately defined, and that the diagnosis of ADD often overlaps with other learning and behavior problems.
“Effect of Stimulant Medication on Children with Attention Deficit Disorder: A Review of Reviews”, Exceptional Children, Volume 60, Number 2, pp. 154-162.
Published in ERN, January/February 1994, Volume 7, Number 1.