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Cited by 951Attention Deficit Hyperactivity DisorderDevelopmental and Educational NeuropsychologyBehavioral and Psychological Studies

Academic and Educational Outcomes of Children With ADHD

Loe, I. M., Feldman, H. M.·2007·Journal of Pediatric Psychology
DOI 10.1093/jpepsy/jsl054
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Abstract

Attention-deficit/hyperactivity disorder (ADHD) is associated with poor grades, poor reading and math standardized test scores, and increased grade retention. ADHD is also associated with increased use of school-based services, increased rates of detention and expulsion, and ultimately with relatively low rates of high school graduation and postsecondary education. Children in community samples who show symptoms of inattention, hyperactivity, and impulsivity with or without formal diagnoses of ADHD also show poor academic and educational outcomes. Pharmacologic treatment and behavior management are associated with reduction of the core symptoms of ADHD and increased academic productivity, but not with improved standardized test scores or ultimate educational attainment. Future research must use conceptually based outcome measures in prospective, longitudinal, and community-based studies to determine which pharmacologic, behavioral, and educational interventions can improve academic and educational outcomes of children with ADHD.

AI snapshot

Written from the paper’s full text.

TL;DR

This review synthesizes evidence that ADHD is associated with persistent academic underachievement and educational problems, including lower grades and test scores, higher grade retention, and lower high school and postsecondary completion. Pharmacologic and behavioral treatments reduce core symptoms and improve academic productivity, but the evidence does not show improvement in standardized test scores or ultimate educational attainment.

Key findings

  • Children with ADHD show significant academic underachievement, poor academic performance, and educational problems; they score lower on reading and arithmetic achievement tests, have increased repeated grades, remedial services, and special education placement, and are 4 to 5 times more likely to use special educational services than children without ADHD.
  • Longitudinal studies show difficulties persist: followed into adolescence, subjects fail more grades, have lower class rankings, perform more poorly on standardized achievement tests, take more years to complete high school, and have lower rates of college attendance and graduation; as young adults, approximately 25% eventually function comparably to matched controls, the majority show continued functional impairment, and less than 25% develop significant severe problems.
  • Community samples of children with ADHD symptoms but without formal diagnoses also show adverse outcomes, with a linear relationship between the number of behavioral symptoms and academic achievement even among children generally below the clinical diagnostic threshold.
  • Stimulants reduce core symptoms and improve academic productivity (e.g., note-taking, quizzes and worksheets, written-language output, homework completion) but are not associated with normalization of learning and applying knowledge or improved reading; combined medication and behavioral treatment in the MTA was better than behavioral treatment and community care for reading achievement, but differences were small and of questionable clinical significance, and a 2-year study found no advantage of combined treatment over medication alone on any academic measures.

Methods

  • Narrative review applying the World Health Organization International Classification of Functioning, Disability, and Health (ICF) framework to organize functional problems associated with ADHD into body functions/impairments, activities/limitations, and participation/restrictions.
  • Synthesizes prior longitudinal, community-based, clinic-referred, and treatment outcome studies; no new primary data are collected and no systematic search strategy is described.
  • Discusses treatment effects (medication, behavior management, combined treatment, educational interventions) and recommends future research designs including community- or school-based samples, repeated achievement measures, hierarchical linear modeling, and a 2-tiered approach of universal design improvements plus specific ADHD interventions.

Limitations

  • The paper states that clinic-referred samples suffer from circularity because DSM-IV ADHD diagnosis requires functional impairment often defined by school problems, and from selection bias in who gets referred; longitudinal treatment studies often lacked a true nontreatment ADHD group, had attrition, and most children receive medication for only 2 to 3 years, so long-term treatment effects remain unclear.
  • The paper states that comparative long-term outcome studies of ADHD subtypes have not been conducted; the impact of remedial educational services and many commonly recommended accommodations (such as preferential seating) on outcomes is not known; and the contributions of comorbid conditions and environmental factors to outcomes are unclear.
  • Evident from the text: as a narrative review, it does not report a systematic search, formal quality appraisal, or meta-analysis, and its recommendations are consensus-based rather than derived from new empirical analysis.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1093/jpepsy/jsl054

Cites

72 of 72 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 88 cited sources checked · 0 supported · 0 flagged

  • Interpretationnone given

    ADHD is associated with increased rates of detention and expulsion.

    “ADHD is also associated with increased use of schoolbased services, increased rates of detention and expulsion, and ultimately with relatively low rates of high school graduation and postsecondary education.”
    Quote in the paperSubstantial claim
  • Interpretationnone given

    Pharmacologic treatment and behavior management are not associated with improved standardized test scores.

    “Pharmacologic treatment and behavior management are associated with reduction of the core symptoms of ADHD and increased academic productivity, but not with improved standardized test scores or ultimate educational attainment.”
    Quote in the paperSubstantial claim
  • Interpretationcitation

    Children with ADHD are more likely to be suspended compared with controls.

    “Children with ADHD are more likely to be expelled, suspended, or repeat a grade compared with controls.10”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10]

      Not checked in the free run.

  • Interpretationcitation

    Children with ADHD show significant decreases in estimated full-scale IQ compared with controls.

    “In terms of impairment of body functions, children with ADHD show significant decreases in estimated full-scale IQ compared with controls but score on average within the normal range.9”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9]

      Not checked in the free run.

  • Interpretationnone given

    Pharmacologic treatment and behavior management are not associated with improved ultimate educational attainment.

    “Pharmacologic treatment and behavior management are associated with reduction of the core symptoms of ADHD and increased academic productivity, but not with improved standardized test scores or ultimate educational attainment.”
    Quote in the paperSubstantial claim
  • May combine two claims. 10
  • Classified as probably not a substantial claim. 16

  • May combine two claims.

    Interpretationreasoning

    School problems are almost always present to make the diagnosis of ADHD and therefore are more likely to be present at follow-up.

    “School problems are almost always present to make the diagnosis and therefore are more likely to be present at follow-up.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    Initial symptoms of hyperactivity, distractibility, impulsivity, and aggression remain present and increased in comparison to controls.

    “Initial symptoms of hyperactivity, distractibility, impulsivity, and aggression tend to decrease in severity over time but remain present and increased in comparison to controls.21”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    The contribution of environmental factors to outcomes of ADHD is unclear.

    “The contribution of environmental factors to outcomes is also unclear.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Both children diagnosed and treated during childhood and children with symptoms and/or behavior indications who were never diagnosed or treated were far more likely to attend special education schools than asymptomatic controls.

    “Both groups were far more likely to attend special education schools and far less likely to graduate from high school or go to college than the asymptomatic controls.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    It is unclear what factors determine the long-term outcomes of ADHD.

    “It is unclear what factors determine the long-term outcomes.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationreasoning

    Given the chronic nature of ADHD and its impact on multiple domains of function, it is likely that multiple treatment approaches are needed.

    “Given the chronic nature of ADHD and its impact on multiple domains of function, it is likely that multiple treatment approaches are needed.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Advocates pursued making ADHD a category of disability under the Individuals with Disabilities Education Act of 1990 (IDEA), but this attempt was not successful.

    “Although advocates pursued making ADHD a category of disability under the Individuals with Disabilities Education Act of 1990 (IDEA), this attempt was not successful.53”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [53]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Subjects lost to follow-up may include those with worse outcomes.

    “Another problem was attrition; subjects lost to follow-up may include those with worse outcomes.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    It remains unclear whether steady treatment over many years would be associated with improved outcomes.

    “it remains unclear whether steady treatment over many years would be associated with improved outcomes.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Premisenone given

    It is unethical to withhold standard treatments for long periods of time from an affected sample to create a control group.

    “Designing convincing studies on the long-term impact of medication or behavior management on academic and educational outcomes is challenging because it is unethical to withhold standard treatments for long periods of time from an affected sample to create a control group.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In a study of choice making with children with emotional and behavioral difficulties in a special education classroom, students demonstrated increased academic engagement and decreased behavior problems.

    “In a study of choice making with children with emotional and behavioral difficulties in a special education classroom, students demonstrated increased academic engagement and decreased behavior problems.68”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [68]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Teachers perceive class size to be one of the major barriers to inclusion of ADHD students in regular education.

    “Teachers perceive class size to be one of the major barriers to inclusion of ADHD students in regular education.63”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [63]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationcitation

    The strategy of pulling a child out of the classroom and then returning the child to the original setting identifies the child as the problem, serves to isolate and potentially stigmatize the child, and precludes the exploration of environment-based solutions.

    “This strategy identifies the child as the problem, serves to isolate and potentially stigmatize the child, and precludes the exploration of environment-based solutions.59”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [59]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Antecedent strategies make tasks more stimulating and provide students with opportunities to make choices related to academic work.

    “These strategies make tasks more stimulating and provide students with opportunities to make choices related to academic work.67”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [67]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Measures such as grades may vary across school systems.

    “Unfortunately, measures such as grades may vary across school systems.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Antecedent interventions are proactive, support appropriate adaptive behavior, and prevent unwanted, challenging behaviors.

    “Such strategies are proactive, support appropriate adaptive behavior, and prevent unwanted, challenging behaviors.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [51]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Most children with ADHD are educated in general education settings.

    “The advantage of universal design is that most children with ADHD are educated in general education settings.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    The evidence that ADHD is associated with poor academic and education outcomes is overwhelming.

    “The evidence that ADHD is associated with poor academic and education outcomes is overwhelming.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The use of interventions that teach children how to replace disruptive behaviors with appropriate behaviors is less punitive than suspensions and more effective in promoting academic productivity and success.

    “The use of interventions that teach children how to replace disruptive behaviors with appropriate behaviors is less punitive than suspensions and more effective in promoting academic productivity and success.17”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [17]

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Such methods can take into account the number and types of interventions, duration of treatment, intensity of treatment, and adherence to protocols.

    “Such methods can take into account the number and types of interventions, duration of treatment, intensity of treatment, and adherence to protocols.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationreasoning

    Large-scale studies that use modern statistical methods, such as hierarchical linear modeling, hold promise for teasing apart the impact of various treatments on outcomes.

    “However, large-scale studies that use modern statistical methods, such as hierarchical linear modeling, hold promise for teasing apart the impact of various treatments on outcomes.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    A small study of 3 children with ADHD that used a game-format math program found increases in academic achievement and increased task engagement.

    “A small study of 3 children with ADHD that used a game-format math program found increases in academic achievement and increased task engagement.76”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [76]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    It may be impossible to conduct long-term randomized, controlled trials with medication or behavior management used as treatment modalities for practical and ethical reasons.

    “It may be impossible to conduct long-term randomized, controlled trials with medication or behavior management used as treatment modalities for practical and ethical reasons.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    We remain ill informed about how to improve academic and educational outcomes of children with ADHD, despite decades of research on diagnosis, prevalence, and short-term treatment effects.

    “We remain ill informed about how to improve academic and educational outcomes of children with ADHD, despite decades of research on diagnosis, prevalence, and short-term treatment effects.”
    Quote in the paperNot a substantial claim
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  • The paper relies on this without support.

    The ICF framework is a useful model for describing functional problems associated with ADHD and for comparing health-related states across conditions, studies, interventions, populations, and countries.

    “The World Health Organization developed the ICF to provide a systematic and comprehensive framework and common language for describing and assessing functional implications of health conditions, regardless of the specific disease or disorder.Use of this model facilitates comparisons of health-related states across conditions, studies, interventions, populations, and countries.”

  • The paper relies on this without support.

    Many children with ADHD have comorbid conditions, including anxiety, depression, disruptive behavior disorders, tics, and learning problems.

    “Many children with ADHD have comorbid conditions, including anxiety, depression, disruptive behavior disorders, tics, and learning problems.”

  • The paper relies on this without support.

    It is unethical to withhold standard treatments for long periods of time from an affected sample to create a control group.

    “Designing convincing studies on the long-term impact of medication or behavior management on academic and educational outcomes is challenging because it is unethical to withhold standard treatments for long periods of time from an affected sample to create a control group.”

  • The paper relies on this without support.

    Repetition of instructions alone is not likely to increase the attention of children with ADHD.

    “Repetition of instructions alone is not likely to increase the attention of children with ADHD.”

  • The paper relies on this without support.

    Peer tutoring reduces the demands on teachers to provide one-on-one instruction.

    “Peer tutoring reduces the demands on teachers to provide one-on-one instruction.”

  • The paper relies on this without support.

    Peer tutoring gives students with ADHD the opportunity to practice and refine academic skills, as well as to enhance peer social interactions, promoting self-esteem.

    “At the same time, it gives students with ADHD the opportunity to practice and refine academic skills, as well as to enhance peer social interactions, promoting self-esteem.”

  • The paper relies on this without support.

    Increased physical exercise would be beneficial for long-term health and for behavioral regulation in both children developing typically and children with ADHD.

    “Increased physical exercise would be beneficial for long-term health and for behavioral regulation in both children developing typically and children with ADHD.”

  • The paper relies on this without support.

    For children who are avoiding work, suspensions or being sent to the principal's office are equivalent to positive reinforcement.

    “For those children who are avoiding work, these approaches are equivalent to positive reinforcement.”

  • The paper relies on this without support.

    Classroom changes are unlikely to create adequate improvements without concomitant changes in the educational system.

    “Classroom changes are unlikely to create adequate improvements without concomitant changes in the educational system.”

  • The paper relies on this without support.

    The optimal management of children with ADHD requires close collaboration of their parents, teachers, and health care providers.

    “The optimal management of children with ADHD requires close collaboration of their parents, teachers, and health care providers.”

  • The paper relies on this without support.

    Currently there is no organized system to support collaboration among parents, teachers, and health care providers for children with ADHD.

    “Currently there is no organized system to support this collaboration.”

  • The paper relies on this without support.

    Small class sizes will probably result in use of innovative educational approaches that are precluded in the current system.

    “Small class sizes will probably result in use of innovative educational approaches that are precluded in the current system.”

  • The paper relies on this without support.

    Children with ADHD do better with one-on-one instruction.

    “Because children with ADHD are reported to do better with one-on-one instruction, smaller class size makes intuitive sense.”

  • The paper relies on this without support.

    Classrooms are often noisy and distracting environments.

    “Classrooms are often noisy and distracting environments.”

  • The paper relies on this without support.

    Many students receive suspensions or are sent to the principal's office for disruptive behavior.

    “Many students receive suspensions or are sent to the principal's office for disruptive behavior.”
15 of 15

Claims other papers make about this one

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Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. Hechtman, L. (2000). Subgroups of adult outcome of attention-deficit/hyperactivity disorder. In: T. E. Brown (Ed.). Attention-Deficit Disorders and Comorbidities in Children, Adolescents, and Adults (pp. 437-452). Washington, DC: American Psychiatric Publishing Inc.
  2. Forness, S. R., & Kavale, K. A. (2002). Impact of ADHD on school systems. In P. S. Jensen, & J. R. Cooper (Eds.), Attention Deficit Hyperactivity Disorder: State of the Science-Best Practices (pp. 24-1-24-20). Kingston NJ: Civic Research Institute.
  3. Danielson, L., Henderson, K., & Schiller, E. (2002). Educational policy-educating children with atten- tion deficit hyperactivity disorder. In: P. S. Jensen, & J. R. Cooper (Eds.). Attention Deficit Hyperactivity Disorder: State of the Science-Best Practices (pp. 26-1-26-12). Kingston, NJ: Civic Research Institute.

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Related

Authors
Loe, I. M., & Feldman, H. M.
Affiliations
University of Pittsburgh (US)
ORCID
Venue
Journal of Pediatric Psychology
Publisher
Oxford University Press (OUP)
Published
2007-05-28
Volume
32
Issue
6
Pages
643-654
ISSN
  • 0146-8693 (ISSN-L)
  • 1465-735X
DOI
10.1093/jpepsy/jsl054
OpenAlex
W2148411178
Semantic Scholar
c618ea0dde3f9417d56dc38e8f73050bca1b8ccd
Cited by
951
References
72
Citations by year
2026: 32 · 2025: 45 · 2024: 52 · 2023: 50 · 2022: 66 · 2021: 72 · 2020: 72 · 2019: 68 · 2018: 55 · 2017: 60 · 2016: 80 · 2015: 66 · 2014: 44 · 2013: 57 · 2012: 42
FWCI
2.61
Type
journal article
Language
en
Open access
closed
Locations
  • Journal of Pediatric Psychology (publishedVersion)
  • PubMed (publishedVersion)
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, educational outcomes, educational attainment, academic performance, standardized test scores, school retention, high school graduation, pharmacotherapy, behavior management, educational intervention, children
MeSH terms
Attention Deficit Disorder with Hyperactivity, Child, Education, Educational Status, Humans, Research Design, School Health Services, Outcome Assessment, Health Care

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