
Kindergarten enrollment dates affect ADHD diagnosis rates - blasdel
http://news.ncsu.edu/releases/wmsmorrilladhd/
======
zeteo
Well, considering the criteria used to diagnose ADHD, pretty much any kid who
fails to be in exact lockstep with the rest of his/her class runs the risk of
being forced into conformity with psychoactive drugs. Below are the currently
official criteria (from
[http://www.neurosurvival.ca/ClinicalAssistant/scales/dsm_IV/...](http://www.neurosurvival.ca/ClinicalAssistant/scales/dsm_IV/child.html#Attention);
note that these criteria are the ONLY means of diagnosis). I think personally
I failed more than half the things on the list back when I was 6; thank
Goodness they didn't have ADHD diagnostics back then.

-Fails to pay close attention to details or makes careless errors in schoolwork, work or other activities

-Has trouble keeping attention on tasks or play

-Doesn't appear to listen when being told something

-Neither follows through on instructions nor completes chores, schoolwork, or jobs

-Has trouble organizing activities and tasks

-Dislikes or avoids tasks that involve sustained mental effort (homework, schoolwork)

-Loses materials needed for activities (assignments, books, pencils, tools, toys)

-Easily distracted by extraneous stimuli

-Forgetful

-Squirms in seat or fidgets

-Inappropriately leaves seat

-Inappropriately runs or climbs

-Has trouble quietly playing or engaging in leisure activity

-Appears driven or "on the go"

-Talks excessively

-Answers questions before they have been completely asked

-Has trouble or awaiting turn

-Interrupts or intrudes on others

~~~
glhaynes
You left out some qualifiers, though:

\- "Persisting for at least 6 months to a degree that is maladaptive and
immature..."

\- "The disorder impairs school, social or occupational functioning."

While all kids are going to exhibit many/most of the items on the list, most
don't do so in a maladaptive way that's immature relative to their peers and
that impairs their function. So while I'm certain there are inappropriate
diagnoses of ADHD (perhaps disproportionately many, I don't know), I don't
find the list you posted to be an indictment of the DSM-IV criteria.

~~~
patio11
After you start to hit many items on that list, though, some people box you in
and hear impairment without objective evidence of it. I was seen by a
counselor a few times for a witches brew of issues, mostly synonymous with
being shy. She gave me the usual battery and picked up on my pervasive
disorganization -- loses pencils, check, routinely avoids doing homework,
check, not looking intimidating counselor in eye, check. She became convinced,
quote, I would have no academic success without addressing my ADD. My mother
explained that I had had straight As for my entire life and she wrote that off
to "unusually good coping skills for his ADD"

I have one or two friends whose lives were very improved by medication, but
the use of this diagnosis to label and crowd control scares me. And once you
get it, that is the scarlet A. God bless my mother for keeping it out of my
record. Otherwise, every paper I delivered late would have been because I was
ADD. Bored in pre algebra because I had already solved systems of equations in
two variables? ADD. Prefer reading books to group work? ADD.

~~~
zeteo
In the old days, naughty kids would get a spanking, and shy kids would be
lectured by parents. These days, society has decided to go "Clockwork Orange"
on such crimes instead, and the seed of nonconformity is chemically suppressed
in the brain.

------
hartror
Nice.

The first study I've heard of of it's type and it confirms the anecdotal
evidence I've been reading about for years!

Hope there are a few more studies like this around so doctors sit up and pay
attention (pun unintended).

~~~
antics
Let's nip this in the butt before people actually think this is correct. This
study confirms ONLY (edit: [redacted]) that development is affected by what
kids do with themselves. (Duuuuuh.) It does NOT erase the fact that there are
real, empirical differences between the brains of kids with and without ADHD.
For example, it doesn't erase the fact that kids with ADHD do have
demonstrably abnormal cerebral myelination.

ADHD is actually one of the most researched areas of Pediatric Psychiatry, so
before everyone jumps on the Starbucks MD bandwagon, at least do the research.
I don't want to be overly rude about this, and I apologize if I am, but it's
hard to have patience for intellectual whack-a-mole.

~~~
RK
I don't think the article or the parent comment make any claim that ADHD is
not a real disorder.

What the study is saying is that children who are relatively young compared to
their peers are diagnosed with ADHD at a higher rate because their teachers
report them acting in ways "consistent with ADHD" more often than their peers.
The physicians use these reports as part of their evidence when making a
diagnosis. The explanation is that these children are probably just less
mature due to relative age. Their ADHD diagnosis rate is higher than the other
group of children, who are essentially the exact same age, but relatively old
compared to their classmates.

~~~
antics
Since the author of the parent comment expected other users to pick up what
"anecdotal" evidence he was talking about, I took it to mean what it typically
means.

I know what the study is saying. I wasn't responding directly to it.

~~~
hartror
I was talking about over diagnosis which is anecdotally an issue and is the
conclusion the authors of this study drew.

~~~
antics
My mistake then. I apologize.

------
Digital
Most American babies are born around August and September:

<http://abcnews.go.com/Health/Science/story?id=945911>

Which happens to be the cut off date for Kindergarten in many states.

[http://users.stargate.net/~cokids/kindergarten_cut-
off_dates...](http://users.stargate.net/~cokids/kindergarten_cut-
off_dates.htm)

Since most children are born in Aug/September, you'd probably have the most
premature births around then too right?

Premature children are 70% more likely to have ADHD:

<http://www.medicalnewstoday.com/articles/44574.php>

Could it be that a lot of premature children happen to come right before the
early/mid September deadline at the peak of the "birthing season"?

If the relationship between ADHD and prematurity is correct, these children
would face a double whammy...being young for their grade and ADHD.

~~~
antics
That's very insightful, but it's my guess is that it's not as salient as one
would think. Scientists (at least in the lab) will typically use a number of
metrics to measure ADHD, most notably cerebral myelination. ADHD tends to
involve improper development in this regard (i.e., the brain does NOT
myelinate as fast as one would expect). Since the authors posit that younger
children may simply be less mature, my suspicion is that they are talking
about this. And the obvious thing to do would be to correct for what you talk
about (in fact, it's hard to see how they could get into a journal and not do
so).

------
leot
Implicit in the study seems to be the assumption that the development of ADHD
would occur irrespective of developmental context. It could be that always
being the least mature person in one's class helps cause ADHD-like behaviors
(e.g., your peer group's conversation is less interesting, so you act up or
become easily distracted).

Indeed, the whole study is predicated on ADHD being entirely genetic.

------
Marticus
Moral of the story:

Being a kid = ADHD.

Parents need to stop resorting to "parenting in a pill" for their own
inadequacies, or pressure by society to "act" on their child being precisely
that.

That's not to say that ADHD doesn't exist or some-such nonsense, but I believe
this study at least is going somewhat in the right direction to prevent
overzealous diagnosis.

As someone already stated (and with whom I definitely agree) - the test set is
already biased for a large percentage based on age.

Not to mention the pressure that is allowed by teachers. I myself was suddenly
diagnosed after ONE of my teachers decided I was too active and made an
enormous fuss about it. Took the meds for a couple of weeks, lost ~10 pounds
(I'm already a stick), and told them to bugger off.

~~~
miloshh
Doctors are actually very careful not to be overzealous in diagnosis. To meet
the criteria for a real diagnosis, the symptoms must be "excessive, long-term,
and pervasive".

Similarly, not everyone with "blues" is clinically depressed, and not everyone
with unexplained weight loss has cancer... the folk estimates of the
prevalence of these conditions are way overblown.

------
jacquesm
A while ago I wrote this:

[http://jacquesmattheij.com/content/adhd-ritalin-and-
evolutio...](http://jacquesmattheij.com/content/adhd-ritalin-and-evolution)

It's how I feel about the whole ADHD thing and the industry surrounding it.

------
Groxx
An alternate theory based on the same information (and I'd be interested in
others' opinions on this):

Younger kids have different stresses on them than older kids in the same
grade. You don't often hear of the youngest in a class bullying the oldest.
The increase in ADHD diagnoses could also be because they may _be_ more ADHD
prone, and not just because of age.

I just think we need to lose the focus on medication for ADHD. For some:
absolutely. For most: hell no, they just need to learn to manage it. Many of
the most productive people were _clearly_ ADHD, but managed it to at least
some degree.

------
jan_g
>Morrill explains that the study shows that children born just after the
kindergarten cutoff date were 25 percent less likely to be diagnosed as having
ADHD than children born just before the cutoff date.

Anyone care to explain what is "kindergarten cutoff date" ?

EDIT: nevermind, found explanation via
google([http://users.stargate.net/~cokids/kindergarten_cut-
off_dates...](http://users.stargate.net/~cokids/kindergarten_cut-
off_dates.htm))

~~~
studer
The title is somewhat misleading -- it's not like Kindergarten causes ADHD.
The key observation is that if you grab any group of young kids with an age
spread of a full year, "younger children may be mistakenly diagnosed as having
ADHD, when in fact they are simply less mature." You cannot just pretend
they're all at the same stage of development.

You see a similar effect in sports (where again, older kids in the group will
have a big advantage).

~~~
aplusbi
That's not quite it either. The reason Kindergarten is important is because
it's examining kids among their peers. Kids who are on average 6 months
younger than their peers are more likely to be diagnosed with ADHD.

~~~
studer
Yeah, but the Kindergarten cutoff mechanism is irrelevant -- the point is that
if you group young kids by some system that's aligned with the calender year
rather than their actual age, they're not really peers. You'd get the same
effect if you group them by what year they were born in (i.e. used January 1st
as the cutoff date).

~~~
aplusbi
You are correct that these traits would apply to any arbitrary group of young
children with a one year age spread. Kindergarten is an ideal such group, not
only because it encompasses a one year spread of young children, but also
because it is a group that is being observed for signs of ADHD.

But yeah, I'm not trying to say that the title isn't misleading - there is a
correlation between Kindergarten enrollment dates and ADHD diagnosis and
that's it. The article makes this pretty clear but the title does not.

------
drtse4
Luckily, ADHD is still unknown here (Italy, and as far as i know also in the
rest of europe, UK excluded), i wonder what will happen when the gullible
public will discover its existence. ADHD treatments could become even more
popular than homeoteraphy.

EDIT: Report about ADHD awareness in Europe: <http://www.adhs-
deutschland.de/pdf/pdf0007.pdf>

EDIT2: Why the downvotes?

~~~
aplusbi
You are probably being downvoted because you are making the claim that ADHD is
not a real disorder and that treatment for it is comparable to homeopathy.

~~~
numeromancer
I claim: ADHD is not a real disorder and that treatment for it is comparable
to homeopathy.

~~~
Digital
The treatment for ADHD is Adderall. Regardless of if ADHD is real or not,
Adderall is nothing like any Homeopathy treatment.

[http://en.wikipedia.org/wiki/Adderall#Performance-
enhancing_...](http://en.wikipedia.org/wiki/Adderall#Performance-
enhancing_use)

------
mcantor
They did a similar study about sports expertise. Being born at the wrong time
makes you less likely to become a sports star, because the kids who are
nominally your "peers" are physically superior, and it creates the perception
that you are not as skilled. Pretty rough deal.

~~~
Splines
I believe RadioLab touched upon this in their recent podcast "Secrets of
Success". My memory is a bit fuzzy on the details, but IIRC they interviewed
someone who noticed that most hockey teams were made up of players that were
born in the first few months of the year.

------
RK
Here's a link to the authors' presentation:

<http://www.academyhealth.org/files/2010/saturday/morrill.pdf>

------
pvg
Wasn't something like that Malcolm Gladwell's theory for the prevalence of top
Canadian hockey players born in the early months of the year?

~~~
ovi256
Malcolm just rehashed something than any coach or school teacher can tell you:
the smarter, stronger kids are the older.

~~~
pvg
Interestingly, that was one of the parts where he had some sort of numbers
listed so it seems a little unfair to accuse him of rehashing anecdotal
evidence. Not that he's shy about using anecdotal evidence.

------
j_baker
This doesn't prove anything at all. It simply proves that school makes you
more likely to be diagnosed with ADHD, which is hardly shocking. However, the
idea that this implies that kids are getting misdiagnosed is a non sequiter.
How do you know that this isn't a sign that kids aren't getting the medical
attention they need until they get to school.

------
taylorwc
And VC's are accused of being lemmings...looks like doctors get to share that
label.

------
c00p3r
ADHD isn't about age, it is about amygdala sensitivity and compensating
behavioral habits, like shying away, avoiding eye contacts and playing alone
with/in own imagination.

~~~
DerKommissar
This is kind a little off topic but I have a question for you.

I am in the middle of being diagnosed with ADHD (I'm 30). It was actually HN
that prompted me to take action, but that's another story which I can expand
on if anyone is interested.

I haven't read much about ADHD being linked to shyness and introversion,
although I certainly haven't done enough research. But it describes me very
well, could you possibly say a little more or point me to some resources?
Everything I've read talks about impulsiveness and extroversion. I would guess
that shyness and introversion are learned reactions to the impulsiveness.

~~~
c00p3r
I'm not a guru, but I have my own experience, which matches resent publicly
accepted studies.

[http://www.amazon.com/Emotional-Intelligence-Matter-More-
Tha...](http://www.amazon.com/Emotional-Intelligence-Matter-More-
Than/dp/0553375067) is a good starting point.

I think everyone involved (I'm with Asperger's) should study the topic, to be
able to understand (and then make a corrections to) one's own behavior,
instead of believing what other people (including doctors) are saying.

~~~
DerKommissar
I've heard good things about that book, I probably should get a copy.

I didn't word my question very well. I was wondering where you got your
examples. None of the ADHD info I've read says anything about shyness or eye
contact. A child playing by themselves would seem to be the exact opposite of
the popular notion of what a kid with ADHD is like (assuming that they weren't
totally spaced out to the world around them, which you didn't mention).

I'm just interested because that's me. I'm shy, I have minor problems with eye
contact (more like I just have problems relating to new people) and I spent a
large chunk of my childhood playing by myself with Legos and Transformers.
That last bit was one of the reasons my parents said they didn't think I could
have ADHD. "But you used to amuse yourself for hours by yourself. You
certainly were paying attention to THAT."

