Younger children in the classroom likely overdiagnosed with ADHD

March 5, 2012, Canadian Medical Association Journal

The youngest children in the classroom are significantly more likely to be diagnosed with attention-deficit/hyperactivity disorder (ADHD) -- and prescribed medication -- than their peers in the same grade, according to a study just published in CMAJ (Canadian Medical Association Journal).

ADHD, which is often treated with , is the most commonly diagnosed behavioural disorder in children. Two recent studies have shown a link between the relative age of children and diagnosis of ADHD and prescription of medication. Younger children in the same grade as children who may be almost a year older may appear to be immature compared with their older . This apparent lag in maturity has been called the "relative-age effect" and influences both academic and .

Researchers from the University of British Columbia were interested to see whether this relative age effect was present in Canada and looked at a large cohort of 937 943 children in British Columbia, a province where the cut-off for entry into or grade one is Dec. 31. The research included children who were between 6 and 12 years at any point during the 11-year study conducted from Dec. 1, 1997 to Nov. 30, 2008.

Researchers found that children were 39% more likely to be diagnosed and 48% more likely to be treated with medication for ADHD if born in December compared to January. Due to the Dec. 31 cut-off birth date for entry into school in British Columbia, children born in December would typically be almost a year younger than their born in January.

"The relative age of children is influencing whether they are diagnosed and treated for ADHD," said lead author Richard Morrow, University of British Columbia. "Our study suggests younger, less mature children are inappropriately being labelled and treated. It is important not to expose children to potential harms from unnecessary diagnosis and use of medications."

There are significant health and social ramifications of inappropriate diagnosis of ADHD. Medication to treat ADHD can have negative health effects in children such as sleep disruption, increased risk of cardiovascular events and slower growth rates. As well, younger children who have been labelled ADHD may be treated differently by teachers and parents, which could lead to negative self-perception and social issues.

"This study raises interesting questions for clinicians, teachers and parents," noted coauthor and psychiatrist Jane Garland, University of British Columbia and BC Children's Hospital. "We need to ask ourselves what needs to change. For example, attention to relative age of children for their grade and more emphasis on behaviour outside the school setting might be needed in the process of assessment."

Although the prevalence of ADHD diagnosis and treatment is about three times higher in boys than girls, the effect of relative age applied to both. In fact, girls born in December and typically younger within their grade were 70% more likely to be diagnosed with ADHD than girls born in January.

"The potential harms of overdiagnosis and overprescribing and the lack of an objective test for ADHD strongly suggest caution be taken in assessing children for this disorder and providing treatment," conclude the authors.

The medications included in the study were methylphenidate, dextroamphetamine, mixed amphetamine salts and atomoxetine.

Explore further: Study finds children with ADHD also at risk for writing difficulties

More information: Paper online: www.cmaj.ca/lookup/doi/10.1503/cmaj.111619

Related Stories

Study finds children with ADHD also at risk for writing difficulties

August 26, 2011
(Medical Xpress) -- Researchers from the Mayo Clinic have just completed a study to find out if children with Attention Deficit Hyperactivity Disorder (ADHD) also have problems with writing. It has long been known that children ...

AAP expands ages for diagnosis and treatment of ADHD in children

October 16, 2011
Updated guidelines from the American Academy of Pediatrics (AAP) offer new information on diagnosing and treating Attention-Deficit/Hyperactivity Disorder (ADHD) in younger children and in adolescents.

Prescribed stimulant use for ADHD continues to rise steadily

September 28, 2011
The prescribed use of stimulant medications to treat attention deficit hyperactivity disorder (ADHD) rose slowly but steadily from 1996 to 2008, according to a study conducted by the National Institutes of Health (NIH) and ...

Quality of life for children with ADHD and their families worsens with greater disease severity

July 26, 2011
The greater the severity of a child's Attention Deficit Hyperactivity Disorder (ADHD) symptoms, the more negative impacts on the child's health-related quality of life from the perspective of the child and the parent, a new ...

Recommended for you

For children with ADHD, a brief, school-based program can help dramatically with homework problems, study finds

December 6, 2017
Children with attention deficit hyperactivity disorder who took part in a brief, school-based program displayed significant improvements in their homework, organization and planning skills, according to a new study led by ...

What can twitter reveal about people with ADHD?

November 9, 2017
What can Twitter reveal about people with attention-deficit/hyperactivity disorder, or ADHD? Quite a bit about what life is like for someone with the condition, according to findings published by University of Pennsylvania ...

Brain imaging reveals ADHD as a collection of different disorders

November 8, 2017
Researchers have found that patients with different types of attention-deficit/hyperactivity disorder (ADHD) have impairments in unique brain systems, indicating that there may not be a one-size-fits-all explanation for the ...

Can adults develop ADHD? New research says probably not

October 20, 2017
Adults likely do not develop ADHD, according to new research by FIU clinical psychologist Margaret Sibley.

Nearly a third of college kids think ADHD meds boost grades

October 16, 2017
(HealthDay)—Many college students who abuse ADHD drugs mistakenly believe that doing so will lead to better grades, a new survey suggests.

School year 'relative age' causing bias in ADHD diagnosis, says research

October 9, 2017
Younger primary school children are more likely to be diagnosed with attention deficit hyperactivity disorder (ADHD) than their older peers within the same school year, new research has shown.

1 comment

Adjust slider to filter visible comments by rank

Display comments: newest first

JRDarby
not rated yet Mar 06, 2012
www DOT madinamerica DOT com/2012/02/why-anti-authoritarians-are-diagnosed-as-mentally-ill/

I make no endorsements of any other aspect of the site, but I found the article appropriate.

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.