Age at school entry and reported symptoms of attention-deficit/hyperactivity in first graders: results of the prospective cohort study ikidS

Abstract

Young age at school entry (ASE) is related to attention-deficit/hyperactivity disorder in higher grades. The reason for this association is unclear, but medical oversupply and stress-related factors are discussed. We aimed to investigate whether ASE is associated with reported symptoms of attention-deficit/hyperactivity (ADH) already in first grade. Data of a population-based prospective cohort study (N = 2003; Mainz-Bingen region; Rhineland-Palatinate; Germany) with baseline assessments prior to school entry and two follow-ups during first grade were analysed. ADH symptoms were assessed by parent and teacher versions of the Strengths and Difficulties Questionnaire. Associations between ASE and scores of the hyperactivity/inattention subscale (range 0–10) were investigated by regression analysis and adjusted for potential confounders and baseline symptoms prior to school entry. In total, 1633 children (52% boys, mean ASE 6.5 years) were included. There were no relationships between ASE and parent-reported scores of the hyperactivity/inattention subscale prior to school entry and 3 months thereafter. However, at the end of first grade, ASE was negatively associated with the hyperactivity/inattention subscale in parent (− 0.7 subscale points per year ASE, standard error = 0.16, p < 0.0001) and teacher reports (− 1.2 subscale points per year ASE, standard error = 0.25, p < 0.0001). This ASE effect appeared more pronounced in girls than in boys. Young ASE is related to more reported symptoms of ADH at the end of first grade, but not before. The evolvement of this effect during first grade may be a clue to ASE-related stress factors.

Relative Age Effect in Attention Deficit/Hyperactivity Disorder at Various Stages of the Medicalization Process

“…In this hypothesis, ADHD is conceptualized as an individual deficit, but the RAE is blamed on an inadequate match between individual characteristics of the students and that of the school environment. This stress-related hypothesis was confirmed by the study of Diefenbach et al [ 34 ]: RAE was associated with ADHD-related behaviors at the end of the first grade but not at the beginning of the school year. However, this effect does not seem to endure over time because studies have shown that the RAE in ADHD is less common in adolescence and even disappears in adulthood [ 23 ].…”

“…We tested another hypothesis ( H4 ), which suggested that teachers were more likely to identify children having the double burden of being young in class and exhibiting ADHD behaviors because of their greater struggle in school. This hypothesis emphasized the importance of functional impairment as the main reason to seek medical care [ 17 , 34 ]. However, it could not be confirmed by our models, which were limited by the cross-sectional nature of the study.…”

“…A second hypothesis suggests that “entering school at a young age triggers ADHD” due to the younger-in-class students generally struggling to meet the demands of the classroom [ 6 , 34 ]. In this hypothesis, ADHD is conceptualized as an individual deficit, but the RAE is blamed on an inadequate match between individual characteristics of the students and that of the school environment.…”

The impact of relative age effects on psychosocial development: A systematic review

“…Twenty‐two studies investigated the association between relative age and behaviour using questionnaires to assess internalizing and externalizing behaviours. The necessary information to obtain effect sizes was only available for ten studies (Broughton et al, 2022; Diefenbach et al, 2021; Goodman et al, 2003; Lien et al, 2005; Lincove & Painter, 2006; Price et al, 2017; Reijneveld et al, 2006; Wendt et al, 2018; Wienen et al, 2018; Wisniewski et al, 1995). These studies were included in a random effect meta‐analysis.…”