According to a recent study by a Michigan State University economist, nearly one million children in kindergarten in the United States are misdiagnosed with ADHD. The study attributes this to the disparity of ages in a kindergarten classroom. Most kindergarten classrooms have children who are either 5 or 6 years old. The study shows that the younger children are more likely to be rated by their teacher as being inattentive and hyperactive. However, these ratings may more likely reflect the immaturity of these children rather than a mental disorder.
ADHD is considered a developmental disorder. There is always a disparity in when children within the same age range reach a given developmental milestone and this of course is more pronounced when there is also a disparity in age as well. Actually most children do not develop selective attention until 6 or 7 years of age. For years, studies have shown that teachers will rate 50% of the children in the class with scores indicating possible ADHD when the prevalence is known to be no more than 10%.
Children are starting kindergarten later due to increased academic demands. It make sense that a class of kindergarten children are able to do first grade work since many of them are 6 years old. Imagine the stress of a five year old who may be somewhat on the late side of developing selective attention being required to achieve at least one grade level above his age level. The pressure from teachers and parents and peers can lead to acting out behavior that might be expected under the circumstances but could lead to a professional evaluation.
Parents, teachers, and physicians should be careful to consider not only the chronological age of the child but also the developmental age when considering a possible diagnosis of ADHD. Perhaps the child should be placed in a pre-K class where he or she is truly with peers and the work is more appropriate to the child’s development. This would be a far more appropriate intervention than medication. Unfortunately, I have found that school districts may not want to put a 5 year old in preschool or pre-K because they may not receive funding for the child when state guidelines say a child of 5 must be in kindergarten.
For now, hopefully, this study will evoke caution in all concerned so that decisions will be made based on all of the factors that should be considered. In the future, the whole issue of the mismatch between child development and academic expectations needs to be re-evaluated but that is another blog post.