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ADHD in Children Health Center

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Ritalin, Behavior Modification Make the Grade for ADHD

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WebMD Health News

May 31, 2001 -- Here's some good news, for a change, about teens and drugs: Junior high school students with attention deficit hyperactivity disorder (ADHD) who took the drug Ritalin, and who also got help with their behavior, had improvement in academic scores -- enough to boost their scores by one or two letter grades.

The students were both more likely to complete assignments and to get them done more accurately when they were taking Ritalin than when they were taking a look-alike placebo drug, report Stephen W. Evans, PhD, and colleagues in a study published in the journal Experimental and Clinical Psychopharmacology.

"We believe very strongly that what this shows is that you need to combine medication on top of appropriate behavioral interventions for teens, just like lots of studies have shown to be true for younger kids," says co-author William E. Pelham Jr., PhD, professor of psychology, pediatrics, and psychiatry at SUNY at Buffalo, in an interview with WebMD

The study also showed that for kids with ADHD who benefit from taking Ritalin, increasing the dose does not necessarily improve academics -- and could even hurt performance, the authors say.

Children who are diagnosed with ADHD generally have trouble paying attention, are easily distracted, impulsive, and hyperactive -- in other words, they just can't seem to keep still or to focus on the task at hand. The disorder is frequently broken down into three subcategories according to whether the child is hyperactive and impulsive alone, inattentive alone, or a combination of all three.

"ADHD children suffer from serious impairment in relationships with parents, teachers, peers, and siblings, as well as major difficulties in academic functioning. Although it has been well established that such difficulties continue into young adulthood for individuals with ADHD, there has been very little research directed at the nature of these impairments in adolescents with ADHD," Evans and colleagues write.

To determine whether specific doses of Ritalin had an effect on classroom behavior and academic performance in teens, the researchers looked at 45 adolescents diagnosed with ADHD -- 40 boys and five girls -- who were enrolled in an intensive summer treatment program at the University of Pittsburgh.

The students received either placebo or Ritalin three times per day during the eight weeks of the study. Each student received a different dose of the drug or a placebo each day of the study, allowing the researchers to compare how the students behaved and performed academically at each dose.

The students also received behavior modification therapy aimed at helping them to control their behavior and function better in settings such as school. Instruction included tips on better note-taking, social skills, and problem-solving.

The researchers looked at the quality of the students' notes, performance on daily quizzes, writing assignments, in-class worksheets, and how often they completed assigned homework. The students were also monitored for signs of ADHD-related behavior in the classroom.

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