Youngest in Class at Higher Risk of Mental Woes

Study finds no cause-and-effect relationship

(HealthDay is the new name for HealthScoutNews.)

THURSDAY, Aug. 28, 2003 (HealthDayNews) -- Being at the bottom of the class, at least in terms of age, puts a child at greater risk of developing psychiatric problems.

Or at least that's the conclusion of a study that looked at more than 10,000 British schoolchildren, which is published in the Aug. 30 issue of the British Medical Journal.

"This has been known for a while, that younger kids are usually a little more burdened or stressed," says Patricia Saunders, director of Graham Windham's Manhattan Mental Health Center in New York City. "It's nice to see it in a very large sample, and this was indeed a big sample."

Different experts at different times have proposed that "season of birth" (when a child is born) helps dictate mental health, or that age relative to other children in the same class is more decisive. The current study takes the latter view.

The study sample consisted of 10,438 schoolchildren aged 5 to 15 in Scotland, England and Wales. The authors used reports from teachers, parents and the students themselves to assess different aspects of emotional health.

When all the information was in, it appeared that younger children in a class were significantly more likely to have psychiatric symptoms and disorders, although the actual rates varied depending on whose reports were being used.

The differences were also quite small on an individual level, but nevertheless could represent a significant public health impact, the authors state.

It's not clear from the study, which found only an association and not a cause-and-effect relationship, why this might be so.

The authors seem to attribute the differences to the academic environment and suggest that teachers might alter their behavior to soften the impact on the youngest kid on the block.

Dr. Elizabeth Berger, a child psychiatrist in Elkins Park, Pa., and author of the book Raising Children with Character, questions this line of reasoning.

"It is based upon the assumption that the stressors for the youngest emerge from academic challenges," she says. "It is my counter-suggestion that the factor responsible for the psychiatric distress of the younger cohort is bullying. Younger children in any grade, I hypothesize, are more likely to be smaller, to thus be bullied, and to thus suffer psychiatric symptoms. Because bullying is so very common and so very devastating to the child, it may account for the authors' clinical findings rather than their assumption that psychiatric symptoms emerge from the teacher's expectations."

Saunders attributes the phenomenon to a one-size-fits-all approach to education. Because different children develop at different rates and because different developmental areas within one child may proceed at differing rates, most kids' overall developmental path is uneven, she says.

Decades ago, children used to be placed in a grade depending on competence and readiness, not biological age. "We don't do that anymore. There is a real problem in our educational system in not taking into account individual children's competence and readiness in lots of different areas and not just academics," Saunders says. "Younger children will have a higher probability of experiencing stress in school because of a lack of readiness in certain areas, or their very uneasiness puts them at greater risk for stress." Even if they can handle things cognitively, being behind socially or emotionally may put them at risk for scapegoating and bullying.

But whatever the cause, simple school stress cannot explain away psychiatric conditions, Saunders adds. "Stress in school by itself is not going to cause a psychiatric disturbance unless there are other risk factors," she says.

More information

The University of Glasgow in Scotland has information on bullying in school. For more on child psychiatric issues, visit the American Academy of Child and Adolescent Psychiatry.

SOURCES: Elizabeth Berger, M.D., child psychiatrist and author of Raising Children With Character, Elkins Park, Penn.; Patricia Saunders, PhD, director, Graham Windham's Manhattan Mental Health Center, New York City; Aug. 30, 2003, British Medical Journal
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