COMMENTARY

Let Kids Be Kids: School Demands and ADHD

William T. Basco, Jr., MD, MS

Disclosures

June 23, 2016

Changes in Academic Demands and Attention-Deficit/Hyperactivity Disorder in Young Children

Brosco JP, Bona A
JAMA Pediatr. 2016;170:396-397

Study Summary

This research letter reviews recent literature on academic demands in young children. The authors hypothesized that increasing academic demands on children might contribute to the rise in the prevalence of attention-deficit/hyperactivity disorder (ADHD). This study evaluated published literature from 1970 onward to identify studies that documented the time children spend on both academic and leisure activities. They began by looking at the time children spent studying per week, dividing children into age groups of 3-5 years old, 6-8 years old, and 9-12 years old, as well as all children combined.

Since 1970, for all age subgroups, there was an increase in weekly time spent studying, but the difference was largely concentrated in the 6-8 years age group, whose weekly time spent studying more than doubled, from approximately 50 hours to approximately 125 hours. Other studies have demonstrated an inverse relationship between the time spent on academic activities each week and the time spent playing or in leisure activities each week. Time spent reading tripled in children aged 3-5 years, from approximately 30 minutes to approximately 1.5 hours each week. Of note, since 1970, the proportion of young children who participate in full-day preschool programs significantly increased, from 17% in 1972 to almost 60% by the mid-2000s.

This brief evaluation of the temporal relationship between time spent on academic activities and the epidemiologic increase in ADHD diagnoses can only show association, not causation. Competing hypotheses for the rise in ADHD include increased screen time and lower levels of physical activity.

Viewpoint

This article was primarily a review of the literature rather than a de novo study. Whether school demands are now bumping up against developmentally appropriate tasks for very young children has been a concern of mine since my own children were in preschool. When my wife began her teaching career, she taught first grade. I distinctly remember her saying to me that the primary goal of first grade was for a child "to learn to read." Admittedly, this conversation took place two decades ago, in another educational era, but anyone who has had a child go through early education recently knows that reading is now an expectation of most kindergartners, despite the tremendous variation in when 4- and 5-year-olds reach such developmental milestones as learning letters, numbers, and colors.

Although many children can indeed finish kindergarten knowing how to read, I remain very concerned that there is a lack of appreciation for the degree of variation that should be considered normal, and there is certainly a need to consider that classroom environments should be adjusted to accommodate the wide range of skills and abilities for preschool and early school-age children. In a similar vein, not every 5- or 6-year-old will want to follow the rigidity of full-day preschool or kindergarten, so we should always consider developmental stage when we are evaluating a child for ADHD.

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