Holding children back: Can it “prevent” ADHD?

The Pediatric Insider

© 2013 Roy Benaroch, MD

I’ve been skeptical of the trend of “holding back” children with late birthdays. These are kids, usually born in the summer, who are just a few months short of the next grade cut-off. Some parents wonder whether it would be wise to hold them back a few months, so they end up one of the oldest (rather than youngest) kids in their class. This might seem to confer an advantage in terms of maturity, academic ability, and physical size, strength and coordination. Since children usually continue tracking up yearly, without later switching grades, kids “held back” in kindergarten will end up perhaps bigger and stronger and faster when trying out for teams in high school. A good idea?

Recent research has shown some stark differences in children who end up as the youngest versus the oldest kids in a classroom, which gives support to the idea of re-considering firm birthday-based rules for choosing when to start kids in school.

One good study was performed by researchers collaborating in Boston and Iceland. They looked at a nationwide cohort of Icelandic children, about 12000 kids, specifically grouping them by both birthdate and grade in school. Some findings from the study:

  • Mean test scores were lowest among the youngest children, especially in early grades. This gap lessened by middle school, but was still significant.
  • Children in the youngest third of a class were about 50% more likely to be prescribed medication for ADHD than kids in the oldest third of the class.

Similar findings have been reported by other researchers—this seems to be a real effect. Lumping children together by age creates a disparity in abilities within a classroom, with the youngest children being put at a relative disadvantage. That seems to create a greater likelihood of medical diagnoses and treatment for attention deficit disorder. It’s not known if holding back these younger kids with ADHD would allow them to become better students without fulfilling an ADHD diagnosis.

I’m not certain what the best approach is, here. Some kind of division between grades is inevitable, and some kids in any group are going to be the youngest. Perhaps smaller classes with a smaller age-range of children would help; or, perhaps an individualized approach to determining which kids will do best to start sooner versus later would address this disparity. In the held-back year, children who weren’t ready for school could get extra help with their attention abilities and other skills that will help them advance. However, this could lead to other problems later on, when kids of greatly varying age (and therefore physical and sexual maturity) are mixed together.

I don’t have a solution, but it seems like this is a genuine problem. We’d better figure out a way to work this out that doesn’t depend on more medications for the youngest kids in a grade.

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2 Comments on “Holding children back: Can it “prevent” ADHD?”

  1. Durango Says:

    We had our son repeat 7th grade for social reasons, and it was the best decision we ever made. It’s not holding-back in the standard sense, but after watching him struggle through elementary school and the fiasco that middle school became it was the right choice and I wonder how much better it could have been if we had held him back earlier. I wish that there were more flexibility and less social stigma with holding kids back after they have already started school so that there isn’t essentially just one time to make that decision. Most parents and kids feel locked-in to a grade level once they begin.


  2. wellillbe Says:

    My son is the youngest in his kindergarten class. He is the youngest of three. He is ahead of the older children in his class in both reading and math capabilities ( he is reading on a third grade level). He behaves as well as them also and is socially more advanced. He sticks up for the kid that inevitably gets teased. His only problem this year was talking to himself when he was bored. A pack of chewing gum in the teachers control worked wonders. He talked she’d give him gum to occupy his mouth. After a week of this he didn’t need the gum anymore either.,… Sometimes its the fact that parents have treated their preschoolers as babies instead of encouraging them to grow independence (within reason of course) as they were meant to do.


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