Starting School Early May Affect ADHD Diagnosis

By Todd Neale, Senior Staff Writer, MedPage Today

Starting School Early May Affect ADHD DiagnosisSchoolchildren who are young for their grade may have a greater risk than their older classmates of being diagnosed with and treated for attention-deficit hyperactivity disorder (ADHD), researchers found.

Boys and girls born in the month before the age cutoff for entry into kindergarten were 30% more likely to be diagnosed with ADHD and 41% more likely to receive a prescription for an ADHD medication than those born in the month after the cutoff, according to Richard Morrow, MA, of the University of British Columbia in Victoria, and colleagues.

And those born in the month before the age cutoff for entry into first grade were 70% more likely to get an ADHD diagnosis and 77% more likely to be prescribed ADHD medication, the researchers reported online in CMAJ.

Although the appropriateness of diagnosis and treatment could not be evaluated, the findings raise concerns about possible overdiagnosis and overprescribing in children who are younger — and presumably less mature — for their grade, they wrote.

“Children who are given medications to treat ADHD are exposed to adverse effects on sleep, appetite, and growth,” Morrow and colleagues wrote. They also noted an increased risk of cardiovascular events, although that link was disputed in studies published last year in Pediatrics and the New England Journal of Medicine.

“Inappropriate diagnosis of ADHD in a child born late in the year might lead parents and teachers to treat the child differently or adversely change the child’s self-perceptions,” they explained. “Our analyses add weight to concerns about the medicalization of the normal range of childhood behaviors, particularly for boys.”

Previous U.S. studies have yielded similar findings, but the issue had not been explored in Canada, which has lower reported rates of ADHD diagnosis and treatment and differences in healthcare delivery, cultural attitudes, and marketing by pharmaceutical companies.

Morrow and colleagues tackled the issue using administrative health databases from British Columbia, where the annual cutoff birth date for entering kindergarten or first grade is Dec. 31. So children born in December are typically the youngest and those born in January are typically the oldest in each grade.

The study included 937,943 schoolchildren who were 6 to 12 years old at any time from Dec. 1, 1997 through Nov. 30, 2008, and were covered by the provincial health plan.

The average age for children born in December and those born in January was similar (7.8 years).

For all years combined, the percentage of children who received an ADHD diagnosis increased from January to September birth dates and then leveled off. The proportion rose from 5.7% for those born in January to 7.4% for those born in December for boys and from 1.6% to 2.7% for girls.

Similar trends were seen for ADHD medication prescriptions.

Being born in December versus January was associated with a greater risk of receiving an ADHD diagnosis for both boys (RR 1.30) and girls (RR 1.70), as well as a greater risk of being treated for the condition (RRs 1.41 and 1.77 for boys and girls, respectively).

The relationships remained relatively stable over the study period and were present for all ages included in the study. The magnitude of the associations diminished for older girls, however.

“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 treatment,” Morrow and colleagues wrote.

“Greater emphasis on a child’s behavior outside of school may be warranted when assessing children for ADHD to lessen the risk of inappropriate diagnosis,” they continued. “Further research into the determinants of ADHD and approaches to its assessment and treatment should consider a child’s age within a grade.”


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Ritalin Gone Wrong

Ritalin Gone WrongBy L. Alan Sroufe

THREE million children in this country take drugs for problems in focusing. Toward the end of last year, many of their parents were deeply alarmed because there was a shortage of drugs like Ritalin and Adderall that they considered absolutely essential to their children’s functioning. But are these drugs really helping children? Should we really keep expanding the number of prescriptions filled? Read more @

Related Online Continuing Education Courses:

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Navigating the Social World of Elementary School

By: Diane I. Ferber-Collins MBA, MA, C.A.S.

Navigating the Social World of Elementary SchoolSocial Skills, Social Cognition and Social Thinking are all terminology used to describe the social abilities. As our students develop physically, cognitively and emotionally, their social development also follows a developmental trajectory. For many children, the full repertoire of social skills come easily through everyday interactions with adults and peers, but it is still important for educators and parents to reinforce this casual learning with direct and indirect instruction. For other children, direct instruction and support in navigating the trials and tribulations of skill acquisition are even more important. While there are direct interventions for children with documented difficulties in this arena, including children on the autism spectrum, even more ‘typical’ children can benefit from conscious support.

As experts have pointed out, perhaps the most difficult part for parents and teachers is toaccept that setbacks and uncomfortable situations are part of the growth process; and to recognize that rather than “bubble” a child or swoop in to “fix,” we can use these situations to guide and help empower each child to create his/her own solutions and strategies that will last a lifetime.

Strongly developed social skills will impact a child’s ability to adapt to change and variable situations, as well as to provide resilience across settings. The child with good social skills is more likely to have a positive self image and to meet challenges with confidence. As they mature, these children will have better developed peer resistance and better conflict resolution skills, which also impact tolerance and acceptance of diverse groups. In turn, these areas of comfort will inform life choices into adulthood.

What is “Social?” The ability to share space with others effectively, which requires a complex set of capabilities.

The required capabilities for positive social interactions involve complex and numerous skills. For example, we rely on being able to interpret others’ perspectives, including their emotions, point of view, thoughts, beliefs, prior knowledge and intentions, gleaned and remembered from previous interactions, and read from body language and facial expressions. Successfully sharing space with others also relies on our own ability to reflect on, sort through, process and regulate our own reaction and to adapt across situations. For young children, it requires the developed ability to share one’s experience of an object or event (joint attention) and to successfully wield “pragmatic” everyday informal language. There are hundreds of social cognition and communication skills – from initiating conversations, reading body language and expression, understanding of abstract and inferential communication, to adequate attention and motivation.

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Attention Deficit Hyperactivity Disorder

Frequently asked questions about ADHD and teenagers.

Frequently asked questions about ADHD and teenagers

Click to view continuing education courses addressing ADHD

Q: What is ADHD?

A: Attention Deficit Hyperactivity Disorder (ADHD) is a term used to describe a group of behaviors that most often appear in young, school-aged children.

Q: What are the symptoms of ADHD?

A: ADHD has a wide range of symptoms and it can be confusing and stressful for the child or teen. Young people mature at different rates and have different personalities, temperaments, and energy levels. Most of us get distracted, act impulsively, and struggle to pay attention at one time or another. It is when symptoms such as these, or acting in impulsive or reckless ways, daydreaming, becoming easily confused, or trouble sitting still for any length of time are hurting school work or impairing social activities that ADHD should be looked into.

Q: How is ADHD diagnosed?

A: Most ADHD symptoms usually appear early in life, often between the ages of 3 and 6. No single test can diagnose ADHD, but a licensed health professional such as a pediatrician or mental health specialist with experience in childhood mental disorders can first try to rule out other reasons for the symptoms.

Q: What causes ADHD?

A: Scientists are not sure what causes ADHD, although many studies suggest that genes (the “blueprints” for who we are) play a large role. Like many other illnesses, ADHD probably results from a combination of genetic and environmental factors such as nutrition, brain injuries, or social environment.

Q: Can a teenager have ADHD?

A: Most children with ADHD continue to have symptoms as they enter adolescence. Some may not be diagnosed until then. It’s not easy being a teenager, but for a teenager with ADHD, it can be especially hard. Staying with the recommended treatments, prescribed medications, psychosocial interventions, or a combination of the two, is also a challenge. Since inattention can be a problem, driving is another major concern for those with ADHD. Working cooperatively with parents, schools, and health care professionals is key.

Q: How is ADHD treated?

A: Available treatments focus on reducing the symptoms of ADHD and improving functioning. A one-size-fits-all treatment does not exist and sometimes several different medications or dosages must be tried before finding one that works for a specific person. Anyone taking medications must be closely watched by their doctors. Parents and doctors need to work together to decide which medication is best, if the young person needs medication only for school hours or also for evenings and weekends, and also what psychosocial interventions are best for that individual.

Q: What can be done if you or your friend has ADHD?

A: First you need to help reduce the stress caused by the frustration that is experienced with these conditions. It is best for you or your friend to work with your family and a team of health professionals to find the best treatments.

Q: Once diagnosed, what is there to do about it?

A: With the right kind of help, most children and teens with ADHD can usually improve dramatically.

Q: Where can I get more information?

A: Knowledge in genetics, brain imaging, and behavioral research is leading to a better understanding of the causes of the disorder, how to prevent it, and how to develop more effective treatments for all age groups. NIMH has studied ADHD treatments for pre-school and school-aged children in a large –scale, long term studies. NIMH-sponsored scientists are continuing to look for the biological basis of ADHD and how differences in genes and brain structures may combine with life experiences to produce the disorder.

Source: National Institute of Mental Health:

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Evidence-Based Education: Preventing Reading Failure in America

NIH Clinical Center's 2004 Medicine for the Public lecture series

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Free Video Resource from the NIH

Reading proficiency is critical to academic learning and success in school. Studies show that children who learn to read in the early grades are more likely to become better students. In the United States, about 40 percent of children are left behind in reading. Scientists are researching how children learn to read and why some children have difficulty reading. Learn about the progress to date of a comprehensive study that examines children’s reading abilities during the early years, including the efforts to understand how to prevent reading failure.