Checking healthy kids

While the ‘Healthy Kids Check’ announced in the Sydney Morning Herald, 10 June 2012, represents a praiseworthy attempt to spend money on children’s mental health, it raises a number of issues in relation to preventative programmes.

Universal prevention programmes such as the Healthy Kids Check are subject to the criticism of labelling, and unnecessary expenditure of scarce resources and finances (particularly in the mental health area). While case finding is relatively easy, case treatment can be expensive and scarce, and should therefore be selective in its application. In the case of 3-year-olds, many such children manifest normal degrees of exuberance, activity and oppositional behaviour, and behaviour management programmes such as Triple-P have been available for some years. Prediction of adverse outcomes is more difficult, and a universal programme needs to demonstrate its selectivity before burdening scarce and expensive resources.

An alternate strategy is to selectively identify early markers of impending illness utilizing a staged approach (Pantelis et al., 2007). For example, Levy and Hobbes (1982) showed that ‘younger’ hyperactive children aged 48 to 71 months showed differences in verbal or performance components of IQ testing greater than 11 points, but ‘older hyperactives’, who continued to require medication at 30 months’ follow-up, tended to have a lower median IQ. Although a small study, it demonstrated both significant developmental markers of possible dysfunction, and a group with more severe dysfunction, none of which would be clearly identifiable at 3 years of age. A staged approach might target identifiable problems such as autism at an early age, learning and attention and possibly conduct problems in kindergarten years, and perhaps later personality problems in the pubertal years. While this sounds grandiose given our current level of neurobiological understanding of psychiatric disorders, this is rapidly changing. Like all prevention programmes, a staged approach would still face issues of labelling, but these would be greatly reduced by having employed targeted and selective strategies. Meanwhile, the present untested programme will need to urgently demonstrate its predictive and therapeutic value.