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Eur Child Adolesc Psychiatry (2014) 23:841844 DOI 10.1007/s00787-013-0508-5
BRIEF REPORT
Common Danish standards in prescribing medication for children and adolescents with ADHD
Sren Dalsgaard Maria Knoth Humlum
Helena Skyt Nielsen Marianne Simonsen
Received: 8 May 2013 / Accepted: 11 December 2013 / Published online: 29 December 2013 Springer-Verlag Berlin Heidelberg 2013
Abstract Assessing whether symptoms of attention-deficit hyperactivity disorder (ADHD) in children are age-inappropriate is essential. Hence, comparing children within one school grade is problematic and the risk of applying relative standards is inherent. Being young-for-grade increases the likelihood of receiving medication in countries with high prevalence of ADHD medication. We test the same hypothesis in a cohort of 418,396 children and nd no difference between children who are young-for-grade and old-for-grade. The Danish system, with its restrictive approach to medication and clear diagnostic guidelines seems to have avoided a systematic bias of ADHD medication in young children reported in other countries.
Introduction
When parents, teachers or clinicians assess whether a child is hyperactive, inattentive or impulsive it is essential to compare the child with children of the same age.
Comparing a child with its classmates may not be appropriate as the age of children in a grade typically varies by up to a year. Relative age is an important subject in education [7], medicine [6] and sports [12]. In Denmark, school entry rules imply that children born in December are typically enrolled in school 1 year earlier than children born in January. Previous studies have raised concern that being relatively young-for-grade may signicantly increase the likelihood of being diagnosed with or receiving pharmacological treatment for attention-decit hyperactivity disorder (ADHD) [4, 5, 9, 13]. This suggests that relative standards are applied in some countries in the clinical assessment. Relative standards are not applied in diagnosing children with ADHD in Denmark [2], and the objective of this study was to examine whether children in Denmark who are young for their grade in school are more likely to be treated with ADHD medications than children who are old for their grade.
Methods
The Danish Civil Registration System [11] supplied the unique personal identier for all children born in Denmark 100 days from January 1st from July 1990 to June 2001 (N = 418,396). Cohort members were followed...