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The youngest children in each school cohort are over-represented in referrals to mental health services

Author: Erlend Berg

The youngest children in each school cohort are over-represented in referrals to mental health services

It is known that the children who are the youngest in their class tend to do worse, in several respects, than their classmates. On average, they do less well academically throughout their school careers and are less likely to attend university. They have also been found to be less confident in their academic ability and are more likely to report being bullied or unhappy at school, and they are less likely to participate in both youth and professional sports.

Given this, it is perhaps not surprising that these children are also more likely to have mental health problems: they are more likely to be diagnosed with attention disorders, learning disability and dyslexia.

Still, little is known about the consequences for health service provision, and in particular the extent to which these children are over-represented as users of specialist mental health services. In a paper forthcoming in the Journal of Clinical Psychiatry, Shipra Berg and Erlend Berg investigate whether August-born children, who are the youngest in their class in the English educational system, are over-represented in referrals to specialist Child and Adolescent Mental Health Services. The threshold for referral to these services is relatively high, since minor problems are often dealt with by school health workers or family doctors.

The research method is simple. The cut-off date for school entry in England is 1 September. So a child born in August will be among the youngest in his or her class, while a child born in September will be one of the oldest. The researchers obtained dates of birth for all children referred to mental health services in three boroughs of West London for a period of four years, and compared the frequency of birth months of the referred children to the birth-month frequencies in the population.

For example, children born in September represent 8.6% of the population but only 8.0% of referrals. Hence they are 7.3% less likely to be referred to mental health services than the average child.

For August-born children the situation is reversed. Of all children referred to mental health services, 9.4% were born in August. But only 8.6% of the population of children in the relevant age group are born in August. That means that August-born children are 9.1% more likely to be referred than the average child, and 17.8% more likely to be referred than their September-born classmates. These figures are statistically significant, meaning they are very unlikely to be caused by random fluctuations in the data.

When boys and girls are examined separately, the main findings are confirmed for both sexes.

Children in the UK start school at a particularly young age, so an age difference of one year is substantial. The September-born child, who starts school around her fifth birthday, has had a 25% longer life experience than the August-born child, who starts school around his fourth birthday. Clearly, a one-year age difference shrinks as a proportion of life experience as the children grow up. One might therefore expect that the negative effect of being the youngest wears off over time. However, the authors find that the main effect holds for children of both primary-school and secondary-school age. This could mean that being the youngest is detrimental even in secondary school, or alternatively that the disadvantage of being the youngest in primary school has lasting consequences.

It is, in principle, possible to defer a school start to the term (there are three terms per year) in which the child turns five. However, this is rarely practised, because the child would still join the same class they would have been in had entry not been deferred. Deferring entry can therefore mean falling behind in academic and social development even before starting school.

It is worth pointing out that a large majority of children born in August are not referred to mental health services. Other factors, including the children’s home environment, are likely to be more important determinants of mental health than month of birth. Still, August-born children, being the youngest – physically, emotionally and intellectually – in their class, may be more vulnerable than their older peers.

 

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