Halldner Linda, Tillander Annika, Lundholm Cecilia, Boman Marcus, Långström Niklas, Larsson Henrik, Lichtenstein Paul
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Karolinska Institutet Center of Neurodevelopmental Disorders (KIND), Karolinska Institutet, Stockholm, Sweden.
J Child Psychol Psychiatry. 2014 Aug;55(8):897-904. doi: 10.1111/jcpp.12229. Epub 2014 Mar 26.
We addressed if immaturity relative to peers reflected in birth month increases the likelihood of ADHD diagnosis and treatment.
We linked nationwide Patient and Prescribed Drug Registers and used prospective cohort and nested case-control designs to study 6-69 year-old individuals in Sweden from July 2005 to December 2009 (Cohort 1). Cohort 1 included 56,263 individuals diagnosed with ADHD or ever used prescribed ADHD-specific medication. Complementary population-representative cohorts provided DSM-IV ADHD symptom ratings; parent-reported for 10,760 9-year-old twins born 1995-2000 from the CATSS study (Cohort 2) and self-reported for 6,970 adult twins age 20-47 years born 1959-1970 from the STAGE study (Cohort 3). We calculated odds ratios (OR:s) for ADHD across age for individuals born in November/December compared to January/February (Cohort 1). ADHD symptoms in Cohorts 2 and 3 were studied as a function of calendar birth month.
ADHD diagnoses and medication treatment were both significantly more common in individuals born in November/December versus January/February; peaking at ages 6 (OR: 1.8; 95% CI: 1.5-2.2) and 7 years (OR: 1.6; 95% CI: 1.3-1.8) in the Patient and Prescribed Drug Registers, respectively. We found no corresponding differences in parent- or self-reported ADHD symptoms by calendar birth month.
Relative immaturity compared to class mates might contribute to ADHD diagnosis and pharmacotherapy despite absence of parallel findings in reported ADHD symptom loads by relative immaturity. Increased clinical awareness of this phenomenon may be warranted to decrease risk for imprecise diagnostics and treatment. We speculate that flexibility regarding age at school start according to individual maturity could reduce developmentally inappropriate demands on children and improve the precision of ADHD diagnostic practice and pharmacological treatment.
我们探讨了相对于同龄人而言，出生月份所反映出的不成熟是否会增加注意力缺陷多动障碍（ADHD）诊断和治疗的可能性。
我们将全国范围的患者和处方药登记册相链接，并采用前瞻性队列研究和巢式病例对照设计，对2005年7月至2009年12月期间瑞典6至69岁的个体进行研究（队列1）。队列1包括56263名被诊断患有ADHD或曾使用过ADHD特定处方药的个体。具有人群代表性的补充队列提供了《精神疾病诊断与统计手册》第四版（DSM-IV）中ADHD症状评分；1995年至2000年出生的10760名9岁双胞胎通过父母报告的方式提供症状评分（队列2），1959年至1970年出生的6970名20至47岁成年双胞胎通过自我报告的方式提供症状评分（队列3）。我们计算了11月/12月出生的个体与1月/2月出生的个体相比，各年龄段ADHD的比值比（OR）（队列1）。队列2和队列3中的ADHD症状作为出生月份的函数进行研究。
11月/12月出生的个体与1月/2月出生的个体相比，ADHD诊断和药物治疗均显著更为常见；在患者和处方药登记册中，分别在6岁（OR：1.8；95%置信区间：1.5 - 2.2）和7岁（OR：1.6；95%置信区间：1.3 - 1.8）时达到峰值。我们未发现按出生月份划分的父母报告或自我报告的ADHD症状存在相应差异。
与同班同学相比相对不成熟可能导致ADHD诊断和药物治疗，尽管在报告的ADHD症状负荷方面未因相对不成熟而有类似发现。可能有必要提高对这一现象的临床认识，以降低诊断和治疗不准确的风险。我们推测，根据个体成熟度灵活确定入学年龄可以减少对儿童发展不适当的要求，并提高ADHD诊断实践和药物治疗的准确性。
