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:

Relative age suggests a transactional process

The authors data suggests that the relative age effect is more
apparent for teacher than parent ratings.This would imply a situational
factor in play.

As Prof. Caan points out in his response,the impact of a
constitutional vulnerability such as shyness &/or learning disability
transacting with ordinal position within the class would help define a
"target" population more vulnerable to the negative attention of a
proportion of the older cohort, some of whom will be bullies.

There is no empirical evidence that simply delaying school entry or
repeating the year will address these "relative age" effects.

Clinical experience demonstrates that the solutions for an individual
child will depend on many "bio-psycho-social" factors.

The reduced opportunities for segregated classes for some vulnerable
children have been evident in my practice in recent years.

Whilst the authors present a range of solutions to address the
relative age effect, I think we need to better understand the different
patterns of psychopathology which are not readily visible in the data as
presented. This might suggest different psychopathological mechanisms in
different sub-groups of this large data set.

Laurence Jerome

Competing interests:  
None declared

Competing interests: No competing interests

02 September 2003
Laurence Jerome
Consultant Psychiatrist
Amethyst Demonstration School