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Do The Youngest Kids In Class Get Labeled ADHD More Frequently?

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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