Adventist La Grange Memorial Hospital issued the following announcement on July 23.
Parents and teachers alike are better-equipped than ever to recognize the symptoms of attention-deficit/hyperactivity disorder (ADHD)., which can be invaluable for diagnosing kids at a young age. But according to a 2018 Harvard study, there might be a surprising hidden reason for some of the kids that get diagnosed with ADHD: the month they were born.
Oh, My Sweet Summer Child
In Illinois, as in many other states throughout the country, kindergarten enrollment cuts off at September 1. Since you generally have to be at least five years old to start school, that means kids who were born in August are often the youngest members of any class. A girl who turns five on August 30, 2019 can start kindergarten this year, while her next-door neighbor who turns five on September 2, 2019 will have to wait until 2020. Thus, the first girl might end up being nearly a year younger than many of her classmates, and that could affect how her teacher perceives her ability to concentrate or sit still.
According to the Harvard study, which was published in the New England Journal of Medicine, children from states with a September 1 cutoff who were born in August are approximately 30% more likely to receive an ADHD diagnosis. The theory is that teachers who notice some kids being less able to sit still or pay attention might ascribe their struggles to ADHD instead of to their comparatively younger age.
So is ADHD misdiagnosis a big problem? Not necessarily, says AMITA Health neuropsychologist, Jill Dorflinger, PhD. Here’s why.
The Age Factor
“In [neuropsychology], we do everything by age expectations,” says Dr. Dorflinger. “With younger kids, it’s even down to months. A child who is five years, eight months and a child who is six years, one month … would not be compared to each other.” For most kids, ADHD doesn’t start to show up on the radar of the adults in their life until they start to attend full days of school — generally first grade, or around ages 6 and 7.
That means that even if your child is the youngest member of their class, an AMITA Health neuropsychologist will not be comparing them to their older classmates. They’ll be tested for age-appropriate attentiveness, and not just in a classroom setting. According to Dr. Dorflinger, “You’re supposed to diagnose ADHD if the symptoms are present in more than one environment.… A neuropsychological evaluation could definitely help, because it would not just be relying on the teacher’s perceptions.”
Dr. Dorflinger points out that, while the study does highlight some potential for risk, it also falls short of actually showing that kids born in August are more likely to be misdiagnosed with ADHD — only that they are more likely to be diagnosed with the disorder. “The study is based on statistics, and they didn’t confirm if those children actually merited a diagnosis. They didn’t see the children, and they don’t even know if the child did start kindergarten at that age or if they were held back.”
Think of it this way. The study might suggest that younger kids are more likely to be misdiagnosed with ADHD. But it could just as easily mean that it’s easier for ADHD to be spotted in younger children than in older children. If teachers recommend more August babies be tested for ADHD, it would then follow that more August babies would be diagnosed.
To Hold Back or Not to Hold Back
So what kind of lessons should a parent take from the Harvard study? And more importantly, what kind of actions should they take if their kids were born in that pre-schoolyear window?
To Dr. Dorflinger, that depends entirely on the individual child and their needs. “I get questions from parents on both sides,” she says. “Some parents, their children were born on September 5, and they’re trying to decide if they should try to have their child start early,” since some school districts allow younger children to test into kindergarten ahead of schedule.
For kids that are younger? “You could talk to their preschool teachers to see how their development is compared to other kids.… If the child has any history of developmental delays, you may want to get an evaluation to help you make an informed decision.”
And then there’s the question of when you should hold a child back. If you decide your child would be better off waiting a year, Dr. Dorflinger thinks sooner might be better than later. “I don’t want to say it’s any kind of policy, but my personal opinion is that if you’re going to hold a child back, do it in preschool.” If they repeat another year of preschool, they might not be as conscious of their peers moving on.
What's Next After Diagnosis
Wherever your child’s birthday falls on the calendar, an ADHD diagnosis isn’t the end of the world. There are many actions you can take to help your kids deal with their individual challenges — and you don’t have to do it alone. “Talk to your school and see if your child qualifies for support, such as with a Section 504 accommodation plan, or services such as working with a special education teacher a couple times a week.” And of course, a pediatric neuropsychology team will be able to give you tools and support the whole way.
Curious about your child's neuropsychology? Here's what a neuropsycholgy evaluation entails, and you can schedule one at any of these AMITA Health locations.
Original source can be found here.
Source: Adventist La Grange Memorial Hospital
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