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A younger entry to school could pave the way for the diagnosis of ADHD



A study shows that younger kindergarten children are more likely to suffer from attention-deficit hyperactivity disorder in the early grades, which is intriguing for parents looking for when they start school at school.

The study found that younger students, especially boys, were also more likely to start taking medication for ADHD and continue to take longer than older children. Medications are usually safe, but can have harmful side effects.

"Doctors and therapists must take this into account in their decision-making," said Dr. Anupam Jena, co-author of the Harvard Medical School study. They should ask, "Does he really have ADHD, or is it because it takes him six more months to mature? This extra year makes all the difference."

ADHD has been diagnosed in approximately 6 million American children and adolescents, causing inattention, hyperactivity and impulsivity. The diagnosis rate is rising.

The study, published Wednesday by the New England Journal of Medicine, is from a lunchroom conversation on the "kindergarten redshirt" for a co-author's son. The term is borrowed from athletics and means waiting a year to give a child time to mature.

"The parents were wondering whether or not to hold their child for another year," Jena said. This led the researchers to ask, "What happens to children of the same class who are perceived to be different?"

They used insurance claims to compare more than 71,000 students to the August and September birthdays in 18 US states with the September 1 st thresholds. A child who turns 5 before September 1st can start kindergarten. Otherwise, the child waits until next year. An anniversary in August may mean that a child is the youngest in the class, while those born in September are the oldest.

Overall, from birth to early school years, the number of children diagnosed with ADHD was low. The researchers calculated that the rate of diagnosis of ADHD was one-third higher among children born in August than those born in September, 309 cases out of about 36,300 with birth in August and 225 cases out of about 35,300 born in September. .

There was no group difference before the age of 4; he appeared after schooling.

The researchers also examined the rates of asthma, diabetes and obesity and found that they were identical for babies in August and September. And no other monthly comparison has shown a clear difference in ADHD.

Finally, using data on the insurance of more than 400,000 children in the 50 US states, the researchers looked at states that do not use the September 1 threshold and whose effect has disappeared.

"They did a lot of checking to make sure of their findings – it was really striking, they were so consistent," said Dr. William Cooper, professor of pediatrics and health policy at the University of Toronto. Vanderbilt University, Nashville. the research.

Cooper said that younger children may have more difficulty paying attention, sitting down and controlling their urges. Compared to other children, they can look like ADHD.

The study did not assess whether the children had been diagnosed correctly. The difference between August and September could be a reflection of the discovery of real cases of ADHD in children born in August because of their early school year, said Dr. Jonathan Posner, Associate Professor of Psychiatry at Columbia University Medical Center in New York. York.

On the other hand, in the absence of laboratory testing for ADHD, doctors rely on subjective observations from their parents and their teachers. A young student may just need time to catch up, but his immature behavior resembles ADHD and raises the concern of a teacher, said Posner, who has not participated in l & # 39; study.

"The information we receive about a child needs to be interpreted in a development context," Posner said. "A 4-year-old will not respond as well to school challenges as a 5-year-old."

ADHD stimulant medications are generally considered safe, Posner said, but some kids have side effects such as loss of appetite, sleep disturbances and hyperactivity rebounds in after -midday.

The study does not include children covered by Medicaid, the government insurance program that serves 35 million low-income children. Other research has shown that children under Medicaid were more likely to be diagnosed with ADHD, which could explain the low rates of diagnosis described in the new study, explained Jena.

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