Adolescent Health Scale

The "Youth Health Scale" is essentially a screening and assessment tool designed for the three dimensions of physical, psychological and social adaptation of people aged 10-24. There is no universal "perfect version". All scales have clear applicable scenarios and boundaries. They can only be used as a risk warning reference and can never be directly used as the only basis for health judgment.

Last year, when I followed the city's disease control team to conduct annual health screenings for three middle schools in our jurisdiction, I really encountered the pitfalls of misuse of scales. At the beginning, the logistics were easy to organize, so we directly used a set of general adolescent health scales circulated on the Internet to distribute them. As a result, 27% of the children in the collected questionnaires scored the highest score in the "depressed mood" item, which scared the school's moral education department and almost held a parent-teacher meeting for the entire grade to inform them of the risks. Later, we urgently changed to a scale revised by Peking University's Institute of Child and Adolescent Health and adapted to the domestic norm for middle school students, and then worked with the head teacher to follow up the interviews one by one. In the end, less than 3% of the children actually had persistent emotional distress - most of the children with high scores either failed in the monthly exam just before filling out the questionnaire, or they had an emotional quarrel with their parents the day before and checked randomly.

Interestingly, the industry has been arguing for almost ten years about whether the Youth Health Scale should take the "standardized" or "localized" route, but there is still no conclusion. Scholars who support standardization mostly come from the field of public health and believe that only by unifying the questions and unifying the national norms can the measured data be compared across regions and years, making it easier for the national level to grasp the overall trend of adolescent health. The "Chinese Youth Health-Related Behavior Questionnaire", which is now commonly used for large-scale screening in the education and health care systems, is the product of this idea. Its reliability and validity have been verified by nearly 100,000 national samples, and the probability of error is very low when it is promoted on a large scale.

But most of the front-line school social workers and adolescent psychological counselors do not accept this approach. A sister I know who has worked as a social worker in a middle school in Shenzhen for 8 years changed the standardized scale she had on hand and added more than a dozen questions that were not included in the original questions: such as "Have you ever been ridiculed by a teacher in public?" "Do your parents look through your chat history?" "Do you think the school lunch is enough for you?" She always said that those standardized questions were too "floating" and asked "Have you accumulated 150 minutes of exercise every week?" However, many children's exercises are forced running exercises and physical test training, which are not considered exercises that can bring pleasure at all, and it is useless to ask. The results of the questions she revised were able to identify more children who were missed by the standardized scale and were suffering from school bullying or family relationship problems. Of course, the problem with this school is also obvious: there is no unified norm for the self-adjusted scale, and the measured results can only be used for internal reference within the school, and cannot be used for horizontal comparison across the city or province.

Many people still have a big misunderstanding about the scale, thinking that a high score means there is something wrong with it. I have encountered a very outrageous thing before. A private middle school sent the screening results directly to the parents. One of the children in the second grade of junior high school had a high score on the depression dimension. The parents dragged the child to a psychiatrist on the same day and scolded him in front of the child, "We feed you and clothe you. Why are you so unhappy? It's embarrassing." As a result, the child, who was just a little anxious before the exam, swallowed half a bottle of sleeping pills and was sent to the emergency room that day.

Do you think this pot is on a scale? Not at all, it’s because the people using it don’t understand its positioning. The sensitivity of the Youth Health Scale is deliberately increased. The essence is that "I would rather screen a few more suspected ones than miss the ones that are really risky." If a high-risk child is screened, the next step should be to find a professional psychologist for a one-on-one interview and assessment, rather than directly labeling the child as having a "psychological problem."

When I provide training for schools on how to use the scale, I will not give teachers any rigid rules of 1, 2, 3, or 4. I will only repeatedly mention a few points that I have summarized after going through many pitfalls: Don’t engage in “one-size-fits-all”. The results of the scale must be viewed together with three things - first, the class teacher’s daily observations, such as whether the child’s grades have suddenly dropped significantly recently, or whether he suddenly doesn’t like to play with his friends.； The second is a less formal interview. Find a deserted corridor and talk to your child about whether they have been bothered by anything recently. Don’t start by saying, “Is your high score on the scale because of depression?”” ； The third is low-pressure communication with parents. Ask if there have been any changes at home recently. Don’t tell parents that “your child has a psychological problem” right away. Also, when using scales for children under the age of 14, it is best to avoid long questionnaires with dozens of questions. Last time I saw a primary school issued a 60-question scale to fifth-grade children. Many children got tired of filling in the last part and just checked the front options. The results were useless.

In fact, to put it simply, the Youth Health Scale is like a camera equipped with a wide-angle lens. It is okay for you to take a panoramic view and see where the problem may be hidden. But if you take the blurry photo and insist that there is a bad guy in that corner, you will definitely make a mistake. It is never a test paper for grading children. It is just a small step to help us adults, who are used to standing and talking, squat down to see the child's world.