Your child’s risk of having ADHD or an autism diagnosis depends on his age compared to his classmates, scientists say

BEING one of the youngest children in the class means your child will be more likely to receive a diagnosis of ADHD or autism, scientists say.

Younger children who have a birthday just before the school start date are more likely to be diagnosed with the disease than their older peers, researchers from the University of Nottingham have found.

Teacher and parent assessments often form an important part of assessments for attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD), researchers said.

Interviews are usually conducted with a suspected patient’s friends, family, and teachers to assess the severity of symptoms.

The fact that more young students are receiving an ADHD diagnosis or medication for the condition could mean that teachers are confusing age-related signs of immaturity with the behavioral condition, they claimed.

People with ADHD may have difficulty concentrating, appear restless, and act on impulse.

Meanwhile, ASD is an umbrella term for a wide range of neurodevelopmental conditions that affect the way people interact and communicate with each other.

Senior author Professor Kapil Sayal, from the Faculty of Medicine at the University of Nottingham, said: “This analysis shows that adults involved in identifying or raising concerns about a child’s behavior – such as parents and teachers – may inadvertently misattribute relative immaturity as symptoms of ADHD.

“The child’s age relative to their peers (their ‘relative’ age) needs to be considered when making this type of diagnosis.”

THE ‘RELATIVE AGE’ EFFECT

The researchers carried out an extensive database search to identify studies written on the topic – they narrowed down the pool up to 32 studies to review.

Most of these studies focused on ADHD, while two dealt with the diagnosis of ASD.

The findings confirmed that the youngest students in the school year are more likely to be diagnosed with ADHD and receive medication for it, compared to their older peers.

According to the researchers’ analysis, the youngest in the class were 38% more likely to receive an ADHD diagnosis and 28% more likely to be prescribed ADHD medication.

The scale of this “relative age” effect varied across studies.

“Overall, our results show that teacher ratings of ADHD-related symptoms are more influenced by relative age, in contrast to parent ratings,” the study authors said.

This difference between parent and teacher reports of ADHD symptoms may be influenced by several factors, the researchers noted.

“The higher demands and limited flexibility of the school environment, the presence of a large number of peers with whom to compare the child, and the less close and shorter duration of the relationship between teacher and child, compared with parent and child, can cause this observation bias. in teacher evaluations.

“Parents may also be subject to social desirability biases toward their children, potentially overlooking certain behaviors.

“Teachers’ perceptions and susceptibility to ageism can impact a child’s referral and diagnosis process.

“Teachers are more likely to identify ADHD symptoms in younger children during the school year and assign higher scores on symptom scales, which are then taken into consideration by clinicians when making a diagnostic assessment.”

The study authors also noted that the opposite can also happen, where teachers miss ADHD symptoms in older children due to comparison with their younger, less mature peers.

The effect of “relative age” on the diagnosis and treatment of ADHD was most pronounced in the youngest children attending elementary school and gradually diminished as children reached adolescence.

“This observation suggests that actual age and developmental expectations significantly influence the identification of ADHD,” the study authors noted.

For ASD, both studies on the topic found that the youngest children in a class were also more likely to be diagnosed with the condition compared to their older peers.

The researchers said: “The reasons behind this are unclear, but it is possible that the immature speech or social skills of relatively younger children could be interpreted as traits of autism by referrers.”

But they stressed that more research is needed into the effect of “relative age” on ASD diagnoses, as there are only a small number of studies available.

Dr Eleni Frisira, from the Faculty of Medicine and lead author of the study, said: “Teachers play an important role in identifying ADHD symptoms in children.

“Our findings suggest that they may be more likely to rate younger students in a class as having ADHD symptoms than their older peers.

“It is important that teachers are supported in considering the relative age of a child in the classroom when ADHD is being addressed.”

Dr Josefina NetherlandsAnother of the authors added: “This phenomenon has been demonstrated in research for over a decade, but knowledge of it does not appear to be changing practice.”

The study team said their research emphasizes the importance of considering a child’s age in relation to their classmates when evaluating and diagnosing conditions such as ADHD and ASD.

This is an important message for healthcare professionals who assess young children, but also for teachers and parents when they observe and report symptoms, they added.

“Teacher ratings form an important part of ADHD assessments, and therefore it is important to understand the effect of relative age on their perception of normative or immature behaviors,” the researchers wrote in the study published in the journal. European Child and Adolescent Psychiatry.

“It will be useful to incorporate this phenomenon (the ‘relative age’ effect) into clinical guidelines and training for health professionals specializing in neurodevelopmental disorders, as well as teachers, to help them think critically about children’s symptoms during their assessments.”

GROWING AWARENESS

It is estimated that 2.6 million people in the UK have ADHD, almost 700,000 of them children.

Symptoms tend to be noticed at an early age and may become more noticeable when a child’s circumstances change, such as when they start school.

Most cases are diagnosed when children are under the age of 12, but sometimes it is diagnosed later in childhood or even adulthood.

ADHD can be categorized into two main types – inattention and hyperactivity.

Although most people experience symptoms of both, this is not always the case.

In adults, hyperactivity is less common and the symptoms are more subtle, making them more difficult to identify, for example.

A recent think tank report warned that increased awareness of the disease has left people in the UK waiting up to two years for an assessment.