The Combined Effects of Young Relative Age and Attention-Deficit/Hyperactivity Disorder on Negative Long-term Outcomes
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Objective: 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. Method: 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. Results: 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]). Conclusion: 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.
Original language | English |
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Journal | Journal of the American Academy of Child and Adolescent Psychiatry |
Volume | 61 |
Issue number | 2 |
Pages (from-to) | 291-297 |
Number of pages | 7 |
ISSN | 0890-8567 |
DOIs | |
Publication status | Published - 2022 |
Bibliographical note
Funding Information:
The project has received funding from the European Commission's Horizon 2020 research and innovation program under grant agreement No. 667302 and the from the Swedish Council for Health, Working Life and Welfare ( 2019-00176 ).
Publisher Copyright:
© 2021 American Academy of Child and Adolescent Psychiatry
- ADHD, attention-deficit/hyperactivity disorder, long-term outcomes, relative age
Research areas
ID: 314069894