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, 29 (5), 641-56

The Importance of Relative Standards in ADHD Diagnoses: Evidence Based on Exact Birth Dates

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The Importance of Relative Standards in ADHD Diagnoses: Evidence Based on Exact Birth Dates

Todd E Elder. J Health Econ.

Abstract

This paper presents evidence that diagnoses of attention-deficit/hyperactivity disorder (ADHD) are driven largely by subjective comparisons across children in the same grade in school. Roughly 8.4 percent of children born in the month prior to their state's cutoff date for kindergarten eligibility - who typically become the youngest and most developmentally immature children within a grade - are diagnosed with ADHD, compared to 5.1 percent of children born in the month immediately afterward. A child's birth date relative to the eligibility cutoff also strongly influences teachers' assessments of whether the child exhibits ADHD symptoms but is only weakly associated with similarly measured parental assessments, suggesting that many diagnoses may be driven by teachers' perceptions of poor behavior among the youngest children in a classroom. These perceptions have long-lasting consequences: the youngest children in fifth and eighth grades are nearly twice as likely as their older classmates to regularly use stimulants prescribed to treat ADHD.

Keywords: ADHD; diagnoses; regression discontinuity; symptoms.

Figures

Figure 1
Figure 1
Rates of ADHD Diagnosis and Behavioral Medication Usage by Birth Month, ECLS-K
Figure 2
Figure 2
Average Actual and Predicted ADHD Diagnoses by Birth Date Relative to Eligibility Cutoffs
Figure 3
Figure 3
Sensitivity of the Estimated Effects of School Starting Age on ADHD-Related Outcomes to the Width of Sample Windows
Figure 3
Figure 3
Sensitivity of the Estimated Effects of School Starting Age on ADHD-Related Outcomes to the Width of Sample Windows
Figure 4
Figure 4
Predicted ADHD Rates by Birth Month and Eligibility Cutoff, ECLS-K
Figure 5
Figure 5
Average Teacher (Left) and Parent (Right) SRS Composite Ratings by Birth Date Relative to Cutoff Dates
Figure 5
Figure 5
Average Teacher (Left) and Parent (Right) SRS Composite Ratings by Birth Date Relative to Cutoff Dates

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