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