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 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.”
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.”
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
I found the 4 year old health checks are just a money generator for G.P clinics( maybe not all but our local one)- a nurse does it by asked a few questions and nothing is really looked into or done with the info.
Waste of time- a check for parents I. The blue book would be fine with a list of follow ups required if needed.
Most health care plans are abused as money generators by G.P’s- I know as I get send many patients that do not need me because the G.P gets paid to do it.
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My child health nurse did a 3 1/2 year check on my daughter. She found an eye problem I would never have been able to diagnose.
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And a health nurse check up is free.
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I believe this is not as bad as it may sound. Sure many parents who take there child will be given the all clear, but it is the children who are being neglected that I hope this would help identify. Child abuse can show in many different forms when it is currently happening and behavior is one of those.
Also another point is that we throw our hands up with fury that our government doesn’t do enough to support and offer new and differing things to help & support children and parents and now when they do we criticise and crucify them for it!
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The 4 year health check and booster shots are free. My 4yo has just had his and it was a thorough review of his health and behaviour. I thought it was excellent.
I’m not sure why anything that allows GPs and nurses to sight and check children should be considered a waste of time.
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It is the wrong access point to target kids who slip thought the net as those parents wouldn’t go to a G.P.
a preschool check would catch a lot more issues
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I agree that GPs aren’t the right access point to do the check, but I don’t think preschools are either. Preschool is expensive, my daughter’s year of preschool is probably going to be her most expensive year of school for her whole life (not including uni). In Sydney there are huge areas with no access to public preschool, I don’t think there are any public preschools in the Eastern Suburbs or North Shore. Not sure what it’s like in the rest of Australia. People think of these as rich areas, but not everyone who lives there can afford $100-$150 a week for preschool, and so some kids just don’t go, it’s not compulsory.
In light of this, and the huge waiting lists for access to public speech therapy and developmental assessments, I can’t help but think that the money designated for the health checks could be better spent, ie. spent on public preschools, or spent on employing more staff to see the kids who are already on the waiting lists.
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I think this will be a good thing for little kids in horrible family situations.
If a 3 year old is in a family situation with abuse and or neglect of any kind and no one knows yet, it is often the child’s behaviour that is the best indication of what is happening at home. 3 year olds that are being sexually abused for example often exhibit sexual behaviour and knowledge that you would not normally see in a 3 year old. Kids that are badly neglected often hoard food for example.
I’d go as far to say that I think that a big chunk of mental illnesses later on in life stem from individuals that have traumatic family life experiences early on in their development and this affects brain development. I used to feed the homeless and the ones with severe metal illness had nearly always come from the most horrific circumstances. A close girlfriend of mine works at a very large special needs school and the amount of kids that have intellectual disabilities/mental illnesses due to coming from abusive upbringings is scary.
Anyone with a background in social work knows that early intervention and prevention is the key to breaking the cycle.
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very good point
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You hit the nail on the head- Early Intervention has the most impact. By the time children reach school they may face an uphill battle if they have not received support to address areas where they are developmentally behind their peers. And as you suggest this is especially important in disdavantaged families.
I am alarmed at the overacction to this news, as the more support we can give our children in the most critical years of their devlopment the better.
This policy direction backs up research gatherered through the Australian Early Development Index that alarming numbers of children starting school are developmentally vulnerable in multiple domains which is frankly appallingly bad for an affluent western country like ours!
If anything this debate highlights how narrow our understandings of ‘mental health’ and its impact on human development are…
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As a teacher of young children I often am the person to ‘identify’ that a child has physical, mental or other issue for which the child would benifit from specialised support. By the time the children are in my class there is usually a 12 month wait list for support services like speech or occupational therapy so the child does not get the support they need early enough.I think any kind of testing that would help children recieve the support they need at an early age would have to be considered a good thing. While I am aware it is not always the case often parents do not realise that their child has difficulties as they have nothing to compare their child’s development to or dont know what to look for. In my opinion anything that benifts the child has to be a good thing.
Also as for the medicating children – as with all specialist supports I recommend at the end of the day it is the parents decision if their child is to take part in any of it.
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Exactly! Such a great comment, especially relating to waiting lists for services & the need to identify issues asap
Thankyou.
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Spot on Miss Maya, I couldn’t have put it better.
My son was diagnosed with and autism spectrum disorder just before he turned 6, his ‘difficult’ behaviours and social awkwardness weren’t picked up until he was in 4 year old kinder, then took another 8 months to get in to see the paed and associated specialists to get the diagnosis. I our case, I truly believe that this mental health check would have pointed to developmental issues in my son.
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I just don’t understand, possibly because I’m not an expert on this topic. How can someone as young as 3 have depression (which they said was on sunrise was one of the reasons for the check) sleeping with a light on, tantrums and being shy is apart of being a 3YO to some (not all) children isn’t it? As a parent I would be gut wrenched to think people were judging me (we get judged enough) if
My son is to chuck tantrums at that age… To then
Suggest he may have developed a mental illness ?! I just can’t wrap my head around it to be honest.. I know the infant mental health study suggests CIO techniques give children anxiety so I understand how they can get tested for anxiety but depression?! *shakes head* (not starting an argument on CIO just stating what I’ve read) I’m also worried people may use this as an excuse.. “my child
Chucked a tantrum or is shy they must have something wrong with them” kids really aren’t perfect, I’ve never seen a perfectly behaved
Kid.. I know the professionals state they will see normal behaviour and look past that but will they really? There are a lot of questions to ask.
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WTF? I had never heard of the Healthy Kids Check before today!!!!!
I am a paediatric nurse and I have 3 children – the oldest is almost 5. None of my friends and family with young children seem to be aware of this either?
Who initiates the check? Does it fall on our GP (should it have been done with the 4 year old immunisations?) Or was I supposed to seek it out?
Sounds like another super idea from the government that looks great on their portfolio but isn’t made widely known to those that would actually benefit….
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Hi Beck, the 4 year-old health check was initiated somewhere between my almost 7 year old turning 4 and my 5 year old turning 4, as the 5 year old had it but he 7 year old did not. It was done at the GP when he had his 4 year old immunisations. They booked the extra time with the GP for the check to be done when I made the appointment for his immunisations. Having said that however, the GP was in such a rush on the day that despite having booked the extra time especially, he raced through the check and completely missed important parts of it that luckily I was on top of any way. I guess the potential is there but it has to be implemented correctly for it work.
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My 8 year old was offered it, but we had already had her seen by colleagues of mine (child health nurses) and given her vaccination. Ideally, it is done with vaccinations and your GP should initiate it. I’m surprised you haven’t heard of it.
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I checked my “red book” for the 4yr old check for my 4 yr old born in 2007 (before the “Healthy Kid Check” was implemented).
I also checked the red books of my 2.5 yr old and 1 yr old…exactly the same for the 4yr old check…
Where is the information on the “Healthy Kid Check?” Why does it fall on the GP? I think my GP is fantastic but I know there are plenty that aren’t. Why isn’t it in the red book?
I guess my point is, how may people don’t know about it and how is it different from the old 4 yr old check?
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My son was diagnosed in a country that used this system and this is how it works:
My son was diagnosed with possible Aspergers (he was not given a formal label, but in Australia you need one for school funding). His symptoms were delayed speech, lack of age appropriate social skills, and inability to function within a structured environment.
A GP cannot diagnose Aspergers, this must in most states (maybe all?) done through two approved mental health specialists.
Following his diagnosis my son was given in classroom support (he was at kinder), speech therapy and went to a specialist playgroup. He was given extra hours of support to transition him to school, and a special class of 12 was set up for the two ASD children in that year.
The medications began when we moved to a state in Australia that doesn’t have particularly good strategies for schools, and the teachers were not able to cope with them in classes of 32 children (despite the school being suggested to us by our state department). So we medicated our son at the school’s request. We saw his psychologist and paediatrician before we agreed to it. The government collects and registers children on ritalin and other similar medications, and rarely is it given to very young children as it suppresses their appetite.
I am presently looking into a specialist ASD school in NSW or England as my son misses at least 1/3 of his education each year due to behavioural issues.
At present the best system is probably to support all kids with learning and behavioural issues in a school (after all, kids going through divorce or death or a new school might need help too), without having to force a diagnosis on them, but someone in government somewhere probably needs to meet a KPI…
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Laws for Clouds, I read this with great interest. Was your son’s early assessment done in the UK? How old was he at the time? It seems the support in Australia is clearly lacking in light of your experience. How did you find the process personally? For you and your son.
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He was diagnosed in New Zealand at around age three, over multiple appointments with two specialists. In Australia he had the same diagnosis at age seven but in only one appointment with two specialists due to demand for the service/the fact he’d already been diagnosed.
I find the support for parents is brilliant through carer’s payments, mental health care plans and health care cards. I find the support for schools is generally just a response to crisis management, which is extremely frustrating when I can see a crisis coming!
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I feel very sorry for parents who think Autism is a mental illness. I think less time in front of dim wit medico’s will do you a world of good. This programme has nothing to do with developmental disorders such as Autism and as for Laws for Clouds..how can you have “possible” Aspergers? I think these funds would be better served for parenting classes . It is a clear case of “Medicare card? Sign…next” . Doctors who support this crazy scheme should be ashamed ..
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My daughter is coming on to being 3yrs old. I would have no problems having an early assessment done on her. This is not a diagnosis of mental illness and this is not to chuck drugs down a toddler’s throat. It’s about considering every day behaviours. Just like at my daughter’s 2yr old check up the clinic they asked me about tantrums, sleeping, can she build a tower of blocks, is she talking in sentences etc. I trust my GP and I trust my early childhood clinic. More importantly I trust my own judgment for my children. Anyway, all these developmental assessments, including this one, are voluntary. You don’t like it, well, don’t do it.
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That kid has the most perfect skin. He’s positively glowing!
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Prof Oberfield:
If you CAN’T predict which challenging, stressful and distressing behaviours in our three-nagers are going to disappear and which ones are going to go on and cause mental health problems…. then what is the point?
Perhaps we should wait a bit before handing out the diagnoses those with no frontal lobe?
Most toddlers exhibit worrying behaviour anywhere from hourly, to daily to monthly. Call me a cynic but it sounds like someone is trying to make $$$ out of pathologising the poor tackers.
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Early intervention is a life changer for many mental health problems. Mental health is as important as physical health. So the positioning of this article is a little upsetting.
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Couldn’t agree more Katie. I am going through the process of getting my 2.5 yr old assessed at the moment and it will take 6 months to get into the early intervention clinic. Having autism and ADHD on both sides f the family, I’ve seen the benefits of early intervention, and the struggles without it.
I wholeheartedly support this, my 2cents are that the benefits of supporting families with early intervention where needed far outweigh the potential downside of over diagnosis.
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i dont think anyone is suggesting that early intervention is not important, but to screen the entire 3yr old population at large is perhaps wasting resources that would be better directing at helping families such as yourself. When a parent recognises a problem it should not take so long to get the assistance that is needed. Maybe if more resources were poured into this area, you might get the answers you need sooner. Best of luck on your journey.
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I picked up on this story via ABC news on facebook a few days back…the comments on ABC news page overwhelming think this is a terrible, wasteful Gillard Government programme. Again this Federal Government is funding a programme to the tune of 11 million which will result in –NOTHING– other than worry poor children and their parents.. The people who think this will be of benefit need a mental health check themselves..Leave children alone. The ABC facebook page, in comments from readers, provide more insight into why this is appalling, the Author of this article should go into more detail if posting about such a controversial topic like this..
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Crazy
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err and my now 5 yr old never had any Heathy Kid Check either…didn’t even know about it.
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oops neither did mine!
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Are you sure? I remember being tested for hearing and sight at school when I was 5. In 1985!!
I think it’s always been happening, to some degree?
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I remember that too and mine has had hers done as part of school testing, not a Kevin Rudd Healthy Kid Check when she was 4 (infact the GP didn’t even mention it when she had her immunisations so did anyone actually know about this KRudd initiative?)
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Mass vision and hearing screening in preschool/prep has been going on for donkeys. School nurses are the ones who do it. The teachers will refer kids for speech, gross and fine motor assessment if they’re concerned too.
The KRudd initiative has been widely known, but I guess it’s use varies from doctor to doctor. Weird, given there’s a financial incentive for GPs to do this check.
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There was a letter sent to us from our GP on behalf of the government to make an appointment for the 4yo check, it was free and the clinic nurse did it. All was fine so I thought it a bit of a waste of time but for kids who have issues it’s a good thing.
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We combined our check up with the 4yo immunisations and were not charged for the consultation. Win/Win
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I think 3 is too young for this kind of thing. I also wonder whether this would be better done through preschool funding similar to the 4 year old eye sight testing, rather than gp check’s. GP’s are too busy, and don’t really have an accurate picture of a child compared to a preschool teacher who sees a child over a longer period of time.
I have a child who has been treated for anxiety, I had to pursue it all myself. I think more information at a preschool level would have been helpful. My GP isn’t really my first choice for these behavioural issues anyway.
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*shudder* GPs are not experts on mental health, and wanting to sleep with a light on, throw a temper tantrum, or hide behind mum when there’s people you don’t know about, are all perfectly normal three-year-old behaviours. Hell, there are high-functioning adults who might want to sleep with the light on, because they can. It’s hugely open to exploitation and stuff ups. I have an elderly father with dementia whose treatment order was issued by the Mental Health Tribunal – do you think the GP follows it or listens to us? No. Does he think he knows better than the tribunal and assorted specialists? Yes.
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My child had a hearing problem picked up at her 5 year old screening. I know its controversial now, but I think early diagnosis of mental conditions can lead to much more effective treatments. I’d be willing to watch and see if the program actually does some good before trashing it completely.
The skepticism seems to be in whether mental illness can actually be diagnosed at such a young age, but don’t we have to rely on the experts to answer that question?
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what i’ve read is that the skeptics are worried that normal 3 year old behaviour will be labelled as possible mental illness, and mental illness being over-diagnosed as a result.
i have a 3 year old who is intelligent and gregarious, but also sensitive and can be anxious, leading to sporadic full-blown anxiety attacks (which some people might label tantrums, if they didn’t know my kid). from what i’ve observed, read and researched, and spoken to my doctor about, i am sure this is normal, although not common, 3 year old behaviour. my husband and i are trying to help develop the tools to get him (and us) through hard times.
i don’t think every child at such a volatile age (hormones and emotions raging, extreme growth and development, both physically and mentally) needs mental health screening. the majority of parents, i think, ask for help when needed.
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