European Child & Adolescent Psychiatry

, Volume 28, Issue 10, pp 1341–1352 | Cite as

Mental health problems and school performance in first graders: results of the prospective cohort study ikidS

  • Christine Gräf
  • Isabell Hoffmann
  • Christiane Diefenbach
  • Jochem König
  • Martina F. Schmidt
  • Kathleen Schnick-Vollmer
  • Michael Huss
  • Michael S. UrschitzEmail author
  • for the ikidS Project Group
Original Contribution


We aimed to estimate unbiased effects of mental health problems (MHPs) on school performance in first graders, with an emphasis on rigorous adjustment for potential confounders. A population-based prospective cohort study was performed in the area of Mainz-Bingen (Germany). In 2015, all preschoolers were approached, and the presence and type of MHP (externalising/internalising) and other physical chronic health conditions were identified by the preschool health examination and study-specific questionnaires. At the end of the first grade, school performance (reading, writing, numeracy, and science) was assessed by the class teacher and rated on a four-item scale ranging from − 8 to + 8. Of 3683 children approached, 2003 (54%) were enrolled. School performance was available for 1462 children (51% boys, mean age 7.3 years). Of these, 41% had signs of at least one MHP. Compared to children without indications of mental and physical chronic health conditions, children with MHPs had lower school performance scores [adjusted mean difference − 0.98, 95% CI (− 1.35; − 0.61); P < 0.001]. Regarding the type of MHP, externalising MHPs were associated with poor school performance [adjusted mean difference − 1.44, 95% CI (− 1.83; − 1.05); P < 0.001], while internalising MHPs were not. Children with hyperactivity inattention problems were most affected [adjusted mean difference − 1.96, 95% CI (− 2.36; − 1.56); P < 0.001]. Externalising MHPs and in particular hyperactivity inattention problems may already affect school performance in early primary school. Identification of children with externalising MHPs prior to school entry may help to prevent impaired academic achievement in affected children.


Externalising problems Attention-deficit hyperactivity disorder Academic achievement School health Community paediatrics Children 



Our thanks go to the documentation specialists and student research aids for conducting the surveys and managing the data. Grateful acknowledgement goes to Katherine Taylor for proofreading as well as Jennifer Schlecht and Anna-Liesa Filbert for additional statistical analyses. Last but not least, we particularly wish to thank all the parents and children for their patience and cooperation; they made this study possible.

Members of the ikidS Project Group are Dietmar Hoffmann (Department of Public Health, County Government Mainz-Bingen), Maria Blettner, Peter Kaatsch (Institute of Medical Biostatistics, Epidemiology, and Informatics; University Medical Centre of the Johannes Gutenberg-University Mainz), Annette Queisser-Wahrendorf, Awi Wiesel, Fred Zepp, Jörg Faber, Stephan Gehring, Eva Mildenberger (Department of Pediatrics; University Medical Centre of the Johannes Gutenberg-University Mainz), Stephan Letzel (Institute of Occupational, Social and Environmental Medicine; University Medical Centre of the Johannes Gutenberg-University Mainz), Heike Elflein, Alexander K. Schuster (Department of Ophthalmology, University Medical Centre of the Johannes Gutenberg-University Mainz), Brita Willershausen, Jens Weusmann (Department of Prosthodontics, University Medical Centre of the Johannes Gutenberg-University Mainz), Christoph Matthias (Department of Communication Disorders; University Medical Centre of the Johannes Gutenberg-University Mainz), Margarete Imhof (Department of Educational Psychology, Johannes Gutenberg-University Mainz), and Perikles Simon (Department of Sports Medicine, Johannes Gutenberg-University Mainz).


This project was supported by a research grant from the German Federal Ministry of Education and Research (grant application number 01ER1302).

Compliance with ethical standards

Conflict of interest

On behalf of all the authors, the corresponding author states that there is no conflict of interest.

Supplementary material

787_2019_1296_MOESM1_ESM.pdf (471 kb)
Supplementary material 1 (PDF 471 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Christine Gräf
    • 1
  • Isabell Hoffmann
    • 1
    • 2
  • Christiane Diefenbach
    • 1
  • Jochem König
    • 1
  • Martina F. Schmidt
    • 1
  • Kathleen Schnick-Vollmer
    • 1
  • Michael Huss
    • 3
  • Michael S. Urschitz
    • 1
    Email author
  • for the ikidS Project Group
  1. 1.Division of Paediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology, and InformaticsUniversity Medical Centre of the Johannes Gutenberg-UniversityMainzGermany
  2. 2.Paul-Ehrlich-InstitutFederal Institute for Vaccines and BiomedicinesLangenGermany
  3. 3.Department of Paediatric and Adolescent Psychiatry and PsychotherapyUniversity Medical Centre of the Johannes Gutenberg-UniversityMainzGermany

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