Why is it that the youngest kids in any given grade level are more likely to get an ADHD or autism diagnosis?
This phenomenon has been known for years.
Research led by experts at the University of Nottingham has highlighted a significant issue in the diagnosis of conditions such as ADHD and Autism Spectrum Disorder in young children.
The study, published in European Child and Adolescent Psychiatry (2024), indicates that teachers might be misattributing signs of age-related immaturity to these conditions.
The study found that the youngest students in a class, particularly those born just before the school entry cut-off date, are over-represented among children receiving an ADHD diagnosis or medication for the condition.
This observation points to the potential influence of a child’s relative age in the classroom on the likelihood of being diagnosed with ADHD or ASD.
ADHD is characterized by significant challenges with attention and hyperactivity, while autism is a complex developmental condition affecting communication and interaction.
I find this study exceptionally interesting, because I entered first grade at age 5 and have a December birthday, making me at least a year on average younger than most classmates in any given grade. In fact, when I was 13 in the ninth grade, some of my classmates were already 15.
Professor Kapil Sayal, from the School of Medicine at the University of Nottingham and senior author of the paper, emphasized the importance of considering a child’s relative age when diagnosing ADHD.
Professor Sayal points out that when adults raise concerns over a student’s behavior, they may be unknowingly assigning age-related “immaturity” to ADHD.
How the Study Was Done
The researchers conducted comprehensive searches to identify all relevant studies on this topic worldwide, reviewing 32 studies in total.
Most of these studies focused on ADHD, with only two focusing on autism.
The findings consistently showed that younger students in a school year are more likely to be diagnosed with ADHD and to receive medication for it, compared to their older classmates.
The extent of this relative age effect varied among the studies reviewed.
For ASD, while the youngest children in a class were also more likely to be diagnosed, the researchers called for more studies due to the limited number available.
This begs a question: Is it possible that the younger kids, who were diagnosed with autism, were younger than their classmates because they were academically or intellectually advanced?
I wanted to go to school when I was five and skipped kindergarten. So I was enrolled in first grade.
This scenario just might describe many “relatively young” autistic children who are academically on the same level as kids a year or so older.
Their autism traits then catch the attention of teachers.
Nevertheless, with only two of the studies focusing on ASD, more need to be done.
My autistic traits during primary school fell under the radar because I grew up during a time when the public awareness of autism was pretty much limited to a severe form that affects mainly boys.
Ironically (or maybe this isn’t ironic?), I was actually much better behaved all throughout school than were my older classmates!
Teachers vs. Parents
Interestingly, the study revealed a more significant difference in how teachers rated younger children compared to parents.
Dr. Eleni Frisira, the lead author of the study, notes the critical role of teachers in identifying ADHD symptoms, pointing out that they’re more likely to rate younger students as having ADHD symptoms than their older peers.
She stressed the importance of supporting teachers in considering the relative age of a child in the classroom when querying ADHD.
Dr. Josephine Holland, another author of the paper, pointed out that although this phenomenon has been recognized in research for over a decade, it has not yet significantly influenced practice.
The research indicates the importance of considering a child’s age relative to their classmates when assessing and diagnosing conditions like ADHD and ASD.
Lorra Garrick has been covering medical and fitness topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer. In 2022 she received a diagnosis of Level 1 Autism Spectrum Disorder and subsequently has developed an intense interest in ASD.
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