Youngest Kids in Class May Be More Likely to Get ADHD Diagnosis, Study Claims

A study claims that the youngest children in the class may be incorrectly diagnosed with ADHD and medicated due to a natural lack in maturity.

A new study from Iceland adds to existing evidence that kids are more likely to be diagnosed with attention deficit hyperactivity disorder if they're among the youngest in their grade at school.

The findings suggest -- but don't prove -- that some children are diagnosed with attention deficit hyperactivity disorder (ADHD) when they're just less mature than their peers.

"Educators and health-care providers should take children's ages in relation to their [classmates] into account when evaluating academic performance and other criteria for ADHD diagnosis," said study author Helga Zoega, a postdoctoral fellow at Mount Sinai School of Medicine in New York City. "Parents can use these findings to help inform their decisions about school readiness for children born close to cutoff dates for school entry."

Debate has erupted in recent years about whether ADHD is overdiagnosed in children who are naturally rambunctious and don't need to be medicated.

Earlier this year, a Canadian study found that more boys aged 6 to 12 were diagnosed with ADHD if they were the youngest in their grade levels: the percentages were 7.4 percent among the youngest boys and 5.7 percent among the oldest.

There also was a gap between older and younger girls, although they're much less likely than boys to be diagnosed with ADHD.

The new study tracked nearly 12,000 children born between 1994 and 1996 in Iceland, where there's also been a debate over the diagnosis of the condition and the use of stimulants to treat it, Zoega said. The researchers looked at the children's test scores at ages 9 and 12, and examined whether they were prescribed drugs for ADHD.

Overall, 740 children -- about 6 percent of the total -- were prescribed ADHD drugs at some point from 2003 to 2009.

Children in the youngest third of their classes were 50 percent more likely than those in the oldest third to be prescribed ADHD medications from ages 7 to 14.

The study also found that "being younger relative to one's classmates affects academic performance throughout childhood," Zoega said.

Richard Morrow, a health research analyst at the University of British Columbia who studies ADHD, said the findings are consistent with those from other countries.

"In the education system, it leads to the question, 'What strategies or resources do we need to help ensure the well-being of all children in the classroom, where children vary in age by up to a year?' " he asked. "Parents need to be aware that if behavioral issues arise for their child, this may be related to their child's relative age in the classroom.

"Similarly, doctors need to consider a child's relative age in school or other settings such as athletics before making a diagnosis or writing a prescription," Morrow added. "Lastly, we may need to revisit how the diagnosis is defined to lessen the risk of inappropriate diagnosis."

The findings appear online Nov. 19 and in the December print issue of the journal Pediatrics.

So what can be done?

"Children behave and perform according to their own maturity level within the classroom," Zoega said. "Being younger relative to one's classmates affects academic performance throughout childhood. When evaluating whether a child has ADHD, this should be taken into account to prevent unnecessary diagnoses and prescribing of stimulants."

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Youngest kids in class more likely to be diagnosed with ADHD

The youngest boys and girls in a classroom are dramatically more likely to be diagnosed with — and prescribed drugs for — attention deficit hyperactivity disorder, a new study based on nearly a million B.C. children shows.

Boys who were born in December were 30 per cent more likely to receive a diagnosis of ADHD than boys born in January. The youngest girls, meanwhile, were 70 per cent more likely to be diagnosed with the brain disorder than the oldest, the analysis, published in this week’s edition of the Canadian Medical Association Journal, finds.

“Our study suggests younger, less mature children are inappropriately being labelled and treated,” lead author Richard Morrow, of the University of British Columbia, said in a statement released with the study.

“It is important not to expose children to potential harms from unnecessary diagnosis and use of medications.”

Children within the same grade can be almost one year apart in age. Yet only a handful of studies — and none of them outside of the U.S. — have examined what is known as the “relative-age” effect on the diagnosis of ADHD.

The UBC team wanted to see whether the same phenomenon exists in Canada.

A total of 937,943 children were included in the study. The team included children who were aged six to 12 at any time during the study period from 1997 to 2008.

In B.C., the cut-off for entry into kindergarten or Grade 1 is Dec. 31. Children with birthdays in mid- to late-December were compared to children born in early January.

The researchers found that the youngest and least mature children within the grade were at higher risk for treatment and diagnosis of ADHD at all ages, from six to 12 — a pattern that held for the duration of the 11-year study.

The researchers note in the CMAJ that “even children born during the three days before the end of the calendar year had a higher risk than children born during the first three days of the following year” — even though they were all born in the same season and within a six-day period.

Overall, girls were 77 per cent more likely, and boys were 41 per cent more likely, to be given a prescription for a medication to treat ADHD if they were born in December than if they were born in January.

“The potential harms of over-diagnosis and over-prescribing and the lack of an objective test for ADHD strongly suggest caution be taken in assessing children for this disorder and providing treatment,” the authors write.

Drugs used to treat ADHD can cause sleep problems, decreased appetite, anxiety and irritability. Concerns have also been raised over whether stimulant medications such as methylphenidate (the active ingredient in Ritalin) and amphetamines increase the risk of heart attack or stroke.

In 2006, Health Canada advised Canadians not to use ADHD drugs if they have high blood pressure, heart disease or abnormalities, hardening of the arteries or an overactive thyroid gland. The Canadian Paediatric Society has recommended that all children undergo a careful history and physical examination before being started on stimulant medications to check for risk factors for sudden death.

However, a study published last month involving more than 171,000 youth aged six to 21 found no link between stimulant use and an increased risk of heart-related events in otherwise healthy young people.

ADHD is the most commonly diagnosed behavioural disorder of childhood.

Read more: http://news.nationalpost.com/2012/03/05/youngest-kids-in-classroom-more-likely-to-be-diagnosed-with-adhd-ubc-study/