Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom.
Karolinska Institutet, Stockholm, Sweden; Örebro University, Sweden.
J Am Acad Child Adolesc Psychiatry. 2022 Feb;61(2):291-297. doi: 10.1016/j.jaac.2021.07.002. Epub 2021 Aug 11.
Young relative age (ie, being among the youngest in a school class) and attention-deficit/hyperactivity disorder (ADHD) are both potential risk factors for adverse long-term outcomes. Young relative age also increases the risk of ADHD diagnosis. Using data from Swedish national registers, we investigate the independent and joint long-term effects of young relative age and ADHD on educational achievement, substance use disorder (SUD), criminality, and depression.
We identified a national cohort of individuals with young relative age (born November-December) and a comparison group with old relative age (born January-February). Of the total sample of 297,840 individuals, 6,528 individuals had a diagnosis of ADHD in childhood. The 4 outcomes were measured at ages 15 to 23 years. We examined main, additive, and interactive effects of young relative age and ADHD on long-term outcomes.
In the individuals without ADHD, young relative age was associated with increased risk of depression (odds ratio [OR] = 1.14 [95% CI =1.09-1.20]), SUD (OR = 1.14 [1.09-1.20]), and low educational achievement (OR = 1.17 [1.14-1.20]), but not criminality (OR = 1.00 [0.98-1.03]). In the individuals with ADHD, young relative age was associated with increased risk of SUD (OR = 1.23 [1.01-1.50]) and low educational achievement (OR = 1.12 [1.00-0.26]; CI included 1), but not depression or criminality (OR = 0.88 [0.73-1.07] and OR = 0.89 [0.79-1.01], respectively). An interaction emerged between young relative age and ADHD for depression (OR = 0.78 [0.64-0.95]).
We observed relative age effects that add to the evidence supporting a more flexible approach to school starting age and that emphasize the importance of careful age-match comparisons during assessment of childhood ADHD symptoms.
年轻的相对年龄（即，在学校班级中年龄最小的人）和注意力缺陷多动障碍（ADHD）都是不良长期结果的潜在风险因素。年轻的相对年龄也会增加 ADHD 诊断的风险。使用来自瑞典国家登记处的数据，我们研究了年轻的相对年龄和 ADHD 对教育成就、物质使用障碍（SUD）、犯罪和抑郁的独立和共同的长期影响。
我们确定了一个具有年轻相对年龄（11 月至 12 月出生）的全国队列和一个具有年老相对年龄（1 月至 2 月出生）的对照组。在总共 297840 名个体中，有 6528 名个体在儿童时期被诊断出患有 ADHD。4 种结果在 15 至 23 岁之间进行了测量。我们检查了年轻的相对年龄和 ADHD 对长期结果的主要、附加和交互影响。
在没有 ADHD 的个体中，年轻的相对年龄与抑郁的风险增加有关（优势比 [OR] = 1.14 [95%置信区间 [CI] = 1.09-1.20]）、SUD（OR = 1.14 [1.09-1.20]）和低教育成就（OR = 1.17 [1.14-1.20]），但与犯罪无关（OR = 1.00 [0.98-1.03]）。在患有 ADHD 的个体中，年轻的相对年龄与 SUD 的风险增加有关（OR = 1.23 [1.01-1.50]）和低教育成就（OR = 1.12 [1.00-0.26]；CI 包括 1），但与抑郁或犯罪无关（OR = 0.88 [0.73-1.07]和 OR = 0.89 [0.79-1.01]）。年轻的相对年龄和 ADHD 之间出现了抑郁的相互作用（OR = 0.78 [0.64-0.95]）。
我们观察到相对年龄的影响，这增加了支持更灵活的入学年龄方法的证据，并强调了在评估儿童期 ADHD 症状时进行仔细年龄匹配比较的重要性。
