8/15/2016

NearlyonemillionchildreninU.S.potentiallymisdiagnosedwithADHD,studyfindsScienceDaily

Yoursourceforthelatestresearchnews

NearlyonemillionchildreninU.S.potentiallymisdiagnosedwith
ADHD,studyfinds
Date:
Source:
Summary:

August17,2010
MichiganStateUniversity
NearlyonemillionchildrenintheUnitedStatesarepotentiallymisdiagnosedwithattentiondeficit
hyperactivitydisordersimplybecausetheyaretheyoungestandmostimmatureintheir
kindergartenclass,accordingtonewresearch.

FULLSTORY

ADHDisthemostcommonlydiagnosedbehavioraldisorderforkids
intheUnitedStates,withatleast4.5milliondiagnosesamong
childrenunderage18,accordingtotheCentersforDiseaseControl
andPrevention.However,therearenoneurologicalmarkersfor
ADHD(suchasabloodtest),andexpertsdisagreeonits
prevalence,fuelingintensepublicdebateaboutwhetherADHDis
underdiagnosedoroverdiagnosed,Eldersaid.
Credit:iStockphoto/JaniBryson

Nearly1millionchildrenintheUnitedStatesarepotentiallymisdiagnosedwithattention
deficithyperactivitydisordersimplybecausetheyaretheyoungestandmostimmature
intheirkindergartenclass,accordingtonewresearchbyaMichiganStateUniversity
economist.
Thesechildrenaresignificantlymorelikelythantheirolderclassmatestobeprescribedbehaviormodifying
stimulantssuchasRitalin,saidToddElder,whosestudywillappearinaforthcomingissueoftheJournalof
HealthEconomics.
Suchinappropriatetreatmentisparticularlyworrisomebecauseoftheunknownimpactsoflongtermstimulant
useonchildren'shealth,Eldersaid.Italsowastesanestimated$320million$500millionayearon
unnecessarymedicationsome$80million$90millionofitpaidbyMedicaid,hesaid.
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NearlyonemillionchildreninU.S.potentiallymisdiagnosedwithADHD,studyfindsScienceDaily

Eldersaidthe"smokinggun"ofthestudyisthatADHDdiagnosesdependonachild'sagerelativeto
classmatesandtheteacher'sperceptionsofwhetherthechildhassymptoms.
"Ifachildisbehavingpoorly,ifhe'sinattentive,ifhecan'tsitstill,itmaysimplybebecausehe's5andtheother
kidsare6,"saidElder,assistantprofessorofeconomics."There'sabigdifferencebetweena5yearoldanda
6yearold,andteachersandmedicalpractitionersneedtotakethatintoaccountwhenevaluatingwhether
childrenhaveADHD."
ADHDisthemostcommonlydiagnosedbehavioraldisorderforkidsintheUnitedStates,withatleast4.5million
diagnosesamongchildrenunderage18,accordingtotheCentersforDiseaseControlandPrevention.
However,therearenoneurologicalmarkersforADHD(suchasabloodtest),andexpertsdisagreeonits
prevalence,fuelingintensepublicdebateaboutwhetherADHDisunderdiagnosedoroverdiagnosed,Elder
said.
Usingasampleofnearly12,000children,ElderexaminedthedifferenceinADHDdiagnosisandmedication
ratesbetweentheyoungestandoldestchildreninagrade.ThedataisfromtheEarlyChildhoodLongitudinal
StudyKindergartenCohort,whichisfundedbytheNationalCenterforEducationStatistics.
AccordingtoElder'sstudy,theyoungestkindergartnerswere60percentmorelikelytobediagnosedwithADHD
thantheoldestchildreninthesamegrade.Similarly,whenthatgroupofclassmatesreachedthefifthandeighth
grades,theyoungestweremorethantwiceaslikelytobeprescribedstimulants.
Overall,thestudyfoundthatabout20percentor900,000ofthe4.5millionchildrencurrentlyidentifiedas
havingADHDlikelyhavebeenmisdiagnosed.
Elderusedthestudents'birthdatesandthestates'kindergarteneligibilitycutoffdatestodeterminethe
youngestandoldeststudentsinagrade.ThemostpopularcutoffdateinthenationisSept.1,with15states
mandatingthatchildrenmustturn5onorbeforethatdatetoattendkindergarten.
Theresultsbothfromindividualstatesandwhencomparedacrossstatesweredefinitive.Forinstance,in
MichiganwherethekindergartencutoffdateisDec.1studentsbornDec.1hadmuchhigherratesofADHD
thanchildrenbornDec.2.(ThestudentsbornDec.1weretheyoungestintheirgradethestudentsbornDec.2
enrolledayearlaterandweretheoldestintheirgrade.)
Thus,eventhoughthestudentswereasingledayapartinage,theywereassesseddifferentlysimplybecause
theywerecomparedagainstclassmatesofadifferentageset,Eldersaid.
Inanotherexample,AugustbornkindergartnersinIllinoisweremuchmorelikelytobediagnosedwithADHD
thanMichigankindergartnersborninAugustofthesameyearastheirIllinoiscounterparts.That'sbecause
Illinois'kindergartencutoffdateisSept.1,meaningthoseAugustbornchildrenweretheyoungestintheir
grade,whereastheMichiganstudentswerenot.
Accordingtothestudy,adiagnosisofADHDrequiresevidenceofmultiplesymptomsofinattentionor
hyperactivity,withthesesymptomspersistingforsixormoremonthsandinatleasttwosettingsbeforethe
ageofseven.Thesettingsincludehomeandschool.
AlthoughteacherscannotdiagnoseADHD,theiropinionsareinstrumentalindecisionstosendachildtobe
evaluatedbyamentalhealthprofessional,Eldersaid.
"ManyADHDdiagnosesmaybedrivenbyteachers'perceptionsofpoorbehavioramongtheyoungestchildren
inakindergartenclassroom,"hesaid."Butthese'symptoms'maymerelyreflectemotionalorintellectual
immaturityamongtheyoungeststudents."

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NearlyonemillionchildreninU.S.potentiallymisdiagnosedwithADHD,studyfindsScienceDaily

ThepaperwillbepublishedintheJournalofHealthEconomicsinconjunctionwitharelatedpaperby
researchersatNorthCarolinaStateUniversity,NotreDameandtheUniversityofMinnesotathatarrivesat
similarconclusionsastheresultofaseparatestudy.

StorySource:
TheabovepostisreprintedfrommaterialsprovidedbyMichiganStateUniversity.Note:Contentmaybe
editedforstyleandlength.

JournalReference:
1. Elderetal.TheimportanceofrelativestandardsinADHDdiagnoses:Evidencebasedonexactbirth
dates.JournalofHealthEconomics,2010DOI:10.1016/j.jhealeco.2010.06.003

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