Preschool Socioemotional Screening
Minnesota Senate Early Childhood Finance Division
by Karen R. Effrem, MD
EdWatch Board of Directors
Alliance for Human Research Protection Board of Directors
ICSPP Board of Directors
Issues and Action in Education,
An e-letter produced by EdWatch, a nonprofit organization.
March 9, 2006
http://www.edwatch.org/updates06/030906-SF2841.htm
The following testimony may be useful for similar legislation being introduced in legislatures in states across the country.
Thank you Mr. Chairman and members of the
Committee. My name is Dr. Karen Effrem. I am a mother of three wonderful
children, a pediatrician, and a policy analyst that serves on the boards of
several national organizations, including EdWatch, the Alliance for Human
Research Protection, and the International Center for the Study of
Psychiatry and Psychology. I am here in vigorous opposition to SF 2841 that
would implement mental health screening for three-year-old children entering
public school.
Government sponsored and controlled universal mental health screening, no
matter how sweetly wrapped in the fig leaf of parental consent, should
never, ever be implemented. It is never, EVER, the proper role of
government to set norms for, assess or intervene in the thoughts and
emotions of free citizens, much less innocent, vulnerable, and still
developing children. It is our thoughts and emotions that make each of us
uniquely and individually human, and we use these thoughts and emotions to
understand the world and maintain our inalienable right to liberty.
We are all well aware that the parental consent or opt-out language referred
to for this bill is just a way to assuage concerns long enough to put this
dangerous system into place. Once it is passed with parental consent, that
language will either be changed by future legislators, not enforced, or side
stepped in some other way. The non-existent enforcement of the federal
Protection of Pupil Rights Amendment on invasive surveys is a classic
example of this phenomenon. Another is the lack of parental notification of
their rights in current Minnesota statute 121A.17 to decline to answer the
part of the screening that involves invasive and subjective assessment of
family risk factors, or that parents may have their child’s screening
administered by private providers, or that no preschool screening is
required if it is against the conscientiously held beliefs of the parents.
SF 2841 is proposed as part of the Roadmap for Mental Health System
Transformation in Minnesota, which is an outgrowth of the federal New
Freedom Commission report and the federal Mental Health Action Agenda. The
Minnesota Roadmap clearly states what that plan is for young children. It
proposes to, “…integrate early childhood screening systems to assure that
all children ages birth to five are screened early and continuously for the
presence of health, socioemotional or developmental needs” and then to
implement, among other things, “mental health services and early care and
education.”
Members of the New Freedom Commission as well as groups advocating the
Minnesota Roadmap plan have inherent financial, professional, and policy
conflicts of interest and do not mention any scientific or medical problems
with screening or treatment. For example, Michael Hogan, the chairman of
the New Freedom Commission, was paid by the Janssen Pharmaceutica, the
manufacturer of one of the drugs advocated in the model psychiatric drug
treatment program (TMAP) in the commission’s report. The National Alliance
for the Mentally Ill and the National Mental Health Association, both
supporters, of this legislation and the Minnesota Roadmap received tax
dollars from the federal mental health agency, SAMHSA, to help implement the
New Freedom Commission’s recommendations, including universal screening and
TMAP.
Even if mental health screening did not have these fatal policy and
philosophical flaws, the medical and scientific justification for this idea
is equally lacking. Proponents tell us that mental illnesses are biological
brain disorders due to chemical imbalances of neurotransmitters, and that
mental health screening is therefore scientific and objective and fully
equivalent to hearing or blood pressure screening. They also tell us that
children who screen positive will merely be sent for further evaluation,
that screening does not yield a diagnosis, and that services do not
necessarily mean drugs. Here is but a small sample of facts and statements
from experts and the medical literature that contradict that view:
Not a single peer reviewed study exists to support the theory of a
neurotransmitter (chemical) imbalance as the cause of mental illness or the
means of treatment.
There are no structural, functional, or
laboratory tests or chemical markers that can consistently identify any of
the mental illnesses.
Experts like the US Surgeon General, the World Health Organization, the
chief of child psychiatry at the National Institutes of Mental Health,
psychiatric textbook authors, and the authors of psychiatry’s Diagnostic and
Statistical manual, considered the gold standard of psychiatric diagnosis,
call these criteria “subjective,” “impressionistic” and “social
constructions.”
These same experts also state that it is very
difficult to accurately diagnose children due to rapid developmental
changes.
The screening instruments are based on these highly subjective diagnostic
criteria and are not at all like medical screening tests, such as for
hearing or vision.
In fact, the technical data for the Ages and Stages questionnaire being promoted for this legislation admits that its overall positive predictive value is only 27%. That means that for every 27 children that are supposedly correctly identified by the admittedly subjective DSM or other impressionistic screening instruments, 73 are falsely told that something is wrong with them and referred for further evaluation. That is three times the rate of false positives to putative true positives and worse than a coin flip. Any other screening procedure with that large a false positive rate would be eliminated from consideration with hysterical laughter.
A movement already exists within organized psychiatry to label and drug people mentally ill based on highly controversial political and religious criteria, such as “intolerance.”
Due to reimbursement patterns, government promotion, and pharmaceutical industry influence, treatment almost always means use of psychotropic drugs.
According to a survey of members of the American Academy of Child and Adolescent Psychiatry, 9 out of 10 children that see a psychiatrist receive a prescription for psychoactive drugs.
Dr. David Willis, medical director of the Northwest Early Childhood Center said, “Psychopharmacology is on the horizon as preventive therapy for children with genetic susceptibility to mental health problems.”
Rates of psychotropic drug use in children, often in unapproved, unstudied multi-drug cocktails, as young as age two, have already skyrocketed and will only increase with widespread mental health screening. Psychiatric drugging coerced by schools has resulted in several deaths and has prompted at least 7 states and the US House of Representatives to pass legislation against it.
No psychiatric drug has been found to be effective in the long term for treating ADHD or depression in children.
Every class of psychotropic drug is either under the FDA’s most stringent black box warning short of a ban for serious or fatal side effects or is being so considered. These side effects include suicide, violence, psychosis, diabetes, and cardiac sudden death. There are no studies available of long–term safety or effectiveness or the effects on the brains and bodies of growing children.
Government and pharmaceutical industry promoted drug regimens are rapidly depleting Medicaid budgets.
Even if psychosocial or educational programs were used instead of medications, Dr. Benedetto Vitiello, head of child psychiatry at NIMH said in 2002, “Little research has been conducted to study the effectiveness of psychosocial interventions in young children, and the long-term risk-benefit ratio of psychosocial and pharmacologic treatments is basically unknown.”
In November of 2005, researchers at the
University of California and Stanford released a study that said,
“Attendance in preschool centers, even for short periods of time each week,
hinders the rate at which young children develop social skills and display
the motivation to engage classroom tasks, as reported by their kindergarten
teachers...Our findings are consistent with the negative effect of
non-parental care on the single dimension of social development first
detected by the NICHD research team [in 2002]” This data is suggesting that
not only is there no scientific justification for psychosocial interventions
including preschool education, but that these interventions may be causing
some of the very problems that supposedly justify screening and that they
are purported to treat.
In summary, universal mental health screening and treatment for preschool
aged children is far beyond the proper role of government, lacks scientific
and medical justification and will have dangerous effects on our youngest
citizens. The premier dictum of medicine is “First, do no harm.” Both the
psychiatric profession and policymakers would do well to heed that advice.
For more information, link to these resources:
HYPERLINK "http://www.edwatch.org/updates05/112305-imh.htm"Infant
mental health (11/23/05)
HYPERLINK "http://www.edwatch.org/pdfs/Mental%20Health%20Briefing%20Myths%20and%20Facts.pdf"Myths
and Facts Regarding Mental Health Screening Programs and Psychiatric Drug
Treatment for Children (pdf)
HYPERLINK "http://edwatch.org/MHSbb2005.html"Dangers
of Universal Mental Health Screening, Briefing Book (Newly Updated)
_____
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See also Brave New Schools, Chapter 2: The International Agenda