By RNZ
A new study says giving kids with ADHD extra time for tasks and more frequent breaks while in class may not affect their behaviour.
Researchers from Florida International University got more than 200 primary school children at summer camps in the United States to switch between taking and not taking medication and different classroom environments.
The study, published in the Jama Paediatrics medical journal, found that medication improved the kids’ rule-following and test results. But the adaptations in the classroom, including extended time for tasks, frequent breaks, using a standing desk and having a low distraction space, didn’t affect their behaviour or achievement.
University of Auckland development neuropsychology expert Professor Karen Waldie said the study came as no surprise to those who work with children with ADHD and do research in the area.
“Procrastination and time blindness are one of the key symptoms of ADHD. The main reason for the benefits of medication and behavioural therapy comes down to the brain chemical dopamine and the reward system of the brain.
“Stimulant medication such as Ritalin works to increase dopamine in the prefrontal cortex and this helps those with ADHD focus on the task at hand: right now.”
Waldie said the study found that medication and behaviour therapy improved academic productivity and rule-following behaviour in the classroom, but accommodations such as extended time on tasks had no effect.
“Another thing that works in a similar way as stimulant meds is a hard deadline and quick consequences of actions – so basically people with ADHD work very well under pressure, which gives them a dopamine reward hit, and do less well when there is time available to perform a task like a test or when there is a distant or inconsequential reward.”
Consultant clinical psychologist and honorary senior lecturer at University of Auckland’s Te Ara Hāro Centre for Infant, Child and Adolescent Mental Health, Dr Melanie Woodfield, said the study is an important signal from a carefully designed experiment, but needs testing in the real world.
“Positive behaviour supports, medication, or both, are known to improve academic performance and decrease challenging behaviour for many children with ADHD.”
Woodfield said the study leaned towards strict control, excluding children with low IQ or autism alongside ADHD, and taking place in a specialist American summer camp treatment classroom, where staff even counted the ratio of teacher praise to commands, to ensure it was 3:1.
“That’s quite far removed from a messy, complex, real world classroom with fewer resources, stretched teachers, and children with higher needs. The authors themselves recommend the study now needs to be repeated in real-world classrooms, where they expect the effects would be weaker.
“Ideally, we should also acknowledge that some accommodations do work for some children, some of the time,” Woodfield said.
“However, this research suggests that a blanket, Oprah-style giveaway ‘You get extra time! And you get extra time’ may not return reliable dividends, compared to behavioural approaches and/or medication.”
Clinical psychologist Giselle Bahr said there’s been no specific research about what happens when children with ADHD are offered structured classroom changes and while the study showed they did not make a difference to behaviour in this instance, it was food for thought.
“It’s like, of course it would make sense to give a child more time if they’re struggling, but it looks like it’s not as simple as that,” she said.
“What we already know is that behavioural strategies help children and they don’t have any adverse effects, there’s no risks associated with them. We already know that methylphenidate changes children’s behaviour in the short term, but over the long term it leads to worse outcomes.”
Bahr said the study had not been done in a normal classroom setting, but at a summer camp during one-hour class periods, and the adjustments were randomised.
“The rest of the hours of the day they were doing fun activities and the classes were small. They only had 15 to 18 students in them and there were two adults in each of those classrooms. It’s not an exact match with how a classroom generally run, so we have to be careful about what we extrapolate from that.
“It doesn’t look like they matched a child’s kind of need for what’s going to help them learn better in a classroom, they just kind of trailed these adaptations.”
She said the researchers, Fabiano and Pelham, had authored papers about children and ADHD for decades and said behavioural interventions remained an important, low-risk strategy for supporting children with ADHD.
“Some of their previous work looked at the best order for interventions. They found that starting with behavioural strategies was more effective than starting with medication. Also, that ADHD medication made things worse for children in the long term, even if it produced improvements in the short-term.”
Bahr said ADHD medication came with serious risks, including reduced growth, a risk of psychotic symptoms, and cardiovascular problems.
Bahr said the findings challenged the common-sense assumptions that adaptations like extra time or low distraction spaces would always improve outcomes, but more research was needed to determine how classroom adjustments could benefit kids with ADHD.
- RNZ