New research on diagnosing younger children with attention issues has come out at the same time that media sources have drawn attention to what is sometimes called "redshirting" - the practice of holding younger children out of kindergarten for a year so that they do not move through school as one of the youngest children in their class.
In an article in the Journal of the Canadian Medical Association, researcher Richard Morrow of the University of British Columbia and his colleagues looked at more than 900,000 Canadian children over an 11 year period. The cut-off for enrollment in kindergarten in Canada is December 31st. The oldest children in any given kindergarten class will have January birthdays and the youngest children will have been born in December. Morrow and his team noted that children with December birthdays were 39% more likely to be diagnosed with attention deficit hyperactivity disorder (ADHD) and 48% more likely to receive medication to treat ADHD. Furthermore, the likelihood of diagnosis and treatment decreased with each month of age -- so children born in March, for example, were less likely to be diagnosed and treated with medication than children born in October. This study raised concerns both about the rate of diagnosis and the impact of treating young children with ADHD medications. As quoted in Time Magazine, Morrow noted, “What is clear from our study is that younger children in a classroom are more likely to receive a diagnosis of ADHD and drugs to treat that ADHD... but their relative maturity should come into play. Something to keep in mind when we look at behavioral problems is whether the behavior relates to differences in age and maturity.”
The social, academic, and even athletic consequences of holding children back was the topic of a recent segment on 60 Minutes. What was apparent from the piece was that parents had a variety of reasons for holding children back. Some did it because they felt their child needed more time to mature. Others wanted to give their child an academic advantage and still others wanted their child to have additional size and coordination for future athletic endeavors. What was noted by the correspondent was that parents who were holding their children out of kindergarten were generally affluent; families with fewer resources or where both parents needed to be in the workforce could not afford the additional year of nursery school or child care that comes with the decision to hold back from kindergarten enrollment. The segment also highlighted parents who felt strongly that holding their child back from kindergarten was both unnecessary and fundamentally unfair to other children.
The American Academy of Pediatrics has taken the position that schools need to deal with children at all levels of school readiness and that parents, communities, and pediatricians need to work together to make sure that all children are ready to begin school with the tools to succeed.
Perhaps the best perspective on this issue is one we heard from a parent who faced this question when her now adult children were of kindergarten age. Both children, born two years apart, had November birthdays in a district where the cut off date for kindergarten was December 1st. She and her husband decided to keep one child on track and he entered kindergarten as one of the youngest in his class and remained so throughout his school career. They decided to hold another child back for a year, and he entered kindergarten and moved through school as one of the older students in his class. "In each instance," she noted, "it was the right decision. I don't think there is one right path, just what seems to be the right path at a given time for a particular child."