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Why Scorpios and Sagittarius Get More ADHD Diagnoses

The youngest students in each grade — typically those born in November and December — are up to two times more likely than their peers to get an ADHD diagnosis and treatment. Learn why that is, and what educators and parents can do about it.

Parents-to-be plan pregnancies around a number of considerations: health, work and family obligations, desired season of birth. But here’s one little-known factor worth parents’ consideration: The date of your child’s birth may impact his or her perceived mental health down the road.

This has nothing to do with astrology. Rather, your child’s birthdate largely determines when she will start school, and how old she will be relative to her classmates. That’s because in a majority of countries (the U.S. included), school entry is based on cut-off dates. In New York City’s public school system, for example, the cut-off is December 31. This means that James, born December 30, will be placed a full grade ahead of Jeremy, born just two days later! James will be the youngest in his class, and Jeremy, the oldest in his.

Studies reveal the youngest children in each grade are 1.5 to 2 times more likely to be treated for attention-related disorders such as attention deficit disorder (ADHD or ADD) than are their relatively older classmates. This may sound shocking at first, but, once deconstructed, it makes sense. Children spend a significant portion of their day in school, largely together as cohorts of classmates. Problems are often first noted based on how a given child is performing — be it at math, reading, music, or soccer — relative to her or his classmates.

In the early years of life, a one-year physical age difference can reflect an eternity in developmental terms. So a child who has just turned 5 could easily be perceived as lagging behind a classmate about to turn 6, and thus referred for further evaluation, and possibly treatment. And in cities that offer that pre-K education, this ‘age-relative-to-grade’ gradient can start even earlier in life.

This is not unique to the U.S. Similar patterns have been reported in Australia, Canada, Iceland, Israel, Spain and Sweden. Interestingly, in Sweden’s Nordic neighbor Denmark, where school entry is based more on parental judgment than on strict cut-offs, this pattern is not observed. And even in countries where the gradient exists, it diminishes as kids get older. That, too, is intuitive, as the maturity differential between a 14 and a 15 year old will invariably be less than that between a 4 and 5 year old. But it doesn’t disappear completely, and being relatively young in grade school can put a child at risk for worse academic performance throughout his or her academic career.

[Self Test: Could Your Child Have ADHD?]

There are a few caveats to note, though. First, we’re not talking cause and effect here. Being young for one’s class does not “cause” ADHD. Rather, it serves as a magnifying lens, increasing the likelihood that educators will notice behavioral variations.

Second, this isn’t necessarily a bad thing. Many children, regardless of their birth date, can and do benefit greatly from early diagnosis and treatment. The challenge lies in distinguishing between children who genuinely need treatment from those who appear to need it by being incorrectly compared to older peers.

And, finally, age-relative-to-grade considerations don’t apply to children ‘misaligned’ with their grade— that is, children who’ve either skipped or have been held back a year. The latter also known as academic red-shirting, is an increasingly prevalent phenomenon, and will have to be a topic for another day.

So what can be done to help children with ADHD?

More flexible school entry based on a child’s individual development rather than strict birthday cut-offs could help reduce age-inappropriate burdens on children, while at the same time reducing some of the imprecision in ADHD diagnoses. That’s a longer-term proposition, however, with its own logistic issues.

Meanwhile, should we encourage women to schedule their pregnancies around school cycles instead of menstrual ones? Of course not. The answer, I believe, lies in greater awareness. An ADHD diagnosis requires symptoms to be present in multiple settings. For the vast majority of children, this translates to home and school, where parents and teachers, respectively, have the front row seat. It is thus incumbent on the parents, teachers, and pediatricians, to be cognizant of this age-relative-to-grade gradient when evaluating a child, particularly one born in the fourth quarter. Otherwise, we run the risk of treating some kids as problematic when all they’re doing is living and breathing their age.

[Related Reading: Should My Child Repeat Kindergarten?]

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