ADHD News & Research

Study: Teens Less Likely to Recognize Positive Effects of ADHD Medication

Recent research finds that teens with ADHD most commonly attribute their successes to “high effort” and their setbacks to “being treated unfairly,” even when a direct correlation exists between taking stimulant medication and achieving academic and social progress.

February 6, 2018

Studies confirm that stimulant medication is largely effective in helping teens with ADHD manage the condition during adolescence and beyond. Yet many adolescents with ADHD start resenting or refusing to take their medication in middle and high school. In fact, some studies suggest that as few as 10 percent of teens with ADHD continue to take their medication after turning 18.

Experts wondered: Why would so many teens refuse to take medication that helps them focus and perform better at school? A recent study1 may reveal part of the answer; its findings suggest that teens with ADHD can’t always tell when they’re on medication — and the very rarely perceive the positive effect it has on their academic and social progress.

The study, published early last year in The Journal of Attention Disorders, observed 46 teens between the ages of 12 and 17 who were enrolled in a summer ADHD treatment program. Along with behavioral and academic treatments, the teens underwent a controlled medication assessment, where they alternated between 3 different doses of methylphenidate and a placebo.

Each day, the subjects were asked to:

  • determine whether they had been given active medication or a placebo
  • rate their behavioral and academic performance throughout the day
  • indicate how much their performance had been influenced by medication, their own effort, or fair treatment by others.

The teens’ ratings were compared to those given by teachers and counselors at the treatment program.

The teens performed significantly better on days when they took medication. But their ability to tell whether they were on medication — even on high-performing days — was no better than if they had guessed, the researchers said. And when asked what they thought had affected their performance, the teens attributed their successes to high effort on their part — and perceived that they had been “treated unfairly” on days when their academic and behavioral outcomes were negative. Medication’s effect was largely ignored; in fact, it was rated as the main determinant of the teens’ success in less than 1 percent of the subjects’ daily ratings.

“While attributing their success to effort and ability is a positive attribution, not recognizing the important help provided by medication may contribute to why so many teens refuse to take it,” said David Rabiner, Ph.D., who was not involved in the study. “After all, if you don’t believe medication is really helping, why bother to take it? Given that the adolescents in this study could not reliably tell when they had taken medication or placebo, it is not surprising that they would be similarly unaware of any benefits it provided.”

Other factors — like a teen’s desire for independence, or a need to fit in with their peers — may also contribute to a refusal to take medication, experts say. “For most children, teens, and adults who have been correctly diagnosed with ADHD, part of accepting the condition is to accept the implications of treatment,” said Wes Crenshaw, Ph.D., who was also not involved in the study. “The best way to sell medication to a teen or young adult is with honesty.”

1 Pelham, William E., et al. “Attributions and Perception of Methylphenidate Effects in Adolescents With ADHD.” Journal of Attention Disorders, vol. 21, no. 2, 1 Jan. 2017, pp. 129–136., doi:10.1177/1087054713493320.