Youngest Kids in Class More Likely to Get ADHD Diagnosis: Study with very important conclusions.
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Monday, March 5, 2012
MONDAY, March 5
(HealthDay News) -- A new Canadian study provides more evidence that too many young kids may be diagnosed with attention-deficit/hyperactivity disorder, or ADHD, simply because they're younger than their peers in the same classrooms.
Researchers found that nearly 7 percent of boys aged 6 to 12 were diagnosed with ADHD overall, but the percentage ranged from 5.7 percent for those who were the oldest in their grade levels to 7.4 percent for the youngest. There was a similar gap for girls, although they're much less likely to be diagnosed.
The findings, which are similar to those from U.S. studies, don't prove definitively that any kids are being wrongly diagnosed with ADHD or being diagnosed purely because they're younger than their peers.
Still, "it's good for parents to know about this," said study author Richard Morrow, a health research analyst at the University of British Columbia. "In general, the younger you are within your grade, the more likely you are to receive this diagnosis and get treatment."
ADHD is a controversial developmental disorder, and there's been debate about whether it is overdiagnosed. The researchers launched the study to determine whether a student's age in relation to his or her peers may have something to do with the likelihood of diagnosis.
The study authors examined the records of over 930,000 kids in British Columbia who were between the ages of 6 and 12, during the time period from 1997 to 2008. They focused on differences between kids born in January (who'd typically be the oldest in their classes) and December (who'd typically be the youngest due to cut-off dates for school enrollment).
The level of ADHD diagnosis was lowest for kids born early in the year -- the oldest ones in their classes -- and highest for those born later in the year. Kids born in January and December had the lowest and highest rates, respectively: 5.7 percent of boys and 1.6 percent of girls for those born in January, and 7.4 percent of boys and 2.7 percent of girls among those born in December.
Boys born in December were 30 percent more likely to be diagnosed and 41 percent more likely to be treated with ADHD medications than boys born in January were, while the youngest girls were 70 percent more likely to be diagnosed and 77 percent more likely to be treated with medications than the oldest girls were, the study found.
"There is no reason for them to have this kind of difference in their diagnosis," Morrow said. "The way we would interpret that is that there are differences in maturity that are coming into play."
In other words, physicians and teachers may think kids have ADHD when they're actually just younger and less mature than their peers.
Richard Milich, a professor of psychology at the University of Kentucky who studies ADHD, said the findings make sense considering that the disorder is difficult to diagnose, especially at younger ages.
When ADHD becomes an issue, Milich said, parents should be aware of this kind of research and bring it up with their pediatrician or whomever else is appropriate. However, "I hope it doesn't get to the point that people say it's not a valid disorder," he said.
Kids with ADHD "do poorer in school, they're more likely to be left behind and more likely to drop out of school early. Across the board, they are impaired," Milich said. "Whether you want to call it a disorder or not, we know that's what they're at risk for."
The study appears in the March 5 issue of the CMAJ (Canadian Medical Association Journal).
SOURCES: Richard Morrow, M.A., health research analyst, University of British Columbia, Vancouver, Canada; Richard Milich, Ph.D., professor, psychology, University of Kentucky, Louisville; March 5, 2012, CMAJ (Canadian Medical Association Journal)
Influence of relative age on diagnosis and treatment of attention-deficit/hyperactivity disorder in children
- Richard L. Morrow, MA,et al.
- From the Department of Anesthesiology, Pharmacology and Therapeutics (Morrow, Maclure, Dormuth), University of British Columbia, Victoria, BC.
- Correspondence to:
Richard Morrow, firstname.lastname@example.org.
SO NEARLY DOUBLE THE RATE OF DIAGNOSIS!
The results of our analyses show a relative-age effect in the diagnosis and treatment of ADHD in children aged 6–12 years in British Columbia. These findings raise concerns about the potential harms of overdiagnosis and overprescribing. These harms include adverse effects on sleep, appetite and growth, in addition to increased risk of cardiovascular events.
"Thank you! Thank you! Thank you!"
Finally a proper study that shows that this pseudo disorder has nothing to do with the child but everything to do with the environment in which the child has to live.
I have practiced paediatrics in BC for more than 25 years and fought this ADHD nonsense for as long. The diagnosis criteria are wrong: the Conner's rating scale (and all its clones) was never intended as a diagnostic tool but as a follow-up tool and is a purely subjective questionnaire with no gold standard (e.g.: how long a child of a specific age, and specific socio- cultural and economical background, in a standardized situation should stay at a standardized task?). The labeling is wrong: there is NO disorder, at the most there is a behavioural issue that is perceived as a problem. The approach is wrong: medicating these young brains in the middle of their development with amphetamine will be looked down on by future generations the way we look today at lobotomies, to cite only one of numerous erroneous dogmas medicine has produced.
A child who is too young to be put in a cohort of other children and learn material he/she can't, will misbehave. Similarly, the familial environment is more than too often "in-adapted" to the child's needs and the child, of course misbehaves. I have seen so many children put on one of these poisonous drugs because they lived in an environment no adult could survive intact!
A child who misbehaves always has a good reason to do so. Sometimes it is a trivial reason that is easy to remedy, a reason the child perceived as traumatic but is not an abnormal situation; other times it is a genuine and really traumatic problem that must be addressed. Medicating these children and telling them they have a "brain disorder", is wrong in both cases. Neuro-stimulant medication should be the exception instead of the rule.
The importance of relative standards in ADHD diagnoses: evidence based on exact birth dates.
pp. e601 -e609
To investigate factors that are associated with the probability of attention-deficit/hyperactivity disorder (ADHD) diagnosis among U.S. elementary school children, including child, family, school, and policy factors.
Logistic regression was used to estimate relative risks associated with independent variables using a nationally representative sample of 9278 children in the 2002 follow-up of the Early Childhood Longitudinal Survey–Kindergarten Cohort. Most children in the sample were in third grade at this point. Previous ADHD diagnoses by professionals were reported by parent respondents.
A total of 5.44% of children were reported to have received an ADHD diagnosis. Girls, black children, and Hispanic children were less likely to have the diagnosis even after controlling for other characteristics. Living with one's biological father was negatively associated with ADHD diagnosis. We also found regional variation in diagnosis with the western region of the United States having significantly lower instances of ADHD cases. Higher diagnosis rates were associated with having an older teacher, and lower rates were associated with having a white teacher, relative to a nonwhite teacher. In schools that were subject to stricter state-level performance accountability laws, we found higher odds of ADHD diagnoses, but we found no differences associated with larger class sizes or the presence of state laws that restrict school personnel from discussing ADHD treatment options with parents.
Who Receives a Diagnosis of Attention-Deficit/ Hyperactivity Disorder in the United States Elementary School Population?
Helen Schneider, PhDa,
Daniel Eisenberg, PhDb
ADHD diagnosis is likely to be influenced by a child's social and school environment as well as exogenous child characteristics. Concerns that increased pressures for school performance are associated with increased ADHD diagnoses may be justified.
Behaviour drugs given to four-year-olds prompt calls for inquiry
Family-based therapy is recommended for treating children with ADHD (attention deficit hyperactivity disorder), with prescription drugs used only for children over six years old and as a last resort.
The figures, based on data from 479 GPs, show prescription rates were highest for children aged six to 12, doubling to just over eight per 1,000 in the five years up to 2008. Children aged 13 to 17 had the second highest rate at six per 1,000, while those aged 25 and over had less than one per 1,000.
Concern is greatest over children under six who should not be receiving drugs at all, says the National Institute for Health and Clinical Excellence (Nice).
There are no reliable figures for how many children under six have been given Ritalin. But Professor Tim Kendall, joint director of the National Collaborating Centre for Mental Health, who chaired the Nice guideline committee, confirmed that he had heard reliable reports of children in nursery and pre-school being prescribed medication unnecessarily, and that it was often parents who were putting pressure on GPs.
He said: "There are two reasons why parents go shopping for a diagnosis. The first is to improve their child's performance at school, and the second is to get access to benefits. There are always GPs that will do it, but it's wrong to give a child a diagnosis without also consulting schools and teachers."
In one case seen by the Guardian, a five-year-old from the West Midlands was found to be receiving a double dose of methylphenidate, commonly known by the brand name Ritalin, the drug used to treat ADHD, despite his school insisting that he is "among the best-behaved children in his class".
In notes seen by the leading educational psychologist in the case, the boy's headteacher reports that the school does not believe he has ADHD, but that the medication is being prescribed "to help mum at home".
In another case in the West Midlands a five-year-old was put on the drugs for three years at the request of his parents without any consultation with teachers or psychologists.
Kendall said prescriptions could continue to rise due to impending health cuts. "It's a false economy … all the evidence says that parent training courses combined with partnership working with schools is what works, but these programmes are being cut by local councils."
Speaking on behalf of the British Psychological Society, Peter Kinderman, chair of the division of clinical psychology, said he supported calls for a review, saying he would be concerned if children were being prescribed medication as a quick fix.
He added that mental health services were already "grossly under-resourced" and that cuts were likely to put services to children at risk.
Kinderman expressed particular worries about the cases uncovered by the Guardian. "Many psychologists are very concerned at the use of psychiatric and medical diagnoses in cases such as mild social anxiety or shyness, not only because of doubts about the validity of many of the diagnostic approaches, but because of the possible adverse effects."
But Dinah Jayson, consultant child and adolescent psychiatrist at Trafford general hospital and a spokesperson for the Royal College of Psychiatrists, insisted that in some cases it could be "cruel" not to treat children of any age if all other options had been exhausted.
She said: "With every child there is a risk of doing something but there is also a risk of doing nothing. We know early [medical] intervention can help children who would otherwise be losing out."
Professor Ian Wong, director at the Centre for Paediatric and Pharmacy Research, who led the prescriptions research, pointed out that prescription rates were still below the expected number of diagnoses for hyper-kinetic disorders.
"GPs and psychiatrists are much more aware of mental illness, and the drugs are so effective and have such a big effect that it's tipped the balance. They [drugs] can make a real difference not just to the child but to households and classrooms where children may be causing real disruption."
According to Nice guidelines, between 1% and 9% of young people in the UK now have some form of ADHD, depending on the criteria used. NHS figures show a rise in all methylphenidate prescriptions across all age groups by almost 60% in five years, rising from 389,200 in 2005 to 610,200 in 2009.
Side-effects include sleeplessness, appetite loss and reduced growth rates. Wong, who says the long-term effects are inconclusive, recently received a €3m (£2.6m) grant from the European commission to investigate side-effects further.
Professor Paul Cooper, a psychologist and professor of education based at Leicester University, who has completed qualitative research with adolescents on psychostimulant medication, expressed concerns about the possible effects of the drugs on personality development.
"Some young people say that it affects their personality but accept it because it gets mum and dad off their case or stops them getting into trouble," he said. "They don't like it, but take it for the benefit of other people."
Medical experts in the West Midlands say over-prescription continues to be a problem. "This whole area needs public scrutiny – there has to be some kind of review," said the educational psychologist who oversaw the cases but did not want to be named. "Handing out strong psychotropic drugs to children should be a last resort, but they're being handed out like sweets."
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