Children's Relative Age and Medicine Treatment for Attention-Deficit/Hyperactivity Disorder Across Australian Jurisdictions with Different School Enrolment Policies

Claudia Bruno; Alys Havard; Mark Hanly; Kathleen Falster; Natasha Nassar; Ben Edwards; Adam J. Guastella; Sallie Anne Pearson; Helga Zoega

doi:10.1089/cap.2022.0032

Children's Relative Age and Medicine Treatment for Attention-Deficit/Hyperactivity Disorder Across Australian Jurisdictions with Different School Enrolment Policies

Claudia Bruno
, Alys Havard
, Mark Hanly
, Kathleen Falster
, Natasha Nassar
, Ben Edwards
, Adam J. Guastella
, Sallie Anne Pearson
, Helga Zoega

Faculty of Medicine

University of Iceland

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Children who are relatively young for their school grade are more likely to receive treatment for attention-deficit/hyperactivity disorder (ADHD). It is unclear whether the phenomenon also exists across Australia or is impacted by the school enrolment policy in place. Objective: We evaluated the association between children's relative age and initiation of ADHD medicines across Australian jurisdictions with different school enrolment policies and rates of delayed school entry. Methods: We used Australia-wide dispensing data for a 15% random sample of children 4-9 years of age in 2013-2017 to create a nationwide cohort. Due to high rates of delayed school entry in New South Wales (NSW), we used linked prescribing and education data for a cohort of NSW residents starting school in 2009 and 2012. We estimated incidence rate ratios (IRRs) for ADHD medicine across children's birth month, sex, and jurisdiction. We used asthma medicines as a negative control. Results: For girls, we observed a relative age effect in three out of five jurisdictions, with an IRR ranging from 1.3 to 2.8, comparing the youngest versus oldest birth month thirds. We observed more modest effects among boys, ranging from null to 1.5-fold. In NSW, the relatively youngest boys were less likely to initiate stimulant medicines than the oldest (IRR = 0.5, 95% confidence interval 0.29-0.78). We did not observe a relative age effect for initiation of asthma medicines. Conclusions: In jurisdictions with low rates of delayed entry, relatively young children were more likely to initiate ADHD medicines than their older classmates. We observed the inverse association in NSW where delayed entry was highest, likely reflecting the characteristics and needs of children who delay school entry for 1 year and become the oldest children in the grade. Increased awareness around children's maturity differences and school readiness may enhance appropriate diagnosis and treatment of ADHD.

Original language	English
Pages (from-to)	349-357
Number of pages	9
Journal	Journal of Child and Adolescent Psychopharmacology
Volume	32
Issue number	6
DOIs	https://doi.org/10.1089/cap.2022.0032
Publication status	Published - 1 Aug 2022

Bibliographical note

Funding Information: 1Centre for Big Data Research in Health, 2National Drug and Alcohol Research Centre, and 3School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia. 4Children’s Hospital at Westmead Clinical School and 5Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, Sydney, Australia. 6Centre for Social Research and Methods, College of Arts and Social Sciences, Australian National University, Canberra, Australia. 7Brain and Mind Centre, Children’s Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia. 8Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland. *Current address: School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia. Funding: This research is supported by the National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Medicines Intelligence (ID: 1196900). The Centre for Big Data Research in Health, UNSW Sydney has received funding from AbbVie Australia to conduct postmarket surveillance research. AbbVie did not have any knowledge of, or involvement in, the current study. A/Prof. Zoega is supported by a UNSW Scientia Fellowship. Ms. Bruno is supported through an Australian Government Research Training Program Scholarship. The other authors received no additional funding. Funding Information: Prof. Pearson is a member of the Drug Utilization Subcommittee of the Pharmaceutical Benefits Advisory Committee; the views expressed in this article do not represent those of the Committee. In 2020, the Centre for Big Data Research in Health, UNSW Sydney has received funding from AbbVie Australia to conduct research, unrelated to this study. AbbVie did not have any knowledge of, or involvement in, this study. The remaining authors report no actual, potential, or perceived conflicts of interest regarding the submission of this article. Publisher Copyright: © Copyright 2022, Mary Ann Liebert, Inc., publishers 2022.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Other keywords

CNS stimulants
attention-deficit/hyperactivity disorder
child health
relative age

Access to Document

10.1089/cap.2022.0032

Cite this

Bruno, C., Havard, A., Hanly, M., Falster, K., Nassar, N., Edwards, B., Guastella, A. J., Pearson, S. A., & Zoega, H. (2022). Children's Relative Age and Medicine Treatment for Attention-Deficit/Hyperactivity Disorder Across Australian Jurisdictions with Different School Enrolment Policies. Journal of Child and Adolescent Psychopharmacology, 32(6), 349-357. https://doi.org/10.1089/cap.2022.0032

@article{23bfd3e6f7924d89bae46c2d8fa7e060,

title = "Children's Relative Age and Medicine Treatment for Attention-Deficit/Hyperactivity Disorder Across Australian Jurisdictions with Different School Enrolment Policies",

abstract = "Background: Children who are relatively young for their school grade are more likely to receive treatment for attention-deficit/hyperactivity disorder (ADHD). It is unclear whether the phenomenon also exists across Australia or is impacted by the school enrolment policy in place. Objective: We evaluated the association between children's relative age and initiation of ADHD medicines across Australian jurisdictions with different school enrolment policies and rates of delayed school entry. Methods: We used Australia-wide dispensing data for a 15\% random sample of children 4-9 years of age in 2013-2017 to create a nationwide cohort. Due to high rates of delayed school entry in New South Wales (NSW), we used linked prescribing and education data for a cohort of NSW residents starting school in 2009 and 2012. We estimated incidence rate ratios (IRRs) for ADHD medicine across children's birth month, sex, and jurisdiction. We used asthma medicines as a negative control. Results: For girls, we observed a relative age effect in three out of five jurisdictions, with an IRR ranging from 1.3 to 2.8, comparing the youngest versus oldest birth month thirds. We observed more modest effects among boys, ranging from null to 1.5-fold. In NSW, the relatively youngest boys were less likely to initiate stimulant medicines than the oldest (IRR = 0.5, 95\% confidence interval 0.29-0.78). We did not observe a relative age effect for initiation of asthma medicines. Conclusions: In jurisdictions with low rates of delayed entry, relatively young children were more likely to initiate ADHD medicines than their older classmates. We observed the inverse association in NSW where delayed entry was highest, likely reflecting the characteristics and needs of children who delay school entry for 1 year and become the oldest children in the grade. Increased awareness around children's maturity differences and school readiness may enhance appropriate diagnosis and treatment of ADHD.",

keywords = "CNS stimulants, attention-deficit/hyperactivity disorder, child health, relative age",

author = "Claudia Bruno and Alys Havard and Mark Hanly and Kathleen Falster and Natasha Nassar and Ben Edwards and Guastella, \{Adam J.\} and Pearson, \{Sallie Anne\} and Helga Zoega",

note = "Funding Information: 1Centre for Big Data Research in Health, 2National Drug and Alcohol Research Centre, and 3School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia. 4Children{\textquoteright}s Hospital at Westmead Clinical School and 5Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, Sydney, Australia. 6Centre for Social Research and Methods, College of Arts and Social Sciences, Australian National University, Canberra, Australia. 7Brain and Mind Centre, Children{\textquoteright}s Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia. 8Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjav{\'i}k, Iceland. *Current address: School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia. Funding: This research is supported by the National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Medicines Intelligence (ID: 1196900). The Centre for Big Data Research in Health, UNSW Sydney has received funding from AbbVie Australia to conduct postmarket surveillance research. AbbVie did not have any knowledge of, or involvement in, the current study. A/Prof. Zoega is supported by a UNSW Scientia Fellowship. Ms. Bruno is supported through an Australian Government Research Training Program Scholarship. The other authors received no additional funding. Funding Information: Prof. Pearson is a member of the Drug Utilization Subcommittee of the Pharmaceutical Benefits Advisory Committee; the views expressed in this article do not represent those of the Committee. In 2020, the Centre for Big Data Research in Health, UNSW Sydney has received funding from AbbVie Australia to conduct research, unrelated to this study. AbbVie did not have any knowledge of, or involvement in, this study. The remaining authors report no actual, potential, or perceived conflicts of interest regarding the submission of this article. Publisher Copyright: {\textcopyright} Copyright 2022, Mary Ann Liebert, Inc., publishers 2022.",

year = "2022",

month = aug,

day = "1",

doi = "10.1089/cap.2022.0032",

language = "English",

volume = "32",

pages = "349--357",

journal = "Journal of Child and Adolescent Psychopharmacology",

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publisher = "SAGE Publications Ltd",

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Bruno, C, Havard, A, Hanly, M, Falster, K, Nassar, N, Edwards, B, Guastella, AJ, Pearson, SA & Zoega, H 2022, 'Children's Relative Age and Medicine Treatment for Attention-Deficit/Hyperactivity Disorder Across Australian Jurisdictions with Different School Enrolment Policies', Journal of Child and Adolescent Psychopharmacology, vol. 32, no. 6, pp. 349-357. https://doi.org/10.1089/cap.2022.0032

Children's Relative Age and Medicine Treatment for Attention-Deficit/Hyperactivity Disorder Across Australian Jurisdictions with Different School Enrolment Policies. / Bruno, Claudia; Havard, Alys; Hanly, Mark et al.
In: Journal of Child and Adolescent Psychopharmacology, Vol. 32, No. 6, 01.08.2022, p. 349-357.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Children's Relative Age and Medicine Treatment for Attention-Deficit/Hyperactivity Disorder Across Australian Jurisdictions with Different School Enrolment Policies

AU - Bruno, Claudia

AU - Havard, Alys

AU - Hanly, Mark

AU - Falster, Kathleen

AU - Nassar, Natasha

AU - Edwards, Ben

AU - Guastella, Adam J.

AU - Pearson, Sallie Anne

AU - Zoega, Helga

N1 - Funding Information: 1Centre for Big Data Research in Health, 2National Drug and Alcohol Research Centre, and 3School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia. 4Children’s Hospital at Westmead Clinical School and 5Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, Sydney, Australia. 6Centre for Social Research and Methods, College of Arts and Social Sciences, Australian National University, Canberra, Australia. 7Brain and Mind Centre, Children’s Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia. 8Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland. *Current address: School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia. Funding: This research is supported by the National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Medicines Intelligence (ID: 1196900). The Centre for Big Data Research in Health, UNSW Sydney has received funding from AbbVie Australia to conduct postmarket surveillance research. AbbVie did not have any knowledge of, or involvement in, the current study. A/Prof. Zoega is supported by a UNSW Scientia Fellowship. Ms. Bruno is supported through an Australian Government Research Training Program Scholarship. The other authors received no additional funding. Funding Information: Prof. Pearson is a member of the Drug Utilization Subcommittee of the Pharmaceutical Benefits Advisory Committee; the views expressed in this article do not represent those of the Committee. In 2020, the Centre for Big Data Research in Health, UNSW Sydney has received funding from AbbVie Australia to conduct research, unrelated to this study. AbbVie did not have any knowledge of, or involvement in, this study. The remaining authors report no actual, potential, or perceived conflicts of interest regarding the submission of this article. Publisher Copyright: © Copyright 2022, Mary Ann Liebert, Inc., publishers 2022.

PY - 2022/8/1

Y1 - 2022/8/1

N2 - Background: Children who are relatively young for their school grade are more likely to receive treatment for attention-deficit/hyperactivity disorder (ADHD). It is unclear whether the phenomenon also exists across Australia or is impacted by the school enrolment policy in place. Objective: We evaluated the association between children's relative age and initiation of ADHD medicines across Australian jurisdictions with different school enrolment policies and rates of delayed school entry. Methods: We used Australia-wide dispensing data for a 15% random sample of children 4-9 years of age in 2013-2017 to create a nationwide cohort. Due to high rates of delayed school entry in New South Wales (NSW), we used linked prescribing and education data for a cohort of NSW residents starting school in 2009 and 2012. We estimated incidence rate ratios (IRRs) for ADHD medicine across children's birth month, sex, and jurisdiction. We used asthma medicines as a negative control. Results: For girls, we observed a relative age effect in three out of five jurisdictions, with an IRR ranging from 1.3 to 2.8, comparing the youngest versus oldest birth month thirds. We observed more modest effects among boys, ranging from null to 1.5-fold. In NSW, the relatively youngest boys were less likely to initiate stimulant medicines than the oldest (IRR = 0.5, 95% confidence interval 0.29-0.78). We did not observe a relative age effect for initiation of asthma medicines. Conclusions: In jurisdictions with low rates of delayed entry, relatively young children were more likely to initiate ADHD medicines than their older classmates. We observed the inverse association in NSW where delayed entry was highest, likely reflecting the characteristics and needs of children who delay school entry for 1 year and become the oldest children in the grade. Increased awareness around children's maturity differences and school readiness may enhance appropriate diagnosis and treatment of ADHD.

AB - Background: Children who are relatively young for their school grade are more likely to receive treatment for attention-deficit/hyperactivity disorder (ADHD). It is unclear whether the phenomenon also exists across Australia or is impacted by the school enrolment policy in place. Objective: We evaluated the association between children's relative age and initiation of ADHD medicines across Australian jurisdictions with different school enrolment policies and rates of delayed school entry. Methods: We used Australia-wide dispensing data for a 15% random sample of children 4-9 years of age in 2013-2017 to create a nationwide cohort. Due to high rates of delayed school entry in New South Wales (NSW), we used linked prescribing and education data for a cohort of NSW residents starting school in 2009 and 2012. We estimated incidence rate ratios (IRRs) for ADHD medicine across children's birth month, sex, and jurisdiction. We used asthma medicines as a negative control. Results: For girls, we observed a relative age effect in three out of five jurisdictions, with an IRR ranging from 1.3 to 2.8, comparing the youngest versus oldest birth month thirds. We observed more modest effects among boys, ranging from null to 1.5-fold. In NSW, the relatively youngest boys were less likely to initiate stimulant medicines than the oldest (IRR = 0.5, 95% confidence interval 0.29-0.78). We did not observe a relative age effect for initiation of asthma medicines. Conclusions: In jurisdictions with low rates of delayed entry, relatively young children were more likely to initiate ADHD medicines than their older classmates. We observed the inverse association in NSW where delayed entry was highest, likely reflecting the characteristics and needs of children who delay school entry for 1 year and become the oldest children in the grade. Increased awareness around children's maturity differences and school readiness may enhance appropriate diagnosis and treatment of ADHD.

KW - CNS stimulants

KW - attention-deficit/hyperactivity disorder

KW - child health

KW - relative age

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DO - 10.1089/cap.2022.0032

M3 - Article

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SN - 1044-5463

VL - 32

SP - 349

EP - 357

JO - Journal of Child and Adolescent Psychopharmacology

JF - Journal of Child and Adolescent Psychopharmacology

IS - 6

ER -

Children's Relative Age and Medicine Treatment for Attention-Deficit/Hyperactivity Disorder Across Australian Jurisdictions with Different School Enrolment Policies

Abstract

Bibliographical note

UN SDGs

Other keywords

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