Early ADHD Treatment May Save Math Skills

Here is British Columbia we are very reluctant to test children in the early school years. Often, from parents, I hear that their child, who is failing academically at school, is not a "priority" as there are no severe behavioural issues. So, they are placed on a waiting list, which usually is rewritten every school year, and they never get assessed. Parents are often waiting for the school assessment - a psychoeducational assessment - to tell them about ADHD. They are often surprised when the psychoeducational assessment is completed to find out the schools neither diagnose ADHD, nor do they provide any structured and measurable treatments for ADHD (for the most part.) While there are some individual school districts here in BC that do have organized interventions for ADHD, they are few and far between, and BC is known for providing the fewest services for children with ADHD of all the provinces. So, we often wait through grades 1,2 and 3 and maybe in grade 4 or 5 we finally get a psychoeducational assessment and are old to visit either a medical doctor or a registered psychologist for a diagnosis of ADHD. Only after all of this waiting around are we ready to begin treatment interventions. And one thing we have known for sure is that early intervention for ADHD is critical, because its a developmental disorder, and developmentally appropriate skills are often not learned, and are hard to teach at the "wrong" developmental stage. Math is often the first academic skills to suffer. And trying to catch up in math in grades 5,6 or 7 is very difficult. This review article from Medpage looks at the results of EARLY treatment for ADHD, and how early ADHD treatment may be critical in saving math skills. Click http://www.medpagetoday.com/Pediatrics/ADHD-ADD/33441 for the full story The research points out two critical facts that I want to make clear at the beginning: 1) Starting treatment for attention-deficit/hyperactivity disorder (ADHD) sooner rather than later appears to lower the likelihood of a decline in academic performance as children move from elementary to middle school, and 2)that the timing of ADHD treatment had little influence on the risk of a decline in language arts performance.This is also important because parents, and teachers, often assume that because language based skills -reading, writing - are pretty much up to par the student only needs to be further encouraged to take academic work seriously. "They can do the work they want to do ...so we know they can do the work," is the false, misinformed and unfortunate thing I often hear. Here are the basic findings from the article, found at Medpage: "Starting treatment for attention-deficit/hyperactivity disorder (ADHD) sooner rather than later appears to lower the likelihood of a decline in academic performance as children move from elementary to middle school." "Among Icelandic children receiving ADHD medications, those who started treatment later had greater risks of a decline in math performance (RR 1.7, 95% CI 1.2 to 2.4), an association that was stronger in girls than in boys." Fairly early meds lead to better academic outcomes. Here is an interesting historical fact: "In 1937 -- 75 years ago -- when children were treated with stimulant medication for the first time, the boys referred to the medication as their 'arithmetic pills' since they noticed their math performance improve." Even the kids knew this was helping, and helping specifically in math. "More recently," the researchers continued, "math performance (speed and accuracy) has proven to be a very sensitive and reliable clinical measure of medication effectiveness in many research studies." The researchers noted that previous studies have shown that mathematics disabilities and language disorders involve different parts of the brain. "Possibly," they wrote, "stimulant drug treatment has more positive effects on the cognitive function underlying mathematical ability than on that underlying language ability." Although stimulants have been shown to improve the core symptoms of ADHD, there are few long-term data on their effect on academic progress. To explore the issue, the researchers, Zoëga and colleagues looked at data from 11,872 children ages 9 to 12 born from 1994 to 1996 who took standardized tests in the Icelandic school system in the fourth and seventh grades. Information came from the Icelandic Medicines Registry and the Database of National Scholastic Examinations. About 8% of the children were treated with ADHD drugs at some point during the study period. Nearly all of those treated received methylphenidate (96%); 9% also received atomoxetine and 34% received another psychotropic drug concurrently. The children who started taking ADHD drugs between the fourth and seventh grades were more likely to decline in test performance -- defined as a drop of at least 5 percentile points -- compared with nonmedicated children. So we see that while the medication might be helping, it is not enough alone. But they noted, "There were also differences seen within the treated group; later treatment initiation (25 to 36 months after the fourth grade tests) was associated with higher rates of performance decline compared with earlier initiation (within 12 months of the fourth grade tests).Declines in math were seen in 73% of those who started later and 41% for those who started earlier. Language arts declines were seen in 43% of those who started later and 39% of those who started earlier." They also note that, "When broken down by sex, the relationship between starting treatment later and a decline in math performance was stronger for girls than for boys (RR 2.7 versus 1.4). That finding could be due to chance or could be related to sex differences in ADHD symptoms, according to the researchers, who noted that girls with ADHD typically present with symptoms of inattention and have less hyperactivity than boys." They noted, "It is possible that children who started ADHD treatment earlier may have more family or social support to help them in school." However the results are fairly clear. Here in BC we find ourselves in an educational system that is over focused on math. You can't get into a university here without completing specific high school math courses - even if you have high grades in all your other courses and plan on majoring in history or fine art, problems in math will hold you back in BC (while the schools essentially ignore ADHD and other neurological deficits that are at the root). You may agree or disagree with this emphasis on math. The problem is that it is real. So EARLY intervention is critical. Talk to your medical doctor, see a registered psychologist for information on ADHD diagnosis and non-medical interventions, and speak up for services at school. For those interested in the problem of math education, the New York Times had an excellent article this morning on just this subject. It can be found here: http://www.nytimes.com/2012/07/29/opinion/sunday/is-algebra-necessary.html?smid=pl-share Information on ADHD assessment and treatment services I provide can be found at www.relatedminds.com or www.adhdhelp.ca.