The Relationship Between ADHD and School Attendance, School Behavior, and School Performance

Sunday, 27 July 2014: 10:30 AM

Nancy M. H. Pontes, PhD, RN, APN, FNP-BC
School of Nursing, Camden, Rutgers University, Camden, NJ
Manuel C. F. Pontes, PhD
Marketing, Rowan University, Glassboro, NJ


Previous research has shown that Attention Deficit Disorder (ADHD) is negatively associated with school attendance and school performance, and positively associated with school behavioral problems. However, these studies were conducted with samples drawn from individual schools or school districts. Few studies were conducted with nationally representative samples.  One such study from the National Health Interview Survey (NHIS) was based on parent report, and did show a positive association between ADHD and missed days of school.  The purpose of this research is to investigate the relationship between ADHD and school attendance, school behavior, and school performance of school-aged children in the US using a large nationally representative sample.


Multivariate analyses were used to examine the relationship between ADHD and school attendance, school behavior and school performance.  Data are from the Medical Expenditure Panel Survey 2008-11 (MEPS), using a complex survey design.  The Columbia Impairment Scale (CIS) was used to measure problems with school behavior and school work.  The analysis was done by SAS version 9.2, using proc surveymeans, surveyfreq and surveylogistic for data analyses. 


ADHD had a significant positive relationship to increased school absences, and greater problems with school behavior and schoolwork.  Analyses with health insurance, family income, family structure, and gender as covariates showed that ADHD had a significant positive relationship with increased school absences and problems with schoolwork.


These data illustrate the significant burden of ADHD on school performance. While some research has shown that better management of ADHD in school settings improve outcomes, further research is needed.  More specifically, multidisciplinary teams with advanced practice nurses such as nurse practitioners in school-based health centers should be further explored to see if their intervention is associated with improved school performance in these children.