It's only fair to share…

Last year I wrote an article about screening of four year olds for illness to see if they are “fit” to start school. The notion that children were not fit until screened to be, so turned the normal notion of healthy until there is some reason to think otherwise on its head. This post has been the most commented on.

This scheme has now been running for a year and it would be interesting to see how much money has been wasted and how many children have been over diagnosed with an “illness” that they do not actually have. As I alluded to, the next stage was to screen three year olds for “mental health” problems.

This is officially due to start on July first!

Whilst it may be well intended, like all poorly devised screening programs the harm will dwarf any benefit.

The notion of screening this age group for “risk” of mental health problems in later life is fundamentally flawed. Normal three-year-old children are and should be emotional. They should run around, have short concentration spans, be pushing the boundaries and scream.

Equally some may be a bit quiet. There is a wide diversity of normal childhood.

Their language development is at different stages as is their capacity to explain their feelings, which is central to any psychiatric assessment.

To be clear, children demonstrating symptoms can and are assessed now. We are not talking about normal diagnosis, we are talking mass screening. The two are very different even though from the outside they may look similar.

There is NO behavior that a three year old can demonstrate that is a reliable  “pointer” to any future illness. The promoters of this scheme say they have tools. Yet these have been put together from a variety of assessments all of which have flaws. When combined the deficiencies are multiplied.

In addition there has been NO testing of this system. Before a drug is released onto the market trials are done with control groups to assess benefit and also harm (side effects). No such testing is being done here. It is just being rolled out.

Essentially Australian three-year-old children and their parents are part of a giant experiment. Normally in clinical trials there is consent and no coercion to be involved. Here, not only is there no informed consent, there is a potential financial penalty (depending on the circumstances of the family) with the loss of a family benefit payment for non-compliance.

It is claimed that 27,000 children will be identified as being “at risk”. As soon as quotas are set there is a tendency to strive to reach them. Hence when in doubt the child will be labeled as having a problem rather than it being seen that they are just being a three year old.

As respected psychiatrist Professor Allen Francis told The Australian the scheme is “reckless”. He added that children at this age were developmentally fluid and that;  “ There is a tendency to use labels too loosely and kids who are going to outgrow them, are going to be harmed by the label and some of them medicated, which may cause difficulty, stigma, change of a parents expectations of a child and affect their life’s chances.”

Worse still, as the false diagnoses mount up this will be used as justification for continuing the scheme. See we were right all along will be the claim. Just imagine if there are no cases found. Funding will be withdrawn and the reputation of the schemes devisors will be in tatters. Not to mention egg on the face of the relevant minister.

According to Frank Oberklaid who chairs the committee devising criteria for the check there is  “zero” danger of false labeling or wrongful medicating of children reports The Australian. (12/06/12)

If there was any doubt left in anyone’s mind, this sort of overconfidence in subjective criteria applied with no trialing or testing and done on hundreds of thousands of children should send shivers down the spine.

There are never any absolutes in medicine. Any psychiatric assessment is subjective and subject to error. This overconfidence, in my opinion, is without any basis and reflects a cavalier attitude to the very real prospect of harm (or side effects).

Nothing, but nothing in medicine has zero potential for side effects.

Media attention is already having some impact. There is talk of delaying till January 2013. There is some backtracking from the idea of identifying mental health illness. I do not know whether this is a real reassessment or if the schemes promoters just want to soothe public opinion.

Based on track records I fear the latter.

The bottom line is that children develop at differing rates. We do not all walk or talk on exactly the same day. Emotional and language development also differs. The assumption that all children will be at exactly the same stage at a given age is 100% wrong.

The assumption that the emotional status of a three year old predicts illness in adult life is fundamentally flawed. The assumption that a screening process can find supposed” at risk” children without doing considerable harm via over diagnosis and incorrect use of medication is fantasy land stuff.

I urge any concerned parent or community member to lobby their member of parliament, ring talk back radio, write to the paper or comment on web sites with your concerns.

Let us hope it is not too late to resist the medicalization of childhood.