Kiwi preschoolers are undergoing mental health tests - some without their parents' knowledge.
The Ministry of Health's B4 School Check was thrust in to the spotlight after Australia announced plans to introduce a similar programme which created controversy as critics warned about the risk of creating an epidemic of problems such as autism.
The Australian programme would see doctors use a checklist to consider behaviours like shyness and sleeping with the light on as signs of possible psychological problems.
Critics here say New Zealand has been doing something similar for four years. Since 2008, Plunket, doctors, mobile clinics and home visits have screened more than 100,000 four to five year-olds for health, behavioural, social and developmental problems.
In the same period, Pharmac figures show a 140 per cent increase in antidepressant prescriptions for 0 to 4-year-olds between 2009 and 2010, and an average 10 per cent increase in mood-stabilising drug prescriptions in the last five years for children aged five and over.
B4 School includes a checklist called the Strength and Difficulties Questionnaire alongside vision, hearing and health tests. It asks parents and teachers about a child's behaviour, including if they often lose their temper, are easily distracted, are generally liked by others, and if they are nervous or clingy in new situations.
It rates children as normal, abnormal or borderline, and produces a score indicating whether a child is likely to have a significant problem.
The results can be broken down for pro-social behaviour, hyperactivity, emotional symptoms, conduct and peer disorders.
In the most recent quarter one in 10 children was identified as borderline or abnormal. They can be referred to a paediatrician or child mental health expert.
The questionnaire was developed by King's College London Institute of Psychiatry child psychiatrist Dr Robert Goodman.
Community Action on Suicide Prevention Education and Research founder Maria Bradshaw says Goodman's test is designed to screen for mental health disorders, and his website and academic papers outline how scores are used to predict issues like attention deficit hyperactivity disorder.
She says the ministry does not disclose the questionnaire's real purpose to parents, and discourages those conducting the test to tell parents if their child's scores are borderline or abnormal.
Ministry child and youth health adviser Pat Tuohy said the key was identifying issues early, before they became a problem, a view supported by some paediatricians and doctors, who say child health and welfare checks are critical.
Medical Association GP Council chair Dr Kate Baddock said it was a good idea to screen children for problems before they began school. "Particularly picking up deafness because of glue ear. You might pick up autistic tendencies, you might pick up dyslexia, and that's the kind of thing it's good to know before school."
Baddock said while the questions might appear intrusive, they were there for good reason, although that may not have been adequately explained.
Tuohy was adamant the questionnaire was not a diagnostic tool that attaches a label to a child, but a screen that triggers professionals to offer parents help. He said the checks were optional and last year "3 or 4 per cent" of parents opted out. "No one is leaning on them to say they have to do it."
Mum Jordana Clarke put her son Oliver through B4 School six months ago, assuming it was compulsory. No one told her otherwise.
She found the vision and hearing tests useful but said the questionnaire was "very black and white" with little room to elaborate.
"We have a child who is affected by the earthquake, so some of the questions were influenced by that. The teachers weren't keen to do it, they didn't like the questionnaire. They didn't want to tick the boxes because it labels children."
When she completed the forms, a nurse gave them a "cursory glance", and Clarke says she wasn't aware they could stay on her son's medical file, or were being used to predict mental health issues.
"Do kids have mental health issues at that age?"
Other parents expressed similar views. One Auckland mother, who asked not to be named, did her son's check through Plunket.
She wasn't told about or given a Strength and Difficulties Questionnaire to fill out with her son's preschool teacher, and instead completed a form about how well she thought her child was developing. After reading the Strength and Difficulties Questionnaire she described it as "full-on" and broad.
"All four-year-olds display those behaviours at some point. I don't know if I'd like a Plunket nurse deciding whether my son was normal or not. I'd probably try to make him sound as normal as possible."
Another said the questionnaire became a two-hour ordeal that almost left her in tears, with her twin boys' running around the clinic. She wondered how her answers would be interpreted.
"In the back of my mind I was wondering if there were some negatives and they would want to send counsellors round. The forms were fine but you never know what the agenda is."
Her boys' scores came back as normal, however one was almost borderline for discipline.
"But that could have been because I was stressed in the office, so I ticked the box for that day. In hindsight, I wouldn't have." Told she would have signed a consent for the form to go to her family doctor, she said there were several forms to sign, and "I always just sign those things".
A Sunday Star-Times reader poll asked if it was right to profile preschoolers for mental health issues and came back with 49 per cent saying yes, 38 per cent no, and 14 per cent didn't know.
- Fairfax Media
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