Temper tantrum concept, angry child

Child having a temper tantrum at school (© Photographee.eu - stock.adobe.com)

The findings, in a nutshell

In any classroom, you’ll find kids that may be noticeably older than their peers. Depending on the school’s cutoff date for certain grades, children in the same class may be several months older than other students. This could even bring them a little closer to adolescence and puberty while their younger friends are still acting more like little kids.

The comprehensive review, published in the journal European Child & Adolescent Psychiatry, revealed the youngest kids in their grade are a striking 38% more likely to be diagnosed with ADHD than their oldest classmates. The findings suggest that adults may be incorrectly labeling immaturity as a clinical condition for hundreds of thousands of children around the world.

“This review shows that adults involved in identifying or raising concerns over a child’s behavior – such as parents and teachers – may be inadvertently misattributing relative immaturity as symptoms of ADHD. The child’s age in relation to their classmates (their ‘relative’ age) needs to be considered when making this kind of diagnosis,” explains Professor Kapil Sayal from the School of Medicine at the University of Nottingham in a media release.

“This phenomenon has been shown in research for over a decade, but knowing about it does not seem to be changing practice,” adds Dr. Josephine Holland, one of the authors of the paper.

Methodology

Study authors searched through seven major databases to identify all studies examining the link between a child’s birth month and their risk of an ADHD diagnosis or prescription medication. In total, they found 30 studies meeting their criteria from locations as diverse as Taiwan, Norway, Canada, and the United States.

To allow for an apples-to-apples comparison across the different studies, the researchers classified children into two groups – those born after the cutoff date for starting school, and those born before it. For example, in areas with a Sept. 1 cutoff, kids born in August would be the youngest in their classes. They then calculated the relative risk of an ADHD diagnosis or medication between the “young” and “old” groups. Their analysis covered over 19 million children in total.

Key Results

  • The meta-analysis showed the youngest children were 38% more likely to be diagnosed with ADHD than their oldest classmates in the same grade.
  • Younger children were also 28% more likely to take prescription ADHD medication like Adderall or Ritalin.
  • This relative age effect was driven largely by teachers’ assessments of ADHD symptoms like inattention and poor self-control.
  • Parents’ assessment of the same behaviors showed no consistent age trend.
  • The authors even found some evidence the effect extended beyond ADHD to autism spectrum disorder, though only two studies examined this link.

Study Limitations

Most of the data came from the United States, Canada, and Nordic countries, raising questions about how applicable the findings are worldwide.

The researchers also couldn’t determine if the relatively younger kids received misdiagnoses or if their slightly immature comportment at the time of assessment represented real but temporary developmental lags.

Takeaways from the study: Rethinking ADHD Diagnosis

Despite the caveats, the results suggest that adults need to take a hard look at subjective factors like relative age when it comes to evaluating children for ADHD and related conditions. Even respected clinical guidelines now explicitly warn against the age issue.

Teachers play an important role in identifying ADHD symptoms in children. Our findings suggest that they can be more likely to rate younger students in a class as having ADHD symptoms than their older classmates. It is important teachers are supported in considering the relative age of a child in a classroom when ADHD is being queried,” says Dr. Eleni Frisira from the School of Medicine and lead author of the study.

Experts argue that we need a fundamentally more holistic approach to ADHD assessment that relies less on subjective teacher reports and one-time clinic observations and more on long-term tracking and real-world functional impairments. Of course, some children do suffer from underlying neurological differences that justify diagnosis and treatment. However, this extensive new data suggests we’re almost certainly pathologizing immaturity in many, perhaps even most, cases. That has major consequences for families, schools, and society.

StudyFinds Editor Chris Melore contributed to this report.

About StudyFinds Staff

StudyFinds sets out to find new research that speaks to mass audiences — without all the scientific jargon. The stories we publish are digestible, summarized versions of research that are intended to inform the reader as well as stir civil, educated debate. StudyFinds Staff articles are AI assisted, but always thoroughly reviewed and edited by a Study Finds staff member. Read our AI Policy for more information.

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5 Comments

  1. Eric says:

    The US consumes vast amounts of Adderall, far more than any other country. “The US accounts for <5% of the world's population but 83.1% of the global volume of ADHD medication" – NIH. The US majority is morally defunct and is addicted to all kinds of drugs and will use all means available, including the co-opting of science by so called medical professionals. But this is all really just an outward sign of a larger progressive decay.

    The US is a corrupt, absolutely insane failing state. It is hell bent on liberal internationalism at the cost of the planet and its own US middle and working class. It uses its intelligence and defense industry and foreign cartels to disrupt the stability of many countries to generate a migratory labor force willing to be exploited (as US cheap labor) for a chance at a better life.
    The US economy is held together by deficit spending that propels the markets to new highs but only so long before maximum debt is reached. Once that happens, newer generations will be impoverished for their lifetimes. Unless you vote independent, your vote will be used against you by both Democrats and Republicans.

    1. Yoppyman says:

      Well-founded comments!

  2. Dale S. Hoover says:

    This is a tender spot with me b’cuz when I had just made 9 yrs. old our family moved to Japan for a year & before we went we took a # of vaccine immunizations for various (POTENTIAL) diseases. I am sure that is how & when I acquired my A.D.H.D. & limited learning ability, & also it is now KNOWN that vaccines cause ADHD, ADD, Autism, & so very many other PERMANENT disorders/disabilities. These are life-ALTERING in the extreme. Nature was created perfectly for life on Earth but with the use of vaccines & antibiotics we’ve forced people to live that might not have been choosing to live (at their spirit/soul-level,~~as we ALL do NOT choose to always live a LONG life each lifetime: sometimes just mere minutes, hours, days, weeks, months, a few years, etc.),~ but by using artificial means to prolong life we’ve bull-dozed over the natural order, & in doing so we’ve severely weakened the human-template genetic code & severely over-populated the Earth [= 8 BILLION!] to the detriment-challenge of ALL the various life forms on Earth as well as to the Earth Itself.      #1: ”ADHD” is NOT a disease! It is a description of humans who have strong nomadic/hunter-gatherer genes with strong ancestral hereditary links to this type ‘historical’ way of life; &/or vaccine injury.
      #2: Childhood ”ADHD” is likewise the above PLUS simply being unmatured: it is HIGHLY UNNATURAL to stuff bunches of young same-biological-age-kids into a classroom FOR HOURS at a time [AND expect ALL of them to behave similarly]! SOME will be more immature than their same-age classmates & therefore maintain their NATURAL ‘childish’ characteristics of ‘hyperactivity,’ ‘impulsivity,’ ‘distractibility’ [= ALL due to being NATURALLY ENERGETIC, INQUISITIVE, & EXPLORATORY-minded, – NOT ”disordered/diseased!”].  Too, there can be IQ differences [= lower IQ] that can contribute heavily to high-frustration felt by these seemingly ‘ADHD’ ones when they’re expected to perform like their same-age peers [& can create very low self-worth].  Breaks my heart every time I read of all the kids being DRUGGED so they’ll ‘fit in,’ when all that’s required would be to hold them back a year or even two years BEGINNING IN NURSERY SCHOOL or at least by kindergarten age… but of course the parents would hate that, so wouldn’t do it!
    https://www.msn.com/en-us/health/other/adult-adhd-may-take-a-toll-on-the-brain-here-s-what-to-know/ar-AA1iSz9W?ocid=winp1taskbar&cvid=87ade0f40d9241a5893bf093564b9bde&ei=22 
    Humans have somehow forgotten we’re immortal Spirit-Consciousness having brief TEMPORARY sojourns in mortal physicality. If one TRULY desires to live they will (& have!) overcome every disease “AGAINST ALL ODDS” in order to remain here!  Read Thom Hartmann’s ‘The Edison Gene – ADHD and the Gift of the Hunter Child: ‘http://www.amazon.com/The-Edison-Gene-Hunter-Child/dp/1594770492AND,’The Fiction of ADHD and the Chemical Imbalance Theory of Mental Illness: ‘http://wakeup-world.com/2015/09/06/the-fiction-of-adhd-and-the-chemical-imbalance-theory-of-mental-illness/
    Presents new genetic TRAIT-evidence [‘the Edison gene’ & NOT a disorder!] that kids with A.D.H.D./A.D.D. have gifts & unique abilities, & are simply skilled dangerous-world ‘alert hunters’ residing in a contemporary more settled ‘farmer-world’ who shouldn’t be constrained to the limitations of enforced routine/forced conformity (conform-to-the-norm) fixed classroom-style schooling. Solutions-based required reading for all teachers & parents of ‘ADHD/ADD’ kids. Some wise parents are now holding their ‘ADHD’ children back a year or two in school (kindergarten & 1st grade) as these children can also be shy &/or more socially immature than their same-age peers. They perhaps, as I did, simply experienced retarded development (‘developmental arrest’) in maturation.

  3. D.A. Petersen says:

    As a Professional counselor, I have known for decades that kids gets labeled “ADD, ADHD because teachers are not taught how to deal with energetic children; and parents never learned how to care for a child that was plain energetic, artistic, inquisitive or just plain fun. Teacher & parents’ live are driven by “conform” to get along. Many parents don’t engage with their children and now with the electronic age, there is even less face to face conversation. When my daughter’s preschool teacher (20 years ago) told me my daughter should be tested for ADHD, I laughed in her face and told her if she was not able to keep my daughter engaged/interested enough in the preschool activities then she needed to go back to school. My daughter is an artist. She thinks globally, she now has a BS degree in Business. She is thoughtful of others and has life goals. Parents need to embrace the energetic child, teach them to focus when they need to, set boundaries and have consistent rules. I have taught many children to swim, and when I see a parent on their phone and not watching their child, I kick them out of the pool area. I see the disappointment in the child’s eyes when their parent is more interested in the phone than their achievement in the water. My swim students that are labeled ADD or ADHD actually are more attentive than some of the ones that do not have those labels. It is unfortunate, many individuals in my past profession think it is job security to label a child when the child is just in a stage of growing up. Granted there are truly some children that can benefit from treatment, but the numbers are no where near what the statistics say. What do I base this upon, 1. common sense, 2. communicating with the child, 3. educating myself from a variety of authors & 4. remembering kids should be active, physically and mentally that is how they develop.

  4. Kay Gos says:

    We needed a study for this?