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 Now, parents can add another concern to the list – higher odds that
their child will be diagnosed with attention-deficit hyperactivity
disorder (ADHD) and put on medication.
Researchers in Taiwan, where August 31 is the cutoff date for school
enrollment, found children born in that month were much more likely
to be diagnosed and treated for ADHD than their peers with September
birthdays.
It’s possible this happens at least in part because parents and
teachers forget the August babies are almost one year younger than
the September babies in class, and perceive behavior problems when
kids are actually acting appropriately for their age, lead study
author Dr. Mu-Hong Chen of Taipei Veterans Hospital in Taiwan said
by email.
“Children’s self-control – essentially the ability to keep still –
evolves as children mature,” said Dr. Dimitri Christakis, director
of the Center for Child Health Behavior and Development at Seattle
Children’s Research Institute.
“Thus, younger children may be at greater risk for being perceived
as hyperactive,” Christakis, who wasn’t involved in the study, added
by email.
The findings also mirror what’s been seen in the U.S. and other
countries, Christakis noted.
“For parents, the implications are to think twice before starting
very young children on medication,” Christakis said.
To see how students’ age relative to their classmates might
influence their odds of an ADHD diagnosis, Chen and colleagues
analyzed data on about 370,000 Taiwanese children aged 4 to 17 years
between 1997 and 2011.
Overall, there were 32,394 August babies in the study; 2.9 percent
of them were diagnosed with ADHD and 2.1 percent were put on
medication for the condition.
Among the 33,607 September babies in the study, 1.8 percent were
diagnosed with ADHD and 1.2 percent were put on medication,
researchers report in the Journal of Pediatrics.
Boys born in August were 63 percent more likely to be diagnosed with
ADHD than boys with September birthdays. The August boys were 76
percent more likely to be put on medication for the condition.
Girls with August birthdays were 71 percent more likely to be
diagnosed with ADHD, and 65 percent more likely to be put on
medication.
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Stimulants such as Ritalin and Adderall are the most commonly
prescribed drugs for ADHD. These pills are thought to work by
increasing levels of dopamine, a chemical in the brain associated
with pleasure, attention and movement.
Common side effects such as loss of appetite, insomnia, mood swings,
depression and dizziness make some doctors and parents reluctant to
put kids on these drugs, which can also cause personality changes
and lead to obsessive-compulsive symptoms in certain children.
The study findings reinforce that medication should only be
prescribed after careful consideration of how the child’s behavior
seems relative to what’s age-appropriate, and not compared with what
other students do in class, the authors conclude.
Limitations of the study include the possibility that researchers
underestimated ADHD diagnosis and treatment because they used data
from Taiwan’s National Health Insurance that would exclude kids who
didn’t seek medical help for the condition, the authors note. They
also lacked data on the severity of ADHD symptoms.
Parents should make sure they consider their child’s age and the
severity of any impairments associated with ADHD when weighing
whether to use medication, said Dr. Luis Augusto Rohde, director of
the ADHD program at Clinicas Hospital of Porto Alegre in Brazil.
They should not, however, see the study findings as a blanket
recommendation to delay school enrollment for kids that would be the
youngest ones in class, Rohde, who wasn’t involved in the study,
said by email.
“A recent study assessing this strategy did not find any benefit in
school achievements several years later,” Rohde added. “So we need
more evidence-based data to propose interventions.”
SOURCE: http://bit.ly/1Rmul36 Journal of Pediatrics, online March
10, 2016.
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