Grade effects on teacher ratings of ADHD symptoms among primary school students.

Several studies have reported that being younger for grade increases the risk of having attention deficit hyperactivity disorder (ADHD) diagnosis and being on ADHD medication among students. The aim of this study was to investigate this association in a low-middle income country setting. Sample included 2,627 children from first to fourth grades. We compared students who were older than the 75th and younger than the 25th percentiles in consecutive grades. Teachers completed SNAP-4 scale. Results indicated that teacher rated ADHD symptoms were 2.5 to 3.6 times more common in students who were younger for their grade, after age, gender, and Fluid IQ scores were controlled. Teacher SNAP-4 scores were also significantly associated with grade. Our results suggested that the phenomenon of higher rates of teacher rated ADHD symptoms among younger for grade students was not limited to Western countries and that the teacher reported symptom loads were higher in these children.