Determining medication treatment effects using teacher ratings and classroom observations of children with ADHD: Does neuropsychological impairment matter?

Abstract

Children with attention deficit hyperactivity disorder (ADHD) often experience significant academic and behavioural problems in the classroom and other settings, but clinicians often rely on qualitative judgements and informant reports to formulate diagnostic impressions and make treatment recommendations rather than on direct measurement of child performance or behaviour. Although there is mounting evidence for a neuropsychological model of ADHD, the disorder remains largely a behavioural one, which could limit diagnostic accuracy and intervention efficacy, especially for academic problems in the classroom. In this study of 49 children diagnosed with ADHD, robust medication treatment effects were observed, with increasing dose resulting in better teacher ratings and direct observations of classroom academic performance and behaviour. However, when participants were classified according to level of neuropsychological impairment, only those children who showed significant deficits in executive function and self-regulation responded to medication, according to teacher report. Children who showed minimal or no response were more likely to be classified with the inattentive type of ADHD, but those who showed dramatic medication effects were more likely to be diagnosed with the combined type ADHD. Results suggest that neuropsychological impairment, but not baseline teacher ratings or classroom observations, can help clinicians determine the likelihood of medication response in children with ADHD. Implications for classroom academic performance and behaviour are addressed.