Misdiagnosis of attention deficit hyperactivity disorder: 'Normal behaviour' and relative maturity

Attention deficit hyperactivity disorder (ADHD) is one of the most frequently diagnosed disorders in children, yet it remains poorly understood. Substantial controversy exists regarding correct diagnosis of ADHD, and areas of subjectivity in diagnosis have been identified. Concerns for appropriate diagnosis are critical in terms of children's educational outcomes, as well as health concerns associated with the use and potential overuse of stimulant medications. There exists a relative-age effect in which children who are relatively younger than their peers and born closest to the school start age cut-off are more frequently diagnosed and treated for ADHD. Additionally, substantial variation exists in ADHD diagnosis between boys and girls, with boys often presenting with more stereotypical symptoms. Both the relative-age effect and variation in sex diagnosis, as well as the challenges of early preschool diagnosis, emphasize the importance of considering relative maturity in ADHD diagnosis of children. Implications and knowledge translation strategies for practitioners, parents and the education system are presented.