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:

Peer effects and mental health promotion in schools

Congratulations to Professor Goodman and colleagues (1)on an
excellent demonstration of the way that small effects at an individual
level can create significant opportunities at the population level for
public health interventions. It is possible, as they suggest, that it is
the differential behaviour of teachers towards slightly younger pupils in
the classroom that increases their risk of developing mental health
problems. However, there are other players learning their parts in the
classroom drama: the older children. As professionals and adults it is
easy for us to neglect the longterm impact of early social adversity (2)
but patterns of bullying and sexual aggression can undermine mental
wellbeing in the school age population. At five, if there are going to be
targets for classroom bullying, the younger (smaller, less articulate,
less assertive) child may be at greatest risk. At eleven-plus, the young
people who reach puberty first may show aggression towards their less
developed classmates. Most children do not experience trauma during "the
best years of their lives", but for some The Lord of the Flies can be
closer to their experience of schooldays. Where young people do become
trapped in harmful social situations, it is possible that quite subtle
differences in age and development could increase the risks. However,
this growing knowledge base (1) around child development and life
trajectories could also improve our interventions to promote mental

1 Goodman R, Gledhill J, Ford T. Child psychiatric disorder and
relative age within school year: cross sectional survey of large
population sample. BMJ 2003; 327: 472-475.

2 Caan W. Good for mental health - an academy for the social
sciences. Journal of Mental Health 2000; 9: 117-119.

Competing interests:  
Chair of the School Health Research Group, 2001-2003

Competing interests: No competing interests

30 August 2003
Woody Caan
Professor of Public Health
Department of public and family health, APU, Chelmsford, Essex CM1 1SQ.