Youngest kids in class more likely to be diagnosed with ADHD
New research has shown that the youngest child in a classroom is more likely to be diagnosed with ADHD, throwing into question the value of the ADHD label.
Dr Martin Whitely, research fellow at the John Curtin Institute of Public Policy based at Curtin University, told doctorportal that “I personally think the label of ADHD is not at all useful.”
“It masks a whole host of factors. Late birthdate isn’t the only thing that characterises ADHD – it’s kids that are sleep deprived, kids who have suffered trauma, kids whose parents are going through a messy divorce, kids who are being bullied, kids who have been sexually abused.”
“There’s research showing that all of these other factors are associated with ADHD diagnosis.”
“What we can do is stop labelling kids and start looking at their individual circumstances. And even if you don’t accept that, we have to give kids the time they need to mature.”
Late birthdate effect just as strong in low and high prescribing countries
Dr Whitely co-authored the systematic review, published in the Journal of Child Psychology and Psychiatry, which looked at a total of 19 studies in 13 countries, covering over 15.4 million children.
A total of 17 of the 19 studies found that the youngest children in a school year were considerably more likely to be diagnosed and/or medicated for ADHD than their older classmates. Two Danish studies found either a weak or no late birth date effect.
Dr Whitely said that what was especially interesting was that “this effect was just as strong in a high prescribing country like the US, Canada or Iceland, or a relatively low prescribing country like Denmark, Sweden or Taiwan, or to a lesser extent Australia which is on the lower to middle end.”
A lack of a strong effect in Denmark may be accounted for by the common practice of academic ‘redshirting’, where children judged by parents as immature have a delayed school start. Redshirting may prevent and/or disguise late birthdate effects and further research is warranted
Dr Whitely said that the findings of the study are significant because previously, it had been argued that the birthdate effect was evidence of high prescribing countries like the US.
“This actually brings into question: is there a safe level of prescribing that eliminates misdiagnosis? Based on this evidence, there isn’t.”
“We can’t have confidence that even when prescribing rates are low, there isn’t misdiagnosis”, he said.
Teachers can mistake immaturity for ADHD in the classroom
Dr Whitely explained that a potential reason for the late birthdate effect stems from the fact that parent perception of these children differs considerably from how teachers see them.
“Parents don’t rank them against other kids in the class, whereas teachers do, so the teachers are ranking the youngest kids in the class as having behavioural problems, when this is actually just a perfectly normal function of their age-related immaturity.”
He said there is evidence to indicate that while teachers do not diagnose ADHD, they are often the first person to suggest a diagnosis.
“Teachers start off the diagnostic process by talking to parents and even when they don’t do that, they provide information via a behavioural checklist and report on the kid’s behaviour.”
“If they’re ranking a child in the class who is aged 5 against other kids in the class who are 6 years old, and they’ve seen him acting very immaturely, then they’re ranking him based on 20% less life experience and that’s leading to kids being labelled as psychiatrically disordered”, Dr Whitely said.