Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Department of Management, University of Toronto Scarborough, Toronto, Ontario, Canada.
Health Econ. 2022 Sep;31(9):1926-1953. doi: 10.1002/hec.4555. Epub 2022 Jun 28.
ADHD diagnoses increase discontinuously by a child's school starting age, with young-for-grade students having much higher ADHD diagnostic rates. Whether these higher rates reflect over-diagnosis or under-diagnosis remains unknown. To decompose this diagnostic discrepancy, we exploit differences in parent and teacher pre-diagnostic assessments within a regression discontinuity strategy based on school starting age. We show that being young-for-grade or male generates over-assessment of symptoms specifically from teacher assessment. However, under-assessments of the oldest students in a grade, especially the oldest females, account for a large part of the observed school starting age assessment gap. We argue that this difference by sex and higher school starting age effects in lower-income schools may exacerbate known gaps in educational attainment by gender and socioeconomic status. Importantly, we fail to find evidence that teachers who receive special education training make such errors.
ADHD 诊断在儿童入学年龄上呈不连续增加，年级较小的学生 ADHD 诊断率要高得多。这些更高的比率是反映过度诊断还是漏诊仍不清楚。为了解剖这种诊断差异，我们利用了入学年龄为基础的回归不连续策略中家长和教师预诊断评估的差异。我们表明，年龄较小或男性会导致教师评估中症状的过度评估。然而，年级中最年长的学生，尤其是最年长的女性，对评估的低估很大程度上解释了观察到的入学年龄评估差距。我们认为，这种性别差异和低收入学校中更高的入学年龄效应可能会加剧性别和社会经济地位在受教育程度方面已知的差距。重要的是，我们没有发现接受特殊教育培训的教师会犯这样的错误的证据。
