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Attention-Deficit/Hyperactivity Disorder, School Performance, and Effect of Medication

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Objective

Individuals with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for poor school performance, and pharmacological treatment of ADHD may have beneficial effects on school performance. Conclusions from previous research have been limited by small sample sizes, outcome measures, and treatment follow-up. The current study analyzed school performance in students with ADHD compared to students without ADHD, and the association between pharmacological treatment of ADHD and school performance.

Method

A linkage of Swedish national registers covering 657,720 students graduating from year 9 of compulsory school provided measures of school performance, electronically recorded dispensations of ADHD medication, and potentially confounding background factors such as parental socioeconomic status. Primary measures of school performance included student eligibility to upper secondary school and grade point sum.

Results

ADHD was associated with substantially lower school performance independent of socioeconomic background factors. Treatment with ADHD medication for 3 months was positively associated with all primary outcomes, including a decreased risk of no eligibility to upper secondary school, odds ratio = 0.80, 95% confidence interval (CI) = 0.76−0.84, and a higher grade point sum (range, 0.0−320.0) of 9.35 points, 95% CI = 7.88−10.82; standardized coefficient = 0.20.

Conclusion

ADHD has a substantial negative impact on school performance, whereas pharmacological treatment for ADHD is associated with higher levels in several measures of school performance. Our findings emphasize the importance of detection and treatment of ADHD at an early stage to reduce the negative impact on school performance.

Section snippets

Data Sources

We extracted data on school performance from the Swedish National School Register (NSR) for all 657,720 students graduating from year 9 of compulsory school between 2008 and 2013. The NSR contains individual level data on final grades (FGs) from school-leaving certificates and grades in standardized tests (subsequently referred to as tests) taken in Swedish, English, and mathematics, information about eligibility to upper secondary school (USS), and school of graduation. Using the Longitudinal

Descriptives

Of the 657,720 students graduating in 2008 to 2013, a total of 29,128 (4.4%) students had either received a diagnosis of ADHD and/or dispensation of ADHD medication. There were fewer female participants in the ADHD group (35.8%), than in the student population without ADHD (49.4%). A larger portion of students with ADHD (12.5%) graduated later than expected based on their age, compared to students without ADHD (3.8%). A comorbid diagnosis of developmental disorder was found in 14.9% of the ADHD

Discussion

To our knowledge, this is the largest study to examine the associations among ADHD, medication use, and school performance. We used a population cohort of 657,720 individuals graduating from compulsory school between 2008 and 2013. The main findings were that ADHD has a substantial negative impact on school performance that was independent of several important confounders (eg, parental education), and that pharmacological treatment for ADHD was associated with an attenuation in this

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    The authors acknowledge financial support from the Swedish Research Council (2013-2280 and 538-2013-8864), the Swedish Initiative for Research on Microdata in the Social and Medical Sciences (SIMSAM) framework grant no. 340-2013-5867, and the National Institute of Mental Health grant no. 1R01MH102221.

    This study was presented as an abstract at the American Professional Society of ADHD and Related Disorders Annual Meeting; Washington, DC; January 12−14, 2018.

    Disclosure: Dr. Bulik has served as a Scientific Advisory Board member of Shire and receives royalties from Pearson. Dr. Lichtenstein has served as a speaker for Medice. Dr. Larsson has served as a speaker for Eli Lilly and Co. and Shire and has received research grants from Shire. Drs. Stålhandske, Chang, Chen, Almqvist, Feldman, D’Onofrio, and Kuja-Halkola, and Mr. Jangmo report no biomedical financial interests or potential conflicts of interest.

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