Is your 5-year-old ready for kindergarten? Or should you wait one more year before enrolling him in school? These questions can torment preschool parents — especially parents of kids with late-summer birthdays.
Now there may be more cause for concern. A recent study has found that younger students in kindergarten are more likely to be diagnosed with attention-deficit/hyperactivity disorder (ADHD)than older students in the same class.
ADHD or typical behavior?
It’s actually not a new discovery. Earlier studies reported the same finding. But this study by Harvard researchers, published in The New England Journal of Medicine, is one of the largest to date.
Researchers studied insurance records of more than 400,000 U.S. children born from 2007 through 2009. They compared the rate of ADHD diagnosed in states with and without the mandate that students be 5 years old by Sept. 1 to enroll in kindergarten that school year.
In states with the September cutoff, the rate of ADHD was 85 out of 10,000 children born in August (the youngest students in the class), compared to 64 out of 10,000 children born in September (the oldest students in the class). That’s a 34 percent higher chance of younger students being diagnosed with ADHD.
Younger students did not have higher rates of diagnosed asthma, diabetes or obesity. And the ADHD difference between August- and September-born kids was not seen in states without a Sept. 1 cutoff.
So, is ADHD really more prevalent in younger students — or is it just being confused with less mature behavior?
“We can’t say if these kids are being overdiagnosed with ADHD, but it does seem strange to have such a consistent finding across a large number of children,” says Michael Manos, PhD, Clinical Director of the ADHD Center for Evaluation and Treatment. “The real concern is not about overdiagnosing, however, but about misdiagnosing. It’s about accurately diagnosing the condition and ensuring that kids who do have ADHD get proper treatment.”
Three steps to diagnosis
Accurate diagnosis requires 3 steps
More children today are being diagnosed with ADHD — 6.1 million U.S. kids between ages 2 and 17, according to the Centers for Disease Control and Prevention. The rate of ADHD diagnosis has consistently increased since it was first tracked in 1997.
There are three steps to properly diagnose ADHD, says Dr. Manos:
- Identify the behaviors (ADHD symptoms). Rating scales help pediatricians objectively evaluate a child’s behavior. Children must have six of nine symptoms to qualify as inattentive and/or six of nine other symptoms of overactivity and impulsivity to qualify as hyperactive. Proper assessment requires input from multiple observers, usually a parent and a teacher. But rating scales alone may not properly diagnose ADHD.
- Consider other causes. “Maybe inattention is due to the distraction of a new smartphone, not ADHD,” says Dr. Manos. “Maybe misbehavior is due to staying up too late and not getting enough sleep, or due to parenting style and ineffective behavior management techniques at home. Other causes, such as lagging development, also may be present. If the physician does not rule out these factors, misdiagnoses may result.”
- Determine the effect of other health conditions. Anxiety, depression, sleep disorders and other behavioral health conditions can aggravate or mimic ADHD symptoms.
“In our center, we follow this three-step process and use multiple behavior-rating scales as well as parent interviews,” says Dr. Manos. “We ask parents to describe behavior and how often it occurs. With both ratings and interviews, we can clearly determine if the patient does or does not have ADHD — alleviating any concern of misdiagnosis.”
When to treat ADHD
Proper ADHD diagnosis is important because proper treatment is vital.
“The sooner we start treatment, the better the outcome,” says Dr. Manos.
A combination of behavior therapy and medication for children with ADHD is considered the best approach. Behavior therapy can help reduce the dose of medication required.
“The adage ‘pills don’t teach skills’ is an important distinction for treating ADHD,” says Dr. Manos.
The longer you wait to treat ADHD, the worse the effects, he notes.
“Adults who have wrestled with the condition on their own for years, seeing they often produce less than others but not discerning why, tend to be self-critical and feel defeated,” he says. “They struggle at work and with relationships. Often there are very negative emotional effects that manifest over time with untreated ADHD.”
Send your kid to kindergarten — or wait another year?
Back to the recent study: While the research findings may sound alarming, your child’s early readiness to start kindergarten does not raise his or her risk of having ADHD.
“If you have a bright, precocious young 5-year-old who needs the stimulation that school provides, by all means, send her to kindergarten,” says Dr. Manos.
No matter a student’s age or maturity level, the three-step process can accurately identify those who actually have ADHD. Getting proper treatment as soon as possible will prepare them for years of success in school and beyond.
Note: This article was first published at Cleveland Clinic on December 10, 2018.
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