The University of Southampton
University of Southampton Institutional Repository

Association between relative age at school and persistence of ADHD in prospective studies: an individual participant data meta-analysis

Association between relative age at school and persistence of ADHD in prospective studies: an individual participant data meta-analysis
Association between relative age at school and persistence of ADHD in prospective studies: an individual participant data meta-analysis

Background: The youngest children in a school class are more likely than the oldest to be diagnosed with ADHD, but this relative age effect is less frequent in older than in younger school-grade children. However, no study has explored the association between relative age and the persistence of ADHD diagnosis at older ages. We aimed to quantify the association between relative age and persistence of ADHD at older ages. Methods: For this meta-analysis, we searched MEDLINE, Embase, CINAHL, PsycINFO, and PubPsych up to April 1, 2022, with terms related to “cohort” and “ADHD” with no date, publication type, or language restrictions. We gathered individual participant data from prospective cohorts that included at least ten children identified with ADHD before age 10 years. ADHD was defined by either a clinical diagnosis or symptoms exceeding clinical cutoffs. Relative age was recorded as the month of birth in relation to the school-entry cutoff date. Study authors were invited to share raw data or to apply a script to analyse data locally and generate anonymised results. Our outcome was ADHD status at a diagnostic reassessment, conducted at least 4 years after the initial assessment and after age 10 years. No information on sex, gender, or ethnicity was collected. We did a two-stage random-effects individual participant data meta-analysis to assess the association of relative age with persistence of ADHD at follow-up. This study was registered with PROSPERO, CRD42020212650. Findings: Of 33 119 studies generated by our search, we identified 130 eligible unique studies and were able to gather individual participant data from 57 prospective studies following up 6504 children with ADHD. After exclusion of 16 studies in regions with a flexible school entry system that did not allow confident linkage of birthdate to relative age, the primary analysis included 41 studies in 15 countries following up 4708 children for a period of 4 to 33 years. We found that younger relative age was not statistically significantly associated with ADHD persistence at follow-up (odds ratio 1·02, 95% CI 0·99–1·06; p=0·19). We observed statistically significant heterogeneity in our model (Q=75·82, p=0·0011, I 2=45%). Participant-level sensitivity analyses showed similar results in cohorts with a robust relative age effect at baseline and when restricting to cohorts involving children with a clinical diagnosis of ADHD or with a follow-up duration of more than 10 years. Interpretation: The diagnosis of ADHD in younger children in a class is no more likely to be disconfirmed over time than that of older children in the class. One interpretation is that the relative age effect decreases the likelihood of children of older relative age receiving a diagnosis of ADHD, and another is that assigning a diagnostic label of ADHD leads to unexplored carryover effects of the initial diagnosis that persist over time. Future studies should be conducted to explore these interpretations further. Funding: None.

2215-0366
922-933
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Gosling, Corentin, Caparos, Serge, Pinabiaux, Charlotte, Schwarzer, Guido, Rücker, Gerta, Agha, Sharifah, Alrouh, Hekmat, Ambler, Antony, Anderson, Peter, Arnold, Eugene, Arseneault, Louise, Asherson, Philip, Babinski, Leslie, Barbati, Vittoria, Barkley, Russel, Barros, Aluisio, Barros, Fernando, Bates, John, Bell, Laura, Berenguer, Carmen, van Bergen, Elsje, Biederman, Joseph, Birmaher, Boris, Bøe, Tormod, Boomsma, Dorret, Brandt, Valerie, Bressan, Rodrigo, Brocki, Karin, Broughton, Thomas, Bufferd, Sara, Bussing, Regina, Cao, Meng, Cartigny, Ariane, Casas, Ana, Caspi, Avshalom, Castellanos, F Xavier, Caye, Arthur, Cederkvist, Luise, Collishaw, Stephan, Copeland, William, Cote, Sylvana, Coventry, William, Mol Debes, Nanette, Denyer, Hayley, Dodge, Kenneth, Dogru, Hicran, Efron, Daryl, Eller, Jami, Elmaksoud, Marwa Abd, Ercan, Eyup Sabri, Faraone, Stephen, Fenesy, Michelle, Fernández, Mariana, Fernández-Somoano, Ana, Findling, Robert, Fombonne, Eric, Fossum, Ingrid, Freire, Carmen, Friedman, Naomi, Fristad, Mary, Galera, Cerdic, Garcia Argibay, Miguel, Garvan, Cynthia, González, Llúcia, Groenman, Annabeth, Guxens, Mònica, Halperin, Jeffrey, Hamadeh, Randah, Hartman, Catharina, Hill, Shirley, Hinshaw, Stephen, Hipwell, Alison, Hokkanen, Laura, Holz, Nathalie, Íñiguez, Carmen, Jahrami, Haitham, Jansen, Pauline, Jónsdóttir, Lilja, Julvez, Jordi, Kaiser, Anna, Keenan, Kate, Klein, Daniel, Klein, Rachel, Kuntsi, Jonna, Langfus, Joshua, Langley, Kate, Lansford, Jennifer, Larsen, Sally, Larsson, Henrik, Law, Evelyn, Lee, Steve, Lertxundi, Nerea, Li, Xiaobo, Li, Yueling, Lichtenstein, Paul, Liu, Jianghong, Lundervold, Astri, Lundström, Sebastian, Marks, David, Martin, Joanna, Masi, Gabrielle, Matijasevich, Alicia, Melchior, Maria, Moffitt, Terrie, Monninger, Maximilian, Morrison, Claire, Mulraney, Melissa, Muratori, Pietro, Nguyen, Phuc, Nicholson, Jan, Øie, Merete Glenne, O'Neill, Sarah, O’Connor, Cliodhna, Orri, Massimiliano, Pan, Pedro, Pascoe, Leona, Pettit, Gregory, Price, Jolie, Rebagliato, Marisa, Riaño-Galán, Isolina, Rohde, Luis, Roisman, Glenn, Rosa, Maria, Rosenbaum, Jerrold, Salum, Giovanni, Sammallahti, Sara, Santos, Ina, Schiavone, Nella, Schmid, Lorrie, Sciberras, Emma, Shaw, Philip, Silk, Tim, Simpson, Jeffry, Skogli, Erik, Stepp, Stephanie, Strandberg-Larsen, Katrine, Sudre, Gustavo, Sunyer, Jordi, Tandon, Mini, Thapar, Anita, Thomson, Phoebe, Thorell, Lisa, Tinchant, Hannah, Torrent, Maties, Tovo, Luciana, Tripp, Gail, Ukoumunne, Obioha, Van Goozen, Stephanie, Vos, Melissa, Wallez, Solène, Wang, Yufeng, Westermaier, Franz, Whalen, Diana, Yoncheva, Yuliya, Youngstrom, Eric, Sayal, Kapil, Solmi, Marco, Delorme, Richard and Cortese, Samuele (2023) Association between relative age at school and persistence of ADHD in prospective studies: an individual participant data meta-analysis. The Lancet Psychiatry, 10 (12), 922-933. (doi:10.1016/S2215-0366(23)00272-9).

Record type: Article

Abstract

Background: The youngest children in a school class are more likely than the oldest to be diagnosed with ADHD, but this relative age effect is less frequent in older than in younger school-grade children. However, no study has explored the association between relative age and the persistence of ADHD diagnosis at older ages. We aimed to quantify the association between relative age and persistence of ADHD at older ages. Methods: For this meta-analysis, we searched MEDLINE, Embase, CINAHL, PsycINFO, and PubPsych up to April 1, 2022, with terms related to “cohort” and “ADHD” with no date, publication type, or language restrictions. We gathered individual participant data from prospective cohorts that included at least ten children identified with ADHD before age 10 years. ADHD was defined by either a clinical diagnosis or symptoms exceeding clinical cutoffs. Relative age was recorded as the month of birth in relation to the school-entry cutoff date. Study authors were invited to share raw data or to apply a script to analyse data locally and generate anonymised results. Our outcome was ADHD status at a diagnostic reassessment, conducted at least 4 years after the initial assessment and after age 10 years. No information on sex, gender, or ethnicity was collected. We did a two-stage random-effects individual participant data meta-analysis to assess the association of relative age with persistence of ADHD at follow-up. This study was registered with PROSPERO, CRD42020212650. Findings: Of 33 119 studies generated by our search, we identified 130 eligible unique studies and were able to gather individual participant data from 57 prospective studies following up 6504 children with ADHD. After exclusion of 16 studies in regions with a flexible school entry system that did not allow confident linkage of birthdate to relative age, the primary analysis included 41 studies in 15 countries following up 4708 children for a period of 4 to 33 years. We found that younger relative age was not statistically significantly associated with ADHD persistence at follow-up (odds ratio 1·02, 95% CI 0·99–1·06; p=0·19). We observed statistically significant heterogeneity in our model (Q=75·82, p=0·0011, I 2=45%). Participant-level sensitivity analyses showed similar results in cohorts with a robust relative age effect at baseline and when restricting to cohorts involving children with a clinical diagnosis of ADHD or with a follow-up duration of more than 10 years. Interpretation: The diagnosis of ADHD in younger children in a class is no more likely to be disconfirmed over time than that of older children in the class. One interpretation is that the relative age effect decreases the likelihood of children of older relative age receiving a diagnosis of ADHD, and another is that assigning a diagnostic label of ADHD leads to unexplored carryover effects of the initial diagnosis that persist over time. Future studies should be conducted to explore these interpretations further. Funding: None.

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Accepted/In Press date: 6 August 2023
e-pub ahead of print date: 25 October 2023
Published date: December 2023
Additional Information: Funding Information: This study received no funding from any funding agency. GM was supported by funds from the Ricerca Corrente 2021, Italian Ministry of Health. Academic Development Study of Australian Twins cohort: this research was supported by two Australian Research Council Discovery Project Grants (DP 120102414 [2012–2014] and DP 150102441 [2015–2018]). Access to the sample was facilitated by Twins Research Australia, a national resource supported by a Centre of Research Excellence Grant (1079102) from the Australian National Health and Medical Research Council (NHMRC). ADHD Detection and Service Use cohort: This research was supported by an NIH grant (RO1MH57399). Avon Longitudinal Study of Parents and Children cohort: We are extremely grateful to all the families who took part in this study, the midwives for their help in recruiting them, and the whole Avon Longitudinal Study of Parents and Children (ALSPAC) team, which includes interviewers, computer and laboratory technicians, clerical workers, research scientists, volunteers, managers, receptionists, and nurses. ALSPAC is a prospective pregnancy cohort based in the UK. Pregnant women resident in Avon, UK with expected dates of delivery between April 1, 1991 and Dec 31, 1992 were invited to take part in the study. An initial 14 541 women returned a questionnaire or attended a clinic subsequently. From these pregnancies, 13 988 children were alive at 1 year of age. When the oldest children were approximately 7 years of age, an attempt was made to bolster the initial sample with eligible cases who had failed to join the study originally. The total eligible sample at age is therefore 15 447 pregnancies, resulting in 15 658 foetuses. Of these, 14 901 children were alive at 1 year of age. The study website contains details of all the data available through a fully searchable data dictionary and variable search tool (https://www.bristol.ac.uk/alspac/researchers/our-data/). Ethical approval for the study was obtained from the ALSPAC Ethics and Law Committee and the Local Research Ethics Committees. Consent for biological samples was collected in accordance with the Human Tissue Act (2004). Informed consent for the use of data collected via questionnaires and clinics was obtained from participants following the recommendations of the ALSPAC Ethics and Law Committee at the time. The MRC and Wellcome Trust (217065/Z/19/Z) and the University of Bristol provide core support for ALSPAC. A comprehensive list of grant funding is available on the ALSPAC website (https://www.bristol.ac.uk/alspac/external/documents/grant-acknowledgements.pdf). Berkeley Girls with ADHD Longitudinal Study cohort: this research was supported by funding from NIMH (R01 45064) to SPH. Brazilian High Risk Cohort: this work was supported by the National Institute of Developmental Psychiatry for Children and Adolescents, a science and technology institute funded by Conselho Nacional de Desenvolvimento Científico e Tecnológico (National Council for Scientific and Technological Development; 573974/2008-0), the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Brazil (Finance Code 001), NIMH (RO1 MH120482-01, subaward n° 576811); the National Institute of Developmental Psychiatry for Children and Adolescents (Fapesp 2014/50917-0, CNPq 465550/2014-2), the National Center for Research and Innovation in Mental Health (Fapesp 2021/12901-9), and Banco Industrial do Brasil S/A. Children's Attention Project cohort: the Children's Attention Project was funded by grants from the NHMRC (1008522 and 1065895) and the Collier Foundation. Child and Adolescent Twin Study in Sweden cohort: we acknowledge The Swedish Twin Registry for access to data. The Swedish Twin Registry is managed by Karolinska Institutet and receives funding through the Swedish Research Council (2017-00641). Child Development Project cohort: the Child Development Project has been funded by NIMH (MH56961, MH57024, and MH57095), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (HD30572), and the National Institute on Drug Abuse (DA016903). China Jintan Child Cohort Study cohort: the China Jintan Child Cohort Study was funded by NIH (R01-ES-018858, K02-ES-019878, K01-ES015877, P30-ES013508). Cardiff Longitudinal ADHD Sample Study cohort: this research was funded by the MRC (G1000632), the Wellcome Trust (079711), Action Medical Research, and the Baily Thomas Charitable Fund. Danish National Birth Cohort (DNBC): this cohort was established with a significant grant from the Danish National Research Foundation, with additional support from the Danish Regional Committees, the Pharmacy Foundation, the Egmont Foundation, the March of Dimes Birth Defects Foundation, the Health Foundation, and other minor grants. The DNBC Biobank has been supported by the Novo Nordisk Foundation and the Lundbeck Foundation. Follow-ups of mothers and children have been supported by the Danish Medical Research Council (SSVF 0646, 271-08-0839/06-066023, O602-01042B, 0602-02738B), the Lundbeck Foundation (195/04, R100-A9193), Innovation Fund Denmark (0603-00294B, 09-067124), the Nordea Foundation (02-2013-2014), Aarhus Ideas (AU R9-A959-13-S804), University of Copenhagen Strategic Grant (IFSV 2012), and the Danish Council for Independent Research (DFF-4183-00594, DFF-4183-00152). Environmental Risk Study cohort: the Environmental Risk Study is funded by grants from the MRC (G1002190, MR/X010791/1). Study of Cardiovascular Risk in Adolescents (ERICA) cohort: this project was funded by a grant from the Swedish Council for Health, Working Life and Welfare (2020-00630). Fenesy cohort: this research was funded by NIH (R03AA020186 awarded to SSL). Generation R Study cohort: the general design of the Generation R Study is supported by the Erasmus Medical Center, Erasmus University Rotterdam, the Netherlands Organisation for Health Research and Development, the Netherlands Organisation for Scientific Research (NWO), the Ministry of Health, Welfare and Sport, the Municipal Health Service for the Rotterdam area, and the Stichting Trombosedienst and Artsenlaboratorium Rijnmond. Great Smoky Mountains Study cohort: The Great Smoky Mountains Study has been funded by various NIH Institutes over the past 25 years. International Multi-centre ADHD Gene (IMAGE)-UK/Sibling EEG Follow-up Study cohort: this project was supported by generous grants from Action Medical Research and the Peter Sowerby Charitable Foundation (GN1777 awarded to JK). Initial sample recruitment of the ADHD sample was supported by NIMH (R01MH062873 awarded to SVF). The recruitment of the control sample and initial cognitive assessments of ADHD and control groups were supported by the MRC (G0300189 awarded to JK). Infancia y Medio Ambiente (Environment and Childhood) cohort: this study was funded by grants from Instituto de Salud Carlos III (Red INMA G03/176, CB06/02/0041, PI041436, PI04/2018, PI081151 including European Regional Development Fund [ERDF] funds, PI09/02311 including ERDF funds, PI12/01890 including ERDF funds, CP13/00054 including ERDF funds, PI13/02429 including ERDF funds, PI15/00118 including ERDF funds, CP16/00128 including ERDF funds, PI16/00118 including ERDF funds, PI16/00261 including ERDF funds, PI17/01340 including ERDF funds, PI18/00547 including ERDF funds, PI18/00909 including ERDF funds, CP18/00018 including ERDF funds), Miguel Servet (CPII19/00015), the Center for Biomedical Research in Epidemiology and Public Health Network, Fundación Cajastur, Universidad de Oviedo, Generalitat de Catalunya CIRIT (1999SGR 00241), Generalitat de Catalunya AGAUR (2009 SGR 501, 2014 SGR 822), Fundació La Marató de TV3 (090430), the Spanish Ministry of Economy and Competitiveness (SAF2012-32991 including ERDF funds), Agence Nationale de Securité Sanitaire de l'Alimentation, de l'Environnement et du Travail (1262C0010; EST-2016 RF-21), the EU Commission (261357, 308333, 603794, 634453), and Margarita Salas (MS21-125), and co-funded by the European Union: NextGenerationEU. We acknowledge support from the grant CEX2018-000806-S funded by MCIN/AEI/10.13039/501100011033, and support from the Generalitat de Catalunya through the CERCA programme. Longitudinal Assessment of Manic Symptoms (LAMS) cohort: the LAMS study was supported by NIH (R01MH073967, R01MH073801, R01MH73953, and R01MH073816). The LAMS Group includes EAY, MAF, LEA, BB, RLF, and Sarah M Horwitz, as well as principal investigators for performance sites and coinvestigators on the Steering and Publication Committee for the LAMS Consortium. Lillehammer Neurodevelopmental Follow-Up Study cohort: this research was supported by the Innlandet Hospital Trust (150663, 150610, 150624, 150616, 150186), the South-Eastern Norway Regional Health Authority (150663), and the Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Department of Rare Disorders and Disabilities, Oslo University Hospital (150616, 150182). Longitudinal Study of Urban Youth cohort: this research was funded by NIH (R01MH046448 and R01MH060698, principal investigator JMH). Masi cohort: GM and PM were supported by a grant from the Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Stella Maris (Ricerca Corrente) and by the “5*1000” voluntary contributions (Italian Ministry of Health). Millennium Cohort Study: we are grateful to the Centre for Longitudinal Studies, University College London Social Research Institute for the use of these data, and to the UK Data Service for making them available. However, neither the Centre for Longitudinal Studies nor the UK Data Service bears any responsibility for the analysis or interpretation of these data. Minnesota Longitudinal Study of Risk and Adaptation cohort: this research was supported by grants from NIMH to Byron Egeland, L Alan Sroufe, and W Andrew Collins (R01-MH40864) and to JAS (R01-MH49599); a National Institute for Child Health and Human Development grant to W Andrew Collins, Byron Egeland, and L Alan Sroufe (R01-HD054850); and a National Institute on Aging grant to JAS (R01-AG039453). NeuroIMAGE cohort: funding support for the IMAGE project was provided by NIH (R01MH62873, R01MH081803 awarded to SVF). The follow-up and extension studies of the NeuroIMAGE project were supported by an NWO Large Investment Grant (1750102007010) and an NWO Brain & Cognition: an Integrated Approach grant (433-09-242 awarded to Jan K Buitelaar), and grants from Radboud University Nijmegen Medical Center, University Medical Center Groningen and Accare, Vrije Universiteit Amsterdam, and the European College of Neuropsychopharmacology Network ADHD across the lifespan. Netherlands Twin Registry cohort: “Genotype/phenotype database for behavior genetic and genetic epidemiological studies” (ZonMw Middelgroot 911-09-032); “Why some children thrive” (OCW_Gravity programme NWO-024.001.003); “The impact of parental genes on offspring health: nurture via nature” (NWO-Hestia: VidW.1154.19.013); “Netherlands Twin Registry Repository: researching the interplay between genome and environment” (NWO-Groot 480-15-001/674); “Genetics of mental illness” (European Research Council Advanced 230374). New York State cohort: this research was supported by NIH (R01DA016979, R01MH018579) and the Scientific and Technological Research Council Of Turkey (1059B192101153). Otago cohort: data collection was funded by grants from Lottery Health Research, the Health Research Council, the New Zealand Neurological Foundation, and the University of Otago. Pelotas cohort: the 2004 Pelotas Birth Cohort was conducted by the Postgraduate Program in Epidemiology at Universidade Federal de Pelotas, with the collaboration of the Brazilian Public Health Association (ABRASCO). It was supported by the Wellcome Trust from 2009 to 2013, WHO, the National Support Program for Centers of Excellence, the Brazilian National Research Council, the Brazilian Ministry of Health, and Children's Pastorate. Preschool Depression Study cohort: funded by grants R01 5R01MH090786 and K23 MH118426. Pittsburgh Girls Study cohort: the Pittsburgh Girls Study was supported by NIH (MH056630, Loeber). Queens College Preschool Project cohort: the project was supported by NIMH (R01 MH68286; principal investigator JMH). Quebec Newborn Twin Study: The authors are grateful to the children and parents, and to the participating teachers and schools of the Quebec Newborn Twins Study. Special thanks to Jocelyn Malo, Marie-Élyse Bertrand, and Anaëlle Fradette for coordinating the data collections over the years, and to Hélène Paradis, Alain Girard, and Bei Feng for data management and analysis. The Quebec Newborn Twins Study was supported by multiple grants from the Fonds de recherche du Québec—Société et Culture, Fonds de recherche du Québec—Santé, the Social Science and Humanities Research Council of Canada, the Canadian Institutes for Health Research, the National Health Research Development Program, St Justine Hospital's Research Center, Université Laval, and Université du Québec à Montréal (principal investigators: MB, Mara Brendgen, Ginette Dionne, Isabelle Ouellet-Morin, and Frank Vitaro). MB and Isabelle Ouellet-Morin are supported by the Canada Research Chair programme. Study of ADHD, Genes and Environment cohort: this research was supported by funding from the Wellcome Trust (079711), MRC (MR/L010305/1), and the Wolfson Foundation. Stony Brook Temperament Study cohort: this study was supported by NIMH (R01 MH069942; principal investigator DNK). Trajectoires Epidémiologiques en Population cohort: the Trajectoires Epidémiologiques en Population cohort received funding from the French National Research Agency, including the Flash COVID-19 funding scheme; the French Institute for Public Health Research-IReSP (TGIR Cohortes); the French Inter-departmental Mission for the Fight against Drugs and Drug Addiction; the French Institute of Cancer; and the Pfizer Foundation. EFFECT-1: a longitudinal study of the role of the early family environment in the development of cognitive self-regulation. This project was funded by The Swedish Research Council (421-2012-1222; grant awarded to KCB) and the Centre for Women's Mental Health during the Reproductive Lifespan (UFV 2021/1318). Funding support for the IMAGE project was provided by NIH (R01MH62873 and R01MH081803, awarded to SVF). The second follow-up study of the NeuroIMAGE project was supported by an NWO Large Investment Grant (1750102007010) and NWO Brain and Cognition: an Integrative Approach grant (433-09-242, awarded to Jan K Buitelaar); and financial support from Radboud University Nijmegen Medical Center, University Medical Center Groningen and Accare, and Vrije Universiteit Amsterdam. Val-IMAGE: The follow-up and extension studies of the Val-IMAGE project were supported by Generalitat Valenciana (AICO/2018/198). Victorian Infant Brain Studies cohort: this research was supported by the NHMRC (237117, 491209, 1066555; Centre for Research Excellence in Newborn Medicine 1153176; Senior Research Fellowship 1081288; Leadership Fellowship 1176077) and the Victorian Government's Operational Infrastructure Support Program. Publisher Copyright: © 2023 The Authors. Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

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Local EPrints ID: 483665
URI: http://eprints.soton.ac.uk/id/eprint/483665
ISSN: 2215-0366
PURE UUID: 8a4cf7ab-f1d8-459a-b3ea-1bcd7d5aaafa
ORCID for Miguel Garcia Argibay: ORCID iD orcid.org/0000-0002-4811-2330
ORCID for Samuele Cortese: ORCID iD orcid.org/0000-0001-5877-8075

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Date deposited: 03 Nov 2023 17:44
Last modified: 10 Apr 2024 04:02

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Author: Corentin Gosling
Author: Serge Caparos
Author: Charlotte Pinabiaux
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Author: Eric Youngstrom
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Author: Richard Delorme
Author: Samuele Cortese ORCID iD

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