Intended for healthcare professionals

Rapid response to:


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

Rapid Response:

Holding Back May Cause More Harm

If the increased level of psychiatric stress found in the relatively
younger students is the result of inappropriate expectations on the part
of teachers or the absence of streaming students by ability, holding back
students may have no net beneficial effect. The held back student will
now become one of the older students in the class making all the other
students relatively younger than they were before and making them appear
of lower ability when compared to the new elevated average. This may
increase the stress on them, and result in no net gain in psychiatric well
-being. Indeed, some held back students may be resentful and increase
stress both in the held back student and in the classroom.

I would point out that at least in the United States, school systems
often have a conflict of interest on the holding back issue, since holding
a child back will very likely increase the number of years that child is
in that particular school system and, therefore, increase the amount of
government funding that school system will receive if there is a capitated
reimbursement system. Since I have personally witnessed students denied
early graduation for just this reason, I would not dismiss it too readily.

Students who are held back are injured in at least one way. They are
stuck in an extremely lengthy educational system one extra year and denied
one extra year of occupational income and freedom from schooling.

A sizeable number of American studies have found no psychological
harm associated with the grade acceleration of the more academically
capable students. Indeed, only one study detected any difference and it
found that gifted students who were not grade accelerated suffered more
psychological difficulties. I fear the BMJ study, with its simply remedy
of holding back, may be used by some less than perfect teachers to hold
back many students unnecessarily. While I applaud the study for better
documenting a problem, I would note that there is absolutely no research
showing that holding back on strictly psychiatric grounds helps any
student, let alone which students. Therefore, I am troubled by its
promotion in the article as a primary remedy. While I think there almost
certainly are psychiatric situations for holding back, we must remember
that harm is also possible.

Unfortunately, here in the U.S., there is often a very politically
correct hostility against streaming students by their abilities and
against grade acceleration. In view of the strong dysgenic effect of
college education on the more academically gifted around the world, we
need to find ways shorten the amount of time college bound students are
forced to spend in school, so that they may have more time to earn money
and have larger families than they currently do. I fear this article will
be used to increase resistance against grade acceleration and to hold
students back simply because they are "more immature," and not because
they have any increased psychiatric difficulties.

Obviously, my 13 year old daughter is more immature physically than
the other freshmen in her college classes, but that doesn't mean she would
have benefited from being held back.

Competing interests:  
None declared

Competing interests: No competing interests

29 August 2003
Thomas E. Radecki
Private practice psychiatrist
Urbana, IL 61801