Psychiatry Research 284 (2020) 112680

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Psychiatry Research
journal homepage: www.elsevier.com/locate/psychres

Creativity in children with ADHD: Effects of medication and comparisons T

with normal peers
⁎
Wen Tena,b, Chien-Chih Tsengb, Yu-Shu Chiangb, Ching-Lin Wuc,d, Hsueh-Chih Chenb,d,e,f,
a
Xing De Elementary School, Taipei, Taiwan
b
Department of Educational Psychology and Counseling, National Taiwan Normal University, Taipei, Taiwan
c
Program of Learning Sciences, National Taiwan Normal University, Taipei, Taiwan
d
Institute for Research Excellence in Learning Sciences, National Taiwan Normal University, Taipei, Taiwan
e
Chinese Language and Technology Center, National Taiwan Normal University, Taipei, Taiwan
f
MOST AI Biomedical Research Center

A R T I C LE I N FO A B S T R A C T

Keywords: This study is to identify the performance of children with and without ADHD in open-ended and closed-ended
Attention deficit hyperactivity disorder creativity assessments, and investigate the moderating effect of medicated and unmedicated Children. The study
Creativity subjects included third to sixth graders: 43 children with ADHD and 43 typically developing children. The
Medication treatment of attention deficit participants with ADHD were those who were identified by local Committees of Identification, Placement and
hyperactivity disorder
Consultation for Children with Special Needs or those who were diagnosed by medical institutions. Children with
ADHD were further divided into medicated (22 participants) and unmedicated groups (21 participants) based on
their current medication treatment. This study employed the New Tests of Creative Thinking to gauge the
participants’ open-ended creativity, while Remote Associates Test and the Insight Test were used to assess the
participants’ closed-ended creativity. Although previous evidence for creativity in children with ADHD have
been mixed, this study includes medication as moderation variable and suggests that the performance of un-
medicated children with ADHD in the open-ended creativity assessments was better than medicated children
with ADHD and typically developing children. The study results can further explore the creativity characteristics
of children with ADHD.

1. Introduction demonstrate symptoms of being easily distracted and frequently switch

As described in the Diagnostic and Statistical Manual of Mental
Disorders, Fifth Edition (DSM-V), and elaborated by scholars from dif-
ferent disciplines, attention-deficiency/hyperactive disorder (ADHD) is
typically characterized by inattention, hyperactivity and impulsivity.
People with ADHD are described as frequently switching between ac-
tivities, daydreaming and having the following struggles: staying fo-
cused on one task, paying attention to schoolwork, completing some
tasks, getting organized, maintaining work performance, and self-reg-
ulating or remembering things. They are also often distracted and can
disturb others (Barkley, McMurray, Edelbrock, and Robbins, 1990;
Barkley, 2013; Fenollar Cortés et al., 2014; Lahey et al., 1988). Some of
the symptoms persist into adulthood, for example, being easily dis-
tracted, “zoning out,” frequently switching between activities, and
difficulty staying attentive or taking instructions (Millstein et al., 1997;
Nigg et al., 2002). People with ADHD, in childhood or adulthood,
from one activity to another, and these traits are often associated with
creativity.
Creative people tend to have diffused attention (Mendelsohn, 1976),
and this trait is associated with the characteristics of people with
ADHD. Kaufman and Sternberg (2010) concluded that creativity is as-
sociated with certain personality traits, including questioning rules and
disregarding social conventions. Some highly creative individuals may
find it hard to receive approval at school (Gowan et al., 1979). Davis
(1992) thought creative individuals should have the personalities of
keen awareness, originality, risk-taking, curiosity and attraction to
complexity, which are not necessarily all innate characteristics but
could be developed abilities (Nie andZheng, 2005).
Disinhibition theory explains creativity in relation to cortical acti-
vation, and it was found that a high level of creativity is more sus-
ceptible to disturbances and shows less-high-intensity inhibitions.
Creative people are highly attracted to novel things. From the

⁎
Corresponding author at: Department of Educational Psychology and Counseling, National Taiwan Normal University, 162 HE-PING E. RD., SEC 1, Taipei 10610,
Taiwan, ROC.
E-mail addresses: rain69625@mail2.hdps.tp.edu.tw (W. Ten), chcjyh@ntnu.edu.tw (H.-C. Chen).

https://doi.org/10.1016/j.psychres.2019.112680
Received 23 February 2019; Received in revised form 4 November 2019; Accepted 4 November 2019
Available online 05 November 2019
0165-1781/ © 2019 Published by Elsevier B.V.
W. Ten, et al.
perspective of neuroscience, disinhibition theory emphasizes the
arousal of cortical activities. With an increase in the intensity of cortical
arousal, people's movements become more rigid and less versatile
(Martindale, 1999). Researchers using electroencephalography (EEG)
indicated that a highly activated cortical system inhibits remote as-
sociates thinking, and in turn, a high level of cortical arousal lowered
the chance of creativity (Kaufman et al., 2010). Highly creative people
also find it harder to shut out disturbances (Dorfman et al., 2008;
Kwiatkowski et al., 1999; Martindale et al., 1996; Vartanian et al.,
2007). Kwiatkowski et al. (1999) found that highly creative individuals
were more responsive to single-goal tasks but were slower than controls
in terms of responding to tasks with unclear goals. Based on the hy-
pothesis that highly creative individuals have cognitive inhibition and
attention deficiency, a study concluded that creative individuals have
higher responsiveness to additional stimuli (Martindale et al., 1996). In
these studies, the creative individuals had more difficulty getting ac-
customed to the white noises during the tests, produced higher galvanic
skin response (GSR), and had higher motivations toward new things.
Dorfman et al. (2008) reproduced Vartanian et al. (2007) research and
had similar results that showed that creative individuals could deal
with intuitive tasks more efficiently, but their responses to tasks while
there were disturbances present turned out to be slower than those of
the controls.
Many researchers of these studies suggested possible correlations
between creativity and mental illnesses. Scholars supporting this theory
believe that ADHD patients have better divergent thinking (Abraham
et al., 2006; Cramond, 1994; Fugate et al., 2013; White and Shah, 2006,
2011). When having trouble with top-down thinking, an individual may
be more impulsive, inattentive and have poor self-control, but these are
characteristics associated with creativity. However, some studies have
questioned this point (Aliabadi et al., 2016; Healey and
Rucklidge, 2005, 2006, 2008; Tucha et al., 2011).
Are the medications ADHD patients take one of the factors con-
tributing to the inconsistency of the conclusion above? The medications
used in the studies on creativity and medications included beta-
blockers, caffeine as an ergogenic aid, methylphenidate (MPH, a central
nervous system stimulant), etc. Some studies have suggested that
medications lower the pursuit of creativity and make people's responses
more uniform (Funk et al., 1993; González-Carpio Hernández et al.,
2016; Swartwood et al., 2003; Gvirts et al., 2016), while other studies
have suggested that medications increase creative output
(Berman et al., 1999; Douglas et al., 1995; Solanto and Wender, 1989).
Berman et al. (1999) agreed that the purpose of medications is to in-
crease attention and cognition and should consequently enhance the
output of related executive functions, and the view was supported by
the results of relevant studies (e.g., Bubnik et al., 2015; Tannock et al.,
1995). Douglas et al. (1995) also agreed that MPH enhances ADHD
patients’ divergent thinking. On the other hand, some studies have
found evidence in which medications lowered the fluency and origin-
ality in creativity (Funk et al., 1993; González-Carpio Hernández et al.,
2016; Swartwood et al., 2003).
MPH and atomoxetine, a norepinephrine reuptake inhibitor (NRI),
are commonly prescribed to ADHD patients in hospitals. They are dif-
ferent in engineering but similar in mechanisms of action and side ef-
fects (Kratochvil et al., 2002). Methylphenidate is a stimulant used to
increase the activity of the central nervous system (Fond et al., 2015;
Kalil et al., 2014). Some studies found that inhibitory control in chil-
dren with ADHD improved under MPH compared to placebo
(Schere et al., 2003), while some studies found that people who took
the medications showed increased levels of anxiety (Segev et al., 2016).
Hsieh and Meng (2010) found evident effects of Ritalin and Concerta on
behavioral issues and suggested that there were no distinct differences
between the two brands. The major side effects observed were de-
creased appetite, depression and weight loss, which are similar to the
descriptions in the relevant literature. The side effects often lead to
parents’ reservations in giving medications to their children. Despite
2
Psychiatry Research 284 (2020) 112680
the side effects, there has not been any agreement on how medications
affect creativity.
In the studies that found ADHD patients’ creativity to be poorer or
no different, Funk et al. (1993) ensured that the participants with
ADHD took medications when they administered the Torrance Test of
Creative Thinking (TTCT); Aliabadi et al. (2016) asked the participants
with ADHD to take medications prior to the TTCT; and Healey and
Rucklidge (2005) asked ADHD patients not to take medications the day
prior to the TTCT. White and Shah (2006), by contrast, eliminated all
individuals taking medications in their study and found the participants
with ADHD did better in the Unusual Uses Test (UUT) than the control
group. Many past studies did not have full control over the medications
of the participants with ADHD or whether their conditions on the day of
the test required medications. Many of the past studies that found that
ADHD patients demonstrated higher creativity did not have specific
control over test participants’ medications, while in most of the studies
that found ADHD patients’ performance was the same or poorer than
that of normal people, the majority of test participants took medications
prior to the test or were asked not to take medications on the day of the
test. Thus, the issue of inconsistent control over medications must be
resolved.
In addition, most of the previous studies explored open-ended
creativity assessments and remote associates test (RAT) in adults, but
none of them investigated the area of insight thinking. Creativity, in
addition to divergent thinking, also includes remote associates thinking
(Wu, 2019; Wu et al., 2017) and closed-ended insight thinking (Wu and
Chen, 2019). Discussions of creativity often revolve around Guilford's
Structure of Intellect (Guilford, 1968) and Mednick's theories (1962).
Today, Csikszentmihalyi and Wolfe (2014) discuss creativity as a pro-
cess involving the individual, the field and the domain, which under-
lines the interaction between creative output and applications of
knowledge. Runco (2008) pointed out that in modern days there is an
increasing emphasis on the potential for creative thought production.
Using creativity or insight thinking as problem-solving skills (Smith and
Smith, 2010) involves systematic analysis of problems and insight
thinking. Thus, insight thinking is one of the factors in creativity to be
discussed (Huang et al., 2019). The current study employed the clas-
sification scheme by Wakefield (1989) in the exploration of creativity,
using different dimensions to measure the creative traits of people with
ADHD with open-ended or closed-ended creativity assessments.
Current Study. Following the analysis above, in the discussion of the
creativity of children with ADHD, the study verified test participants’
medications and incorporated different forms of creativity.
Additionally, based on the results of previous studies on adults and
children with ADHD, the study has the following two hypotheses:
H1. Unmedicated children with ADHD have better performance in
open-ended creativity assessments than medicated and typically
developing controls.
H2. Unmedicated children with ADHD have lower performance in
closed-ended creativity assessments than medicated and typically
developing controls.
2. Methods
2.1. Participants
A total of 44 students with ADHD from 18 schools participated in
this study—41 boys and 3 girls, aged from 8 to 12. Every participant
with ADHD and IQs equal to or above 70 was identified by a scale for
assessing emotional disturbance (Zheng, 2001), student adaptation
questionnaire (Hong et al., 2004), personality and behavior scale (Lin,
1992), and problem behavior screening scale (Hong et al., 2004); was
recognized by the Committee of Identification, Placement and Con-
sultation for Children with Special Needs, an organization consisting of
scholars, doctors and experts; and received a diagnosis according to
W. Ten, et al.
DSM-V criteria. The pool of participants included students with diag-
nosed ADHD and students having hospital-diagnosed ADHD and re-
ceiving special education services in an effort to ensure that all parti-
cipants were within the target group. The study excluded suspected
cases without medical diagnoses and individuals who received medical
treatments but had not shown any manifestations at school.
Among the 44 children diagnosed with ADHD, 22 children were
currently taking medications, and 22 children were currently not taking
medications. However, we considered that the effects of medications
not only occur during the treatment period but also might affect brain
development in some way, allowing the residual effects of medications
to persist during medication withdrawal. Therefore, we carefully ex-
amined the medication history of the 22 currently unmedicated chil-
dren and found that 21 children had never taken any medication; the
other child had taken medications, but they had been discontinued for
more than a month. To ensure a valid comparison between the children
with and without ADHD, the data for this child and the matched child
in the control group were excluded from this study. Therefore, the
children in the unmedicated group in this study were all medication
naïve.
There were no significant differences in gender ratio (χ2(1,
N = 43) = 0.410, p = .607), age (t (41) = 0.184, p = .855), or IQ (t
(41) = 1.598, p = .118) between the two groups. All 21 of the un-
medicated children had no history of taking medicine because their
parents had worried about the side effects, such as poor appetite,
weight loss, sleep loss, and agitation. The aforementioned temporarily
unmedicated child had become too thin and had been losing sleep at
night according to the mother; thus, medication had been stopped. In
the medicated group, the parents of the children with ADHD followed
their doctors' advice and decided to let the children take medicine that
could improve their concentration and learning ability. The medicated
group all took medications, including Ritalin, Strattera and Concerta,
for one month or more. Regarding the brand of medication, 10 parti-
cipants took only Concerta, 6 took only Ritalin, 2 took only Strattera, 3
took both Concerta and Ritalin, and one took both Concerta and
Strattera.
In the process of selecting typically developing children, each par-
ticipant with ADHD was age-, gender- and academic-achievement (or
IQ percentile rank)-matched with a control student. The homeroom
teachers of the children with ADHD were asked to recommend students
in the same classes with similar levels of performance (N = 9). Those
without peers participating in the study were selected based on their IQ
percentile ranks from the group intelligence test administered at school.
The study ruled out children with other disorders, and typically de-
veloping children were paired up with ADHD children based on their IQ
percentile ranks to eliminate differences in intelligence in the pairs,
which resulted in a total of 43 participants: 10 third-graders, 13 fourth-
graders, 6 fifth-graders and 14 sixth-graders. There were no significant
differences in IQ (F (2, 83) = 1.547, p = 0.219) among the three groups
(medicated and unmedicated children with ADHD and typically de-
veloping children). Table 1 shows the grade level, sex, IQ, and medi-
cation treatment duration and history for the three groups. Two groups
of typically developing children were paired with medicated and
Table 1
The grade, sex, IQ, medicine treatment duration and history for medicated and unmedicated children with ADHD and typically developing children.
Medicated Children with ADHD(n = 22)
Grade 4.62(1.07)
Sex (% Female) 4.55%
IQ (in percentile rank) 39.14 (29.06)
Medicine treatment Longer than 1 month.
duration
Medicine treatment history 10 participants only took Concerta, 6 only took Ritalin, 2 only took Strattera, 3
took both Concerta and Ritalin, and one took both Concerta and Strattera.
3
Psychiatry Research 284 (2020) 112680
unmedicated children with ADHD: Group 1 of the typically developing
children was paired with unmedicated children with ADHD, and Group
2 of the typically developing children was paired with medicated
children with ADHD.
The study was reviewed and approved by the Institution Review
Board (IRB) of Taipei Medical University. All participants were in-
formed of the nature of the experiment and provided informed consent
before the experiment began.
2.2. Measures
The Wechsler Intelligence Scale for Children (WISC) and Raven's
Standard Progressive Matrices Test (SPM) were used as the principal
assessment tools. WISC-IV was administered to the children with ADHD
and yielded full-scale intelligence quotient (fsiq) percentile ranks; SPM
was administered among the typically developing children in the first
grade and yielded perceptual reasoning percentile ranks. These results
were used as the reference data in the study.
The entire assessment process followed the standard operating
procedure. After consent forms were received, three tests were ad-
ministered in 40 min to each individual student and in groups before
the first class began or during lunch breaks based on students’ needs
and medications. Tests were administered in three different orders, a
counterbalancing design, to avoid the progressive effect resulting from
testing sequences. The assessments also used standardized wording in
instructions. It was noted that participants with ADHD, if taking Ritalin,
had to take the tests 1–2 h after taking medications to ensure the effects
of the medicine. An examiner was hired to assist with test administra-
tion.
Open-Ended Assessment. The assessments of divergent thinking partly
used the figural version of the New Tests of Creative Thinking
(Wu et al., 1998). The test measured divergent thinking by asking ex-
aminees to draw in a 10-minute time frame. From the test, one can
analyze examinees’ fluency, flexibility and originality in creativity. The
reliability of subscale raters is between 0.76 and 0.99, exclusive of
differences in word usages.
Closed-Ended Creativity Assessments. The assessments of remote as-
sociates thinking used the Chinese Word Remote Associates Test for
Children (CWRAT-C) to evaluate examinees’ remote associates thinking
capacity. CWRAT-C is a closed-ended test designed for third- to sixth-
graders (Lo et al., 2017). The reliability test showed an internal con-
sistency index of 0.79 and 0.76 for Forms A and B, respectively. The
insight problem-solving process test administered to measure the cri-
terion-related validity showed a moderate positive correlation in effect
size (rs = 0.44, 0.50). The “alternate uses of newspapers” test showed
low to moderate effect size correlations between the discriminant va-
lidity and some indicators, while some other indicators had no corre-
lations at all (rs is between approximately −0.11 and 0.38). To main-
tain consistency throughout the study, only Form A of the two forms of
the test was administered. The test had a total score of 20 points, 1
point per question, and was administered in a 15-minute time frame.
Insight thinking assessment adopted the Insight Problem Test compiled
and designed by Chiu and Chen (2005). The problems in this test mostly
Unmedicated Children with Typically Developing
ADHD(n = 21) Children (n = 43)
4.50(1.30) 4.56(1.18)
9.52% 6.98%
47.81 (27.10) 52.95 (31.70)
Never took medicine Never took medicine.
N/A N/A
W. Ten, et al.
matched those listed by Weisberg (2006) for insight thinking research,
with 6 types of formal problems. The insight problem-solving test must
take into account any item bias as a result of prior knowledge of the
problems in the test. Thus, examinees had to perform a self-check to
confirm whether they had seen any of the problems before or had ac-
quired the answers. The test, consisting of 6 problems, 1 point per
question, with a total of 6 points, was administered in a 10 min time
frame.
2.3. Procedure
The entire assessment process followed the standard operating
procedure. After consent forms were received, three tests were ad-
ministered in 40 min to each individual student and in groups before
the first class began or during lunch breaks based on students’ needs
and medications. Tests were administered in three different orders, a
counterbalancing design, to avoid the progressive effect resulting from
testing sequences. The assessments also used standardized wording in
instructions. It was noted that participants with ADHD, if taking Ritalin,
had to take the tests 1–2 h after taking medications to ensure the effects
of the medicine. An examiner was hired to assist with test administra-
tion. The examiner, with an MA in educational psychology, experienced
with test administration and currently a schoolteacher, had sufficient
knowledge of the purpose, tools and orders of test administration of the
study.
3. Results
3.1. Descriptive results in the open-ended assessment
In the fluency results, the one-way ANOVA results of the four
groups, homogeneous as determined by the test for homogeneity of
variance, showed significant differences in fluency (F(3,82) = 6.040,
MSE = 23.507, p = .001, η2 = 0.181). A comparison of the four groups
showed that the mean fluency of the unmedicated group (M = 13.240)
was higher than that of the medicated group (M = 7.680), Typically
Developing Group 1 (M = 8.330) and Typically Developing Group 2
(M = 8.270). The other three groups did not show significant differ-
ences. According to the analysis method of Cohen (1988), the effect
size, 0.181, was a small effect. As shown in Tables 3 and 4, with in-
telligence as a control variable, the analyses of the two groups of
children with ADHD and the two groups of typically developing chil-
dren showed significant differences in the fluency results of the two
ADHD groups (F(1,40) = 9.480, MSE = 22.835, p = .004, ηp2 = 0.192),
a higher adjusted mean in the unmedicated group (M = 12.762 a) than
in the medicated group (M = 8.136a), and no differences between the
two typically developing groups (F(1,40) =0.031, MSE = 17.669,
p = .860, ηp2 = 0.001).
In the flexibility results, the one-way ANOVA results of the four
groups, homogeneous as determined by the test for the homogeneity of
variance, showed significant differences in flexibility (F(3,82) = 4.300,
MSE = 9.869, p = 0.007, η2 = 0.136). A comparison of the four groups
showed that the mean flexibility of the unmedicated group (M = 8.330)
was higher than that of the medicated group (M = 4.950), Typically
Table 2
One-way ANOVA results of all four groups.
ADHD
Unmedicated Medicated
M SD M SD
Fluency 13.240 5.108 7.680 5.075
Flexibility 8.330 2.781 4.950 2.820
Originality 14.900 5.665 7.230 5.597
Remote Associates 6.000 3.715 4.950 4.705
Insight Thinking 0.710 0.902 0.730 1.352
Psychiatry Research 284 (2020) 112680
Developing Group 1 (M = 6.330) and Typically Developing Group 2
(M = 6.050). No significant differences were shown among the other
three groups. According to the analysis method of Cohen (1988), the
effect size, 0.136, was a small effect. With intelligence as a control
variable, the analyses of the two groups of children with ADHD and the
two groups of typically developing children, as shown in Tables 3 and 4,
showed significant differences in the flexibility results of the two ADHD
groups (F(1,40) = 11.507, MSE = 7.050, p = .000, ηp2 = 0.365), a
higher adjusted mean in the unmedicated group (M = 8.088 a) than in
the medicated group (M = 5.189 a), and no differences between the two
typically developing groups (F(1,40) = 0.165, MSE = 9.291,
p = 0.686, ηp2 = 0.004).
In the originality results, the one-way ANOVA results of the four
groups, homogeneous as determined by the test for the homogeneity of
variance, showed significant differences in originality (F
(3,82) = 14.188, MSE = 26.707, p = .000, η2 = 0.342). A comparison
of the four groups showed that the mean flexibility of the unmedicated
group (M = 14.900) was higher than that of the medicated group
(M = 7.230), Typically Developing Group 1 (M = 6.810) and Typically
Developing Group 2 (M = 5.640). The other three groups did not show
significant differences. According to the analysis method of Cohen
(1988), the effect size, 0.342, was a medium effect. With intelligence as
a control variable, the analyses of the two groups of children with
ADHD and the two groups of typically developing children, as shown in
Tables 3 and 4, showed significant differences in the originality results
of the two ADHD groups (F(1,40) = 11.548, MSE = 30.635, p = .000,
ηp2 = 0.366), a higher adjusted mean in the unmedicated group
(M = 14.569 a) than in the medicated group (M = 7.548 a), and no
differences between the two typically developing groups (F
(1,40) = 1.415, MSE = 19.268, p = 0.241, ηp2 = 0.034 ).
3.2. Descriptive results in the closed-ended assessment
The Remote Associate Thinking test results, as shown in Table 2,
were not significantly different among the four groups (F
(3,82) = 2.045, MSE = 16.265, p = .114, η2 = 0.070). Further ana-
lyses with intelligence as a control variable found no differences in the
RAT test results of both the ADHD groups (F(1,40) = 0.061,
MSE = 11.183, p = .807, η2P = 0.002) and the two typically developing
groups (F(1,40) = 0.133, MSE = 12.282, p = .718, η p2 = 0.003).
The Insight Test results, as shown in Table 2, were not sig-
nificantly different among the four groups (F(3,82) = 0.007,
MSE = 1.192, p = .999, η2 = 0.002). With intelligence as a control
variable, the analyses of the two groups of children with ADHD and the
two groups of typically developing children did not show significant
differences in the insight test results of the two ADHD groups (F
(1,40) = 0.674, MSE = 1.084, p = .417, η p2 = 0.017 ) or in those of the
two typically developing groups (F(1,40) = 0.001, MSE = 0.926,
p = .975, η p2 = 0.000 ).
4. Discussion
In terms of creativity, this study pioneered using the insight test to
assess closed-ended creativity in children with ADHD and found that
Typically Developing F p η2
Group 1 Group 2
M SD M SD
8.330 5.247 8.270 3.869 6.040 .001 0.181
6.330 3.903 6.050 2.952 4.300 .007 0.136
6.810 4.986 5.640 4.327 14.188 .000 0.342
7.480 4.262 7.500 3.306 2.045 .114 0.070
0.710 1.056 0.680 0.995 0.007 .999 0.002
4
W. Ten, et al. Psychiatry Research 284 (2020) 112680

Table 3
One-way ANCOVA results of the ADHD group with intelligence as a control variable.
ADHD
Unmedicated Medicated F p η2
Intelligence (WISC-IV) Adjusted M Intelligence (WISC-IV) Adjusted M

Fluency 100.29 12.762 a 92.95 8.136 a

9.480 .004 0.192
Flexibility 8.088 a 5.189 a
11.507 .000 0.365
Originality 14.569 a 7.548 a
11.548 .000 0.366
Remote Associates 5.332 a 5.592 a
0.061 .807 0.002
Insight Thinking 0.583 a 0.852 a
0.674 .417 0.017

unmedicated children with ADHD did have better performance in open-
ended creativity. On the other hand, no differentiations were found in
the closed-ended creativity assessments. These results not only sup-
ported the disinhibition hypothesis but also suggested that creativity is
domain-specific.
This study measured the performance of its participants—medicated
children with ADHD, unmedicated children with ADHD and typically
developing children—instead of considering only the varied perfor-
mance before and after medications were taken. In addition, it was
confirmed that unmedicated children with ADHD had an unusual ad-
vantage in divergent thinking in relation to open-ended creativity. Last,
this study provided evidence for the impact of medication treatments
on children with ADHD, but the impact did not involve causal in-
ference.
The results supported Hypothesis 1. The unmedicated group had
better performance in all three aspects of fluency, flexibility and ori-
ginality than the medicated and typically developing groups in the di-
vergent thinking assessment in the open-ended creativity category,
while the medicated and typically developing groups did not show
differences from each other. ADHD patients are easily distracted and
tend to switch between tasks, which could be associated with the
characteristics of highly creative individuals who have diffused atten-
tion and tend to question school rules and refuse to follow social con-
ventions. The study results indeed demonstrated the entwined corre-
lations.
The current study reached a conclusion similar to previous studies.
The findings in Cramond's research (1994) suggested that children with
ADHD had superior creativity to their peers. Fugate et al. (2013) had
the same findings in gifted children with ADHD. The current study
further confirmed that unmedicated children with ADHD had ad-
vantages in divergent thinking, showing better performance in fluency,
flexibility and originality in creativity.
By contrast, medicated children with ADHD showed lower fluency
and originality than unmedicated children with ADHD and typically
developing controls (Funk et al., 1993; González-
Carpio Hernández, and Serrano Selva, 2016; Swartwood et al., 2003).
In addition to this finding, it was found in this study that even flexibility
was affected. In their investigation on participants before and after
taking medications, Swartwood et al. (2003) found that medicated in-
dividuals showed less complex creative performance than unmedicated
individuals. González-Carpio Hernández et al. (2016) also found that
medicated students demonstrated lower fluency and originality in
creativity than unmedicated students. In this study, investigations were
conducted on different groups of participants and reached a similar
conclusion, indicating differences between the creative performance of
mediated and unmedicated individuals.
Previous studies showed that ADHD patients demonstrated the same
or even poorer creativity than typically developing children
(Aliabadi et al., 2016; Funk et al., 1993; Healey and Rucklidge, 2005).
With a closer look, it was found that the two groups of participants in
the study by Funk et al. (1993) were only medicated individuals with
ADHD and typically developing individuals, and the study concluded
there were no significant differences between the two groups. This
current study had similar results but found that the medicated group
and the typically developing group did not demonstrate any differences
in divergent thinking. However, this does not mean that unmedicated
children with ADHD do not have advantages in divergent thinking.
While the participants in the studies by Healey and Rucklidge (2005)
and Aliabadi et al. (2016) were asked not to take medications on the
day of assessments, it was still impossible to verify the effects that
medications normally had on the participants and their experiences
with medication treatments. This issue remains to be resolved in future
studies, but the current study had further findings after sorting through
participants’ conditions after medications.
The results of the study did not support Hypothesis 2. The four
groups did not show any differences in the results of the RAT test and
insight test that consisted of closed-ended creativity assessments.
Previous studies indicated that the divergent thinking of both children
and adults with ADHD was better than their convergent thinking
(Abraham et al., 2006; Cramond, 1994; Fugate et al., 2013; White and
Shah, 2006, 2011), and this finding is similar to what was found in the
current study: the unmedicated group outperformed the typically de-
veloping and medicated groups in divergent thinking, but no differ-
ences were shown among the three groups in the RAT test and the in-
sight test. Unmedicated children with ADHD had specificity in their
creative performance.
In contrast to previous studies, the current study did not find either
group with ADHD to be inferior to the typically developing group in
RAT. The study on adulthood ADHD by White and Shah (2006) found
that unmedicated ADHD patients had lower performance in RAT,
whereas Tucha et al. (2011) found that adults’ convergent thinking
improved with medication treatments. The current study, however, did
not find any difference among the children, and this discrepancy was
speculated to originate from the variations in tests or in age (adults and
children) in different studies. This remains a topic for future explora-
tion.

Table 4
One-way ANCOVA results of the typically developing group with intelligence as a control variable.
Typically Developing
Intelligence (CPM) Adjusted M Intelligence (CPM) Adjusted M F P η2

a
Fluency 25.86 8.297 25.71 8.070 a 0.031 .860 0.001
a
Flexibility 6.254 5.876a 0.165 .686 0.004
a
Originality 6.894 5.301 a 1.415 .241 0.034
a
Remote Associates 7.482 7.448 a 0.133 .718 0.003
a
Insight Thinking 0.680 0.573 a 0.001 .975 0.000

5
W. Ten, et al.
In conclusion, in addition to the differences in assessment tools and
participant age, differentiation of medicated and unmedicated partici-
pants can be a cause of the different outcomes. Most of the findings in
previous studies are supported by the results of the current study. There
are also traces to follow for the two opposite views on divergent
thinking. The sharp distinction between the two conclusions could have
come from the same speculation that children with ADHD have ad-
vantages over their peers in terms of some creative potentials. These
results could be linked to the traits of children with ADHD—distraction
and the tendency to switch from task to task. Overall, as shown in the
study, the unmedicated children with ADHD had potential advantages
in divergent thinking; no differences were shown among the un-
medicated, medicated and typically developing groups in the RAT test
and the insight test; the medicated group had slightly lower results on
the RAT test than the typically developing group; and the analyses of
the results in all three tests showed no significant differences between
the medicated group and the typically developing group.
4.1. Limitations
The sample size of the study is relatively small (N = 86) and is
limited by the passiveness of whether participants took medications.
The study recruited participants who met the assessment requirements.
However, the study could group the participants only based on whether
they took medications without differentiating medication efficacies and
other effects; consequently, the effects of the medications were not
identified. Additionally, the participants in the study, both children
with ADHD and typically developing children, were elementary stu-
dents at the time and had taken various intelligence tests at school. A
group test was out of the question. The study could compare only the
results of the participants who took the same types of intelligence tests.
Despite the limitations, the study still made some breakthrough in some
blind spots in this research area by confirming that medication as a
variable did make a difference. This could be explored in more so-
phisticated discussions in later studies.
5. Conclusion
This study provided evidence for the advantages of the unmedicated
children with ADHD in divergent thinking over the medicated group
and the typically developing group in terms of their performance on
tests of fluency, flexibility and originality in creativity. That means that
the unmedicated group of children with ADHD indeed stood out in the
divergent thinking assessment in relation to open-ended creativity and
possibly has more promising potential in the field of art.
Declaration of Competing Interest
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Acknowledgments
This work was financially supported by the grant MOST-108-2634-
F-002-022 from Ministry of Science and Technology of Taiwan, MOST
AI Biomedical Research Center, and the “Institute for Research
Excellence in Learning Sciences” and “Chinese Language and
Technology Center” of National Taiwan Normal University (NTNU)
from The Featured Areas Research Center Program within the frame-
work of the Higher Education Sprout Project by the Ministry of
Education (MOE) in Taiwan.
Supplementary materials
Supplementary material associated with this article can be found, in
the online version, at doi:10.1016/j.psychres.2019.112680.
6
Psychiatry Research 284 (2020) 112680
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