Tuesday , May 18 2021

Disorder of hyperactive attention disturbance and month of commencement of tuition – Medical news



When school starts, younger children are more likely to be diagnosed with ADHD

Background

Young children in a group of school departments may be more likely to be diagnosed with a deficit of attention deficit hyperactivity deficiency (ADHD) than their older groups due to age-dependent variations in behavior that can be attributed to the ADHD location of the youngest children .

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

Methods

We used data from 2007 to 2015 from a large insurance database to compare the diagnosis rate of ADHD in children born in August with that children born in September in countries with and without condition children become 5 years old by September 1 in day care.

The diagnosis of ADHD is determined on the basis of the diagnostic codes of the International Classification of Diseases, the 9th revision. We also use the prescription records to compare the treatment with ADHD in children born in August and children born in September in countries with and without interruption on September 1.

Results

The study includes a population 407,846 children in all US states UU who were born in the period from 2007 to 2009 and were monitored by December 2015.

On diagnostic rate of ADHD based on claims in children in countries with cut September 1 was 85.1 for every 10,000 children (309 cases among 36,319 children, confidence interval [IC] 95%, 75.6 to 94.2) between births in August and 63.6 per 10,000 children (225 cases among 35,353 children, 95% CI, 55.4 to 71.9) among those born in September, an absolute difference of 21.5 per 10,000 children (CI 95%, 8 , 8-34.0); the corresponding difference in states without frontier from September 1 was 8.9 per 10,000 children (95% CI, -14.9 to 20.8).

On treatment rate the ADHD was 52.9 per 10,000 children (192 of 36,319 children, 95% CI, 45.4 to 60.3) among those born in August and 40.4 per 10,000 children (143 of 35,353 children, 95% CI, 33.8 to 47.1) among those born in September, an absolute difference of 12.5 10,000 children (95% CI, 2.43 to 22.4).

These differences were not observed in comparison with the other months of the month, nor were they recorded in countries with disruption dates that are not September for the beginning of the kindergarten.

Also, in countries with a limit on September 1, no significant differences were observed between children born in August and those born in September in the rates of asthma, diabetes or obesity.

Differences in rates of diagnosis of ADHD by gender and the month of birth. The broken line shows that there is no difference. The bars show 95% confidence intervals. The diagnosis of ADHD was defined on the basis of the ICD-9 diagnostic code for ADHD in the billing claims or the prescription for a cure for ADHD.

Conclusions

Rates of diagnosis and treatment of ADHD are higher in children born in August than in those born in September in countries with cuts on September 1 for admission to kindergarten. (Funded by the National Institute of Health.)


Commentary in the Harvard Journal

Can a child's birthday put him at risk of wrong diagnosis of ADHD?

The answer seems to be that Yes, at least in children born in August, who start school in countries where enrollment was terminated on September 1, according to a new study led by researchers at Harvard Medical School.

The findings, published on November 28 in the New England Journal of Medicine, show that children born in August in these countries are 30 percent more likely to receive a diagnosis of ADHD compared to their older peers enrolled in the same degree.

The rate of ADHD diagnoses among children has risen dramatically in the last 20 years. Only in 2016, more than 5 percent of American children UU They were actively treated with drugs for ADHD. Experts believe that the increase is due to a combination of factors, including greater recognition of the disorder, a real increase in the incidence of the disease, and in some cases an inappropriate diagnosis.

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

"Our findings point to the possibility that many children receive an excessive diagnosis and excessive treatment for ADHD because they have been shown to be relatively immature compared to older schoolchildren in the early years of primary education," said the lead author of the study. study, Timothy Leighton, associate professor of health at the Blavatnik Institute of Medicine at Harvard Medical School.

Most states have an arbitrary date of birth that determines the extent to which the child will be placed and when they can start a school. In countries with a ceiling of 1 September, the child born on August 31 will be nearly one year younger on the first day of schooling than the child born on September 1.

At this age, Leighton noted that the youngest child may find it harder to sit still and concentrate on long periods of time. This additional miscarriage can lead to a medical reference, Leighton said, followed by a diagnosis and treatment for ADHD.

For example, researchers say that what may be normal behavior at a noisy age of 6 may seem abnormal with regard to the behavior of older partners in the same classroom.

This dynamics can be especially important in younger children, because the difference in age of 11 or 12 months can lead to significant behavioral differences, the researchers added.

"As children grow up, small age differences become equalized and dissipated over time, but in terms of behavior, the difference between a 6-year-old boy and a 7-year-old can be quite pronounced," said lead author of the study , Anapam Jena. Ruth L. Newhouse, Associate Professor of Health Care Policy at Harvard Medical School and Internal Medicine Practitioner at Massachusetts General Hospital. "Normal behavior may seem anomalous in relation to a paternal group of a child."

Using the records of a large insurance database, the researchers compared the difference in the diagnosis of ADHD by month of birth, August to September, among more than 407,000 primary school children born between 2007 and 2009, which were monitored by the end of 2015.

According to the analysis, in the countries that use it September 1 As a deadline for enrollment in school, children born in August were 30% more likely to have a diagnosis of ADHD than children born in September. No such differences were observed between children born in August and September in countries with termination dates, except on September 1.

For example, 85 of 10,000 students born in August were diagnosed or treated for ADHD, as compared to 64 students of 10,000 born in September.

When researchers only looked at the treatment of ADHD, the difference was also great: 53 of 10,000 students born in August received ADHD drugs, compared to 40 of 10,000 births in September.

Jenna pointed to a similar phenomenon described in the book "Caring" by Malcolm Gladwell. Canada's professional hockey players are much more likely to be born earlier this year, according to a survey in the Gladwell book. Canadian Youth Hockey League use January 1st as a deadline for age groups.

In the first years of youth hockey training, players born in the first months of the year were older and more mature, so it is more likely that they will be watched in elite leagues, with better training, more ice time and more talented teammates. Over the years, this accumulated advantage has given relatively older players an edge over their younger competitors.

Similarly, Jenna stressed that the 2017 work document by the National Bureau of Economic Research suggests that children born shortly after the deadline for starting classes tend to have better long-term educational performance than their relatively young peers. born later in the year.

"In all these scenarios, moment and age appear to be powerful factors that influence the outcome," Jena said.

The research showed excellent changes in the diagnosis and treatment of ADHD in different regions of the United States. UU The rates of diagnosis and treatment of ADHD have also increased dramatically in the last 20 years.

Only in 2016, more than 5 percent of all children in the US UU They were taking medication for ADHD, the authors said. All of these factors have raised concerns about the overdosage of ADHD and excessive treatment.

The reasons for increasing the incidence of ADHD are complex and multifactorial, Jena said. Arbitrary deadlines are probably one of the many variables that lead this phenomenon, he added.

In recent years, many countries have adopted measures by which schools are responsible for identifying ADHD and offering incentives for teachers to recommend each child with symptoms that indicate ADHD for medical evaluation.

"The diagnosis of this condition is not related only to symptoms, but to the context," said jena. "The relative age of children in class, laws and regulations and other circumstances are gathering."

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

"The child's age in relation to his peers in the same grade should be considered and the reasons for the referral should be carefully examined."


Additional co-authors include researchers from the Department of Health Protection, the National Bureau of Economic Research and the Department of Health Policy and Management, and Harvard T.H. Chan School of Public Health.

Using the records of a large insurance database, the researchers compared the difference in the diagnosis of ADHD by month of birth, August to September, among more than 407,000 primary school children born between 2007 and 2009, which were monitored by the end of 2015.

According to the analysis, in countries that use September 1st as a deadline for enrollment in school, children born in August were 30% more likely to have a diagnosis of ADHD than children born in September. No such differences were observed between children born in August and September in countries with termination dates, except on September 1.

For example, 85 out of 10,000 students born in August have been diagnosed or treated for ADHD, compared to 64 students in 10,000 born in September. When researchers only looked at the treatment of ADHD, the difference was also great: 53 of 10,000 students born in August received ADHD drugs, compared to 40 of 10,000 births in September.

Jenna pointed to a similar phenomenon described in the book "Caring" by Malcolm Gladwell. Canada's professional hockey players are much more likely to be born earlier this year, according to a survey in the Gladwell book. Canadian Youth Hockey League use January 1st as a deadline for age groups. In the first years of youth hockey training, players born in the first months of the year were older and more mature, so it is more likely that they will be watched in elite leagues, with better training, more ice time and more talented teammates. Over the years, this accumulated advantage has given relatively older players an edge over their younger competitors.


Source link