Abstract
Attention Deficit/Hyperactivity Disorder (ADHD) is negatively associated with a range of academic achievement measures. We use Danish administrative register data to study the impact of medical treatment of ADHD on children’s academic performance assessed by student grade point average (GPA). Using administrative register data on children, who begin medical treatment, we conduct a natural experiment and exploit plausible exogenous variation in medical nonresponse to estimate the effect of medical treatment on school-leaving GPA. We find significant effects of treatment on both exam and teacher evaluated GPAs: Compared to consistent treatment, part or full discontinuation of treatment has large significant negative effects reducing teacher evaluation and exam GPA with .18 and .22 standard deviations, respectively. The results demonstrate that medical treatment may mitigate the negative social consequences of ADHD. Placebo regressions indicate that a causal interpretation of our findings is plausible.
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Data Availability: Due to restrictions related to Danish law and protecting patient privacy, the combined set of data as used in this study can only be made available through a trusted third party, Statistics Denmark. This state organization holds the data used for this study. University-based Danish scientific organizations can be authorized to work with data within Statistics Denmark and such organizations can provide access to individual scientists inside and outside of Denmark. Requests for data may be sent to Statistics Denmark:
Introduction
One in five individuals experiences the onset of mental health problems before reaching adulthood. Mental health problems in childhood have substantial consequences for later life because such problems are associated with lower educational achievement and attainment. Attention Deficit/Hyperactivity Disorder buy adderall online represents one such mental health problem, which infers substantial individual and societal costs if left untreated . Children with ADHD have lower grade point average (GPA), do worse on academic tests, have higher retention rates and absenteeism, and have lower high school and college completion rates.Recent research has linked ADHD to delayed maturation of parts of the brain directly related to cognition . indicating a direct biological link between ADHD and low educational achievement. In addition, ADHD may also negatively affect the learning environment in children’s homes. An emerging body of work demonstrates that undiagnosed or untreated ADHD leads to increased family instability, such as increased risk of parental union dissolution and for entering an out-of-home placement. Thus, beyond the direct effect on cognitive abilities, ADHD may cause lower educational achievement and attainment through affecting life circumstances outside the classroom, leaving affected children double disadvantaged.
One of the modal ways to address the behavioral problems related to ADHD is through medical treatment with psychotropic drugs. Although the use of these drugs is not uncontroversial , drug therapy has been consistently shown to address core symptoms among children with moderate to severe ADHD. If ADHD affects educational outcomes negatively, successful treatment could reduce the negative educational consequences caused by ADHD.
This study tests whether efficient medical treatment of ADHD affects children’s academic performance by utilizing a natural experiment. The medical literature documents that 25 to 30 percent of treated individuals with ADHD are nonresponders. Nonresponders are unaffected by the medication or have severe side effects, in either case causing them to discontinue treatment even though they show the same symptoms as responders prior to treatment . There do not appear to be significant socioeconomic differences between responders and nonresponders nor do individual characteristics (age, gender, IQ, ADHD subtypes and symptoms, neuropsychological characteristics) predict treatment response . Under this assumption of no significant differences between responders and nonresponders, we compare the academic performance of children diagnosed with and treated for ADHD, who either discontinue treatment (nonresponders) or continue treatment (responders) to estimate the effect of medical treatment on academic performance. In our study, we have no selection into treatment as all individuals in our analysis initiate treatment. We may have selection out of treatment. However, as argued above, we believe that selection out of treatment is random. We substantiate this below.
We find that medical treatment has a significant and sizeable effect on long-term academic performance outcomes in terms of school-leaving GPA. The effect of medical treatment of ADHD is comparable in size to the gender differences in GPA. To test whether a causal interpretation of the results is plausible and to account for any social gradient in treatment patterns, we estimate the effect of treatment with and without a rich set of potential confounders and perform placebo regressions on a sample of children, who initiate medical treatment after graduation (i.e. after receiving their final grades). We find no significant differences in the effect of treatment with and without confounders and we find no differences in the GPA between medical responders and nonresponders in the placebo sample, indicating that the main results likely express causal effects. Our results demonstrate that medical treatment of ADHD may play a substantial role in diminishing educational disparities caused by the condition.
The remainder of this paper is organized as follows: Section 2 reviews relevant literature and theories on the effect of ADHD and ADHD treatment on educational outcomes. Section 3 presents the data for our empirical analysis. Section 4 presents our identification strategies and statistical methods. Section 5 presents results. Section 6 discusses the findings and concludes.
ADHD and educational outcomes
Untreated behavioral problems may substantially impair children’s learning and educational achievement . Previous studies have found that children diagnosed with ADHD on average attain 2.2 to 2.5 years less schooling than non-ADHD peers do, and 25 percent of students with ADHD drop out of high school . Recent work has further shown that both externalizing behaviors and attention deficits contribute to lower educational attainment . Children with buying adderall online also display lower cognitive achievements, lower test scores, and higher scholastic impairment , with especially attention problems predicting poorer math and reading achievement. Thus, research consistently shows that ADHD affects a number of various educational outcomes ranging from performance and achievement measures to school behaviors. In this study, we focus specifically on student academic performance assessed by teacher evaluation and exam GPA. In the remainder of this section, we discuss biological and social mechanisms linking ADHD to decreased educational achievement outcomes, as well as how efficient medical treatment can sever parts of the link.