The Effect of Lowering School Entry Age on Attention Deficit Hyperactivity Disorder Diagnosis

Abstract

Objective: The school entry age was changed from 72 to 66 months in 2012 with a new education system adjustment in Turkey. The aim of the study was to investigate the effects of lowering school entry age on Attention Deficit Hyperactivity Disorder (ADHD) diagnosis and symptom severity. Methods: The records of children at first and second grade diagnosed with ADHD according to the DSM-IV diagnostic criteria in the Child Psychiatry outpatient clinic between January and July 2010 (when the old system was in use) and between January-July 2013 (when the new system was in use) were retrospectively screened to create the old-system and new system groups. Among the two groups, T-DSM-IV-S fulfilled by parents and teachers were used to assess symptom severity. Results: The frequency of ADHD and ADHD predominantly inattentive subtype diagnosis we found to be significantly higher among the girls in the new system compared to old system (25.8%, 8.9%, p=0.027 - 56.3%, 0%, p=0.012). Additionally, mothers subscale scores of T-DSM-IV-S were lower among the children in the new system compared to the ones in the old system. Discussion: By lowering school entry age due to the new education system, frequency of ADHD diagnosis increased while symptom severity rates decreased among the first-grade girls. Thus, it may be suggested that despite decreased symptom severity, the girls who started school with the new system were diagnosed with ADHD more frequently due to a marked disruption in academic, social, and behavioral functionality associated with insufficient neurodevelopmental maturity.

Keywords

• Attention Deficit Hyperactivity Disorder
• ADHD
• symptom severity
• school entry age

References

1. American Psychiatric Association, 2013. Diagnostic and Statistical Manual of Mental Disorders. DSM-5. Amer Psychiatric Pub.
2. Barkley, R.A., Poillion, M.J., 1994. Attention deficit hyperactivity disorder. A handbook for diagnosis and treatment. Behavioral Disorders. 19, 150-152.
3. Bedard, K., Dhuey, E., 2006. The persistence of early childhood maturity, International evidence of long-run age effects. The Quarterly Journal of Economics. 121, 1437-1472.
4. Biederman, J., Mick, E., Faraone, S.V., Braaten, E., Doyle, A., Spencer, T., Wilens, T.E., Frazier, E., Johnson, M.A., 2002. Influence of gender on attention deficit hyperactivity disorder in children referred to a psychiatric clinic. American Journal of Psychiatry. 159, 36-42.
5. Binbaşıoğlu, C., 2004. İlkokuma ve Yazma Öğretimi. Nobel Yayın Dağıtım, Ankara.
6. Blair, C., 2002. School readiness: Integrating cognition and emotion in a neurobiological conceptualization of children's functioning at school entry. American Psychologist. 57, 111.
7. Chen, M., Hong, Lan, W., Hsuan, Bai, Y., Mei, Huang, K., Lin, Su, T., Ping, Tsai, S., Jen, Li, C., Ta, Lin, W., Chen, Chang, W., Han, Pan, T., Long, 2016. Influence of relative age on diagnosis and treatment of attention deficit hyperactivity disorder in Taiwanese children. The Journal of Pediatrics. 172, 162-167.
8. Dalsgaard, S., Humlum, M.K., Nielsen, H.S., Simonsen, M., 2012. Relative standards in ADHD diagnoses, the role of specialist behavior. Economics Letters. 117, 663-665.

9. Elder, T.E., 2010. The importance of relative standards in ADHD diagnoses, evidence based on exact birth dates. Journal of Health Economics. 29, 641-656.
10. Ercan, E., Amado, S., Somer, O., Çikoglu, S., 2001. Dikkat eksikliği hiperaktivite bozukluğu ve yıkıcı davranış bozuklukları için bir test bataryası geliştirme çalısması. Journal of Child and Adolescent Mental Health. 8, 132-44.
11. Evans, W.N., Morrill, M.S., Parente, S.T., 2010. Measuring inappropriate medical diagnosis and treatment in survey data, The case of ADHD among school-age children. Journal of Health Economics. 29, 657-673.
12. Resmi Gazete, 2012. 6287 sayılı ilköğretim ve eğitim kanunu ile bazı kanunlarda değişiklik yapılmasına dair kanun. Legal Gazette, 28261.
13. Gershon, J., Gershon, J., 2002. A meta-analytic review of gender differences in ADHD. Journal of Attention Disorders. 5, 143-154.
14. Goodman, R., Gledhill, J., Ford, T., 2003. Child psychiatric disorder and relative age within school year, cross sectional survey of large population sample. Bmj. 327, 472.
15. Gökçe, S., Yazgan, Y., Ayaz, A.B., Kayan, E., Yusufoğlu, C., Carkaxhiu Bulut, G., Aslan Genç, H., Dedeoğlu, C., Demirhan, S., Sancak, A., 2017. Association between age of beginning primary school and attention deficit hyperactivity disorder. Journal of Developmental & Behavioral Pediatrics. 38, 12-19.
16. Gündüz, F., Çalışkan, M., 2013. 60-66, 66-72, 72-84 aylık çocukların okul olgunluk ve okuma yazma becerilerini kazanma düzeylerinin incelenmesi. Electronic Turkish Studies. 8.
17. Layton, T.J., Barnett, M.L., Hicks, T.R., Jena, A.B., 2018. Attention deficit hyperactivity disorder and month of school enrollment. New England Journal of Medicine. 379, 2122-2130.
18. Spetie, L., Arnold, L.E., 2007. Attention Deficit Hyperactivity Disorder. Lewis's Child and Adolescent Psychiatry, A Comprehensive Textbook. Martin, A., Volkmar, F.R., Lewis, M, ed. Lippincott Williams & Wilkins. 430-454.
19. Morrow, R.L., Garland, E.J., Wright, J.M., Maclure, M., Taylor, S., Dormuth, C.R., 2012. Influence of relative age on diagnosis and treatment of attention deficit hyperactivity disorder in children. Canadian Medical Association Journal. 184, 755-762.
20. Mühlenweg, A., Blomeyer, D., Stichnoth, H., Laucht, M., 2012. Effects of age at school entry (ASE) on the development of non-cognitive skills, Evidence from psychometric data. Economics of Education Review. 31, 68-76.
21. Oktay, A., 2010. İlköğretime hazır oluş ve hazır oluşu etkileyen temel faktörler. İlköğretime Hazırlık ve İlköğretim Programları. A. Oktay, ed. Pegem Akademi, Ankara. 21-24.
22. Pottegård, A., Hallas, J., Zoëga, H., 2014. Children's relative age in class and use of medication for ADHD, a Danish nationwide study. Journal of Child Psychology and Psychiatry. 55, 1244-1250.
23. Sharp, C., 2002. School starting age: European policy and recent research. In LGA Seminar, When Should Our Children Start School.
24. The UNESCO Institute for Statistics, 2020. Official entrance age to compulsory education. http://data.uis.unesco.org/Index.aspx
25. Yavuzer, H., 2013. Çocuk Psikolojisi. Remzi Kitabevi, İstanbul.