This is an old story. I first heard it in the early ’70s. Bureaucracy trumps common sense….
Immature but age-normal behaviors may be taken for ADHD symptoms.
Children born in August had higher rates of attention deficit-hyperactivity disorder (ADHD) diagnosis and treatment than peers born a few weeks later in September, according to a large-scale nationwide analysis.
In states with a Sept. 1 birthdate cutoff for kindergarten entry, children born in August — the youngest in their class — had a 34% higher risk of ADHD diagnosis and a 32% higher risk of ADHD treatment than children with September birthdays, reported Anupam Jena, MD, PhD, of Harvard Medical School and co-authors in the New England Journal of Medicine.
“This is important not only because it highlights how subjective the diagnosis of ADHD can be, but it also emphasizes a particular channel that may be important: the assessment of inattentive symptoms in a child may rely heavily on peer-to-peer comparisons made by teachers, other educational providers, parents, and ultimately doctors,” Jena told MedPage Today.
The findings suggest the possibility that younger children may be over-diagnosed and over-treated for ADHD: “What may be perceived as normal, developmentally appropriate inattentive behavior in one child may be perceived as ADHD in another child,” Jena said.
Most states have arbitrary cutoff birthdates to determine when a child can start school. These cutoff dates create a distribution of ages of children in a classroom, with the oldest child approximately 1 year older than the youngest child.
While problems associated with arbitrary cutoffs have been known for some time — they have been tied to ADHD diagnoses and medications, academic performance, and other factors — this analysis shows they persist, Jena pointed out: “The issue has arguably been known for more then a decade and yet as recent as 2015, we still observe meaningful differences in the likelihood of ADHD diagnosis and treatment among August- versus September-born children in states with a Sept. 1 cutoff.”
