It may seem that there is a connection between the time of year Norwegian children are born and how often they are diagnosed with the mental disorder ADHD. At least if we are to believe the results of a new Norwegian study. – We found major differences in the prescription of ADHD medication. Children born in November and December had an 80 percent higher risk of using medication for ADHD, compared to those born in January and February. That’s what research fellow and paediatrician, Christine Strand Bachmann, says. She has led the new study, which includes all Norwegian children born between 1989 and 1998. A total of 488,000 people. Bachmann believes that the youngest children in the class are being overmedicated. And one group in particular is at risk. Disadvantage after disadvantage The group of researchers has looked at all the prescriptions the participants had written from the time they were 10–23 years old. Among other things, she has compared children born early in the year with children born in December. And there is one group in particular Bachmann has taken an extra look at – the premature. That is, children born before week 37 of pregnancy. And these stand out. The use of ADHD medication is higher among the premature children than among their peers who were born at term. The tendency is also the same for the premature – medication occurs most often among the youngest in the class. – In this way, the youngest premature children have a double burden. The disadvantage of being born late in the year comes in addition to the disadvantages of being premature. Christine Strand Bachmann is a research fellow at the Faculty of Community Medicine and Nursing at NTNU. She is also a pediatrician at St. Olav’s hospital. Photo: Jøte Toftaker / news Wrong basis? Bachmann found another negative effect for the premature children. While ADHD medication among the full-term children decreased with age, the same did not happen for the premature children. Here, medication continued at the same level into early adulthood. – It may appear that those born prematurely are extra vulnerable to persistent negative effects of being the youngest in the school environment. But is it the case that children who really shouldn’t have had this diagnosis get it on the wrong basis? Maybe, says the researcher. – I think the increased ADHD medication for the youngest in the cohort has to do with the way we organize our education system. Simply put, it can look like we’re giving medication to the most immature children because we’re comparing them to their oldest classmates. Which is a whole year older, says Bachmann. She believes that it must be expected that a child born in November is more immature than a February child. Does the school system inflict unnecessary diagnoses on our children? It could be, says the NTNU researcher. Photo: Ingvild Edvardsen / news – Something to be aware of Olav Bjerkehagen Smeland is senior physician in psychiatry at Oslo University Hospital. He himself has researched ADHD. He says that it is known from the past that the youngest children in a school class have a higher risk of being diagnosed with ADHD. – Bachmann and colleagues show here that this relationship also applies to children born prematurely. These are important observations that may indicate that more immaturity in the youngest children may be misinterpreted as a sign of ADHD. This is something that both teachers, parents and therapists must be aware of, he says to news. Olav Bjerkehagen Smeland is senior physician in psychiatry at OUS. He says that the ADHD diagnosis is based a lot on judgement. Photo: YNGVE VOGT/APOLLON-UIO Facts about ADHD ADHD stands for Attention Deficit Hyperactivity Disorder. A neurological disorder that primarily involves increased restlessness and difficulties with attention. Referred to as a condition, not a disease. The core symptoms are: Hyperactivity (restlessness and inner restlessness) Impulsivity (interrupting or disturbing others) Difficulty paying attention (easily distracted) In Norway, 3-5 per cent of children and young people under the age of 18 have ADHD. More boys than girls are diagnosed, but in the adult group the ratio between men and women is quite similar. ADHD is hereditary, which means that several people in a family can have ADHD. Heredity is the main cause of ADHD. The diagnosis is the result of an overall assessment, and is only given if difficulties appear in several arenas, such as both at school or the workplace, at home or among friends. A final diagnosis is made by a specialist. Source: ADHD Norway and the Norwegian Institute of Public Health The diagnosis is based on judgement. Smeland says there are good tools for mapping ADHD, but that the assessments are based on judgement. And that there will then be a certain degree of uncertainty associated with that. – There are many reasons why a child can be unfocused or restless at school. It does not mean that the child has a mental disorder. The head doctor further explains that it is also not sufficient to make an ADHD diagnosis based on school difficulties alone. The child must also have significant difficulties in other areas of life. – During the assessment, the therapist must therefore make a good survey of the child’s life situation, and take into account other factors that come into play, such as, for example, the interaction in the family. Principal confirms big differences Rigmor Furu is principal at Vikåsen School in Trondheim. She says the results are surprising, but not at the same time. You see big differences in maturity when it comes to the six-year-olds, she explains. – You have those who have a maturity at the level of a three-year-old, while others can both read and write when they start with us. There is a big gap in the transition from kindergarten to school. Therefore, she believes it is important that the schools facilitate. – Adapted training is very important. Maturity and ADHD are all about attention, impulsivity and concentration. There are different children, so it is extremely important that we make arrangements for this from day one, says the principal to news. Rigmor Furu is the principal at Vikåsen School in Trondheim. She says there are very big differences in the maturity of the six-year-olds. Photo: Jøte Toftaker / news Looking to Denmark? Researcher Christine Strand Bachmann points out that studies from Denmark, which practice a more flexible attitude to delayed starting school, do not show increased use of ADHD medication among the youngest in the class. 40 per cent of Danish children born between October and December have their school start postponed until the following year. Here, both parents and the nursery are involved when assessing whether the child is mature enough for school. – I think that in Norway we could do something similar for the youngest children. Especially when it comes to premature babies born late in the year. Some of them would actually have gone to a lower class if they had been born at term, says the researcher. She is supported by senior physician Olav Bjerkehagen Smeland. – It is an important and timely question whether our school system is equally well adapted to all children. For some children born late in the year, and perhaps especially those who are not so mature yet, it would possibly have been an advantage to delay the start of school by one year, says Smeland.
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The youngest children in the school class get the most ADHD diagnoses – news Trøndelag
