The news has been buzzing with the results of a new study which suggests that over 1 million American kids are misdiagnosed with ADHD, when they don’t in fact have it.
When I saw these news reports, I got a copy of the article to review it, and I was also interviewed for a TV news show to discuss this issue.
What Does This Research Study show?
This study was published in the Journal of Health Economics. The author, Todd Elder, reviewed statistical information from insurance databases, and prescriptions records to look at the rates of the diagnosis and treatment of ADHD as it relates to birth month.
Each school system has a ‘cut off date’ for kids entering kindergarten. In my local school system, it is January 1st. So, if a child is born on January 1, 2005, he can be in the same kindergarten class as a child born on December 31st, 2005. Of course, these kids are a year apart in chronological age, even though they are in the same year. So there are some kids who are younger than their peers in the same grade, related to their birthday.
This study showed that there was a higher rate of diagnosis and treatment of ADHD in the kids who were younger for their grade compared to kids who were older for their grade. The study also showed that these younger kids were more likely to be taking stimulant medicines in grade 5 and grade 8 related to the higher rate of ADHD diagnosis.
It is important to note that this is not the first study to show this – I found two other studies – one by the same author, and one by William Evans et al who found similar findings. It’s important to note that these other studies were also statistical analyses of databases and not clinical studies. In other words, the researchers did not interview and assess children, or even doctor’s clinical charts to assess the rates of ADHD diagnosis, and the relationship to birth month as it relates to the school entry cut 0ff.
What do I see in my office?
In my clinical office, I see a lot of children and teens with ADD/ADHD who clearly meet criteria for diagnosis. Are there more of them who are younger for their grade? I don’t honestly know – I’ve never been aware to even consider that as a factor.
I have had many kids with ADHD whose parents may have held them back a year in kindergarten because they were younger for their grade, and the parent was concerned about the child’s maturity level and functioning. Did this eliminate lower the risk of ADHD diagnosis? In my opinion, not at all. Kids who met criteria for ADHD who became the oldest in their class (because they were held back a year, so that their November or December birthday made them older than all of the kids who started the year with a birthday after January 1st) still met criteria for ADHD. They may have functioned better… but I can only say that this was an individual response, and I can’t say what it was like for each person.
Who Assesses ADHD As A Factor:
The study suggests that most ADHD diagnoses are done by Pediatricians, and even Family Doctors, and only a small percentage of patients see Psychiatrists, or other mental health professionals. This is mentioned as a criticism, and suggests that more errors are made in diagnosis because of this.
I believe that there are excellent pediatricians and even family doctors who do a very thorough job in assessing and treating ADD/ADHD. Should you refuse to accept a diagnosis unless it comes from a child psychiatrist? Absolutely not. There is such a shortage of child psychiatrists that it would just interfere with diagnosis and treatment if that were to happen.
Does Birth Month Matter?
In his book on success Outliers, author Malcolm Gladwell discusses the factors which help people to succeed. One such factor he discusses is birth month – using the example of Canadian Elite Hockey players. He contends that players who are born early in the year (i.e. January birthdays) are older, bigger, and have more skill than the players with later birthdays (i.e. November, December birthdays). He describes that these players get noticed more readily, and then they get the opportunity to develop their skills more readily. The suggestion is that the ‘advantage’ of an early birthday may provide a slight margin, and then that margin improves chances of developing opportunities through the years, which can widen the gap.
It is possible that a similar process is occurring with ADD/ADHD.
What You Should Do With This Information:
I know that there will be many parents who will read this and say, “My son was born in November or December – does this mean he doesn’t have ADD/ADHD? Does this mean we should stop the medication?’ Here are my suggestions on how to proceed with this information:
Remember – ADHD is real. This study doesn’t suggest that ADHD is a farce, that it is not a true medical condition, or that it doesn’t need treatment.Make sure you had a thorough assessment and diagnosis: You will want to make sure that your child has a proper assessment for ADD/ADHD, and that you are confident with the assessment done. Hold your doctor to a high standard, particularly if you are concerned that your child is born late in the year.Do not stop prescribed medication just because you heard about this news story. Talk to your doctor before any treatment decisions are made.Probably the most important suggestion is #2 – ensure you had a thorough and proper assessment. Realize that I suggest that to everyone, not just people who are concerned that their kids are young for their grade.
What do you think about this issue? Did this news story raise concerns for you? Please share your opinions below in the comments.
Best,
Dr. Kenny
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