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ADHD - The Need To Consider Comparative Ages

Posted Aug 18 2010 12:00am

Interesting article here that reviews research into the assessment of ADHD.  The article covers the details, with the main concern being that the youngest children in early grades are being excessively diagnosed (and subsequently medicated) due to comparisons with the older students in the class.  Given there is no biological marker for ADHD, and the diagnosis requires the symptoms be present in at least two settings, teachers are often asked to provide their observations of children in the classroom.  The difficulty can be when the youngest child in a class such as kindergarten or first grade is compared against the other children, who are older and thus more developed, in terms of attention, impulsivity, etc., the very areas of concern with respect to ADHD.  From the article:

According to Elder's study, the youngest kindergartners were 60 percent more likely to be diagnosed with ADHD than the oldest children in the same grade. Similarly, when that group of classmates reached the fifth and eighth grades, the youngest were more than twice as likely to be prescribed stimulants.

The article does not mention gender, but this can also be a factor.  If someone compares a just-turned five year old boy against a six-year old girl, they may well appear to be from different planets when it comes to the diagnostic issues related to attention and behavior.  However, these comparisons are not appropriate; the evaluator should be examining the child in the context of other children at a similar developmental stage.  As adults, the groups are often distinguished by decade.  In children, however, differences of as little as three months can have a significant impact.  Clinically, it would make sense to consider ADHD only if the youngest of a class were displaying symptoms of ADHD relative to the other younger students, not the class as a whole.

Interestingly, I read somewhere a theory that older boys do well in school, relative to their younger classmates, for an indirectly related reason - sports.  Athletic prowess is of particular importance in the perception of a boy's success in school, and at early ages, older boys tend to have a natural biological advantage; they are not only likely to be bigger, stronger, etc., but also more coordinated, and able to focus longer.  It would be interesting to examine how the early athletic success afforded the older boys in second, third, fourth grade, etc. relative to the youngest boys of each class (who are, at times a year or more younger, depending on various admission factors), shapes their later attitude towards sports.  I would imagine it would be hard to develop a dominating athletic mentality at age 18, when things have evened out (maybe the student is even bigger than his peers), but during those early years, that student was always the least athletic, simply because they were younger and lagged behind their classmates during those early, formative years.  Who knows? 

Maybe that's what accounts, at least partially, for some of these college and pro athletes who, by all accounts, have "all the physical tools," but simply can't manage to dominate, despite the physical advantages; maybe in their head, they are still smaller than everyone else...David Robinson comes to mind.  A late bloomer anyway, he seems like a wonderful guy, with many intellectual and artistic interests.  But that's just it - I wonder if he would have truly dominated the NBA if he had developed a Jordanesque attitude, and I wonder if he would have done just that, if he'd been kicking everyone's butt in basketball since an early age.  A less well-rounded individual, but a more dominating NBA career.  I'm guessing, since he attended Navy, he wasn't the dominating presence in high school his later physique suggested, and in the NBA, he had a really good career, but not what was expected (just ask Bill Simmons).  As much as anything, David Robinson didn't dominate more because of his mental approach to the game; clearly, it wasn't his physical skills.  Was he a younger guy in class growing up?  I don't know, but I'm guessing going from 6'7' to 7'1" after high school hurt his ability to play center in the NBA - he simply wasn't able to develop a center's mentality early enough.  Okay, how did I get from ADHD in kindergarten to David Robinson?  Oh, that's right - maybe being the smallest guy on the team from the age of 6-12 sours you on sports, or at least impacts your self-view, even when you eventually turn out to be just as big and strong as everyone else.

For that matter, going back to the original article, how much does being diagnosed impact one's self-view related to academics, if you are behind simply because you are the youngest in the class?  Interesting stuff...

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