
Youngest Kids in Class at Higher Risk of ADHD Diagnosis - daegloe
http://www.npr.org/sections/health-shots/2016/03/10/469929700/a-late-birth-date-could-boost-the-risk-of-an-adhd-diagnosis
======
Spooky23
It's a great illustration of the lack of rigor around this stuff.

My college provided significant benefits to ADHD diagnosed students. Rather
than take finals in stadium seating, you got a personal, air conditioned
office, received unlimited time and could use reference material.

A few of my friends found a "Do you need Ritalin" quizzes in a magazine, went
to a doc-in-the-box and got the diagnosis. They sold the Ritalin and got
better grades.

~~~
rtpg
This is very belittling to the amazing amount of research that goes into ADHD.

Many studies have been done with regard to treatment and diagnosis, and at
this point we are better able to treat ADHD than we are able to treat
depression

There might be a bit of an over-treatment culture (I'm not sure, though), but
the science is extremely well developed and tested

~~~
nerfhammer
There's a big difference between the rigor of the question of whether ADHD is
a real thing or that of ADHD diagnoses being reliable in practice.

There are huge regional variations to rates of ADHD diagnosis. For example,
it's 3.5x higher in North Carolina vs. Nevada. There doesn't seem to be any
reason why this would be given that ADHD is believed to be almost entirely
genetic.

[http://www.ncbi.nlm.nih.gov/pubmed/19648195](http://www.ncbi.nlm.nih.gov/pubmed/19648195)

[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4473855/](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4473855/)

~~~
Throwaway23412
I had to take a long questionaire, a computer program testing focus/reactions,
and a comprehensive IQ test before I was diagnosed with severe impairment from
ADHD a year ago. In fact, I was originally diagnosed with ADHD after taking a
comprehension IQ test to get accepted to kindergarten at a magnet school, but
my parents figured it was just a phase and never did anything about it.

It's frustrating to think about the lack of consistency in ADHD diagnosises
and treatment. In /r/ADHD (ADHD subreddit), some people get diagnosed after a
few minutes of talking with a psych. Others live in countries where ADHD isn't
even considered a thing. Many went through the same rounds of tests that I
did. Even after diagnosis, I had the same problem as several /r/ADHD members
in that the first psychiatrist I went to looked at my psychologist's diagnosis
and was like "Meh, you got decent grades in high school anyway. You're just
stressed/tired/depressed/etc." Wasted my time with four months on four
different depression medications before I got a second opinion.

~~~
jwdunne
My (UK) diagnosis was an endurance test. It took 2 years of consultations,
appointments and referrals to get a diagnosis. Of course, this is the NHS so
everything non-life threatening takes longer but if there was no impact day to
day there would be no motivation for the many hoops and consultations. Due to
the nature of the beast, many who do suffer could drop out of such a marathon
because, for example, their referral form had fallen underneath a filing
cabinet due to a chaotic office and thus forgotten about by both sides
(happened to me - called up because after 3 months after prodding by my mrs.
She was going insane).

Overdiagnosis is almost a cliché. This might happen in some places. There are
just as many that the diagnosis is painful and thorough.

------
sjclemmy
This doesn't surprise me. My youngest is a July baby and was constantly in
trouble up to around the age of 11, for being a bit silly and immature. We, as
parents, got to realise this and would often say, "If he was in the year
below, his behaviour wouldn't be unusual."

------
bsder
ADHD -- middle class children with behaviors that annoy elementary school
teachers

If they're poor, you call them thick. If they're rich, you get them a tutor.
If they're middle class, you medicate them.

~~~
ThrustVectoring
Or middle class children with behavior that annoys their parents.

Well, it's both that and a legitimate medical condition. The problem is that
the medication that works for ADHD also works for suppressing childish
behavior that authority figures find annoying. Everyone involved are fallible
humans that respond to incentives, and often the incentives align for
teachers, parents, and psychiatrists to medicate children into compliance.

~~~
crapolasplatter
Or kids who actually have a problem. ADHD is not only hyper activity. Many
have an attention disorder with no hyper activity issue.

Actually those are the most at risk because they seldom stand out or are
called out for having a problem ,except with their grades.

------
damla
The thing is, the youngest child is not just taken to the specialists with the
suspect of ADHD, it really is diagnosed with ADHD. Gifted children also
diagnosed frequently with ADHD, they even have a name for it, twice
exceptional. The ADHD comes to me like a deviation from the social standarts.
What's normal, and what's not. For most children, ADHD is not a cause of worry
until school age. The normal student is defined by current education system.
ADHD comes to me like being gay, you are not sick or nothing's wrong with you,
just different than the average, and have problems with fitting in the current
social standarts.

------
drpgq
Is there anywhere that divides up their younger grade classes into who is born
in the first half of the educational year and who is born in the second half?
That could help somewhat although the teacher of the second half kids probably
is going to have a tough time.

~~~
DanBC
England has very recently allowed summer born children to defer.

[https://www.gov.uk/government/uploads/system/uploads/attachm...](https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/389448/Summer_born_admissions_advice_Dec_2014.pdf)

[http://www.theguardian.com/education/2015/sep/08/parents-
of-...](http://www.theguardian.com/education/2015/sep/08/parents-of-summer-
born-children-get-right-to-delay-start-of-school)

It's a bit confusing.

~~~
jeffwass
I don't see how that solves the issue, as it just moves (w/ optionality) the
cutoff from 1st Sep back a few months. Meaning if everybody opted in, the
spring kids would become the youngest in class, instead of late summer kids.

Edit - I see this helps ensure kids don't start Reception (ie, the equiv of
Kindergarten in the US) too early. But it also shifts the point of youngest
back a few months, so in later years, the kids born in spring season will be
the least mature in class, and judged in this regard relative to the others.

~~~
ryandrake
Exactly, it just changes which group of students are in the "too early" group.
When I start a new job, they don't say, "Well, your job offer was made on
12-May, but our fiscal year starts in April, so you'll have no choice but to
wait until 1-Apr to start work." The solution likely involves abandoning the
model of childhood education consisting of fixed, arbitrarily-long cycles
beginning on arbitrarily-chosen dates, progressing linearly. But when you
leave it up to voters, abandoning "The Way Things Were Always Done" is about
as impossible as curing cancer.

------
peleroberts
Once upon a time no such reference letters existed, you had slow kids, fast
kids and middle of the road kids. All of a sudden kids are getting the labels
as if they belong on supermarket shelves. An old schooler would say there's a
cure for that, either bad parenting, not eating the right foods or balanced
diet, bad sleeping pattern. Or basically some parents just like to get extra
government money to support their own needs. (I know a family that's done this
- and it's disgusting) What's next?

------
BurningFrog
This is just one of several disadvantages for kids born towards the end of the
year.

One logical solution is to have two classes per year. Kids born Jan-June start
in the fall, the rest the following spring.

~~~
RhysU
Another, deliberately distasteful, one would be to incentivize reproducing to
ensure one's family doesn't run afoul of the cutoffs.

~~~
tlarkworthy
That's Valentine's day, hence the September skew ...

~~~
phillc73
Or move to the southern hemisphere where the school year matches the calendar
year.

------
im3w1l
> the difference in diagnosis rates vanished by the time the students reached
> their teenage years

Makes me think this isn't that big a deal

------
eruditely
"By adolescence, these chronic and cumulative experiences with school failure,
learning disorders, school misbehavior, and sometimes lower intelligence begin
to generate other adverse educational outcomes. For instance, the academic
outcome of the hyperactive (ADHD) adolescents was considerably poorer in
Barkley and Fischer’s Milwaukee follow-up study at the teen follow-up than
that of the typically developing adolescents followed concurrently. __At least
three times as many hyperactive (ADHD) children had failed a grade (29.3 vs.
10.0%) or been suspended (46.3 vs. 15.2%) or expelled (10.6% vs. 1.5%)
(Fischer, Barkley, Edelbrock, & Smallish, 1990). __Others have also identified
such high educational risks in longitudinal studies dating back as much as 40
years (Ackerman, Dykman, & Peters, 1977; Mendelson, Johnson, & Stewart, 1971;
Stewart, Mendelson, & Johnson, 1973; Weiss, Minde, Werry, Douglas, & Nemeth,
1971; Wilson & Marcotte, 1996). In another sample of clinic-referred teenagers
with ADHD, a similar risk for school retention and suspension was documented
(Barkley, Anastopoulos, Guevremont, & Fletcher, 1991). __Almost 10% of the
hyperactive sample followed into adolescence had quit school at this follow-up
point in the Milwaukee Study, compared to none of the normal sample
__(Barkley, Fischer, et al., 1990). Fischer and colleagues (1990) also found
that the levels of academic achievement on standard tests were significantly
below normal on tests of math, reading, and spelling, falling toward the lower
end of the normal range (standard scores between 90 and 95). " (Quoted from
the 4th edition)

ADHD IS real and really bad and it goes away on meds, your brain is
underdeveloped 30% compared to your peers, in exec functioning. So if you're
18, you're at 12.5 on average. It's called Barkley's 30% rule.

It's serious but responds great to meds, STOP believing the anti-adhd hype.

------
conceit
Backronym to Age Dependent H. [Age] Deficiency/Disorder?

------
tibbetts
This article fails to admit the possibility of mistaken non-diagnosis caused
by the same phenomenon. It would be interesting to see the relationship
between being old for grade and late (eg adult) diagnosis of ADHD.

~~~
nommm-nommm
What? Yes, it does mention this.

"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."

------
cheez
This is some Malcolm Gladwell-level stuff... Damn.

~~~
askafriend
Can you expand on your criticism? I've heard people offhandedly criticize
Gladwell's work but I've never really gotten a full explanation of why they
dislike his style.

~~~
cheez
I can't, because my neurons misfired. I was thinking freakonomics :)

------
fweespee_ch
> 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.

> "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 is disturbing. It is clear they aren't taking age into account except at
the broadest levels when handing out ADHD medication.

This rings dangerous close to "That kid is too much trouble, just medicate
them and move on."

~~~
eruditely
ADHD is a developmental disorder, they're 30% behind their peers anyways in
exec functioning(front part of brain) in development, it's called "Barkley's
30% rule" It's very severe and bad but goes away if you just take your meds.

So if you're 18, you're when people were at 12.5 in your ability to perceive
time/planning. It's worse than having low intelligence, EF deficits.

""By adolescence, these chronic and cumulative experiences with school
failure, learning disorders, school misbehavior, and sometimes lower
intelligence begin to generate other adverse educational outcomes. For
instance, the academic outcome of the hyperactive (ADHD) adolescents was
considerably poorer in Barkley and Fischer’s Milwaukee follow-up study at the
teen follow-up than that of the typically developing adolescents followed
concurrently. __At least three times as many hyperactive (ADHD) children had
failed a grade (29.3 vs. 10.0%) or been suspended (46.3 vs. 15.2%) or expelled
(10.6% vs. 1.5%) (Fischer, Barkley, Edelbrock, & Smallish, 1990). __Others
have also identified such high educational risks in longitudinal studies
dating back as much as 40 years (Ackerman, Dykman, & Peters, 1977; Mendelson,
Johnson, & Stewart, 1971; Stewart, Mendelson, & Johnson, 1973; Weiss, Minde,
Werry, Douglas, & Nemeth, 1971; Wilson & Marcotte, 1996). In another sample of
clinic-referred teenagers with ADHD, a similar risk for school retention and
suspension was documented (Barkley, Anastopoulos, Guevremont, & Fletcher,
1991). __Almost 10% of the hyperactive sample followed into adolescence had
quit school at this follow-up point in the Milwaukee Study, compared to none
of the normal sample __(Barkley, Fischer, et al., 1990). Fischer and
colleagues (1990) also found that the levels of academic achievement on
standard tests were significantly below normal on tests of math, reading, and
spelling, falling toward the lower end of the normal range (standard scores
between 90 and 95). " (Quoted from the 4th edition)"

"Substantially fewer hyperactive than control children had ever enrolled in
college (21 vs. 78%) or were currently attending at this follow-up point (15
vs. 66%). These findings were reaffirmed 6 years later at the age 27 follow-up
(Barkley et al., 2008). In the Canadian follow-up study, approximately 20%
attempted a college program, yet only 5% completed a university degree
program, compared to over 41% of control children (Weiss & Hechtman, 1993).
The longest running (30-year) follow-up study of hyperactive children into
midlife likewise indicates that less education is an outcome of childhood
ADHD, with 30% either not completing high school or getting a general
equivalency diploma (GED), compared to just 4% of the control group (Klein et
al., 2012). These findings demonstrate that the educational domain is major in
terms of impaired functioning and reduced attainment for children growing up
with ADHD." (quoted from the 4th edition handbook) linked below

[http://www.filedropper.com/russellabarkley-attention-
deficit...](http://www.filedropper.com/russellabarkley-attention-
deficithyperactivitydisorderahandbookfordiagnosisandtreatment-
theguilfordpress2014)

[http://www.amazon.com/Attention-Deficit-Hyperactivity-
Disord...](http://www.amazon.com/Attention-Deficit-Hyperactivity-Disorder-
Fourth-
Diagnosis/dp/1462517722/ref=sr_1_1?s=books&ie=UTF8&qid=1457913239&sr=1-1&keywords=russell+barkley+handbook)

~~~
fweespee_ch
> 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 problem is they are diagnosing 6-7 year olds and not diagnosing true peers
but using proxies for age.

~~~
eruditely
False. The most cited person is Russell Barkley and his advice is the one that
goes through. His work _is_ considered a paradigm shift that the literature
revolves around. We know it is very severe from the 4th edition it states
there have been over 300 studies done on stimulants in kids in ADHD and we
know it's safe. Wait till they're in high school but it's too powerful to be
overcome, sorry, it's strict consensus and well corroborated. Not even high
intelligence is powerful enough to overcome it.

It's a developmental disorder, their brains aren't done developing until
they're in their late twenties or early thirties, you can't "wait it out".

[http://www.drthomasebrown.com/pdfs/HighIQAdults.JADonlinever...](http://www.drthomasebrown.com/pdfs/HighIQAdults.JADonlineversion.pdf)
Look read it. It's a well known fact working memory decides school performance
better than I.Q. (I can grab that study) look at those ratios.

I have it. I'm aware of the literature.

[https://scholar.google.com/citations?user=lG2w3PAAAAAJ&hl=en](https://scholar.google.com/citations?user=lG2w3PAAAAAJ&hl=en)

[http://www.medicalnewstoday.com/articles/289931.php](http://www.medicalnewstoday.com/articles/289931.php)
<\--

^^ ADHD DOUBLES-QUADRUPLES your mortality rate. If you're a girl it's 3x the
average person. It's severe.

~~~
fweespee_ch
1) Correct diagnosis is important.

2) ADHD meds have side effects.

[http://childmind.org/article/side-effects-of-adhd-
medication...](http://childmind.org/article/side-effects-of-adhd-medication/)

~~~
eruditely
Who doesn't believe in accurate diagnosis? I do.

Their life failure rate is _that_ much higher. The data is too strong and well
corroborated.

I'm providing data and you haven't. When it gets to last 2 years of high
school meds matter, but what if they've repeated a grade already? That's not
fair to them.

~~~
fweespee_ch
> Who doesn't believe in accurate diagnosis? I do.

Then you shouldn't be pushing ADHD meds on 6-7 year olds.

> I'm providing data and you haven't. When it gets to last 2 years of high
> school meds matter, but what if they've repeated a grade already? That's not
> fair to them.

You are aware I was talking about 6-7 year olds based on what I wrote in the
first comment I replied to, right?

I'm not talking about high school students or even Jr High students. I'm
perfectly fine with them being diagnosed at that point.

I think the problem is you are missing what part of the OP I was talking
about.

~~~
eruditely
They're still behind in effective brain development no matter what. When
they're in high school, say 14 years old

14-4.2= 9.8, so they're 9.8 on avg in exec functioning. It isn't the same
thing. But yes, wait a medium amount.

~~~
fweespee_ch
> They're still behind in effective brain development no matter what.

The whole point of the article is they were "finding" 20-100% of the younger
members of the same grade level had ADHD. ADHD shouldn't be detected at
20-100% higher rates at 6 instead of 7 at the same grade level if the process
was working correctly.

That isn't okay. Period.

Maybe I take this a bit personally because I have a friend who had all 3 kids
who were misdiagnosed at 7-8 and at 8-9 they were told they were "normal" and
to stop medication.

ADHD doesn't magically cure itself in a year.

------
amelius
Perhaps astrology has some truth to it after all :)

------
foota
I was diagnosed with ADHD as a kid in elementary school but I didn't want to
take the medication (Or I may have just been being contrary...). and now as a
junior in college I'm considering talking to a doctor to see whether
medication might be able to help me focus. I find myself constantly unable to
fin-

~~~
eruditely
""By adolescence, these chronic and cumulative experiences with school
failure, learning disorders, school misbehavior, and sometimes lower
intelligence begin to generate other adverse educational outcomes. For
instance, the academic outcome of the hyperactive (ADHD) adolescents was
considerably poorer in Barkley and Fischer’s Milwaukee follow-up study at the
teen follow-up than that of the typically developing adolescents followed
concurrently. __At least three times as many hyperactive (ADHD) children had
failed a grade (29.3 vs. 10.0%) or been suspended (46.3 vs. 15.2%) or expelled
(10.6% vs. 1.5%) (Fischer, Barkley, Edelbrock, & Smallish, 1990). __Others
have also identified such high educational risks in longitudinal studies
dating back as much as 40 years (Ackerman, Dykman, & Peters, 1977; Mendelson,
Johnson, & Stewart, 1971; Stewart, Mendelson, & Johnson, 1973; Weiss, Minde,
Werry, Douglas, & Nemeth, 1971; Wilson & Marcotte, 1996). In another sample of
clinic-referred teenagers with ADHD, a similar risk for school retention and
suspension was documented (Barkley, Anastopoulos, Guevremont, & Fletcher,
1991). __Almost 10% of the hyperactive sample followed into adolescence had
quit school at this follow-up point in the Milwaukee Study, compared to none
of the normal sample __(Barkley, Fischer, et al., 1990). Fischer and
colleagues (1990) also found that the levels of academic achievement on
standard tests were significantly below normal on tests of math, reading, and
spelling, falling toward the lower end of the normal range (standard scores
between 90 and 95). " (Quoted from the 4th edition)"

"Substantially fewer hyperactive than control children had ever enrolled in
college (21 vs. 78%) or were currently attending at this follow-up point (15
vs. 66%). These findings were reaffirmed 6 years later at the age 27 follow-up
(Barkley et al., 2008). In the Canadian follow-up study, approximately 20%
attempted a college program, yet only 5% completed a university degree
program, compared to over 41% of control children (Weiss & Hechtman, 1993).
The longest running (30-year) follow-up study of hyperactive children into
midlife likewise indicates that less education is an outcome of childhood
ADHD, with 30% either not completing high school or getting a general
equivalency diploma (GED), compared to just 4% of the control group (Klein et
al., 2012). These findings demonstrate that the educational domain is major in
terms of impaired functioning and reduced attainment for children growing up
with ADHD."

You get remission of symtoms very frequently if you take your meds, it works
great. there's no way you can "overcome" it as you're a) time myopic (look it
up) b) cannot execute knowledge you have acquired.

------
Noge_Sako
Removing actual firm discipline for all the young boys has been a disaster.

We replaced strict and perhaps unpleasant discipline in favor of medicine, and
its worse long term side effect profile.

~~~
benologist
You say strict but don't you really just mean threatening children with
violence?

The last time someone told me to stand still so they could hit me as hard as
they could with a cane was when I was 7 or 8 years old. That's not education.
Real educators, much like real democracy, do not rely on fear and violence to
control others.

~~~
adrusi
I definitely understand why using fear to control children is a bad thing, but
as for violence, it's at the root of all power anyway. Whenever you impose a
disciplinary sanction, it's implicit that if the sanction is not respected, it
will be replaced by an alternative, at least as harsh sanction, and eventually
the alternative sanction will be violent.

Fear is clearly not a great way of controlling your children, but no one does
it in any other way. If instead of corporal punishment you discipline your
child by revoking privileges, you're still using threats and fear. The
alternative is to reason with your child, to present a convincing argument for
why they should listen to you. But kids aren't (always) rational actors, so
that doesn't always work.

Both hitting your child and grounding your child are based on fear and
violence. They each have their disadvantages. Hitting your child might end up
teaching them that hitting people is OK, grounding your child gives them a lot
of time to build resentment and keeps them cooped up with negativity and
inactivity so that they're more likely to get into trouble again. I'm not sure
which I would have chosen as a kid, but now I'd choose corporal punishment.

~~~
true_religion
While it's often pointed out that children are not rational actors, I'd also
like to include that parents are not rational actors all the time either.

Often people want to impose a rule on their children without properly
evaluating it because its what they were taught, and has become part and
parcel of their socialization.

Other times people _must_ impose a rule on their children due to government
regulation (e.g. you can't leave children under X age home without someone
over Y age responsible for them). In those cases, people fail to explain their
guiding logic because no one likes to say "I have to do this, the government
is making me do it through threat of jail time" and thus their justification
---both to themselves and their children---comes off as flimsy.

