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expert reaction to relative age in school year, and diagnosis of intellectual disability, depression and ADHD

A study, published in JAMA Pediatrics, reports that being amongst the youngest in a school year is linked to a higher risk of intellectual disability, depression and ADHD.


Dr Celso Arango, Director, Institute of Psychiatry and Mental Health, Chair, Department of Child and Adolescent Psychiatry,  Hospital General Universitario Gregorio Marañon and Past President of European College of Neuropsychopharmacology (ECNP), said:

“The study is impressive for its large number of children and adolescents included. It has been known for a long time that children that are born in the first months of the school year are less likely to be diagnosed with ADHD and more likely to become professional sportsmen/women. As they are more mature, and at these ages the difference in 9-11 months is very notable, they perform better in motor coordination and other cognitive abilities than their younger class-mates. They are selected among others and get more training and better self-esteem which creates a vicious circle. What is really new in this study is the association with depression that may be also linked to more stress for worse performance and teachers’ lower expectations with another vicious circle in the other direction (less self-esteem and self-confidence).

“If a child already has some difficulties and is born in the latter months of the year these problems will be exaggerated when compared with peers which will increase chances to receive a diagnosis such as learning disabilities.

“To what extent the 3 diagnosis are independent form each other is a question that the study does not answer.

“What is important from the study is that:

  • Diagnosis should always take age into account and what is expected for the real age.
  • Schools should have different classes based on the month children are born in order not to create those vicious circles.

“I believe that results of this study are more relevant for professionals (health and education) than for parents. Health professionals should always take into account age (not class) and education professionals should pair pupils not by alphabetic order or any other variable but for age (e.g. if in one year there are 3 classes the first one should have the first four months and so on…).”


‘Association of Relative Age in the School Year With Diagnosis of Intellectual Disability, Attention-Deficit/Hyperactivity Disorder, and Depression’ by Adrian Root et al. was published in JAMA Pediatrics at 16:00 UK time on Monday 23rd September. 

DOI: 10.1001/jamapediatrics.2019.3194


Declared interests

Dr Celso Arango:  Dr. Arango. has been a consultant to or has received honoraria or grants from Acadia, Angelini, Gedeon Richter, Janssen Cilag, Lundbeck, Otsuka, Roche, Sage, Servier, Shire, Schering Plough, Sumitomo Dainippon Pharma, Sunovion and Takeda.

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