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When starting school, younger children are more likely to be diagnosed with ADHD, study says – Harvard Gazette
"Could a child’s birthday put him or her at risk for an ADHD misdiagnosis? The answer appears to be yes, at least among children born in August who start school in states where enrollment is cut off at a Sept. 1 birth date, according to a new study led by Harvard Medical School researchers.

The findings, published Nov. 28 in The New England Journal of Medicine, show that children born in August in those states are 30 percent more likely to receive an ADHD diagnosis, compared with their slightly older peers enrolled in the same grade.

The rate of ADHD diagnoses among children has risen dramatically over the past 20 years. In 2016 alone, more than 5 percent of U.S. children were being actively treated with medication for ADHD. Experts believe the rise is fueled by a combination of factors, including a greater recognition of the disorder, a true rise in the incidence of the condition and, in some cases, improper diagnosis.

The results of the new study underscore the notion that, at least in a subset of elementary school students, the diagnosis may be a factor of earlier school enrollment, the research team said.

“Our findings suggest the possibility that large numbers of kids are being overdiagnosed and overtreated for ADHD because they happen to be relatively immature compared to their older classmates in the early years of elementary school,” said study lead author Timothy Layton, assistant professor of health care policy in the Blavatnik Institute at Harvard Medical School.

Most states have arbitrary birth date cutoffs that determine which grade a child will be placed in and when they can start school. In states with a Sept. 1 cutoff, a child born on Aug. 31 will be nearly a full year younger on the first day of school than a classmate born on Sept. 1. At this age, Layton noted, the younger child might have a harder time sitting still and concentrating for long periods of time in class. That extra fidgeting may lead to a medical referral, Layton said, followed by diagnosis and treatment for ADHD.

For example, the researchers said, what may be normal behavior in a boisterous 6-year-old could seem abnormal relative to the behavior of older peers in the same classroom.

This dynamic may be particularly true among younger children given that an 11- or 12-month difference in age could lead to significant differences in behavior, the researchers added.

“As children grow older, small differences in age equalize and dissipate over time, but behaviorally speaking, the difference between a 6-year-old and a 7-year-old could be quite pronounced,” said study senior author Anupam Jena, the Ruth L. Newhouse Associate Professor of Health Care Policy at Harvard Medical School and an internal medicine physician at Massachusetts General Hospital. “A normal behavior may appear anomalous relative to the child’s peer group.”

Using the records of a large insurance database, the investigators compared the difference in ADHD diagnosis by birth month — August versus September — among more than 407,000 elementary school children born between 2007 and 2009, who were followed until the end of 2015.

In states that use Sept. 1 as a cutoff date for school enrollment, children born in August had a 30 percent greater chance of an ADHD diagnosis than children born in September, the analysis showed. No such differences were observed between children born in August and September in states with cutoff dates other than Sept. 1.

For example, 85 of 10,000 students born in August were either diagnosed with or treated for ADHD, compared with 64 students of 10,000 born in September. When investigators looked at ADHD treatment only, the difference was also large — 53 of 10,000 students born in August received ADHD medication, compared with 40 of 10,000 for those born in September.

Jena pointed to a similar phenomenon described in Malcolm Gladwell’s book “Outliers.” Canadian professional hockey players are much more likely to have been born early in the year, according to research cited in Gladwell’s book. Canadian youth hockey leagues use Jan. 1 as a cutoff date for age groups. In the formative early years of youth hockey, players born in the first few months of the year were older and more mature, and therefore likelier to be tracked into elite leagues, with better coaching, more time on the ice, and a more talented cohort of teammates. Over the years this cumulative advantage gave the relatively older players an edge over their younger competitors.

Similarly, Jena noted, a 2017 working paper from the National Bureau of Economic Research suggested that children born just after the cutoff date for starting school tended to have better long-term educational performance than their relatively younger peers born later in the year.

“In all of those scenarios, timing and age appear to be potent influencers of outcome,” Jena said.

Research has shown wide variations in ADHD diagnosis and treatment across different regions in the U.S. ADHD diagnosis and treatment rates have also climbed dramatically over the last 20 years. In 2016 alone, more than 5 percent of all children in the U.S. were taking medication for ADHD, the authors noted. All of these factors have fueled concerns about ADHD overdiagnosis and overtreatment.

The reasons for the rise in ADHD incidence are complex and multifactorial, Jena said. Arbitrary cutoff dates are likely just one of many variables driving this phenomenon, he added. In recent years, many states have adopted measures that hold schools accountable for identifying ADHD and give educators incentives to refer any child with symptoms suggesting ADHD for medical evaluation.“The diagnosis of this condition is not just related to the symptoms, it’s related to the context,” Jena said. “The relative age of the kids in class, laws and regulations, and other circumstances all come together.”

It is important to look at all of these factors before making a diagnosis and prescribing treatment, Jena said.

“A child’s age relative to his or her peers in the same grade should be taken into consideration and the reasons for referral carefully examined.”

Additonal co-authors include researchers from the Department of Health Care Policy, the National Bureau of Economic Research and the Department of Health Policy and Management, and Harvard T.H. Chan School of Public Health."
adhd  children  schools  schooling  schooliness  2018  psychology  health  drugs  diagnosis  behavior 
november 2018 by robertogreco
ADHD Diagnoses? Why the Youngest Kids in Class Are Most Affected | MindShift | KQED News
"By the time they’re in elementary school, some kids prove to be more troublesome than others. They can’t sit still or they’re not socializing or they can’t focus enough to complete tasks that the other kids are handling well. Sounds like ADHD. But it might be that they’re just a little young for their grade.

Studies done in several countries including Iceland, Canada, Israel, Sweden and Taiwan show children who are at the young end of their grade cohort are more likely to get an ADHD diagnosis than their older classmates.

The youngest students were between 20 percent and 100 percent more likely to get the diagnosis or ADHD medication than were the oldest students in the cohort, says Helga Zoëga, an epidemiologist at the University of Iceland who worked on the Icelandic and Israeli studies.

The most recent evidence comes from Taiwan, where an analysis showed the youngest students in a grade were roughly 75 percent more likely to get a diagnosis of attention deficit hyperactivity disorder than the oldest ones. It was published Thursday in the Journal of Pediatrics.

Kids are generally 6 years old when they start first grade. A scant few months can span a lot of mental growth at this age.

“Within that age range there is a huge difference in developmental and social and emotional maturity,” says Dr. Adiaha Spinks-Franklin, a developmental and behavioral pediatrician at Texas Children’s Hospital who was not involved in any of the studies. “A 6-year-old is just not the same as a 7-year-old.”

And yet a first-grader might stand shoulder to shoulder with another student nearly 12 months her elder. “And the way we diagnose ADHD is we talk to the parent about the child’s behavior, and we mail the teacher questionnaires,” Spinks-Franklin says. “The teacher will be comparing the child’s behavior relative to other children in the class.”

That could lead to a mistaken diagnosis of ADHD. Zoëga says the younger the student, the greater the likelihood that student will receive an ADHD diagnosis or medication. “If you look at the [students’ age] just month by month, you’ll see that the likelihood increases with each month,” she says.

Zoëga says the only country studied so far where the relative age of young children doesn’t seem to have an effect on ADHD diagnosis is Denmark, where there’s more flexibility for when children enter school. So this could be because Danish parents with kids who are born just before the cutoff date for grade school entry choose to hold their offspring back one year.

But if you’re an American parent with children born in the months of December, November or October, that doesn’t mean a child should repeat a grade for the fear their relative youth will handicap them, Spinks-Franklin says. “There is absolutely no data to support grade repetition for maturity issues. Children who repeat a grade are at a higher risk of dropping out of high school. They are more likely to be bullied.” If the child does have ADHD or another disorder, she notes, repeating a grade will not fix the disorder.

And relatively younger children diagnosed with ADHD might really have ADHD, says Dr. Mu-Hong Chen, a psychiatrist at Taipei Veterans General Hospital. “There’s a potential for the harm of overdiagnosis and overprescription.” That would unnecessarily subject kids to unwanted side effects of stimulant medication and the stigma of the disorder. But perhaps older, more mature-looking students are just being underdiagnosed and not get help they might need, he says. The studies didn’t look into that.

The best thing for worried parents to do is just give the kids a chance to grow up, Chen says. In most of the studies done on relative age and ADHD, the difference in diagnosis rates vanished by the time the students reached their teenage years. “I think we have to wait for a while, he says. “We have to have more time to evaluate their behavior, attention and brain development.”

The data also mean that doctors should take the child’s relative age into account when diagnosing ADHD, Zoëga says. “It has a sensible solution. Just treat the individual according to his or her age."
adhd  age  children  diagnosis  2016  taiwan  canada  us  israel  iceland  sweden  denmark  adiahaspinks-franklin  attention  labels 
march 2016 by robertogreco
PLOS Medicine: Medicine Goes to School: Teachers as Sickness Brokers for ADHD
"Over the last twenty years, attention deficit hyperactivity disorder (ADHD) has emerged as a disorder of importance in childhood. Prescription of psychostimulants for ADHD escalated in many countries through the 1990s. Between 1990 and 1995, prescriptions of methylphenidate for young people increased 2.5-fold in the US [1], and 5-fold in Canada [2]. In New South Wales, Australia, rates of treatment for children in 2000 were nine times those in 1990 [3].

ADHD joins dyslexia and glue ear as disorders that are considered significant primarily because of their effects on educational performance. Medicalising educational performance can help children receive specialised medical and educational services; at the same time it can lead to them receiving medications or surgical therapies which may have short-term and long-term ill effects.

In the case of ADHD, there has been a complex, often heated debate in the public domain about the verity of the illness and the personal cost-benefit ratio of treatment with psychostimulant medication [4–6]. Much of the polemic for and against psychostimulants is concerned with the part played by doctors, the prescribers of medication, in diagnosing or discounting ADHD. ADHD is, however, a disorder of educational performance, and so teachers have a critical role in advocating for the illness, and its medical treatment. This essay explores the roles of teachers as brokers for ADHD and its treatment, and the strategies used by the pharmaceutical industry to frame educators' responses to ADHD."
education  schools  teaching  teachers  2006  adhd  medication  diagnosis  drugs  christinephillips  pharmaceuticals  business  performance 
september 2014 by robertogreco
Defining My Dyslexia - NYTimes.com
"Fortunately, humor and hard work proved a good strategy. Also helpful were my crafty parents. They often read out loud to me and, noticing my passion for fantasy novels, would stop at the most exciting point in a chapter — then leave the book in case I wanted to read by myself. It wasn’t long before I was sneaking paperbacks into study hall.

Though slow out of the gate — I couldn’t read fluently until 13 — I went to Yale, then medical school at Stanford, and I published two fantasy novels with disabled heroes (think Harry Potter and the Special-Ed Classroom). At every step, I used my diagnosis to my advantage, arguing that I had succeeded despite being dyslexic. It helped me stand out.

Now a growing body of research suggests that I was unintentionally lying."



"The conference’s organizers made a strong case that the successes of the attending dyslexic luminaries — who ranged from a Pulitzer-winning poet to a MacArthur grant-winning paleontologist to an entrepreneur who pays a dozen times my student loans in taxes every year — had been achieved “not despite, but because of dyslexia.”

It was an exciting idea. However, I worried that the argument might be taken too far. Some of the attendees opposed the idea that dyslexia is a diagnosis at all, arguing that to label it as such is to pathologize a normal variation of human intellect. One presenter asked the audience to repeat “Dyslexia is not a disability.”

Not a disability? My years of functional illiteracy suggest otherwise. Today’s educational environment exacerbates dyslexic weaknesses. Schools misidentify poor spelling and slow reading as a lack of intelligence; typically diagnose the condition only after students have fallen behind; and too often fail to provide dyslexic students with the audio and video materials that would help them learn. Until these disadvantages are removed, “disability” most accurately describes what young dyslexics confront.

At the heart of the conference was the assumption that a group of advocates could alter the definition of dyslexia and what it means to be dyslexic. That’s a bigger idea than it might seem. Ask yourself, “What role should those affected by a diagnosis have in defining that diagnosis?” Recently I posed this question to several doctors and therapists. With minor qualifications, each answered “none.” I wasn’t surprised. Traditionally, a diagnosis is something devised by distant experts and imposed on the patient. But I believe we must change our understanding of what role we should play in defining our own diagnoses."



"I believe that scientific evidence and social observation will continue to show that defining dyslexia based solely on its weaknesses is inaccurate and unjust, and places too grim a burden on young people receiving the diagnosis. A more precise definition of dyslexia would clearly identify the disabilities that go along with it, while recognizing the associated abilities as well. If the dyslexic community could popularize such a definition, then newly diagnosed dyslexics would realize that they, like everyone else, will face their futures with a range of strengths and weaknesses."
emilyhall  blakecharlton  dyslexia  disability  disabilities  2013  susansontag  diagnosis  reading  writing  schooling  education  parenting 
may 2013 by robertogreco
Diagnosis - Human - NYTimes.com
"I fear that being human is itself fast becoming a condition. It’s as if we are trying to contain grief, and the absolute pain of a loss like mine. We have become increasingly disassociated and estranged from the patterns of life and death, uncomfortable with the messiness of our own humanity, aging and, ultimately, mortality.

Challenge and hardship have become pathologized and monetized. Instead of enhancing our coping skills, we undermine them and seek shortcuts where there are none, eroding the resilience upon which each of us, at some point in our lives, must rely."
psychology  grief  depression  add  adhd  diagnosis  2013  tedgup  psychiatry  medicine  mortality  aging  humans  beinghuman  resilience  pharmaceuticals  pain  shortcuts  life  living  society  us  coping 
april 2013 by robertogreco
Why Anti-Authoritarians are Diagnosed as Mentally Ill | Mad In America
"Some activists lament how few anti-authoritarians there appear to be in the United States. One reason could be that many natural anti-authoritarians are now psychopathologized and medicated before they achieve political consciousness of society’s most oppressive authorities.



Americans have been increasingly socialized to equate inattention, anger, anxiety, and immobilizing despair with a medical condition, and to seek medical treatment rather than political remedies. What better way to maintain the status quo than to view inattention, anger, anxiety, and depression as biochemical problems of those who are mentally ill rather than normal reactions to an increasingly authoritarian society."

…authoritarians financially marginalize those who buck the system, they criminalize anti-authoritarianism, they psychopathologize anti-authoritarians, and they market drugs for their “cure.”"
despair  inattention  xanax  drugs  adderall  overdiagnosis  diagnosis  policy  illegitimacy  saulalinsky  defiance  hyperactivity  children  youth  teens  russellbarkley  impulse-control  impulsivity  disruption  behavior  oppositiondefiantdisorder  odd  trust  skepticism  opression  marginalization  deschooling  unschooling  education  schooliness  schools  cv  brucelevine  medication  depression  add  adhd  criticalthinking  society  control  anxiety  anger  compliance  attention  pathology  2012  anti-authoritarians  authoritarianism  authority  psychiatry  politics  health  psychology  anti-authoritarian  problemswithauthority  issueswithauthority 
march 2012 by robertogreco
Is there an artist in the house? - The Irish Times - Sat, Oct 29, 2011
"It’s not just patients who benefit from paintings: medical students who study art can increase their observational and diagnostic skills. GEMMA TIPTON examines the relationship between art and medicine, and probes a pioneering course at Trinity College Dublin"
art  arttherapy  research  medicine  health  2011  yale  trinitycollegedublin  observation  diagnosis  noticing  via:irasocol 
october 2011 by robertogreco
What diversity means « Snarkmarket
"…if you’re broke or have less education, your child’s more likely to go undiagnosed/misdiagnosed & be treated as slow or mentally retarded…even if you get the “right” diagnosis, the therapies offered & your ability to take advantage of them will vary wildly depending on your resources. Maybe especially time.

…just as autism stories overwhelmingly focus on children, not adults, they also overwhelmingly focus on the wealthy, not the poor…& the link between autism & poverty is extraordinary once a child becomes an adult — what “independence” means in that context is very different.

This is also to say that while all these additional considerations are important, fuck that shit. Because autism does cut across class, race, gender, sexual identity & physical ability, etc…because of that, it changes what we mean by diversity, what kinds of diversity count, what diversity we ought to care about, & how we think about all of these issues of identity & privilege taken all together."
autism  aspergers  timcarmody  2011  poverty  class  race  diversity  gender  wealth  independence  childhood  parenting  adulthood  privilege  identity  education  diagnosis 
september 2011 by robertogreco
Bipolar kids: Victims of the 'madness industry'? - health - 08 June 2011 - New Scientist
"Spitzer grew up to be a psychiatrist…his dislike of psychoanalysis remaining undimmed…then, in 1973, an opportunity to change everything presented itself. There was a job going editing the next edition of a little-known spiral-bound booklet called DSM - the Diagnostic & Statistical Manual of Mental Disorders.

DSM is simply a list of all the officially recognised mental illnesses & their symptoms. Back then it was a tiny book that reflected the Freudian thinking predominant in the 1960s. It had very few pages, & very few readers.

What nobody knew when they offered Spitzer the job was that he had a plan: to try to remove human judgement from psychiatry. He would create a whole new DSM that would eradicate all that crass sleuthing around the unconscious; it hadn't helped his mother. Instead it would be all about checklists. Any psychiatrist could pick up the manual, & if the patient's symptoms tallied with the checklist for a particular disorder, that would be the diagnosis."
children  psychology  health  2011  add  adhd  bipolardisorder  psychiatry  dsm  jonronson  robertspitzer  overdiagnosis  mania  pharmaceuticals  psychoanalysis  checklists  healthcare  mentalillness  mentalhealth  medicine  treatment  diagnosis  ptsd  autism  anorexia  bulimia  society  conformity  hyperactivity  childhood  parenting 
june 2011 by robertogreco
CureTogether
"CureTogether helps people anonymously track and compare health data, to better understand their bodies, make more informed treatment decisions and contribute data to research."
activism  crowdsourcing  healthcare  medicine  opensource  education  health  curetogether  diagnosis  ehealth  aggregator  collaboration  community  socialsoftware  statistics  visualization  socialnetworking  tracking  research  patients  data 
july 2010 by robertogreco

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