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ADHD diagnosis more common among youngest kids in classrooms: UBC study

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  • ADHD diagnosis more common among youngest kids in classrooms: UBC study

    From an article in the Toronto Star:
    The youngest kids in class are diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) much more often than children born at the beginning of the year, and it may be simply because they are less mature, a new study concludes.

    Researchers at the University of British Columbia suggest too many youngsters are incorrectly labelled and treated with medication for the neurobiological disorder when they may just need time to catch up to peers born 11 months earlier.

    The study, which followed 938,000 British Columbia students ages 6 to 12 over an 11-year period, was published Monday in the Canadian Medical Association Journal.

    “What’s clear is the relative age of children within their grade is having an influence on who receives the diagnosis,” said Richard Morrow, lead author and health research analyst at UBC’s department of anesthesiology, pharmacology and therapeutics.

    The researchers found that children with December birthdays were 39 per cent more likely to be diagnosed with ADHD than the oldest children in their grade, born the previous January. The youngest kids were also 48 per cent more likely to be treated with medication.

    Dec. 31 is the cut-off date for entry into school in British Columbia as well as in Ontario and other provinces.

    “In some cases a lack of maturity among children is being misinterpreted as symptoms of a neuro-behavioural disorder,” Morrow said in an interview from Vancouver. “It’s really a case of medicalizing a normal range of childhood behaviours. Some children mature at a slower rate.”

    In 2010, two major U.S. studies came to similar conclusions and cautioned teachers and parents against comparing children in the same grade when they can be up to almost a year apart in age.

    The “relative age effect” — which puts younger kids within an age cohort at a disadvantage — isn’t new. It is known to impact children’s performance in academics and sports, and was most notably explored by Malcolm Gladwell in his bestselling book The OutliersEND.

    The UBC study suggests this same phenomenon is at play in when it comes to behaviour. ADHD is the most common childhood psychiatric disorder, affecting between 5 and 12 per cent of school-age children. But symptoms, which include impulsivity, inattention and hyperactivity, are also typical of kids still developing self-control and the ability to focus.

    Morrow says one of the potential harms of misdiagnosis is unnecessary medication. Like all drugs, Ritalin, Adderall and others used to treat ADHD have some risk of side effects.

    The study doesn’t surprise Georgina Rayner of Toronto, who has spent years advocating for students with special needs, including many with ADHD.

    She frequently sees cases where a child is disruptive, and schools then recommend testing or suggest parents approach the family physician to investigate ADHD.

    “I really believe it can be a classroom management problem. The behaviour is driving the diagnosis,” Rayner says. “And it does a disservice to the children who really need the diagnosis.”

    She says the study is a red flag for parents, who should ensure anyone diagnosing their child is a trained professional with experience in assessing the disorder in kids.

    An ADHD diagnosis must also include evidence of impairment in multiple settings and not just the classroom, says Dr. Declan Quinn, child and adolescent psychiatrist at the University of Saskatchewan.

    Quinn said the UBC study is important but needs further investigation, including similar research in other provinces.

    Boys are typically treated for ADHD three times more often than girls but the UBC researchers found both were affected by their birth dates. December-born boys were 30 per cent more likely to be diagnosed than boys born 11 months earlier. The youngest girls were identified as having ADHD 70 per cent more often than those born in January.

    Here is the article in the Globe and Mail as well.
    Last edited by Tina; March 5, 2012, 02:53 PM.
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  • #2
    Re: ADHD diagnosis more common among youngest kids in classrooms: UBC study

    From the Vancouver Sun:

    Overall, girls were 77 per cent more likely, and boys were 41 per cent more likely, to be given a prescription for a medication to treat ADHD if they were born in December than if they were born in January.

    "The potential harms of over-diagnosis and over-prescribing and the lack of an objective test for ADHD strongly suggest caution be taken in assessing children for this disorder and providing treatment," the authors write.

    Drugs used to treat ADHD can cause sleep problems, decreased appetite, anxiety and irritability. Concerns have also been raised over whether stimulant medications such as methylphenidate (the active ingredient in Ritalin) and amphetamines increase the risk of heart attack or stroke.

    In 2006, Health Canada advised Canadians not to use ADHD drugs if they have high blood pressure, heart disease or abnormalities, hardening of the arteries or an overactive thyroid gland. The Canadian Paediatric Society has recommended that all children undergo a careful history and physical examination before being started on stimulant medications to check for risk factors for sudden death.

    However, a study published last month involving more than 171,000 youth aged six to 21 found no link between stimulant use and an increased risk of heart-related events in otherwise healthy young people.

    ADHD is the most commonly diagnosed behavioural disorder of childhood.

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