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At the start of the school, younger children are more likely to be diagnosed with ADHD

Background

Younger children in a school grade cohort may be more likely to diagnose an ADHD or older groups due to the variation in age behavior that can be attributed to ADHD instead of the youngest children .

Most US states UU have arbitrary age limits to enter the public school. Therefore, within the same grade, children with birthdays near the deadline may be almost age-old 1 year.

Methods

Data from 2007 to 2015 was used from a large insurance database to compare ADHD diagnostic rate among children born August with the children of the children born September in the states with the requirement and without having to turn children 5 years old by September 1 in day care.

It was decided to diagnose ADHD based on Diagnostic Codes of International Classification of Diseases, 9th Review. We also use prescription records to compare ADHD treatment among children born in August and children born in September stating with a date not breaking on September 1.

Results

The study population included 407,846 children in each US country born during the period 2007 to 2009 and followed until December 2015.

Y diagnostic rate of ADHD is based on claims among children in states with a breach on September 1 85.1 per 10,000 children (309 cases among 36,319 children, confidence interval [IC] 95%, 75.6 to 94.2) among those born in August and 63.6 per 10,000 children (225 cases among the 35,353 children, 95% CI, 55.4 to 71.9) among those born in September, absolute difference of 21.5 per 10,000 children (IC 95%, 8.8 to 34.0); The corresponding difference in the states without a restriction on September 1 was 8.9 per 10,000 children (95% CI, -14.9 to 20.8).

Y treatment rate of ADHD was 52.9 per 10,000 children (192 or 36,319 children, 95% CI, 45.4 to 60.3) among those born in August and 40.4 per 10,000 children (143 35,353 children, 95% CI, 33.8 to 47.1) among those born in September, an absolute difference of 12.5 per 10,000 children (95% CI, 2.43 to 22.4).

These differences were not seen in other month-by-month comparisons, and are not observed in statements with non-September break dates for start-ups and kindergarten.

Also, states with a restriction on September 1, no significant differences were seen between children born in August and those born in September in asthma, diabetes or obesity rates.

Differences in ADHD diagnosis rates by gender to my geni The break line indicates that there is no difference. The bars indicate 95% confidence intervals. ADHD diagnosis is defined based on ICD-9 diagnostic code for ADHD in billing or prescription claims and filling for medication for ADHD.

Collections

ADHD diagnosis and treatment rates are higher among children born in August than among those born in September, stating with a break on September 1 for admission to a nursery. (Funded by National Health Organizations.)


Comment at The Harvard Gazette

Would a child's birthday put her at risk of diagnosis of ADHD?

That seems to be the answer ie, at least among the children born in August that begins the school stating where registration is suspended on September 1, according to a new study led by researchers at Harvard Medical School.

The findings, published November 28 in New England Journal of Medicine, show that children born in August in those conditions are 30 percent more likely to diagnose ADHD, compared with a little older peers who have registered in the same grade.

The ADHD rate of children diagnosis has increased dramatically over the last 20 years. Only in 2016, more than 5 per cent of US children UU are actively treated with medicines for ADHD. Experts believe that the increase is the result of a combination of factors, including greater recognition of disorder, a real increase in the number of cases of disease and, in some cases, inadequate diagnosis.

The results of the new study underline the idea that diagnosis can be a factor, at least in a sub group of primary school students. early registration at school, according to the research team.

"Our findings suggest the potential for a large number of children to receive excessive diagnosis and excessive treatment for ADHD because they are relatively immature and versatile compared to their co- older pupils in the first years of primary school, "said the study's main author. study, Timothy Layton, Assistant Healthcare Policy teacher at the Blavatnik Institute of Harvard Medical School.

Most statements have arbitrary limitations of birth date that determine the extent to which a child is given and when they can start school. Notes with a restriction on 1 September, a child born on August 31 will be almost one year younger on the first day of the school than a child born on September 1st.

In this age, Layton noted that the smallest child could have been more difficult to sit confidently and concentrate for long periods of time in class. That additional disturbance can lead to a medical referral, says Layton, and then diagnosed and treated for ADHD.

For example, the researchers said that normal 6-year-old noisy behavior might seem abnormal in relation to the behavior of older partners in the same classroom.

This dynamic can be particularly true among younger children, as an age difference of 11 or 12 months could lead to significant differences in behavior, the researchers added.

"As children grow older, the small age differences become equal and are redundant over time, but in terms of behavior, the difference between a 6-year-old boy and a a 7-year-old child is quite obvious, "said study author, Anupam Jena. Professor Ruth L. Newhouse, Healthcare Policy at Harvard Medical School and an in-house medicine doctor at Massachusetts General Hospital. "Normal behavior can seem unusual in relation to the child's peer group."

Using large insurance database records, researchers compared the difference in ADHD diagnosis by month of birth, August against September, among more than 407,000 primary school children born between 2007 and 2009, followed up to the end of 2015 .

According to the analysis, in the statements that are using September 1 As the deadline for school registration, children born in August were 30% more likely to diagnose ADHD than children born in September. No differences were found between children born in August and September stating with deadlines other than September 1.

For example, 85 out of 10,000 Adults born in August were diagnosed or treated for ADHD, compared to 64 students from 10,000 named in September.

When the researchers only looked at ADHD treatment, the difference was also great: 53 out of the 10,000 students born in August received medicines for ADHD, compared to 40,000 and 10,000 born in September.

Jena emphasized a similar phenomenon described in the book "Outliers" by Malcolm Gladwell. Canadian hockey players are much more likely to be born earlier this year, according to the research set out in Gladwell's book. The Canadian youth hockey leagues use 1 January as the deadline for the age groups.

During the early years of youth hockey training, players born in the first few months of the year were older and more mature, and therefore more likely to be traced to elite alliances, with better training, more time on the ice and a more talented team of team friends. Over the years, this accrued advantage has given the advantage of relatively older players for their younger competitors.

Similarly, Jena noted, the 2017 work document suggested by the National Office for Economic Research that children born immediately after the school start date tended to have a better long-term educational performance than their peers relatively young. named later in the year.

"In all those scenarios, it seems that momentum and age are powerful factors that can influence the outcome," said Jena.

The research has shown great variations in ADHD diagnosis and treatment in different regions in the USA. UU ADHD diagnosis and treatment rates have also increased dramatically over the last 20 years.

Only in 2016, more than 5 per cent of all children in the US UU took medication for ADHD, the authors said. All of these factors have caused concerns about the excessive diagnosis of ADHD and excessive treatment.

The reasons for the increase in ADHD cases are complex and multi-factor, Jena said. One of the number of variables that drive and this phenomenon is like arbitration limits.

In recent years, many states have adopted measures that are schools that are responsible for identifying ADHD and offer incentives for educators to recommend any child with symptoms that suggest ADHD for a medical evaluation .

"The diagnosis of this condition is not only associated with the symptoms, but to the context," she said. "The relative age of children comes in class, laws and regulations, and other circumstances, together."

It is important to consider all of these factors before diagnosing and prescribing treatment, says Jena.

"Consideration should be given to the age of a child in relation to peers in the same grade and the reasons for the reference should be carefully examined."


Additional co-authors include researchers from the Healthcare Department's Policy, the National Economic Research Office and Department of Health's Policy and Management, and Harvard T.H. No Public Health School.

Using large insurance database records, researchers compared the difference in ADHD diagnosis by month of birth, August against September, among more than 407,000 primary school children born between 2007 and 2009, followed up to the end of 2015 .

According to the analysis, in the statements using September 1 as the deadline for school registration, children born in August were 30% more likely to diagnose ADHD than children born in September. No differences were found between children born in August and September stating with deadlines other than September 1.

For example, 85 out of 10,000 students born in August were diagnosed or treated for ADHD, compared to 64 students from 10,000 born in September. When the researchers only looked at ADHD treatment, the difference was also great: 53 out of the 10,000 students born in August received medicines for ADHD, compared to 40,000 and 10,000 born in September.

Jena emphasized a similar phenomenon described in the book "Outliers" by Malcolm Gladwell. Canadian hockey players are much more likely to be born earlier this year, according to the research set out in Gladwell's book. The Canadian youth hockey leagues use 1 January as the deadline for the age groups. During the early years of youth hockey training, players born in the first few months of the year were older and more mature, and therefore more likely to be traced to elite alliances, with better training, more time on the ice and a more talented team of team friends. Over the years, this accrued advantage has given the advantage of relatively older players for their younger competitors.

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