Attention-deficit/hyperactivity disorder, school performance, and effect of medication
Open accessAbstract
OBJECTIVE Individuals with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for poor school performance, and pharmacological treatment of ADHD may have beneficial effects on school performance. Conclusions from previous research have been limited by small sample sizes, outcome measures, and treatment follow-up. The current study analyzed school performance in students with ADHD compared to students without ADHD, and the association between pharmacological treatment of ADHD and school performance. METHOD A linkage of Swedish national registers covering 657,720 students graduating from year 9 of compulsory school provided measures of school performance, electronically recorded dispensations of ADHD medication, and potentially confounding background factors such as parental socioeconomic status. Primary measures of school performance included student eligibility to upper secondary school and grade point sum. RESULTS ADHD was associated with substantially lower school performance independent of socioeconomic background factors. Treatment with ADHD medication for 3 months was positively associated with all primary outcomes, including a decreased risk of no eligibility to upper secondary school, odds ratio = 0.80, 95% confidence interval (CI) = 0.76-0.84, and a higher grade point sum (range, 0.0-320.0) of 9.35 points, 95% CI = 7.88-10.82; standardized coefficient = 0.20. CONCLUSION ADHD has a substantial negative impact on school performance, whereas pharmacological treatment for ADHD is associated with higher levels in several measures of school performance. Our findings emphasize the importance of detection and treatment of ADHD at an early stage to reduce the negative impact on school performance.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
A Swedish registry study of over 650,000 students found that three months of ADHD medication treatment resulted in a more than nine-point gain in grade point sum and was associated with a two-thirds increase in the probability of completing upper secondary school.
“A Swedish registry study of over 650,000 students found that treatment with ADHD medication for three months resulted in a more than nine-point gain in grade point sum (on a scale of 0 to 320); treatment was associated with an increase in the probability of completing upper secondary school by two-thirds”
From The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder (2021) · cites this paper as Jangmo et al., 2019
The Abstract (Method and Results) reports 657,720 Swedish students and an association between three months of ADHD medication and a 9.35-point higher grade point sum on a 0–320 scale. But the Results (Sensitivity analyses) reports an adjusted odds ratio of 0.89 for *not completing* upper secondary school, not a two-thirds increase in the probability of completing it. The registry study also reports an association, so “resulted in” overstates the evidence for a causal gain. (LLM, conf=0.91)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
The worldwide prevalence of ADHD: a systematic review and metaregression analysis
Polanczyk, G., de Lima, M. S., Horta, B. L., Biederman, J., & Rohde, L. A. (2007) · American Journal of Psychiatry · doi:10.1176/ajp.2007.164.6.942 · Cited by 5,346 · see citing works
(1999) · Archives of General Psychiatry · doi:10.1001/archpsyc.56.12.1073 · Cited by 3,372 · see citing works
FARAONE, S. V., BIEDERMAN, J., & MICK, E. (2006) · Psychological Medicine · doi:10.1017/s003329170500471x · Cited by 2,267 · see citing works
BARKLEY, R. A., FISCHER, M., EDELBROCK, C. S., & SMALLISH, L. (1990) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-199007000-00007 · Cited by 1,507 · see citing works
Molina, B. S. G., Hinshaw, S. P., Swanson, J. M., Arnold, L. E., Vitiello, B., Jensen, P. S., Epstein, J. N., Hoza, B., Hechtman, L., Abikoff, H. B., et al. (2009) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/chi.0b013e31819c23d0 · Cited by 1,182 · see citing works
Academic and Educational Outcomes of Children With ADHD
Loe, I. M., & Feldman, H. M. (2007) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsl054 · Cited by 951 · see citing works
A Prospective 4-Year Follow-up Study of Attention-Deficit Hyperactivity and Related Disorders
Biederman, J. (1996) · Archives of General Psychiatry · doi:10.1001/archpsyc.1996.01830050073012 · Cited by 768 · see citing works
Treatment of Attention-Deficit/Hyperactivity Disorder: Overview of the Evidence
Brown, R. T., Amler, R. W., Freeman, W. S., Perrin, J. M., Stein, M. T., Feldman, H. M., Pierce, K., & Wolraich, M. L. (2005) · PEDIATRICS · doi:10.1542/peds.2004-2560 · Cited by 331 · see citing works
A systematic review of prospective studies on attention problems and academic achievement
Polderman, T. J. C., Boomsma, D. I., Bartels, M., Verhulst, F. C., & Huizink, A. C. (2010) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2010.01568.x · Cited by 303 · see citing works
Swanson, J., Baler, R. D., & Volkow, N. D. (2011) · Neuropsychopharmacology · doi:10.1038/npp.2010.160 · Cited by 252 · see citing works
Larsson, H., Rydén, E., Boman, M., Långström, N., Lichtenstein, P., & Landén, M. (2013) · British Journal of Psychiatry · doi:10.1192/bjp.bp.112.120808 · Cited by 203 · see citing works
Self-citationEvans, S. W., Pelham, W. E., Smith, B. H., Bukstein, O., Gnagy, E. M., Greiner, A. R., Altenderfer, L., & Baron-Myak, C. (2001) · Experimental and Clinical Psychopharmacology · doi:10.1037//1064-1297.9.2.163 · Cited by 185 · see citing works
Barbaresi, W. J., Katusic, S. K., Colligan, R. C., Weaver, A. L., & Jacobsen, S. J. (2007) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0b013e3180cabc28 · Cited by 161 · see citing works
Scheffler, R. M., Brown, T. T., Fulton, B. D., Hinshaw, S. P., Levine, P., & Stone, S. (2009) · Pediatrics · doi:10.1542/peds.2008-1597 · Cited by 160 · see citing works
Langberg, J. M., Molina, B. S. G., Arnold, L. E., Epstein, J. N., Altaye, M., Hinshaw, S. P., Swanson, J. M., Wigal, T., & Hechtman, L. (2011) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2011.581620 · Cited by 158 · see citing works
Pharmacological and non-pharmacological treatment of adults with ADHD: A meta-review
De Crescenzo, F., Cortese, S., Adamo, N., & Janiri, L. (2017) · Evidence Based Mental Health · doi:10.1136/eb-2016-102415 · Cited by 150 · see citing works
Evans, S. W., Pelham, W. E., Smith, B. H., et al. (2001) · Experimental and Clinical Psychopharmacology · doi:10.1037/1064-1297.9.2.163 · Cited by 146 · see citing works
What's in a grade? The multidimensional nature of what teacher-assigned grades assess in high school
Bowers, A. J. (2011) · Educational Research and Evaluation · doi:10.1080/13803611.2011.597112 · Cited by 140 · see citing works
Prasad, V., Brogan, E., Mulvaney, C. A., Grainge, M. J., Stanton, W., & Sayal, K. S. (2012) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-012-0346-x · Cited by 137 · see citing works
Langberg, J. M., & Becker, S. P. (2012) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-012-0117-8 · Cited by 129 · see citing works
Lekholm, A. K., & Cliffordson, C. (2008) · Educational Research and Evaluation · doi:10.1080/13803610801956663 · Cited by 105 · see citing works
Powers, R. L., Marks, D. J., Miller, C. J., Newcorn, J. H., & Halperin, J. M. (2008) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2008.021 · Cited by 104 · see citing works
Does methylphenidate improve academic performance? A systematic review and meta-analysis
Kortekaas-Rijlaarsdam, A. F., Luman, M., Sonuga-Barke, E., & Oosterlaan, J. (2019) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-018-1106-3 · Cited by 99 · see citing works
Baweja, R., Mattison, R. E., & Waxmonsky, J. G. (2015) · Pediatric Drugs · doi:10.1007/s40272-015-0144-2 · Cited by 61 · see citing works
Marcus, S. C., & Durkin, M. B. (2011) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2011.02.007 · Cited by 59 · see citing works
Lu, Y., Sjölander, A., Cederlöf, M., D'Onofrio, B. M., Almqvist, C., Larsson, H., & Lichtenstein, P. (2017) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2017.1472 · Cited by 56 · see citing works
Self-citationDoubly robust methods for handling confounding by cluster
Zetterqvist, J., Vansteelandt, S., Yudi Pawitan, Y., & Sjölander, A. (2015) · Biostatistics · doi:10.1093/biostatistics/kxv041 · Cited by 46 · see citing works
A Population-Based Study of Stimulant Drug Treatment of ADHD and Academic Progress in Children
Zoëga, H., Rothman, K. J., Huybrechts, K. F., Ólafsson, Ö., Baldursson, G., Almarsdóttir, A. B., Jónsdóttir, S., Halldórsson, M., Hernández–Dı́az, S., & Valdimarsdóttir, U. A. (2012) · PEDIATRICS · doi:10.1542/peds.2011-3493 · Cited by 42 · see citing works
Estimating Fixed Effects Logit Models with Large Panel DataPreprint
Stammann, A., Heiß, F., & McFadden, D. (2016) · RePEc: Research Papers in Economics · Cited by 42 · see citing works
Medication effects in the classroom: Three naturalistic indicators
Whalen, C. K., Henker, B. A., & Finck, D. (1981) · Research on Child and Adolescent Psychopathology · doi:10.1007/bf00917793 · Cited by 38 · see citing works
Murray, D. W., Childress, A. C., Giblin, J. M., Williamson, D., Armstrong, R., & Starr, H. L. (2011) · Clinical Pediatrics · doi:10.1177/0009922810394832 · Cited by 32 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Faraone, S. V., Banaschewski, T., Coghill, D., Zheng, Y., Biederman, J., Bellgrove, M. A., Newcorn, J. H., Gignac, M., Al Saud, N. M., Manor, I., et al. (2021) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2021.01.022 · Cited by 1,545 · see citing works
“…over 650,000 students found that treatment with ADHD medication for three months resulted in a more than nine-point gain in grade point sum (on a scale of 0 – 320); treatment was associated with an increase in the probability of completing upper secondary school by two-thirds (Jangmo et al., 2019).”
Self-citationA literature review and meta-analysis on the effects of ADHD medications on functional outcomes
Boland, H., DiSalvo, M., Fried, R., Woodworth, K. Y., Wilens, T., Faraone, S. V., & Biederman, J. (2020) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2020.01.006 · Cited by 240 · see citing works
Coghill, D., Banaschewski, T., Cortese, S., Asherson, P., Brandeis, D., Buitelaar, J., Daley, D., Danckaerts, M., Dittmann, R. W., Doepfner, M., et al. (2023) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-021-01871-x · Cited by 180 · see citing works
Zhang, J., Peng, C., & Chen, C. (2024) · Acta Psychologica · doi:10.1016/j.actpsy.2024.104351 · Cited by 125 · see citing works
Skoglund, C., Kopp Kallner, H., Skalkidou, A., Wikström, A.-K., Lundin, C., Hesselman, S., Wikman, A., & Sundström Poromaa, I. (2019) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.12463 · Cited by 67 · see citing works
Sexuality in Adults With ADHD: Results of an Online Survey
Hertz, P. G., Turner, D., Barra, S., Biedermann, L., Retz-Junginger, P., Schöttle, D., & Retz, W. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.868278 · Cited by 39 · see citing works
Lazzaro, G., Didino, D., Fucà, E., Sperandini, V., Falvo, S., Passarini, S., Bergonzini, P., D'Aiello, B., De Rossi, P., De Rose, P., et al. (2025) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2025.107561 · Cited by 1 · see citing works
Sweiss, E. C., Vargas, V., Sandman, C., Poggi Davis, E., Hankin, B. L., & Glynn, L. M. (2026) · Journal of Developmental Origins of Health and Disease · doi:10.1017/s2040174426100622
- Authors
- Jangmo, A., Stålhandske, A., Chang, Z., Chen, Q., Almqvist, C., Feldman, I., Bulik, C. M., Lichtenstein, P., D’Onofrio, B., Kuja-Halkola, R., & Larsson, H.
- Affiliations
- Karolinska Institutet (SE)
- Region Stockholm (SE)
- Karolinska University Hospital (SE)
- Uppsala University (SE)
- University of North Carolina at Chapel Hill (US)
- Örebro University (SE)
- Corresponding author
- Jangmo, Andreas
- ORCID
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2019-04
- Volume
- 58
- Issue
- 4
- Pages
- 423-432
- ISSN
- 0890-8567 (ISSN-L)
- PMC
- PMC6541488
- OpenAlex
- W2911482599
- Semantic Scholar
- 61b13f3d29a4dbe3b68f442617c64dc0ba127539
- Cited by
- 213
- References
- 31
- Citations by year
- 2026: 27 · 2025: 32 · 2024: 30 · 2023: 21 · 2022: 36 · 2021: 44 · 2020: 18 · 2019: 5
- FWCI
- 20.51
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
- UNC Libraries
- Funders
- National Institute of Mental Health (R01MH102221)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Developmental and Educational Neuropsychology
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Keywords
- attention deficit hyperactivity disorder, academic performance, ADHD medication, pharmacotherapy, grade point average, socioeconomic status, compulsory school students, early detection and treatment
- MeSH terms
- Academic Success, Adolescent, Attention Deficit Disorder with Hyperactivity, Central Nervous System Agents, Educational Status, Female, Humans, Male, Parents, Registries, Schools, Socioeconomic Factors, Students, Sweden, Logistic Models, Treatment Outcome
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
