AD/HD and younger students

I'm really mad. USA Today published a story that the youngest kids in a grade are frequently misdiagnosed with AD/HD and it is all over the news.  What's making me angry is hearing respected MDs speak of holding young for grade children back as a means of lowering the number of misdiagnosed children.  REALLY? 

As a psychologist specializing in learning challenges, I have some questions:

• Are educators and pediatricians making sure that children are put in age appropriate situations at school? 
• If evaluations are necessary, are they conducted by licensed professionals who base diagnoses on symptom profiles with age appropriate behaviors in mind?  

Teachers do not have the knowledge, expertise, or right to diagnose children with behavior disorders. They are invaluable contributors to the evaluation process. Children spend up to 6-hours of waking time per day at school. Every evaluation for issues occurring at school include at least one observation of the child at school as well as interviews with the teachers and all other professionals that interact with the child at school.  

They know our kids well and their observations should be respected.

BUT, symptoms for AD/HD must be present in multiple settings for the diagnosis to even be considered. So teacher concerns are not enough.

• Do parents, teachers and pediatricians expect and accept that the younger children will behave differently than the older children when classrooms serve children with a likely age range of 15-18 months?
• Are they aware that children with learning disabilities, anxiety, depression, and AD/HD often demonstrate the same symptoms and until those symptoms are identified, picked-apart, and studied systematically, it is not possible to make an accurate diagnosis? 

Kindergarten is not only about academics; teaching social skills is an important aspect of the curriculum. Consider if the children that are old for Kindergarten  are creating this mis-diagnosis problem – their behaviors are not necessarily grade appropriate if they are overly mature. 

There will always be a youngest child in every class.  The problem is the age range in classes has become huge and expectations are inconsistent and often inappropriate.  Rather than simply stating a date by which a child is allowed to start Kindergarten, states need to add a date by which children MUST start Kindergarten (particularly difficult given that many states do not require that children attend Kindergarten at all) so that the age range is restricted. 

Look at the research – the young for grade children do fine.  In fact, students from all places in the age range do fine. In later years, old for grade students disproportionately act out. They are bigger, stronger, have access to the car keys, and can write their own notes to leave high school whenever they want (and the school can’t share that information with the parents because the student is a legal adult). 

Finally, most of these articles also fail to note that “red shirting” Kindergarteners is only a phenomena in affluent communities.  Are well off children really that much less ready for Kindergarten than their poorer peers and if so, why?