Children's mental health assessment

Children's mental health assessment is essentially a tool to assist in identifying deviations in children's mental development, rather than a basis for labeling children with "problems." The accuracy of standardized assessments currently commonly used in clinical practice ranges from 65% to 85%. It can only be used as a reference when operated by professionals with professional qualifications, combined with face-to-face consultations and family observations. The reliability of the scattered scale assessment results found online is less than 20%.

Last week, a junior sister who was attending a clinic in the city's maternal and child psychology department complained to me. She said that she met a mother who came in crying, clutching the "Children's Depression Self-Assessment Paper" on her mobile phone, and said that her third-grade son was found to be moderately depressed. "I'm not very strict with him at ordinary times, so why is he depressed?" As a result, it took 20 minutes of face-to-face consultation to find out that the child had failed in the exam last week and had an argument with his best deskmate. He had been in a bad mood for two days in a row. When filling out the scale, he deliberately chose negative options, which did not meet the diagnostic criteria for depression at all.

In fact, there have always been differences in the academic circles on the applicable boundaries of children's psychological assessment. Most researchers in the field of developmental psychology do not recommend conducting emotional and personality assessments for children under 6 years old. The reason is that children in this age group have not yet formed their self-awareness and their way of expressing emotions is unstable. It is easy for accidental factors such as not sleeping enough on the day of the assessment and not being satisfied with their sugar cravings to affect the results. I encountered such an example two years ago. A parent took his 4-year-old son for a so-called "behavior problem screening" and it was found that he had a "high risk of aggressive behavior." The reason was that the child lost his temper and pushed the evaluator during the assessment. After the parents went home, they restricted the child's contact with peers for fear that he would hit others. As a result, after half a year, the child became shrinking and would hide even when someone approached him.

But clinicians who deal with sick children every day have completely different considerations. After all, the manifestations of many children's psychological problems are too similar to ordinary "naughty" and "emotional" problems, and it is easy for parents to identify them by themselves. Let’s talk about Attention Deficit Hyperactivity Disorder (ADHD). More than 60% of parents of children with the disease initially thought that their children just “couldn’t sit still and loved to be troublesome”. They waited until the third or fourth grade of elementary school and couldn’t keep up before they came to see a doctor, missing the best intervention period. And if we use the Wechsler Intelligence Scale for Children combined with the Conners Child Behavior Scale, and cooperate with face-to-face observations by professionals, the tendency of ADHD can be identified as early as around 5 years old. With early intervention, the recovery effect of later social functions and learning abilities can be more than 30% higher than with late intervention. This data is obtained by following up on thousands of cases in our industry, and it is very reliable.

Many parents now always think about "checking problems in advance" and always look for free online scales to test their children. In fact, they have stepped on a big mistake. Formal standardized psychological assessments must have a matching norm. To put it bluntly, it is an average reference sample of children of the same age. If you use the norm 10 years ago to test today's children, the results will definitely be biased - today's children have been exposed to the Internet since childhood, and their emotional expression and cognitive development are much faster than those of children 10 years ago. The old reference values ​​are no longer applicable. Not to mention that many online scales have not been tested for reliability and validity at all. They just throw in a few questions and call them "evaluations." The results are useless except to cause trouble for parents.

Even if it is an assessment done in a formal institution, you cannot just focus on the scores. Last month, I met a fifth-grade child. During the sandbox game evaluation, he set up an all-black scene and painted a completely black picture. The evaluator was sweating at the time, thinking that the child was severely depressed. After talking to the child, we found out that he had just taken an art class to learn ink painting the day before and thought black was very cool. He did it on purpose. If we only judge the child based on the evaluation results, wouldn't it be a big joke?

This does not mean that everyone should avoid assessment at all. If a child has abnormal behavior for more than two weeks in a row, such as a child who used to love running and jumping and suddenly stays at home every day without going out, or frequently exhibits degenerative behaviors such as nail biting and bedwetting that have disappeared long ago, or if academic performance suddenly drops off a cliff, and the relationship with teachers and classmates continues to deteriorate, then it is indeed necessary to seek an assessment from the child psychology department of a regular tertiary hospital, or an institution with registered psychologist qualifications. It is always good to detect problems early.

To put it bluntly, the children's mental health assessment is like a flashlight, which can help you shine a light on the unspoken emotional problems hidden behind the child's coquettishness and tantrums. However, it is definitely not a judgment book. It cannot illuminate the child's entire personality, and it cannot determine his life. Instead of looking for a scale to test your child every day, it is better to ask him more about what fun things he did at school today during meals, and chat with him for a while before going to bed. Your understanding of your child is inherently more reliable than any cold test scores.