Michael Bloch, MD, MS: How astrological signs may be associated with risks for ADHD

December 01, 2020

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Associate Professor in the Child Study Center; Associate Director, Albert J. Solnit Integrated Training Program, Child Study Center; Co-Director of the Tic and OCD Program, Child Study Center

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00:00I am Michael block.
00:02I'm associate professor in
00:03the Child study center.
00:05I was also a resident in the
00:08solar Program from 2004 to two,
00:102010 and now the associate
00:12Program Director of that program.
00:14Today I'm going to be trying to
00:17convince you that your astrological
00:19sign is associated with your
00:21risk for ADHD specifically,
00:23will be talking bout a meta analysis
00:26looking at the risk of 80 HD as
00:30a function of your birth date.
00:32So this is work that I've done with
00:35Jose Flores who's a resident in the
00:38adult psychiatry programs also work
00:41closely with the Child Study Center
00:43through the T 32 and we're going to
00:46be talking about ADHD and 80 HD is
00:49a child onset psychiatric disorder
00:51characterized by both inattention,
00:53hyperactivity,
00:54and impulsive iti that has
00:56an on set priority age,
00:5812 years and in affects hidden causes,
01:01symptoms in multiple settings.
01:03Home, school and or work and
01:06causes significant impairments.
01:07Also ADHD is quite heritable disorder,
01:10so it has a high degree of heritability
01:13as compared to other psychiatric
01:16disorders similar to autism.
01:18Schizophrenia, bipolar disorder.
01:20Much higher than depression or anxiety.
01:23When you look at a twin studies
01:26or molecular data.
01:28Also,
01:28there's a pretty clear brain
01:31signature associated with those CD.
01:33That is,
01:34with 80HD,
01:35that is that ADHD is associated with
01:38delayed development of the prefrontal
01:40brain regions that are involved in
01:43cognitive control processes involved
01:45in sustained attention and motor planning.
01:50So I'm going to be talking a
01:52little bit about my family,
01:55so this is a picture of my wife,
01:58Angie,
01:58and our three kids going from left to right,
02:01Sam, Paul, and Rachel.
02:03And this is a picture in Paul and Sam's
02:07and Rachel's kindergarten room at the
02:09Child Care Center at Bodel here at Yale.
02:12And Paul will be talking bout now
02:15is now bout to turn 8 years old.
02:18His birthday pretty soon he plans
02:20to have a YouTube channel where
02:22he where he plans to be a star.
02:25He doesn't know quite what he's
02:27gonna do on on his YouTube channel
02:29yet but he really likes to race
02:32Matchbox cars in my monster trucks.
02:34Watch Minecraft videos on YouTube and
02:36also really likes unboxing presence,
02:38so maybe he's I think he's hoping to
02:42have a career in that at this point.
02:45So a couple of years ago.
02:50Is the scene was very different
02:52in this kindergarten classroom,
02:53so both Sam and Paul were in kindergarten
02:56at Bloedel and I remember when I
02:58picked up all one day from kindergarten,
03:01he said I'm not as smart
03:03as all the other kids.
03:05I can't do what what they can do and and
03:08actually his experience was probably
03:10pretty accurate in that classroom.
03:13He was one thing you don't
03:15know about Paul and Sam,
03:17yet is that their birthday was right at
03:20the end of the calendar year in 2012,
03:23so they so they were born on December 13th,
03:272012.
03:27So it did day after 1212.
03:29Twelve. That was hoping for and a
03:32little before the Mayan Apocalypse,
03:34which was twelve 2112 chairs.
03:36Also hoping for, but like you don't
03:39know and relevant to this potentially
03:41is that the cut off date for.
03:44Kindergarten and grades in school in
03:47Connecticut is actually January 1st,
03:49so both Paul and Sam were extremely young
03:52for their for their grade in school when
03:56they were starting out in kindergarten.
03:59And so their experience that they were,
04:02you know Paul's experience that he was
04:04behind all the other kids may actually
04:06be accurate and true at that age Ann.
04:09And So what we were really interested
04:11in a lot of and similarly a lot of
04:14patients that I come across in clinic.
04:17They get evaluated for 80 HD and they
04:20are often kind of really young for
04:22their age for their grade and young.
04:25And so the question is,
04:26is birthday to actually associated
04:28with the risk of.
04:30Of being diagnosed,
04:31you're treated for ADHD and we
04:33actually did a meta analysis.
04:35Jose and I involving 14 studies that
04:38were actually involved more than 3
04:41million children across nine countries.
04:43Looking at is there Association
04:45between birthdate and risk of ADHD.
04:47And is it related to the school cut off date?
04:51You know, in schools?
04:53And so when you look at risk of
04:57ADHD being diagnosed or treated by
05:00by birth month in school districts
05:03that have a January cut off,
05:06you see that there's a.
05:08There's an increasing risk of being
05:11diagnosed or treated for ADHD.
05:13As you get later in the calendar year.
05:17So as as when you're younger for your grade,
05:21so the largest odds ratios.
05:24For risk of 80 HD is in October,
05:27not November.
05:27The seven December,
05:29right before the January cut off,
05:31and it's the least in January,
05:33February, March,
05:34right after the January cut off.
05:36And if you look similarly in
05:38studies where the cut off for
05:40school district is September 1st,
05:42you see a very similar trend.
05:45I'll be it offset by four months for
05:48the different cut off date and then
05:50you see the highest risk of ADHD
05:53occurring in kids that are born.
05:55In August, July,
05:57June,
05:57right before the that our youngest for their
06:01school grade and you see the lowest risk
06:04of being diagnosed or treated for ADHD,
06:07being right after the school
06:10cut off date September October,
06:12November, December.
06:14And not surprisingly,
06:16when you overlay these two possible.
06:21Patterns for school cut off dates and
06:24you line them based on cut off date.
06:27You see a very similar pattern where
06:29kids are most likely to be diagnosed
06:32with ADHD and have an odds ratio
06:35of about 1.2 in the in the month.
06:37Birth month right before the school
06:39cut off and have the least risk in
06:42the month after the school cut off.
06:46Furthermore, another way of
06:48looking at this is based on your
06:51likelihood of being diagnosed with
06:53ADHD or being treated for ADHD.
06:56If you were born 120 days,
06:59so the four months before this school
07:02cut off first is 120 days after
07:05the school cut off and you see the
07:09odds of being diagnosed with ADHD,
07:12the odds ratio is about one point 1.38.
07:15If you were born in the 120
07:18days before the school,
07:19cut off rather than 120
07:21days after the school,
07:23cut off date and so that's associated with.
07:26So being younger is associated with a
07:30fairly substantial increase risk of ADHD.
07:32And if you look at this heat map,
07:35which looks at how the odds ratio
07:38depends on when you set the the
07:40interval time before and after you
07:42see that the closer the interval
07:44time is to the cut off date,
07:47the higher the odds ratio of 80 HD.
07:50So if you're born in the 30 days
07:52before the school cut off compared
07:54to 30 days after the odds ratios
07:57approximated to be about 1.5,
07:59meaning that you're about 50%,
08:01you have about a 50%.
08:03Higher likelihood of being
08:05diagnosed with ADHD.
08:06If you were born in the month
08:09before the school cut off date
08:12as opposed to the month after.
08:15And into the bottom line is hopefully
08:18first of all that I convinced you that.
08:21Your astral astrological sign is
08:24associated with your risk for ADHD,
08:26but that the month of your birth is
08:30strongly associated with your risk of
08:32being diagnosed and treated for ADHD.
08:35And this then the relationship is really
08:38defined by the school entrance cut
08:40off for the particular location you lived in.
08:44There's evidence that the affect
08:46re creases with increasing age,
08:48in that the odds ratio for treatment.
08:51But not diagnosis gets less as
08:53the kids get older so that this
08:56affect someone goes away as kids
08:58get further advanced in school.
09:00It's also clear that the effect
09:02is fairly substantial if you look
09:05at the the four months prior,
09:06the odds ratio is a little
09:09more than 1/3 higher,
09:10and if you estimate the month
09:12before it's about 50% higher,
09:14so this is quite a substantial risk,
09:16and I think this has significant
09:19implications for first of all,
09:20biological studies of children with ADHD.
09:23So that the important biological marker
09:25may not be your brain development compared
09:28to your actual chronological age,
09:31but it's what you're expected.
09:34Age is supposed to be in school.
09:37It also has profound implications for early
09:40childhood education and public policy,
09:43so Paul's doing great in school
09:45now we held both him and Sam back
09:49a year before they repeat repeated
09:51kindergarten at a different school.
09:54But then.
09:56That decision is significant
09:58financial implications,
09:59you know probably cost.
10:01I estimated about $36,000.
10:03The decision to have the kids stay
10:07at home for an extra year.
10:10It's actually probably much more
10:12than that and and clearly.
10:15Kids from more advantage
10:17households have more of an ability
10:19to delay the start of schooling
10:21and that may have significant
10:23effects over the long term.
10:26It also just emphasizes again the
10:28importance of school readiness
10:30programs that I was, you know,
10:32I was well aware of Paul and Sam being
10:35behind before they started kindergarten.
10:38This definitely affected how we treated
10:40them in school and probably part of
10:43the reason why they're doing well.
10:46So I wanted to thank you for
10:49listening and hope you come to you.