Sunday , December 5 2021

Disorder & # 39; hyperactivity of & # 39; the deficit & # 39; attention and the beginning of & # 39; school – Medical News



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When school starts, the younger children get & # 39; likely to be diagnosed & # 39; ADHD

background

Younger children in cohort & # 39; school may be more likely to receive a diagnosis of & # 39; disorder & # 39; & # 39 deficit; attention (ADHD) than their older cohorts due to variation in behavior based on age can & # 39; be attributed to ADHD place & # 39; the youngest children.

Most states & # 39; US UU They have & # 39; arbitrary age limit to enter public school. Therefore, within the same grade, with children & # 39; closing date of & # 39; closing can vary in age by nearly 1 year.

methods

We used data from 2007 to 2015 from a large insurance database to compare the diagnostic rate & # 39; ADHD among children born in 2008 August with & # 39; that & # 39; children born in & # 39; Malta September in states with and without children 5 years to begin 1 & # 39; September in the treatment of & # 39; throughout the day.

Diagnosis & # 39; ADHD was determined on the basis of diagnostic codes of the International Classification of Diseases, 9th Revision. We also use records & # 39; to compare prescription treatment & # 39; ADHD among children born in & # 39; and children born in August & # 39; September in states b & # 39; cutting data and without a & # 39; September 1.

results

The population & # 39; study was included 407 846 children in all states & # 39; US UU born in the period from 2007 to 2009 and were followed until December 2015.

the – diagnostic rate a & # 39; ADHD based on claims among children in states with & # 39; cut at 1 & # 39; September was & # 39; 85.1 per 10,000 children (309 cases among 36 319 children, interval & # 39; confidence [IC] 95%, 75.6 up 94.2) among those born in & # 39; August and 63.6 per 10,000 children (225 cases among children 35 353 and a daughter, 95% CI, 55.4 up 71.9) among those born in & # 39; in September, the difference absolute & # 39; 21.5 per 10,000 children 95%, up 34.0 8.8); the corresponding difference in states without limit & # 39; September 1 was & # 39; 8.9 per 10,000 children (95% CI, -14.9 to 20.8).

the – rate & # 39; treatment a & # 39; ADHD was 52.9 per 10,000 children (192 from children 36 319 and a daughter, 95% CI, 45.4 up 60.3) among those born in & # 39; August and 40.4 per 10,000 children (143 of 35 353 children, 95% CI, 33.8 up 47.1) among born in & # 39; in September, an absolute difference of & # 39; 12.5 per 10,000 children (95% CI, 2.43 up 22.4).

These differences were not observed in & # 39; & # 39 other comparisons, month to month, nor were seen in states b & # 39; cutting dates are not & # 39; September to start kindergarten.

Also, in states b & # 39; threshold & # 39; 1 & # 39; September, no significant difference was observed between children born in & # 39; born in August and & # 39; September in the & # 39; asthma rates, diabetes or obesity.

Differences in rates of & # 39; diagnosis & # 39; ADHD gender and month of birth. The broken line indicates that m & # 39; there is no difference. The bars indicate intervals of & # 39; & # 39 confidence; 95%. Diagnosis & # 39; ADHD was defined on the basis of & # 39; ICD-9 diagnostic codes for ADHD in & # 39; & # 39 claims, billing or filled a prescription medication for ADHD.

Conclusions

The diagnosis rates and treatment of & # 39; ADHD are higher among children born in & # 39; August from those born in & # 39; September in states b & # 39; flock & # 39; 1 & # 39; September for admission to kindergarten. (Funded by the National Institutes of Health.)


Comment in the Harvard Gazette

Can & # 39; children iqiegħduh closing in & # 39; risk & # 39; misdiagnosis & # 39; ADHD?

The answer seems to be that yes, At least among children born in & # 39; August to start school in states where registration is suspended at 1 & # 39; in September, according to a new study led by researchers at the Medical School & # 39; Harvard.

The findings, published in the 28 & # 39; November in & # 39; The New England Journal of Medicine, show that children born in & # 39; August in & # 39; those states are 30 percent more likely to receive a diagnosis of & # 39; ADHD, compared with & # 39; the same degree.

Rate & # 39; diagnosis & # 39; ADHD among children increased by & # 39; dramatically in & # 39; the last 20 years. In 2016 only, more than 5 percent of children & # 39; US UU were treated & # 39; & # 39 active manner; medications for ADHD. Experts believe that the increase is due to a combination of & # 39; factors, including greater recognition of the disorder, a real increase in the incidence of the disease and, in & # 39; some cases, inadequate diagnosis.

The results of & # 39; the new study emphasize the idea that, at least in & # 39; & # 39 subgroup; students & # 39; primary school, the diagnosis can & # 39; be a factor Early registration at school, According to the research team.

"Our findings suggest the possibility that a large number of & # 39; children receive excessive diagnosis and excessive treatment for ADHD because they prove to be relatively immature compared to the class & # 39; their elders first year & # 39; primary school ", said the main author & # 39; the study. study, Timothy Layton, assistant Health care policy professor at the Institute of Medical Blavatnik School & # 39; Harvard.

The majority of states have limits arbitrary date of birth to determine the degree of & # 39; & # 39 placement; and when children can start school. In states b & # 39; threshold & # 39; September 1, a child born at 31 & # 39; August will be almost one year younger on the first day of school a child born on 1 & # 39; September.

F & # 39; this age, Layton noted that the youngest son could & # 39; it was difficult to stand by the bed and concentrate for long periods & # 39; time in class. That extra restlessness can & # 39; leading to a medical referral, said Layton, followed by diagnosis and treatment of ADHD.

For example, the researchers said, x & # 39; can & # 39; is normal behavior in & # 39; & # 39 noisy sound; 6 years can & # 39; seems abnormal in relation to behavior & # 39; largest partner in the same class.

This dynamic can & # 39; is particularly true among younger children, because of the age difference & # 39; 11 or 12 months can & # 39; resulting in significant differences in behavior, the researchers added.

"As children grow older, small differences in age become equal and dissolve over time, but in & # 39; terms & # 39; behavior, the difference between child & # 39; 6 years and a child & # 39; 7 years can & # 39; to be quite pronounced "lead author of the study, Anupam Jena. Ruth L. Newhouse Professor of Health Care Policy Associate at the Medical School & # 39; Harvard and internal medicine doctor at the General Hospital & # 39; Massachusetts. "The behavior can & # 39; seems anomalous in relation to children's peer group."

Through records & # 39; & # 39 database; big insurance, researchers compared the difference in the diagnosis & # 39; ADHD month of birth, August versus September, among more than a child 407,000 and primary girls born between 2007 and 2009, up to end of 2015.

Under – analysis, – states use – September 1 As the registration deadline in schools, children born in & # 39; August were 30% more likely to have a diagnosis of & # 39; ADHD than children born in & # 39; September. No such differences were observed between children born in & # 39; August and f & # 39; September in states b & # 39; dates & # 39; threshold than the 1 & # 39; September.

For example, 85 10,000 students born in & # 39; August diagnosed or treated for ADHD, compared with & # 39; 64 student & # 39; 10,000 born in & # 39; September.

When the researchers looked only at the treatment of ADHD, the difference was also great: 53 of 10,000 students born in & # 39; August received medications for ADHD, compared with & # 39; 40 of the 10,000 born in & # 39; September.

Jena indicated similar phenomenon described in the book "Outliers" by Malcolm Gladwell. The Canadian professional hockey players get & # 39; likely born earlier this year, according to research mentioned in the book & # 39; Gladwell. The hockey leagues of Canadian youth use 1 & # 39; in January as the deadline for teams & # 39; age.

In the early years of training young hockey players born in the first months of the year were older and more mature, and thus more likely to be traced to an elite leagues, b & # 39; better training, more time on the ice and larger cohorts with & # 39; talent & # 39; teammates. Over the years, this accumulated score advantage to relatively older players an advantage over their smaller competitors.

Similarly, Jena noted, document & # 39; work of 2017 by the National Bureau for Economic Research has suggested that children born just after the deadline to start the school tended to have educational performance long beyond their relatively young partner. born later in the year.

"F & # 39; they all scenarios, the time and age appear to be factors b & # 39; health to influence the outcome," said Jena.

Research has shown wide variations in the diagnosis and treatment of & # 39; & # 39 in ADHD, different regions in the United States. UU rates of & # 39; diagnosis and treatment of & # 39; ADHD increased by & # 39; dramatically in & # 39; the last 20 years.

In 2016 only, more than 5 percent of all children in the United States UU are taking medication for ADHD, the authors said. All these factors have concerns about the excessive diagnosis of & # 39; ADHD and excessive treatment.

The reasons for the increase in incidence & # 39; ADHD are complex and multifattorji, Jena said. The arbitrary deadlines are probably one of the many variables that drive this phenomenon, he added.

F & # 39; in recent years, many states have adopted measures to hold schools responsible for identifying ADHD and offer incentives to educators to recommend any child b & # 39; symptoms suggestive of ADHD medical evaluation.

"The diagnosis of & # 39; this condition is not only related symptoms, but with the context," said Jena. "The relative age of children in the classroom, laws and regulations, and other circumstances, join."

It is important to consider all these factors before a diagnosis and prescribe treatment, said Jena.

"Consideration should be given to the age of the child in relation to its peers in the same grade and the reasons for referral should be examined carefully."


Additional co-authors include researchers from the Department of Health Care Policy, the National Bureau for Economic Research and Policy Department and Health Management, Harvard and T.H. Chan School of Public Health.

Through records & # 39; & # 39 database; big insurance, researchers compared the difference in the diagnosis & # 39; ADHD month of birth, August versus September, among more than a child 407,000 and primary girls born between 2007 and 2009, up to end of 2015.

According to the analysis, in states using 1 & # 39; September as the deadline for enrollment in school, children born in & # 39; August were 30% more likely to have a diagnosis of & # 39; ADHD than children born in & # 39; September. No such differences were observed between children born in & # 39; August and f & # 39; September in states b & # 39; dates & # 39; threshold than the 1 & # 39; September.

For example, 85 out of 10,000 students born in & # 39; August diagnosed or treated for ADHD, compared with & # 39; 64 students in 10,000 born & # 39; September. When the researchers looked only at the treatment of ADHD, the difference was also great: 53 of 10,000 students born in & # 39; August received medications for ADHD, compared with & # 39; 40 of the 10,000 born in & # 39; September.

Jena indicated similar phenomenon described in the book "Outliers" by Malcolm Gladwell. The Canadian professional hockey players get & # 39; likely born earlier this year, according to research mentioned in the book & # 39; Gladwell. The hockey leagues of Canadian youth use 1 & # 39; in January as the deadline for teams & # 39; age. In the early years of training young hockey players born in the first months of the year were older and more mature, and thus more likely to be traced to an elite leagues, b & # 39; better training, more time on the ice and larger cohorts with & # 39; talent & # 39; teammates. Over the years, this accumulated score advantage to relatively older players an advantage over their smaller competitors.

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