Issue 24 / 25 June 2012

SCREENING is always controversial. It has the capacity to convert a person into a patient even though they may feel perfectly well.

It can label a person with a disorder — hypertension or whatever.

Accumulated wisdom distilled from a vast literature has applied a brake on the earlier enthusiasm for screening, although once in a while a fresh outbreak of screening enthusiasm pops up.

Before embarking on screening, the research data caution us to ask questions and provide answers on issues such as, if we find something during a screening test, what does it mean? Who will follow up abnormalities detected at screening?

At a health system and policy level we ask, how does the cost and effectiveness of a screening program compare with those of treatment programs competing for scarce health dollars?

“First do no harm” should be the first priority applied to all screening.

In 2002, the NHMRC published a report on screening children. Under the leadership of paediatrician Professor Frank Oberklaid from Melbourne, the 250-page report considered all the commonly recommended screening tests for children — hearing, hips, hypothyroidism and many more — and explored the available data. Suffice to say that evidence for the value of many screening tests was scant.

By a complex policy pathway, the $25 million Healthy Kids Check, introduced nationally in 2008, is under revision to align it more closely with evidence of effect.

Under the revision, the age at which children are assessed will change from 4 to 3 years and, according to a report in The Australian, it will “check the child’s immunisation status, allergies, height and weight and ask parents if they had any concerns about their child’s behaviour”.

Professor Oberklaid and colleagues continue to advise on the content and form of this program. In the report in The Australian it said the assessment “involves checking the child’s progress against a validated instrument of child development”.

“Each of the criteria to be used was based on peer-reviewed evidence that has been ‘solidly tested’ and used in the US, Britain, and sometimes in Australia”, the newspaper reports Professor Oberklaid as saying.

Great concern was raised by American psychiatrist Professor Allen Frances, while visiting Australia, about “an explosion of false diagnoses that would see youngsters overmedicated and labelled with a mental illness for life”, but that seems not to be a major worry with this proposal.

The knowledge and expertise of the group of experts in child mental health advising on this program provides assurance that any check of a child’s mental health and wellbeing as part of the Healthy Kids Check will be based on good evidence. Let’s wait to see their final recommendations before we judge this new initiative.

Professor Stephen Leeder is the director of the Menzies Centre for Health Policy and professor of public health and community medicine at the University of Sydney.

Click here to read comment from Professor Jon Jureidini, who says there is little hard evidence to support mental health checks for children.

Posted 25 June 2012

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3 thoughts on “Stephen Leeder: Don’t judge too soon

  1. Anonymous says:

    “First do no harm” should be the first priority applied to all screening.

    Agree fully with above statement.

  2. Beryl Shaw says:

    Are none of those advocating for such checks parents themselves? As a mother of 5 and observer of thousands of others, I know that what’s normal for one child of 3 can be totally different in another child.

    And surely your overworked GP is the last person to run any type of psychological check — A. They are not practiced in such matters B. They’re stretched for time anyway.

    Most people will ask their GP if they think there’s a problem with their child anyway. What is being proposed is very far from ‘evidence based medicine’ which has become the buzz word over recent years.

    So keep your hands off those poor little kids!!!

  3. Sue Ieraci says:

    Am I correct in understanding that, in many cases, at least some of the checks will be done by a practice nurse?

    In a sense, this may be replacing the “healthy kids check” of old – the child health nurse who visited schools – they measured, tested eyesight and hearing – perhaps other things I don’t recall.

    What we do know from evidence is that early intervention helps with many later difficulties – behavioural, developmental, vision and hearing. I am wary of the spectre of “medicating normal children” that is being waved around by the conspiracy theorists. How realistic do people think this fear is? Perahps, instead, some young kids with potential problems will get help earlier.

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