Mental Health Screening For Children & Teens

Nearly 1:5 kids in the United States has a mental, emotional, or behavioral disorder, and children and youth with special health care needs (CYSHCN) are at increased risk. According to Children’s Mental Health (CDC), the following percentage of children at any given time experienced the following mental health problems in the United States:

• ADHD: >9% (ages 2-17).
• Behavioral problems: >7% kids (ages 3-17)
• Anxiety: 7% (ages 3-17).
• Depression: 3.2% (ages 3-17)

Often these conditions are comorbid in children. The Bright Futures guidelines from the AAP advises the following: [Committee: 2017]

• Assess family-centered psychosocial/behavioral wellness at all well-child checks.
• Screen for maternal depression at months 1-6 well-child checks.
• Screen for depression in ages 12-21.
• Screen for substance abuse in ages 11-21.

Additionally, in 2016 the U.S. Preventive Services Task Force recommended screening youth ages 12-18 for depression provided there are adequate systems to diagnose and treat depressive disorders. (Depression in Children and Adolescents: Screening (USPSTF))

Compared to routine surveillance, screening improves identification of at-risk patients so appropriate interventions can be offered before problems escalate. A normal screen can also help reassure those who are at lower risk. Responses on the behavioral health screen can be a starting point to discuss sensitive topics during a well-child visit

Mental and behavioral health screening tools and questionnaires vary in length, languages offered, sensitivity and specificity, and whether they are offered on paper or online (or both). Sensitivity and specificity of at least 70% each are considered acceptable for screening purposes (see National Assistive Technology Act Technical Assistance and Training (AT3) Center); however, this information is not readily available for all of the listed instruments. Validity refers to the ability to differentiate between a child with and a child without the problem, and reliability refers to the test’s ability to produce consistent results.

This page provides an overview of the multiple mental health screening and assessment tools that may be used in the primary care setting. Many tools encompass more than one mental health issue, but those that have a primary focus have been grouped into the following categories: ADHD, Anxiety, Depression, Substance Use, and Trauma. Clinicians should evaluate a variety of tools before determining what is best for use in their clinical setting.

The following set of screening and assessment tools for children and adolescents encompasses more than one mental health issue, such as depression and anxiety. A broadband instrument is useful for clinicians who are screening for multiple issues at a time or for use in tracking patients with comorbid disorders over time. The subsequent sections provide examples of focused questionnaires and assessment tools, sometimes called Level 2 screens, to use if there is concern or increased risk for a specific mental health or neurodevelopmental disorder.

• Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) Level 1 Cross-Cutting Symptoms Measures contains 25 questions to screen for depression, anger, irritability, mania, anxiety, somatic symptoms, inattention, suicidal ideation/attempt, psychosis, sleep disturbance, repetitive thoughts and behaviors, substance use, parent (DSM-5 Parent-Rated Level 1 Symptom Measure—Age 6–17 (APA) ( 367 KB)) and youth (DSM-5 Self-Rated Level 1 Symptom Measure—Age 11–17 (APA) ( 250 KB)) versions. There are additional Level 2 assessments to use for further investigation into these areas when a Level 1 screen is positive. Ages 6-17 years. Free.

• PHQ offers multiple questionnaires that range from 2-83 questions: the longer versions address mood problems, anxiety, eating problems, alcohol use, somatoform disorders. Free.
  • PHQ-4: 4 questions to screen for anxiety and depression, general population screen, can be used with ages 11 and older
  • PHQ-SADS: up to 38 questions to screen for anxiety, panic attacks, depression, and somatoform disorder; general population screen, can be used with teens.
  • Brief PHQ: 2-page version of the full PHQ with up to 34 questions screening for depression, anxiety, somatoform disorder, alcohol abuse, and disordered eating, general population screen, can be used with older teens.

• 17 or 35 question versions: internalizing and externalizing behaviors, and attention, 4-16 years. Free. The 17-question version has reasonable validity based on comparisons to similar instruments. The 35-question version has sensitivity of 80-95%, specificity of 68-100% (National Assistive Technology Act Technical Assistance and Training (AT3) Center).

• 25 questions, screens for problems with attention, anxiety/depression, conduct, peer relationships, and prosocial behaviors, 2-17 years. Free. Sensitivity of 63-94%, specificity of 88-98% (National Assistive Technology Act Technical Assistance and Training (AT3) Center).

The following instruments are used specifically for ADHD. Tools that screen for multiple conditions, including ADHD, anxiety, depression, and others, are found in Broadband Mental Health Screens, above.

Conners CBRS (Conners Comprehensive Behavior Rating Scales)

• Shortest versions are the Conners 3AI and Conners 3GI, taking <5 minutes to complete, with 2 more in-depth versions also available. Parent, teacher, and youth versions, assesses for ADHD and comorbid disorders, English and Spanish. Updated for DSM-5. Ages 6-18 years. Available for purchase.

• 45-tems, parent and teacher versions. Assesses for oppositional/defiant behaviors, inattention, impulsivity/overactivity. Ages 5-10 years. Free.

• Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) Level 1 Cross-Cutting Symptoms Measures contains 25 questions to screen for depression, anger, irritability, mania, anxiety, somatic symptoms, inattention, suicidal ideation/attempt, psychosis, sleep disturbance, repetitive thoughts and behaviors, substance use, parent (DSM-5 Parent-Rated Level 1 Symptom Measure—Age 6–17 (APA) ( 367 KB)) and youth (DSM-5 Self-Rated Level 1 Symptom Measure—Age 11–17 (APA) ( 250 KB)) versions. There are additional Level 2 assessments to use for further investigation into these areas when a Level 1 screen is positive. Ages 6-17 years. Free.