March 11, 2016
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Younger age at school entry increases risk for ADHD diagnosis

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Entering school at an earlier age increased the risk for attention-deficit/hyperactivity disorder diagnosis and medication treatment among a cohort of children in Asia, according to recent research in The Journal of Pediatrics.

Perspective from Erica D. Musser, PhD

“This study investigated whether the impact of relative age is exclusive to Western countries, such as the United States, Canada, Spain and Sweden, or is also present in Asian countries, such as Taiwan,” Mu-Hong Chen, MD, of the department of psychiatry at Taipei Veterans General Hospital, and colleagues wrote. “Our results supported the study hypothesis, which is consistent with previous studies conducted in the U.S. and Canada, and indicated a significant effect of relative age on ADHD diagnosis and treatment.”

The researchers studied data from the Taiwan National Health Insurance Research Database for 378,881 children aged 4 to 17 years, from Sept. 1 1997 to Aug. 31, 2011. Chen and colleagues used a cut-off birthdate of Aug. 31 for school enrollment to identify children entering school at a younger age. Statistical analysis was used to determine the risk for diagnosis and treatment for younger children born in August vs. those who were older and born in September.

Study data indicated that boys (OR = 1.63; 95% CI, 1.45-1.84) and girls (OR = 1.71; 95% CI, 1.36-2.15) who entered school at a younger age had a greater risk for being diagnosed with ADHD and being treated with ADHD medications (boys; OR = 1.76; 95% CI, 1.53-2.02; girls; OR = 1.65; 95% CI, 1.26-2.18) compared with older children.

According to the researchers, this trend was not observed when adolescents born in August were compared with adolescents born in September (OR = 1.27; 95% CI, 0.98-1.64), suggesting that increased age and maturity may decrease the risks for ADHD diagnosis associated with birth month.

“The relative age among classmates affects the academic performance of children and their risk of receiving ADHD diagnosis and medication,” Chen and colleagues wrote. “Our findings emphasize the importance of considering the age of a child within a grade when diagnosing ADHD and prescribing medication to treat ADHD.” – by David Costill

Disclosure: The researchers report no relevant financial disclosures.