EDITED: NHS: Youngest Often Misdiagnosed With ADHD

The youngest children in a class are more likely to be misdiagnosed with ADHD simply because they are less mature and more impulsive than their classmates, a new study suggests.

Children who are bored and fidgety – or downright naughty – are being wrongly diagnosed with a behavioural disorder when they are simply younger and less mature than their peers.

Attention deficit hyperactivity disorder — known as ADHD — is a group of symptoms that include inattentiveness, hyperactivity and impulsiveness. Experts believe it affects up to 400,000 British children.

A major study has suggested many children may be being mistakenly diagnosed with the disorder. Researchers at the University of Nottingham found that those in the same school class were far more likely to be diagnosed with ADHD if they were the youngest in the year group.

The study was reported in the Lancet Psychiatry journal and noted that when children are very young an age variation of less than 12 months can result in a large difference in maturity. Using population data from all children in Finland born between 1991 and 2004, the study found that younger pupils in a class were significantly more likely to be diagnosed with ADHD.

Children under the age of 10 who were born in the last four months of the school year were 64% more likely to be diagnosed with ADHD than those born in the first four months of the year. Working with the Turku University Hospital in Finland, the researchers from Nottingham found that the disparity could not be explained by other behavioural or developmental disorders.

Getting It Wrong

Professor Kapil Sayal, from the Institute of Mental Health in Nottingham, said the findings had many implications for teachers, parents and clinicians.

“With an age variation of up to 12 months in the same class, teachers and parents may misattribute a child’s immaturity,” he said.

“This might lead to younger children in the class being more likely to be referred for an assessment for ADHD. Parents and teachers as well as clinicians who are undertaking ADHD assessments should keep in mind the child’s relative age,” he added.

Sayal called for greater flexibility in school starting dates for younger children who may be less mature than their peers. “From an education perspective, there should be flexibility with an individualised approach to best meet the child’s needs’,” he said.

Evidence suggests that roughly 5% of children around the world develop ADHD but the researchers said the chance of being diagnosed with the disorder varies significantly country to country.

They said this inconsistency may be because adults “benchmark the development of younger children and compare them against older peers in the same year group.” They may then inadvertently interpret immaturity as a more serious problem.

Some 100,000 British children have been diagnosed with ADHD, and the problem is rapidly growing. Many experts in the field believe up to 7% of British children, or 400,000, have the condition, meaning three-quarters may be undiagnosed.

Prescriptions for ADHD medications in England rose rapidly from 1997 to 2012, NHS figures show. Controversial treatments include therapy and medication such as the central nervous system stimulants Ritalin and Dexamphetamine but there is no known cure.

 

by Bob Graham

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