According to the Centers for Disease Control, 4.5 million children have been diagnosed with ADHD as of 2006. Diagnostic rates increased an average of 3% per year from 1997 to 2006, so one can only imagine they have increased a bit since then. The pharmaceutical industry stands to profit immensely off ADHD treatments; Healthline says in 2008, the ADHD pharmaceutical market was worth four billion dollars.
So what if I told you a new study out of Michigan State University suggests that nearly one million kids have been misdiagnosed with ADHD? That fact alone might not surprise you, but I bet the reason will.
Todd Elder, economist at MSU says, “Nearly 1 million children in the United States are potentially misdiagnosed with attention deficit hyperactivity disorder simply because they are the youngest and most immature in their kindergarten class.” He says the youngest members of a kindergarten class are “significantly more likely than their older classmates to be prescribed behavior-modifying stimulants such as Ritalin.”
Now I don’t feel so bad about wanting to hold my four-year-old daughter back. But boys are diagnosed with ADHD much more frequently than girls. And, curiously, the CDC reports that “ADHD diagnosis is significantly higher among non-Hispanic, primarily English-speaking, and insured children.”
Elder says that up to 500 million dollars are wasted annually on unnecessary medications, with at least 80 million of that amount covered by Medicaid. More importantly, though, children are being fed drugs they don’t really need. Elder stresses that the impact of long-term stimulant use in children is yet unknown.
But let’s get back to kindergarten kids, the focus of Elder’s study, to be published in the Journal of Health Economics. Elder says, “ADHD diagnoses depend on a child’s age relative to classmates and the teacher’s perceptions of whether the child has symptoms.” Meaning, “If a child is behaving poorly, if he’s inattentive, if he can’t sit still, it may simply be because he’s 5 and the other kids are 6.”
Is it wrong to simply say, “Duh?” It strikes me as so troubling that teachers might have trouble taking that into account. But that’s precisely why so many parents hold their children – especially boys – back from kindergarten until they’re 6 turning 7. It’s a process called red-shirting, and it’s meant to give their children an advantage over the other smaller, younger kids. Obviously, it’s working.
I’ve mentioned in the past that I’m reticent to send my 4-year-old to kindergarten, despite the fact that she’ll be 5 in October – well before New York State’s December 1 cutoff date. But Elder found that “students born December 1 had much higher rates of ADHD than children born December 2.” That’s because the students born on the 1st were the youngest in their grade and those on the 2nd the oldest.
Elder notes that a teacher’s assessment is not enough to diagnose a child with ADHD, but “their opinions are instrumental in decisions to send a child to be evaluated by a mental health professional.” Kindergartners aren’t the only ones affected by this age gap; Elder found that when that same group of classmates reached the fifth and eighth grades, “the youngest were more than twice as likely to be prescribed stimulants.”
Photo: woodleywonderworks via Flickr