Average score for ADHD symptom ratings on the Disruptive Behavior Disorders rating scale Average score ranges from 0.0 to 3.0 with higher scores indicating greater impairment.
Teacher rating of academic productivity. Average scores range from 1.0 to 5.0 with lower scores indicating academic underperformance.
Fall (Baseline)
Group
Value
95% CI
School as Usual
3.51
± .83
Immediate Relative Age Effect Intervention
3.22
± .97
Delayed Relative Age Effect Intervention
3.36
± .97
Winter
Group
Value
95% CI
School as Usual
3.17
± .55
Immediate Relative Age Effect Intervention
3.36
± .83
Delayed Relative Age Effect Intervention
3.34
± .94
Spring
Group
Value
95% CI
School as Usual
3.15
± 1.03
Immediate Relative Age Effect Intervention
3.5
± .81
Delayed Relative Age Effect Intervention
3.49
± .84
First Grade Follow-up (Fall)
Group
Value
95% CI
School as Usual
3.7
± .87
Immediate Relative Age Effect Intervention
3.49
± .8
Delayed Relative Age Effect Intervention
3.01
± 1.09
Number of Children Who Were Referred to Special EducationSecondary· Collected at the end of the kindergarten school year, approximately 10 months from the start of study procedures.
Dichotomous parent rating of yes or no for referral for special education at the end of kindergarten
Group
Value
95% CI
School as Usual
1
Immediate Relative Age Effect Intervention
2
Delayed Relative Age Effect Intervention
3
Number of Children Who Were Prescribed Stimulant MedicationSecondary· Collected at the end of the kindergarten school year, approximately 10 months from the start of study procedures.
Dichotomous parent rating of yes or no for initiation of stimulant medication at the end of kindergarten
Group
Value
95% CI
School as Usual
0
Immediate Relative Age Effect Intervention
0
Delayed Relative Age Effect Intervention
2
Number of Children Who Were Retained in KindergartenSecondary· Collected at the end of the kindergarten school year, approximately 10 months from the start of study procedures.
Dichotomous parent rating of yes or no for retained in kindergarten at the end of kindergarten
Group
Value
95% CI
School as Usual
0
Immediate Relative Age Effect Intervention
3
Delayed Relative Age Effect Intervention
0
Sponsor's own description
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. This situation, termed the "Relative Age Effect"has potentially serious consequences for kindergarten children (e.g., greater likelihood of being prescribed psychoactive medication to control behavior).
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. Anticipated benefits include attenuation of any negative effects for children who receive intervention, and risks include breach of confidentiality and worsening of symptoms initially if an intervention is instituted. The knowledge to be gained is important as it could reduce untoward outcomes for the relatively youngest children in the grade.
Publications & conference data
No peer-reviewed publications indexed yet for this trial. Completed trials usually publish results within 12-18 months.
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Sponsor: as reported to ClinicalTrials.gov by Florida International University
Last refreshed: 19 November 2025
Drug Landscape aggregates and links these public records for informational use only. Always verify against the primary source before clinical or regulatory decisions. Canonical URL: https://druglandscape.com/trial/NCT05142826.