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David Baxter PhD

Late Founder
ADHD diagnosis skewed by age: study
CBC News
Tuesday, August 17, 2010

As many as one million children in the U.S. may have been misdiagnosed as having an attention deficit disorder because of their age when they started kindergarten, a new study finds.

The youngest children in class were more likely to be diagnosed with attention deficit-hyperactivity disorder, or ADHD, than the oldest children, researchers report in an upcoming issue of the Journal of Health Economics.

"We believe that younger children may be mistakenly diagnosed as having ADHD, when in fact they are simply less mature," Melinda Morrill, a professor of economics at North Carolina State University and a co-author of the paper, said in a release.

In the study, researchers looked at almost 12,000 children to check for differences in ADHD diagnosis and medication rates between the youngest and oldest children in a grade.

Children born just after the kindergarten cut-off date, typically Sept. 1 in the U.S., were 25 per cent less likely to be diagnosed as having ADHD than children born just before the cutoff.

Birth date matters
For example, students who were born on Dec. 1 in Michigan and were the youngest in their class had much higher rates of ADHD than those born Dec. 2 and enrolled a year later as the oldest in their class, the researchers found.

"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," the study's authors wrote.

"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."

Even though the students were just a day apart in age, they seemed to be assessed differently, said study author Todd Elder, a professor of economics at Michigan State University in East Lansing.

If a child is behaving poorly, is inattentive or can't sit still, it may be because he's five and the classmates are six, Elder said.

There is no blood test for ADHD, and experts disagree on its prevalence, Elder said, noting teachers' opinions are often important in deciding to send a child for a mental health exam. The study used data from two national health surveys and a national private health insurance claims database to examine rates of ADHD diagnosis and treatment.

A second study by researchers at North Carolina State University, Notre Dame and the University of Minnesota came to the same conclusion and appears in the same issue of the journal.
 

David Baxter PhD

Late Founder
Younger kids may wrongly get ADHD diagnosis
MSNBC
August 17, 2010

Less mature kids more likely to be diagnosed than their older peers, researchers say

How mature a child is compared to his peers may partly determine how likely he is to be diagnosed with attention deficit hyperactivity disorder (ADHD), according to a new study. This finding validates concerns that the condition is misdiagnosed, researchers say.

North Carolina State University researchers found that children born just after the kindergarten eligibilty cutoff date were 25 percent less likely to be diagnosed with ADHD than children born just before the cutoff date. Children born just after the cutoff date are among the oldest in their class, and those born just before the cutoff date are among the youngest in their class.

For example, in schools where the cutoff date is Sept. 1, children born on Aug. 31 make the cutoff and are the youngest in their class; children born on Sept. 2 will wait an additional year to enter school and be among the oldest in their class.

Children born just a few days apart should have the same underlying risk of having ADHD, according to the researchers, so this significant difference in diagnosis rates is strong evidence that medically inappropriate diagnoses are being given.

"We believe that younger children may be mistakenly diagnosed as having ADHD, when in fact they are simply less mature," study researcher Melinda Morrill said in a statement.

The characteristic behaviors associated with ADHD are inattention, hyperactivity and impulsivity, according to the National Institutes of Health. Rising rates of ADHDand large differences in diagnosis rates have led to fears that the condition is not accurately diagnosed.

Accurate diagnosing is crucial, the researchers say, because stimulant medicationsare often prescribed as a treatment for ADHD. The stimulants have side effects, including insomnia, stomachache, headache, dizziness and decreased appetite, and they have been shown to increase heart rates and blood pressure. Little is known about their long-term effects.

Youngest are 50 percent more likely to get ADHD diagnosis
The new findings are consistent with those of another forthcoming study that suggests children born just before the kindergarten cutoff date are 50-percent more likely to be diagnosed with ADHD than those born just after, Morrill and her colleagues write in a forthcoming issue of the Journal of Health Economics.

The findings indicate that there are children who are diagnosed, or who are not diagnosed, because of something other than underlying biological or medical reasons, according to Morrill.
"We are not downplaying the existence or significance of ADHD in children," Morrill said. "What our research shows is that similar students have significantly different diagnosis rates depending on when their birthday falls in relation to the school year."

In the study, the researchers examined data from two national health surveys and a national private health insurance claims database to evaluate rates of ADHD diagnosis and treatment in children. The data sources covered different time periods ranging from 1996 to 2006.

The findings will be published in a forthcoming issue of the Journal of Health Economics.
 
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