The stimulant drug Ritalin has long been used to treat children with attention deficit hyperactivity disorder, which is the most common behavioral disorder among the young.
But the findings of a federally funded study at the University of Pittsburgh suggest that behavior modification can be just as important to help teenagers with the disorder manage impulsivity, inattention and defiant behavior that characterizes the condition.
Researchers found that performance on quizzes, daily assignments and note-taking improved in teenagers who were taught behavior modification techniques while being treated with Ritalin.
Scores improved by an average of 17 percent, a jump that could mean two or three letter grades, in 80 percent of the 45 teens studied. The study appears in the current issue of the journal Experimental and Clinical and Psychopharmacology.
In addition, researchers found that low doses of Ritalin worked well for most of the adolescents, which is significant because doctors usually increase the dosage as children grow, thinking the benefits are greater.
"More isn't always better," said Steven W. Evans, director of the Attention and Learning Disability Center at James Madison University in Virginia. "The common practice is to keep upping the dose, or if you don't get a response with a low dose, switch medication to a drug that may not have as safe a profile as Ritalin.
"The bottom line is there are great individual differences and we need to carefully assess presenting problems when prescribing medication."
The research team studied teenagers who were enrolled in an eight-week intensive summer treatment program when Evans was on staff at Western Psychiatric Institute and Clinic in Oakland during the early 1990s.
Three times a day, a participant received either a placebo, which has no medicinal effect, or a 10-, 20- or 30-milligram dose of Ritalin. Each received the drug or placebo for one day each week in random order, which allowed the researchers to compare behavior and academic performance under each condition.
Because attention deficit hyperactivity disorder affects mostly boys, most of the study participants were male.
Two-thirds of the adolescents showed moderate to large improvement in academic performance while on 10 milligrams of Ritalin, compared with the placebo.
Fewer than half showed substantial improvement when the dose was increased to 20 milligrams. On a 30-milligram dose, very few students achieved significant gains while the performance of some deteriorated.
The boys attended a one-hour history class four days a week as well as other structured activities such as note-taking instruction, social skills lessons and problem-solving groups designed to help them control their behavior.
Researchers measured the quality of students' note taking, their performance on daily quizzes, in-class worksheets and writing assignments, and how often they completed homework. Evans' team also observed how often students displayed disruptive, inattentive or defiant behavior in the classroom.
The researchers caution that the study doesn't indicate whether stimulant medication enhances students' school performance over the long term.