Our three year old children are next in line for routine screening for potential mental health issues according to a plan recently made by the federal government.
In a recent extension of the existing Healthy Kids Check, attention will be given to emotional, social and behavioural questions. An amount of $11 million over five years has been promised and the government expects it will identify 27,500 three-year-olds over that five year interval who will require further support. Fuller details of the new checks will become available in July 2012 when Mr Mark Butler, federal Minister for Health, has received advice from an expert working group.
The move to screen younger children had conditional support of the president of the Australian Medical Association, Steve Hambleton, who acknowledges that this is an “emotive topic”. Mr Hambleton went on to say “It's about recognising this concerning behaviour and looking at strategies to minimise it” (‘Testing times ahead for toddlers’, 2012).
The AMA has two concerns regarding this intended screening. First, there could be an incorrect diagnosis arising from existing conditions such as ADHD and autism. There is a related concern that schools could seek GPs to make such a wider diagnosis in order to get more supports. The second concern raised by the AMA is that there will be an increased ‘medicalisation’ of normal childhood conditions.
Medicalisation is the name given to the trend to give observed traits and behaviours a label. Then the label becomes a new disease, disorder or mental health condition. There may also be some assigned treatment including medication and therapy usually a psychologist or a psychiatrist.
This concern that unnecessary medicalisation is taking place can caused Allen Frances to speak out over this issue. Emeritus Professor Frances is former chair of the committee that prepares the Diagnostic and Statistical Manual of Mental Disorders (DSM).
Allen Frances has said that ''children are the most difficult to diagnose because they are in flux. If you allow the child to grow up, very often the symptoms will disappear”. He gives an example of a recent Canadian study that found being born in December rather than January is a strong predictor of ADHD, especially in boys. Further commentary and audio of Professor Frances may be found at http://www.abc.net.au/news/2012-06-11/expert-warns-against-child-mental-health-checks/4064474
A new version of the Diagnostic and Statistical Manual of Mental Disorders (DSM V) will be issued soon that will add a number of new disorders to the realm of psychiatric diagnosis. Among the new disorders are:
· “premenstrual dysphoric disorder'' (severe PMT),
· ''attention deficit/hyperactivity disorder (ADHD) not elsewhere classified'' (where it is not classical ADHD) and
· ''disruptive mood dysregulation disorder in children'' (temper tantrums) (Savulescu, 2012)
How is this screening of out three year olds designed to work?
The child would be examined by a GP who, on the basis of his concern or opinion, would make a referral to psychiatrist or a paediatrician for a confirmed diagnosis. It is valid to ask ‘what skill or qualification will be required to make this assessment?’ It is even more valid to ask when the observed behaviour is ‘normal’ and what is normal for a three year old child?
Initially the screening of our children will be voluntary, in the future, who knows what will happen?
Savulescu, J, 2012, ‘Label with care’ Brisbane Times, 17 June, viewed 21 June 2012,<http://www.brisbanetimes.com.au/opinion/society-and-culture/label-with-care-20120616-20gvv.html>
‘Testing times ahead for toddlers’, 2012, Sydney Morning Herald, 16 June, viewed 21 June 2012, <http://www.smh.com.au/national/testing-times-ahead-for-toddlers-20120615-20f9y.html>