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.
While the aim is to prevent mental illnesses - 50 per cent of which start in childhood - the Australian Medical Association and some mental health experts fear children may be misdiagnosed or given psychiatric drugs unnecessarily.
''We have to be careful we don't medicalise normal behaviour and that's a real caution with children,'' the AMA president, Steve Hambleton, said. ''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.''
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 ...
Frank Oberklaid, director of the centre for community child health at Melbourne's Royal Children's Hospital and chair of the expert committee appointed by the Minister for Mental Health, Mark Butler, to develop the check, said their priority was to ''first do no harm''.
''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,'' Professor Oberklaid said. ''Many parents and preschool teachers face behaviours in children that are challenging and cause stress and distress. We also know that 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. What we're really doing is having a more systematic way of finding out those kids who are causing difficulties and doing something about it.''
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.
A checklist of potentially troubling behaviours for GPs is being finalised and Professor Oberklaid said it would likely include behaviours such as aggression, difficulty with impulse control and trouble interacting with other children.
''We'll also look at internalising disorders. Three and four-year-olds can get anxious as well. Children who have persistent fears, extreme levels of shyness, won't go to bed without the light on, won't sleep in their own bed … We want to begin a narrative that says Johnny or Jane is exhibiting these behaviours that cause concern to parents and then put in place strategies to help parents and early childhood professionals deal with them and if they disappear that's terrific. If they don't, then at least those kids will have been picked up by the system.''
Professor Allen Frances, a visiting American psychiatrist who chaired the last edition of the "bible of psychiatry" - the Diagnostic and Statistical Manual of Mental Disorders - said childhood epidemics of autism, bipolar disorder and attention deficit disorder had begun with well-intentioned doctors who wanted to intervene early, but led to widespread mislabelling and medicating.
''Many kids have developmental problems that disappear by themselves and it's very difficult to evaluate in any given child whether the improvement resulted from treatment or just growing up. Before you have a mass national experiment like this it needs to be carefully piloted to make sure that the harms are not going to be greater than the risks,'' Professor Frances said.
Anna Sexton from East Brunswick has children aged 3, 5 and 6 who all sleep with the hallway light on. She said she was concerned this behaviour would be viewed as abnormal under the tests. ''I can appreciate the benefit of early intervention if it's warranted but my gut reaction is one of concern for over-diagnosis.''
However, Chris Tanti, chief executive of headspace, the youth mental health foundation said early intervention did not automatically lead to children being labelled.
While 70 per cent of more than 42,000 young people visiting headspace between 2009-10 and 2010-11 displayed signs of mental illness, only 19 per cent went on to receive a diagnosis. ''When you talk to parents who are really struggling with their kids … they should be able to get help from a very early age,'' Mr Tanti said.
What do you think? Are mental health checks for three-year-olds a good idea or are you concerned it will lead to over-diagnosis? Discuss on the Essential Kids Forums.