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Kids who start school at younger age at increased risk for ADHD
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Results of a population-based cohort study that included more than 1 million school-age children in the United Kingdom suggested that the youngest children in a school class were around 1.4 times more likely to be diagnosed with ADHD compared with the oldest children. Researchers also noted that these children were 1.3 times more likely to be diagnosed with intellectual disability and depression.
“We would expect to see similar patterns of results in other countries, such as the United States, where school entry is based on a cut-off and there is minimal delayed entry,” Jeremy P. Brown, MSc, a research degree student in pharmacoepidemiology at the London School of Hygiene & Tropical Medicine, told Infectious Diseases in Children. “Differences between countries, such as age at school entry, and differences in school admissions and health care systems could, however, affect results.”
Brown and colleagues conducted a population-based cohort study in which they assessed data from electronic health records for 1,042,106 children aged 4 to 15 years. All data were collected before Jan. 3, 2017, from more than 700 general practices in the U.K. and were used to analyze the relationship between age at school entry among children split into four quarters of the school year, intellectual disability, ADHD and depression before age 16 years.
Of the participants, 51.1% were male and the median age at school entry was age 4 years. EHR data demonstrated that children born in the fourth quarter in each school year were at increased risk for intellectual disability (adjusted HR = 1.3; 95% CI, 1.18-1.42), ADHD (aHR = 1.36; 95% CI, 1.28-1.45) and depression (aHR = 1.31; 95% CI, 1.08-1.59) compared with children born in the first quarter of the year.
The middle two age groups had a smaller increased risk for each diagnosis compared with the oldest group. The aHR for intellectual disability was 1.06 for children born in the second quarter (95% CI, 0.96-1.17) compared with children born in the first quarter, and was also higher for ADHD (aHR = 1.15; 95% CI, 1.08-1.23) and depression (aHR 1.05; 95% CI, 0.85-1.29).
Children born in the third quarter of the year had a slightly increased risk for all outcomes compared with children in the first and second quarters, the researchers wrote (intellectual ADHD aHR = 1.2 [95% CI, 1.09-1.32]; ADHD aHR = 1.31 [95% CI, 1.23-1.4]; depression aHR = 1.13 [95% CI, 0.92-1.38]).
The researchers suggested that potential interventions could include increasing awareness among parents, teachers and clinicians about early school entry; being more diligent about effective ADHD diagnosis using rating scales; and increasing educational support for young children beginning school.
“Further research into effective interventions is needed,” Brown said. “Increased recognition of the issue among teachers, clinicians and parents might help. Additional support for children, such as from mental health services, may be of value. In addition, a fairer and clearer process for deferring school entry for relatively young and developmentally immature children may be of benefit.” – by Katherine Bortz
Disclosures: Brown reports receiving financial support from the Association of the British Pharmaceutical Industry for work unrelated to the study. Please see the study for all other authors’ relevant financial disclosures.
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