Screening Kids for Treatable Problems

by Guy McKhann, M.D.

September 22, 2011

As children return to school, it is worthwhile to focus on areas where there have been advances in determining which students are likely to have trouble. There are three articles on that topic in this issue: “Will Students Take a Mental Health Test?;” “New Focus on Concussions Is Altering Prep Athletics;” and “Profile of ADHD Sharpens in Each School Year.” All three articles encourage some form of testing or screening of children.

We screen for many things in medicine, hoping the results are negative but able to respond when they are positive. Almost all screening requires permission from the subject or from the parents (screening for TB in hospital workers and for AIDS in blood donors are exceptions).

For school kids, the problems of acceptance of screening may be emotionally laden; tests can be scary for some, especially if they don’t know why they’re being tested. Education about the methods of screening and the subsequent use of this information is essential for a screening program to succeed. Screening for mental illness, such as depression, has only recently appeared on the scene. The figures for unrecognized illness are astoundingly high, and the outcomes of self-injury or injury to others can be devastating. The idea that overworked and, usually, undertrained teachers can do this alone is naïve. Most teachers welcome the assistance that a screening program provides; it can re-enforce their attempts to get help for a child. How this will be done with presently impoverished school systems is the real challenge.

I have written previously about concussions in younger athletes. Most of the emphasis has been on football, and screening to determine who has not returned to baseline performance after a concussion is a big step forward. But what about other sports, particularly soccer? I have nine grandchildren, seven of whom play soccer. (The younger two are three-year-old twin boys, who seem to be quite able to clobber each other without any help from organized athletics.) Is heading the ball repeatedly OK for your brain? One of my adult sons, a neurosurgeon who plays soccer on Sunday mornings, makes a point of no longer heading the ball. He says that he has had his “bell rung” too many times.

The problem is not restricted to boys, or contact sports (see: “Some Worry Girls’ Concussions Are Being Ignored”). A head injury is a head injury. Your brain doesn’t know or care about the origin. Whatever is developed for football should be considered for other sports as well.

ADHD is not a newly recognized problem for kids. What Mascarelli’s article reports could have been written 20 years ago. It is as if each generation rediscovers the problem. Like mental illness, it can be recognized and, in many cases, successfully treated.

We would all like our children to do well in school. A significant number will have readily diagnosed and treatable problems that interfere with their learning and performance. Screening kids is an important first step in getting them the help they need.