Top

Published in:

Open Access 01-11-2019 | Review

Relative age and ADHD symptoms, diagnosis and medication: a systematic review

Authors: Josephine Holland, Kapil Sayal

Published in: European Child & Adolescent Psychiatry | Issue 11/2019

Abstract

There is a growing international literature investigating the relationship between attention-deficit/hyperactivity disorder (ADHD) and younger relative age within the school year, but results have been mixed. There are no published systematic reviews on this topic. This study aimed to systematically review the published studies on the relative age effect in ADHD. Systematic database searches of: Medline, Embase, PsycINFO, Web of Science, ERIC, Psychology and Behavioral Sciences Collection and The Cochrane Library were conducted. Studies were selected which investigated the relative age effect in ADHD in children and adolescents. Twenty papers were included in the review. Sixteen (of 20) papers reported a significantly higher proportion of relatively younger children being diagnosed with ADHD and/or receiving medication for this. Meta-analyses involving 17 of these 20 papers revealed a modest relative age effect in countries with higher prescribing rates, risk ratio = 1.27 (95% CI 1.19–1.35) for receipt of medication. The relative age effect is well demonstrated in countries with known higher prescribing rates. Amongst other countries, there is also increasing evidence for the relative age effect, however, there is high heterogeneity amongst studies. Further research is needed to understand the possible reasons under-pinning the relative age effect and to inform attempts to reduce it.

Biederman J, Faraone SV (2005) Attention-deficit hyperactivity disorder. Lancet 366:237–248. https://doi.org/10.1016/s0140-6736(05)66915-2 CrossRefPubMed

Polanczyk G, de Lima M, Horta B, Biederman J, Rohde L (2007) The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry 164(6):942–948. https://doi.org/10.1176/ajp.2007.164.6.942 CrossRefPubMed

Willcutt E (2012) The prevalence of DSM-IV Attention-deficit/hyperactivity disorder: a meta-analytic review. Neurotherapeutics 9(3):490–499. https://doi.org/10.1007/s13311-012-0135-8 CrossRefPubMedPubMedCentral

Polanczyk G, Willcutt E, Salum G, Kieling C, Rohde L (2014) ADHD prevalence estimates across three decades: an updated systematic review and meta-regression analysis. Int J Epidemiol 43(2):434–442. https://doi.org/10.1093/ije/dyt261 CrossRefPubMedPubMedCentral

Sayal K, Prasad V, Daley D, Ford T, Coghill D (2018) ADHD in children and young people: prevalence, care pathways, and service provision. Lancet Psychiatry 5(2):175–186. https://doi.org/10.1016/s2215-0366(17)30167-0 CrossRefPubMed

Hinshaw S, Scheffler R, Fulton B et al (2011) International variation in treatment procedures for ADHD: social context and recent trends. Psychiatr Serv 62(5):459–464. https://doi.org/10.1176/ps.62.5.pss6205_0459 CrossRefPubMed

Scheffler R, Hinshaw S, Modrek S, Levine P (2007) The global market for ADHD medications. Health Aff 26(2):450–457. https://doi.org/10.1377/hlthaff.26.2.450 CrossRef

Dalsgaard S, Humlum M, Nielsen H, Simonsen M (2014) Common Danish standards in prescribing medication for children and adolescents with ADHD. Eur Child Adolesc Psychiatry 23(9):841–844. https://doi.org/10.1007/s00787-013-0508-5 CrossRefPubMed

Sharma A, Couture J (2013) A review of the pathophysiology, etiology, and treatment of attention-deficit hyperactivity disorder (ADHD). Ann Pharmacother 48(2):209–225. https://doi.org/10.1177/1060028013510699 CrossRefPubMed

10.

Ford-Jones P (2015) Misdiagnosis of attention deficit hyperactivity disorder: ‘Normal behaviour’ and relative maturity. Paediatr Child Health 20(4):200–202. https://doi.org/10.1093/pch/20.4.200 CrossRefPubMedPubMedCentral

11.

Taylor E (2016) Attention deficit hyperactivity disorder: overdiagnosed or diagnoses missed? Arch Dis Child 102(4):376–379. https://doi.org/10.1136/archdischild-2016-310487 CrossRefPubMed

12.

Musch J, Grondin S (2001) Unequal competition as an impediment to personal development: a review of the relative age effect in sport. Dev Rev 21(2):147–167. https://doi.org/10.1006/drev.2000.0516 CrossRef

13.

Cobley S, McKenna J, Baker J, Wattie N (2009) How pervasive are relative age effects in secondary school education? J Educ Psychol 101(2):520–528. https://doi.org/10.1037/a0013845 CrossRef

14.

Patalay P, Belsky J, Fonagy P et al (2015) the extent and specificity of relative age effects on mental health and functioning in early adolescence. J Adolesc Health 57(5):475–481. https://doi.org/10.1016/j.jadohealth.2015.07.012 CrossRefPubMed

15.

Evans W, Morrill M, Parente S (2010) Measuring inappropriate medical diagnosis and treatment in survey data: the case of ADHD among school-age children. J Health Econ 29(5):657–673. https://doi.org/10.1016/j.jhealeco.2010.07.005 CrossRefPubMed

16.

Zoega H, Valdimarsdottir U, Hernandez-Diaz S (2012) Age, academic performance, and stimulant prescribing for ADHD: a nationwide cohort study. Pediatrics 130(6):1012–1018. https://doi.org/10.1542/peds.2012-0689 CrossRefPubMedPubMedCentral

17.

Dalsgaard S, Humlum M, Nielsen H, Simonsen M (2012) Relative standards in ADHD diagnoses: the role of specialist behavior. Econ Lett 117(3):663–665. https://doi.org/10.1016/j.econlet.2012.08.008 CrossRef

18.

Pottegård A, Hallas J, Hernández-Díaz Zoëga H (2014) Children’s relative age in class and use of medication for ADHD: a Danish Nationwide Study. J Child Psychol Psychiatry 55(11):1244–1250. https://doi.org/10.1111/jcpp.12243 CrossRefPubMedPubMedCentral

19.

Sayal K, Chudal R, Hinkka-Yli-Salomäki S, Joelsson P, Sourander A (2017) Relative age within the school year and diagnosis of attention-deficit hyperactivity disorder: a nationwide population-based study. Lancet Psychiatry 4(11):868–875. https://doi.org/10.1016/s2215-0366(17)30394-2 CrossRefPubMed

20.

Schwandt H, Wuppermann A (2016) The youngest get the pill: aDHD misdiagnosis in Germany, its regional correlates and international comparison. Labour Econ 43:72–86. https://doi.org/10.1016/j.labeco.2016.05.018 CrossRef

21.

Stang A (2010) Critical evaluation of the Newcastle-Ottowa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 23:603–605. https://doi.org/10.1007/s10654-010-9491-z CrossRef

22.

Bachmann C, Wijlaars L, Kalverdijk L et al (2017) Trends in ADHD medication use in children and adolescents in five western countries, 2005–2012. Eur Neuropsychopharmacol 27(5):484–493. https://doi.org/10.1016/j.euroneuro.2017.03.002 CrossRefPubMed

23.

Hoshen M, Benis A, Keyes K, Zoëga H (2016) Stimulant use for ADHD and relative age in class among children in Israel. Pharmacoepidemiol Drug Saf 25(6):652–660. https://doi.org/10.1002/pds.3962 CrossRefPubMedPubMedCentral

24.

Whitely M, Lester L, Phillimore J, Robinson S (2017) Influence of birth month on the probability of Western Australian children being treated for ADHD. Med J Aust 206(2):85. https://doi.org/10.5694/mja16.00398 CrossRefPubMed

25.

Halldner L, Tillander A, Lundholm C et al (2014) Relative immaturity and ADHD: findings from nationwide registers, parent- and self-reports. J Child Psychol Psychiatry 55(8):897–904. https://doi.org/10.1111/jcpp.12229 CrossRefPubMed

26.

Gökçe S, Yazgan Y, Ayaz AB et al (2017) Association between age of beginning primary school and attention deficit hyperactivity disorder. J Dev Behav Pediatr 38(1):12–19. https://doi.org/10.1097/dbp.0000000000000370 CrossRefPubMed

27.

Elder T (2010) The importance of relative standards in ADHD diagnoses: evidence based on exact birth dates. J Health Econ 29(5):641–656. https://doi.org/10.1016/j.jhealeco.2010.06.003 CrossRefPubMedPubMedCentral

28.

Morrow R, Garland E, Wright J, Maclure M, Taylor S, Dormuth C (2012) Influence of relative age on diagnosis and treatment of attention-deficit/hyperactivity disorder in children. Can Med Assoc J 184(7):755–762. https://doi.org/10.1503/cmaj.111619 CrossRef

29.

Chen M, Lan W, Bai Y et al (2016) Influence of relative age on diagnosis and treatment of attention-deficit hyperactivity disorder in taiwanese children. J Pediatr 172(162–167):e1. https://doi.org/10.1016/j.jpeds.2016.02.012 CrossRef

30.

Karlstad Ø, Furu K, Stoltenberg C, Håberg S, Bakken I (2017) ADHD treatment and diagnosis in relation to children’s birth month: nationwide cohort study from Norway. Scand J Public Health 45(4):343–349. https://doi.org/10.1177/1403494817708080 CrossRefPubMed

31.

Krabbe E, Thoutenhoofd E, Conradi M, Pijl S, Batstra L (2014) Birth month as predictor of ADHD medication use in Dutch school classes. Eur J Spec Needs Educ 29(4):571–578. https://doi.org/10.1080/08856257.2014.943564 CrossRef

32.

Librero J, Izquierdo-María R, García-Gil M, Peiró S (2015) Children’s relative age in class and medication for attention-deficit/hyperactivity disorder. A population-based study in a health department in Spain. Medicina Clínica (English Edition) 145(11):471–476. https://doi.org/10.1016/j.medcle.2016.04.002. Accessed 15 Sept 2017

33.

Rivas-Juesas C, de Dios J, Benac-Prefaci M, Fernandez-Martinez S, Colomer-Revuelta J (2015) Influence of the month of birth on the demand for healthcare to treat attention deficit hyperactivity disorder. Results of a retrospective study conducted in a neuropaediatric clinic. Revista De Neurologia 61(7):289–294CrossRef

34.

Folgar M, Boubeta A, Lamas M, Mocino L (2017) Evaluation of impact of relative age effect on school performance, bullying, self esteem, ADHD diagnosis and consumption of tobacco in the transition from primary education to high school. Revista Iberoamericana de Diagnóstico y Evaluación—e Avaliação Psicológica. RIDEP 44(2):92–104. https://doi.org/10.21865/ridep44.2.08. Accessed 17 Dec 2017

35.

Schmiedeler S, Klauth L, Segerer R, Schneider W (2015) Relationship between age of school entry and behaviour problems. Praxis Der Kinderpsychologie Und Kinderpsychiatrie 64(2):104–116. https://doi.org/10.13109/prkk.2015.64.2.104 CrossRefPubMed

36.

Goodman R (2003) Child psychiatric disorder and relative age within school year: cross sectional survey of large population sample. BMJ 327(7413):472. https://doi.org/10.1136/bmj.327.7413.472 CrossRefPubMedPubMedCentral

37.

Radecki T (2003) Child psychiatric disorder and relative age in school year: holding back may cause more harm than good. BMJ 327(7426):1286. https://doi.org/10.1136/bmj.327.7426.1286 CrossRefPubMedPubMedCentral

Title: Relative age and ADHD symptoms, diagnosis and medication: a systematic review
Authors: Josephine Holland
Kapil Sayal
Publication date: 01-11-2019
Publisher: Springer Berlin Heidelberg
Published in: European Child & Adolescent Psychiatry / Issue 11/2019
Print ISSN: 1018-8827
Electronic ISSN: 1435-165X
DOI: https://doi.org/10.1007/s00787-018-1229-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Relative age and ADHD symptoms, diagnosis and medication: a systematic review

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 11/2019

Risk factors for psychological functioning in German adolescents with gender dysphoria: poor peer relations and general family functioning

Does maternal somatic anxiety in pregnancy predispose children to hyperactivity?

Developmental trajectories of motor skills during the preschool period

The interplay between self-regulation and affectivity in binge eating among adolescents

Outcomes of young people who reach the transition boundary of child and adolescent mental health services: a systematic review

Mind the gap: evidence that child mental health inequalities are increasing in the UK