title: Increased behavior problems associated with delayed school entry and delayed school progress.
abstract: OBJECTIVE
  To investigate whether students who are old-for-grade have higher rates of reported behavior problems and to investigate whether this association is independent of having been retained a grade in school.
  
  
  METHODS
  Cross-sectional analyses of parental reports from the nationally representative sample of 9079 children ages 7 to 17 years who participated in the Child Health Supplement to the 1988 National Health Interview Survey. Students older than the modal age for their grade were considered old-for-grade, either due to delayed school entry (those without grade retention) or to delayed school progress (with history of grade retention). Behavior problems were defined as scores >90th percentile on a well-utilized, standardized Behavior Problem Index (BPI).
  
  
  RESULTS
  Twenty-six percent of 7- to 17-year-old children in the United States are old-for-grade. Being old-for-grade is more common in males (31%), blacks (33%), Hispanics (32%), those living in single-parent households (31%) or poverty (43%), and those with mothers with low educational attainment (42%). Most children (84%) who repeated a grade are old-for-grade, but only 54% of old-for-grade students have been retained. For children who were old-for-grade, 19% of those grade-retained and 12% of those nonretained had extreme BPI scores, and for those not old-for-grade, 17% of grade-retained and 7% of nonretained children had extreme BPI scores. Although rates of extreme BPI scores were consistently lower for children who were neither old-for-grade nor grade-retained, and consistently higher for those with both, these rates increased with age for children who were old-for-grade without being retained. Controlling for multiple potential confounders with logistic regression, both old-for-grade status and grade retention are independently associated with increased rates of behavior problems. Separate logistic regression analyses for blacks and whites showed that these findings pertained only to white children.
  
  
  CONCLUSIONS
  Whereas grade retention is associated with increased rates of behavior problems in children and adolescents, simply being older than others in one's class, without having experienced grade retention, is also associated with increased rates of behavior problems, most noticeably among adolescents. These data suggest that there may be latent adverse behavioral outcomes that result from delaying children's school entry.
authors.affiliation: Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester General Hospital, Rochester, New York, USA.
authors.forename: R S
authors.initials: RS
authors.lastname: Byrd
authors.forename: M
authors.initials: M
authors.lastname: Weitzman
authors.forename: P
authors.initials: P
authors.lastname: Auinger
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000367:Age Factors; D002648:Child; D002653:Child Behavior Disorders / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D004493:Education; D005260:Female; D006801:Humans; D008297:Male; D012574:Schools