Two studies link child ADHD diagnoses to poor performance and unhappiness at school

Clinicians are warning ADHD diagnoses might have unexpected side effects for children, after two independent studies have linked it to poor performance and unhappiness at school.

The studies involving hundreds of adolescents have independently shown those with an ADHD diagnosis tended to have worse outcomes in areas like reported happiness, academic grades, even their likelihood of self-harm.

But while some clinicians are concerned by these results, it remains true that for many people, a diagnosis brought validation and life-changing help.

Meanwhile, behavioural experts say labels and medication are far from the only solution.

The two studies, one in Irelandpublished in 2020 and one in Australia in 2022 compared children with behaviours such as hyperactivity and inattentiveness (H/I) who did have an ADHD diagnosis, to those with the same behaviours but no diagnosis.

The Australian study found diagnosed teens had a worse sense of belonging, believed in themselves less, displayed more negative social behaviours and were more likely to self-harm themselves.

Among the Irish cohort, they displayed more emotional and relationship problems, worse prosocial behaviour, and poorer self-concept.

New Zealand clinical psychologist Giselle Bahr told RNZ the results were surprising, even to the authors.

"When you compare them a few years down the track, when they've all become adolescents, the adolescents who have been given a formal diagnosis did worse on every measure than the children who had the same behaviours but weren't given a diagnosis," she said.

She said it was possible a diagnosis lead to children developing a negative view of themselves, or receiving different treatment from teachers and parents.

"I know that there's also ... people feel like they belong to a community, and they feel a relief and they feel like they finally have an answer, but the research shows that this happens, but so does this other process of stigmatisation."

The Australian authors - Luise Kazda, Kevin McGeechan and Katy Bell - found a diagnosis had "significant negative associations with academic self-concept, negative social behaviours, sense of school membership, self-efficacy, and self-harm", with no difference between boys and girls.

They wrote they had expected the inverse effect - that a diagnosis would have improved outcomes, and concluded a large, randomised clinical trial with long-term follow-up was needed.

The authors of the Irish study - Cliodhna O'Connor and Fiona McNicholas - identified no significant differences in the demographic characteristics or socio-emotional wellbeing of 9-year-olds with hyperactivity/inattention who had and who had not received a diagnosis of ADHD.

"However, by age 13, those who had held a diagnosis at 9 years showed more emotional and peer relationship problems, worse prosocial behaviour, and poorer self-concept. Further research is required to clarify the developmental pathways responsible for these effects."

Bahr said while correlation did not equal causation, it would be unwise to ignore these studies - clinicians should be aware of the risks, and inform parents of the risk of a diagnosis having this effect.

"I think it's really off for us to not be at least letting parents know that this is what studies have shown," she said. "And you can see that with a study like that, some researchers aren't going to want to explore that more."

For her, it sat in the context evidenced already - like the immaturity bias, wherein the youngest child in the class was far more likely to be diagnosed with ADHD than the eldest.

[https://www.rnz.co.nz/news/national/585715/first-gp-prescriptions-for-adult-adhd-patients-issued

Changes to ADHD prescription rules] this week mean GPs can now prescribe ADHD medication for adults, meaning easier access to medication.

And of course, for many, a diagnosis could be life-changing for the better.

Kelly Cuff, who lives in Wairarapa, told RNZ she often thought about the person she could have been, had she been diagnosed and had access to medication earlier.

She said she got lucky in childhood, attending a small rural primary school in which the student-teacher ratios were small, which meant less chance for her to slip through the cracks.

But when she moved to intermediate and then high school, she said she had trouble focusing, found school work difficult, and was often sent out of the classroom on errands to stop her distracting her classmates, meaning she missed big chunks of learning time.

"I just sort of was constantly sort of confronted by my limitations, which was wildly frustrating."

She observed other students who had a diagnosis receiving the help of a laptop and extra time during exams.

Outside of the classroom, she was making decisions in search of immediate rewards. "I was drinking when I was younger, I was making sort of questionable relationship choices," she said.

"If I had support and if I had, at least, just the medication to sort of pause my thinking a little, I might not have taken so many sort of personal risks."

It was not until about four years ago, finding herself struggling to focus in a new job, that she sought a diagnosis and medication. That had been life-changing, she said.

"I look at my dishes and I go, I should do those dishes. And then I stand up and I do them, and it's not something that I have to force myself to do. I don't have to bribe myself with treats or bully myself into doing it. There's no guilt there."

Jayne Fox, a Wellington-based ADHD coach, said plenty of adults sought a diagnosis in order to have access to medication to help them focus at work, or regulate their emotions.

A diagnosis could also provide "that feeling of legitimacy" and "self-compassion".

But it was not the only solution.

"For some people, they may already have some level of self-understanding and self-identification with those ADHD traits, and may not be seeking that validation from a doctor," she said. "And it may be that they are quite happy to look at what strategies can support them without an actual diagnosis of ADHD."

Her coaching played to people's strengths, rather than putting the emphasis on where they were lacking.

Carolyn Robertson, who works with parents of children with ADHD, told RNZ some kids responded to charts, others to a rush of dopamine from doing something they love, before settling into a difficult task.

"For us, it's more about meeting them where they're at, and looking at tapping into what your child is interested in and can find success in, and therefore gain a better understanding of themselves, and more confidence in themselves."

She said sometimes differences could be a strength, and tapping into what kids were excited about could be a path to a solution.

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