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Child psychiatric disorder and relative age within school year: cross sectional survey of large population sample

BMJ 2003; 327 doi: (Published 28 August 2003) Cite this as: BMJ 2003;327:472
  1. Robert Goodman, professor (r.goodman{at},
  2. Julia Gledhill, clinical research fellow2,
  3. Tamsin Ford, clinical research fellow1
  1. 1Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's College London, London SE5 8AF
  2. 2Child and Adolescent Psychiatry, Imperial College School of Medicine (St Mary's), London W2 1PG
  1. Correspondence to: R Goodman
  • Accepted 9 July 2003


Objective To test the hypothesis that younger children in a school year are at greater risk of emotional and behavioural problems.

DesignCross 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 and0.35 (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 acrossdifferent 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.


  • Contributors RG, JG, and TF all participated in the design, analysis, and writing up of this study. RG and TF were on the steering committee of the original survey. RG is guarantor of the study.

  • Funding The original survey was funded by the British Department of Health. JG and TF are currently supported by Wellcome Trust research training fellowships. The guarantor accepts full responsibility for the conduct of the study, had access to the data, and controlled the decision to publish.

  • Competing interests None declared

  • Ethical approval The ethical committee of the Institute of Psychiatry, King's College London approved the study.

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