Screening Tools
The following is a list of recommended screening tools for children and adolescents presenting symptoms of various mental disorders. These tools may be used to identify children that may benefit from a diagnostic assessment. Screening tools alone are not enough for diagnosis.
Strengths and Difficulties Questionnaire (SDQ)
This is a 25-item tool, recommended to be used broadly to guide discussions and to focus on treatment targets with an awareness of the patient’s strengths. This tool identifies emotional and behavioral problems as well as protective prosocial behaviors (strengths) that can be leveraged.
Strengths and Difficulties Questionnaires
Pediatric Symptoms Checklist (PSC)
The Pediatric Symptoms Checklist is a freely available 35-question screen for cognitive, emotional, and behavioral problems. Rather than being specific for a particular diagnosis or disorder, the PSC is a broad screen meant to indicate the need for additional evaluation, either by the primary care provider or by a mental health provider, and flag potential areas of concern. There is a version to be completed by the caregiver as well as a youth self-report version (Y-PSC) for youth ages 11 and older.
HEADSSS Psychosocial Assessment
The HEADSS assessment is mnemonic for providers to inquire about the following domains: Home, Education/Employment, Activities, Drugs, Sexuality, Suicide/Depression, and Safety. This tool is commonly used by providers to gather information about psychosocial functioning broadly along with risk factors and protective factors for adolescent medical and mental health. The HEADSSS assessment is suggested during the assessment of the following mental health disorders: eating disorders, and trauma and post-traumatic stress disorder (PTSD).
Eating Disorder
SCOFF: A mnemonic that is useful to identify symptoms of eating disorders. It includes an assessment of the following domains: Sick (do you make yourself sick because you feel uncomfortably full?), Control (do you worry that you have lost control over how much you eat?), One (have you recently lost more than one stone (14lb) in a 3-month period?), Fat (do you believe yourself to be fat when others say you are too thin?), and Food (would you say that food dominates your life?)
Depression
Patient Health Questionnaire-9 (PHQ-9): May be used to screen for depression. It should be noted that a question on suicidal ideation exists on the PHQ-9. If the adolescent states that they are experiencing suicidal ideation a follow up clinical interview must be conducted to ensure their safety. There is a PHQ-9 that is slightly modified for adolescents sometimes called the PHQ-A. The main differences is that the PHQ-A includes 4 additional questions, one about feeling depressed most days, one about functional impairment from symptoms asked about in the PHQ-A, one about suicidal ideation within the past month, and one about a lifetime history of a suicide attempt. Additionally, the examples provided for the item about concentration are different for the adolescent version (trouble concentrating on things like school work, reading, or watching TV) compared with the general PHQ-9 (trouble concentrating on things, such as reading the newspaper or watching television). The numerical score for either version of the PHQ-9 is the same since it is calculated from the first nine questions.
Patient Health Questionnaire-9
Children’s Depression Rating Scale: A 16-item clinician-rated measure of depression severity. It may be used by clinicians as a way to better characterize depression symptoms and the severity of depression.
Children's Depression Rating Scale
Trauma and Post Traumatic Stress Disorder (PTSD)
Pediatric Traumatic Stress Screening Tool: This is 13-item screening tool for PTSD in children and adolescents ages 11 and older, developed to be used as a care process model which suggests brief interventions or specialized assessment and care, depending on severity.
Pediatric Traumatic Stress Screening Tool
Child and Adolescent Trauma Screen (CATS): a 40-item instrument used to measure potentially traumatic events and post-traumatic stress symptoms.
ISTSS - Posttraumatic Stress Disorder Checklist
Additional assessment tools and other resources for trauma are available from the International Society for Traumatic Stress Studies (ISTSS).
Suicide Risk
Ask Suicide-Screening Questions (ASQ): A free screening tool, validated by the National Institute of Mental Health (NIMH), with 4 yes/no questions, as well as a fifth question indicating acuity in those who answered yes to one of the first four questions. The ASQ is intended to be delivered verbatim, and directly with the child or adolescent being screened.
Columbia-Suicide Severity Rating Scale (C-SSRS): The C-SSRS, sometimes called the "full" C-SSRS is a set of detailed questions used to help characterize suicidal thoughts and behaviors in individuals who have screened positive for suicide risk, such as the ASQ. There is a version intended to be used to detect and describe both recent and lifetime suicidal thoughts and behaviors, and another version for thoughts and behaviors since last contact. This should not be confused with the brief screener version of the C-SSRS, which as 6 yes or no questions.
Brief Suicide Safety Assessment (BSSA): Designed to serve as a follow up to a positive ASQ screening, the BSSA is used to assess suicide risk further. It characterizes frequency of suicidal thoughts, present of a suicide plan, past suicidal behavior, the presence of 11 different signs of suicide risk, and social supports and stressors.
Substance-Related and Addictive Behavior Screening Tools
CRAFFT: A mnemonic that can be used to screen for substance-related difficulties. It includes questions pertaining to the following domains: Car (have you ever ridden in a car by someone (including yourself) who was high or using alcohol or drugs?), Relax (do you ever use alcohol or drugs to relax, feel better about yourself, or fit in?), Alone (do you ever use alcohol or drugs while alone?), Forget (do you ever forget the things you did while using alcohol or drugs?) , Friends (do your family or friends ever tell you that you should cut down on your drinking or drug use?), Trouble (have you ever gotten in trouble while you were using alcohol or drugs?).
Anxiety Disorders
The Screen for Child Anxiety Related Emotional Disorders (SCARED): A 41 item Likert scale assessment that is delivered to both the child or adolescent and parent(s). The scale can indicate the likely presence of an anxiety disorder and suggest whether panic disorder, generalized anxiety disorder (GAD), separation anxiety disorder, social anxiety disorder, significant somatic symptoms, and/or school avoidance should be evaluated further.
SCARED Child and Parent Versions
5-item Screen for Child Anxiety Related Emotional Disorders (SCARED-5)
The SCARED-5 can be used as an initial screener to identify patients who need a more in-depth evaluation of anxiety symptoms. Once it is clear that evaluation for anxiety is needed, the 41-item SCARED can give detailed information about specific symptoms and types of symptoms.
Severity Measure for Generalized Anxiety Disorder (GAD-7): A 10 item self-report scale that assesses the presence and possible severity of Generalized Anxiety Disorder. It was originally developed for adults in primary care settings but has since been utilized in children and adolescents as well.
Attention Deficit/Hyperactivity Disorder (ADHD)
Vanderbilt Assessment Scales: The Vanderbilt Assessment Scales has items related to inattentive and hyperactive-impulsive symptoms of ADHD, along with items suggesting oppositional-defiant disorder, conduct disorder, mood concerns, and problems with academic performance or classroom behavior. The assessment specifically asks about a child's behaviors within the past 6 months, with a version of the scales for caregivers and one for teachers.
Additional Tools
Youth Mania Rating Scale (YMRS)
The YMRS is an 11-item clinician-scored tool to characterize features of a manic episode.