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who were born late in the school year and so are almost 12 months younger than
their oldest classmates are more likely to be diagnosed and given medication
like Ritalin for attention deficit hyperactivity disorder, it was found.
are being 'inappropriately labelled and treated' the authors said.
caution should be given to making the diagnosis in order to prevent children
from being given potentially harmful medicines without justification, they
are thought to be around 1.7m people with attention deficit problems in Britain
with between three and seven per cent of school age children affected.
is no data collected on how many children in Britain are on drugs for the
problem but in 2010 there were over 850,000 prescriptions dispensed for
medicines to treat the condition in England and Wales at a cost of almost £44m.
study was conducted on children in British Columbia in Canada where the school
year coincides with the calender year.
was found that children born in December, so the youngest in their school year,
were 40 per cent more likely to be diagnosed and almost 50 per cent more likely
to be treated for ADHD than children born in January, the start of the school
Britain this would correspond to children born in August compared with those
born in mid to late September.
is well known that the youngest children in the school year tend to struggle
with academic performance, behaviour and sport, in what is known as the
relative age effect.
findings were published in the Canadian Medical Association Journal.
author Richard Morrow, University of British Columbia, said: "The relative
age of children is influencing whether they are diagnosed and treated for ADHD.
study suggests younger, less mature children are inappropriately being labelled
and treated. It is important not to expose children to potential harms from
unnecessary diagnosis and use of medications."
side effects of ADHD drugs can include sleep disruption, increased risk of
heart problems and slower growth rates. As well, younger children who have been
labelled ADHD may be treated differently by teachers and parents, which could
lead to negative self-perception and social issues, the authors said.
and psychiatrist Jane Garland, University of British Columbia and BC Children's
Hospital, said: "This study raises interesting questions for clinicians,
teachers and parents.
need to ask ourselves what needs to change. For example, attention to relative
age of children for their grade and more emphasis on behaviour outside the
school setting might be needed in the process of assessment."
study investigated almost one million schoolchildren in British Columbia over
ten years who were between the age of six and 12.
the prevalence of ADHD diagnosis and treatment is about three times higher in
boys than girls, the effect of relative age applied to both.
born in December were 70 per cent more likely to be diagnosed with ADHD than
girls born in January.
researchers wrote in the journal: "The potential harms of overdiagnosis
and overprescribing and the lack of an objective test for ADHD strongly suggest
caution be taken in assessing children for this disorder and providing
in Britain said the findings could mean that ADHD was not not being picked up in
the older children in the year group as well as or instead of too many
diagnoses being made in the younger children.
Dave Coghill, Reader in Child and Adolescent Psychiatry, at University of
Dundee, said: "In a culture where ADHD is over diagnosed it may be that
relative age increases the likelihood that younger children in a year will be
cultures where there is under recognition of ADHD such as the UK and Canada the
opposite may occur with there being a more appropriate recognition in younger
children with under recognition of ADHD in the older children in a year.
researchers suggest that this relative age effect is likely to be driven by the
teacher. In the UK parents are always intimately involved in the assessment for
ADHD and in almost all cases it is them that provide the key information that
drives the assessment process. As a consequence it is possible that the UK will
be less prone to these relative age effects."
Liz Didcock, mental health lead at the Royal College of Paediatrics and Child
Health, said: "This paper adds an interesting perspective on the diagnosis
and treatment of ADHD in children.
reminds us of the importance of understanding behaviour in its context,
particularly in relation to the influence of parental and teacher expectations.
potential 'over-medicalisation' of what can be considered 'normal' childhood
behaviour is an obvious concern. It is vital that all clinicians from
Paediatric and Child and Adolescent Mental Health Services teams are skilled in
the assessment of children's development, including their social and emotional
must take into account biological, social and psychological factors before a
diagnosis is made and appropriate treatment is prescribed."