Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK.
Administrative Data Research Wales, Swansea University Medical School, Swansea, SA2 8PP, UK.
BMC Public Health. 2022 May 30;22(1):1070. doi: 10.1186/s12889-022-13453-w.
Previous studies suggest an association between age within schoolyear and attention-deficit hyperactivity disorder (ADHD). Scotland and Wales have different school entry cut-off dates (six months apart) and policies on holding back children. We aim to investigate the association between relative age and treated attention deficit hyperactivity disorder (ADHD) in two countries, accounting for held-back children.
Routine education and health records of 1,063,256 primary and secondary schoolchildren in Scotland (2009-2013) and Wales (2009-2016) were linked. Logistic regression was used to examine the relationships between age within schoolyear and treated ADHD, adjusting for child, maternity and obstetric confounders.
Amongst children in their expected school year, 8,721 (0.87%) had treated ADHD (Scotland 0.84%; Wales 0.96%). In Wales, ADHD increased with decreasing age (youngest quartile, adjusted OR 1.32, 95% CI 1.19-1.46) but, in Scotland, it did not differ between the youngest and oldest quartiles. Including held-back children in analysis of their expected year, the overall prevalence of treated ADHD was 0.93%, and increased across age quartiles in both countries. More children were held back in Scotland (57,979; 7.66%) than Wales (2,401; 0.78%). Held-back children were more likely to have treated ADHD (Scotland OR 2.18, 95% CI 2.01-2.36; Wales OR 1.70, 95% CI 1.21-2.31) and 81.18% of held-back children would have been in the youngest quartile of their expected year.
Children younger within schoolyear are more likely to be treated for ADHD, suggesting immaturity may influence diagnosis. However, these children are more likely to be held back in countries that permit flexibility, attenuating the relative age effect.
先前的研究表明，学年内的年龄与注意缺陷多动障碍（ADHD）之间存在关联。苏格兰和威尔士的入学截止日期（相差六个月）和留级政策不同。我们旨在调查两个国家中相对年龄与经过治疗的注意缺陷多动障碍（ADHD）之间的关联，同时考虑留级儿童的情况。
苏格兰（2009-2013 年）和威尔士（2009-2016 年）的 1063256 名中小学生的常规教育和健康记录进行了链接。使用逻辑回归检查了学年内年龄与经治疗的 ADHD 之间的关系，同时调整了儿童、产妇和产科混杂因素。
在预期就读年级的儿童中，有 8721 名（0.87%）患有经治疗的 ADHD（苏格兰为 0.84%；威尔士为 0.96%）。在威尔士，ADHD 随年龄的降低而增加（最小四分位数，调整后的 OR 为 1.32，95%CI 为 1.19-1.46），但在苏格兰，最小和最大四分位数之间没有差异。在对预期年份的留级儿童进行分析时，经治疗的 ADHD 的总体患病率为 0.93%，且在两个国家的年龄四分位数中均增加。苏格兰的留级儿童（57979 人；7.66%）多于威尔士（2401 人；0.78%）。留级儿童更有可能接受治疗（苏格兰的 OR 为 2.18，95%CI 为 2.01-2.36；威尔士的 OR 为 1.70，95%CI 为 1.21-2.31），且 81.18%的留级儿童将处于预期年龄的最小四分位数。
学年内年龄较小的儿童更有可能接受 ADHD 的治疗，这表明不成熟可能会影响诊断。然而，在允许灵活性的国家，这些儿童更有可能留级，从而减轻了相对年龄的影响。
