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Michael Silverstein, MD, MPH; Nicole Guppy, MD; Robin Young, MA; Marilyn Augustyn, MD

Arch Pediatr Adolesc Med. 2009;163(6):547-553.

Objective  To estimate the proportion of children who receive an Individualized Education Program (IEP) following grade retention in elementary school.

Design  Longitudinal cohort study.

Participants  Children retained in kindergarten or first (K/1) grade and third grade, presumably for academic reasons, were followed up through fifth grade.

Main Outcome Measure  Presence or absence of an IEP.

Results  A total of 300 children retained in K/1 and 80 retained in third grade were included in the study. Of the K/1 retainees, 68.9% never received an IEP during the subsequent 4 to 5 years; of the third-grade retainees, 72.3% never received an IEP. Kindergarten/first-grade retainees in the highest quintile for socioeconomic status and those with suburban residence were less likely to receive an IEP than retained children in all other socioeconomic status quintiles (adjusted odds ratio, 0.17; 95% confidence interval, 0.05-0.62) and in rural communities (0.16; 0.06-0.44). Among K/1 retainees with persistently low academic achievement in math and reading, as assessed by standardized testing, 38.2% and 29.7%, respectively, never received an IEP.

Conclusions  Most children retained in K/1 or third grade for academic reasons, including many of those who demonstrated sustained academic difficulties, never received an IEP during elementary school. Further studies are important to elucidate whether retained elementary schoolchildren are being denied their rights to special education services. In the meantime, early-grade retention may provide an opportunity for pediatricians to help families advocate for appropriate special education evaluations for children experiencing school difficulties.

Author Affiliations: Department of Pediatrics, Boston Medical Center (Drs Silverstein, Guppy, and Augustyn), and Department of Biostatistics, Boston University School of Public Health (Ms Young), Boston, Massachusetts.

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