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Wednesday 30 May 2012

CONTRAVERSIAL FINDINGS : Youngest Kids in Class Are More Likely to Get ADHD Diagnosis and Consequently be Prescribed Psycho-stimulant Drugs : 2 conclusive studies show there can be a link and prove that there can be long term consequences through childhood and life for those 'labelled.' + Professional bodies still call for a national review of psychotropic drugs for children.

"You are one of the youngest in this class, just by a few months,  listen to me and take one of these tablets." says a 'trusted adult.'

"Youngest in school year more likely to be diagnosed with ADHD: research."


Tens of thousands of children are being misdiagnosed with ADHD because they are the youngest in their class and their immaturity is being mistaken for hyperactivity, a study has suggested.

Children who were born late in the school year and so are almost 12 months younger than their oldest classmates are more likely to be diagnosed and given medication like Ritalin for attention deficit hyperactivity disorder, it was found.
They are being 'inappropriately labelled and treated' the authors said.
Greater caution should be given to making the diagnosis in order to prevent children from being given potentially harmful medicines without justification, they said.
There are thought to be around 1.7m people with attention deficit problems in Britain with between three and seven per cent of school age children affected. 
There is no data collected on how many children in Britain are on drugs for the problem but in 2010 there were over 850,000 prescriptions dispensed for medicines to treat the condition in England and Wales at a cost of almost £44m.
The study was conducted on children in British Columbia in Canada where the school year coincides with the calender year.

It was found that children born in December, so the youngest in their school year, were 40 per cent more likely to be diagnosed and almost 50 per cent more likely to be treated for ADHD than children born in January, the start of the school year. 

In Britain this would correspond to children born in August compared with those born in mid to late September.
It is well known that the youngest children in the school year tend to struggle with academic performance, behaviour and sport, in what is known as the relative age effect.
The findings were published in the Canadian Medical Association Journal.

Lead author Richard Morrow, University of British Columbia, said: "The relative age of children is influencing whether they are diagnosed and treated for ADHD.
"Our study suggests younger, less mature children are inappropriately being labelled and treated. It is important not to expose children to potential harms from unnecessary diagnosis and use of medications." 

The side effects of ADHD drugs can include sleep disruption, increased risk of heart problems and slower growth rates. As well, younger children who have been labelled ADHD may be treated differently by teachers and parents, which could lead to negative self-perception and social issues, the authors said.
Coauthor and psychiatrist Jane Garland, University of British Columbia and BC Children's Hospital, said: "This study raises interesting questions for clinicians, teachers and parents. 

"We need to ask ourselves what needs to change. For example, attention to relative age of children for their grade and more emphasis on behaviour outside the school setting might be needed in the process of assessment."

The study investigated almost one million schoolchildren in British Columbia over ten years who were between the age of six and 12.

Although the prevalence of ADHD diagnosis and treatment is about three times higher in boys than girls, the effect of relative age applied to both.

Girls born in December were 70 per cent more likely to be diagnosed with ADHD than girls born in January.

The researchers wrote in the journal: "The potential harms of overdiagnosis and overprescribing and the lack of an objective test for ADHD strongly suggest caution be taken in assessing children for this disorder and providing treatment."

Experts in Britain said the findings could mean that ADHD was not not being picked up in the older children in the year group as well as or instead of too many diagnoses being made in the younger children. 

Dr Dave Coghill, Reader in Child and Adolescent Psychiatry, at University of Dundee, said: "In a culture where ADHD is over diagnosed it may be that relative age increases the likelihood that younger children in a year will be over diagnosed. 

"In cultures where there is under recognition of ADHD such as the UK and Canada the opposite may occur with there being a more appropriate recognition in younger children with under recognition of ADHD in the older children in a year.
"The researchers suggest that this relative age effect is likely to be driven by the teacher. In the UK parents are always intimately involved in the assessment for ADHD and in almost all cases it is them that provide the key information that drives the assessment process. As a consequence it is possible that the UK will be less prone to these relative age effects." 

Dr Liz Didcock, mental health lead at the Royal College of Paediatrics and Child Health, said:‬ "This paper adds an interesting perspective on the diagnosis and treatment of ADHD in children.

"It reminds us of the importance of understanding behaviour in its context, particularly in relation to the influence of parental and teacher expectations. 

"The potential 'over-medicalisation' of what can be considered 'normal' childhood behaviour is an obvious concern. It is vital that all clinicians from Paediatric and Child and Adolescent Mental Health Services teams are skilled in the assessment of children's development, including their social and emotional health.
"Assessments must take into account biological, social and psychological factors before a diagnosis is made and appropriate treatment is prescribed."


Youngest Kids in Class More Likely to Get ADHD Diagnosis: Study with very important conclusions.



Researchers suggest some may just be immature for their grade and are give drugs as a result -CRAZY!

Monday, March 5, 2012 

HealthDay news image

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

  1. From the Department of Anesthesiology, Pharmacology and Therapeutics (Morrow, Maclure, Dormuth), University of British Columbia, Victoria, BC.
  1. Correspondence to:
    Richard Morrow, richard.morrow@ti.ubc.ca.


The annual cut-off date of birth for entry to school in British Columbia, Canada, is Dec. 31. Thus, children born in December are typically the youngest in their grade. We sought to determine the influence of relative age within a grade on the diagnosis and pharmacologic treatment of attention-deficit/hyperactivity disorder (ADHD) in children.

We conducted a cohort study involving 937 943 children in British Columbia who were 6–12 years of age at any time between Dec. 1, 1997, and Nov. 30, 2008. We calculated the absolute and relative risk of receiving a diagnosis of ADHD and of receiving a prescription for a medication used to treat ADHD (i.e., methylphenidate, dextroamphetamine, mixed amphetamine salts or atomoxetine) for children born in December compared with children born in January.

Boys who were born in December were 30% more likely (relative risk [RR] 1.30, 95% confidence interval [CI] 1.23–1.37) to receive a diagnosis of ADHD than boys born in January. Girls born in December were 70% more likely (RR 1.70, 95% CI 1.53–1.88) to receive a diagnosis of ADHD than girls born in January. 

Similarly, boys were 41% more likely (RR 1.41, 95% CI 1.33–1.50) and girls 77% more likely (RR 1.77, 95% CI 1.57–2.00) to be given a prescription for a medication to treat ADHD if they were born in December than if they were born in January 


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.

Again thank you RL Morrow, EJ Garland, JM Wright, M Maclure, S Taylor and CR Dormuth for this superb article. Thank you also to the CMAJ for publishing it. 

The importance of relative standards in ADHD diagnoses: evidence based on exact birth dates.

Economics Department, Michigan State University, East Lansing, MI 48824-1038, USA. telder@msu.edu

This paper presents evidence that diagnoses of attention-deficit/hyperactivity disorder (ADHD) are driven largely by subjective comparisons across children in the same grade in school. Roughly 8.4 percent of children born in the month prior to their state's cutoff date for kindergarten eligibility - who typically become the youngest and most developmentally immature children within a grade - are diagnosed with ADHD, compared to 5.1 percent of children born in the month immediately afterward. 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. 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.

Pediatrics Vol. 117 No. 4 April 1, 2006
pp. e601 -e609
(doi: 10.1542/peds.2005-1308)


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

ADHD medication given in breach of NHS guidelines as professor says parents putting pressure on GPS.
Child taking a pill
Children as young as four have been prescribed Ritalin-style drugs in breach of NHS guidelines. Photograph: Murdo MacLeod
Children as young as four are being given Ritalin-style medication for behavioural problems in breach of NHS guidelines, the Guardian has discovered, prompting the leading psychological society to call for a national review.
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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