A few months ago a short article in the New York Times asked “Is It Really ADHD or Just Immaturity?” It’s a question I often hear.
The article was based on a study done in Taiwan. Researchers studied the records of almost 379,000 children between the ages of 4 and 17. They wanted to know if the youngest in each age group were more likely to be diagnosed and treated for ADHD than the older ones.
The answer, results showed, is yes. The youngest in each grade did have a greater chance of being diagnosed and treated.
While there are cases when kids are misdiagnosed with ADHD (and cases when they’re underdiagnosed), the study didn’t address that. But here are a few facts about the study that you might want to consider:
- Only a small percentage of kids in any grade were diagnosed with ADHD.
- The differences between the younger group and the older group were not huge. In the older group, only 1.8 percent were diagnosed with ADHD; in the younger group, 2.9 percent got that diagnosis.
- The predicted difference between youngest and oldest was found in preschoolers and grade-schoolers. It wasn’t found in tweens or teens.
- The effect of being the youngest was not as consistent with girls as with boys.
- The study was not able to take into account how severe the child’s ADHD was. It also didn’t look at family history of ADHD or environmental factors that could impact the results.
These factors are important for parents to keep in mind—especially parents of a child who is the youngest in his grade and who shows signs of ADHD. Should his parents hold him back a grade so he can gain more maturity before being diagnosed or treated?
And what if a child has already been diagnosed? Should his parents hold him back and delay treatment to see if he functions better in school when he’s the oldest in his grade?
The answer I usually give them is no. That’s because kids with ADHD are less mature than their peers. That’s what ADHD is: an immaturity of the brain’s infrastructure. That immaturity impacts a child’s , including attention and self-control. If a child is much younger than others in his grade, he may appear even more immature.
That doesn’t mean it’s a good idea to hold kids back, however, or delay getting a diagnosis in the hope that they will mature fast enough to catch up.
The rate at which brain infrastructure matures can vary greatly, even within the same age group. There’s no guarantee that the necessary changes will happen in a year. And just holding a child back without treating ADHD can create additional problems. A one-year delay can hurt him both socially and academically.
The research cited in the article didn’t really focus on those factors. That’s why I would tell parents not to view this study as a reason to take a wait-and-see approach. It occasionally makes sense to delay kindergarten or to repeat a grade. But usually the costs outweigh the benefits.
All kids mature at different rates. There can be big differences among a group of kids who are 9 to 12 months apart in age at any given point. But if your child is far more immature than his peers and you think he might have ADHD, it’s usually wise to get help earlier rather than later.
Learn about how early ADHD can be diagnosed. If you suspect your young child might have ADHD, there are steps you can take. Talk to your child’s teacher to find out what she’s seeing in class. You can also consider having your child evaluated for ADHD.
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About the author
Thomas E. Brown, PhD is a clinical psychologist and clinical associate professor of psychiatry at the Keck School of Medicine of USC.