New research suggests parents of children with late summer birthdays may want to consider holding their kids back one more year before starting school.

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When young children are held up to a standard of behavior they aren’t yet developmentally prepared for, they may be misdiagnosed with ADHD. Getty Images

The start of kindergarten is a big deal for a lot of families.

It’s the beginning of a new stage of childhood and parenting, and it brings with it all of the excitement and anxiety that come along with such a change.

But for parents of kids with late summer birthdays, the transition can be even more daunting. This is because those parents usually have a choice to make: Allow their child to be among the youngest in the class, or give them another year to develop in both maturity and attention skills prior to beginning their educational career.

There are a lot of factors that can go into making this choice.

On the side of holding kids back, parents may be considering the potential for athletic opportunities in the future, a child’s individual ability to sit still, and the fact that research has consistently shown better outcomes for kids who tend to be among the oldest in their class. This includes higher test scores, improved college attendance rates, and reduced juvenile criminal activity.

On the side of starting early, however, parents might cite the appeal of saving money on childcare, or of simply being convinced their child truly is ready.

These are fair points. But a new study published in The New England Journal of Medicine may give those parents one more reason to reconsider.

According to the latest research, children born in August attending schools with September 1st enrollment cutoffs are 30 percent more likely to receive an ADHD diagnosis when compared to their only slightly older peers.

For the study’s lead author, Timothy Layton, PhD, these results bring up some important points for parents to keep in mind.

“I think parents of children with summer birthdays (or birthdays close to the cutoff in their state) should be skeptical when teachers come to them suggesting their child has ADHD,” he told Healthline.


The results indicate a possibility that younger children are being over-diagnosed with ADHD, held up against a standard for behavior they just aren’t yet developmentally prepared for.

According to the Centers for Disease Control and Prevention (CDC), the percentage of children who have been diagnosed with ADHD at some point in their lives rose nearly 38 percent between 2003 and 2016.

Layton warned that parents “should also do everything they can to help their children weather the storm of being the youngest child in their class, which brings with it numerous disadvantages for the child.”

He suggests parents at least consider holding their children with late summer birthdays back a year, so they can be the oldest in the class rather than the youngest.

Dr. Mark Wolraich, a professor of pediatrics and Chief of the Section of Development and Behavioral Pediatrics at Oklahoma University Health Sciences Center, told Healthline that while over-diagnosis may be a valid concern, he worries that there is also a fair amount of under-diagnosis when it comes to ADHD.

And he expressed concern that fears of over-diagnosis may actually keep kids who really need the help from receiving a proper diagnosis.

“One of the important aspects of making the diagnosis is determining if the symptoms are impairing the child’s function,” he told Healthline. “Those children who are having problems need to have those problems addressed, because the experience with failure and not doing well can be very negative for these kids.”

He said it’s important for practitioners to look at the child’s environment when making a diagnosis — which includes their teachers and their school. He also wants to make sure parents know that ADHD does not have to be a permanent diagnosis.

“Clearly, if they improve with maturity, they no longer have a diagnosis,” he said.

Layton acknowledged his study does not definitively conclude over-diagnosis is happening.

“ADHD is not really a 0/1 type of condition,” he explained, continuing on to talk about how it is more likely something that occurs across a spectrum. “One major caveat of our study is that we cannot say whether the additional children diagnosed with ADHD because they were born in August benefited from that diagnosis. They may have received additional attention, which may have helped them.”

But, he added, “The main concerning factor is that they also receive drugs, and we do not understand the long-term consequences of being on these drugs as a child.”

However, Wolraich had a slightly different take, wanting to assure parents that drugs are not the first line of defense in ADHD treatment — especially with younger children.

“For children four to six years of age, the guidelines for the AAP say that the first line of treatment is parent behavior training — helping to improve the parenting and also providing behavioral interventions in the school. Those things aren’t going to be harmful for the child and also don’t necessarily require a specific diagnosis.”

However, a definitive diagnosis can be hard to pin down.

Jessica Francis is a therapist and licensed clinical social worker in private practice in Georgia. She specializes in ADHD and told Healthline, “What we call ADHD is a set of characteristics caused by generally genetic factors that lead to differences in the structure and functioning of the brain.”

She explained that those differences have actually been identified on brain scans, but that brain scanning is not exact enough to use for diagnosis.

She also pointed out that while researchers are still working to find out what genes are involved in ADHD, between 25 and 44 genes have already been identified as possibly creating the symptoms of ADHD.

When it comes to diagnosis, she explained, “A person simply has to show a certain number of symptoms much of the time and in multiple environments, and those symptoms have to get in the way of their life.”

The symptoms she was discussing are divided into two sets: inattentiveness and hyperactive/impulsivity.

“A person can show symptoms on one set, the other, or both, and this determines whether they are diagnosed with Inattentive Type (what used to be called simply ADD), Hyperactive/Impulsive Type (what was called ADHD when there was a difference in the naming), or Combined Type.”

Francis also raised concerns that under-diagnosis of ADHD is a far larger problem than over-diagnosis.

“The diagnostic criteria for ADHD were written based on what ADHD looks like in hyperactive boys. Hyperactive girls are more likely to be diagnosed later or not at all, because their hyperactivity more often shows in talkativeness and smaller fidgeting movements and is thus often dismissed as ‘just being overly social.’”

Meanwhile, she said that inattentive children are often dismissed as being “dreamers” or “space cadets,” or even bored and lazy.

“The smarter the inattentive child is, the longer he or she will go before being diagnosed because the amount of attention the child does manage to muster is enough to get them through the earlier years with decent grades.”

But that doesn’t mean parents should jump right on the diagnosis bandwagon.

Francis and Wolraich both encouraged parents to talk to their children’s educators, their pediatricians, and to compare their children to other children around the same age — even if that means comparing them to children a grade above or below. Because, as the research shows, even the difference of a few months in age can make a big difference in developmentally appropriate behaviors.

Which may simply be one more point in the column for holding children with late summer birthdays back an additional year.