Who Is Diagnosed with Attention Deficit Hyperactivity Disorder?

Boys who are younger than their classmates are most likely to be diagnosed with ADHD. They may have other emotional problems, too. Here’s what you should know.

Children who can’t keep still in class, especially boys, are ever more likely to receive a diagnosis of attention deficit hyperactivity disorder (ADHD). That’s especially true if they’re younger than their classmates. 

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As children get older, they typically calm down and become more able to focus at a desk. So, comparing older kids to younger ones could easily make the young ones look abnormal. It’s also possible that children who are the oldest in the class, but suffer from ADHD, aren’t being identified because they look calm compared to their younger classmates. 

Being among the youngest in your class increases your chance of being diagnosed with ADHD by about 27 percent in richer countries, according to one meta-analysis. Often the first referral to doctors for younger students comes from a teacher, a study of 17 elementary schools concluded.

The trend towards diagnosing (and possibly misdiagnosing) this disorder has slowed down somewhat. Nearly 10 percent of U.S. school-age children now carry the label, the Centers for Disease Control and Prevention (CDC) reports, down from 11 percent a decade ago, after rising steadily from 2003. Among boys, the figure is 13 percent, compared to 6 percent for girls. Research, however, suggests the numbers may be increasing again.

The CDC reports that about two-thirds of children with ADHD take medication. Half get counselling to change their behavior. About a third get both kinds of help, the recommendation from the American Academy of Pediatrics.  

With good counselling, people tend to need less medication, observes Michael Manos, PhD, head of the Cleveland Clinic Children’s ADHD Center for Evaluation and Treatment.

An early diagnosis is a good thing, assuming a child actually needs help, he notes. But parents too often rely on pediatricians.

“The time that a pediatrician can spend with a family is going to be maybe 15 to 30 minutes. When we do a diagnosis here in our offices, we spend a minimum of 90 minutes,” he explains.

Artificial intelligence programs analyzing brain images and records of activity have had success with diagnosis. Video games can also be diagnostic tools. Those tools might help correct for the biases of frustrated parents and teachers.

Take the case of one 12-year-old boy who came to the Teachers College Dean-Hope Center for Educational and Psychological Services to be evaluated for learning problems. His parents believed he had ADHD; his grades were mostly Bs, and they thought he was smart enough to earn As.

The Teachers College team noted that he was able to pay attention for two-hour sessions of testing. He was also doing well in some areas, which meant he could focus when he chose. Their bottom line: He didn’t have ADHD. 

Teachers College professor Steve Peverly, PhD, observes that many children are misdiagnosed with academic problems like dyslexia or attention deficit disorder, when they are actually normal. Sometimes they are distracted by family problems like:

• Fights in the home
• Recently separated parents
• Mew family members
• Lack of privacy

A child may suffer from anxiety or depressoin or be reacting to a home with frequent punishment, Manos notes.

In one of the largest American studies, documenting the young-for-their-class problem, 8.4 percent of children who were the youngest in their kindergarten class were diagnosed with ADHD, compared to 5.1 percent of the oldest children.

The study drew on data on nearly 12,000 children from government surveys of parents and teachers of kindergarteners, who were contacted again several times through the eighth grade. Teachers were more likely than parents to report problems with children who were young for their class.

The author of the study, an economist, observed that, if a child’s birth date was irrelevant, 20 percent of the children identified as having ADHD had been misdiagnosed and may be taking medication unnecessarily. 

ADHD medications are stimulants with side effects. They raise pulse rates and blood pressures and can stunt growth. One study concluded that children who took medication continuously for 16 years ended up 1.3 inches shorter and 16 pounds heavier as adults in their 20s.  

That’s a high risk to take, especially since some research indicates that the benefits of the medications wear off. That can happen in as soon as two years, other research found.

Children from poorer families with less educated parents are more likely to get labeled with ADHD. At least some of them are not getting a fair shake.

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