Mention the drug Ritalin (methylphenidate) and most of us think of hyperactive children.  Hundreds of studies have shown that stimulants like Ritalin improve the behavior of children with Attention Deficit Hyperactivity Disorder (ADHD).  As kids get older some have questioned the appropriateness of prescribing stimulants.  A study by Steven W. Evans, Ph.D., William E. Pelham Jr., Ph.D., and Bradley H. Smith, Ph.D. found that methylphenidate improves daily academic performance and academic behavior of teenagers.

Evans and his colleagues studied adolescents diagnosed with ADHD, and found that methylphenidate in combination with behavior modification improved their  performance on a range of academic measures, such as note-taking, daily assignments and quiz scores.  They also found that the medication did not cause  major side effects.

In an interview with an APA writer, Evans summarized the study in the following manner: "When they were taking stimulant medication, students were more likely not only to get schoolwork done, but to get it done more accurately than when they were taking a placebo.  Scores improved by an average of about 17 percent--a jump that could mean two or three letter grades."

Many of the previous studies on ADHD used younger children and focused on their hyperactive, inattentive and disruptive behaviors.  This study focused on teenagers and looked more closely at academic performance.  The researchers examined 45 adolescents diagnosed with ADHD who were enrolled in a University of Pittsburgh intensive summer treatment program for youth with ADHD. Most of the study participants were male, primarily because ADHD affects males more often than females.

Subjects received either a placebo or a 10, 20 or 30 milligram dose of methylphenidate.  All students received the active drug on some days and a placebo on other days.  This allowed the researchers to  compare the behavior and academic performance of each of the students in each of the drug conditions.

Students attended a one-hour history class four days a week, along with structured activities (such as note-taking instruction and social skills and problem solving groups) designed to help them learn to control their behavior.  Students in the various drug and placebo conditions evaluated on the quality of their note-taking, their performance on daily assignments, and on how often they completed their homework. The researchers also measured students' disruptive, inattentive and defiant behavior in the classroom.

Evans and his colleagues found that methylphenidate and behavior modification significantly boosted the quality of students' schoolwork. Eighty percent of the adolescents in this study showed improved academic performance while taking some dose of this medication.  But more Ritalin was not always better.  Fully two-thirds of teen-agers in the study showed moderate to large improvement in academic performance while on the lowest dose - 10 milligrams. Those did not improve on that dose did not always improove with a higher does.  Fewer than half of these teens showed improvement when the dose was increased to 20 milligrams, and even fewer of the remainder improved on a 30-milligram dose. Some students' performance actually deteriorated when their doses of methylphenidate were increased.

William Pelham, Ph.D. commented on this aspect of the study: "That's extremely important.  There are lots of psychiatrists out there who believe that if you keep upping the dose, people will continue to get better." Pelham argued against this practice. "You want the total amount of psychoactive drugs that a person takes in his or her lifetime to be as low as possible, because we don't know what the long-term effects are."

Will studies like this result in Ritalin being given to more and more teenagers?  It's hard to predict the future, but these drugs are already being used into adolescence in many cases.  We still don't know the long-term effects of prescribing stimulants like Ritalin to millions of children and teenagers.  Because it stimulates parts of the brain that we use to attend, these medications probably improve concentration in almost anyone who takes them, not just people with ADHD.  These stimulants have long been popular as "study pills" on college campuses.  The recent study adds to our knowledge of effective treatment techniques for ADHD.  It does not answer the questions that many people have about the long term safety of giving stimulants to our children.  

The full text of the original article is available after June 13 at http://www.apa.org/journals/pha.html.  Please share your thoughts on the Forum.