The importance of relative standards in ADHD diagnoses: Evidence based on exact birth dates

Abstract

This paper presents evidence that diagnoses of Attention-Deficit/Hyperactivity Disorder (ADHD) are driven largely by subjective comparisons across children in the same grade in school. Roughly 8.4 percent of children born in the month prior to their state’s cutoff date for kindergarten eligibility – who typically become the youngest and most developmentally immature children within a grade – are diagnosed with ADHD, compared to 5.1 percent of children born in the month immediately afterward. A child’s birth date relative to the eligibility cutoff also strongly influences teachers’ assessments of whether the child exhibits ADHD symptoms but is only weakly associated with similarly measured parental assessments, suggesting that many diagnoses may be driven by teachers’ perceptions of poor behavior among the youngest children in a classroom. These perceptions have long-lasting consequences: the youngest children in fifth and eighth grades are nearly twice as likely as their older classmates to regularly use stimulants prescribed to treat ADHD.

ADHD: a critical update for educational professionals

“…Several studies (Elder, 2010; Evans, Morrill, & Parente, 2010; Halldner et al, 2014; Morrow et al, 2012; Zoëga, Valdimarsdóttir, & Hernández-Díaz, 2012) showed that relative age is a significant determinant of ADHD diagnosis and treatment. Overall, the youngest children in class are twice as likely as their classmates to receive a diagnosis of ADHD and medication.…”

Alterations in brain neurotrophic and glial factors following early age chronic methylphenidate and cocaine administration

“…A major concern arising from overdiagnosis of attention deficit hyperactivity disorder (ADHD) [1][2][3][4] is the frequent use of differ in their mode of action [8][9][10][11]. Psychostimulants modulate the monoamine transporters function, thereby increase the monoaminergic signaling, in one of two mechanisms; inhibition of monoamine reuptake, like cocaine, methylphenidate and amphetamine, or substance-type releasers, as amphetamine [12,13].…”

Birth month as predictor of ADHD medication use in Dutch school classes

“…This concern was amplified when various large-scale international studies noted an association between birth date and ADHD or ADHD medication (Elder 2010;Evans, Morrill and Parente 2010;Halldner et al 2014;Morrow et al 2012;Zoega, Valdimarsdóttir, and Hernández-Diaz 2012). According to these studies, younger children in a year group are much more likely to be diagnosed with ADHD and be prescribed ADHD medication than are elder children in a year group.…”