Pediatric Mental Health Screening: Evidence-Based Instruments

You're not going to catch every depressed or anxious kid with just clinical judgment. Use the tools. They're validated, quick, and actually work.

PHQ-A: Depression Screening

The PHQ-A is 9 questions about how the kid felt over the last 2 weeks. Total score 0–27.

5–9: Not much going on. Chat with parents.
10–14: Mild depression. Is school failing? Are they sleeping? Are they eating? Ask about safety.
15–19: Needs a mental health referral.
≥20: Urgent psychiatric evaluation. Think hospitalization if they're suicidal.

Here's the critical piece: if they check the box on question 9 (thoughts of being better off dead or hurting themselves), you stop and do suicide risk assessment right then, regardless of the total score.

Use PHQ-A in clinic.

SCARED: Anxiety Assessment

SCARED is 41 questions. Takes maybe 10 minutes. Breaks down where the anxiety is coming from.

Five subscales:

Panic/somatic (9 items, 0–18)
General anxiety (8 items, 0–16)
Social anxiety (7 items, 0–14)
School avoidance (4 items, 0–8)
Separation anxiety (5 items, 0–10)

Total ≥25 = significant anxiety, work it up. Look at the individual scores too. High panic = panic attacks. High social anxiety = they're terrified of other kids. High school avoidance = school refusal, which is a whole different beast.

About half of anxious kids are also depressed. Run both screens.

Use SCARED to score it.

C-SSRS: Suicide Risk Assessment

C-SSRS is what you use when someone endorses suicidal thoughts. It's the gold standard because it actually works.

0 = no ideation. 5 = attempted suicide. The middle ground:

1: Wishes they were dead (but isn't planning it)
2: Active ideation, no plan
3: Ideation plus some intent but no plan
4: Intent + plan = hospitalization

Important: In category 5, we count cutting or overdose with suicidal intent as actual suicidal behavior, not just self-injury. The intent matters.

If someone answers yes to any suicide screening question, do the full C-SSRS. Do it in kids with depression, anxiety, substance use, or any acute psych crisis.

Use C-SSRS for this.

Vanderbilt ADHD Rating Scale

Vanderbilt is 55 items, parent form and teacher form. You need both because a kid might look fine at school but be a terror at home, or vice versa.

Symptom subscales (each item scored 0–3: never, occasionally, often, very often):

Inattention (9 items)
Hyperactivity/Impulsivity (9 items)
Oppositional Defiant Disorder screening (8 items)
Conduct Disorder screening (14 items, parent form)
Anxiety/Depression screening (7 items)
Performance items (8 items, rated 1–5)

A positive screen requires ≥6 items rated "often" or "very often" on either the inattention subscale or the hyperactivity/impulsivity subscale, PLUS ≥1 performance item rated "problematic." This mirrors DSM-5 criteria requiring ≥6 symptoms in at least one domain with functional impairment.

Key: You need to see the symptoms in both settings. A kid who's fine at school but hyperactive at home isn't ADHD. You also need functional impairment, not just "my kid is a little distractible."

Get a baseline before medication. Recheck at 2–4 weeks to see if the meds are working.

Use Vanderbilt ADHD to score.

PSC-17: The Screener for Everything

PSC-17 is 17 questions, takes 2 minutes, works for 6–16 year-olds. Good for universal screening at well-child visits.

Score ≥15 says there's something there. Sensitive but not super specific, so a positive PSC-17 doesn't tell you what the problem is, just that there probably is one.

Use PSC-17 to score.

How to Actually Screen

Layer 1: PSC-17 on everyone. If ≥15, move to layer 2.

Layer 2: Run the specific tools. Depression? PHQ-A. Anxiety? SCARED. ADHD? Vanderbilt. Suicidal? C-SSRS.

Layer 3: Refer out to psychiatry for the complicated stuff or anything suicide.

After You Screen Positive

Assess safety right now
Get parents involved
Give them 988 (Suicide Prevention Lifeline)
See them in a week
If you're starting an antidepressant, warn about the black box warning in SSRIs (increased suicidality, especially weeks 1–4)
Stay alert for suicidality in those first few weeks on the medication

Pediatric Mental Health Screening: PHQ-A, SCARED, C-SSRS, and Vanderbilt ADHD Tools