Treatments based on methylphenidate (Ritalin and generics), which are used to treat attention deficit hyperactivity disorder (ADHD), are prescribed more frequently to children born at the end of the year compared to their peers born at the beginning of the year, according to a vast study conducted by the Epi-Phare group. This group includes the Medicines Agency (ANSM) and Health Insurance. The study also found a similar discrepancy in the prescription of speech therapy sessions.
The study followed a cohort of more than 4 million children aged 5 to 10, born from 2010 to 2016. It revealed that among children at the same school level, those born in December have a 55% higher risk of starting treatment with methylphenidate and a 64% higher risk of receiving speech therapy sessions compared to those born in January of the same year. This risk increases consistently with the age difference: children born in February have a 7% higher risk, those born in April 9%, those in July 29%, and those in October 46%.
Similar trends were observed in the use of speech therapy sessions. Children born in February had a 3% higher usage, those born in April 12%, those in July 30%, and those in October 49%.
To explain these differences, the authors propose several hypotheses. Younger children in a class may face academic demands that are too high for their age, particularly in the early years of school. This could lead to a higher likelihood of being mistakenly diagnosed with ADHD or learning disorders, even though their difficulties may be age-appropriate.
Conversely, older students might be underdiagnosed because they can compensate for their disorders with greater maturity. Alain Weill, a public health doctor and deputy director of the Epi-Phare group, suggests that these findings should lead to specific recommendations. For instance, not necessarily expecting a child in CP (Cours Préparatoire) to read by Christmas or specifying the month of birth when prescribing Ritalin or speech therapy.
Dr. Weill also mentioned that the High Authority of Health would soon review this work to provide new recommendations for managing ADHD.
- The study underscores the importance of considering a child's age within their school year when diagnosing and prescribing treatment for ADHD and speech therapy. This could prevent younger children from being prematurely diagnosed due to their relative immaturity compared to their older classmates.
- The research highlights the need for tailored academic expectations and diagnostic criteria that take into account the developmental differences among children born in different months of the same year. This approach could lead to more accurate diagnoses and appropriate treatments.
