In a class of the same grade level, the youngest children, those born at the end of the year, are more at risk of being diagnosed with attention deficit hyperactivity disorder (ADHD).
- Children born at the end of the year are more likely to receive speech therapy or take medication for ADHD than those in the same class born at the beginning of the year.
- There may be a diagnostic bias for ADHD and language and learning disorders.
- The demands on young children would be higher, in terms of development and learning.
In a classroom, the exact age of the children matters. According to a study conducted by the GIS EPI-PHARE group, a collaboration between the National Health Insurance Fund and the National Agency for the Safety of Medicines, children born at the end of the year are more at risk of being diagnosed with attention deficit hyperactivity disorder (ADHD) or specific language and learning disorders (SLD), compared to those born at the beginning of the year.
ADHD: Are younger children more at risk?
This finding is based on the analysis of data from more than four million children, aged 5 to 10. The authors of the research were interested in the frequency of treatments with methylphenidate, a drug used for ADHD, and speech therapy sessions, also indicated for ADHD or language disorders. To understand the precise effects of age, the researchers compared the data according to the month of birth in a class of the same grade level.
“Among children of the same school level, those born in December have a 55% higher risk of starting methylphenidate treatment and a 64% higher risk of receiving speech therapy sessions than those born in January of the same year.”they conclude. There is a correlation between this risk and the month of birth: the later in the year the month of birth is, the higher the probability. Compared to children born in January, those born in February have a 7% higher risk of being prescribed methylphenidate, those born in April 9%, those born in July 29%, those born in October 46% and those born in December 55%. This observation is identical for speech therapy sessions: the later in the year the child is born, the higher their risk of attending speech therapy sessions, compared to a child in the same class born in January.
A diagnostic bias for language and attention disorders?
According to them, its results could be the consequence of a “diagnostic bias” ADHD and specific language and learning disorders. Natives at the end of the year would be less mature than those at the beginning of the year, even if they have the same academic level.Younger children in a class, with less neurological maturation relative to actual age, may be faced with too high demands, particularly in the early years of school, they estimate. At the time of entering CP, a child aged 6 years and 8 months has lived 13% more years of life than a child aged 5 years and 9 months.” This difference in age experience could lead to an excess of diagnosis for children at the end of the year and, conversely, to a lack of diagnosis for those at the beginning of the year.
Diagnosing ADHD: How to limit the effects of relative age?
To get a more accurate diagnosis, there are several solutions. The authors of the study point out that in countries where the school entry age is more flexible (Denmark, Australia, Israel, Scotland), this so-called “of relative age” on ADHD is less frequently observed.”Teachers, prescribing physicians, and speech-language pathologists should be aware of the possibility that relative immaturity related to actual age (and not relative to classmates) may be overdiagnosed as ADHD or a specific language and learning disorder and adjust their teaching, diagnostic, and therapeutic management practices accordingly.”they recommend.
