Over the past two decades, rates of ADHD diagnosis in children and adolescents have increased steadily. According to data released by the Centers for Disease Control (CDC) in 2016, approximately 6.1 million children age 4-17 – 9.4% – received an ADHD diagnosis at some point during their lives. Of these children, 2.4 million age 6-11 received an ADHD diagnosis.
These figures represent an increase of roughly 62% since 1997.
Experts in youth and adolescent mental health cite several reasons for this steady increase in ADHD diagnosis among children:
- Actual increase in incidence of the disorder
- Increased awareness of the disorder
- Rise in use of electronic media among young children
- Poor sleep habits in young children
- Decreasing free play and outside time for school-age children
- Inaccurate or misdiagnosis
This article addresses that last bullet point – inaccurate or misdiagnosis – in a specific group of kids: first graders who attend schools with a September 1st birthday cutoff as opposed to first graders who attend schools with an August 1st birthday cutoff. A recent study published by researchers at Harvard University indicates that these different cutoff dates may contribute to the increasing rates of ADHD diagnosis in first graders.
In Early Elementary School, A Year Makes a Difference
Here’s the problem.
A child born on August 31st who attends a school with a September 1st cutoff date will be almost a full year younger than a child in the same class born on September 1st the previous year.
This is particularly significant for kids entering first grade.
Anyone who has worked with children, has children, or spent time around children can see the potential problem. There can be dramatic differences in maturity between a six-year-old and a seven-year-old.
These differences can appear in behavior, mood, types of play, and communication.
In the case of ADHD diagnoses, researchers from Harvard University think that some teachers are referring children to doctors based on behavior that’s typical for their age, but appears atypical compared to classmates who may be a full year older than their disruptive or fidgety young peers.
These referrals can lead to professional assessment, diagnosis for ADHD, and subsequent treatment for ADHD, sometimes with medication.
Here’s a comparison of ADHD diagnosis for kids born in August or September in schools with a September 1st cutoff date:
- Kids born in August: 85 students per 100,000
- Kids born in September: 64 students per 100,000
And here’s a comparison of ADHD treatment rates for kids born in August or September in schools with a September 1st cutoff date:
- Kids born in August: 53 students per 100,000
- Kids born in September: 40 students per 100,000
Now, for the rub.
Many of the August kids may have simply displayed behaviors appropriate for their age and developmental level. Experts who look at the data believe they may have received both a referral and diagnosis because they were surrounded by children further along in their emotional and behavioral development, which may have made their behavior appear developmentally inappropriate or problematic.
Recognizing ADHD in the Classroom: Context Matters
In an interview with Science Daily, Dr. Timothy Layton, a principal author of the Harvard study, offers his opinion:
“Our findings suggest the possibility that large numbers of kids are being over-diagnosed and overtreated for ADHD because they happen to be relatively immature compared to their older classmates in the early years of elementary school.”
While a thorough discussion of the relative merits of ADHD treatment and medication are beyond the scope of this article, it’s safe to say that in any context – physical, emotional, or psychological – an inappropriate diagnosis followed by an equally inappropriate course of treatment might create problems.
Stated plainly, six-year-olds don’t need treatment or medication for being six years old. Yet that appears to be what’s happening to many kids across the country.
Don’t misunderstand us: we know kids with ADHD. We know that for some kids, therapy works. For others, medication works. Some kids need both. And for still others, neither therapy nor medication are necessary: lifestyle changes may be all they need.
But for kids who don’t have ADHD, we know another thing. They don’t need therapy for ADHD and they don’t need medication for ADHD.
That’s why getting an accurate diagnosis that assesses all relevant factors is essential. According to Dr. Anupam B. Jena, another principal author of the Harvard study:
“A child’s age relative to his or her peers in the same grade should be taken into consideration and the reasons for referral carefully examined.”
This makes perfect sense to us.
It should also make sense – and serve as valuable cautionary advice – to parents, teachers, school administrators, and mental health professionals involved in diagnosing ADHD in young children: the right diagnosis at the right time can make all the difference.