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NOTTINGHAM, United Kingdom — Every parent knows kids develop at vastly different paces. However, new research shows a child’s birth month may stack the deck against them when it comes to one of the most common neurological diagnoses: attention deficit hyperactivity disorder (ADHD). Researchers in the United Kingdom have found that both teachers and parents may be confusing the immaturity of younger children in the same classrooms as a sign of ADHD.
The findings, in a nutshell
In any classroom, you’ll find kids that may be noticeably older than their peers. Depending on the school’s cutoff date for certain grades, children in the same class may be several months older than other students. This could even bring them a little closer to adolescence and puberty while their younger friends are still acting more like little kids.
The comprehensive review, published in the journal European Child & Adolescent Psychiatry, revealed the youngest kids in their grade are a striking 38% more likely to be diagnosed with ADHD than their oldest classmates. The findings suggest that adults may be incorrectly labeling immaturity as a clinical condition for hundreds of thousands of children around the world.
“This review shows that adults involved in identifying or raising concerns over a child’s behavior – such as parents and teachers – may be inadvertently misattributing relative immaturity as symptoms of ADHD. The child’s age in relation to their classmates (their ‘relative’ age) needs to be considered when making this kind of diagnosis,” explains Professor Kapil Sayal from the School of Medicine at the University of Nottingham in a media release.
“This phenomenon has been shown in research for over a decade, but knowing about it does not seem to be changing practice,” adds Dr. Josephine Holland, one of the authors of the paper.
Methodology
Study authors searched through seven major databases to identify all studies examining the link between a child’s birth month and their risk of an ADHD diagnosis or prescription medication. In total, they found 30 studies meeting their criteria from locations as diverse as Taiwan, Norway, Canada, and the United States.
To allow for an apples-to-apples comparison across the different studies, the researchers classified children into two groups – those born after the cutoff date for starting school, and those born before it. For example, in areas with a Sept. 1 cutoff, kids born in August would be the youngest in their classes. They then calculated the relative risk of an ADHD diagnosis or medication between the “young” and “old” groups. Their analysis covered over 19 million children in total.
Key Results
- The meta-analysis showed the youngest children were 38% more likely to be diagnosed with ADHD than their oldest classmates in the same grade.
- Younger children were also 28% more likely to take prescription ADHD medication like Adderall or Ritalin.
- This relative age effect was driven largely by teachers’ assessments of ADHD symptoms like inattention and poor self-control.
- Parents’ assessment of the same behaviors showed no consistent age trend.
- The authors even found some evidence the effect extended beyond ADHD to autism spectrum disorder, though only two studies examined this link.
Study Limitations
Most of the data came from the United States, Canada, and Nordic countries, raising questions about how applicable the findings are worldwide.
The researchers also couldn’t determine if the relatively younger kids received misdiagnoses or if their slightly immature comportment at the time of assessment represented real but temporary developmental lags.
Takeaways from the study: Rethinking ADHD Diagnosis
Despite the caveats, the results suggest that adults need to take a hard look at subjective factors like relative age when it comes to evaluating children for ADHD and related conditions. Even respected clinical guidelines now explicitly warn against the age issue.
“Teachers play an important role in identifying ADHD symptoms in children. Our findings suggest that they can be more likely to rate younger students in a class as having ADHD symptoms than their older classmates. It is important teachers are supported in considering the relative age of a child in a classroom when ADHD is being queried,” says Dr. Eleni Frisira from the School of Medicine and lead author of the study.
Experts argue that we need a fundamentally more holistic approach to ADHD assessment that relies less on subjective teacher reports and one-time clinic observations and more on long-term tracking and real-world functional impairments. Of course, some children do suffer from underlying neurological differences that justify diagnosis and treatment. However, this extensive new data suggests we’re almost certainly pathologizing immaturity in many, perhaps even most, cases. That has major consequences for families, schools, and society.
StudyFinds Editor Chris Melore contributed to this report.
