View Full Version : Boys born in December more likely to be diagnosed with ADHD?


Zanela123
07-01-14, 08:15 PM
Found this interesting study:

http://www.cmaj.ca/content/184/7/755.short

“One of the most shocking studies of the rise in ADHD diagnoses was published in 2012 in the Canadian Medical Association Journal. It was called “Influence of Relative Age on Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder in Children.” Nearly one million children between the ages of six and twelve took part, making it the largest study of its kind ever. The researchers found that “boys who were born in December”—typically the youngest students in their class—”were 30 percent more likely to receive a diagnosis of ADHD than boys born in January,” who were a full year older. And “boys were 41 percent more likely to be given a prescription for a medication to treat ADHD if they were born in December than if they were born in January.”

I personally have no comment.
Just thought this was an interesting finding that perhaps I'd share.

Hyperman87
07-01-14, 08:28 PM
Well,I was born on Thanksgiving 1987.So I guess that's close enough.:lol:

kilted_scotsman
07-02-14, 04:33 AM
This would be an easy hypothesis to test.... just go to other countries where the cutoff date is different and see if the same trend is present.

This is similar to what Gladwell talked about in his book "Outliers"....

I'm also wondering if it's more male orientated.... As i watched my own kids and their friends growing up I sensed that a year seems to have more developmental impact in boys around that age. This was why we used the option of delaying my son's school entry for a year....

I think it paid off and it reinforced Gladwell's observation....my son was immediately put in the fast track for sporting development.

MADD As A Hatte
07-02-14, 06:37 AM
And here's a peer response, the following April

Lies, Damned Lies, and Statistics: Influence of Relative Age on
Diagnosis and Treatment of ADHD in Children
Jerome, Laurence

http://m.cmaj.ca/content/184/7/755.short/reply#cmaj_el_714996

Fuzzy12
07-02-14, 11:55 AM
I've only read the abstract, not the entire paper but based on the abstract it does make sense to me.

I guess, ADHD is diagnosed relative to the level of development of your peers. So if you are in grade 1 but an entire year younger than most others in your class, you'd be at a different stage of development and possibly less mature and less capable. You might struggle more than your older class mates, struggle in more obvious ways and this could be falsely interpreted as having a disorder or some sort of developmental delay even though you are at the right stage based on your age.

Of course this doesn't mean that everyone diagnosed with ADHD and born in December has been misdiagnosed (or that cases of underdiagnosis/missed diagnosis don't exist) but I guess it's something to consider. Though to be honest, I find it hard to imagine that psychiatrists really wouldn't consider the actual age of the child or how younger kids might struggle more compared to older kids.

I've skimmed through the rest of the paper now and unfortunately, I can't find any information on the diagnostic process among those kids, i.e. did authors really not consider functional impairments as is claimed in the rebuttal posted by Madd.

I also don't exactly see why they think that the authors of the paper don't understand that ADHD is diagnosed not only based on symptoms but also based on functional impairments. Can relative functional impairments not be caused by the age difference? I'm not sure I understand this correctly so I'm asking in case anyone does (or has read the paper more carefully than me..or has more knowledge, etc...)

Fuzzy12
07-02-14, 12:09 PM
This would be an easy hypothesis to test.... just go to other countries where the cutoff date is different and see if the same trend is present.



In the paper they've written that two similar studies were carried out in the US and found higher diagnosis and treatment rates among kids who were relatively younger than their class mates.

I think, they also say that towards the higher age range, this effect diminishes for girls.

Stevuke79
07-02-14, 12:28 PM
I think if we're going to disagree with the original study, it's important to cite exactly what we're disagreeing with (and what the critiques were disagreeing with).

The actual STUDY and SCIENTIFIC FINDINGS seem very valid and even intuitive. I would expect you to find that children with a younger "relative age" are more likely to be diagnosed. This may even imply that "relative age" is a cause of misdiagnosis - I think that makes a lot of sense as well. There are two problems with this study:

1. As almost all of the critiques pointed out, a higher chance of diagnosis for a subset of the population IN NO WAY implies an over-diagnosis for the population in general or EVEN the subset in question. You have to look at the expected incidence of ADHD versus the incidence of diagnosis. When we do that we see that ADHD is under-diagnosed. Relative-Age may exacerbate symptoms and increase the likelihood of a diagnosis OR may mimic symptoms and increase the likelihood of a misdiagnosis. If the latter then I agree that this is a good point of caution for doctors diagnosing the disorder. But it still doesn't imply over-diagnosis.

2. As the second critique highlighted, the authors made the jump to growth and cardiovascular problems. They cite no sources for these concerns. The mainstream consensus based on actual studies is that this is not a concern.

Fuzzy12
07-02-14, 12:35 PM
1. As almost all of the critiques pointed out, a higher chance of diagnosis for a subset of the population IN NO WAY implies an over-diagnosis for the population in general or EVEN the subset in question. You have to look at the expected incidence of ADHD versus the incidence of diagnosis. When we do that we see that ADHD is under-diagnosed. Relative-Age may exacerbate symptoms and increase the likelihood of a diagnosis OR may mimic symptoms and increase the likelihood of a misdiagnosis. If the latter then I agree that this is a good point of caution for doctors diagnosing the disorder. But it still doesn't imply over-diagnosis.

I don't think they've mentioned taht there is an overdiagnosis in general (though I might have missed it). The results don't necessarily indicate that there is an overdiagnosis for this particular subset either but I guess more research is required to find out why there is this difference based on relative age and if this is not a factor that clinicians already consider.

From the paper, on their limitations:

We aimed to determine the influence of birth month on diagnosing and prescribing medications for ADHD, but our study faced certain limitations. To interpret the increased risk of diagnosis and treatment among younger children within a grade as overdiagnosis or overprescribing implies an assumption as to appropriate levels of diagnosis and treatment, such as that children born in January received appropriate levels of diagnoses and treatment. However, the true incidence of ADHD is unknown. The proportion of children born in January who received a diagnosis of ADHD might underestimate incidence of the disorder if more mature children within each grade are better able to cope with an underlying disorder. However, it is possible that the January proportion overestimates the incidence if a larger issue of overmedicalization of childhood behaviour exists.

2. As the second critique highlighted, the authors made the jump to growth and cardiovascular problems. They cite no sources for these concerns. The mainstream consensus based on actual studies is that this is not a concern

Yeah, that's true and unfortunately, it does make the whole research slightly less credible. I suppose they needed to state a reason why overdiagnosis would be a problem at all and they thought these might make for catchy keywords. Or rather it seems that unfortunately they didn't think (or research) too much about it at all.

Stevuke79
07-02-14, 12:38 PM
I've only read the abstract, not the entire paper but based on the abstract it does make sense to me.

I guess, ADHD is diagnosed relative to the level of development of your peers. So if you are in grade 1 but an entire year younger than most others in your class, you'd be at a different stage of development and possibly less mature and less capable. You might struggle more than your older class mates, struggle in more obvious ways and this could be falsely interpreted as having a disorder or some sort of developmental delay even though you are at the right stage based on your age.

Of course this doesn't mean that everyone diagnosed with ADHD and born in December has been misdiagnosed (or that cases of underdiagnosis/missed diagnosis don't exist) but I guess it's something to consider. Though to be honest, I find it hard to imagine that psychiatrists really wouldn't consider the actual age of the child or how younger kids might struggle more compared to older kids.

I've skimmed through the rest of the paper now and unfortunately, I can't find any information on the diagnostic process among those kids, i.e. did authors really not consider functional impairments as is claimed in the rebuttal posted by Madd.

I also don't exactly see why they think that the authors of the paper don't understand that ADHD is diagnosed not only based on symptoms but also based on functional impairments. Can relative functional impairments not be caused by the age difference? I'm not sure I understand this correctly so I'm asking in case anyone does (or has read the paper more carefully than me..or has more knowledge, etc...)

That's a good question. Are you referring to Laurence Jerome:
... If a child has ADHD and is also significantly younger than their peer group the likelihood of functional impairment increases. Clinical experience over 30 years in Ontario has shown that relative age effect of immaturity in the presence of ADHD is not remediated by having a child repeat the year which used to be the case. Unless ADHD and associated learning disabilities are identified and appropriately managed the child continues to have ongoing functional impairments.
The authors misunderstand the nature of clinical diagnosis of ADHD. This is based on functional impairment not on symptoms alone. The diagnosis should made by clinicians after a careful developmental and family history and assessment of functional impairment In evaluating ADHD, functional impairment is critical in making the decision to treat. ADHD is not a static impairment. It is extremely context dependent. For children in elementary school the most functionally impairing environment is the classroom. The author's advice that "greater emphasis on a child's behavior outside the classroom may be warranted when assessing children for ADHD to lessen the risk of inappropriate diagnosis" reveals their misunderstanding that the classroom demands on social, behavioral and academic performance rather than home or community contexts produce the most impairment in executive function in children with ADHD. Unfortunately it is still often the case that physicians who make the diagnosis and prescribe the medication have very little contact with teachers either in terms of establishing the diagnosis or indeed in monitoring effects of medication. (4). the erroneous conclusion that teacher identified ADHD automatically leads clinicians to make an erroneous diagnosis is not supported by the fact that there is relatively little communication between school and physician's office.

I think what he's saying is that for these children, their most significant symptoms would be in the classroom, so you can't say that you need to place extra emphasis when looking outside the classroom to determine ADHD; the problems are primarily in the classroom. He also notes that statistically speaking children who are held back tend not to catch up, which seems to imply that relative age has helped children to be properly diagnosed where as their older colleagues may go without diagnosis.

Stevuke79
07-02-14, 12:45 PM
I don't think they've mentioned taht there is an overdiagnosis in general (though I might have missed it). The results don't necessarily indicate that there is an overdiagnosis for this particular subset either but I guess more research is required to find out why there is this difference based on relative age and if this is not a factor that clinicians already consider.

I should have worded that to be only for the subset in question - you're right. My bad wording. Btw, in case you meant it wasn't clear that they were saying it regarding the subset in general, personally I think they were in their Interpretation.
Interpretation: The results of our analyses show a relative-age effect in the diagnosis and treatment of ADHD in children aged 6–12 years in British Columbia. These findings raise concerns about the potential harms of overdiagnosis and overprescribing. These harms include adverse effects on sleep, appetite and growth, in addition to increased risk of cardiovascular events.

Yeah, that's true and unfortunately, it does make the whole research slightly less credible. I suppose they needed to state a reason why overdiagnosis would be a problem at all and they thought these might make for catchy keywords. Or rather it seems that unfortunately they didn't think (or research) too much about it at all.

It really does impugn their objectivity. By the way,.. I know what you're saying with "they needed to state a reason why overdiagnosis would be a problem at all", but actually I'm going to go the other way,.. they DON'T have to do that. Just to highlight a concern for over-diagnosis in general would be an interesting and valuable finding all on it's own.

I think that's why so many responders wrote that they "expose their bias". Validity of their methods aside, if you have an interesting finding, why make an unsubstantiated extrapolation unless you have an agenda. If your goal was science, you achieved your goal before you made an invalid extrapolation. Ergo, your goal was not science.

Fuzzy12
07-02-14, 12:55 PM
That's a good question. Are you referring to Laurence Jerome:
... If a child has ADHD and is also significantly younger than their peer group the likelihood of functional impairment increases. Clinical experience over 30 years in Ontario has shown that relative age effect of immaturity in the presence of ADHD is not remediated by having a child repeat the year which used to be the case. Unless ADHD and associated learning disabilities are identified and appropriately managed the child continues to have ongoing functional impairments.
The authors misunderstand the nature of clinical diagnosis of ADHD. This is based on functional impairment not on symptoms alone. The diagnosis should made by clinicians after a careful developmental and family history and assessment of functional impairment In evaluating ADHD, functional impairment is critical in making the decision to treat. ADHD is not a static impairment. It is extremely context dependent. For children in elementary school the most functionally impairing environment is the classroom. The author's advice that "greater emphasis on a child's behavior outside the classroom may be warranted when assessing children for ADHD to lessen the risk of inappropriate diagnosis" reveals their misunderstanding that the classroom demands on social, behavioral and academic performance rather than home or community contexts produce the most impairment in executive function in children with ADHD. Unfortunately it is still often the case that physicians who make the diagnosis and prescribe the medication have very little contact with teachers either in terms of establishing the diagnosis or indeed in monitoring effects of medication. (4). the erroneous conclusion that teacher identified ADHD automatically leads clinicians to make an erroneous diagnosis is not supported by the fact that there is relatively little communication between school and physician's office.

I think what he's saying is that for these children, their most significant symptoms would be in the classroom, so you can't say that you need to place extra emphasis when looking outside the classroom to determine ADHD; the problems are primarily in the classroom. He also notes that statistically speaking children who are held back tend not to catch up, which seems to imply that relative age has helped children to be properly diagnosed where as their older colleagues may go without diagnosis.

Yes, that's what I meant. I think the question of what causes the classroom issues of younger kids remains. If the age difference can cause problems then exclusively considering classroom problems when diagnosing ADHD can give misleading results and the authors have not suggested not considering the class room issues.

Greater emphasis on a child’s behaviour outside of school may be warranted when assessing children for ADHD to lessen the risk of inappropriate diagnosis

I interpret "greater emphasis" here as meaning that more emphasis should be placed on behaviour outside school than is currently done rather than more emphasis should be placed on behaviour outside school than classroom behaviour.

I agree that relative age can result in a kid with ADHD being diagnosed earlier but this doesn't mean that a kid without ADHD can't be falsely diagnosed because of relative age IF relative younger age can look like a developmental delay. The authors have mentioned as well that rather than an overdiagnosis their results could be due to an underdiagnosis of the older kids.

Fuzzy12
07-02-14, 01:00 PM
It really does impugn their objectivity. By the way,.. I know what you're saying with "they needed to state a reason why overdiagnosis would be a problem at all", but actually I'm going to go the other way,.. they DON'T have to do that. Just to highlight a concern for over-diagnosis in general would be an interesting and valuable finding all on it's own.

I think that's why so many responders wrote that they "expose their bias". Validity of their methods aside, if you have an interesting finding, why make an unsubstantiated extrapolation unless you have an agenda. If your goal was science, you achieved your goal before you made an invalid extrapolation. Ergo, your goal was not science.

Theoretically, I agree but there's this growing attitude in academia (or rather in funding bodies) of having to show the impact of your research. Science for its own sake or for the sake of knowledge isn't good enough a reason anymore. I fully agree that over diagnosis on its own even without the scaremongering about health risks is interesting enough to publish.

I do think though that they could have found better and more substantiated risks of over diagnosis to state in their paper. And of course, making unsubstantiated claims is never acceptable if you need a a reason for your research or not.

Stevuke79
07-02-14, 01:27 PM
Yes, that's what I meant. I think the question of what causes the classroom issues of younger kids remains. If the age difference can cause problems then exclusively considering classroom problems when diagnosing ADHD can give misleading results and the authors have not suggested not considering the class room issues.

Right so again, this is the part of their study which is interesting and even well founded on it's own. I think the criticism is more the extension they make.

There was criticism on this part too, which I think is valid. Namely they suggested giving greater emphasis outside the classroom, which is innocuous enough but if typical impairments for younger children are in the classroom, and you're goal is to help them with their impairments, then why is this your concern unless either ADHD misdiagnosis is particularly harmful (mor than other Dx's).

But I think that as a whole, that assertion was the stronger part of the study that definitely has some value. I probably wouldn't even think to be cynical about their suggestion to have "added emphasis" outside the classroom if not for their invalid extrapolation to the dangers of overdiagnosis. Knowing me I would probably just say, "Oh, good observation.. Oh! And good suggestion too!" But the extrapolation makes me more cynical about their intentions here as well.

I interpret "greater emphasis" here as meaning that more emphasis should be placed on behaviour outside school than is currently done rather than more emphasis should be placed on behaviour outside school than classroom behaviour.

I agree that relative age can result in a kid with ADHD being diagnosed earlier but this doesn't mean that a kid without ADHD can't be falsely diagnosed because of relative age IF relative younger age can look like a developmental delay. The authors have mentioned as well that rather than an overdiagnosis their results could be due to an underdiagnosis of the older kids.

They do, and in a vacuum I probably would have just seen it as mentioning both possibilities and had no problem with it. I probably wouldn't have even noticed that they only mention the second possibility in passing. I'm generally not cynical and like to interpret people in ways that make them appear fair and intelligent. But that extrapolation at the end makes me more likely to notice that the thrust was over-diagnosis, and general under-diagnosis was mentioned in only half a sentence. But to be completely fair, despite their unfounded suggestion about the harms of over-diagnosing ADHD, it's still theoretically 100% possible that they really did intend to innocently mention both possibilities equally.

Stevuke79
07-02-14, 01:55 PM
Theoretically, I agree but there's this growing attitude in academia (or rather in funding bodies) of having to show the impact of your research. Science for its own sake or for the sake of knowledge isn't good enough a reason anymore. I fully agree that over diagnosis on its own even without the scaremongering about health risks is interesting enough to publish.

It's possible,.. and again I am the sort who would be inclined to say, "good observation .. good suggestion .. " You would know better than me, but I think over-diagnosis or mis-diagnosis is an impact in itself. When I read the study I was on board with them, it was their "Interpretation" that was invalid.

But if mis-diagnosis isn't impact enough, it still seems unlikely that they mention the dangers of meds just to show impact. Their study seemed to be directed at this particular impact of choice. Both in terms of their "Interpretation" and the impact they show. Regarding interpretation, given their findings: ADHD is more common when relative age differences are present, possible over-diagnosis is not the intuitive conclusion. The expected incidence of ADHD is much higher than the incidence of diagnosis; under-diagnosis of ADHD is a scientific fact. The intuitive conclusion is under-diagnosis and our threshold for impairment is too high (or some other factor causing relative age difference to lead to greater incidence of diagnosis, proper and otherwise.) And for that more intuitive conclusion, impact is obvious; many children who are being deemed poor performers are simply not getting the help they need.

But when they devote the half sentence to under-diagnosis, they don't even mention the impact of children who might not be getting the help they need. Again if our goal is to "show impact" rather than "suggest ADHD is over-diagnosed" then I would think we would appreciate the opportunity to suggest this impact which doesn't involve making unfounded extensions. The fact that they don't seems damning to me. In other words, it seems the goal was to show a specific, pre-decided impact, rather than show potential impacts of their study.

I think the critiques who suggest bias are at the very least, well founded.

Stevuke79
07-03-14, 08:32 AM
It's possible,.. and again I am the sort who would be inclined to say, "good observation .. good suggestion .. "

Not to you, .. that would sound condescending,.. I meant "good observation,.. good suggestion" to the idea that December babies have a higher incidence of ADHD and that we should focus more outside the classroom. I reread my post and realized it didn't sound the way I had intended.

Kunga Dorji
07-03-14, 05:09 PM
And here's a peer response, the following April

Lies, Damned Lies, and Statistics: Influence of Relative Age on
Diagnosis and Treatment of ADHD in Children
Jerome, Laurence

http://m.cmaj.ca/content/184/7/755.short/reply#cmaj_el_714996

That response does make many valid points but the problem with it is that it does not address the statistic that the younger end of the class is getting diagnosed at a higher rate.

That statistic, should be repeatable on re- test. It also should be amenable to amelioration by holding some children back from school for longer.

The patterns of school entry age that our countries have adopted are a cultural preference after all, they are not written in stone.

MADD As A Hatte
07-04-14, 01:37 AM
... it does not address the statistic that ... .

Agreed. However, I just don't think the interpretation of the statisics, in the Marrow et al. study (in the OP), nor other similar studies, stand up. Inevitably they seem to reveal bias in their conclusions.

My thinking is (rounding the figures):
if the current estimate of ADHD prevalence in the USA and Australia are similar at roughly 1 in 20 = 5%;
and if treatment rates (with meds) are around 2%,
that leaves more than half of estimated cases UNTREATED.

I can't see how anyone draws the conclusion that this an over-medicated disorder!

I found an interesting piece of research on attitudes and perceptions towards treating depression with meds, and towards treating ADHD with meds:

Over-diagnosed and over-treated: a survey of Australian public attitudes towards the acceptability of drug treatment for depression and ADHD
Brad Partridge, Jayne Lucke and Wayne Hall
http://www.biomedcentral.com/1471-244X/14/74

"This raises the prospect that scepticism about drug treatment may be partly based on scepticism about the appropriateness of the diagnosis. Some members of the public who believe that depression and ADHD are too readily diagnosed may be reluctant to seek help from a health care provider even when they (or their children) need it."

The thing is, we're ALL human beings. So, scepticism is as much a potential in the experts as it is in the rest of us. And I think the greatest concern is in the reluctance to seek treatment (noted above).


Back to the original opint, here's a piece of research relating to the RAE (Relative Age Effect) and SOBE (Season of Birth Effect) effects. Neither of these effects translates (retrospectively) in adults, according to Kowalyk et al (2012), Journal of Attention Disorders.
"No Link Between Date of Birth and ADHD Symptoms in Adults"

"Research has highlighted several negative consequences for individuals born in the later part of the academic year, including increased likelihood of being diagnosed with learning disabilities. Results did not support a RAE or SOBE among males or females. Possible reasons for these findings and their implications are discussed".

I can't attach the .pdf of the article here because of the ADDforum attachment quota (if someone could assist by explaining how to delete previous attachments, that would be REALLY helpful), Otherwise, if you PM me, I'll e-mail you a copy.

Cheers
Happy Independence Day!

Kunga Dorji
07-04-14, 02:59 AM
Agreed. However, I just don't think the interpretation of the statisics, in the Marrow et al. study (in the OP), nor other similar studies, stand up. Inevitably they seem to reveal bias in their conclusions.

My thinking is (rounding the figures):
if the current estimate of ADHD prevalence in the USA and Australia are similar at roughly 1 in 20 = 5%;
and if treatment rates (with meds) are around 2%,
that leaves more than half of estimated cases UNTREATED.

I can't see how anyone draws the conclusion that this an over-medicated disorder!

I found an interesting piece of research on attitudes and perceptions towards treating depression with meds, and towards treating ADHD with meds:

Over-diagnosed and over-treated: a survey of Australian public attitudes towards the acceptability of drug treatment for depression and ADHD
Brad Partridge, Jayne Lucke and Wayne Hall
http://www.biomedcentral.com/1471-244X/14/74

"This raises the prospect that scepticism about drug treatment may be partly based on scepticism about the appropriateness of the diagnosis. Some members of the public who believe that depression and ADHD are too readily diagnosed may be reluctant to seek help from a health care provider even when they (or their children) need it."

The thing is, we're ALL human beings. So, scepticism is as much a potential in the experts as it is in the rest of us. And I think the greatest concern is in the reluctance to seek treatment (noted above).


Back to the original opint, here's a piece of research relating to the RAE (Relative Age Effect) and SOBE (Season of Birth Effect) effects. Neither of these effects translates (retrospectively) in adults, according to Kowalyk et al (2012), Journal of Attention Disorders.
"No Link Between Date of Birth and ADHD Symptoms in Adults"

"Research has highlighted several negative consequences for individuals born in the later part of the academic year, including increased likelihood of being diagnosed with learning disabilities. Results did not support a RAE or SOBE among males or females. Possible reasons for these findings and their implications are discussed".

I can't attach the .pdf of the article here because of the ADDforum attachment quota (if someone could assist by explaining how to delete previous attachments, that would be REALLY helpful), Otherwise, if you PM me, I'll e-mail you a copy.

Cheers
Happy Independence Day!


Interestingly rates are probably significantly higher than the quoted 5%- and they vary significantly geographically within the US. There have not been studies done that are sufficiently fine grained in Australia to show that up.

The last Health Dept statistics I encountered for New South Wales suggested that the rate of treatment in adults was more like 0.1% of adults.

So much for overdiagnosis.

I have said it before though- and will say it again:
It is more common than not for there to be a near complete disconnect between the results of a research project and its conclusions-- and this is especially so in the "softer end" of the biomedical field.

kilted_scotsman
07-04-14, 06:01 AM
My thinking is (rounding the figures):
if the current estimate of ADHD prevalence in the USA and Australia are similar at roughly 1 in 20 = 5%;
and if treatment rates (with meds) are around 2%,
that leaves more than half of estimated cases UNTREATED.

Nope.... that leaves half the estimated cases UNMEDICATED... they may

1) be coping perfectly well
2) be using non-pharmacological treatments.

The problem is the assumption that
1) if you have ADHD you need "treatment"
2) Treatment = medication.

Once these assumptions are questioned it is perfectly possible for 5% of the population to have ADHD, only 2% medicated AND have over medication.

MADD As A Hatte
07-04-14, 08:44 AM
... that leaves half the estimated cases UNMEDICATED...

Apologies, my bad. Wrong choice of terminology. Correction: "That leaves WAY MORE than half estimated cases of ADD unmedicated.". Thanks for picking up my error in vocab. ADD. Ya gotta love it.

That said, my point stands. And yes, KD is correct in saying current medication rates are well under 2%.

Kunga Dorji
07-04-14, 08:56 AM
Nope.... that leaves half the estimated cases UNMEDICATED... they may

1) be coping perfectly well
2) be using non-pharmacological treatments.

The problem is the assumption that
1) if you have ADHD you need "treatment"
2) Treatment = medication.

Once these assumptions are questioned it is perfectly possible for 5% of the population to have ADHD, only 2% medicated AND have over medication.

This is a tricky one to tease out-- but if there is no disorder there is nothing to need "treatment" of any kind.

If we were to look at "treatment" seriously we would need to add in all the ADDers who were self medicating with metamphetamine bought off the black market, with alcohol, or , in extreme cases, with heroin.

As Gabor Mate says, the behavioural characteristics that define high risk for drug abuse are identical to the behavioural syndrome described as ADHD-- so-- tell me the proportion of ADHD adults who remain "untreated"?- -- whether that "treatment" be "official" or "unofficial". Not an easy question to answer when it is framed that way.

daveddd
07-04-14, 09:01 AM
This is a tricky one to tease out-- but if there is no disorder there is nothing to need "treatment" of any kind.

If we were to look at "treatment" seriously we would need to add in all the ADDers who were self medicating with metamphetamine bought off the black market, with alcohol, or , in extreme cases, with heroin.

As Gabor Mate says, the behavioural characteristics that define high risk for drug abuse are identical to the behavioural syndrome described as ADHD-- so-- tell me the proportion of ADHD adults who remain "untreated"?- -- whether that "treatment" be "official" or "unofficial". Not an easy question to answer when it is framed that way.

i do think an "addict" and "adhd" are the same problem... different coping strategies


don't forget pot

pot numbers are astronomical in adhd

kilted_scotsman
07-04-14, 11:07 AM
I feel the issue with early diagnosis of ADHD is the medicalisation of psychology and the labelling of individuals at a very early stage in their development, then intervening pharmacologically to push a round human being through a square educational hole.

willow129
07-04-14, 11:27 AM
haven't read the article, just the posts following but.... I'm a december birthday and was always the youngest in my class...

daveddd
07-04-14, 11:37 AM
i was born in june and was one of the only people to still be 17 when i graduated

i thought the december babies were older

Stevuke79
07-04-14, 11:58 AM
haven't read the article, just the posts following but.... I'm a december birthday and was always the youngest in my class...

QED ;) .. Just kidding, I know that's not what you meant. ;)

Bugsy23
07-04-14, 12:00 PM
I think if we're going to disagree with the original study, it's important to cite exactly what we're disagreeing with (and what the critiques were disagreeing with).

The actual STUDY and SCIENTIFIC FINDINGS seem very valid and even intuitive. I would expect you to find that children with a younger "relative age" are more likely to be diagnosed. This may even imply that "relative age" is a cause of misdiagnosis - I think that makes a lot of sense as well. There are two problems with this study:

1. As almost all of the critiques pointed out, a higher chance of diagnosis for a subset of the population IN NO WAY implies an over-diagnosis for the population in general or EVEN the subset in question. You have to look at the expected incidence of ADHD versus the incidence of diagnosis. When we do that we see that ADHD is under-diagnosed. Relative-Age may exacerbate symptoms and increase the likelihood of a diagnosis OR may mimic symptoms and increase the likelihood of a misdiagnosis. If the latter then I agree that this is a good point of caution for doctors diagnosing the disorder. But it still doesn't imply over-diagnosis.

2. As the second critique highlighted, the authors made the jump to growth and cardiovascular problems. They cite no sources for these concerns. The mainstream consensus based on actual studies is that this is not a concern.

Not to sound weird or anything but I thoroughly enjoy your posts.

Stevuke79
07-04-14, 12:22 PM
Not to sound weird or anything but I thoroughly enjoy your posts.

:thankyou:Thanks, kind of you to say!! Not weird at all! :grouphug:

Bugsy23
07-04-14, 03:48 PM
:thankyou:Thanks, kind of you to say!! Not weird at all! :grouphug:

Always learn something new, and I like the numbering system you use when making points.

willow129
07-04-14, 04:51 PM
Always learn something new, and I like the numbering system you use when making points.

Agreed!!! much easier to read



(Aside: had to look up what QED means :P)

Stevuke79
07-04-14, 05:03 PM
When I REALLY want to flaunt my sophistication, I say quod erat demonstrandum, .. takes people a second to connect it back to the initialism. (QED (http://en.wikipedia.org/wiki/Q.E.D.): "thus needed to be demonstrated" ie. "YAY!! I've proved it!") but unfortunately it never convinces anyone of my sophistication. My pretentiousness however, that's another matter. (so at least I've got that, right?)

willow129
07-04-14, 11:27 PM
i was born in june and was one of the only people to still be 17 when i graduated

i thought the december babies were older

So I think how it worked for me was that I was born just before the cut off for kindergarten, so say it was - you must be 5 by Dec. 11th to be in Kindergarten, well my birthday is Dec. 10th so I was 5 on time, but that means I started kindergarten when I was 4 and most other kids were 5. They had the option of waiting and starting me the next year but they decided to put me in and I did fine.

My brother was a similar situation, and they put him in when he was 4 also but socially they decided he was ready so they held him back.

I guess if I had been 5 turning 6 when I started kindergarten I would have been one of the older ones...because I would have been one of the first kids to turn 6....except for those born in Sept/Oct/Nov. So that does make sense...

Kunga Dorji
07-05-14, 12:01 AM
When I REALLY want to flaunt my sophistication, I say quod erat demonstrandum, .. takes people a second to connect it back to the initialism. (QED (http://en.wikipedia.org/wiki/Q.E.D.): "thus needed to be demonstrated" ie. "YAY!! I've proved it!") but unfortunately it never convinces anyone of my sophistication. My pretentiousness however, that's another matter. (so at least I've got that, right?)

Your sophistication has been duly noted and admired :)

If you've got it-- flaunt it.

A pretentious person, however, would not have made a joke about being pretentious-- they would lack the self awareness.

Pretentious? Moi?? :)

sarahsweets
07-05-14, 06:38 AM
I've heard that girls born in February are more likely to be diagnosed with BWWD-borderline wonder woman disorder.

daveddd
07-05-14, 11:48 AM
So I think how it worked for me was that I was born just before the cut off for kindergarten, so say it was - you must be 5 by Dec. 11th to be in Kindergarten, well my birthday is Dec. 10th so I was 5 on time, but that means I started kindergarten when I was 4 and most other kids were 5. They had the option of waiting and starting me the next year but they decided to put me in and I did fine.

My brother was a similar situation, and they put him in when he was 4 also but socially they decided he was ready so they held him back.

I guess if I had been 5 turning 6 when I started kindergarten I would have been one of the older ones...because I would have been one of the first kids to turn 6....except for those born in Sept/Oct/Nov. So that does make sense...

that must be new

in my days it was early september for the cut

willow129
07-05-14, 12:21 PM
It varies state to state

kilted_scotsman
07-05-14, 01:44 PM
and country to country... when I first went to school i think I joined randomly mid term after a chat between the teacher and my mum (an ex-teacher). It was a very small rural school and all grades were taught in one room, by one teacher at one time.

I wonder how that would fit the model??!

DichotOhMy
07-05-14, 01:49 PM
The December birth finding is a really interesting correlation, but I'm not so sure that being about a year younger than one's school peers is such an important factor. It's especially not an important factor if one doesn't begin to show symptoms of ADHD until around the age-12 cutoff - where in middle school, studying becomes more and more a necessity to doing well.

Personally, I was born in mid fall and didn't begin kindergarten until I was almost 6. Being the same age (or slightly older than my peers) didn't save me from going off the rails in school once I had to actually read, study, and apply some effort to complete the homework during middle school. I skated through elementary school because I had to apply almost zero effort to the material.

Kunga Dorji
07-05-14, 07:28 PM
I've heard that girls born in February are more likely to be diagnosed with BWWD-borderline wonder woman disorder.

I have seen formal scientific proof that children of medical practitioners are far more likely to be diagnosed with a condition requiring treatment with an antibiotic than children of doctors. What that study did NOT show was any evidence that those chiropractors children had suffered consequences of not being treated with an antibiotic.

The point here is that diagnosis is a slippery process and far more likely to be contaminated by the prejudices of those involved than we wish to imagine.

In the case in point the marker for concern is disruptive childhood behaviour-- and it is not exactly rocket science to see that the youngest children in the class would be more neurologically immature.

In ADHD the issue is "behaviours not appropriate to the age".

This sis a slippery concept as behaviours are distributed on a bell curve-- and any individual on the lower end of the bell curve of self regulation is likely to become the focus of attention.

Equally any child on the low end of the bell curve is more likely to struggle with the academic and social demands of the class.

So- if a child is on the low end of the bell curve and the teacher is not both sensitive to that and able to direct extra resources at that child- then school will be traumatising for that child. That trauma will only destabilise that child's performance and may in fact be enough to drive a child on a healthy but late developmental curve right into overt ADHD.

sarahsweets
07-06-14, 09:14 AM
A side note: Wonder woman refers to the DC super hero.


I have seen formal scientific proof that children of medical practitioners are far more likely to be diagnosed with a condition requiring treatment with an antibiotic than children of doctors. What that study did NOT show was any evidence that those chiropractors children had suffered consequences of not being treated with an antibiotic.

The point here is that diagnosis is a slippery process and far more likely to be contaminated by the prejudices of those involved than we wish to imagine.

In the case in point the marker for concern is disruptive childhood behaviour-- and it is not exactly rocket science to see that the youngest children in the class would be more neurologically immature.

In ADHD the issue is "behaviours not appropriate to the age".

This sis a slippery concept as behaviours are distributed on a bell curve-- and any individual on the lower end of the bell curve of self regulation is likely to become the focus of attention.

Equally any child on the low end of the bell curve is more likely to struggle with the academic and social demands of the class.

So- if a child is on the low end of the bell curve and the teacher is not both sensitive to that and able to direct extra resources at that child- then school will be traumatising for that child. That trauma will only destabilise that child's performance and may in fact be enough to drive a child on a healthy but late developmental curve right into overt ADHD.

TurtleBrain
07-07-14, 06:42 AM
Phhtttt, where was this study done, in Alaska? No wait, nevermind... :lol:
I'm just teasing about Alaksa... ;)

I was born in May in the nice sunshine state of Florida, then moved to New York.
I wonder if being born in the city makes my ADHD symptoms worse, but that's another question for a different study to look into...
hmm... I'm curious now to google about that... [scurries away from the computer like... forgets to type the rest of this].

MADD As A Hatte
07-07-14, 07:01 AM
A side note: Wonder woman refers to the DC super hero.

... That's before or after What's Her Name Little Mousy Secretary lifted her big heavy-framed-tortoiseshell spectacles off her Plain-Jane face, swished her Decore-shampooed luscious hair, and shook it loose over her 1970's I-can-carry-it-all-on-my-capable-girly-girl-shoulders, and then ****pazzzzing*** turned into WONDER WOMAN ??

What a role model. It worked for moi!!! On that tv education, I grew a career in advertising, and the Mars Confectionery people entrusted $25m of their advertising budget to me to sell chocolate to junior Wonder Women. Woohoo!!

:goodpost: