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Behavioral intervention, not medication, improves homework performance in ADHD

Homework performance significantly improved among children with ADHD who received behavior treatment focused on homework, while typical ADHD medication had no significant effect on homework performance.

“One of the most impairing aspects of childhood ADHD is the robust relation with prolonged academic underachievement. Elementary aged children with ADHD have severe academic problems characterized by lower seatwork completion, seatwork accuracy, on-task behavior, and homework performance than their peers. Problems continue into later school years as individuals with ADHD in middle and high school have poorer organizational skills, lower report card grades, higher truancy, and higher rates of suspension and grade retention than their peers,” Brittany M. Merrill, BS, of Florida International University, and colleagues wrote. “Further, significantly fewer individuals with ADHD graduate from high school or enroll in 4-year colleges and universities than controls.”

To compare effects of behavioral, psychostimulant and combined treatments on homework problems in children with ADHD, researchers conducted a randomized clinical trial among 75 children with ADHD and their families. Study participants were randomly assigned to receive either behavioral treatment, which entailed homework-focused parent training and a daily report card, or a waitlist control group. Participants also completed a concurrent psychostimulant crossover trial conducted in a summer treatment program.

Behavioral treatment had a significant effect on both completion and accuracy of math and reading and language arts homework (P < .001 for all).

Specifically, children who received behavioral treatment completed 12% more math homework and 10% more reading and language arts homework, compared with controls when controlling for medication.

Further, children who receive behavioral treatment had 6% higher accuracy on math and reading and language arts homework compared with controls when controlling for medication.

“This study indicates that behavioral treatment in the form of parent skills training and a [daily report card] goal focused on child homework problems results in statistically significant and academically meaningful acute improvements in homework performance among children with ADHD,” the researchers wrote. “Children’s homework performance was, on average, about two letter grades higher when considering their accuracy of completed work if they received the [behavioral parent training plus daily report card] intervention compared to the [waitlist control] group. The most commonly used treatment for children with ADHD, stimulant medication, did not have a significant effect on homework completion and resulted in very limited improvement on homework accuracy, which remained lower than accuracy in the [behavioral parent training plus daily report card] group.” – by Amanda Oldt

Disclosure: Merrill reports no relevant financial disclosures. Please see the study for a full list of relevant financial disclosures.