Whether it’s Donald Trump or our children, mental health diagnosis involves more than a ‘yes or no’ checklist

Since being elected US president, Donald Trump’s mental health has been under an unprecedented level of scrutiny. What seems to legitimise this flurry of media attention is the question, “Is he fit for office?” When it is within the reach of Trump’s erratic hands to press the button that fires nuclear missiles, we feel both the weight and urgency of that question. 

However, to frame the ramifications of someone’s mental functioning strictly in either-or terms (“Is he mentally fit to serve as president or not”) distracts us from the wider social and cultural damage that Trump has inflicted on the global community. 

As former FBI director James Comey said in his interview with ABC anchor George Stephanopoulos, the danger of Trump lies in his erosion of fundamental American principles and values and his unabashed attacks on truths and norms. What is all the more alarming, Comey added, is that “[Trump’s antics] should wake all of us up with a start, but there’s been so much of it that we’re a little bit numb and that’s dangerous”. 

By widening the scope of scrutiny from the simplistic question of whether Trump is mentally fit enough for office or not, Comey introduces more depth to the discussion by addressing the president’s moral fitness and what that portends for the future and welfare of his country, and, I would argue, to our increasingly globalised community. 

Similarities can be drawn in understanding the mental health of our children, especially when it comes to how parents approach mental health assessments in Hong Kong. When presenting their child for assessment, parents tend to focus on what they consider the million-dollar question: “Does my child have ADHD/autism/what-have-you, or not?”

Usually, there are concerns – some long term, some short – that prompted the request for an assessment. A child’s academic performance might have been less than stellar, he might have difficulty focusing on and remembering homework assignments; she might be uncooperative in class, isolated at school and withdrawn at home. Or a child might have difficulties with language development, making and keeping friends at school, and regulating emotions. 

First, some background on assessments. A diagnosis is not simply a matter of matching the diagnostic criteria against a cluster of observable behaviours, ticking all the boxes that match, and adding the number of boxes to get a score. That’s part of an assessment, but definitely not all.

Just as a runny nose can indicate a flu, a cold, an allergy, or something stuck in your nose, one symptom alone doesn't tell us much, except that it warrants further investigation. 

If we see a cluster of symptoms, then the picture starts to become more informative. For example, if we are forgetful, lack motivation and are unable to focus, then we can start to narrow it down to some likely possibilities: is it depression, anxiety, attention deficit hyperactivity disorder (ADHD), or something else?

But, as you can see, even with a cluster of symptoms, we still don't have a definitive answer. Some parents are alarmed when a child shows behaviour that fits some symptoms of a condition, and feel sure their child has that condition. That is premature. A thorough interview and observation needs to be conducted by a professional as part of a comprehensive assessment process. 

Nowadays, many children are presented for an ADHD and Autistic Spectrum Disorder (ASD) assessment. When the result is that the child doesn’t have “the scary letters”, parents are usually greatly relieved. That is welcome news.

However, this is also where the Trump either-or analogy sets in. When an often-dreaded diagnosis turns out not to apply to their child, parents tend to feel that all their worries have then disappeared. 

Without the label, parents tend to make a leap of faith and conclude that it means there is no problem. Their anxiety subsides, and the problem areas that first brought their child to an assessor’s office seem less problematic, at least. Sometimes, parents chalk off the concerns as insignificant, just a phase, or part of childhood. Somehow, one way or another, whether a diagnostic label applies seems to change the gravity of their child’s situation. 

The truth is rarely that simple. And the truth is that the concerns (depending how severe and how many there are) that motivated an assessment request in the first place tend to continue to affect a child’s well-being and functioning. An unmotivated child who is socially isolated and withdrawn deserves and needs help just as much as a child with ADHD.

Both of these psychological profiles, among many others, can have long-term consequences for a child if left unattended. 

A problem defined is a problem half solved. The goal of an assessment is to get a good understanding of what the problem is so we can be more effective in helping a child. We certainly don't want to give a stimulant to a child who isn’t struggling with ADHD, just as we wouldn’t give an antihistamine to someone with a headache.

A lot of good can be done for a child if we find out more about, for example, what’s causing his low motivation and isolation, and find ways to help him.

Dr Bertie Wai is a bilingual clinical psychologist at Beautiful Mind Therapy and Family Services in Central. She provides therapy to children, teens, adults and couples, as well as parenting consultation