Mental Health Screening for Children & Teens

Overview

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.

Broadband Mental Health Screens

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.
  • 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.

ADHD Assessments

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.
DSM-5 Online Assessment Measures (APA) Pediatric Symptom Checklist (PSC-17, PSC, PSC-Y/Y-PSC)
  • 17- or 35-question versions, screens for problems with internalizing and externalizing behaviors and attention, 4-16 years. Free.
Swanson, Nolan, and Pelham (SNAP-IV) (PDF Document 415 KB)
  • 26-items, parent and teacher versions, assesses for ADHD and oppositional-defiant symptoms, 6-18 years. Free.
Vanderbilt Assessment Scales - Parent and Teacher Initial and Follow-Up Scales with Scoring Instructions (NICHQ) (PDF Document 1.1 MB)
  • 25-55 questions, parent and teacher initial and follow-up versions, assesses for inattention, impulsivity/hyperactivity, and comorbid oppositional-defiant disorder, conduct disorder, depression/anxiety, ages 6 and older. Free.

Anxiety Assessments

The following tools are specific for anxiety. Tools that screen for multiple conditions, including anxiety, depression, and others, are found in Broadband Mental Health Screens, above.
Generalized Anxiety Disorder 7-Item Scale (GAD-7) (found at Patient Health Questionnaire (PHQ) Screeners)
  • 7 questions about anxiety, completed by patient. Online version at PHQ (Patient Health Questionnaire) Screeners. General population screen, can be used in teens. Free.
Screen for Child Anxiety Related Disorders (SCARED) (University of Pittsburgh) (PDF Document 218 KB)
  • 41 questions screening for DSM-IV anxiety disorders, printable and online self-scoring versions for child and for parent, 8-18 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-15: 15 questions to screen for physical symptoms and somatoform disorder; normed in adults, can be used with teens.
    • PHQ-SADS: combines PHQ-9, PHQ-15, and GAD-7 to screen for anxiety, panic attacks, depression, and somatoform disorder; normed in adults, can be used with teens.
Spence Children’s Anxiety Scale (SCAS)
  • 35-45 questions about anxiety, versions for young child (preschool version), older children, parent, and teacher, 2.5 – 12 years. Free.

Depression Assessments

The following tools are specific for depression. Tools that screen for multiple conditions, including depression, anxiety, and others, are found in Broadband Mental Health Screens, above.
Center for Epidemiological Studies Depression Scale for Children (CES-DC) (PDF Document 37 KB) DSM-5 Online Assessment Measures (APA)
Kutcher Adolescent Depression Scale (KADS)
Patient Health Questionnaire (PHQ) Screeners
Ask Suicide-Screening Questions (ASQ) Toolkit (NIMH)
  • 4 items, ages 10-24 years, administered verbally by nurse or clinician to youth (preferably without parent present) in approximately 20 seconds, available in multiple languages including English, Spanish, Arabic, (Mandarin) Chinese, Dutch, French, Hebrew, Italian, Japanese, Korean, Portuguese, Korean, Russian, Somali, and Vietnamese. Developed by the National Institute for Mental Health to prevent suicides in youth, the free toolkit includes the ASQ Suicide Risk Screening Tool (NIMH) (PDF Document 208 KB) as well as follow-up resources for positive screens (defined as one or more positive responses). For use in medical settings (emergency department, inpatient medical/surgical units, outpatient clinics/primary care). Sensitivity 97%, specificity 88% in an emergency department validation study. [Horowitz: 2012]

Substance Use Assessments

The following assessments are specific for substance use. Tools that screen for multiple conditions, including substance use, depression, and others, are found in Broadband Mental Health Screens, above.
Alcohol Screening and Brief Intervention for Youth (NIAAA)
  • 2 clinician-administered screening questions for alcohol use. Includes guidance on follow-up of a positive screen. Ages 9-18. Free.
Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) (WHO)
  • 8 questions that relate to 10 substances; a clinician-administered version and a self-report version are provided. General population screen, can be used with teens. Free.
Alcohol Use Disorders Identification Test (AUDIT) (WHO) (PDF Document 13 KB)
  • 10-item screening tool that assesses alcohol consumption, drinking behaviors, and alcohol-related problems. General population screen, can be used with teens. Free.
Brief Screener for Alcohol, Tobacco, and Other Drugs (BSTAD)
  • Risky substance use, youth reported or clinician administered online tool with scoring, ages 12-17. Free.
Car, Relax, Alone, Friends, Forget, Trouble (CRAFFT 2.1)
  • 3 screening questions with 6 follow-up questions about substance use, substance-related riding/driving risk, and substance use disorder, youth reported or clinician-administered versions, almost 20 languages. The American Academy of Pediatrics suggests that using this tool after a "yes" response from another screen may help reveal the extent of the patient's substance use problems. [Levy: 2016] Ages 12-21 years. Free.
Drug Abuse Screening Test (DAST-10) (PDF Document 161 KB)
  • A 10-item screen that assesses drug use, not including alcohol or tobacco use, in the past 12 months. A clinician-administered version and a self-report version are provided. General population screen, can be used with teens. Free.
DSM-5 Online Assessment Measures (APA)
Screening to Brief Intervention (S2BI) (PDF Document 126 KB)
  • Risky substance use, youth reported or clinician administered online tool with has 7 questions about frequency of use and scores automatically. Accompanying resources assist clinicians in providing patient feedback and resources for follow-up. The Screening to Brief Intervention tool has 7 questions about frequency of use. Based on DSM-5 diagnoses for SUDs. Ages 12-17. Free.

Trauma Impact Assessments

The following assessments are specific for survivors of trauma. Tools that screen for multiple conditions, including anxiety, depression, and others, are found in Broadband Mental Health Screens, above.
Children’s Impact of Event Scale-13 (CRIES-13) (PDF Document 527 KB)
  • 15 questions for survivors of trauma including avoidance, intrusion, physiologic arousal, youth version, ages 8 and above. Free.

What to Do with a Positive Screen

Before implementing a screening or assessment tool, identify what members of the medical home will do with a positive result. It is particularly important to have a plan in place in the event a screen is positive for an actively suicidal youth (or parent). Local mental health resources vary considerably; consider telehealth providers if local resources are limited or absent. See Services, below. Additional evaluation is generally necessary prior to making a diagnosis.
A more detailed assessment or diagnostic instrument may be useful after an abnormal screening result in the pediatric clinic, as an initial evaluation for a complicated patient with multiple possible comorbidities, or to track response to intervention in a mental health or school setting. These may be completed outside of a pediatric medical home visit and require additional time, training, and support for completing and scoring the tools. Here are some examples:
Behavior Assessment System for Children, Third Edition (BASC-3)
  • 100-160 items, parent, teacher, youth versions, adaptive and problem behavior. Ages 2-21 years. Available for purchase.
  • 10-minute tool for teachers or daycare providers, emotionally reactive, anxious/depressed, somatic complaints, withdrawal, attention problems, and aggressive behavior. Used to augment the CBCL assessments. Ages 1.5-5 years. Available for purchase.
  • 3 different age versions, 99-118 items, assesses for PDD, somatic, conduct, affect, anxiety, oppositional-defiant, ADHD. Administered by professional. Versions for younger and older children/teens, ages 1.5-5, 6-18, 11-18 years. Available for purchase.
Conners CBRS (Conners Comprehensive Behavior Rating Scales)
  • Assessment tools for ADHD, oppositionality, conduct disorder, depression, manic episodes, anxiety disorders, obsessive-compulsive, tics, substance use, PTSD, bullying, pica, trichotillomania, self-harm, developmental delay, academic and social problems, psychosomatic problems. Large normative basis. 6-18 years. Available for purchase.
  • PHQ offers multiple screens that range from 2-83 questions. The full PHQ, with up to 83 questions, addresses mood problems, anxiety, eating problems, alcohol use, and somatoform disorders. General population tool, may be used for teens. Free.
  • 90 items, parent and teacher versions, screens for ADHD, anxiety, oppositional-defiant disorder, conduct disorder, PTSD, personality disorder, intermittent explosive disorder, narcolepsy, stereotypic movements, adjustment disorder, dysthymia, and bipolar disorders, 6-18 years. Free.

Related Material on the Medical Home Portal

Autism Screening
Toxic Stress Screening
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Resources

Information & Support

For Professionals

General Screens for Mental Illness (UACAP)
Screens for anxiety, ADHD, sleep, depression, bipolar, substance use and addiction, and risk assessments that are free and easily downloaded; patient education; and tips and resources for practice; Utah Academy of Child & Adolescent Psychiatry.

Screening & Surveillance Tools and Family Educational Handouts (DB Peds)
Information and checklists for a variety of developmental and behavioral disorders and related medical conditions; University of Washington Developmental & Behavioral Pediatrics.

Children's Mental Health (CDC)
Resources to help ensure that children get the mental health care they need. Includes data and statistics and information on symptoms and evidence-based treatments; from the Centers for Disease Control and Prevention.

Links to Commonly Used Screening Instruments and Tools (AAP)
Organized by age, this resource links to commonly used universal screening for issues such as child development, maternal or adolescent depression, substance use, or oral health; American Academy of Pediatrics

Screening Tool Finder (AAP)
Search for screeners by category, topic, length, language, or cost. Topics include child development, autism, social/emotional, maternal depression, and social determinants of health; American Academy of Pediatrics

Teen Mental Health (teenmentalhealth.org)
Evidence-based ready-to-implement training programs, publications, tools and resources that can be applied across disciplines. Includes School Mental Health curriculum and Transitions guides as well as more condition-specific resources. Resource for teens, parents, educators, and health professionals.

Mental Health Screening and Assessment Tools for Primary Care (AAP) (PDF Document 316 KB)
This table provides a listing of mental health screening and assessment tools, summarizing their psychometric testing properties, cultural considerations, costs, and key references.

For Parents and Patients

Parenting Information (CDC)
Information for parents about different aspects of parenting and age-appropriate health behaviors, including maternal health, infants, children, and teens; Centers for Disease Control.

Practice Guidelines

Weitzman C, Wegner L.
Promoting optimal development: screening for behavioral and emotional problems.
Pediatrics. 2015;135(2):384-95. PubMed abstract
AAP clinical report to increase behavioral and emotional health screening in the primary care setting and to improve understanding of the underlying causes, prevalence, and need for additional research.

Services for Patients & Families in Montana (MT)

For services not listed above, browse our Services categories or search our database.

* number of provider listings may vary by how states categorize services, whether providers are listed by organization or individual, how services are organized in the state, and other factors; Nationwide (NW) providers are generally limited to web-based services, provider locator services, and organizations that serve children from across the nation.

Authors & Reviewers

Initial publication: September 2020
Current Authors and Reviewers:
Author: Jennifer Goldman-Luthy, MD, MRP, FAAP

Page Bibliography

Committee on Practice and Ambulatory Medicine, Bright Futures Periodicity Schedule Workgroup.
2017 Recommendations for preventive pediatric health care.
Pediatrics. 2017;139(4). PubMed abstract / Full Text
Includes a link to the Periodicity Schedule, https://www.aap.org/en-us/Documents/periodicity_schedule.pdf.

Horowitz LM, Bridge JA, Teach SJ, Ballard E, Klima J, Rosenstein DL, Wharff EA, Ginnis K, Cannon E, Joshi P, Pao M.
Ask Suicide-Screening Questions (ASQ): a brief instrument for the pediatric emergency department.
Arch Pediatr Adolesc Med. 2012;166(12):1170-6. PubMed abstract / Full Text
This study developed a brief screening instrument to assess the risk for suicide in youth in medical settings; the Ask Suicide-Screening Questions (ASQ) had high sensitivity and negative predictive value in pediatric emergency department patients.

Levy S, Williams J, Committee on Substance Use and Prevention.
Substance Use Screening, Brief Intervention, and Referral to Treatment.
Pediatrics. 2016;138(1). PubMed abstract