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The importance of relative standards in ADHD diagnoses: Evidence based on exact birth dates

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  • Elder, Todd E.

Abstract

This paper presents evidence that diagnoses of attention-deficit/hyperactivity disorder (ADHD) are driven largely by subjective comparisons across children in the same grade in school. Roughly 8.4 percent of children born in the month prior to their state's cutoff date for kindergarten eligibility - who typically become the youngest and most developmentally immature children within a grade - are diagnosed with ADHD, compared to 5.1 percent of children born in the month immediately afterward. A child's birth date relative to the eligibility cutoff also strongly influences teachers' assessments of whether the child exhibits ADHD symptoms but is only weakly associated with similarly measured parental assessments, suggesting that many diagnoses may be driven by teachers' perceptions of poor behavior among the youngest children in a classroom. These perceptions have long-lasting consequences: the youngest children in fifth and eighth grades are nearly twice as likely as their older classmates to regularly use stimulants prescribed to treat ADHD.

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Bibliographic Info

Article provided by Elsevier in its journal Journal of Health Economics.

Volume (Year): 29 (2010)
Issue (Month): 5 (September)
Pages: 641-656

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Handle: RePEc:eee:jhecon:v:29:y:2010:i:5:p:641-656

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Web page: http://www.elsevier.com/locate/inca/505560

Related research

Keywords: ADHD Symptoms Diagnoses Regression discontinuity;

References

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  1. Justin McCrary & Heather Royer, 2011. "The Effect of Female Education on Fertility and Infant Health: Evidence from School Entry Policies Using Exact Date of Birth," American Economic Review, American Economic Association, vol. 101(1), pages 158-95, February.
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  3. Michael Fertig & Jochen Kluve, 2005. "The Effect of Age at School Entry on Educational Attainment in Germany," RWI Discussion Papers 0027, Rheinisch-Westfälisches Institut für Wirtschaftsforschung.
  4. Fredriksson, Peter & Öckert, Björn, 2006. "Is early learning really more productive? The effect of school starting age on school and labor market performance," Working Paper Series 2006:12, IFAU - Institute for Evaluation of Labour Market and Education Policy.
  5. Janet Currie & Jonathan Gruber, 1995. "Health Insurance Eligibility, Utilization of Medical care, and Child Health," NBER Working Papers 5052, National Bureau of Economic Research, Inc.
  6. Jason Fletcher & Barbara L. Wolfe, 2007. "Child Mental Health and Human Capital Accumulation: The Case of ADHD Revisited," NBER Working Papers 13474, National Bureau of Economic Research, Inc.
  7. Kelly Bedard & Elizabeth Dhuey, 2006. "The Persistence of Early Childhood Maturity: International Evidence of Long-Run Age Effects," The Quarterly Journal of Economics, MIT Press, vol. 121(4), pages 1437-1472, November.
  8. David S. Lee & David Card, 2006. "Regression Discontinuity Inference with Specification Error," NBER Technical Working Papers 0322, National Bureau of Economic Research, Inc.
  9. Carlos Dobkin & Fernando Ferreira, 2009. "Do School Entry Laws Affect Educational Attainment and Labor Market Outcomes?," NBER Working Papers 14945, National Bureau of Economic Research, Inc.
  10. Elizabeth U. Cascio, 2009. "Maternal Labor Supply and the Introduction of Kindergartens into American Public Schools," Journal of Human Resources, University of Wisconsin Press, vol. 44(1).
  11. Patrick J. McEwan & Joseph S. Shapiro, 2008. "The Benefits of Delayed Primary School Enrollment: Discontinuity Estimates Using Exact Birth Dates," Journal of Human Resources, University of Wisconsin Press, vol. 43(1).
  12. Evans, William N. & Morrill, Melinda S. & Parente, Stephen T., 2010. "Measuring inappropriate medical diagnosis and treatment in survey data: The case of ADHD among school-age children," Journal of Health Economics, Elsevier, vol. 29(5), pages 657-673, September.
  13. Guido Imbens & Thomas Lemieux, 2007. "Regression Discontinuity Designs: A Guide to Practice," NBER Working Papers 13039, National Bureau of Economic Research, Inc.
  14. Janet Currie & Mark Stabile, 2009. "Appendix to "Mental Health in Childhood and Human Capital"," NBER Chapters, in: The Problems of Disadvantaged Youth: An Economic Perspective National Bureau of Economic Research, Inc.
  15. Currie, Janet & Stabile, Mark, 2006. "Child mental health and human capital accumulation: The case of ADHD," Journal of Health Economics, Elsevier, vol. 25(6), pages 1094-1118, November.
  16. Datar, Ashlesha, 2006. "Does delaying kindergarten entrance give children a head start?," Economics of Education Review, Elsevier, vol. 25(1), pages 43-62, February.
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Citations

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Cited by:
  1. Dalsgaard, Søren & Nielsen, Helena Skyt & Simonsen, Marianne, 2014. "Consequences of ADHD Medication Use for Children's Outcomes," IZA Discussion Papers 8208, Institute for the Study of Labor (IZA).
  2. Mühlenweg, Andrea & Blomeyer, Dorothea & Stichnoth, Holger & Laucht, Manfred, 2012. "Effects of age at school entry (ASE) on the development of non-cognitive skills: Evidence from psychometric data," Economics of Education Review, Elsevier, vol. 31(3), pages 68-76.
  3. Rasmus Landersø & Helena Skyt Nielsen & Marianne Simonsen, 2013. "School Starting Age and Crime," Study Papers 58, Rockwool Foundation Research Unit.
  4. McGee, Andrew, 2011. "Skills, standards, and disabilities: How youth with learning disabilities fare in high school and beyond," Economics of Education Review, Elsevier, vol. 30(1), pages 109-129, February.
  5. Dalsgaard, Søren & Humlum, Maria Knoth & Nielsen, Helena Skyt & Simonsen, Marianne, 2012. "Relative standards in ADHD diagnoses: The role of specialist behavior," Economics Letters, Elsevier, vol. 117(3), pages 663-665.
  6. Rasmus Landersø & Helena Skyt Nielsen & Marianne Simonsen, 2013. "School Starting Age and Crime," Economics Working Papers 2013-03, School of Economics and Management, University of Aarhus.

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