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

The prevalence of attention-deficit/hyperactivity disorder (ADHD) among children in the United States has doubled since the 1970s.¹ Possible reasons include changes in diagnostic criteria and epidemiological methods, shifts in national policy regarding disability and special education, marketing of ADHD medications by the pharmaceutical industry, and secular trends such as the effect of electronic media.

Increasing academic demands on young children can also affect the diagnosis of ADHD. For example, beginning kindergarten a year early, for example, doubles the chance that a child will receive medications for behavioral issues.² We hypothesized that increased academic demands since the 1970s have contributed to the rise in ADHD.

We searched educational and public policy literature for studies documenting time children spent on academic activities in the United States since 1970. We used these sources to estimate changes in academic demands on young children.

From 1981 to 1997, time spent on academic activities increased substantially for young children (Figure 1).³ The percentage of 9-year-old children reporting having any homework the previous day also increased.⁴ As homework and reading activities increased, time for playing and leisure activity decreased.³

Preschool children showed even greater evidence of increased academic activity. From 1981 to 1997, time spent reading for children ages 3 years to 5 years tripled from 29 minutes to 84 minutes per week.³ From 1993 to 2005, the percentage of family members reporting that they frequently taught 3- to 5-year-old children letters, words, or numbers increased from 58% to 77%.⁵ In the late 20th century, 3-year-old and 4-year-old children also spent more time in formal out-of-home programs (Figure 2).⁶ The percentage of young children enrolled in full-day programs increased from 17% in 1970 to 58% in the mid-2000s.⁶

We found evidence of increased academic demands on very young children that coincides with the increase in prevalence of ADHD, although this does not prove causality. Furthermore, early-prevalence studies of ADHD did not report rates among very young children, so we cannot conclude that the decades-long increase is primarily among children younger than 6 years old.

The studies we used were not designed to test our hypothesis and thus do not provide direct evidence of changes in academic activity. Nonetheless, the variety of sources and consistency of our findings provide confidence that there has been a substantial increase since the 1970s.

It is not surprising that increased academic demands would lead to the diagnosis of ADHD. Although it is a neurobiological condition with genetic causes, ADHD is defined by behaviors that are age dependent, related to the demands of the environment, and occur on a spectrum of typical behavior of children. Diagnosis is based primarily on teacher and caregiver reports, which should be influenced by expectations for behavior. As young children face increased academic demands, some will be seen as outliers and will be diagnosed as having ADHD.

Debates on how best to educate young children should be based on available research. Our work suggests that increased academic demands have adversely affected a significant portion of young children. More research is needed to explore the neurobiological and environmental causes of ADHD.

Corresponding Author: Jeffrey P. Brosco, MD, PhD, Mailman Center for Child Development, University of Miami, Miami, FL 33101 (jbrosco@miami.edu).

Published Online: February 22, 2016. doi:10.1001/jamapediatrics.2015.4132.

Author Contributions: Drs Brosco and Bona had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: All authors.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Bona.

Critical revision of the manuscript for important intellectual content: Brosco.

Administrative, technical, or material support: Brosco.

Study supervision: Brosco.

Conflict of Interest Disclosures: None reported.