Tuesday, November 20th, 2012
A new study suggests that they do.
A population-based study in Iceland looked at the association between relative age in a classroom and likelihood of being prescribed a stimulant medication for ADHD. What they found was startling: the youngest third of a class was 50% more likely to be prescribed stimulant medication for ADHD. This finding held up for girls as well as boys (although much fewer girls get diagnosed), and was observed between the ages of 7 and 14. These younger kids were also more likely to experience academic problems.
This study did not report on the mechanism underlying this association. But the speculation is pretty straightforward. It may be that the youngest kids in a class are a bit more immature in their behaviors. In order to get a diagnosis of ADHD, a child must be showing symptoms at both school and at home. Since the youngest kids reference point isn’t their chronological age – it’s their classroom – they may be more likely to be rated as having elevated symptoms at school.
That said, these findings are a bit more complex than that. The kids who get diagnosed have to be showing problems at home as well. But, again, there may be expectations about how they should be behaving if their peer group is typically older than them.
The overall implication from this study is that schools – and parents – need to take into account a kid’s relative age in the classroom if behavioral (and academic) issues come up. If a kid is one of the youngest, then perhaps the bar should be raised higher in terms of level of symptoms before proceeding with a diagnosis – and stimulant medication.
This study also brings up the issue of “redshirting.” I’m not a big fan of the idea of parents trying to hold back their kids in order to make sure they will be the oldest in a class so that they can excel academically and athletically. Rather, I think studies like this one suggest that parents should consider carefully the implications of their child being the youngest in a class – particularly in terms of academic and social readiness. Another way to look at the data, and this issue, is to recognize that a number of the younger children in a class were doing fine. Thoughtful evaluations of readiness and age need to be made in order to make appropriate placement decisions.
Once these decisions are made, it does seem reasonable to suggest that relative age in a classroom should always be a variable when interpreting behavioral and academic performance. ADHD is a complicated disorder to diagnose. It’s clear that a very small percentage of kids fully meet diagnostic criteria. But it’s also becoming clear that it is important to not rush into medication strategies without careful consideration of a wide range of factors – including if a kid is one of the youngest in a class.
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Categories: Behavior, Health, Intervention, Must Read, Parenting, Questions, Red-Hot Parenting, Stories | Tags: ADHD, age, classroom behavior, Health, Kids Health, labeling, redshirting, stimulant medication
Monday, March 5th, 2012
So “redshirting” – holding back a child from starting kindergarten so that they can be amongst the oldest, rather than the youngest in their class – is in the news again and being debated again. For many kids, it’s not particularly relevant – like if they have a winter birthday, there’s usually no debate on when they start kindergarten. But if your kid has a summer birthday, you can decide if they will be one of the younger kids in their kindergarten class – or wait a year so they can be one of the older kids in the class. So the question is, how do you make that decision?
Well, typically I invest in examining the research on a topic to date. I like to go through the studies, see if there are good reviews of studies, and if possible find analytic approaches that are applied to a number of studies (known as meta-analysis). But on this topic, I’m really not interested in the data that are out there. Why? Well, the data most frequently cited involve looking at birth dates – to determine kids who, at a given point in time, are older or younger – in either highly selected samples (such as hockey players) or in large data bases that track academic performance. The basic idea is that the younger kids are less likely to get put on “fast track” (academically or athletically) because they are developmentally behind the older kids – the younger kids may not be as precocious as readers, or the biggest kids in the class. And this “small effect” (statistically the idea is that this is empirically not a whopper effect but it accumulates over time) thus eventually prevents the younger kids from achieving as much as the older kids. But here’s the thing for me. Anytime you look at either selected samples or very large samples you have to be very wary of drawing conclusions from correlational data – and not just because of the usual disclaimers. To me, you really need to show – empirically, with real data, and not with after the fact inference – that there is a process going on, after taking into account a whole lot of other variables. And for me, until I see process data (which, by the way, I’ve been collecting as a researcher for more than a few years now), I don’t really buy into anything or assume a take-home message. Especially since there are so many other factors (uh, like, genetics, environment, etc) that influence a child’s physical and cognitive growth and shape the vast individual differences you see in a group of kids that are independent of a few months worth of age difference.
So here’s my (obviously) very biased take: I’m not interested in the data that are out there yet. I don’t believe that, for the vast majority of kids, being the oldest or youngest in a class has a profound influence on the rest of their lives. Does it have some immediate impact? Maybe for some kids it does. But so do lots of other factors – factors that are much more connected to process than structurally being older or younger than the rest of the kids. If I’m a parent, I want to get some feedback from educators on my child’s social and academic readiness, which can be quite separate from where they are at in terms of chronological age. Will my child be bored in kindergarten, or find it stimulating? Will my child be able to integrate socially? Will my child have the behavioral control necessary for the change in structure? Are they ready to take off on their own? Will they possibly need some support in some areas? These are the questions every parent should consider – whether or not they have a choice in terms of when their kid starts kindergarten – and should be the rationale platform if a decision on “redshirting” needs to be made. Parents have to bring their resources to help their child develop to their full potential – at every developmental stage – given their unique set of skills and, yes, issues (every kid will have some). And sometimes there are very real structural barriers when a kid is growing up that may be related to their age, their height, their weight, their academic skills, or their social skills. Parenting is all about taking that on – it’s called preparing your kid for the real world. And to me, that’s a much more important focus for parents than trying to find some type of structural advantage to set up a kid to capitalize on the (questionable) probabilities for excellence as determined at age 5.
For more discussion on the topic of redshirting, check out this link – it’s a very good and informative read.
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