Half of mental illnesses begin in childhood. But is the age of three too early to tell? Credit: everystockphoto
SYDNEY: Behaviour and social-emotional functioning assessments have been added to a regular health check for three-year-olds in Australia.
Last year’s National Mental Health Reform pledged $11 million over the next five years to expand the Healthy Kids Check, a universal voluntary health check, adding elements to ensure toddlers’ social and emotional development are on track.
With the start of the new fiscal year, an expert panel of clinicians and researchers is making its final recommendations to the federal Minister for Mental Health and Ageing, Mark Butler, but the very concept of a mental health check for preschoolers has been called into question by visiting American psychiatrist Allen Frances.
“Completely impossible to realise”
“The preventive efforts that are being considered by the government, which I think have a noble goal, seem to me to be completely impossible to realise, and likely to cause a great deal more harm than good,” warned Frances, who presented his views to a hall full of medical professionals at the Garvan Institute in Sydney on June 19th.
Frances was leader of the task force on the most widely used diagnostic manual in psychiatry, the DSM-IV, and is emeritus professor at Duke University, in North Carolina.
While visiting Australia, he gave several lectures on diagnostic inflation – the rapidly escalating rates of mental illness globally – which he believes has more to do with overambitious doctors and opportunistic pharmaceutical companies than a worldwide epidemic.
Toddlers in very changeable time of life
When asked about the Healthy Kids Check, he responded, “Here, diagnostic inflation is expanding so fast that it may actually burst the balloon.”
“The three-year-old is in a very changeable time of life. The fact that a three-year-old needs a nightlight, or is having trouble separating from a parent shouldn’t be panicking everyone into thinking that they have the precursors, prodromes for psychiatric disorder,” said Frances. “It’s way too early to be predicting, and I think that it’s just a little bit weird that this idea has gained that much traction.”
“I want to dispel the notion that this is a mental health check. It’s not a mental health check,” said Frank Oberklaid, director of the Centre for Community Child Health at the Royal Children’s Hospital Melbourne and chair of the multidisciplinary expert panel developing the program.
50% of adult problems begin in childhood
Instead, said Oberklaid, the changes are a response to the concerns of parents and criticisms that the existing check, conducted at four years of age, came a little bit late. The Healthy Kids Check will continue to check height and weight, immunisation status, nutrition, hearing and vision, but will now also provide parents an opportunity to air concerns about sleep problems, temper tantrums and their children’s interactions with peers.
“We know that 50% of adult mental health problems begin in childhood,” said Oberklaid. “There may be clues in those early years, at the age of three or four, when things are starting to go off track.”
“The developmental milestones for kids have tremendous individual variation. Kids don’t talk at the same age, they don’t walk at the same age, they don’t toilet at the same age,” said Frances.
Frances’ own grandchildren were in the audience, visiting Australia with him on a family vacation. “You should have seen these guys at two years. They were late talkers, late walkers, everything that could go wrong. He’s really smart now and he was in special OT [occupational therapy], PT [physical therapy] and all kinds of stuff. He’s the most brilliant graduate of that program,” laughed Frances as his grandson, now in his teens, sunk deeper into his chair.
“The program could take great credit for it, or maybe nature took its course and myelinated [strengthened] some of his nerve cells.”
Contact with health professionals important
Frances pointed to a recent study, published in the Canadian Medical Association Journal this year, which found age was the best predictor of whether a child received a diagnosis of ADD or not. “If you’re the youngest kid in the class, especially a boy, you’re much more likely to get the diagnosis of ADD and [be] treated for it with medication,” he said, “a development difference based on nothing more than age … treated with a pill.”
“You have to worry about that,” said Frances. “The parallel here is pretty close. If this can happen with five-year-olds, the same thing can happen with three-year-olds.”
“We know that many of the concerns parents have about their child’s learning, or development, or behaviour are transient and of no consequence,” said Oberklaid. But he says the stress on parents is very real, and “reassurance about that is pretty important.”
“We’re not diagnosing kids,” he emphasised, “we’re not saying this three-year-old has a problem, you better get some help, and this kid doesn’t have a problem.” But there is a small proportion of children where concerns will lead to more serious things, said Oberklaid, and the fact that parents have established contact to talk to a health professional is important in and of itself.
“The professionals on the committee are very skilled, we know absolutely the potential of labelling and of doing harm, we know the research literature about early detection, we know world’s best practice … we’re not naïve to these sorts of issues,” said Oberklaid.
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These tiny kids are still in imaginary land, somewhat, made or kept that way by their parents and teachers, and all the nursery rhymes and make believe kids stories, that we all feed them.
After all that fantasy beginning, wanting to investigate their psychology, or mental state when their still in fairy tale land to make a judgement/assessment is just ridiculous.
Its going to take most of them till seven, to work out we’ve been tricking them, let alone whether they’ve found that out yet, and what confusions the fantasy stories we’ve been telling them, have caused them to feel, think,see,imagine, and then how that child develops from there, of course there will always be obviously insecure or unsure kids, and kids with “obvious” mental/emotional/psychological developmental concerns,under developed, and well developed academically and socially,which can go hand in hand, kids with good memory’s who will go on to become professionals on big dollars, and kids with crap memory’s like me,who will work in a factory or a trade, kids that just haven’t been able to settle in or become one of the cool kids, or teachers damaging little kids without even realising, the maturity and the way each individual handles their own situation and circumstances,the home and school environment,etc, To say that they’re not looking to make a judgement is a straight out lie, otherwise why are you looking, to access or judge, cant be any other way, busy bodies acting like its doctoring, when its really just being a gig in someone elses family, judge your own kids if you want, but don’t judge mine,thats my job not yours, unless i ask you to, unless i can judge yours, or medicate yours like you might want to medicate mine, unless its obvious, its pre judgement and personal according to personalities between the listener and the looked at,what side of the fence you sit,theirs or yours, your belief system, and individual and personal perceptions about what constitutes not quite right, and how to care for someone, non invasively,without a poison, for instance. psychology knows how to do that but psychiatry doesn’t, and wont, and because they are just poisoning people they haven’t got a clue on how to cognitively heal, in fact they offer no cognitive classes, or courses for their victims in mental health facilities, they offer a telly, and ward to walk drugged off your face up and down in, Would you go and see a counselor who was making you eat poison to your detriment and against your wishes, to talk about love and guidance, sorry, just not going to happen, and thats the problem with mental health, they are for the most “aggressive” nasty judgmental invaders, acting like they are something else, sorry im not buying it. To me everyone is as clever as the next person just some thrive academically and externally for all to see, and some thrive internally, with compassion,understanding emotion and feeling while the other blokes learning what two and two equals, i like the emotional internal lerner more that the academic, but you see im not an academic and i identify with the non academic child, and i understand that child much better and am more tolerant and understanding of that child, what if i was an academic like the psychiatrist with a memory and no personality, it takes all kinds, and psychiatry needs to understand that, and not try to fit everyone into what they imagine is the, normal box.Then poison and leporise, those that don’t meet “their imagination “of whats right thinking/feeling for everybody and anybody, we all develop at a different pace, and we all develop in different ways, for different reasons, there is always a reason and an answer for everything, the very last and most pathetic answer, is a pill.
As Professor Oberklaid describes, three-year-old children may show delay from multiple causes, some of which are amenable to remediation. Contact between mental health professionals and parents is a positive, not a negative. Some comments are from individuals with multiple drums to beat.
Brisbane psychiatrist.
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