Attention deficit hyperactivity disorder (ADHD) is characterized by attention difficulties, hyperactivity and impulsivity and is estimated to affect between 3 and 7% of school-age children. In Spain, the prevalence of this disorder in children and adolescents is 6.8%, according to the Spanish Association of Primary Care Pediatrics (AEPAP).
For a child to be considered to have ADHD, these attention and hyperactivity problems must present to an inappropriate degree for their age and interfere with their normal functioning. However, new research led by experts at the University of Nottingham has found that teachers could be attributing signs of children’s age-related immaturity to conditions such as ADHD or autism spectrum disorder (ASD).
The results of the study have been published in the journal European Child and Adolescent Psychiatry and showed that the youngest schoolchildren in a class, with birth dates just before the school entry cutoff, were overrepresented among children who received a diagnosis of ADHD or medication to treat this condition.
“This review shows that adults involved in identifying or raising concerns about a child’s behavior, such as parents and teachers, may be misattributing relative immaturity as ADHD symptoms. It is necessary to take into account the age of the child in relation to his classmates (his ‘relative’ age) when making this type of diagnosis,” explained Kapil Sayal, professor at the University’s Faculty of Medicine and lead author of the article.
The relative age of a child in the classroom, key to detecting ADHD and ASD
Experts analyzed how being one of the youngest children in a class can influence the likelihood of being diagnosed with ADHD or ASD, a complex developmental condition that affects the way a person communicates and interacts. To do this, they carried out detailed searches to identify all the studies written on this topic worldwide.
The researchers reviewed the 32 studies identified. Most of these studies focused on ADHD and two on ASD. The findings confirmed that younger students within the same school year are more likely to be diagnosed with ADHD and receive medication for it, compared to their older peers. The magnitude of this ‘relative age’ effect varied between studies.
As for ASD, the youngest children in a class were also more likely to be diagnosed, but more research is needed because only a small number of studies are available. Interestingly, there was a more noticeable difference in how teachers evaluated these younger children compared to parents.
“Adults involved in identifying or raising concerns about a child’s behavior, such as parents and teachers, may be misattributing relative immaturity as symptoms of ADHD.”
“Teachers play an important role in identifying ADHD symptoms in children. Our findings suggest that younger students in a class may be more likely to rate themselves as having ADHD symptoms than their older peers. It is important that teachers are supported to consider the relative age of a child in the classroom when asking about ADHD,” said Dr. Eleni Frisira, from the Faculty of Medicine and lead author of the study.
Dr. Josephine Holland, another of the paper’s authors, added: “This phenomenon has been demonstrated in research for more than a decade, but knowing about it does not appear to change practice.” The research emphasizes how important it is to consider a child’s age in relation to her peers when evaluating and diagnosing conditions such as ADHD and ASD. This is a key message for health professionals evaluating young children, but also for teachers and parents, when observing and reporting symptoms.
