Timothy Layton, assistant professor of health policy at Harvard University, has a son who was born in August. Just before entering kindergarten in 2017, Layton read in a research paper that children born in August achieved worse results in a series of inferior school and behavioral interventions than older children in their class.
"The investigation found that the youngest children in the class face a tough fight throughout their school years because they are younger," Layton said. And it made such an impression, he and his wife decided to detain her son for a year. "We thought we would do the opposite ̵
Subsequently, Layton investigated a related phenomenon in his research: How do children born in August compare to his son, September babies? is there a rate of attention deficit hyperactivity disorder? He and several colleagues already knew that ADHD rates were rising and that the rates of diagnosis vary widely across countries. In Arkansas, for example, three times as many children are diagnosed with ADHD than in Nevada. So they wondered if birthdays set the trend: Were the younger children diagnosed in a kindergarten class?
In a recent article in the New England Journal of Medicine Layton and his co-authors noted that birthdays are very important for ADHD diagnosis. In addition, younger children who are still immature are diagnosed for reasons unrelated to their actual medical needs.
For the context, many states require age limits for access to kindergarten. In 18 states, children whose fifth birthday ends on 1 September can go to kindergarten from the age of 5, while children who turn five after that date must wait one year.
The researchers examined insurance claims for more than 400,000 US children born between 2007 and 2009, which followed until 2015. And they found that in states where children need to be born by August 1, in August, are 5 years old. Children had an ADHD diagnosis rate of 85 per 10,000 children. Children born in September had a much lower diagnostic score with 64 out of 10,000 children. This is an absolute difference of 21 diagnoses per 10,000 children, and this trend has not been seen in countries with different age limits.
The study shows, Layton says, that "the diagnosis and treatment of ADHD is still very subjective". Perhaps it is part of the puzzle to explain why the prevalence rate in children has historically risen from 3 to 7 percent to 11 percent today – which many researchers classify as too high.
Considering that more than 5 percent of US children now have ADHD and the medications can have serious side effects, this means that children are likely to be exposed to medical risks for no reason.
What is ADHD?
ADHD has long been a medical diagnosis, but under different names. In the first quarter of the century it was called Hyperkinesis. Then came the hyperkinetic disease. Now it is the attention deficit hyperactivity disorder.
There is still much that researchers do not know about what causes ADHD, but it is becoming clearer that genes play a role. Over the years, awareness has been raised that there is a neurological basis for the attention problems and hyperactive, impulsive behavior associated with the disorder.
ADHD is one of the most common childhood nervous system development problems today and is diagnosed when the normal features of a child – being inattentive and fidgeting – are disruptive. There is no biological marker like a blood test that can identify ADHD. Therefore, physicians must look for symptoms and try to understand whether these symptoms are affected by a child's academic performance or social interactions before the diagnosis is made.
"Having just such behaviors does not mean you have ADHD," said Martin Stein, a professor of pediatrics at San Diego University of San Diego. "Behavior must be accompanied by impairment."
However, the diagnosis can be difficult and can take months. Clinicians need to get to know the child and go through several steps to assess it or her. They do not always have that time, explains Michael Manos, the clinical director of the Cleveland Clinic's ADHS Assessment and Treatment Center.
A correct assessment must determine what ADHD symptoms a child has and how those symptoms disrupt one's life and then exclude other potential causes of symptoms such as depression or anxiety. "The diagnosis is not just to look at a rating scale and hear the brief description of a parent's behavior," Manos added. "You have to be careful to go through the other steps."
The rate of ADHD diagnosis has risen, due in part to pharmaceutical marketing
This difficulty in diagnosing the disease, raising awareness about it and for years Through the campaign of pharmaceutical companies, the number of people taking medication Now, more children will be diagnosed with the condition.
Over the past two decades, manufacturers of ADHD drugs have heavily marketed the disease and promoted their pills to doctors, educators, parents, and even children – through medical education, magazine and television advertising, and comic books.
According to an exposé in the New York Times, this campaign
extended the image of classical ADHD to relatively normal behaviors such as carelessness and impatience, often surpassing the benefits of pills. The Food and Drug Administration has cited all major ADHD drug stimulants such as Adderall, Concerta, Focalin and Vyvanse as well as non-stimulants such as Intuniv and Strattera – several times for false and misleading advertising.
Noteworthy: Over the past 20 years, diagnosis and treatment rates have increased in almost all areas of the US. According to the National Institutes of Health, the prevalence of children diagnosed with ADHD increased between 2003 (then 8 percent) and 2011 (then 11 percent). Some of the latest data from 2015-2016 show that 10 percent of children and adolescents aged 4 to 17 were diagnosed with ADHD in the US.
And Layton's study is not the first to find evidence that ADHD diagnoses may miss the mark. In a 2018 study of 19 studies from 13 countries involving more than 15 million children, researchers found the same relationship: Younger children were diagnosed more frequently in 17 of the 19 studies. "It is the norm internationally that the youngest children in a classroom are at an increased risk of treating ADHD, even in countries with relatively low prescription rates," the authors concluded. Again, this means that factors other than medical need drive the diagnosis of ADHD and may lead to over-treatment of children who are neurologically healthy.
There is growing concern about the damage of the treatment.
According to the American Academy of Pediatrics' ADHS guidelines, there are only two evidence-based treatments for ADHD: behavioral therapy and drugs. Depending on the age of the child, these two approaches may be attempted either alone or in combination. But there is also worrying evidence regarding the side effects of some of the most popular ADHD medications.
For example, the AAP suggests that doctors prescribe methylphenidate (sold under brand names such as Ritalin) to preschool children when behavioral therapy fails or is unavailable. A 2018 Cochrane review of randomized controlled trials of methylphenidate in children and adolescents found a serious adverse event, including death, heart problems, and psychotic disorders, in about one in 100 patients treated with the drug. While the quality of the evidence was low, the authors said that the damage was serious enough to suggest that "clinicians and parents are careful to systematically and carefully monitor adverse events".
The Cochrane review on the use of amphetamines (available under brand names such as Adderall) for childhood ADHD was no longer reassuring. While the medications appeared to improve the core symptoms of ADHD in the short term, "they were also associated with an increased risk of experiencing adverse events such as sleep disorders, loss of appetite, and abdominal pain."
This does not mean nobody should take these drugs, Stein said. When a child is properly diagnosed, treated and treated, most respond to and benefit from first-line drugs as they improve the performance and concentration of the school. But the question is: was the child accurately diagnosed? The results of the birthday studies indicate that many are not without serious serious risks.
For the moment, Layton suggested that physicians should think twice before naming a child with ADHD. "If the child is nearing demolition for the school year, we'll have to take a break."