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Are the youngest boys in a classroom wrongly labeled with ADHD?

Labeling — and medicating — a child who is simply immature can have long-term consequences.

In states that set Sept. 1 as the classroom cutoff date, children with August birthdays may be nearly a year younger — and more immature — than some of their peers.
In states that set Sept. 1 as the classroom cutoff date, children with August birthdays may be nearly a year younger — and more immature — than some of their peers.Read moreistock (custom credit) / Getty Images/iStockphoto

Are our sons being diagnosed with a serious learning disorder just because they are young for their school grade? Are they then being treated with medications, sometimes for many years, because of a mistaken diagnosis? A new report published recently in the New England Journal of Medicine by the health care policy department at Harvard Medical School suggests this may be true.

Rates of diagnosis of attention deficit disorders (ADD or ADHD) in children 5 and younger increased more than 50 percent from 2007 to 2012. In 2016, 5.2 percent — more than one in 20 — of children between ages 2 and 17 were taking medication to treat this diagnosis.

The researchers from Harvard are concerned that this wide use of medication was occurring because the diagnosis of ADD was being applied to children who were just younger and naturally more immature than their classmates, and not because they really had a learning problem.

Many states have arbitrary cutoff dates for starting school — the most common being Sept. 1. Children in those states with September birthdays can be almost a year older than children with August birthdays. The researchers decided to compare the rates of ADD diagnosis in children born in August vs. peers who were almost a year older but in the same grade due to a Sept. 1 cutoff.

They then compared those rates against children with those same birth months in states without a Sept. 1 cutoff. Finally, they compared the rate of ADD diagnosis with the rates of three common diagnoses — asthma, diabetes, and obesity — in the Sept. 1 cutoff states, looking at kids with September vs. August birthdays.

The researchers used a large database of more than 400,000 children and found that in Sept. 1 cutoff states, the youngest students born in August were about 20 percent more likely to be diagnosed with ADD than the oldest students born in September. In states with other cutoffs or no cutoffs for school entry, there was some difference, but it was much less. The researchers then found there was no difference between the diagnosis of the three other diseases according to birth month.

So, children are much more likely to be diagnosed and treated for attention problems because they are young for their grade. Unfortunately, there is pressure to treat these children with medication to manage them since they are often disruptive in class. Once children receive this stimulant medication, they tend to remain on it for a long time.

The diagnosis of ADD is much more common in boys than girls, probably because boys with ADD are generally disruptive while girls with ADD are more likely to become withdrawn. We believe younger girls who are immature for their grade level often are labeled as “slow” or “shy” rather than having ADD.

With inadequate resources in many schools to meet the needs of younger students, we are medicating rather than helping them learn. We often “label” them for life with medical diagnoses that are simply wrong and can harm them.

Teachers tend to believe these labels, and act accordingly. If you have a child who is young for the grade that has been diagnosed, I would suggest discussing with your pediatrician ways to hold off on medication until he or she gets older.

Some ways to manage this behavior can include simply holding your child in preschool or kindergarten for another year. I held my youngest child, a boy and a September birthday, in kindergarten for two years because he had awful fine motor skills. Since he graduated in the top of his class from both Central High School of Philadelphia and the University of Pittsburgh, it was a successful strategy for him. He, like his father, still has mediocre fine motor skills, by the way. Sometimes simply finding a school with smaller classes or two teachers per classroom can help.

Bottom line? Don’t medicate a child for being young and immature.