Teens’ ADHD treatment gets low-dose boost

Most children diagnosed with attention-deficit hyperactivity disorder (ADHD) still exhibit the condition’s symptoms as adolescents and continue to take large, daily doses of prescribed stimulants. Teenagers with ADHD improve their schoolwork and behave better in class when given a low dose of medication combined with behavioral training, a new study finds.

The investigation, published in the May Experimental and Clinical Psychopharmacology, represents a rare attempt to track classroom learning in teens receiving ADHD treatment.

“For students who completed a behavioral-treatment program, those taking low doses of stimulant medication were more likely to get schoolwork done and to do it more accurately than when they were taking a placebo pill,” says psychologist Steven W. Evans of James Madison University in Harrisonburg, Va.

Individual responses to different stimulant doses varied greatly, Evans notes. However, academic performance most often declined among students taking a high dose of the medication.

Nevertheless, by the end of the 2-month program, average improvement on history quizzes and writing assignments corresponded to a grade change from failing to a C.

Evans’ team studied 40 boys and 5 girls with ADHD, ages 13 and 14, who attended a summer program 4 days a week at the University of Pittsburgh. On each day during the program’s last 6 weeks, students received either a placebo or a 10-, 20-, or 30-milligram dose of the stimulant known as Ritalin. Teens received each drug dose and the placebo in random order within each week and ended up taking each of them about six times.

The behavioral program included training in note-taking and social skills, working in problem-solving groups, and attending history and creative-writing classes.

About two-thirds of teens in the program improved markedly in academics and behavior while on the low Ritalin dose, Evans says. About one-sixth of the group performed as well only when the dose rose to 20 milligrams. Just a few did their best at the highest dose.

An earlier study found that grade-schoolers with ADHD behave better after a mix of stimulant treatment and behavioral training (SN: 12/18&25/99, p. 388). However, the teen results point to a link between low medication doses and at least temporary academic gains, Evans says.

He is now examining academic responses among teens with ADHD who attend an after-school behavioral program. To adjust stimulant doses, Evans’ team consults with the students’ pediatricians.

Academic improvement among teens in Evans’ summer-treatment program should spur more research into behavioral approaches to ADHD, comments psychologist George J. Dupaul of Lehigh University in Bethlehem, Penn.

“The problem for teens with ADHD is not a lack of intellectual ability,” Dupaul says. “They need to learn classroom survival skills, such as remembering to bring the right books to class and knowing how to manage their school time.”