A Call for Routine Psychological Check Ups for Children

The tragedy at Virginia Tech last spring precipitated a long needed debate about the interaction of mental health services, courts, law enforcement and other social systems. Hopefully, risk assessment procedures and community responses will continue to improve for at-risk youth. As a child psychologist, I must articulate the value that could be gained by instituting standard psychological check ups.

There is inadequate attention given to the mental health needs of children. While there are uniformly accepted schedules for immunizations and annual physicals, we lack a similar strategy to track and treat our children’s emotional and behavioral health. Mental health check ups should be as widely accepted as dental check ups. This is a simple idea that has been discussed in the mental health community for some time; however, it hasnot received adequate attention among the public at large.

Five, twelve and seventeen.

When children start kindergarten, enter puberty and launch into adulthood they are prone to significant social and emotional upheaval. These transitions are widely believed to be critical time-windows in child development. Thus, at these three intervals, every child
would benefit from a standard psychological check up. This service would be affordable and simple to conduct. In one hour, a clinician could conduct a parent interview, a child interview and score a brief psychological test completed by the parent within 15 minutes.

We currently have remarkably useful, scientifically validated tools at our disposal which differentiate normal developmental struggles from clinical symptoms. Commonly used behavior rating scales compare a parent’s ratings about their child to thousands of other parent ratings. This provides the psychologist with data about how extreme a particular problem may be. For instance, a psychologist can quickly let a family know if their ratings about, say, aggression or thought problems were at the 50th, 75th or 90th percentile compared to other children the same age.

Symptoms that can be assessed in this manner include social problems, attention problems, mood problems, anxiety, adaptability and the like. Check ups could yield three simple outcomes. Parents could be told if a child appears to be growing up normally, is at-risk, or requires formal assessment and treatment. This would not, as some people fear, lead to an overwhelming trend of labeling or pathologizing healthy children.
Psychologists are well trained to appreciate the signs of adaptability and health in children and families. Well-trained clinicians recognize that children and families thrive when their competencies are validated and praised.

Preventative psychological care makes good sense. If recognized early, many moderate “warps” in a child’s personality can be improved with simple interventions. I have seen children overcome school phobias, cease aggressive behavior, pull up failing grades and begin using respectful language at home after only a few therapy visits. Problems such as
these can often be treated quickly, protecting children from unnecessary suffering. We must also recognize that there are children facing severe and chronic mental health conditions requiring intensive and long-term treatments. Even children in this category need systems in place to reassess their progress at critical ages. Child psychologists, who are trained in a scientist-practitioner model, can use validated measures to assess if clients are maintaining a healthy developmental trajectory.

The coordination of psychological care and medical care must become routinized. A significant number of pediatric office visits pertain to psychological issues. Children are frequently brought in to see their pediatrician or family doctor because of symptoms such as mood changes, phobias, temper problems, tics, sleep difficulties, learning problems, or attention problems. Unfortunately, it is rare for families to be granted a full-hour to discuss these matters and it is even less common for families to receive a multi-modal assessment that combines interview, play observation and psychological testing. When
the expertise of physicians and psychologists are combined, children and families are far better served.

Five, twelve and seventeen.

This simple schedule should remind us of the new standard in mental health care for children.

Lisa Bennett, Ph.D.; Licensed Clinical Psychologist, Certified School Psychologist