Studies have indicated that simplifying and structuring a child's environment and routine can impact ADHD symptoms. But when children enter middle school, their environment and routine change dramatically -- they have multiple classes with multiple teachers, more homework, and planning and organisational demands and become more responsible for their own success.

Joshua M. Langberg, PhD, Jeffery Epstein, PhD, University of Cincinnati and Cincinnati Children's Hospital Center, Cincinnati, Ohio, and colleagues analysed data from 258 children in the Multimodal Treatment Study of ADHD (MTA) who completed elementary school and went on to middle school while enrolled in the study.

Using reports from the children's parents and teachers, the researchers found that while ADHD symptoms lessened as the children aged, the transition to middle school interrupted this trend. Parents reported greater disruption in symptoms than did teachers, likely because the impact of the transition may have been more evident at home, according to the researchers.

The researchers also found that children taking medication for ADHD symptoms fared no better compared with those not taking medication during the transition. The authors suggested that while medication is highly effective in treating ADHD symptoms, it is unlikely to help a child develop the specific skills needed to succeed in middle school, such as time management, organisation, planning, and study skills.

For comparison, the authors tracked the experience of a control group of children without ADHD, who transitioned into the same schools at the same time as the children enrolled in the MTA study. They found that the children without ADHD were less likely to experience the same level of distress or difficulty as the children with ADHD, as they entered middle school, according to parent and teacher ratings.

The study provides the first research data to support the assertion that environmental changes associated with the transition to middle school can worsen a child's ADHD symptoms or disrupt the typical pattern of decline.

SOURCE: US National Institute of Mental Health

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