# Development of strategies to reduce the impact of the relative age effect on kindergarteners with ADHD

> **NIH NIH R34** · FLORIDA INTERNATIONAL UNIVERSITY · 2020 · $680,143

## Abstract

PROJECT SUMMARY
 Attention-deficit/hyperactivity disorder (ADHD) is a chronic condition, present from early childhood,
which persists throughout the lifecourse. There is now clear evidence that children entering kindergarten, that
are relatively young for the grade (e.g., born in the months immediately preceding the school entry cut-off) are
at significantly more risk for receiving an ADHD diagnosis and being prescribed stimulant medication. These
risks appear to be related solely to age of entry when other explanatory variables are controlled (Elder, 2010).
This situation, termed the “Relative Age Effect” in this literature has potentially serious consequences for
kindergarten children (e.g., greater likelihood of being prescribed psychoactive medication to control behavior;
Elder, 2010).
 The present proposal aims to develop a teacher intervention to attenuate the impact of the relative age
effect on young kindergarteners with elevated ADHD symptoms, and test the correspondence between the
hypothesized mechanisms and treatment outcomes related to ADHD (e.g., symptoms, impairment). Following
intervention development and refinement, 60 children entering kindergarten in the fall, and young for the grade,
will be randomly assigned to (1) Kindergarten as Usual (KAU); (2) a Relative Age Effect prevention intervention
administered immediately; or (3) a Relative Age Effect prevention intervention administered mid-year. In the
intervention groups, teachers will be introduced to the relative age effect, receive information on how to anchor
behavioral ratings in developmental norms, and implement a positive behavioral support to support growth in
the child across the kindergarten school year.
 Primary aims will be to demonstrate the feasibility and acceptability of the intervention approach as well
as the ability of the team to retain young children in a longitudinal trial. Further, the hypothesized mechanisms
(e.g., improved neurocognitive functioning; improved teacher use of positive behavioral supports) will be
measured and correspondence to hypothesized outcomes (e.g., reduced ADHD symptoms and impairment)
will be evaluated. Data collected will be used to justify a larger efficacy-based trial to support the positive
development of children with ADHD during this critical developmental transition.

## Key facts

- **NIH application ID:** 10057011
- **Project number:** 1R34MH122212-01A1
- **Recipient organization:** FLORIDA INTERNATIONAL UNIVERSITY
- **Principal Investigator:** GREGORY A FABIANO
- **Activity code:** R34 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $680,143
- **Award type:** 1
- **Project period:** 2020-08-01 → 2025-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10057011

## Citation

> US National Institutes of Health, RePORTER application 10057011, Development of strategies to reduce the impact of the relative age effect on kindergarteners with ADHD (1R34MH122212-01A1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10057011. Licensed CC0.

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