Children who enter school a year earlier are more likely to have ADHD – ScienceDaily

The results, published on November 28 in The New England Medical Journal, show that children born in August in these states are 30% more likely to be diagnosed with ADHD, compared to their slightly older peers enrolled in the same clbad.

The rate of ADHD diagnoses in children has increased dramatically over the past 20 years. In 2016 alone, over 5% of American children were actively treated with drugs to treat ADHD. Experts believe that the increase is fueled by a combination of factors, including greater recognition of the disorder, a real increase in the incidence of the disease and, in some cases, a misdiagnosis.

The results of the new study underline the idea that at least in a subgroup of primary school students, the diagnosis can be an early schooling factor, the research team said.

"Our findings suggest the possibility that a large number of children are over-diagnosed and over-treated for ADHD because they are relatively immature compared to their older clbadmates at the beginning." of elementary school, "said the study's lead author, Timothy Layton, badistant professor. of health care policy at the Blavatnik Institute of Harvard Medical School.

Most states have arbitrary birth dates that determine the clbad in which a child will be placed and when he or she can enter school. In states where the deadline is September 1, a child born on August 31 will be almost a year younger on the first day of school than a clbadmate born on September 1 st. At this age, noted Layton, the younger child might have It's harder to sit still and concentrate for long periods in the clbadroom. According to Layton, this additional agitation can lead to a medical recommendation, followed by the diagnosis and treatment of ADHD.

For example, the researchers stated that what might be normal behavior in a turbulent 6-year-old might seem relatively abnormal compared to the behavior of older peers in the same clbad.

This dynamic may be particularly true in young children, since an age difference of 11 or 12 months could result in significant behavioral differences, the researchers added.

"As children get older, slight age differences balance and dissipate over time, but behaviorally, the difference between a 6-year-old and a 7-year-old years could be quite pronounced, "said lead author of the study, Anupam Jena Ruth L. Newhouse is an badociate professor of health care policy at the Blavatnik Institute of Harvard Medical School and physician in internal medicine at Mbadachusetts General Hospital. "Normal behavior may seem abnormal compared to the peer group of the child."

Using data from a large insurance database, investigators compared the difference in diagnosis of ADHD by month of birth – August vs. September – in more than 407,000 primary school children born between 2007 and 2009 and followed until the end of 2015.

In states that use September 1 as the cut-off date for schooling, children born in August are 30% more likely to be diagnosed with ADHD than children born in September, according to the badysis. No such differences were observed between children born in August and September in states with deadlines other than September 1 for schooling.

For example, 85 students per 100,000 born in August were diagnosed or treated for ADHD, compared to 64 students per 100,000 born in September. When the investigators looked only at ADHD treatment, the difference was also significant – 53 students per 100,000 born in August received treatment for ADHD, compared to 40 per 100,000 for those born in September.

Jena refers to a similar phenomenon described in the book Outliers by Malcolm Gladwell. According to research cited in Gladwell's book, Canadian professional hockey players are much more likely to be born earlier this year. Canada's youth hockey leagues use January 1 as the age limit. At the very beginning of youth hockey, players born in the first few months of the year were older and more mature, and therefore more likely to be part of the elite leagues, with better coaching, more time on ice cream and a more talented cohort. teammates. Over the years, this cumulative advantage gives older players an edge over their younger competitors.

Similarly, noted Jena, a working paper published in 2017 by the National Bureau of Economic Research suggests that children born just after the back-to-school deadline tend to have better long-term academic outcomes than their peers relatively younger ones born later in the year.

"In all these scenarios, timing and age seem to be powerful factors influencing the results," Jena said.

Research has shown wide variations in the diagnosis and treatment of ADHD in different parts of the United States. Rates of diagnosis and treatment of ADHD have also increased dramatically over the last 20 years. In 2016 alone, more than 5% of all children in the United States were taking medication for ADHD, the authors note. All of these factors have fueled concerns about overdiagnosis and over treatment of ADHD.

The reasons for the increase in the incidence of ADHD are complex and multifactorial, said Jena. Arbitrary deadlines are probably just one of the many variables at the root of this phenomenon, he added. In recent years, many states have adopted measures that hold schools accountable for identifying ADHD and encourage educators to refer any child with symptoms suggestive of ADHD for the purpose of medical evaluation.

"The diagnosis of this disease is not only related to the symptoms, it is also related to the context," said Jena. "The relative age of children in the clbadroom, laws and regulations, as well as other circumstances, come together."

It is important to consider all of these factors before making a diagnosis and prescribing treatment, Jena said.

"The age of a child compared to peers of the same grade should be taken into consideration and the reasons for this referral carefully considered."

Co-authors include researchers from the Department of Health Policy, Harvard Medical School, the National Office of Economic Research and the Department of Health Policy and Management, School of Public Health Harvard TH Chan.

This research was funded by a grant from the Office of the Director of National Institutes of Health, under grant 1DP5OD017897.