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Medline ® Abstract for Reference 90

of 'School readiness for children in the United States'

Child psychiatric disorder and relative age within school year: cross sectional survey of large population sample.
Goodman R, Gledhill J, Ford T
BMJ. 2003;327(7413):472.
OBJECTIVE: To test the hypothesis that younger children in a school year are at greater risk of emotional and behavioural problems.
DESIGN: Cross sectional survey.
SETTING: Community sample from England, Scotland, and Wales.
PARTICIPANTS: 10 438 British 5-15 year olds.
MAIN OUTCOME MEASURES: Total symptom scores on psychopathology questionnaires completed by parents, teachers, and 11-15 year olds; psychiatric diagnoses based on a clinical review of detailed interview data.
RESULTS: Younger children in a school year were significantly more likely to have higher symptom scores and psychiatric disorder. The adjusted regression coefficients for relative age were 0.51 (95% confidence interval 0.36 to 0.65, P<0.0001) according to teacher report and 0.35 (0.23 to 0.47, P = 0.0001) for parental report. The adjusted odds ratio for psychiatric diagnoses for decreasing relative age was 1.14 (1.03 to 1.25, P = 0.009). The effect was evident across different measures, raters, and age bands. Cross national comparisons supported a "relative age" explanation based on the disadvantages of immaturity rather than a "season of birth" explanation based on seasonal variation in biological risk.
CONCLUSIONS: The younger children in a school year are at slightly greater psychiatric risk than older children. Increased awareness by teachers of the relative age of their pupils and a more flexible approach to children's progression through school might reduce the number of children with impairing psychiatric disorders in the general population.
Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's College London, London SE5 8AF. r.goodman@iop.kcl.ac.uk