Summary: Children younger in a grade are more likely to be diagnosed with ADHD than their older peers. Younger children have an 80% higher risk of being prescribed medication to control ADHD.
Christine Strand Bachmann conducted a study that includes all Norwegian children born between 1989 and 1998, a total of 488,000 people.
The PhD candidate from the Norwegian University of Science and Technology (NTNU) reviewed all the prescriptions the children received from the age of 10 until the age of 23. She compared children born in January or February with those born in November or December.
“We found major differences in ADHD medication prescribing. Children born in November-December had an 80% higher risk of being prescribed ADHD medication, compared to those born in January-February. This finding applies to full-term infants,” says Bachmann.
The researcher thinks this indicates that the youngest children are overmedicated.
“I think the increase in ADHD medication for the younger kids in the cohort has to do with how we organize our education system. Simply put, it seems like we’re treating the more immature kids because we compare to their older classmates, who are a year older,” she says.
“That shouldn’t be the basis for being diagnosed with ADHD. We should expect a child born in November to be less mature than a child born in February of the same year. Of course, we can’t stop diagnosing ADHD and giving medication to those who need it. But what we see here is something else,” she said.
Children born in November or December had an 80% higher risk of being prescribed ADHD medication.
In particular, Bachmann studied children born prematurely, before the 37th week of pregnancy. ADHD medication use is higher in these children than in their full-term peers. The trend for preterm infants is the same as for full-term infants – ADHD medications occur most often in the youngest in class.
“In this sense, the youngest premature infants carry a double burden. The disadvantage of being born late in the year adds to the disadvantages of being premature,” she said.
In addition to being a doctoral candidate in the Department of Public Health and Nursing at NTNU, Bachmann is a pediatrician at St. Olavs Hospital in Trondheim. His study was published in the American research journal Pediatrics.
Medication continued longer
Bachmann found another negative effect for premature infants. Prescriptions for ADHD declined with age in full-term infants, but the same did not hold true for preterm infants who continued to be prescribed ADHD medications at the same level until early adulthood.
“Children born prematurely appear to be more susceptible to the lingering negative effects of being the youngest in school. Perhaps they experience deficiencies in the classroom, in the gymnasium and in social settings, compared to their peers. And perhaps negative experiences settle in the body in a different way and to a greater extent in people born prematurely.
ADHD is characterized by difficulty concentrating, hyperactivity and impulsiveness beyond what is normal for the child’s age.
Some have wondered if the increased drug use was not due to the fact that children born in autumn are simply more hyperactive, impulsive and have greater difficulty concentrating.
However, Bachmann notes that research has shown no such “seasonal variation.”
“We have little reason to believe that parenting is different in families with children born later in the year, or that families with better child-rearing conditions consciously plan to have children early in the year. ‘year,’ she said.
“The results indicate that the school situation is the cause of the overdiagnosis of ADHD. One solution could be for the children in question to wait to start school until the following year,” she said.
Flexible back to school
Bachmann points out that Danish studies, which have a more flexible approach to back-to-school delays, do not show increased use of ADHD medications among younger students in the class. Forty percent of Danish children born in October-December postpone their return to school until the following year.
“In Denmark, parents and kindergartens are involved in assessing a child’s school readiness. I think we could do something similar for our younger children in Norway. Premature babies born later in the year could particularly benefit from this approach. Some of them would actually have started a year later if they had been full term,” she said.
Only for some
Bachmann is not advocating that all “autumn kids” postpone their start to school, which would only shift the issue.
“We believe this could be relevant for the most vulnerable children. They should be assessed individually, focusing on the particular needs of the child. Having the right follow-up and the right support measures for this group is also important, both in the education system and in the health system,” she says.
Some fear that delaying a child’s return to school will stigmatize them. “It’s hard to completely rule that out,” Bachmann says, “but I still think it’s less of a problem than basing our diagnoses on the wrong criteria.” It can be just as, if not more, stigmatizing.
The study also looked at the use of other types of medication, such as depression, anxiety, psychoses and sleeping pills.
“We also saw the same age-related effect for several of these drugs. It is clear that more children born later in the year receive such drugs, compared to those older in the class. This was the case for full-term and premature babies,” says Bachmann.
“But later in adolescence, between the ages of 15 and 23, this inequality disappeared. Those born late in the year in this age group used no more of these drugs than those born early in the same year. This also applied to premature babies,” says Bachmann.
Data for the study was taken from the Norwegian Medical Birth Registry, the Norwegian Prescription Database and Statistics Norway.
The Norwegian Prematurity Association wants a flexible start
Hege Andersson Nordhus, who runs the day-to-day operations of the Norwegian Prematurity Association (Prematurforeningen), said the study shows there is a need for a flexible start to school, especially for premature babies.
“We have repeatedly said that premature children, especially those born before what would be their full school year, should have their start of school postponed. It should definitely be an alternative for children who are clearly not ready for school,” says Nordhus.
“At the same time, I think the school reform of 1997, which introduced compulsory school entry in Norway for six-year-olds, should be reassessed. It seems to be difficult to integrate the game into schools as it was intended for first graders.
Nordhus finds it disheartening to think that the school system causes unnecessary diagnoses to be inflicted on children.
“We can’t stop children from being themselves just because they don’t fit into the school system. It’s time to look at the school system and find out what makes this possible,” says Nordhus.
About this ADHD and psychopharmacology research news
Author: Nancy Bazilchuk
Contact: Nancy Bazilchuk – NTNU
Image: Image is in public domain
Original research: The study will appear in Pediatrics
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