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. 2019 Nov 1;173(11):1068-1075.
doi: 10.1001/jamapediatrics.2019.3194.

Association of Relative Age in the School Year With Diagnosis of Intellectual Disability, Attention-Deficit/Hyperactivity Disorder, and Depression

Adrian Root  1 , Jeremy P Brown  1 , Harriet J Forbes  1 , Krishnan Bhaskaran  1 , Joseph Hayes  2   3 , Liam Smeeth  1 , Ian J Douglas  1
Affiliations

Association of Relative Age in the School Year With Diagnosis of Intellectual Disability, Attention-Deficit/Hyperactivity Disorder, and Depression

Adrian Root et al. JAMA Pediatr. .

Abstract

Importance: Young relative age within the school year has previously been associated with attention-deficit/hyperactivity disorder (ADHD) diagnosis and, based on limited evidence, diagnosis of intellectual disability. No study to date has examined the association between relative age and diagnosis of depression.

Objectives: To estimate the associations with intellectual disability and ADHD and investigate a potential novel association between relative age and childhood depression.

Design, setting, and participants: This population-based cohort study of 1 042 106 children aged 4 to 15 years used electronic record data collected before January 3, 2017, from more than 700 general practices contributing to the UK Clinical Practice Research Datalink. Multivariable Cox proportional hazards regression modeling was used to explore the association between relative age and the incidence of intellectual disability, ADHD, and depression before age 16 years. Data were analyzed between July 2017 and January 2019.

Exposures: Relative age within school year determined by month of birth and categorized into four 3-month groups.

Main outcomes and measures: Intellectual disability, ADHD, and depression.

Results: In the total cohort of 1 042 106 children, 532 876 were male (51.1%) and the median age at study entry was 4.0 years (interquartile range, 4.0-5.0). There was evidence that being born in the last quarter of the school year (ie, being the youngest group in a school year) was associated with diagnosis of intellectual disability (adjusted hazard ratio [aHR], 1.30; 95% CI, 1.18-1.42), ADHD (aHR, 1.36; 95% CI, 1.28-1.45), and depression (aHR, 1.31; 95% CI, 1.08-1.59) compared with being born in the first quarter. A graded association was seen with intermediate age groups at a smaller increased risk of each diagnosis compared with the oldest group, with aHRs for intellectual disability for those born in the second quarter of 1.06 (95% CI, 0.96-1.17) and for those born in the third quarter of 1.20 (95% CI, 1.09-1.32); aHRs for ADHD for those born in the second quarter of 1.15 (95% CI, 1.08-1.23) and for those born in the third quarter of 1.31 (95% CI, 1.23-1.40); and aHRs for depression for those born in the second quarter of 1.05 (95% CI, 0.85-1.29) and for those born in the third quarter of 1.13 (95% CI, 0.92-1.38).

Conclusions and relevance: In this study, relative youth status in the school year is associated with an increased risk of diagnosis of ADHD, intellectual disability, and depression in childhood. Further research into clinical and policy interventions to minimize these associations appears to be needed.

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Conflict of interest statement

Conflict of Interest Disclosures: Mr Brown has received financial support from the Association of the British Pharmaceutical Industry for work unrelated to the study in question; Dr Smeeth has received personal fees for advisory committee work relating to observational and interventional studies of inhalers used in chronic obstructive pulmonary disease from GSK outside the submitted work; and Dr Douglas has received financial support from GlaxoSmithKline for work unrelated to the study in question, consulted for GlaxoSmithKline and Gilead, and holds stock in GlaxoSmithKline. No other conflicts were reported.

Figures

Figure.
Figure.. Study Flow Diagram
ADHD indicates attention-deficit/hyperactivity disorder; CPRD, Clinical Practice Research Datalink. aRegistered at a general practice contributing research quality data to the CPRD and younger than 16 years at last practice data collection.
See this image and copyright information in PMC

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