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Should Relative-Age Adjustment Reduce Overdiagnosis? 

Posted
Updated
ByMy Patient Advice
Author: Avery Lombardi, MSc | Reviewed by: Dr. Rebecca Fernandez, MBBS

Yes, relative-age ADHD overdiagnosis is a growing concern, particularly in school settings where children born just before the school entry cutoff may be mistakenly diagnosed with ADHD. School entry age plays a significant role in how children are assessed, as younger children in a class often exhibit more developmental immaturity compared to their older peers. This gap can lead to misinterpretation of their behaviour as ADHD symptoms, when they may simply be struggling with age-related challenges. 

Relative-age ADHD overdiagnosis involves considering a child’s age in relation to their classmates when assessing behavioural concerns. By adjusting for the differences in maturity between the youngest in class and oldest children in a class, we can reduce the risk of overdiagnosis and ensure that only those who truly meet the criteria for ADHD receive a diagnosis. 

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Why Adjusting for Relative-Age Matters 

Here’s why relative-age adjustment could help reduce ADHD overdiagnosis: 

Developmental differences  

Younger children may have more difficulty focusing or sitting still, which could be misinterpreted as ADHD. 

Academic pressure  

Children who are younger than their classmates may struggle more with academic expectations, leading to higher referrals for ADHD assessment. 

Fairer evaluations  

Considering a child’s relative age ensures that behavioural issues are assessed in context, preventing unnecessary diagnoses and interventions. 

In conclusion, education policy should reflect these developmental differences to help reduce unnecessary ADHD diagnoses in younger children. A fairer approach to assessment can lead to more accurate diagnosis and better support for children. 

Visit providers like ADHD Certify for personal consultations and expert guidance tailored to your unique situation. 

For a deeper dive into the science, diagnosis, and full treatment landscape, read our complete guide to Overdiagnosis vs. Underdiagnosis in ADHD.  

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Avery Lombardi, MSc
Author

Avery Lombardi is a clinical psychologist with a Master’s in Clinical Psychology and a Bachelor’s in Psychology. She has professional experience in psychological assessment, evidence-based therapy, and research, working with both child and adult populations. Avery has provided clinical services in hospital, educational, and community settings, delivering interventions such as CBT, DBT, and tailored treatment plans for conditions including anxiety, depression, and developmental disorders. She has also contributed to research on self-stigma, self-esteem, and medication adherence in psychotic patients, and has created educational content on ADHD, treatment options, and daily coping strategies.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the author's privacy. 

Dr. Rebecca Fernandez, MBBS
Reviewer

Dr. Rebecca Fernandez is a UK-trained physician with an MBBS and experience in general surgery, cardiology, internal medicine, gynecology, intensive care, and emergency medicine. She has managed critically ill patients, stabilised acute trauma cases, and provided comprehensive inpatient and outpatient care. In psychiatry, Dr. Fernandez has worked with psychotic, mood, anxiety, and substance use disorders, applying evidence-based approaches such as CBT, ACT, and mindfulness-based therapies. Her skills span patient assessment, treatment planning, and the integration of digital health solutions to support mental well-being.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the reviewer's privacy. 

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