Vital Link Between Improving Mental Health, Delaying School Start of Youngest Children and Reducing NHS Costs

smiley faceOn November 18, the Royal College of Paediatrics and Child Health (RCPCH) called on politicians to “develop an action plan… focussing on prevention and early intervention to ensure parity of esteem for children and young people” because “1 in 10 children (that’s around 3 in every classroom) have a diagnosable mental health condition“.

Coincidentally, the Journal of Child Psychology and Psychiatry just this month published ‘Children’s relative age in class and use of medication for ADHD: a Danish Nationwide Study‘, which suggests a simple and effective action plan for the improvement of summer born children’s mental health – allowing the holding back of “relatively young children” for one year.

Existing research shows that “Summer babies ‘more likely to be diagnosed with ADHD“(Telegraph, 18/09/10), “disproportionately identified as having special educational needs” (02/09), and “wrongly classed as having special needs” (28/12/12), and the Danish researchers were aware of this phenomenon too:

Previous studies from North America and Iceland have shown that the youngest children within a grade are up to twice as likely to be diagnosed and treated for attention-deficit/hyperactivity disorder (ADHD) compared with their older classmates.”

So they set out to discover whether it held true in their country too… but it didn’t.

Firstly, only 1.2% of the 932,032 eligible children received ADHD medication between 2000 and 2012, and of those that did, there was “no relative age effect” at all, which the researchers “postulate… may be due to the high proportion of relatively young children held back by 1 year in the Danish school system and/or a generally low prevalence of ADHD medication use in the country.

Interestingly, overall, “40% of children born October–December had entered school a year after their age-assigned grade level“, which tells us two things:  1) admissions flexibility for the youngest children exists, and  2) the cut-off date is more than three months after the school year starts, unlike England’s August 31st cut-off.

I found out separately, that while a typical school day in Denmark starts at 8am and finishes at about 3pm, the first three year groups usually end their day at 12pm, and also the school starting age in Denmark is higher than ours, at age 6-7.

This does not mean of course these children escape all risk of mental health problems or that ‘the Danish way’ provides a perfect panacea for our own education system, but its lack of “relative age effect” in relation to mental health could be important.

Cost Savings for the NHS

In its press release, the RCPCH also warned politicians that they “must value” children’s mental health or Britain will face “serious consequences“.

Value and consequences have more than one meaning, but while a parent’s focus might be valuing their child’s opportunity to thrive in school and wanting to avoid the well-documented consequences for some summer born children, governments will always look at the economic value of policies, and their wider social and financial consequences, too.

Understandable, yes, but in February 2009, when the NFER published its ‘International thematic probe: The influence of relative age on learner attainment and development‘ (a report commissioned by the Qualifications and Curriculum Authority, a non-departmental public body, sponsored by the DfE), it actually included this:

…two studies investigated mental health indicators. Both found evidence of significant relative age effects in measures of psychopathology and psychiatric disorders and referrals to psychiatric support services.”

1) Goodman, R., Gledhill, J. and Ford, T. (2003). ‘Child psychiatric disorder and relative age within school year: cross sectional survey of large population sample’, British Medical Journal, 327, 7413, 472–475.

Relative age was found to be an independent risk factor for psychiatric disorder after controlling for socio-demographic characteristics…  The authors conclude that their study provides ‘robust’ evidence of a link between relative age and mental health. They suggest that being youngest in the class is stressful for children. While there is a fairly ‘weak’ effect on an individual’s mental health (for example, compared to the impact of family discord or adverse life events), it could prove important for public health. For example, if all British children had the same risk of psychopathology as that identified among the oldest in the year group, around 60,000 cases of child psychiatric disorder might be prevented…

They point to the policy in New Zealand of allowing young children to progress from a preparatory class to primary school when ready and to the Scottish system whereby parents can choose to defer entry for younger children who do not seem ready for school. They recommend further evaluation (Randomised Control Trials) of the impact of allowing the youngest children experiencing difficulties to repeat the academic year or allowing deferred school entry.”

2) Menet, F., Eakin, J., Stuart, M. and Rafferty, H. (2000). ‘Month of birth and effect on literacy, behaviour and referral to psychological service’, Educational Psychology in Practice, 16, 2, 225–234.

Psychological referral analysis [in Northern Ireland where cut-off is June 30] showed that the number of referrals increased towards the May/June birth date.

So this means cost-savings not just within the education system, but also across the NHS.

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12 Responses to Vital Link Between Improving Mental Health, Delaying School Start of Youngest Children and Reducing NHS Costs

  1. Louise Tee says:

    My July born five year old daughter really struggled starting in year one which affected her mental health. She was having nightmares about school and waking up in a cold sweat. She was becoming violent towards her sisters and her new baby brother. One thing I particularly remember her saying which broken my heart is “mummy I keep having bad thoughts in my head. I cant stop them”. Louise Tee


  2. Gem says:

    Its not just the NHS that can save through having a fair and flexible policy. Think about all that SEN support money that wouldn’t be needed. Summerborns are much more likely to be labeled SEN than Autumn borns (so clearly its an immaturity rather than SEN issue) All that money could be used in schools for the benefit of all children. Also our LEA’s/ county councils are spending ridiculous amounts on ‘panels’, meetings, ‘experts opinions’ and overly drawn out processes to decide if a child should delay. A fair process in all counties would mean parents views were properly respected and held in esteem and this waste wouldn’t be needed. It so obvious that flexibility is vital whn people are brave enough to start thinking ‘outside the box’


  3. Siu Chui Li says:

    I do not understand why with all the evidence that points to the fact that children would benefit from starting school later that the government are so fixated in trying to ‘fix’ the problems that children are having in schools by dishing out SEN statements to normal children who want to play and are not ready for formal learning. What a waste of money. Not to mention the detrimental affect on thousands of children’s lives. It is like putting a bandage on one’s skin when the problem is in the heart. Just let children start school when they are older and more ready to learn! It is so simple. Save money at the same time as creating a well balanced, healthy and thriving future generation. I personally feel strongly about this as I am waiting to find out if my son will be given the chance to delay Reception, terrified that a decision out of my hands is made to force him into school too early which could negatively affect him for the rest of his life with the possibility that he will suffer low self esteem and low self confidence which will affect his future happiness. If given the chance to delay he will be given the opportunity to be able to say ‘I Can’ rather than struggle to keep up. But we are on a knife edge and it could go either way. Shouldn’t every child have the right to thrive? Of course they should. But the summer born child’s rights are being subversively overlooked in vast areas of the country.


  4. Susan King says:

    My august 27th born son started reception at compulsory school age, he was 5 and 4 days old (he simply could not have gone age 4 and 4 days he couldn’t reach the toilet, sit on the chairs or dress himself due to a Sensory processing disorder). As my son had to start full time straight away we had no way of easing him in (he had been doing 4 mornings and two afternoons at nursery but its still a big jump to 5 full days) He would scream all the way to school, when I tried to drop him off he would say “I don`t understand, why don`t you want me anymore mummy” (the school admitted that he continued to sob all day, eventually they agreed to a short spell of part time.
    Despite his troubled start and his learning difficulties the school informed me that he had always been on the school register as year 1 being educated in the reception cohort. Even after endless meetings debates and discussions he was forced to skip an entire year. He was completely incapable of the work having never been in the ,foundation of literacy, year 1 class. He went straight from a play based environment to being punished for not writing 3 sentences in a set time. He was frequently put out in the corridor to work on individual work as he was very easily distracted and totally incapable of joining in with group written work etc. He had nightmares about being left in a corridor and running and running towards the end but there was no one coming back for him and no way out. He said “I’m just too annoying for this class, no one will ever like me because I’m so annoying” He also said ” everyone hates me, you can hate me too mummy if you like, I would hate me if I were you” .

    We decided to try and make the best of the bad situation and support or son and the school as best we could in this higher year cohort, but he never settled. he always identified himself with the cohort he join school with and could not understand why other children from his original class, who were born just days later and were blessed with finding learning relatively easy, were allowed to stay in the lower class but he, with all his problems, was forced to miss out a whole year. The school led us to believe that it was not the head teachers decision and that her hands were tied by LEA policy.
    In Jan 2014, As our son was due to enter the mixed year 5/6 class with the pressure of sats looming we appealed again to return him to his friendship group in the year bellow, children who were mere hours younger than him. An education psychologist agreed that he was more than two years behind now both academically and socially. An independent mediator from an outside council agreed it was in his best interests to move back (and never should have been moved up) a pediatrician agreed he was significantly developmentally behind and an Occupational Therapist wrote a letter supporting our application (it was now considered as back classing rather than maintenance of deceleration). The local high school agreed in principle to accept him 4 days out of year group and the LEA confirmed funding would be in place for him to do so. The head teacher though, finally admitted that it was her decision to make and hers alone. It was her opinion that children like my son should be “taught” how to catch up and be more mature not allowed to mature at a pace more suited to their learning ability. Out application was refused by the head. It was refused by the governor’s appeal panel and both ofstead and the DfE found no grounds for a complaint as the head teacher had not actually breached any specific policy. In light of our sons mental health we felt we had no other option other than to remove him from the education system completely and electively home educate.
    This is why I do not support the line in the proposed new admission guidelines that allows the headteacher more say in the final decision than the parents and the professionals. I feel it is imperative that we remove personal opinions from the school admissions system entirely. decisions on a childs future must not lie with the personal opinions of one head teacher or one head of admissions, Decisions must be made in every county based on the opinions of all involved with particular weight given to the opinions of those who know the child best ie.parents and those who are actually qualified in child development and Special educational needs if relivant. An LEA admissions official once told me in a face to face conversation that he had two summer born girls himself who had both started school age 4 and had excelled therfore he knew that children were ready at the age of 4 and if they weren`t it must be down to somthing the parents had caused and thus the child would be better away from the parent and in school anyway. Being a parent to two children should not be sufficient qualifications for you to make judgements about the other 7000 plus children in an LEA area.

    The system will not be fair until we have a single set of criteria that is adhered to by all LEAs country wide, without personal opinions of unqualified individuals muddying the waters. Sorry for turning this into an essay, but once i get started on the injustice its hard to stop! feel free to abridge if necessary.

    ( As an aside note In his first year at school they studied the great fire of london. He would wake frequently in the night screaming fire, he was convinced that if the wind blowed it could blow a fire to our house from somewhere near by. It is my opinion that 4 years old is too young to study such a tragic and harrowing historical event, they are just too young to understand the context.)


  5. Rosie Dutton says:

    My August 16th born daughter didn’t start school this September with her ‘cohort’ as I felt 17 days after her 4th birthday was toomuchtoosoon. She was still napping during the day, waking up during the night and is still forming those strong attachments with myself and other family members. She attends nursery nearly everyday and has been since she was 9months old, however, even after 3 1/2 years she needs me to stay with her when I drop her off for a little while and be cuddled and nurtured by a member of staff and why wouldn’t she, she’s just turned 4. She needs help dressing/undressing and going to the toilet sometimes and why should I rush this? At her nursery she has a much higher staff to child ratio than a school setting so her needs, her needs of a 4 year old are met.

    It has been a very long, hard and difficult decision to delay sending my daughter to school this Seltember as our outcome with the local authority on whether my daughter can start school next September in Reception still hangs in the balance. They are ‘threatening’ that she may have to skip a year and join year 1. A decision that they say won’t be made until April, this leaves me with no other options if they refuse. This case has been ongoing for nearly a year.

    When we talk about mental health, this may not only effect my daughters emotional well being but has effected mine. It has been an emotional rollercoaster and constant battle with my emotions, wondering if I am, if I have made the right decision. The local authority sure don’t make it easy for us.

    In my heart of hearts I know I have made the right decision and I will fight it until the end. Since the turn of September my daughter has thrived in her nursery setting, her independence and confidence is growing everyday, she is flourishing and she is happy. We are happy. If I had sent her to school this September it would have been toomuchtoosoon. It would have been a constant battle to get her to school, she would have been a whole year younger than many of her peers. By allowing her this extra year, a choice which should inevitably be ours, has given my daughter the dependence she needed to be independent, to be happy, a chance for her little brain to grow, to know that she is valued, heard and understood.

    We now await the outcome. If a year 1 start is enforced all this hard work will be lost. My daughter will miss out on a whole school year she is entitled too, Reception, a gradual, gentle introduction to school, one that every child deserves.

    If the decision doesn’t go our way I will seriously be contemplating home education.

    Please DofE look at your code. Give families back the choice and flexibility they are entitled too.

    The research proves it has an everlasting impact on our summerborns emotional well being. Our children are our future.


    • Rosie Dutton says:

      This is not a decision I made lightly either. It has had a massive financial effect on the family. My daughters nursery fees are higher than my mortgage. I could have taken the easy route and sent my daughter to school where she would have a free place. This is so much more important than money. It is my daughters life.


  6. annamcloughlin says:

    Susan, that’s a heartbreaking story. I feel for you and your son, it’s just not fair. Well done for fighting and being brave enough to make the right decision for him.

    Rosie, you’ve made exactly the right decision! After a HUGE battle we were able to delay our daughter’s start, she began reception aged 5 … and it’s still been a nightmare!

    She’s super tired and uncontrollably angry at least once a day. Up until now everybody who knows her comments on how serene she is, how gentle – she is just not herself since starting school and really seems to have lost not just her equilibrium but her spark too. I have heard the same from over 6 friends with receptions children at different schools and in many different areas.

    Can’t imagine how it would have been if she’d started an entire year earlier. I am going to look into flexischooling as an option to see if that helps her mental health.


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