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:

Importance of preterm birth

The article by Goodman et al. does not mention the main clinical
issue that clinicians meet regarding children born just before the
watershed of the school year.

When they are born with a gestational age below 32 weeks, they carry
compounded risks of developing psychiatric disorders. One source of risk
is that childhood and adult mental health illness is associated with some
of the same neuro-developmental factors that cause preterm birth. A second
source of risk is that when these biologically immature children enter
school they are allocated to the previous school year not just for a few
weeks or months of difference, but it may be up to 16 months. Finally, the
interaction of environmental (parents) expectations with a child
biologically at risk may become quite complex, depending on a number of
family variables. We are talking of all children born in August and due by
December in the UK and children born preterm at Christmas time in Sweden,
Italy and elsewhere. It is a small percentage in the general population
but it is likely that they are overrepresented in child mental health and
learning disability services.

It is then plausible that if the published study had taken into
account preterm births, stronger correlations could have been found for
this subgroup. On a total population, individual pupils and schools
variability may have shadowed the point that the study could have
contributed to make more clearly.

What the article says, in my view, is that children should be
considered for their individual developmental maturity, rather than be
expected to conform to one-size-fits-all educational policies.
Chronological age is just a proxy measure of biological age. Developmental
issues may not be tackled by administrative shortcuts. Obviously the
latter can help, especially when the role of cognitive aspects (not
directly observable) are overshadowed by behavioural and emotional
manifestations (speaking by themselves).

Competing interests:  
None declared

Competing interests: No competing interests

02 September 2003
Stefano Palazzi
Consultant Child and Adolescent Psychiatrist
South-Essex Partnership NHS Trust, Great Oaks, Basildon SS14 1EH