Max and Julian are starting Kindergarten this year and are really looking forward to elementary school. September 12 Max will be 5 years oldth and Julian on October 12. will be 6 years oldth. They are a year apart, but they have so much fun together, they are happy to be in the same class!
This one-year difference between children in the same class is normal. To determine when a child must go to school, their birth date is compared to the end date. For example, in Quebec (Canada), where Max and Julian live, a child must be 5 years old no later than September 30.th start kindergarten. This date varies from province to province in Canada, as well as in other countries around the world. Regardless of the end date chosen, there will always be younger and older children in the same class.
After the first few weeks of school, Max’s teacher, Mrs. Mary, begins to report to his parents about his disruptive behavior in the classroom. Max is restless, can’t sit still on the mat during story time, is also impulsive and has a hard time waiting for his turn to play. At the first parent-teacher conference, Mrs. Mary confirms that Max does not seem to listen or understand the classroom rules and instructions. She talks about Max’s attention level and shares her suspicions, wondering if Max might have symptoms of Attention Deficit Hyperactivity Disorder (ADHD). She recommends that they go through an evaluation process to understand his behavior. Max’s parents are surprised… They occasionally noticed his energy level and rather unfocused attention, but attributed such actions to his young age and immaturity. However, they also found no such difference in Max’s behavior compared to his friend Julian!
It was not uncommon for teachers to suspect ADHD in those whom our research interviews referred to as “the babies of the class.” In fact, in the last ten years, many studies from around the world have shown this phenomenon: compared to their oldest classmates, children born in the months immediately before the school graduation date had a higher risk of being identified as children. having an ADHD diagnosis and taking ADHD medication. This phenomenon is often called the “relative age effect” (RAE).
The reasons for this are not yet well understood. However, almost all hypotheses explaining this phenomenon are related to a) the organization of the school system, b) various actions of teachers, and c) the immaturity of children, defined as a delay in cognitive, behavioral or emotional development. The relative effect of age could be supported by the classroom context, where teachers are constantly interacting with students of different maturities and may unconsciously compare the youngest to the oldest. Teachers may mistake children’s immaturity for ADHD-related behavior. Immaturity refers to a level of development below the expected threshold for a given age. Various aspects of immaturity are associated with ADHD, including emotional, intellectual, behavioral, cognitive, neurocognitive, and brain immaturity. The expression of immaturity encompasses a fairly wide range of childlike behaviors, including impulsivity, hyperactivity, inattention, and difficulty settling in, focusing on school, and meeting school demands. This confusion between ADHD symptoms and immaturity may be due to teachers using the group as a benchmark when forming opinions about a student. A disadvantage of this practice may be that the norms and expectations provided by the comparison group may not always be appropriate for the developmental level of younger students. This may encourage the teacher to begin the process of medicalization, primarily by identifying the problem and addressing it using medical vocabulary or offering medical care.
Indeed, our results showed that at every stage of the ADHD medical process, too many younger children appear, so it begins long before a doctor’s visit. Not all adults around a child contribute equally to RAE in ADHD. For parents, when assessing ADHD-related behavior or suspecting ADHD, the month of birth or relative immaturity of their children usually does not influence them. It is important to remember that not all teachers are the same and that their practices can vary greatly. However, teachers seem to play a key role in early diagnosis steps for younger children. This is not surprising, as school is often the first setting in which ADHD is identified. For example, teachers are involved in following up and identifying what is causing the problem, with medical signs and suspicions, and they either bring children to see doctors or recommend counseling.
The process begins as soon as teachers begin to assess hyperactivity, impulsivity and inattention. And teachers, like Ms. Mary, appear to be more likely to identify higher levels of ADHD-related behavior (hyperactivity and inattention) among children born before they finish school. Although our data did not allow us to determine whether teachers viewed this behavior as “deviant” and problematic, it seems likely because teachers were also more likely to suspect younger students and share their suspicion with parents of younger children in the class. Therefore, it appears that younger graders are more likely to be referred to health care professionals, resulting in a higher number actually going to a consultation, which increases the risk of misdiagnosis.
It is important to share these research findings with parents, teachers, and health care professionals involved in ADHD assessment. After all, this phenomenon is associated with an increased risk of misdiagnosis in children and contributes to the overdiagnosis and overmedication of ADHD, an unfortunate, well-documented situation. If Mrs. Mary had been aware of these dangers, would she still have suspected that Max had ADHD? And could a parent bring up a younger class dispute to start a discussion with the teacher?
Brault MC, Degroote E, Jean M, Van Houtte M. Influence of relative age on attention-deficit/hyperactivity disorder at different stages of the medicalization process. Children. in 2022; 9(6):889. https://doi.org/10.3390/children9060889
Department of Humanities and Social Sciences, University of Quebec at Chicoutimi, Canada
Department of Sociology, Ghent University, Belgium
Mike Van Houtte,
Department of Health Sciences, University of Quebec at Chicoutimi, Canada
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