Dr. Gellner: ADHD in elementary school, on the rise or over-diagnosed?
Announcer: Keep your kids healthy and happy. You are now entering The Healthy Kids Zone, with Dr. Cindy Gellner on The Scope.
Dr. Gellner: ADHD seems to be one of those diagnoses that we're hearing a lot about lately. Is it really increasing, especially among our youngest elementary school kids? A recent study out of Harvard says it may all come down to what month of the year a child is born in. "The New England Journal of Medicine" article found that the youngest kids in a class have a 30% higher chance of being diagnosed with ADHD than older students. In fact, they also found that for every 100,000 students with August birthdays, 53 of them were given ADHD medication, but only 40 out of 100,000 were medicated if they were born in September. The researchers proposed that many of these younger kids are over-diagnosed and over-treated for ADHD because they are just more immature compared to their older classmates.
Older kids have had more time to develop social skills and have better internal control. When teachers are thinking that a child born in late summer or early fall may have ADHD, they're looking at a whole classroom of kids whose birthdays fall within a 12 month period. They may have some who barely meet the September 1st cutoff, and then they have some who are born in September and are almost a whole year older than those August babies. It's hard for teachers of young kids to work with such a diverse range of little kids, especially with all different maturity levels. Sometimes it's hard to give the younger ones more attention because of their behavior, and the behaviors of the younger kids can disrupt the classroom, making a teacher's job even harder.
Now, I have a lot of parents bringing their kids ages four and five to me because their preschool and kindergarten teachers think they have ADHD, and often the parents will agree. "Yes, they are like little Tasmanian devils at home. They're all over the place. They don't listen, and they can't remember to clean up their toys after I've told them three times." Parents start to think, maybe my child does have ADHD. And I can't tell you the number of parents of two and three-year-olds who ask me if their child has ADHD. The problem is those behaviors are still normal and age appropriate for many kids. They most likely don't have ADHD, and medication isn't a good choice if the treatment is actually more structure and playtime.
Another tricky part with ADHD is that, for the diagnosis, there are questionnaires to be completed by both the parent and the teacher. These are called Vanderbilt or Conners Tests. And one thing with these tests is that they are standardized for kids ages seven and up. Kids under seven naturally would still have all the inattention and hyperactive symptoms on those forms because they're still normal at those ages. A child also has to have symptoms for six months or more. And as parents know, a lot of development and maturity changes happen in six months in those age ranges.
You can always tell if a child has just turned five or if they're actually just about to turn six, because a six-year-old normally has a longer attention span, they'll listen to instructions better, they can sit longer. And younger kids want to play more, and classrooms require focus which they don't yet have.
When a parent asks me if their child under seven has ADHD, I try to figure out what else could be going on. Are there changes in the family situation, like siblings, a divorce, moving homes? Is there separation anxiety when being dropped off at preschool or kindergarten? Quite often, there's something other than ADHD that can explain their symptoms.
Some parents of August babies hold their children back a year in school as well and start kindergarten just after they turn six. Every child is different. So remember, as a parent, do what's best for your child and be sure to talk to your child's pediatrician if you have any questions about their development.
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