by JAMILA RIZVI
Are we over-medicalising kids? What would a mental health check on a toddler even INVOLVE? And is this a total waste of time and money?
Not so fast. The idea of mental health checks on three year olds is confronting and confounding. But let’s take a breath and work out what’s really going on.
Back in 2008, the then Rudd-led Labor Government introduced the Healthy Kids Check. It’s a screening test for 4 year olds, which helps detect a whole range of things related to kids’ health and wellbeing.
As part of the test, the doctor checks out all of the basics - height, weight, eyesight, hearing, oral health, bathroom habits and allergies. It helps identify lifestyle risk factors that might affect a child, discover possible delays in development and to catch any early signs of serious illness.
Sounds sensible enough. That’s Government money being well spent, right? Totally uncontroversial.
Now the Government has announced they’re going to move the test so it happens a year earlier. Again sounds sensible – the earlier we detect any developmental problems in kids, the better.
But they’ve also announced that from July they’ll be expanding the test to check for early signs of mental illness.
Mental illness checks for toddlers? Now THAT is controversial. And everyone is weighing in.
Jill Stark from the Sydney Morning Herald writes:
THREE-YEAR-OLDS will be screened for early signs of mental illness in a new federal government program that will consider behaviour such as sleeping with the light on, temper tantrums or extreme shyness as signs of possible psychological problems.
The Healthy Kids Check – starting on July 1 – will be predominantly conducted by GPs, who will refer children with troubling behaviour to psychologists or paediatricians.
The program is expected to identify more than 27,000 children who the government believes will benefit from additional support, but who some doctors say will be wrongly labelled as having a mental illness.
….
The test, although not compulsory, will form part of a check for developmental problems such as hearing, eyesight and allergies. Previously it was conducted on four-year-olds but has been brought forward a year and for the first time will include screening for mental health problems, with doctors to receive training before it is introduced in the next financial year.
Professor Frank Oberklaid, who is in charge of devising the new criteria for the mental illness test has defended the changes, saying:
“The critics are worried that we’re going to slap diagnoses on three-year-olds and treat them with drugs, but this is not the point of the exercise. Many parents and preschool teachers face behaviours in children that are challenging and cause stress and distress. Thankfully many of these are transient, but we can’t predict in a particular child which ones are going to disappear and which ones are going to go on and cause mental health problems.”
But President of the Australian Medical Association Steve Hambleton is warning that:
“We have to be careful we don’t medicalise normal behaviour and that’s a real caution with children. There are genuine kids who need extra support to help them integrate into normal kindergartens and classrooms, and a lot of the funding for that is driven by diagnoses, so there’s a perverse incentive to diagnose conditions like autism. There are kids who need it but we don’t want to make normal kids abnormal.”
What do you think? Will these new tests help prevent the development of mental illness, which is seriously affecting far too many kids as they move into their teen years? Or will it just mean putting medical labels on perfectly normal childhood fears and anxieties?
Comments
149 Comments so far
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A 3 yr old with mental health issues? or a 3 yr old with parents who possibly indulge that childs every whim or a 3 yr old who has food allergy reactions that makes their behaviour unacceptable. Gosh its gonna be a hard call for the assessor to determine if the child has a genuine issue or if its the parents who are creating a problem.
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My sister has bipolar disorder and has been hospitalised numerous times throughout her 30 years. My mum maintains that as a young child my sister was different to other children and didn’t respond to things or behave in the same way. When my mum seeked advice from health professionals she was told my sister would ‘simply grow out of it’ and to try different parenting methods (all of which failed to generate a different response from my sister). Bravo to the government for putting families first – the earlier a mental illness can be identified in a child the better things will be for the child and their family. No bones about it. I have no doubts that if my sister had been identified as having a mental illness as opposed to being viewed simply as a ‘trouble child’ that her life long battle would have been a lot easier.
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When it comes to many of these conditions, and ounce of prevention is worth a pound of cure, as my dear granny used to say. Treatment doesn’t necessarily mean medicines – there are evidence-based cognitive behavioural therapy programs to treat anxiety in kids these days, and it’s much better to get to these children young before anxiety becomes entrenched & thus much harder to eradicate.
Although I hesitate to label them mental health issues, screening for autism spectrum disorder and ADHD makes good sense too, and that’s a topic I’m very well informed on:
http://raisingchildren.net.au/articles/australian_autism_handbook_content_partner.html
Early intervention can be life transforming for a child on the autism spectrum, but too many kids are still falling through the gaps.
Finally there are attachment disorders, that can lead to personality disorders in adults. Not so politically correct to talk about attachment disorders, but these are the kids who have for some reason (not always poor parenting, but it’s a common cause) failed to emotionally attach to their parents & are left with deficits in empathy etc. Bad news down the track, unfortunately.
In summary, all for the checks if they can pick up these problems young and properly address them ( I guess that’s the caveat).
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Or rather ‘an ounce of prevention’ sigh.
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I am in my early twenties and have been struggling with an anxiety disorder since my late teens. Whilst my anxiety wasn’t all that bad in primary school it did start then – I remember times when I had horrible panic attacks (and didn’t have a clue what they were) and days and days of horrible anxiety and I honestly think that an early pick up of my anxiety through one of these checks would have helped so much. We a;; understand the importance of physical health check ups and I think mental health check ups are just as important. My understanding of these checks is that no one is actually diagnosing the children with anything, just picking up warning signs of potential metal illness and monitoring the children over a period and/or intervening early to try and prevent a fully blown mental illness. If that is the case then I don’t have a problem with it, and I actually think it could help a lot of kids.
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all* not a;; – I can’t edit my post for some reason.
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Yet another way a young child’s behavior is schematised, measured, pathologised and unnecessarily scrutinised. What happened to allowing children to be different, eccentric or working at their own developmental and emotional pace. Of course children who are extremely anxious or pathologically introverted may need to be given some extra help and reassurance and provided with some modelling but it is okay for kids to be shy, or to prefer to play alone sometimes or feel anxious about certain situations. We have just recently been through the public system with one of our children and do you know where all the testing and diagnoses and intervention has led us? Unfortunately to the private system – because the public system is so overloaded with apparently ‘abnormal’ children that they can’t genuinely assist more children properly and thoroughly. I think if the government is wanting to do more checking and yet more intervention – they be had better set up more systems for receiving and ‘treating’ these children. Otherwise you are just going to have more anxious parents, left with a ‘label’ and nowhere to get real assistance. I understand the importance of making sure children are happy, stable and integrated into a safe social and familial environment – but sometimes you can’t use a check-list and graph to work that out. Whew! Got my rant out!
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I don’t really get the difference to this new screening and the current system. We all take our kids to the mother-and-child-health-nurse, don’t we? And she asks questions, does tests at some point, of course does the height and weight measurements, and the all important question she asks parents “Do you have any concerns regarding …(insert speech, understanding, motor and sensory skills, etc.).
So as a parent one is either concerned or not, if yes you seek help, if not, everything is fine until the next time meeting.
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I understand where the government is coming from – my comments briefly – gps don’t have the time nor training to do this I suggest doing these basic checks in kindys, daycare centers with a psychologist – yes the earlier the better developmental or anxiety, ASD, ADHD – and Yes, there certainly are red flags for 3 year olds, other mental health disorders do not develop until the terns or early adulthood do another screening here & education in schools would be great. Yes we check for hearing, eyesore, weight etc mental health needs to be added as well.
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I don’t know about three years old, but I’ve recently discovered that my friend’s 7 year old has been having quite severe panic attacks where he couldn’t breathe and thought he was going to die. The poor little thing! His father thinks perhaps he’s doing it for attention, but I have had experience of panic attatcks and I don’t think he could be acting.
I didn’t realise that children could have problems like that, although my husband has had OCD since he was a child, so I should have! I’m so glad that mental health has become so much more important than in previous times. I really hope it helps those poor kids who suffer so much in silence, believing that there is something wrong with them instead of them knowing they have a medical illness.
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I am a practice nurse and the terminology being used is ‘emotional health and wellbeing’. After sitting through a 4 hour seminar a few weeks ago, I can assure you it’s definitely not about diagnosing mental illness in toddlers.
I think these health checks are fantastic. All too often we had parents attending with their children after the school teacher had noticed something in their behaviour, only to find an undiagnosed hearing or sight problem. Poor school teachers have enough on their plates without picking up on these sorts of things too.
Be assured these health checks are only in the best interests of the child and getting them up to scratch with their milestones so they are ready for school.
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Thank you Lisa for being a voice of reason. I do not understand why people keep harping on about doctors labelling a child who sleeps with the light on as having mental illness, or overdiagnoses of schizophrenia and depression (at 3!). This is a screening process people, a way of flagging certain behaviours relating to emotional well being to provide a platform for possible further investigation before the child goes to school.
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So isn’t this what happens and has happened in the past in normal visits to the family doctor ? The parent raises any concerns with their doctor about their child? Why all of a sudden we need 11 million funding into a “mental health ” check , as part of the Rudd initiative Healthy Kids Check, which nobody seems to know about anyway.Just an example of another stupid Fed Labor Government programme and waste of money to add to the list of many. Who is going to manage these checks? What information will the govt require when the parent fills in the form? To me it sounds very spookily like the Eugenics programmes of the turn of the century, to weed out the bad genes in the community..It is appalling and no civilised community should be accepting the baloney being sprouted about it by confused and ignorant parents (Autism Spectrum is not mental illness) and those that are set to gain finacially -community nurses, GP’s etc through a medicare rip off. If people honestly believe, like most readers seem to be of this article, that this is an acceptable govt measure then I am moving to another planet! Leave the poor children alone and get a life mothers outside of the doctors rooms!
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I think labelling this as eugenics is rather extreme. Identifying possible issues to do with mental health is not at all trying to ‘weed out bad genes’. It’s so that it’s flagged and if required, early intervention and support can be given rather than waiting until the problem gets worse.
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Again, parents normally go to the doctor and have a close relationship with a family GP until a child is at least through all the immunisations..conditions of concern with a child are normally “flagged” with the parent by a GP..we don’t need govt intervention , especially a waste of 11mil, This money could be going to programmes for disabled children and children who do fall under the “Autism Spectrum” – these parents could well do with a bit of extra help! no research has found that a mental health check of a 3 yr old child by a govt agency is going to flag anything..and it is bordering on Eugenics, programmes like these are what Dr edmund spencer proposed way back and then taken up again by Hitler and the Nazi party -DYOR,
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Maybe part of the problem is that sometimes despite raising concerns with a GP, some conditions and disorders are still under diagnosed. Often Mum is dismissed as being “over-anxious” only to be proved right after many frustrating months and sometimes years later. There are still many, many cases of mis-diagnoses and under diagnoses of autism etc despite our desperate need for early intervention. Hopefully these screenings will be carried out by specialists in emotional and mental health who are trained to pick up these problems and have specialised screening tests designed to do this successfully.
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Thats why mass sight and hearing screening by school nurses is actually a good program, but it’s slowly being lost due to cutbacks of the programs. Child health nurses are also experts on well baby and child health as well. I do wish govts would encourage more people to use our services.
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I am currently pregnant with child number 3, i live in qld, gave birth in public hospitals and have never ever been told of child health nurses or services in my area. all developmental checks have been done with a dr, and quite frankly no one really follows up if you dont turn up for these checks.
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While I’m extremely happy that the Government is being proactive in mental health three years old is just too young. At three its normal to throw tantrums, sleep with the light on and be shy. I think six is the age they should be investigating more closely. That’s when issues are going to come out as involvement in school increases and so does their social awareness. When I think back to my nephews at three….they were both little terrors. They could have been diagnosed with anything. But now they are nine and seven it is easier to see where the problems are. It was apparent at six for the youngest. By six they should be learning how to regulate their emotions and he hasn’t been able to do that. He gets very angry. My sister has him in counseling which is fantastic. It’s not a discipline problem for him it’s coping skills. And he’s getting the help he needs. I do wish my parents had put me into some sort of counseling when I was that age because I was so so painfully shy and it did go on to affect my confidence and get me into situations which I may not have gotten into with early intervention. However that was the 80s so counseling for kids wasn’t even thought of. I assume this mental health test is for kids whose parents may not see the warning signs or may slip through the cracks. So I’m all for it. However I think the money would be better spent putting more psychologists and counsellors in schools. Then having the testing and follow up monitored through the school. And I can’t stress this enough……there should with out a doubt be a full mental health check and more psychologists and counsellors in high schools! Those are the ages when things can not only be picked up but also treated and prevented in some cases.
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I have a couple of problems with diagnosing at this age. One is that children this age are hardly verbal enough to allow for a valid diagnosis. Two is that most of the mental illnesses you would want to pick up are not apparent at this age. Another is that a clinician is also largely reliant on a parent’s reportage of behaviour which in some cases may be exaggerated or untruthful.
I would like to see more funding put into the guidance counselling in highschool which is the age range where the most mental disorders become apparent.
Another point….it’s all well and good to quantify people for mental illness, but if you don’t have any pathways for help in place what is the point?
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So how much money are they putting towards looking after any 3 year old who are picked up through this program? No point chucking 11 million (or whatever it is ) towards a program like this if they dont have a decent plan in place for after.
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The problem I have with the government’s proposal is that it is unclear what exactly they are defining as ‘mental health’. When I think of mental health disorders, I think of schizophrenia, depression, anxiety, OCD, manic depressive disorder, all of which seem like they would be incredibly difficult (impossible?) to diagnose in a 3 yr old. But if they are actually talking about autism spectrum disorders, developmental delays, learning difficulties, and things like that, then having some sort of check seems like a fine idea.
Now, I don’t know if doing this at the GP is a good idea though. Like many commenters below, my daughter (aged 5) seems to have totally missed the 4 year check. I wasn’t even aware she was meant to get one. Nothing was mentioned at the 4yr vaccinations. My son, on the other hand (age 2.5) has had all sorts of checks with a variety of specialists, therapists and our GP, as he has a severe speech delay. The reason he’s had those checks is because I am an informed parent who was reasonably aware of what his development should be, and when he wasn’t pointing at 12 months, and wasn’t talking by 18 months, I knew that these could be pointers for more serious issues. I sought advice from our GP who referred me to a paediatrician, who suggest we go to a speech therapist, who referred me to a developmental paediatrician, who also suggested speech therapy, and then that latest speech therapist also suggested occupational therapy. Doctors are often cautious, they don’t want to say ‘Nothing is wrong, don’t worry’ if there is any chance that maybe something is wrong.
It’s the parents who don’t know much about development – perhaps they come from disadvantaged backgrounds – who are going to be left behind. They might not even see a regular GP to schedule the checkup – why is there an assumption that every family sees the same doctor all the time? There are so many GP bulk billing clinics around where you see someone different every time. I see this proposal as missing out on the people who presumably it is intended to help the most.
And on top of that, there is the issue of children’s behaviour sometimes changing dramatically in a clinical setting, which means it can be very hard to measure much accurately at all. I always think my son’s speech therapy sessions would be so much more successful if they were carried out in an environment where he feels safe and in control. His home, or his playground.
So, while I think it’s a good idea in principal, I think there must be some better ways to implement it.
Also, how is a GP meant to check for allergies? Surely they won’t do a skin prick test, so will it be on the level of simply questioning the parents? In which case…..wouldn’t it be obvious already?
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I agree with several issues you raise.
The scheme would work if people actually access the GP and are aware. I worry too that for many in society whose children would benefit the most would miss out. Maybe they should have linked this to child health workers/day centres/ preschool/child care centres.
I think some people need to carefully consider this proposal as potentially something good if GPs are correctly trained; the criteria are clear and appropriate referral is made for 2nd opinions. I wish the media would stop sensationalising the issue of mental health and report more carefully and have follow up reporting. Children do have genuine developmental issues, Autism spectrum disorders or in cases where a child may have not had opportunities of appropriate attachment, bonding for whatever reasons – they may have anxiety or some behavioural problems. We even have seen reported children under 5 yr with issues related to body image, self-esteem. If something could help some children develop their full potential why not try to assist. As long as there is appropriate funding for early intervention across all states/territories in Australia. It will be very interesting to see how this all pans out.
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Just a side note regarding all the “passing around” from this therapist to that – check out ABA therapy. It encompasses all aspects so no need for a hundred different types of therapy. My son is also displaying worrying signs (he is also 2.5) and the ABA therapy is amazing, working well, and is done at home where I think it’s more comfortable for him and more effective. Might be something to consider. Ours is through Aspire. Cheers
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There are a number of gaps in the detail in this strategy. Maybe the question should be is their going to be a trained GP in each GP Practice to implement these tests on the children and secondly are they going to open up the extra services required to service the newly assessed children considered to be in need of an early an intervention program for mental health and wellbeing. Are there going to be enough trained professional staff to service the programs needed for the extra numbers of identified children? These are my questions. It may look good on paper 11 Million Dollars however a large percentage of that goes on administration, wages, training and capital works and other. The system as it stands at present is busting at the seams adding more of a burden to an already system under pressure.
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Has anybody thought that by taking some comprehensive assessments at this age then it may just help down the track, whilst some childhood behaviours may be interpreted as normal or abnormal and I don’t think that the majority of kids displaying possible behavioural problems should be medicated, I think this check does have merit.
I tried to get my son diagnosed with ADHD at about this age and he wasn’t diagnosed until about 7 when the damage was done in terms of learning delays from which he never has truly recovered (he is now 21).
Don’t let the kids with genuine problems down by ignoring them in the name of avoiding labels and “over medicating”.
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agree
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Here is the problem. There is no reliable method of screening children at age three for mental health problems. By looking at behaviour through the “diagnostic” prism much normal behaviour will be classified as abnormal.Children will be wrongly labelled and some may be medicated.
And of course children develop at differing rates. This is NOT an abnormality.
At age three children should be emotional and boisterous.
This scheme may be well meant but is fundamentally flawed and will cause harm.
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Broad sweeping statements about “causing harm” aren’t really helping generate useful discussion about this. It depends on who does the assessment, but a good practitioner wont label normal toddler behaviour as problematic. If there are several difficult problems identified by the GP, the doctor refers to someone qualified who will do a comprehensive assessment. I don’t see how you can say flat out that the scheme will cause harm.
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Falsely labelling children causes harm. Prescribing psychotropic medications to children who do not need them causes harm. Screening programs have an inherent bias to overdiagnose because when you are ” looking” you are more likely to find due to observer bias.
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The problem is that it’s being reported that normal toddler issues indicate mental illness and it’s not as simple as that. It sounds like GPs will get extra training in the screening, but even forgetting that, I would seriously doubt any doctor would make such a mistake a to label a kid with mental illness so lightly. The psych and paeds have a good grip on usual and unusual behaviour, and they will be the ones doing the full assessment because the GPs will refer onwards.
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Why do you write doctors off as not being able to recognise a bad day and abnormal behaviour?
What kind of doctor are you, Dr Joe?
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A GP. There is no reliable mechanism to make these determinations. Hence after 25 years in the medicine I see no basis by which doctors can do so in a screening setting. It is just not possible.And there is no evidence any where in the world of such a scheme working. It has not been trialled here either.So do we really want to do a giant experiment on our children?
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But you wont be doing the diagnosing, Dr Joe. It’s intended to pick up on kids with problems that can be treated early. With respect, you aren’t trained in full child psychological assessments. If you get anything coming up on the screening, you refer off to psychs and paeds who do the full assessment and diagnosis, if any.
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That is what happens now and it works fine.The problem with the screening program is that it widens the net to draw more children in for further assessment.The assumption becomes that there is a problem until screening and assessment dictates otherwise. History shows that this leads to more diagnosis and more false or over diagnosis.
Plus the expert assessments are not always valid either because behaviours in three year olds are so variable and there are no proven assessment tools in this age group.
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Why wouldn’t you use your professional knowledge and training to observe or refer on if something is amiss?
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See comment above
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I think this is a good idea. Parents are usually a bad judge of “normal” because we don’t have much of a benchmark for comparison, especially with the first child.
You often hear of kids who may have benefitted from early intervention who have never been diagnosed. I’m sure no child will be slapped with a lable after one assessment, they’d be referred for further investigation.
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I’m a bit dubious about putting all the developmental assessments in a 3 year check. If eyesight and hearing are included, they’d have to be very basic, as a typical 3 year old wouldn’t be up to a typical screening. 4 & 5 year olds can have enough trouble doing them.
I’d be interested to see exactly what is included in the test, because sleeping with the light on and shyness, for example, are well within the normal range of behaviour. Lack of ability to show affection/make eye contact may send up a red flag, however.
To be quite honest, I’d wonder how much time the average GP has to perform a lengthy screen. I know for our youngest, we just got asked if we had any concerns about her….
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Actually, you can do hearing tests on kids from birth. Reliable hearing tests are completely possible for 3 year olds, and should be encouraged at that age if there are recurring middle ear infections or any speech/language delays.
The problem with doing developmental screening at 4 years is that in some areas, the kids are then too old to access local public developmental services (e.g. speech therapy at a community health centre) – some waiting lists close at 4 years old. Waiting lists are also often 12 months +, so by the time the child is eligible, they’re in Prep, and no longer eligible!
Early intervention is so named for a reason – there is PLENTY you can pick up at 3 years of age developmental-delay wise, and plenty to be done about it at that age.
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I doubt whether the purpose of this exercise is to wrongly diagnose and slap labels on little kids. I actually think this is a really great way for parents to start having dialogue about their children’s mental health from early on. We need more awareness about mental health issues, and what better way than to start talking about it as families, with professionals. As someone who teaches 3 and 4 year old kindergarten children, it is quite easy to see the difference between standard tantrums and ill-behaviours, and those that are out of the ordinary. I am confident that a psychologist would be able to identify any atypical behaviours, and rather than label them hastily, I imagine they would provide advice to parents on monitoring behaviours and what indicators to look out for certain developmental problems, as well as advise on follow up consultations.
I think it is a great way to promote mental health awareness.
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Just read your comment after making mine, totally agree.
I think there’s a danger in relying on parental assessment “Do you have any concerns?” won’t cut it because people cover up for their kids. It’s done out of love, and not wanting to be seen as bad parents or defective, but it doesn’t help when you can understand the 3 phrases and smattering of words your 3 year old uses to convey what he wants, but no-one else can.
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Totally. There are lots of parents who would never want to think something is amiss with their child and do not have other children to compare with. And you are right, while speech is still developing rapidly at three years, some parents would not realise how behind their child is, where someone who speaks to/interacts with children every day would know that most children by 3 have a fairly substantial vocabulary and will speak in full sentences. If they are only saying one or two words together to get the message across, development is nearly always atypical.
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Yes yes yes and yes..well said…initiating dialogue about the concerns is the key here…
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Ive just had speach therapist assessments and additional maternal health appointments because my son didn’t have the right number of words for his age. Now a few weeks from third birthday he is sprouting sentences. Luckily the therapist I saw said he was a bit too clever hence not speaking till he could form more adult sentences. He could have been labeled slow and that could have stuck. I think it’s a bit early, checking 4 year olds, is probably good, you’d be able to see better what is a problem and what is just a bad day.
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It is not a pyschologist who would be diagnosing speech problems, any suspected speech problems would directed to a speech pathologist. In your son’s case, the specialist realised that he did not have a problem. That is because he/she is a highly trained professional in the field. Don’t underestimate them. The testing for speech problems is really involved – problems can be related to physical causes, for eg an abnormality in the formation of the hard palate impeding the the physical ability to make certain sounds, or can be related to the hearing and processing of sounds incorrectly. Part of their job is to find the cause – and if there is none to refer to a developmental psychologist or paediatrician to determine other possibilities. It is not common in this day and age for a professional to just label a child as “slow”. That is unprofessional and not PC. Many speech problems would be identifiable by 3, though I doubt this would be a significant part of a 3 year old health check. Usually when children start school and should have most sounds is when problems become more obvious and intervention might be needed.
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You are right, we did the hearing and had tongue and palate checked before seeing speach therapist. ( all professionals who know their stuff) However, it was at the first maternal health check at 2 where the first grain of doubt was lodged,my point isn’t about being labeled in the system do much, although that’s a problem, but if as a parent you have the idea that one of your kids is a bit slow or has a learning problem, you can easily wether knowingly or not start the treat them differently, just day to day, by no expecting as much of them, and them not delivering because they don’t think they need to. Don’t forget these tests are going to be done by GPs, they are not psychiatric professionals, so it’s possibly more out of their area than having a maternal health nurse do it, at least they specialize in preschoolers. Also I was able to afford the tests ( rather expensive) but many people wouldn’t be able too, imagine forking out at 3 years old for specialists bills, and then find it was a phase or like me just him being himself? But by 4 it would have resolved itself. Also 4 year olds understand being instructed a bit better, I just think at 3 people could be chasing their tails a bit ( parents and professionals) instead of letting the kid get on with it.
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Yes, but what if it were too late and the damage was done. If there’s a label for getting help for your child, then I want it.
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I think this is a fantastic idea and it is important not to get carried away with headlines proclaiming we’re going to be diagnosing 3 year olds with actual mental illnesses. This is just an opening for discussion and early intervention if needed. Big tick to the Labor gov for this.
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I think the reaction shows the stigma still attached to mental health and it’s issues in society. Maybe if we start dealing with it when kids are this young, people will start to accept mental health as just another facet of whole body health.
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The thing that worries me is, what happens down the track when the 3 year old is a 30 year old and applies for life insurance or income protection insurance and the insurer refuses to cover them because when they were 3 years old they were slapped with a mental health issue?
Very scary to label children at such a young age when the life long repercussions are unknown.
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What’s the difference between labelling a child with a mental/developmental illness or any other long-term physical illness (asthma, eczema, diabetes etc etc…)? I don’t think this program is designed to ‘label’ children and stigmatise them, but rather implement a way of diagnosing disorders early, so intervention can be started early, especially for things like Autism, where early intervention is key.
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On the whole, I think health check-ups are a great idea, including mental health. However, what troubles me about this initiative – and this may just be the way the Sydney Morning Herald reported – is the definition of ‘troubling behaviour.’ This is something that would have to be crystal clear, because otherwise, yes, kids will be labelled and diagnosed incorrectly.
I mean to me, wanting to sleep with the light on and having temper tantrums at three years old is completely normal. I would want to be very clear on what is considered to be ‘troubling behaviour’ (and ensure my GP was too) before any child of mine was tested.
I do agree with a lot of the comments below that early intervention is the best intervention, so should a truly ‘troubling behaviour’ arise, putting a plan into action is the way to go. My only concern is that medication would be used too quickly. Like Prof Oberklaid said, you cannot predict which behaviours in a three year old may develop into mental illness, so I think as many non-pharmalogical strategies as possible should be utilised first to save a child being on heavy duty meds when it is not necessary.
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I think you hit the nail on the head Lauren … questioning the way the assessment criteria was reported. I suspect those two things (1) wanting to sleep with light on and (2) temper tantrums were two things singled out amongst a list of many others I’m certain. Probably because they appear to be normal if no other symptoms are present and would get us all talking … which it indeed has.
I too agree that early intervention in mental or physical health is definately the right approach. As someone else here has already mentioned, I think a lot of the worries exppressed highlights the stigma associated with mental illness. People are uncomfortable talking or thinking about it which doesn’t help as it stops people from seeking help.
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I think it’s a daft idea. My daughter had the 4 year old health check and it was difficult enough getting her to cooperate (balancing on one foot, reading an eye chart etc). Any younger and it would have been impossible.
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I apologise if this has been perviously discussed, but do we not have 3 1/2 year old assessments currently done by MHN (Maternal Health Nurses)? With my children’s assessments my MHN covered a huge spectrum from health (weight, coordination, eyesight etc), behaviour through to identifying any “abnormal” behaviours. These people work with young children all day. A GP “may” be more qualified to identify health issues. However to identify a behavioural problem?? I would rather this be done by my MHN. If you have a good relationship with your MHN many of these “transient” and more serious issues are much more likely to be identified and dealt with early.
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Show me a three year old that doesn’t throw epic tantrums and I’ll show you a liar. I can just imagine taking my child to be screened when he/she is having a bad day, imagine the labels attached then. I’m all for sceening at four years of age under the current scheme but checking for mental health issues in a three year old is just plain ridiculous. I am a primary school teacher and parents find it hard enough hearing that their child has a delay in reading/writing, etc let a lone being told their child has a mental health problem that chances are is bloody normal behaviour for that age bracket. What is the world coming to?
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Yes! When my daughter was three she had some mega tantrums, she was very frustrated at not being able to communicate as well as she wanted to. They were much worse when she was 1 and 2 but still pretty bad at 3. Now she is 4 and I can’t remember the last time she had a tantrum. She still sleeps with the light on though!
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But Amanda if the person assessing them truly understands and is trained in correct identification of issues (not transient behaviours or “phases”) then there should be no issue. I think we need to be very careful using terminology such as “mental health issues” as this will scare parents away from having their children assessed.
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Very few children will be showing any signs of any true mental health issue by the age of 3. Many don’t become apparent until adolescence and into early adulthood. I would never have my 3 year old tested because this is simply about labeling and soon enough the doctors will be recommended medication for the apparent “illness”
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Yes, very few will have the signs. But for the few who do have problems, it could make a massive difference in their life to have access to early intervention services.
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Thank you Amanda! I was beginning to despair there was any commonsense left.
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Actually all 3 year olds do not have massive tantrums but that is not important. I was a primary teacher and also worked in early childhood intervention for 15 years.
Yes, it is difficult hearing that your child has a problem and some parents are more open to it than others. At school, it is pretty black and white and often the school will push for a diagnosis for funding. In early childhood it isn’t like that. We often had to take a gently, gently approach with families as it is a voluntary thing and if you are too blunt, then families will often withdraw from services and then the child misses out. I have seen children with psychological issues and often the parents don’t realise or are in denial as they feel guilty but the idea of early intervention is to get in their ‘early” and it can make a huge difference to the success of the child in their first year of school.
Checking for mental health issues at 3 in NOT ridiculous. What is unrealistic is to expect that a G.P is going to be able to assess in one visit unless it is glaringly obvious. How many children are too shy to say boo at 3 years of age to a stranger? That is normal. Assessing children takes time.
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I am all for this, just so long as the tests are done by people who are qualified. When my kids were small, it was fashionable to blame many learning difficulties on poor physical coordination, so new kids at school were tested, on whether they could catch a ball etc. The tester told me that my perfectly normal son was so poorly coordinated that he could be considered spastic!!! (This was 30 years ago). I found out later thaalon is vitt the tester was a school support officer (they were not the trained people that they are today) who had had 6 hours training.
It is important to pick up autism and speech problems before the child gets too old, early intervention is vital.
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A very, very interesting video that relates to this:
http://www.youtube.com/watch?v=zDZFcDGpL4U
it’s ‘academic’ and about education, but don’t let that put you off – that’s exactly what the video’s not about.
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Thanks for the link, really hit home to me as someone who was not great at school or in tests but have managed to be quite successful in my adult life!
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I’m torn: on the one hand, providing support for parents whose kids may have emotional issues is clearly a good thig.
On the other, medicalising normal but difficult child behaviours can mark a kid for life. It could make parents treat their otherwise normal kids as though there was a clinical problem. It might just add an extra layer of stress.
The thing that really disturbs me is that the Professor who developed the programme himself admits that they can’t predict whether the problems are just a phase or whether they are indicative of a deeper problem.
Then what’s the point?
But I’ll add this caveat: I don’t have kids (yet – hopefully soon) so I have no idea what it’s like to live with extreme tantrums and other issues. Maybe if I did, I’d be really grateful such a programme existed.
Ipomen Scarlet
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i support this, provided GPs are given the time and additional training to recognise the difference between normal “transient” pre-school behaviours and behaviours of clinical significance. I suspect many younger or more inexperienced GPs would not initially be trained in this. Having said that, GPs won’t be doing any diagnosing of disorders, as some people are suggesting – this will be a screening that may or may not result in referral to a specialist for possibility of diagnosis.
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GP’s don’t need to do this! We have Maternal Health Nurses for this?
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This is a great idea, and i think we just all need to relax a little.
They are not talking about admitting our 3 year olds to a psychiatric unit or medicating them, they are simply going to look at behaviours and feelings and IF there is a combination of these that might point to an emotional or behavioural issue, they will flag it with us. The same way a dentist might raise the point if they notice your child isnt brushing correctly, or a doctor might let you know your child is in a below average weight category.
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The difference here is that a child who is three is rarely displaying mental health issues, they are being children. 99% of children grow out of their childhood behaviours.
Also, what exactly are they going to be looking for? As the article mentioned sleeping with the lights on and temper tantrums are NOT mental health issues. Whereas setting the pet cat on fire deliberately? That is an issue to look at. A HUGE difference. I would hate to think that 3 years olds are going to be treated for problems they will naturally grow out of anyway.
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By the way – I forgot to mention that the documentary series “7- UP” was based also on an old saying – “Show me a child at the age of 7….and I’ll show you the man.”………….I don’t have a problem with 4yr olds being assessed by psychologists as long as those people are very, very experienced, and are supported by at least 2nd opinions.
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There’s a brilliant, brilliant British series created by Michael Apted decades ago where he went into British schools and interviewed several groups of 7 year olds, asking them their views on their lives, their hopes & dreams. I think he admitted that it started out being an experiment on the effects of the “class system” and it’s impact on the children’s future lives……….every 7years he went back to the same children until now we’re up to 56 years of age…..a couple dropped out which is a shame since they denied themselves the honour of being part of one of the most important social documents of childhood and ageing…………what’s fascinating to me is seeing how the children’s personalities develop and which bits remain into adulthood………one dear little boy, so perky and full of life went from being that happy child to a sullen, sad little kid at the age of 14yrs – what followed in his life were repeated bouts of depression and serious dysfunction until at the age of 49yrs he was able to recover enough to become a local councillor………a fascinating series and one of my favourites….it’s called “7-UP”.
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My fave too. Studied it in social analysis class at uni – had a huge impact on me.
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The world has officially gone mad(!!). Any child or adult for that matter won’t be able to have quirks and foibles that make them ‘them’. Are we supposed to live in a society of cookie cutter people with no personalities. I’m sure if they had a good look at me as a 3 yo I would have been pigeon-holed with some syndrome, but so would most kids. Ridiculous.
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There was a fascinating discussion on the Circle this morning, where Leah Giarrantano, a clinical psychologist was interviewed. She spoke about psychopaths and psychopathic behaviour.
She spoke of how psychopaths can hone their tendencies into athletics or stellar business people. They also can also be a product of nature v. nurture, whereas a psychopath has had a traumatic childhood.
She also said that it starts very early in childhood, so by the age of 8, psychopaths have fantasties of harming humans.
It was fascinating to watch, so the timing of this is amazing. I think it would be prudent to carry out these checks, maybe first as a trial to see how it goes.
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This is simply about labelling our children. Temper tantrums and sleeping with the light on are NOT signs of mental illness. I don’t know anyone that has a child that doesn’t have temper tantrums, suffers from shyness in certain situations or other such behaviours during their early childhood.
By labelling the child with already showing certain factors, it will make doctors much quicker to label them as they grow up. It is fairly common knowledge that a true mental illness won’t be properly identified until a person reaches the ages of 18-25. This is due to factors such as upbringing, being a teenager and possibly immature and other such factors.
There is NO way we can deem a 3 year old has mental health issues.
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Really?! Common knowledge!!? Not in the mental health field, where there are professionals dealing with serious mental illness showing in children of all ages, and particularly young teenagers. I don’t know who you are talking to but that is 100% false that mental illness is only diagnosed from 18+.
No one is saying that temper tantrums are mental illness. But if a toddler has several different problems they can indicate that it would be helpful for their parent to seek help to work through them. Not labelling them forever.
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Actually I work within the community service field and have a degree in psychology. I assure you very few psychologists or psychiatrists on the field would consider diagnosing anyone under 18. Yes, there are always some exceptions but they are ver few and far between. Prior to 18 there may be a treatment plan but no formal diagnosis should be given.
Also for most mental health issues, problems should be apparent for at least 1-2 years prior to a formal diagnosis. So does that mean these professionals are making their diagnosis from technically the age of 1?
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So you should be more careful about stating “common knowledge” that disorders aren’t diagnosed under 18. That would be devestating to hear for a young person with depression, a child who is crippled with anxiety or a mother with a significantly out-of-control toddler – just as a few examples. Mental illness exists in young people and it IS treatable.
I have a degree in child psychology and work in the field and I can tell you that we don’t go around slapping diagnoses on children with the few behaviours reported in the media. However, we do diagnose children with disorders when they truly have one. Just like adults, where you have a broad spectrum of ‘normal’ behaiour and a few with mental illness, the same goes for children.
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Oce a label is in place, is it there FOREVER. If a three year old is labelled as having a high risk of mental illness, a doctor will be able to access this information in 20 years time,
I agree with the previous poster, the majority of mental health issues are not officially diagnosed prior to 18 years old. Even if there is some information gathered prior to 18, it is quite surprising how many teenagers grow out of their behaviours. Few will get an official diagnosis before 18 years of age.
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But if the label is there and future doctors can access it – is this a bad thing? I don’t imagine doctors would use this to a person’s detriment. Rather, take it as part of the history taking when assessing someone?
I for one know I suffered from severe anxiety as a 10 year old… it cropped up again when I was 17. But because I had a history of it my GP and my family were on top of it. I was ‘labelled’ in some negative way… instead it was another tool for my GP to use.
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Ess is right on the money. Mental health problems often become apparent in teenagers as that’s when the brains chemistry is starting to shift (amongst other things) and sometimes you can even see the signs before. I work with kids from neglected and abused backgrounds and so I’m for early intervention. Kids who’ve suffered trauma will have a negative impact no matter what age. While they may not be your more commonly know depression and anxiety, attachment disorders are common in this population. I think this is a lot of what they will be screening for. If you get in early you can help kids form secure attachments – something that is incredibly important in our lives, not to mention helping with long term mental health.
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not diagnosed till 18-25?? Maybe that’s sone of the reasons we have such a massive issue with youth suicide in Australia.
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Great idea – early intervention can make a huge difference to a child’s future. Also hope the check focuses on what is going on in the family that is impacting on the child’s behaviour, and addresses those issues too.
Why do people think a young child would be any less susceptible to struggling with their feelings than the rest of us??
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In Tasmania when I was growing up they health checks were done in Kindergarten at school.
I think this is a much better idea as everyone gets access not just those parents who care enough to have it done.
but they start school at 4.
These initiates rarely benefit the kids who need it the most so I wonder if the funding could be redirected into other areas or ways to access those kids that need it the most.
Health checks through preschool or kinder may be a more suitable option( a nurse came to the school in Tasmania and they were done every few years- My eye sight problem, glue ear and curved spine were picked up in a health check at high school)
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I think there is a huge over-reaction to the words ‘mental health’ check and an automatic assumption that if any red flags are raised, that medication will be automatically offered as the treatment. I happen to think these checks are a good idea if implemented correctly. I have a now 13 year old son who had terrible behavioural and emotional issues as a toddler. I literally begged for help for him and was simply told everywhere I turned that it was my parenting skills to blame. Well it turns out amongst other things he is developmentally delayed and on the autism spectrum. Skip forward to my just turned 5-year-old and he is a very typically developing boy in most ways except for the fact that he has crippling shyness when around anyone other than immediate family. A year ago he would not utter a single word to anyone else. He would not play with other kids and spent all of his time at Kindy alone. Despite having adequate language skills he could not communicate his needs with those around him nor could he interact socially. Devastating for his development and yes, potentially for his mental health. But we did not lock him in an asylum or medicate him to the eyeballs, we simply had some wonderful play-filled sessions with a child psychologist (that he loved) who gave us strategies to use at home and Kindy to bring him out of his shell a bit and to help him overcome his anxiety.
Today he is still a quiet, stand-back-and-watch kind of kid but he does talk to his Kindy teachers and he does have a few friends that he will play with. Awesome! He will never be the outgoing leader of the pack but that is absolutely fine! He has improved his skills enough to be able to function and without this intervention I would hate to think how overwhelming school and socialising would be for him throughout his life had we not been made aware that his behaviour was not ‘normal’ and got the bit of intervention that we did. Not all intervention needs to be a negative experience nor does there need to be such a stigma associated with helping ‘normal’ children achieve their potential.
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Well said. I’m so glad you persisted and found some great assistance for your sons
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Thank you so much for the words of support. It has been so worth it.
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I initially thought these kinds of checks at 3 were a bad idea and reading through all the comments to see what others had to say and your comment really made me stop and think.
I’m so pleased that you found such great support with your 5yo and that you eventually found support for your older son as well. The kind of intervention you describe for you 5 yo sounds fantastic and most critically gave you strategies as a parent.
I think the way it has been reported is possibly inflammatory. In fact I would expect most Early Ed Nurses and GPs are looking for issues during the early years checks already.
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Hi JustMum
Could not agree with you more. Your experience is similar one to my own. My child has asperger’s and sensory processing disorder. The kindy teacher saw signs that we just put down as shyness as we had no other children and no bench mark really. We subsequenty had 3x qualified health prof make the diagnosis and we have been having early intervention for past 2.5 yrs. We are so grateful for the early intervention as it is making a difference. Our child had anxiety – something I never thought a 3 yr old would have. Our child was not medicated and it’s not a conspiracy to label children for life or for big pharma to make $$.
Wishing you all the best.
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After some initial reservations, I can see the benefit of including this in the Healthy Check.
It can open a dialogue about any behavioural, social, emotional issues a parent may be worried about. I watched the interview with Pat McGorry and the focus was on bonding and attachment (which is a risk factor down the track) and behaviours indicative of Autism or a disorder on the autism spectrum.
I can’t see a GP being the one to diagnose a 3yr old with a mental illness but rather offer additional support for kids that appear to have “risk factors”. My partner was diagnosed with ADHD as a kid and even now the GP always wants to send him off to see someone to “review” the diagnosis.
My youngest sister was quite shy and anxious as a kid, received some additional support in school and now as an adult has no issue with an anxiety disorder. She was never “diagnosed” but rather it was noted that she could benefit from learning about how to cope with anxiety.
In terms of anxiety, depressive, and schizophrenic disorders there isn’t many drugs that would be prescribed. It would more be behavioural interventions. Many of which I have used in my career as a nanny.
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As a friend of an almost 4 year old girl with a possible chemical imbalance, I think this is awesome. It means my friend and her mummy (my bestie) are going to get the support they desperately need.
Lets get some perspective here, we’re not talking about all 3 year olds who are scared of the dark. Or shy. Or have tantrums. These things IN CONJUNCTION with other concerns (violent outbursts, self harm, anti social behaviour…) will pave the way for these families to have their concerns really listened to and followed up accordingly, rather then having these real problems dismissed as normal toddler behaviour when clearly, they are not. My little mate bites herself till she bleeds, and doesn’t remember doing it after. That’s not normal.
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This goes against everything I know about mental illness. I am not an expert just someone with a serious condition who has tried to read up on it – including peer reviewed material accessed through my university library subscription.
From my understanding of years of reading mental illness tends to evolve in a person, not be something they are born with in a complete sense that is occurring from day one. You can be born with a genetic predisposition but how, when, if, why and in what form it comes to the fore is dependent on many factors such as experiencing trauma when young, lifestyle (drug use or alcohol), emotional stability of family etc. Some people are also born with no genetic predisposition and may become mentally ill solely through something like drug use.
Point is, at three years old in my understanding you do not have a mental illness so advanced you are symptomatic – these things gradually come through, typically from teens onwards right into late adulthood.
The only exception of I have read of is a controverserial experiment where they are possibly identifying pyschopathy children.
I fear this will most definitetly lead to over-medication. It is already a problem in our society. So much easier to drug. I am pro-medication and I take it, but I know for many overworked and under resourced doctors it is just easy to drug and sedate and that could happen to these kids.
A developmental check is by all means necessary, as is checking on the lifestyle the child is living (happy home etc). If you want to include mental health what should be included is an outline of the family history in mental health so that those with a genetic history can be noted and checked at key points – like puberty, late teens, early 20s etc.
Not checked for ‘symptoms’ just a plan put in place to ensure those predisposed get extra checks and are flagged – at a later age you can check for symptoms.
This sounds like it was done with the best intentions but is really worrying. We are already seeing children diagnosed as bipolar under the age of 12 – a condition which is widely accepted to only come to the fore from late teens on. I don’t accept that many children are bipolar, or schizoaffective. These children are heavily drugged. Let’s not do that.
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There are certainly some problems that can be identified as early as 3, kids can have really debilitating anxiety that prevents them from participating in anything. This would really hold them back in their development so it’s much better to have them identified early and addressed so they can get back to being a regular kid. I’m not talking medication, but therapy here.
I hope you’re managing ok with your condition.
Our brains do most of our developing and organising in the first year and so individual differences also come up early.
Good on you for reading in peer reviewed material
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I might be going against the grain here, but I think this is (for the most part) a good idea.
My oldest, now 3.5, was always a very quiet, clingy and nervous child, scared of lots of unusual things. I just put it down to her personality, but when she was not talking at 2, I mentioned my concerns to the nurse at her check-up at our early childhood centre. We put her name down for speech therapy and the developmental pediatrician – both had long waiting lists. We managed to see the pediatrician when she was 2.5, who was lovely and my daughter enjoyed the play-based session. Her anxiety was classified as severe and I felt terrible that I had not been more on top of it. We were referred to an OT and a private speech pathologist, who both agreed she had a sensory processing disorder. After 7 months of therapy, she Improved dramatically and her speech has now caught up. She is now much more confident and can overcome her anxieties herself.
So while I understand people’s concerns about dr’s over-diagnosing some conditions, without these sorts of checks my daughter’ issues may never have been picked up… Early intervention can do wonders!
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Thanks for sharing your story for readers to consider. All the best with your eldest and your family
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Shit, if you were to take our replies seriously to the 3 Year Old article last week (was it last week?), half of our toddlers would be medicated by now. I think most mothers already know if their child is showing some behavioural problems before age 3 and are doing something about it.
For the rest of us, if your child doesn’t listen or reason, has tantrums, meltdowns, hates talking to anyone apart from family, etc, etc, it all seems like perfectly normal 3 year old behaviour.
Surely, we could wait until the child is four when there seems to be a little more maturity in our children’s behaviour and then we can see if the bad outweighs the good?
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I’ve experienced kids with issues who have parents who cover for them. It’s really sad – all they need to do is admit something needs work, but they deny it.
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This could have saved a lot of heart ache for a friend of mine whose son has just been diagnosed with ADHD and ASD.Early intervention is SO important – I’m all for it.
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Today is my beautiful Emma’s 9th birthday. At 3 she was diagnosed with an intellectual disability and autism. At 2.5 everyone including the child health nurse and my GP said “she’s just slow, she’ll catch up”. At 2.5 she was still walking on her knees, was not babbling let alone talking, was making no eye contact and would head bang furiously if she was in a room with bright lights or lots of kids. When I raised my concerns my GP patted me on the knee and said “oh she’ll be okay”. For all you people who say its crazy to assess them for mental health, I say you don’t have a child with a disability and you have no idea. When our second child turned 3 I realised just how far behind the eight ball Emma was at 3. It needs to be done BEFORE they start school!!! Early intervention is the key, if its only picked up by the time they start school, the schools are scrambling to provide a service. If its picked up before they start an early intervention plan can be set in place. Educate yourselves please. Go find a parent of a child with a mental health issue and see what they say if they had a chance to have their child assessed at 3 instead of being treated like a numbnut and beating their heads against a brick wall for years until someone finally listened to them. Oh and Emma’s doing really well now, thanks to her parents jumping up and down until someone listened and to the wonderful intervention therapy we were able to get her BEFORE and during school.
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Well said Ali! Our son’s story is similar to Emma’s and as a parent you never want to hear that something’s not right with your child, but the alternative of not getting the support they need as early as possible is so much worse. I really hope that not only do they bring this in for 3 year olds but that there is also a much needed increase in access to services for those who need it.
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I think its a great idea. Anything that helps a child who is at risk. But often kids who are at risk are the ones who dont have all the necessary health checks, or their parents dont recognise that there is a potential issue with their childs health or behaviour. So is this going to be administered like with vaccinations? Is being up to date with this check like vaccinations and documentation rquired at the time of school enrolment, or is it optional?
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