We hear so much about Attention Deficit Hyperactivity Disorder (ADHD) affecting more and more kids. Do you think it is being over diagnosed? The school just asked us to get our son evaluated and we are hesitant because he is so much younger than most of the boys in his class. We think it is more of a maturity issue.

In terms of the rising numbers of ADHD children, positives explanations include better awareness of the condition and better access to care. Decades ago, we did not do a good job of identifying children with this disorder. Now, more children are benefiting from early detection and treatment.

On the negative side, there is evidence to suggest that frequent misdiagnosis does occur. A study by Michigan State researcher, Todd Elder, suggests that almost a million children have been misdiagnosed.[1] Of the many variables Elder and other researchers studied, child age when entering school was a factor when looking at misdiagnosis.

When a child enters kindergarten at a younger age than his or her peers, teachers may confuse immaturity for ADHD. Elder found that the younger the child is compared to peers, the more likely the diagnosis. Holding back a child one year, decreased the likelihood of a diagnosis significantly.

Because teachers play a vital role in referring children for mental health services, children who are young for their grade may be more at risk for misdiagnosis.[2] I saw this happen at my own child’s school. The age range of kindergartner boys was from four-years of age to seven-years of age. You can imagine how this age spread impacted maturity levels in the classroom. I noticed the teacher had more concerns about the younger boys in terms of their behavior and ability to stay on task. She repeatedly talked to parents, suggesting they might want their child evaluated for ADHD.

Elder also noted that the oldest child in the classroom could be at risk for under diagnosis because he or she is compared to younger counterparts who are likely more immature. Thus, assessing children by using within grade standards can be a problem when it comes to ADHD diagnoses.[3] So my advice, get another opinion and talk to the teacher about this study and the age differences.

[1] Elder, Todd E. 2010. ―The Importance of Relative Standards in ADHD Diagnoses: Evidence Based on Exact Birth Dates.‖ Journal of Health Economics 29(5):641-656.

[2] Evans, W., Morill, M., Parente, S., 2010. Measuring inappropriate medical diagnosis and treatment in survey data: the case of ADHD among school-age children. Working paper, Department of Economics, North Carolina State University.

[3] Elder, Todd E. 2010. ―The Importance of Relative Standards in ADHD Diagnoses: Evidence Based on Exact Birth Dates.‖ Journal of Health Economics 29(5):641-656.