Karen R.
Effrem, MD
Testimony Against SF 2841 - Preschool Socioemotional
Screening
Minnesota Senate Early Childhood Finance
Division
March 9, 2006
EDUCATION
FOR A FREE NATION 105 Peavey Rd, Suite 116, Chaska, MN
55318 952-361-4931 – www.edwatch.org - edwatch@lakes.comTestimony Against SF 2841 - Preschool Socioemotional
Screening Minnesota Senate Early Childhood Finance
Division March 9, 2006 Karen R.
Effrem, MD EdWatch Board of Directors Alliance for Human Research
Protection Board of Directors ICSPP Board of
Directors 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:
Infant mental health
(11/23/05)
Myths
and Facts Regarding Mental Health Screening Programs and Psychiatric Drug
Treatment for Children (pdf)
Dangers of Universal Mental Health
Screening, Briefing Book (Newly Updated)
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