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Youngest children in class more often treated for ADHD
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Relative age among classmates affected academic performance into puberty and heightened their risk for being prescribed stimulants for attention-deficit/hyperactivity disorder, according to researchers, who said this should be taken into account when assessing children’s performance and behavior in school to prevent unnecessary stimulant prescription.
Previous data indicated that being older relative to one’s classmates had no long-term benefits and may even imply increased risk for behavioral problems, but recent studies imply that a relative maturity disadvantage in childhood could have long-lasting negative effects on personal achievements and health outcomes.
In particular, recent evidence has found that the youngest children in the classroom are more often treated for ADHD, which may have lasting effects through adolescence and into adulthood.
“Concrete evidence on the effect of relative age at school entry on ADHD and longer-term academic achievement can be crucial for educators, health care providers, parents and policymakers,” Helga Zoëga, PhD, of the Institute for Translational Epidemiology at Mount Sinai School of Medicine, and colleagues wrote. “It would have implications for basic decisions about when parents may want to start their children in school and what education policymakers recommend on standardized testing and birthday cutoffs.”
To assess whether younger age in class was associated with poorer academic performance and an increased risk for being prescribed stimulants for ADHD, Zoëga and colleagues launched a nationwide population-based cohort study of 11,785 children who took standardized tests in Iceland at age 9 and 12 years.
In the study, researchers obtained nationwide data from 2003 to 2008 on standardized test results and psychotropic drug prescription fills for three national birth cohorts in Iceland.
In addition, the researchers estimated risks of receiving low test scores (0–10th percentile) and being prescribed stimulants for ADHD. Comparisons were made according to children’s relative age in class.
According to study results, mean test scores in mathematics and language arts were lowest among the youngest children in the fourth grade, although the gap attenuated in the seventh grade.
“The results of this population-based, nationwide study indicate that being among the youngest students in class is associated with academic underperformance during childhood,” Zoëga and colleagues wrote. “We found that at age 9, the youngest third of children in their class had, compared with the oldest third, an 80% to 90% increased risk of scoring in the lowest decile on standardized tests. At age 12, this excess risk was 60% for both mathematics and language, indicating that the effect of relative age on academic achievement might ameliorate over time but is still at play into puberty.”
Compared with the oldest one-third, those in the youngest one-third of class had an increased RR of receiving a low test score at age 9 years for mathematics (1.9; 95% CI, 1.6-2.2) and language arts (1.8; 95% CI, 1.6-2.1), whereas at age 12 years, the RR was 1.6 in both subjects. Children in the youngest one-third of class were 50% more likely (1.5; 95% CI, 1.3-1.8) than those in the oldest one-third to be prescribed stimulants when aged 7 to 14 years.
In addition, the researchers observed that the youngest one-third of girls scored comparable to, or higher than, the oldest one-third of boys on tests in language arts, suggesting that gender may be a stronger indicator for academic performance than relative age. In accordance with previous studies and clinical data, girls were less frequently treated for ADHD than boys.
“Educators and health care providers should take relative age and gender into account when evaluating children’s performance in school and other criteria for ADHD diagnosis,” Zoëga and colleagues wrote. “These findings can inform the decision of parents with children born close to birthday cutoffs regarding school entry.”
Disclosure: The researchers reported consulting relationships with Novartis.
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