PROBLEM: In 1997, a policy reform in Quebec expanded insurance coverage for medications. It was accompanied by a dramatic increase in adolescents' use of Ritalin, one of the stimulant commonly prescribed to treat ADHD, and similar medications, relative to the rest of Canada. In theory, more treatment should be accompanied by improved outcomes in areas like education, where kids with ADHD often struggle.
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METHODOLOGY: Janet Currie, a professor of economics and public affairs at Princeton, along with colleagues at the University of Toronto and Cornell, took data from a nationally representative sample of over 15,000 children and their families, who were followed for 14 years. They analyzed potential short-term effects like the severity of the children's ADHD, as evaluated by their teacher, their behavior, as evaluated by their parents, their self-assessed emotional health, and their relationship with their teacher and family members. Currie and her team also looked at standardized test scores, whether the children repeated any grades, and whether they eventually graduated high school and went on to higher education.
RESULTS: The more acute a child's ADHD symptoms, the worse they scored for every outcome measured. But despite confirming that Ritalin use increased, especially among children with the worst ADHD, the authors found "little overall improvement in outcomes" in the short-term. After the policy change, children with high ADHD scores were even more likely to be behind in school, to have repeated a grade, and to have lower standardized math scores. The effect was stronger for boys than for girls -- boys were also more likely to eventually drop out of school. Children with average ADHD symptoms, particularly girls in this case, experienced a 24 percent increase in unhappiness once Ritalin became more commonly used.
IMPLICATIONS: How is it possible that an increase in ADHD treatment led to worse academic performance? The authors put forward the possibility that when made less disruptive, children ended up receiving less attention. The medication may have become "a substitute for other types of cognitive and behavioral interventions that might be necessary to help the child learn."
Because this study looked at Ritalin use from a population level, the authors caution that they were unable to determine whether Ritalin was being used correctly -- if children were getting the optimal dosage, for example, or if they were taking the meds consistently. They find it a bit worrying, then, that "in Quebec, as in the U.S., any doctor can prescribe Ritalin, and it is not necessary to have expertise treating ADHD."
The full study, "Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children With ADHD?" is a National Bureau of Economic Research working paper.