Wellness and periodic health checkups have long been instrumental in disease prevention and early diagnosis in primary care settings. Annual well-child (by child we also include adolescents) checkups specifically, have led to substantial reduction in many of the acute morbidities of the early twentieth century, increased survival from acute illness, and decrease childhood and infant mortality overall (Schor, 2012). These visits aim to achieve two primary goals: (1) promoting health and (2) preventing disease. The American Academy of Pediatrics (AAP) has created a set of guidelines for well-child visits, delineating what the physician should accomplish at each appointment. The Recommendations for Preventive Pediatric Health Care lists a series of tests, exams, screening, and immunizations that are appropriate for each visit. There are five basic areas of focus on the traditional well-child visit: (1) immunization for disease prevention, (2) monitoring and optimization of physical growth, (3) early detection of disease, (4) health promotion (safety and injury prevention, physics activity, nutrition), and (5) anticipatory guidance (eating, sleeping, self-control, discipline) (Talen, Stephens, Marik, & Buchholz, 2007).

These recommendations also include a developmental and behavioral assessment, that includes a developmental screening, autism screening, psychosocial/behavioral assessment, and alcohol and drug use assessment. In practice, however, well-child visits largely neglect aspects related to psychological and emotional health. What is most alarming is that the field of psychology has also failed to address this issue. Some efforts have been made to incorporate psychological screening and interventions during well-child visits. Scholer, Hudnut-Beumler and Dietrich (2012) implemented the use of a mandatory 10 min parenting video during the well-child visit. Participating parents reacted positively. More specifically, participating parents reported that they benefited from the instructional video on a personal level, indicating that the video was educational, reinforced their parenting and facilitated communication about parenting issues with their physicians. However, aside from a few isolated attempts, there is a large gap between parents’ expressed interests, child and adolescent needs, and what actually happens in well-child visits. One survey (Bethell, Reuland, Halfon, & Schor, 2004) indicated that nearly all parents had at least one unmet need for psychosocial concerns. Another study indicated that 40 % of parents were asked about their children’s learning, development, or behavior (Bethell et al., 2002). These data, although not surprising, certainly indicates that there is a gap between actual practice and ideal practice.

The general population has increasingly more information about the benefits of prevention and seeing a health care professional periodically. Cancer, heart disease, prenatal care, are just some of prevention and early detection efforts that can make a significant impact in the course and outcome of treatment. Dentistry is not much different. It is not uncommon for people to visit their dentist for a cleaning and checkup. When it comes to mental health care, the picture looks very different. Psychology has yet to fully join other fields when it comes to prevention. There are arguably several efforts to develop and implement prevention programs in schools and other settings. These programs are not yet widespread, and many lack adequate research and support from other agencies, including managed care organizations. Significant efforts are few and far between, and have adequately met the needs of population. Even when it comes to actual treatment a large portion of the population do not know that we have effective treatments for a variety of emotional difficulties, or that seeking help early before the problem leads to significant impairment in one’s regular routine can help keep things from every getting that bad—or that there are several options for skills training (social skills, interpersonal skills, emotion regulation, etc.) that can be effective in helping people manage their difficulties. It can be said that part of the reason why psychological treatments are so unpopular is because of the dominance of the medical model and pharmacological treatments, as well as therapies that either harm or do not work (Lilienfeld, 2007; Whitaker, 2010). But that is hardly the whole story. What have we, as psychologists, really done to mainstream these effective treatments and make them a part of people’s lives? One solution might come in the form of early and periodical intervention, such as with well-child checkups. Although the AAP guidelines are meant to encompass mental health checkups, the reality is much different. By bringing the responsibility of this important task to the field of psychology we would be able to provide more comprehensive and specialized services. In the remainder of this paper we discuss the model of a psychological well-child checkup and the overall goals. Then a detailed suggestion for three different age groups (adolescence, middle/late childhood, and early childhood) is provided.

As discussed above, the real picture of well-child visits in clinical practice is slightly different than what might have been intended by the AAP with its guidelines. Nonetheless, within its two primary goals of promoting health and disease prevention, well-child checkups can be said to focus on three main areas: (1) early detection of disease, (2) early intervention, and (3) immunization. The application of these same goals to a model of psychological well-child visits may cover an important gap in current practice. What would an annual psychological well-child checkup look like? We can begin exploring the ideas of a well-child checkup by applying the same main areas of focus within the medical model, namely, early detection, early intervention, and immunization. The primary goals of health promotion and disease prevention would also apply to the psychological model. First, early detection of psychopathology or problematic behavior can have great impact in treatment outcome. For example, early autism diagnosis is associated with more favorable treatment outcomes (e.g., Eikesth, Klintwall, Jahr, & Karlson, 2012). Similarly, detecting parenting difficulties early can potentially prevent significant common problems in later life—including adolescence—such as depression, suicidality, or delinquent behavior. If problems are detected, early intervention of course, would be implemented. For example, Linehan (1993) suggests that a pervasively invalidating environment for a child who is highly sensitive and highly reactive to emotions can lead to significant problematic behaviors later such as parasuicidal and suicidal behaviors. If such problems could be identified early on, before the pattern of problematic behavior emerges, it is likely that significant changes in family functioning can be achieved. Finally, a model of psychological well-child checkups can serve to teach skills and build resiliency in both parents and children. Social skills, emotion regulations kills, psychoeducation about bullying, effective problem solving, relationships, etc. could all be implemented in these regular visits in an age appropriate fashion.

Another benefit of annual well-child checkups would be the potential to reach more people, and intervene before impairment occurs. These can take place either during the annual well-child checkup at the pediatrician’s office if an integrated care behavioral health person is co-located, or by an appropriately trained mental health professional in their office. The current model for psychological interventions utilizes the criterion of significant impairment in one or more life domains. Although this criterion makes sense in terms of making a diagnosis, it is less useful for intervention purposes. Most successful treatments we know, both in the medical and psychological fields, are those that are implemented early. Therefore, regular visits would allow the quick detection of problems as they first arise. Behavioral differences across time would be easily monitored and any developmental problems detected. For example, suppose a child comes for their well-child visit at age 6 and displays age appropriate social skills and behaviors. However, during the psychological checkup in the following year, this child appears withdrawn. It would be clear that a significant change occurred within the past year, and the psychologist would be prompted to further assess the child’s difficulties. Clearly, we do not currently have an exhaustive list of evidence based prevention programs and treatments that could be easily implemented. Much still needs to be learned. However, the existence of periodic psychological checkup would set the occasion for further development of these programs and a wide range of materials such as parenting videos, self-help materials, Web sites.

Psychology faces other challenges that could be ameliorated by the implementation of well-child checkups. First, the scope and reach of our services is often limited to those that are experiencing significant distress. We have learned a great deal about human behavior, psychopathology, problematic behaviors, and treatment, but we are still limited to a simplified model of 50-min one-on-one sessions that fail to reach a broader public that could also benefit from our services. Many of these people we currently do not reach may even experience significant distress, but do not come to seek our services due a stigma about psychological treatment that is still prevalent in our society. Regular visits that start in childhood could potentially bring psychological treatments into the mainstream, making it more of a routine part of one’s care, as it is going to the dentist when one has a cavity.

Adolescence is a period in which many of the high prevalence disorders of adulthood begin to emerge, such as anxiety, depression and substance abuse (McGorry et al., 2011). It is therefore critical for the availability of mental health prevention, early identification and intervention efforts in systems with which adolescents frequently come in contact. Accordingly, primary care screening for anxiety, depression and substance abuse is appropriate, however, complicated. Self-report measures of substance use in adolescence are notoriously unreliable (Harris et al., 2008); furthermore, some experimentation with drugs in adolescence is normative and perhaps even adaptive (Tucker et al., 2006), so subjecting all adolescents to drug screening in a routine psychological checkup would likely cause unnecessary stress for both the adolescents being screened and their parents. Screening for Oppositional Defiant Disorder and Conduct Disorder is also recommended at this age; although ODD symptoms usually develop by age 8, diagnosis of ODD tends to overlap significantly with CD, which more commonly emerges during adolescence (James & Campbell, 2006). Finally, eating disorders tend to emerge concurrently with the onset of puberty in early adolescence, so it is important to assess for them at this age as well (Moon & Campbell, 2006).