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Are some ADHD-labeled kids just young for their grade?

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young child who might be diagnosed with ADHDA child that is easily distracted, fidgety and interruptive in school might not have a clinical case of attention-deficit hyperactivity disorder (ADHD), but might rather just be acting his or her age, posit researchers behind two new studies of diagnosis trends.

Kids whose birthdays fall around school enrollment cutoff dates can find themselves as either the youngest or oldest among their peers, depending upon which side of the date they fall on. And that coincidence of the calendar can make a significant difference in a child’s chances of getting diagnosed with ADHD, according to the new research.

Two separate studies, both set to publish in a future issue of the Journal of Health Economics, found that students whose birthdays fell just before their school’s age enrollment cutoff date—and thus were among the youngest in their class—had a substantially higher rate of ADHD diagnoses than students who were born just a day or two later and were the oldest in the grade below.

"We believe that younger children may be mistakenly diagnosed as having ADHD, when in fact they are simply less mature," Melinda Morrill, an assistant professor of economics at North Carolina Sate University and coauthor of one of the papers, said in a prepared statement. "Similar students have significantly different diagnosis rates depending on when their birthday falls in relation to the school year."

After reviewing U.S. diagnosis and treatment records across a decade, she and her colleagues found that "being young for [a] grade more than doubles the change that a student is diagnosed with or treated for ADHD." And as they pointed out in their paper, "ADHD is an underlying neurological problem and incidence rates should not change dramatically from one birth date to the next."

The other paper, written by Todd Elder, an assistant professor of economics at Michigan State University, found that children who had been among the youngest in their kindergarten class had more than double the chance of regularly taking Ritalin (methylphenidate) by middle school and junior high school than their older peers in the same grade.

"If a child is behaving poorly, if he’s inattentive, if he can’t sit still, it may simply be because he’s 5 and the other kids are 6," Elder said in a prepared statement. "There’s a big difference between a 5-year-old and a 6-year-old, and teachers and medical practitioners need to take that into account when evaluating whether children have ADHD…’Symptoms’ may merely reflect emotional or intellectual immaturity among the youngest students."

Some 4.5 million U.S. children under the age of 18 have been diagnosed with ADHD. And approximately 2.5 million children take stimulant medication to counteract the symptoms of the disorder. But if the findings in Elder’s study hold true nationwide, some 20 percent of those kids might have been misdiagnosed due to their relatively young age in the classroom. And, as Elder noted in his paper: "Inappropriate treatment is particularly worrisome because of the unknown impacts of long-term stimulant usage on children’s health." It also adds up to between $320 million and $500 million each year being spent on potentially unnecessary drugs, according to his analysis.

Family doctors are often the ones to make ADHD diagnoses, which are usually based on perceived behavior—especially in comparison with a child’s peers (the National Institute of Mental Health’s ADHD booklet asks if disruptive and other behaviors "happen more often in this child compared with the child’s peers?"). And Elder found that children’s school-start age, though a strong predictor of a teacher’s perception of ADHD symptoms, for parents, is "only weakly related…perhaps because parents’ frames of reference include children of similar ages, rather than children in the same grade."

To be sure, however, age-based development patterns are not to blame for all suspected cases of ADHD. "We are not downplaying the existence or significance of ADHD in children," Morrill said. She and her colleagues acknowledged that the higher rate of diagnoses of younger students might accurately reflecting a higher number of cases in that group—or uncovering a trend of under-diagnosis in the older children. "Even if it is the case that children entering school at younger ages triggers ADHD, this would suggest an important causal mechanism that the medical research should further explore…If being exposed to formal schooling at younger ages is actually causing a rise in ADHD, we must then revisit educational policy," they concluded.

Image courtesy of iStockphoto/NWphotoguy

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  1. 1. abby 5:47 pm 08/17/2010

    I liked Morrill’s statement "Even if it is the case that children entering school at younger ages triggers ADHD, this would suggest an important causal mechanism that the medical research should further explore&If being exposed to formal schooling at younger ages is actually causing a rise in ADHD, we must then revisit educational policy,".

    Is anyone considering that ADHD is not a DISORDER but merely a useful variant on the normal spectrum of attention. We know that it makes it hard to do well in school. But school is a highly artificial situation. ADHD may lead to success in many other areas that have been important to humans over our history, such as warfare, hyper-alertness to the behavior of prey species in hunting, or a weather changes, the ability to get many things done in a short period of time, facility in changing tracks rapidly when a tactic isn’t working, etc. Primitive society requires that someone should notice any changes in the environment while others are absorbed in the fineness of their flint-knapping edges, or the design in their basketry, and that someone should be impulsive enough to face novel situations while others are involved in preserving traditional knowledge.

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  2. 2. Wayne Williamson 5:59 pm 08/17/2010

    interesting article…the obvious solution is to have 144 grades instead of 12…lets see if we can fund that one;-)

    think back to the old school house where grades 1-x were all in the same room….would never work in a modern school…then again, maybe that was why the wild west was so wild….

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  3. 3. ImproperUsername 6:49 pm 08/17/2010

    Not ADHD but immature? Well, duh…

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  4. 4. scientific earthling 11:22 pm 08/17/2010

    The calendar age of child is not necessarily their mental age. Every person is an individual and developed at his/her own pace. The system is bankrupt of ability when it comes to educating and dealing with children. ADHD is an excuse for poor teaching skills. When things go wrong blame someone, never yourself.

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  5. 5. thinkingfish 3:56 am 08/18/2010

    i don’t think it’s something wrong with them, talents may like that too, they can get more inspirations sometimes

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  6. 6. Forlornehope 5:11 am 08/18/2010

    Research in the United Kingdom has shown that age related performance is equivalent to a full grade in examinations taken at the age of 18. It is a major disadvantage to children to be the youngest in their school year group, as great as any ethnic or wealth related differences.

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  7. 7. Carlton22 9:17 am 08/18/2010

    This is absolute hogwash. My wife and I owned a Montessori School (licensed under the Pan-American Montessori Society founded by Elizabeth Caspari the close associate of Maria Montessori) for six years. My wife was trained by Elizabeth Caspari and had 18 years of experience working with very young children from infant to age 6. Children have an insatiable desire to learn and explore their environment and with proper direction will remain self focused for hours, sometimes repeating the same task over and over until they have mastered it. Before graduating from kindergarten all children could read (some as many as 128 "Bob Books"), write, and do arithmetic (add, subtract, multiply and divide) with some exposure to the binomial and trinomial theorems using specially designed take apart cubes to actually see the parts of the equation.

    We absolutely forbade parents to feed their children sugar as it makes them uncontrollable and a distraction to the whole group. If you have a question as to whether a child is really ADHD then remove all sugar from their diet for at least a week. Respect for the child means realizing that you are dealing with an adult in a childs body who is trying to master their environment and must be allowed to learn how to do for themselves. Each child has a timetable unique to them that requires that materials be available to them to meet their unique interests and needs. Satisfying that need builds confidence in the child so that they can pursue more difficult and challenging tasks. Observing, respecting and presenting the proper material at the proper time in the proper fashion is what Montessori training instills in the teacher.

    The "one size (and method) fits all" mentality of public schools instills a conflict in the psyche of the child and rebellion is a result. The child feels (rightly so) disrespected.

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  8. 8. Foresta-Gump 5:30 pm 08/18/2010

    According to citizens commission for human rights(CCHR) Attention Deficit Hyperactivity Disorder(ADHD) has never been scientifically proven, therefore ADHD doesn’t exit, yet psychiatrists are still writing precriptions for it, labling a child for a lifetime.

    The medical field is lining their pockets at their patients expense, addicting them to these drugs.

    It’s about time the facts are acknowledged, anyone with a brain knows children are immature, and portray silly behavior at times. It’s the parents who expect adult behavior from a child is where the trouble begins later, the child is being denied their right to be a child.

    Teachers are the ones who decide a child’s misfortune of being labled and drugged just for being an innocent child.

    It took alot of drugging children to finally realize that sugar is the culprit. Children are naturally energetic and to add sugar to their diet causes temporary chemical imbalance of the brain so that the child cannot focus on much of anything for his attention span is seriously affected.

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  9. 9. iDr Gonzo 8:06 am 08/19/2010

    Applause, Applause. I was beginning to think that there where not any teachers left in the world.

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  10. 10. iDr Gonzo 8:17 am 08/19/2010

    Every single problem in the world can be traced back to education. Usually a lack of. The fact that this system of job training is passed of as education and the kids are drugged if they don’t sit down and accept it is mind boggling. How many Newtons, DaVincis, and Yeats have been medicated. Worse yet they have been put into a classroom with 25 other kids that the only education they have ever had has been the eight hours a day they spend in school and the eight hours they spend in front of the television.

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  11. 11. wax025 1:40 pm 08/20/2010

    Well, ADHD is a spectrum/continuum condition, like high blood pressure, which is going to have more problems at the more deviant extremes. To say they are misdiagnosed is a bit of a misnombre, but it does show that your chance of being diagnosed significantly increases with younger age. That is because ADHD, like IQ, develops progressively over time. The article I saw did not specify whether this was true in 4th graders, as well as in the very young. I would expect this to have much more of a differentiating effect in younger children. Caution should be used in borderline cases of youn-for-grade kids. This also means that older children might be less likely to be diagnosed, early, and might have problems later-on when the ages become relatively less important.

    The measure is valid, reliable, and scientifically proven– as much as the Church of Scientology’s propaganda wing– the Citizens Comission for Human Rights would like you to believe.

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  12. 12. wax025 1:42 pm 08/20/2010

    The CCHR is a front organization for the CHURCH OF SCIENTOLOGY!!! Now, who is lining pockets unethically?

    Sugar’s not great for you, but, no, several reviews have found it does not cause ADHD symptoms.

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  13. 13. wax025 1:47 pm 08/20/2010

    Yes, ADHD is helpful to many aspects of life. But this condition is associated with higher rate of car accidents, higher rate of divorce, higher rates of obesity, higher rates of substance use problems, lower rates of employment, significantly less earning potential, and clinical morbidity as adults similar to that seen in disorders that bring one to a psychiatrist’s office as an adult.
    ADHD people are more innovative, and I am sorry that this topic has never been formally studied, because it seems intuitively obvious.

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  14. 14. NeoKaan 3:25 pm 11/20/2012

    Hi. OK I was thinking about this for an hour. Lets supposedly say you have ADHD. Previous years lets say 1960
    science, math and so forth was about 40 pages of book reading (for logic sakes) now we are in the 21 century, Everything got advanced, now books aren’t 40 pages, are now 100 pages. It takes twice the time to study. As you know we are human not robots. Now today these scientist that are 45 to 70 years old say that young kids have ADHD.
    How long did it take them to know the information that they have now? And not just that. Pills makes money. How can these people be so blind to take ADHD Pills. Lets say computer science, the codes get more advances and more complex so it takes longer to study. Why don’t they create new ways shorter ways to make studying easier? Are they lazy or just not advanced enough to see the concept?

    I do know there are people with learning disorders I understand. But don’t diagnose the wrong people. Am I right. I know so.

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  15. 15. NeoKaan 3:38 pm 11/20/2012

    And also if scientist can manifest a way to see a child’s future of what they will become in a few years, witch is impossible. Then they can put them on a learning spree on subjects needed for that direction. Bee concept. Workers to workers, honey makers to honey makers. People are getting blind. Simply an algorithm of time, age, logic and of course the impossible. Don’t forget about wisdom. Make wise choices. Being wise comes with knowledge. Being knowledgeable doesn’t reward you with wisdom.

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  16. 16. NeoKaan 3:49 pm 11/20/2012

    And how I hate it when you go for an interview and the interviewer ask you this “So where do you see your self in 10 years” I usually answer this in my mind. I don’t know I am not phcykick. I can be in a accident, killed or it can be good. Not a negative answer just a logical answer. I don’t use ADHD Pills. Don’t want to mess with my brain or natures given gifts. Don’t fix that’s not broken.

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