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ADHD: Children who start school young are more likely to be diagnosed

Timothy Layton, Assistant Professor of Health Care at Harvard University, has a son born in August. Just before he started kindergarten in 2017, Layton read a research paper showing that children born in August did worse at school in a series of academic and behavioral actions compared to older children in their class. "The research suggested that the youngest children in class have an upward struggle in their school time because they are younger," Layton said. And it made such an impression that he and his wife decided to keep his son back for a year. "We thought we would do the opposite &#821 1; and give him an advantage." Layton then continued to investigate a related phenomenon in his research: How do children compare in august as their son compared to September children when it comes to frequencies of hyperactivity disorder diagnosis He and several colleagues already knew that ADHD prices rose and that it was large variation in diagnosis rates among states. Three times as many children are diagnosed with ADHD in Arkansas compared to Nevada, for example. Then they wondered if the birthday ran the trend: Was the younger children in a kindergarten more likely to be diagnosed? In a recent paper published in New England Journal of Medicine Layton and his co-authors found that yes, birthdays are very important in the case of ADHD diagnosis. Furthermore, younger children are diagnosed who are only immature for reasons that have nothing to do with their actual medical needs.…

Timothy Layton, Assistant Professor of Health Care at Harvard University, has a son born in August. Just before he started kindergarten in 2017, Layton read a research paper showing that children born in August did worse at school in a series of academic and behavioral actions compared to older children in their class.

“The research suggested that the youngest children in class have an upward struggle in their school time because they are younger,” Layton said. And it made such an impression that he and his wife decided to keep his son back for a year. “We thought we would do the opposite &#821

1; and give him an advantage.”

Layton then continued to investigate a related phenomenon in his research: How do children compare in august as their son compared to September children when it comes to frequencies of hyperactivity disorder diagnosis He and several colleagues already knew that ADHD prices rose and that it was large variation in diagnosis rates among states. Three times as many children are diagnosed with ADHD in Arkansas compared to Nevada, for example. Then they wondered if the birthday ran the trend: Was the younger children in a kindergarten more likely to be diagnosed?

In a recent paper published in New England Journal of Medicine Layton and his co-authors found that yes, birthdays are very important in the case of ADHD diagnosis. Furthermore, younger children are diagnosed who are only immature for reasons that have nothing to do with their actual medical needs.

For coherence, many states mean age disruption for access to kindergartens. In 18 states, children whose fifth birthday can happen before September 1, start kindergarten year when they become 5, while children who reach 5 after that date must wait one year.

The researchers looked at the injuries for more than 400,000 children throughout the United States born between 2007 and 2009 and followed until 2015. And they found that in states where the children must be 5 years no later than September 1, August children had an ADHD diagnosis of 85 per 10,000 children. Children born in September had a much lower diagnosis, at 64 per 10,000 children. There is an absolute difference between 21 diagnoses per 10,000 children, and this trend did not occur in states with different age limits.

What the study shows, Layton says, “diagnosis and treatment of ADHD is still very subjective.” And it can be part of the jigsaw to explain why prevalence in children has risen from 3 and 7 percent historically to 11 percent today – as many researchers say is too high.

Given that more than 5 percent of American children are now on an ADHD drug and that drugs can come with heavy side effects, it means that children are likely to be exposed to medical risks for no reason at all.

What is ADHD?

ADHD as a medical diagnosis has existed for a long time but under different names. In the first quarter, it was called hyperkinesis. Thereafter, hyperkinetic disease occurred. Now the attention deficit is hyperactivity disorder.

There is still a lot that researchers do not understand about what causes ADHD, but it has become clearer that genes play a role. And over the years, there has become an increasing awareness that there is a neurological reason for the attention issues and hyperactive, impulsive behaviors associated with the disease.

Today ADHD is one of the most common neuroproblems in childhood and it is diagnosed when normal characteristics of being a child – being inattentive, fidgeting a lot – becomes disturbing. There is no biological marker, such as a blood sample that can identify ADHD, so physicians must look for symptoms and try to understand if these symptoms hinder the child’s academic performance or social interactions before diagnosis is made.

Just having these behaviors does not mean you have ADHD, “said Martin Stein, professor of pediatrician at UC San Diego School of Medicine. “The behaviors must be associated with a reduction.”

But making a diagnosis can be difficult and take months. Clinics need to get to know the child and go through several steps to assess him or her – and they do not always have that time, “explained Michael Manos, clinical director of the Cleveland Clinic’s ADHD Center for Evaluation and Treatment.

A proper assessment involves determining which ADHD symptoms a child has and how these symptoms interfere with their lives and exclude other potential causes of symptoms such as depression or anxiety. “The diagnosis is nobody, just looking at a grade scale and listening to a parent’s brief description of behavior,” added Manos. “You have to be careful about going through the other steps.”

ADHD diagnosis rate has increased, partly due to drug marketing

This difficulty diagnosing the disorder, more awareness about it and a year-long campaign of pharmaceutical companies to increase the number of people on their medication means that more children are now diagnosed with the state .

Over the past two decades, ADHD manufacturers have strongly marketed the disease and promoted their pills to doctors, teachers, parents, and even children – through medical education, newspapers and television ads and comics.

According to an exposition in the New York Times, this campaign stretched:

the image of classical ADHD to include relatively normal behavior such as negligence and impatience and has often exaggerated the benefits of the pills. The Food and Drug Administration has cited all important ADHD drug stimulants such as Adderall, Concerta, Focalin and Vyvanse and nonstimulants as Intunitive and Strattera – for false and misleading advertising since 2000 several times.

The results of this pharma campaign have been remarkable: Over the past 20 years, the frequency of diagnosis and treatment has increased with almost all measures in the United States. According to the National Institute of Health, the incidence of children ever diagnosed with ADHD increased by 42 percent between 2003 (when it was 8 percent) and 2011 (when it was 11 percent). Some of the latest data, from 2015 -16, show that 10 percent of children and adolescents aged 4 to 17 were diagnosed with ADHD in the United States.

And Layton’s study is not the first to find evidence that ADHD diagnoses lack the mark. In a review of 2018 of 19 studies from 13 countries with more than 15 million children, researchers found the same link – younger children were more likely to be diagnosed in 17 of the 19 studies. “It is the norm internationally for the youngest children in a classroom to have an increased risk of being medicated for ADHD, even in jurisdictions with relatively low prescription rates,” the authors concluded. Again, it means that other factors than medical needs drive ADHD diagnoses and potentially lead to over treatment of children who are neurologically healthy.

There is growing concern about the treatment sentiment

There are only two evidence-based treatments for ADHD, according to the American Academy of Pediatrics ADHD Guidelines: Behavioral Therapy and Medicine. Depending on the age of the child, these two methods can be tested either alone or in combination. But there are also worrying evidence of the side effects of some of the most popular ADHD drugs.

AAP suggests, for example, that doctors prescribe methylphenidate (sold under trademarks including Ritalin) to children in pre-school age when behavioral therapy fails or is not available. A 2018 Cochrane review of randomized controlled studies on methylphenidate in children and adolescents who found that approximately one in 100 patients treated with the drug led to a serious adverse reaction, including death, heart disease and psychotic disorders. While the quality of the evidence was low, the authors stated that these injuries were serious enough to suggest “clinics and parents pay attention to the importance of monitoring side effects systematically and accurately.”

Cochrane Review on the use of amphetamine (sold under brands including Adderall) for ADHD in children was no more calming. While the drugs seemed to improve the cardiovascular symptoms of ADHD in the short term, “they were also linked to a higher risk of experiencing side effects such as sleep problems, decreased appetite and stomach pain.”

This does not mean nobody should take these drugs, Stein said. When a child is diagnosed, treated and followed up, most respond to primary care and benefit from them, as they see better school performance and concentration. But the question is: Was the child carefully diagnosed? And evidence from the birthday studies suggests that many are not, and exposed to serious risks for no reason.

Layton suggested that doctors think twice before they notice a child with ADHD. “If the child has a birthday close-cut for school year, we must pause.”

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