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ADHD diagnosis more common in early school children
A few years ago, German scientists reported that late school enrollment has negative consequences for school performance. However, starting school too early is also not an advantage. Because as American researchers now report, these children are diagnosed with ADHD more often.
The number of ADHD diagnoses is increasing
Research has shown that attention deficit hyperactivity disorder (ADHD) is diagnosed in an increasing number of children in Germany. The number of such diagnoses is also increasing in the USA. This could also have to do with the fact that many children were born in the "wrong" month. Because, according to a new study by researchers from Harvard Medical School, ADHD in the US is diagnosed significantly more often in August children than in children who are born a month later. The reason is therefore the cut-off date for school enrollment, which takes place on September 1 in many US states.
More common diagnosis in children born in August
The study results, recently published in the New England Journal of Medicine, show that children born in these states in August are 30 percent more likely to be diagnosed with ADHD than theirs somewhat older classmates.
According to a Harvard Medical School release published in the EurekAlert! Magazine, the number of ADHD diagnoses in children has increased dramatically in the past 20 years.
In 2016 alone, more than five percent of children in the United States were treated with medication for ADHD.
Experts believe the increase is due to a combination of factors, including better detection of the disorder, a real increase in frequency, and, in some cases, an incorrect diagnosis.
The results of the new study underline the view that, at least in a subset of elementary school students, the diagnosis can be traced back to previous schooling, the research team said.
"Our results suggest that a large number of children are overdiagnosed and overtreated for ADHD because they are relatively immature compared to their older classmates in early elementary school years," said study leader Professor Timothy Layton from the Blavatnik Institute at Harvard Medical School .
Classmates can be around a year younger
As the message states, most states have arbitrary birthday dates that determine what grade a child is in and when they go to school.
For the frequently occurring reference date of September 1st, this can lead to a child born on August 31st being almost a whole year younger on the first day of school than a classmate who was born on September 1st.
At this age, it could be harder for the younger child to sit still and concentrate for a long time in class.
This additional fidgeting could lead the child to a doctor, followed by diagnosis and treatment of ADHD, according to Layton.
Normal behavior can appear unusual compared to older people
As the researchers further explain, what is seen as normal behavior in a 6-year-old may appear relatively unusual compared to older classmates.
This dynamic could be particularly true in younger children, since an age difference of eleven or twelve months could lead to significant differences in behavior.
"When children get older, small age differences converge and dissolve over time, but behaviorally, the difference between a 6-year-old and a 7-year-old can be quite large," said senior author Anupam Jena of Harvard Medical School.
Early schooling is a reason for ADHD diagnosis
To arrive at their results, the researchers compared the difference in ADHD diagnosis by month of birth - August versus September - using documents from a large insurance database.
These 407,000 primary school children born between 2007 and 2009 were observed until the end of 2015.
The analysis showed that in countries using September 1 as the school enrollment deadline, children born in August were 30 percent more likely to be diagnosed with ADHD than children born in September.
No such difference was found between children born in August and September in states with different cut-off dates.
According to the information, 85 out of 100,000 children born in August were diagnosed or treated with ADHD. The number of pupils born in September was 64 per 100,000.
When the researchers focused only on ADHD treatment, it was found that 53 out of 100,000 students born in August received medication, compared to 40 out of 100,000 among those born in September.
Layton concludes from the results that early schooling is a common reason for diagnosing ADHD and prescribing medication. (ad)