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The Australian government has announced a new screening program for three-year-old children to determine whether they have a mental health problem. All children of that age will be offered the Healthy Kids Check from next month, predominantly conducted by general practitioners. As part of this check, which also seeks to identify health problems such as allergies and developmental delays and checks hearing and eyesight, doctors will ask questions of the children’s parents in a bid to identify children who are showing signs of having or developing a mental illness or condition such as anxiety disorder, autism, bipolar disorder or attention deficient hyperactivity disorder (ADHD). Those who are identified as demonstrating such behaviour will be referred to paediatric psychologists or paediatricians for further diagnosis and treatment. Doctors will be looking for such behaviours as shyness, aggression, difficulty with impulse control and the desire to sleep at night with a light left on.
This is a troubling move towards pathologising young children’s emotions as indicators of mental illness. It may be seen as a progressive medicalising of what previously have been understood as normal responses and behaviours. The singling out of such emotional responses as fear of the dark, difficulty in controlling impulses and aggression represents such emotional responses as abnormal and in need of treatment and control, despite the fact that the children involved in the screening are so young that they are barely out of nappies.
Over forty years ago, sociologists such as Freidson, Zola and Illich began to write about the tendency of medicine to exert its power and authority over an increasingly large domain of human behaviour and experience. More recently, Nikolas Rose and others have noted the rise of the ‘psy disciplines’ in particular — psychology, counselling, psychiatry — as well as developments in neurobiology as progressively gathering behaviours under their authority. Rose (2010) has commented on the emergence of the concept of the ‘risky brain’, or the brain considered most likely to potentially cause its owner to behave in irrational, criminal, risk-taking or other ways considered inappropriate. He notes that attempts to identify susceptible individuals is part of a culture of ‘precaution, pre-emption and prevention’, in which it is considered important to identify potential difficulties with the ways in which people conduct themselves, even if there is only a small possibility that these difficulties may occur.
In the Australian government’s new initiative to identify young children who may be susceptible to mental illness in later life, thousands of children and their parents will be incorporated into a web of surveillance in which what seem like very minor behaviours common to many children (such as fear of the dark) will position these children as potentially at risk. Such a program is overtly prescriptive in assuming that young children should not feel fear or shyness or sometimes aggressive towards others, or fail to control their impulses. The notion that children should be able to control their emotions underpins these assumptions. This conforms to a general societal trend towards lack of tolerance of the inability of children to behave in a ‘civilised’ fashion and increasingly high expectations that they should demonstrate emotional control similar to that achieved by adults (see my previous post ‘Animals as children, children as animals’).
While it is important that young children with significant mental illness receive an early diagnosis and treatment, this mental health screening directed at all children in the target age bracket will inevitably result in many children being identified as potentially at risk. It will label them with a possible mental health problem and create great anxiety in their parents. Moral judgements and stigmatisation are inevitably involved in diagnoses of what is considered ‘abnormal’ behaviour in children. Being singled out as ‘at risk’ of mental illness and requiring further medical intervention may lead to the stigmatising of children, potentially for many years.
What is more, there is a continuing debate about how to treat such conditions in children as ADHD, and indeed whether the behaviours incorporated into these conditions should be considered abnormal and requiring treatment. Some critics have argued that ADHD is simply the expression of normal, albeit challenging, childish behaviour that is pathologised because it causes disruption in contexts such as classrooms in ways that adults find difficult to manage and therefore seek to control via medical intervention and treatment with drugs (Visser and Jehan, 2009). The same might be said of aggressive, fearful or anxious behaviour in very young children. Yet it is likely that diagnosis rates of such conditions — and associated therapeutic and pharmaceutical treatments — will rise steeply in the wake of the Healthy Kids Check initiative.
Rose, N. (2010) ‘Screen and intervene’: governing risky brains. History of the Human Sciences, 23(1), 79–105.
Visser, J. and Jehan, Z. (2009) ADHD: a scientific fact or a factual opinion? A critique of the veracity of Attention Deficit Hyperactivity Disorder. Emotional and Behavioural Difficulties, 14(2), 127–40.