Friday , July 30 2021

Attention-deficit hyperactive disorder and school start month – Medical News



At the beginning of a school, younger children are more likely to be diagnosed with ADHD

Background

Younger children in a school college may be more likely to receive a diagnosis of attention deficit hyperactivity (ADHD) than their older cores due to the variation in age-based behavior that can be attributed to ADHD instead of the youngest children.

Most of the US states UU have arbitrary age limits to enter a public school. Therefore, within the same grade, children with birthdays near the deadline can differ in age almost 1 year.

Methods

We used data from 2007 to 2015 of a large insurance database to compare ADHD's diagnosis among children born in August with that of children born September in the states with and without the requirement that children take 5 years before September 1 in day care.

The diagnosis of ADHD was determined based on the diagnostic codes of the International Classification of Diseases, 9th Revision. We also use prescriptive records to compare the treatment of ADHD among children born in August and children born in September in states with and without a cutout date from September 1.

Results

The student population included 407,846 children in all U.S. states that were born in the period from 2007 to 2009 and followed until December 2015.

The Diagnostic rate of ADHD based on claims between children in states with a cut on September 1 was 85.1 for every 10,000 children (309 cases between 36,319 children, a confident interval [IC] 95%, 75.6 to 94.2) among those born in August and 63.6 per 10,000 children (225 cases between 35,335 children, 95% IC, 55.4 to 71.9) among those born in September, an absolute difference of 21.5 for 10,000 children (CI 95 %, 8.8 to 34.0); The corresponding difference in the states without the September 1 limit was 8.9 per 10,000 children (95% IC, -14.9 to 20.8).

The Treatment rate of ADHD it was 52.9 per 10,000 children (192 out of 36.319 children, 95% IC, 45.4 to 60.3) among those born in August and 40.4 per 10,000 children (143 out of 35,353 children, 95% CI, 33.8 to 47.1) among those born in September, an absolute difference of 12.5 per 10,000 children (95% IC, 2.43 to 22.4).

These differences were not observed in other currency comparisons, nor were observed in states with cut dates that are not September for the start of a kindergarten.

Also, in states with a border on September 1, they did not observe significant differences among children born in August and those born in September in the rates of asthma, diabetes or obesity.

Differences in ADHD diagnosis according to sex and a month of birth. The broken line indicates that there is no difference. The bars indicate 95% intervals of confidence. The diagnosis of ADHD was defined based on ICD-9 diagnostic code for ADHD in invoice invoices or prescription filled for ADHD.

Conclusions

ADHD's diagnosis and diagnosis rates are higher among children born in August than among those born in September in states with a cut on September 1 for admission to a kindergarten. (Founded by the National Institutes of Health.)


Comment in The Harvard Newspaper

Can a child's birthday be placed at the risk of a diagnostic diagnosis of ADHD?

The answer seems to be that yes, at least among children born in August, who start a school in states, where the registration is canceled on September 1, according to a new study led by researchers at Harvard Medical School.

The findings, published on November 28 at The New England Journal of Medicine, show that children born in August in those states are 30% more likely to receive ADHD diagnosis, compared with their slightly older constituents registered in the same degree .

The assessment of ADHD diagnosis among children has increased dramatically over the past 20 years. Only in 2016, more than 5 percent of US UU children were actively treated with medecines for ADHD. Experts believe that growth is due to a combination of factors, including greater recognition of the disorder, a real increase in the effect of the disease and, in some cases, insufficient diagnosis.

The results of the new study emphasize the idea that at least in a subgroup of school students, diagnosis can be a factor in early registration at school, according to the research team.

"Our findings suggest the possibility that a large number of children receive excessive diagnosis and excessive treatment for ADHD because they are relatively immature in comparison with their older classmates in the first years of primary school," said the main author of the study. study, Timothy Layton, assistant professor of health care for politics at the Blavatnik Institute of Harvard Medical School.

Most states have arbitrary dates of birth limits that determine the degree to which a child will be placed and when they can start a school. In states with the limit of September 1, a child born on August 31 will be almost an anniversary on the first day of a school than a child born on September 1.

In this age, Layton noted that the smallest child could be harder to sit and concentrate for long periods in class. This extra preoccupation can lead to medical reference, Layton said, followed by diagnosis and treatment for ADHD.

For example, researchers have said, what could be normal behavior in a nuisance 6-year-old seems abnormal in relation to the behavior of older partners in the same classroom.

This dynamics can be particularly true among young children, because an age differentiating from 11 to 12 months could lead to serious differences in behavior, researchers added.

"As children grow older, the small differences in age become equal and dissipated by time, but according to the behavior, the difference between the 6 year old boy and 7 years of age could be quite pronounced," said the main author of the study, Anupam Jena. Ruth L. Newhouse Associate Professor of Health Policy at the Harvard Medical School and internal medical practitioner at the Massachusetts General Hospital. "Normal behavior seems anomalies in relation to the child's group."

Using the records of a large insurance database, researchers compared the difference in ADHD's diagnosis after the birth, August by September, between more than 407,000 primary children born between 2007 and 2009, which had been targeted until the end of 2015.

According to the analysis, in the states that use the September 1 As the deadline for school registration, children born in August were 30% more likely to have ADHD's diagnosis than children born in September. No such differences were observed between children born in August and September in states with cut-off dates except September 1.

For example, 85 the 10,000 Students born in August have been diagnosed or treated for ADHD, compared to 64 students of 10,000 born in September.

When researchers only looked at the treatment of ADHD, the difference was also excellent: 53 of the 10,000 students born in August received medications for ADHD, compared to 40 out of 10,000 in September.

Jena noted a similar phenomenon described in Malcolm Gladwell's "Outliers" book. Canadian professional hockey players were much more likely to be born earlier this year, according to the investigation mentioned in Gladwell's book. The Canadian youth hockey leagues are used on January 1 as the deadline for the age groups.

In the early years of youth hockey training, players born in the first months of the year were older and more mature, and therefore more likely to be followed by links, with better coaching, more time on the ice and more talented cohort of teammates. Over the years, this advantageous advantage has given relatively older players an advantage over their younger competitors.

Similarly, Jena noted, a 2017 document document from the National Bureau of Economic Research suggested that children born immediately after the deadline to start a school had tended to have a better continuing education activity than their relatively young people. born later in the year.

"In all those scenes, moments and ages seem to be powerful factors that influence the outcome," said Jena.

The research showed great variations in the diagnosis and treatment of ADHD in different regions in the United States. UU The diagnosis and treatment of ADHD has also increased dramatically over the past 20 years.

In 2016 alone, more than 5 percent of all children in the US UU took medication for ADHD, the authors said. All of these factors have stimulated concerns about the excessive diagnosis of ADHD and excessive treatment.

The reasons for increasing the impact of ADHD are complex and multifunctional, Jena said. Arbitration terms are probably one of the many variables that lead this phenomenon, he added.

In recent years many States have adopted measures that support schools responsible for identifying ADHD and offer incentives for educators to recommend any child with symptoms that suggest ADHD for medical assessment.

"The diagnosis of this condition is not only related to the symptoms, but to the context," said the following. "Meet the relative age of children in class, laws and rules, and other circumstances."

It is important to consider all these factors before making diagnosis and prescribing treatment, said Jena.

"The age of a child in relation to their members in the same degree must be considered and the reasons for the reference must be carefully examined."


Additional co-authors include researchers from the Department of Health Policy, the National Office of Economic Research and the Department of Health Policy and Administration, and Harvard T.H. School of Public Health.

Using the records of a large insurance database, researchers compared the difference in ADHD's diagnosis after the birth, August by September, between more than 407,000 primary children born between 2007 and 2009, which had been targeted until the end of 2015.

According to the analysis, in the states that are used on September 1 as the deadline for school registration, children born in August were 30% more likely to have ADHD's diagnosis than children born in September. No such differences were observed between children born in August and September in states with cut-off dates except September 1.

For example, 85 out of 10,000 students born in August were diagnosed or treated for ADHD, compared with 64 students from 10,000 born in September. When researchers only looked at the treatment of ADHD, the difference was also excellent: 53 of the 10,000 students born in August received medications for ADHD, compared to 40 out of 10,000 in September.

Jena noted a similar phenomenon described in Malcolm Gladwell's "Outliers" book. Canadian professional hockey players were much more likely to be born earlier this year, according to the investigation mentioned in Gladwell's book. The Canadian youth hockey leagues are used on January 1 as the deadline for the age groups. In the early years of youth hockey training, players born in the first months of the year were older and more mature, and therefore more likely to be followed by links, with better coaching, more time on the ice and more talented cohort of teammates. Over the years, this advantageous advantage has given relatively older players an advantage over their younger competitors.


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