Attention deficit hyperactivity disorder is associated with poorer academic performance
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Question:Is attention deficit hyperactivity disorder (ADHD) associated with poorer academic outcomes?Population:From a large birth cohort for whom school records were available through a contractual agreement with the city, 370 adolescents fulfilling criteria for ADHD (mean age 10.4 years; 75% male), and 740 age and gender matched controls (two for each case) without ADHD or any other psychiatric disorder were selected. Medical records for these participants were available through the Rochester Epidemiology Project. DSM-IV exclusion criteria: severe mental retardation, developmental disorder, schizophrenia or other psychiatric disorder.Setting:Rochester, Minnesota, USA. Participants enrolled in the January 1976 to December 1982 birth cohort.Prognostic factors:ADHD.Outcomes:Reading achievement (percentile rank on the California Achievement Score, measured every 2 years to mean age 13 years), absenteeism (percentage days absent per school grade level for each subject), grade retention (need to repeat one or more grades), and dropout from school prior to graduation, taken from school records.METHODSDesign: Retrospective cohort study.Follow-up period: From age 5 years until emigration, death, school graduation, or dropout.MAIN RESULTSBoth boys and girls with ADHD had significantly lower reading scores (measured on California Achievement Test) than controls (mean CAT score: 45 with ADHD vs 73 for controls; p<0.001) and significantly more days absent than controls across grade levels (p<0.001). Those with ADHD were significantly more likely than controls to have repeated a grade (HR 3; 95% CI 2.1 to 4.4; p<0.001) and to have dropped out from school (HR 2.7; 95% CI 1.8 to 3.9; p<0.001). Findings were similar with adjustment for age and gender.CONCLUSIONSADHD affects academic performance. Adolescents with ADHD have lower standardised reading achievement scores and higher rates of school absenteeism, school dropout and grade retention compared to matched controls.