Influence of the month of birth on persistence of ADHD in prospective studies: protocol for an individual patient data meta-analysis

Introduction: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder with symptoms, especially the hyperactive ones, that tend to decrease in severity with age. Interestingly, children born just before the school-entry cut-off date (ie, the youngest pupils of a classroom) are at higher risk of being diagnosed with ADHD compared with children born just after the cut-off date. Noteworthy, this month-of-birth effect tends to disappear with increasing absolute age. Therefore, it is possible that young children erroneously diagnosed with ADHD due to their month of birth present a lower chance to have their diagnosis confirmed at a later age, artificially reinforcing the low persistence of ADHD across the lifespan. This protocol outlines an individual patient data (IPD) meta-analysis of prospective observational studies to explore the role of the month of birth in the low persistence of ADHD across the lifespan.

Methods and analysis: Five databases will be systematically searched in order to find prospective observational studies where the presence of ADHD is assessed both at baseline and at a follow-up of at least 4 years. We will use a two-stage IPD meta-analytic approach to estimate the role of the month of birth in the persistence of ADHD. Various sensitivity analyses will be performed to assess the robustness of the results.

Ethics and dissemination: No additional data will be collected and no de-identified raw data will be used. Ethics approval is thus not required for the present study. Results of this IPD meta-analysis will be submitted for publication in a peer-reviewed journal.

Prospero registration number: CRD42020212650.