Younger Kids in a Grade More Apt to be Diagnosed with ADHD

Younger Kids in a Grade More Apt to be Diagnosed with ADHD

It is July and before we know it, another school year will be upon us. Over the last several months, I have had several discussions with parents in my practice regarding whether they should start their 5-year-old in Kindergarten or hold her back a year. It is a complex question with many points to consider.

A recent article published in the Journal of Pediatrics showed an approximate 75% increase among the youngest kids in a grade and the receipt of an ADHD diagnosis. In fact, if you examine the data, you can see an increase in the chance of obtaining an ADHD diagnosis with each month younger a student is relative to his or her peers. In the elementary school years, perhaps more so than in later grades, a few months makes a significant difference with regards to social and emotional maturity, as well as overall development. This immaturity can impact the ability to stay on tasks, make and maintain friendships, as well as focus on assignments in parallel with other classmates. ADHD diagnoses are often determined based on parental reports and teacher questionnaires. Teachers have no choice but to compare younger children to older classmates in the same grade, and parents, perhaps more so with their first child, often have expectations above normality.

NPR covered this issue as well, and the physician commentary notably discussed the concern that pediatricians may over diagnose and treat this age group when eventual maturity would eradicate the issue altogether. The NPR quoted pediatrician warned against holding kids back a grade citing data that kids that are held back are more likely to drop-out of school or be bullied. Unfortunately, I think she is dismissing an issue of greater scope and discussion. It absolutely depends on the individual child’s situation and the community in which they live.

In my community, it is often better to err on the side of holding back a younger child; allowing him or her to start kindergarten at 6 for example (for spring and summer birthdays) than to push forward at age 5. One reason for this is multiple private schools exist in our community with robust kindergarten programs that allow a student to grow and mature in the year preceding their public school entrance. Among the private school kids, primer years are becoming the rule rather than the exception, and the baseline has shifted markedly because of this. Of course, delaying public school entry (or an additional year of private school) costs money and understandably for some of us, this route is not an option. But I would argue that in communities where it is an option for most, the youngest in the bunch, especially if they seem somewhat immature relative to their peers anyway, will be at a real disadvantage.

I do agree that holding a child back a grade, especially in the later years, can be tough on his sense of self worth. I’d rather encourage parents to delay entry if there are concerns of any type, be it academic, social or maturational. I have lots of parents tell me that they fear their child will be bored if they hold her back. I have to tell you, even among my patients in the talented and gifted programs, not once have I witnessed this.

Boredom because of intelligence assumes a completely academic experience. It minimizes the social intricacies of forging relationships with peers and teachers, building confidence in extracurricular activities and overall academic abilities.

Some of my brightest patients are my most socially immature. Does that mean that an extra year will solve any issues regarding peer rapport? No, but I’m not convinced it could hurt if it is an option for a family. In fact, in my decade of practice, I have not had a single parent tell me that they wished they had started their child earlier, but I have had so many tell me that they wished they had waited a year. Maybe youth is more complex than it used to be. I joke with parents in my practice that I probably would have been diagnosed with ADHD by today’s standards. Kids are expected to achieve so much from an early age, while managing digital media and a robust extracurricular calendar in a way we never did. Delaying kindergarten entry is not the absolute answer, and of course some children will still experience learning differences and an accurate diagnosis of ADHD, but it is something to think about and consider. And maybe our first thought regarding this issue, is not the best one.