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Relative immaturity and ADHD: findings from nationwide registers, parent- and self-reports

Linda Halldner1, Annika Tillander, Cecilia Lundholm

  • 1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Karolinska Institutet Center of Neurodevelopmental Disorders (KIND), Karolinska Institutet, Stockholm, Sweden.

Journal of Child Psychology and Psychiatry, and Allied Disciplines
|March 29, 2014
PubMed

Insights

Children born in late autumn are more likely to be diagnosed with and treated for Attention Deficit Hyperactivity Disorder (ADHD) due to relative immaturity. This diagnosis pattern for ADHD was not supported by symptom ratings.

Area of Science:

  • Child and Adolescent Psychiatry
  • Neurodevelopmental Disorders
  • Public Health Research

Background:

  • Investigated the link between birth month, relative immaturity, and Attention Deficit Hyperactivity Disorder (ADHD) diagnosis and treatment.
  • Explored potential biases in ADHD diagnosis stemming from age-related differences within school cohorts.

Purpose of the Study:

  • To determine if being younger relative to classmates, indicated by birth month, increases the likelihood of an ADHD diagnosis and subsequent treatment.
  • To examine the association between birth month and ADHD symptom severity in different age groups.

Main Methods:

  • Utilized Swedish nationwide registers (Patient and Prescribed Drug Registers) for a large cohort (N=56,263) aged 6-69 years.
  • Employed prospective cohort and nested case-control designs, analyzing ADHD diagnoses and medication use.
  • Supplemented with population-representative twin cohorts (CATSS and STAGE) for parent- and self-reported ADHD symptoms.

Main Results:

  • Individuals born in November/December showed significantly higher rates of ADHD diagnosis and medication treatment compared to those born in January/February.
  • This diagnostic and treatment disparity peaked at ages 6 and 7 years.
  • No significant differences in parent- or self-reported ADHD symptoms were found based on birth month.

Conclusions:

  • Relative immaturity due to birth month may contribute to ADHD diagnosis and pharmacotherapy, independent of actual symptom load.
  • Highlights the need for increased clinical awareness to prevent diagnostic and treatment inaccuracies.
  • Suggests that flexible school entry age policies could improve diagnostic precision and reduce inappropriate ADHD treatment.
Abstract

Keywords:
ADHDchild developmentepidemiological studiespharmacotherapy

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