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.

DSM-5 Online Assessment Measures (APA)

• 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.

Patient Health Questionnaire (PHQ) Screeners

• 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.

Pediatric Symptom Checklist (PSC-17, PSC, PSC-Y/Y-PSC)

• 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).

Strengths and Difficulties Questionnaire (SDQ)

• 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.

Disruptive Behavior Rating Scale ( 45 KB)

• 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)

• 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. Use an additional Level 2 screeners for further investigation into an area when the Level 1 screen is positive, e.g., DSM-5 Level 2 Screen for Inattention (for Parent/Guardian of Child Age 6-17) (). Ages 6-17. Free.

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) ( 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) ( 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.

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.

DSM-5 Online Assessment Measures (APA)

• 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, 6-17 years. Use additional Level 2 screeners for further investigation into these areas when a Level 1 screen is positive, e.g., DSM-5 Level 2 Screen for Anxiety for Parent/Guardian of Child Age 6-17 (). Free.

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)

• 41 questions screening for DSM-IV anxiety disorders, printable and online self-scoring versions for child and for parent, 8-18 years. Free.

Patient Health Questionnaire (PHQ) Screeners

• 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) ( 115 KB)

• 35-45 questions about anxiety, versions for young child (preschool version), older children, parent, and teacher, 2.5 – 12 years. Free.

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) ( 37 KB)

• 20 items about depression, youth-reported, 6-17 years. Free. Sensitivity 71%, specificity 57% (not optimal discrimination among depressed and non-depressed adolescents but included because provides an option for younger patients; National Assistive Technology Act Technical Assistance and Training (AT3) Center).

DSM-5 Online Assessment Measures (APA)

• 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. Use additional Level 2 screeners for further investigation into these areas when a Level 1 screen is positive, e.g., Severity Measure for Depression-Child Age 11-17, PHQ-ALevel 2, Depression, Parent/Guardian of Child Age 6, 17. Ages 6-17. Free.

Kutcher Adolescent Depression Scale (KADS)

• Two versions: KADS-6 (6-Item Kutcher Adolescent Depression Scale (KADS-6)) and KADS-11 (Kutcher Adolescent Depression Scale: KADS-11 ( 126 KB), PDF; Kutcher Adolescent Depression Scale: KADS-11, online), 12-17 years, youth version. Can be used for monitoring of youth undergoing treatment. Ages 12-17 years. Free. Sensitivity 92%, specificity 71% (National Assistive Technology Act Technical Assistance and Training (AT3) Center).

Patient Health Questionnaire (PHQ) Screeners

• PHQ offers multiple screens that range from 2-83 questions. The shorter versions pertain to depression. Free.
  • PHQ-A (Adolescent version of the PHQ-9) Patient Health Questionnaire Modified for Adolescents (PHQ-A) ( 228 KB) 9 questions to screen for depression, ages 11-18. Overall sensitivity 75% and specificity 92% (National Assistive Technology Act Technical Assistance and Training (AT3) Center).
  • PHQ-2: Patient Health Questionnaire 2 (PHQ-2) ( 13 KB) 2 questions to screen for depression, general population screen, can be used for ages 11 and older. Sensitivity 83-87%, specificity 78-92% (National Assistive Technology Act Technical Assistance and Training (AT3) Center).
  • PHQ-4: 4 questions to screen for anxiety and depression, general population screen, can be used with ages 11 and older.
  • PHQ-9: 9 questions to screen for depression, general population screen, can be used with teens with cutoff score of 10. Sensitivity and specificity 88% for major depression (National Assistive Technology Act Technical Assistance and Training (AT3) Center).

Ask Suicide-Screening Questions (NIMH) and Toolkit

• 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) ( 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]

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) ( 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 2.1/2.1+N)

• 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) ( 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)

• 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)) Use an additional Level 2 screener for further investigation into these areas when the Level 1 screen is positive, e.g., DSM-5 Level 2 Screen for Substance Use, Child Age 11 to 17 (). Ages 6-17 years. Free.

Screening to Brief Intervention (S2BI) ( 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.

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) ( 527 KB)

• 15 questions for survivors of trauma including avoidance, intrusion, physiologic arousal, youth version, ages 8 and above. Free.

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.

Caregiver-Teacher Report Form for Ages 1.5-5 (C-TRF)

• 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.

Child Behavior Checklist (CBCL)

• 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.

Patient Health Questionnaire (PHQ) Screeners

• 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.

Swanson, Nolan, and Pelham (SNAP-IV) ( 415 KB)

• 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.

Screening guidance:

• Autism Screening
• Toxic Stress Screening
• Screening for Sleep Problems
• Infant & Early Childhood Social-Emotional Screening
• Screening for Eating Disorders

Diagnosis and management:

• Obsessive-Compulsive Disorder (OCD)
• Depression
• Anxiety Disorders
• Attention-Deficit/Hyperactivity Disorder (ADHD) Substance Use Disorders
• Foster Care

Answers to questions that families frequently may ask:

• Depression (FAQ)
• Anxiety Disorders (FAQ)
• Attention Deficit Hyperactivity Disorder (ADHD) (FAQ)
• Foster Care (FAQ)