Skip to main content Accessibility help

The relationship between exclusion from school and mental health: a secondary analysis of the British Child and Adolescent Mental Health Surveys 2004 and 2007

  • T. Ford (a1), C. Parker (a1), J. Salim (a1), R. Goodman (a2), S. Logan (a1) and W. Henley (a1)...



Children with poor mental health often struggle at school. The relationship between childhood psychiatric disorder and exclusion from school has not been frequently studied, but both are associated with poor adult outcomes. We undertook a secondary analysis of the British Child and Adolescent Mental Health Surveys from 2004 and its follow-up in 2007 to explore the relationship between exclusion from school and psychopathology. We predicted poorer mental health among those excluded.


Psychopathology was measured using the Strengths and Difficulties Questionnaire, while psychiatric disorder was assessed using the Development and Well-Being Assessment and applying Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM IV) criteria. Exclusion from school and socio-demographic characteristics were reported by parents. Multi-variable regression models were used to examine the impact of individual factors on exclusion from school or psychological distress.


Exclusion from school was commoner among boys, secondary school pupils and those living in socio-economically deprived circumstances. Poor general health and learning disability among children and poor parental mental health were also associated with exclusion. There were consistently high levels of psychological distress among those who had experienced exclusion at baseline and follow-up.


We detected a bi-directional association between psychological distress and exclusion. Efforts to identify and support children who struggle with school may therefore prevent both future exclusion and future psychiatric disorder.


Corresponding author

*Address for correspondence: T. Ford, Ph.D., FRCPsych, University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter EX1 2LU, UK. (Email:


Hide All
Achenbach, TM, McConaughy, SH, Howell, CT (1987). Child/adolescent behavioral and emotional problems: implications of cross-informant correlations for situational specificity. Psychological Bulletin 101, 13.
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (DSM). American Psychiatric Association: Washington, DC, pp. 143147.
Aronsson, G, Svensson, L, Gustafsson, K (2003). Unwinding, recuperation, and health among compulsory school and high school teachers in Sweden. International Journal of Stress Management 10, 217.
Barkley, RA, Anastopoulos, AD, Guevremont, DC, Fletcher, KE (1991). Adolescents with ADHD: patterns of behavioral adjustment, academic functioning, and treatment utilization. Journal of the American Academy of Child & Adolescent Psychiatry 30, 752761.
Bauermeister, JJ, Shrout, PE, Ramírez, R, Bravo, M, Alegría, M, Martínez-Taboas, A, Chaves, L, Rubio-Stipec, M, Ribera, JC, Canino, G (2007). ADHD correlates, comorbidity, and impairment in community and treated samples of children and adolescents. Journal of Abnormal Child Psychology 35, 883898.
Beckett, C, Beecham, J, Doolan, M, Ford, T, Kallitsoglou, A, Scott, S, Sylva, K, HCA Study Teams (2010). Which Type of Parenting Programme Best Improves Child Behaviour and Reading? The Helping Children Achieve Trial. Department for Education: London.
CACI Information Services (1993) ACORN User Guide, CACI Limited 1994. All Rights Reserved. Source: ONS and GRO (S) © Crown Copyright 1991.
Children's Commissioner (2013). ‘Always Someone Else's Problem’: Office of the Children's Commissioner School Exclusions Inquiry. The Stationery Office: London.
Collishaw, S, Goodman, R, Ford, T, Rabe-Hesketh, S, Pickles, A (2009). How far are associations between child, family and community factors and child psychopathology informant-specific and informant-general? Journal of Child Psychology and Psychiatry 50, 571580.
Collishaw, S, Maughan, B, Goodman, R, Pickles, A (2004). Time trends in adolescent mental health. Journal of Child Psychology and Psychiatry, and Allied Disciplines 45, 13501362.
Copeland, WE, Angold, A, Shanahan, L, Costello, EJ (2014). Longitudinal patterns of anxiety from childhood to adulthood: the great smoky mountains study. Journal of the American Academy of Child & Adolescent Psychiatry 53, 2133.
Costello, EJ, Egger, H, Angold, A (2005). 10-year research update review: the epidemiology of child and adolescent psychiatric disorders: I. Methods and public health burden. Journal of the American Academy of Child and Adolescent Psychiatry 44, 972986.
Daniels, H, Cole, T, Sellman, E, Sutton, J, Visser, J, Bedward, J (2003). Study of Young People Permanently Excluded from School. Department for Education and Skills: London.
Department for Children, Schools and Families (2005). Permanent and Fixed Period Exclusions from Schools and Exclusion Appeals in England, 2003/04. The Stationery Office: London.
Department for Children, Schools and Families (2009). Permanent and Fixed Period Exclusions from Schools and Exclusion Appeals in England 2007/08. The Stationery Office: London.
Department for Education (2013). Permanent and Fixed Period Exclusions from Schools and Exclusion Appeals in England 2011/2012. The Stationery Office: London.
Department for Education (2016 a). Permanent and Fixed Period Exclusions in England: 2014 to 2015. The Stationery Office: London.
Department for Education (2016 b). Behaviour and Discipline in Schools: Guidance for Head Teachers and Staff. The Stationery Office: London.
Department for Education, Department of Health (2014). Special Educational Needs and Disability Code of Practice: 0 to 25 Years. The Stationery Office: London.
Department of Health (2015). Future in Mind. The Stationery Office: London.
Donno, R, Parker, G, Gilmour, J, Skuse, D (2010). Social communication deficits in disruptive primary-school children. The British Journal of Psychiatry 196, 282289.
Ford, T, Goodman, R, Meltzer, R (2004). The relative importance of child, family, school and neighbourhood correlates of childhood psychiatric disorder. Social Psychiatry and Psychiatric Epidemiology 39, 487496.
Ford, T, Hamilton, H, Meltzer, H, Goodman, R (2007). Child mental health is everybody's business: the prevalence of contact with public sector services by type of disorder among British school children in a three-year period. Child and Adolescent Mental Health 12, 1320.
Ford, T, MacDiarmid, F, Russell, A, Racey, D, Goodman, R (2017). The predictors of persistent DSM-IV disorders in three-year follow-ups of the British child and adolescent mental health surveys 1999 and 2004. Psychological Medicine 47, 11261137.
Ford, T, Parker, C (2016). Emotional and behavioural difficulties and mental (ill) health. Emotional and Behavioural Difficulties 21, 17.
Goldberg, D, Williams, P (1988). User's Guide to the GHQ. NFER Nelson: Windsor.
Goodman, A, Goodman, R (2011). Population mean scores predict child mental disorder rates: validating SDQ prevalence estimators in Britain. Journal of Child Psychology and Psychiatry, and Allied Disciplines 52, 100108.
Goodman, R (2001). Psychometric properties of the strengths and difficulties questionnaire. Journal of the American Academy of Child and Adolescent Psychiatry 40, 13371345.
Goodman, R, Ford, T, Richards, H, Gatward, R, Meltzer, H (2000). The development and well-being assessment: description and initial validation of an integrated assessment of child and adolescent psychopathology. Journal of Child Psychology and Psychiatry 41, 645655.
Green, H, McGinnity, A, Meltzer, H, Ford, T, Goodman, R (2005). Mental Health of Children and Young People in Great Britain, 2004. Office for National Statistics: London.
Hayden, C (1997). Exclusion from primary school: children ‘in need’ and children with ‘special educational need’. Emotional and Behavioural Difficulties 2(3).
Hayden, C, Dunne, S (2001). Outside, Looking in: Children's and Families’ Experiences of Exclusion from School. The Children's Society: London.
Hemphill, SA, Toumbourou, JW, Smith, R, Kendall, GE, Rowland, B, Freiberg, K, Williams, JW (2010). Are rates of school suspension higher in socially disadvantaged neighbourhoods? An Australian study. Health Promotion Journal of Australia 21, 1218.
Heyman, I, Fombonne, E, Simmons, H, Ford, T, Meltzer, H, Goodman, R (2001). Prevalence of obsessive – compulsive disorder in the British nationwide survey of child mental health. The British Journal of Psychiatry 179, 324329.
House of Commons (2017). First joint report of the Education and Health Select Committee of the session 2016–7; children and young people's mental health; the role of education ( Accessed 23 June 2017.
Kidger, J, Brockman, R, Tilling, K, Campbell, R, Ford, T, Araya, R, King, N, Gunnell, D (2016). Teachers’ wellbeing and depressive symptoms, and associated risk factors: a large cross sectional study in English secondary schools. Journal of Affective Disorders 192, 7682.
Kim-Cohen, J, Caspi, A, Moffitt, TE, Harrington, H, Milne, BJ, Poulton, R (2003). Prior juvenile diagnoses in adults with mental disorder: developmental follow-back of a prospective-longitudinal cohort. Archives of General Psychiatry 60, 709717.
Knapp, M, Snell, T, Healey, A, Guglani, S, Lacko-Evans, S, Ferbandez, JL, Meltzer, H, Ford, T (2015). How do child and adolescent mental health problems influence public sector costs? Inter-individual variations in a nationally representative British sample. Journal of Child Psychology and Psychiatry 56, 667692.
Liddle, EB, Batty, MJ, Goodman, R (2009). The social aptitudes scale: an initial validation. Social Psychiatry and Psychiatric Epidemiology 44, 508513.
Maguire, M, O'Connell, T (2007). Ill-health retirement of schoolteachers in the Republic of Ireland. Occupational Medicine 57, 191193.
Meyer, PA, Garrison, CZ, Jackson, KL, Addy, CL, McKeown, RE, Waller, JL (1993). Undesirable life-events and depression in young adolescents. Journal of Child and Family Studies 2, 4760.
Miller, M, Nevado-Montenegro, AJ, Hinshaw, SP (2012). Childhood executive function continues to predict outcomes in young adult females with and without childhood-diagnosed ADHD. Journal of Abnormal Child Psychology 40, 657668.
National Institute for Health and Care Excellence (2013). Antisocial Behaviour and Conduct Disorders in Children and Young People: Recognition and Management. NICE Clinical Guidelines. (Accessed 31 July 2017).
Newlove-Delgado, T, Ukoumunne, O, Stein, K, Ford, T (2015). Trajectories of psychopathology in relation to mental health related service contacts over three years in the British child and adolescent mental health survey 2004. European Psychiatry 30, 418.
Norwich, B (2002) LEA Inclusion Trends in England, 1997–2001: Statistics on Special School Placements & Pupils with Statements in Special Schools. CSIE: Bristol.
Obsuth, I, Sutherland, A, Cope, A, Pilbeam, L, Murray, AL, Eisner, M (2017). London education and inclusion project (LEIP): results from a cluster-randomized controlled trial of an intervention to reduce school exclusion and antisocial behaviour. Journal of Youth and Adolescence 46, 538557.
O'Regan, F (2010). Exclusion from school and attention- deficit/hyperactivity disorder. The International Journal of Emotional Education 2, 318.
Parker, C, Marlow, R, Kastner, M, May, F, Mitrofan, O, Henley, W, Ford, T (2016 a). The ‘Supporting Kids, Avoiding Problems’ (SKIP) study: relationships between school exclusion, psychopathology, development and attainment – a case control study. Journal of Children's Services 11, 91110.
Parker, C, Paget, A, Ford, T, Gwernan-Jones, R (2016 b). ’.he was excluded for the kind of behaviour that we thought he needed support with…’ A qualitative analysis of the experiences and perspectives of parents whose children have been excluded from school. Emotional and Behavioural Difficulties 21, 133151.
Parker, C, Whear, R, Ukoumunne, OC, Bethel, A, Thompson-Coon, J, Stein, K, Parker, C (2014). School exclusion in children with psychiatric disorder or impairing psychopathology: a systematic review. Emotional and Behavioural Difficulties 20, 229251.
Parry-Langdon, N (2008) Three Years On: Survey of the Development and Emotional Well Being of Children and Young People. ONS: London (ed).
Parsons, C (2010). Review of ‘excluded from school: complex discourses and psychological perspectives’. European Journal of Special Needs Education 25, 109110.
Patton, GC, Coffey, C, Romaniuk, H, Mackinnon, A, Carlin, JB, Degenhardt, L, Olsson, CA, Moran, P (2014). The prognosis of common mental disorders in adolescents: a 14-year prospective cohort study. The Lancet 383, 14041411.
Rohde, LA, Biederman, J, Busnello, EA, Zimmermann, H, Schmitz, M, Martins, S, Tramontina, S (1999). ADHD in a school sample of Brazilian adolescents: a study of prevalence, comorbid conditions, and impairments. Journal of the American Academy of Child & Adolescent Psychiatry 38, 716722.
Rushton, JL, Forcier, M, Schectman, RM (2002). Epidemiology of depressive symptoms in the national longitudinal study of adolescent health. Journal of the American Academy of Child & Adolescent Psychiatry 41, 199205.
Skiba, RJ, Horner, RH, Chung, C-G, Rausch, MK, May, SL, Tobin, T (2011). Race is not neutral: a national investigation of African American and Latino disproportionality in school discipline. School Psychology Review 40, 85.
Snell, T, Knapp, M, Healey, A, Guglani, S, Evans-Lacko, S, Fernandez, J-L, Meltzer, H, Ford, T (2013). Economic impact of childhood psychiatric disorder on public sector services in Britain: estimates from national survey data. Journal of Child Psychology and Psychiatry 54, 977985.
StataCorp 13 (2013). Statistical Software Release 13. Statistical Software. StataCorp LP: College Station, TX.
Strengths and Difficulties Questionnaire. SDQINFO.COM. Normative data ( Accessed 13 December 2013.
Taggart, B, Sammons, P, Smees, R, Sylva, K, Melhuish, E, Siraj-Blatchford, I, Elliot, K, Lunt, I (2006). Early identification of special educational needs and the definition of ‘at risk’: the early years transition and special educational needs (EYTSEN) project. British Journal of Special Education 33, 4045.
Vorhaus, L, Vorhaus, J (2012). The Impact of Pupil Behaviour and Wellbeing on Educational Outcomes. Department for Education: London.
Whear, R, Marlow, R, Boddy, K, Ukoumunne, OC, Parker, C, Ford, T, Thompson-Coon, J, Stein, K (2014). Psychiatric disorder or impairing psychology in children who have been excluded from school: a systematic review. School Psychology International 35, 530543.
Whear, R, Thompson-Coon, J, Boddy, K, Ford, T, Racey, D, Stein, K (2013). The effect of teacher-led interventions on social and emotional behaviour in primary school children: a systematic review. British Educational Research Journal 39, 383420.
Wolke, D, Waylen, A, Samara, M, Steer, C, Goodman, R, Ford, T, Lamberts, K (2009). Selective drop-out in longitudinal studies and non-biased prediction of behaviour disorders. British Journal of Psychiatry 195, 249256.
World Health Organisation (1993). The ICD-10 classification of mental and behavioural disorders: diagnostic criteria for research. Geneva.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed