Too many ADHD diagnoses?

NICK EICHER, HOST: It’s Thursday the 22nd of August, 2019. Glad to have you along for today’s edition of The World and Everything in It. Good morning, I’m Nick Eicher.

MARY REICHARD, HOST: And I’m Mary Reichard. First up today: it’s back to school time. New notebooks and pens and pencils with all the topsy turvy emotions that go with another school year. 

Some children are heading off to kindergarten, usually around 5 or 6 years old. They’ll learn to count and write the alphabet. They’ll learn to sit still and pay attention.

EICHER: Um-hmm I don’t think so, not that last part anyway. The sitting still and paying attention part. That skill can be the most difficult to acquire. 

Of course, most kindergartners have a lot of energy. But how much is normal and how much stems from an actual behavioral issue—like ADHD? Research suggests that might depend on whether the child was born in August or September. 

WORLD Radio’s Anna Johansen explains why.

ANNA JOHANSEN, REPORTER: It’s the first day of classes at Immanuel Lutheran School in Crystal Lake, Illinois. The students gather in groups—second grade, first grade, kindergarten—before heading off to their rooms.

TEACHER: Okay, bye kindergarten! See you later!
TEACHER: Look how little they are! They’re so little!

If national statistics hold true, two of these 15 kindergartners have ADHD. Or…do they?

LAYTON: And we were thinking about–kind of some of the things that might happen to kids who are young for their grades.

Tim Layton is an assistant professor at Harvard Medical School who studies ADHD diagnoses.

LAYTON: And it struck us that it might be the case that children who are young for their grade…may appear to be kind of distracted or hyperactive just because they behave according to their age…

The Harvard study asked a basic question: Are the youngest kids in a class more likely to be diagnosed with ADHD?

Many states have an age cutoff for children starting kindergarten: They must be 5 by September 1st. Children born after that must wait until the next year to start school. Those born at the end of August can start immediately. But that means they’re almost a year younger than their September-born classmates.

LAYTON: So we decided to, to see if we compared kids who were born in August and kids who are born in September, if there was a big difference in rates of ADHD.

The Harvard researchers used insurance data to compare those oldest and youngest students. They looked at ADHD diagnoses and treatment. Here’s what they found: The youngest children, the ones born in August, have a 35 percent higher rate of diagnosis compared to the children born in September. The researchers believe as many as a quarter of those August diagnoses might be incorrect.

Kerry McDonald is a senior fellow at the Foundation for Economic Education. She researches education, family, and child policy.

MCDONALD: There’s a tremendous difference as any parent or early childhood educator would tell you between a child who just turned five and a child who just turned six.

McDonald notes there’s no objective test for ADHD. A diagnosis depends on teachers and parents reporting certain behaviors.

MCDONALD: That’s this checklist of things like, does a child sit still and listen? Are they paying attention? Are they completing tasks on time? You know, all of these things that might be important, but particularly for young children, they’ll arrive at those milestones at very different times.

But all the students are in the same grade. So when teachers try to determine what is “normal” behavior and what is ADHD, they could subconsciously compare children to each other. That might lead a teacher to report a child’s behavior as hyperactive. The student could have legitimate behavioral issues…But McDonald says it’s not always a problem with the child.

MCDONALD: You might have a 5 year old that just needs to be moving around and that’s how they’re learning and exploring their world. 

They can’t always do that in a traditional school setting, so they might get flagged for ADHD.

MCDONALD: ADHD certainly exists; it can be debilitating for some people that have it. But I think the concern is…diagnosing a child with this particular ailment, when in fact they are just displaying kind of normal childhood behavior that becomes pathologized within this kind of institutional school setting.

McDonald also notes expectations about academic achievement have increased. In 1998, only about 30 percent of teachers expected children to learn to read in kindergarten. By 20-10 that number jumped to 80 percent. Now, there’s a lot of pressure for children to learn to read at a young age.

MCDONALD: So just a short period of time and an accelerating expectation that very often is just completely developmentally inappropriate. I mean, you may have some five year olds who are learning to read, but you’ll have many that for whom that’s too young that they’re just not quite ready yet to be reading.

Tim Layton hopes the Harvard study will raise awareness with teachers and medical professionals.

LAYTON: I really hope that physicians be much more cautious in terms of assigning ADHD diagnoses, and even more important than that, prescribing drugs for children who are young for their grade.

And McDonald hopes parents will also keep it in mind as they decide when to send their children to school. She says sometimes it might be better to just wait a year.

MCDONALD: And it also, you know, I hope gives parents some pause when their child is potentially given an ADHD label to really think about, you know, is it really a child problem or is it a schooling problem?

Reporting for WORLD Radio, I’m Anna Johansen.

(Photo/Medical News Today)

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