When it comes to ADHD, age is more than just a number

You could be increasing your child’s chances of receiving an ADHD diagnosis by pushing them ahead in school.

A recent report by NPR claims that the youngest children in the classroom are at a higher risk of acquiring an ADHD diagnosis. The article cites multiple studies  done abroad which indicate that children who are young for their grade in school are diagnosed with ADHD more often than their older peers. In sum, these studies highlight the importance of considering a child’s age within their grade when diagnosing a child with ADHD or prescribing them medication.

While age within a grade seems to be a predictor of diagnosis, it may not be a compelling predictor of disorder. One factor that complicates matters is that teacher-report serves as a focal diagnosis tool. Teachers, however, can be biased against the youngest kids in the classroom because they constantly compare them to older, more mature students. A study recently conducted in the U.S. indicates that where a child’s birthdate falls in relation to their school’s kindergarten cut-off date significantly influences their likelihood of diagnosis due to teacher-report, which could be misconstrued: “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.” Comparison is intrinsic to a classroom setting, but may play to the detriment of those who are behind in their social development.

Not only does social maturation influence teachers’ perception and subsequent diagnosis rates of younger children, but also biological maturation. That is, a child’s maturity is connected to both their bodies and their minds. Evidence shows that children diagnosed with ADHD early in their school careers often show a significant symptom reduction as they age, indicating that misdiagnosis often occurs and is correlated with biological immaturity: “This study gives support to the theory that there is a group of children with ADHD-symptoms who have a biological maturational-lag who will show a decrease in their ADHD-symptoms as they show a maturation catch-up with increasing age.” In essence, children exhibiting immature behavior do not necessarily have ADHD, yet there is a strong bias towards diagnosing them.

While these misdiagnoses are understandable and probably somewhat inevitable, they could be dangerous. First and foremost, it may not be advisable to put a child on stimulants if they’re simply young for their class, for fear of purposeless side effects. Moreover, their symptoms may remedy themselves as the child matures. Secondary dangers include social effects. Children diagnosed without cause could experience a type of Golem Effect,  a self-fulfilling prophecy whereby a child transforms into the label they are diagnosed with… This phenomenon has parallels to Malcolm Gladwell’s “relative-age effect,  by which an initial advantage attributable to age gets turned into a more profound advantage over time.” Gladwell discusses this in the context of professional Canadian hockey players, who are far more likely to be born in January, February and March than in other months, due to the junior hockey league’s cut-off of January 1st. Because the oldest kids are more physically mature and seem better, they get extra attention, better coaching, and more practice, factors that compound over time and eventually lead them to become professionals. The same idea could hold true for ADHD diagnosis, but unfortunately, in the opposite direction. Children who are younger seem symptomatic and are labelled as such, limiting their ability in the eyes of teachers, who in turn put less effort into cultivating their abilities.

Gladwell proposes an interesting solution. He suggests that elementary and middle schools put students with January through April birthdays in one class, the May through August birthdays in another, and those with September through December in a third, in order “to level the playing field for those who—through no fault of their own—have been dealt a big disadvantage.” Promising as it sounds, we’re unlikely to see these kinds of systematic changes anytime soon.

More attainable for you, however, is the possibility of training attention skills to compensate for relative immaturity in the classroom. Products like NeuroPlus can help improve attention skills in children who are developmentally behind their peers. In this way, children can accelerate the maturation of their attention abilities in a safe and controlled environment, void of negative side-effects.

Regardless of the course you take, if you have a child who is young for their grade and struggling in school, know that attention takes practice and time.