ADHD is more likely to be diagnosed in children who start school earlier – Quartz

Children who start school earlier than their peers often have difficulties. When you've been on planet Earth for almost a year less than your kindergarten colleagues, you're bound to be less mature, more energetic and less able to pay attention for long periods of time.

New study published by researchers at Harvard Medical School in The New England Medical Journal sHow do children who go to school early face another risk? Among a large sample of US children whose school enrollment deadline was September 1, children born in August were 34% more likely to be diagnosed and treated for ADHD than their peers older.

"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 classmates at the beginning." from primary school ", senior author, Timothy Layton, assistant professor of health. In a statement, the care policy of the Blavatnik Institute at Harvard Medical School was confirmed.

Attention Deficit Hyperactivity Disorder (ADHD) is a chronic neurobiological disorder that affects the brain structurally and chemically, as well as how different parts of the brain communicate with each other. In boys, the symptoms tend to hyperactivity and inattention; In girls, symptoms of ADHD may include a tendency to daydream and difficulty following instructions.

The diagnosis rates of ADHD have doubled in the last 20 years. In 2016, 5% of American children took medication for ADHD. The researchers attribute this increase in part to a better recognition of the disorder and a real increase in its condition, but they also recognize that overdiagnosis has also played a role.

The anniversary effect

Here is how a child's birthday can affect their school experience: imagine that you live in a school district with a September 1 deadline, which means that your child must be 5 years old on September 1 in order to start school. This means that a boy named Lucas, who turned five on August 15th, will enroll in the same class as Jack, who will turn six on September 15th.

Jack is alive nearly 20% longer than little Lucas. Development, it's an eternity. He will probably have better self-control and be better equipped to do the things needed at school, such as staying still and listening for long periods.

"As children get older, small age differences equalize and dissipate over time, but behaviorally, the difference between a 6-year-old and a 7-year-old could to be quite pronounced, "said lead author of the study, Anupam Jena, associate professor of health care policy at the Blavatnik Institute of Harvard Medical School. What is normal for a five-year-old child appears immature to a six-year-old.

Researchers at Harvard Medical School used the archives of a large insurance database to track more than 407,000 primary school children born between 2007 and 2009, until the end of 2015. They compared the difference in diagnosis of ADHD by month of birth – August compared to September.

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 analysis. These differences do not appear when states have different deadlines.

Diagnosing ADHD is tricky: parents, educators, administrators, and health care providers need to determine whether a child needs help or not. The researchers also noted that many states now hold schools accountable for identifying ADHD, prompting educators to refer any child with symptoms to a medical assessment.

But teachers have noted in comments to a New York Times article that it is sympathy that drives them to direct students toward a diagnosis.

"As a teacher, I do not need kids to take medicine to help me or improve my day," wrote a speaker. "But I've seen drugs relieve the incredible burden of an illness that a child can not control from his little shoulders."

Others pointed out that children are required to follow extremely unrealistic standards these days – arguing that the real problem may not lie in teachers' propensity to view immaturity as a mental disability, but in the expectations of schools as to what a child in kindergarten should be able to do. A teacher from San Francisco wrote:

"When I was in kindergarten in the 1980s, it was a year of play and exploration led by kids. Now, four and five year olds entering my class should complete their reading of the year by solving symbolic addition and subtraction problems.

The case to send children to school later

Other research suggests that enrolling children early in their studies makes them suffer both academic and emotional. A working paper written in 2017 by researchers from the University of Toronto, Northwestern University and the University of Florida revealed that Florida children whose birthday was the month of August – where the deadline for the opening of kindergarten was September 1 – had lower scores at college elementary school tests, and more likely to be put in. prison for a juvenile crime. That's true, regardless of the level of education and the parents' income.

Holding children, or "red shirt", as it is called in the United States, also seems to have benefits. A 2015 study by Stanford University showed that Danish children who reported nursery school up to one year had significantly higher levels of self-control. Rates of inattention and hyperactivity have been reduced by 73% in the meantime. The author of this document explained to Quartz that the effect was lasting: instead of increasing over time, as expected, the postponement of the school virtually eliminated the risk that an average child of 11 years would reach a score inattention or hyperactivity greater than normal. were a little surprised at the persistence of this effect, "said Thomas Dee, one of the co-authors and professor at the Stanford Graduate School of Education.

Countries like Finland and Germany already have children who start school quite late. Children do not seem to suffer later in life for lost time, otherwise known as childhood: Finland scores well in international tests of 15-year-olds.

But now, it is the parents of well-educated and wealthy boys who are most likely to retain their children, creating new inequalities in school. So what else to do? One of the solutions, according to the authors of the latest research, is to take age into account when determining whether a child should be diagnosed. "The age of the child compared to peers of the same level should be taken into account," said Jena, "and the reasons for this referral carefully examined."