Recommended Screening Tools for a 12-Year-Old
For depression screening in a 12-year-old, use the Patient Health Questionnaire-9 (PHQ-9) or PHQ-9 Modified for Teens, with a cutoff score of 11 providing optimal sensitivity (89.5%) and specificity (77.5%) for major depressive disorder. 1
For anxiety screening in a 12-year-old, use the Revised Child Anxiety and Depression Scale (RCADS), which is validated for ages 8-18 and assesses multiple anxiety disorder subtypes according to DSM-IV categories. 2, 3
Depression Screening
Primary Recommendation: PHQ-9
- The PHQ-9 is the most rigorously validated depression screening tool for adolescents ages 12-18 in primary care settings, tested against the gold standard Diagnostic Interview Schedule for Children-IV (DISC-IV) 1
- A cutoff score of ≥11 yields sensitivity of 89.5% and specificity of 77.5% for major depressive disorder, with a negative predictive value of 99.4% 1
- The PHQ-9 consists of 9 items directly corresponding to DSM-IV criteria for major depressive disorder 4
Alternative Depression Screening Options
- PHQ-2 (brief version): A cutoff score of ≥3 provides sensitivity of 73.7% and specificity of 75.2%, useful as a rapid initial screen 1
- Center for Epidemiologic Studies Depression Scale (CES-D): A 20-item scale validated for youth as young as 12 years, with scores ≥16 suggesting moderate to severe depressive symptoms 1, 4
- Mood and Feelings Questionnaire: Mentioned as a validated standalone depression-specific scale for adolescents 1
Critical Safety Consideration
- Never omit the suicidal ideation question (item 9 on PHQ-9), as skipping it artificially lowers risk detection and misses critical safety information 5, 6
- Any endorsement of self-harm ideation requires immediate referral for emergency psychiatric evaluation regardless of total score 5, 6
Anxiety Screening
Primary Recommendation: RCADS
- The Revised Child Anxiety and Depression Scale (RCADS) is a 47-item youth self-report measure validated for children and adolescents in grades 3-12 (ages 8-18), making it ideal for a 12-year-old 2, 3
- The RCADS assesses six DSM-IV anxiety disorder categories: Separation Anxiety Disorder, Social Phobia, Generalized Anxiety Disorder, Panic Disorder, Obsessive-Compulsive Disorder, plus Major Depressive Disorder 7
- The RCADS demonstrates robust internal consistency (α = 0.70-0.96) and excellent short-term stability (ICC = 0.76-0.86) across diverse populations 3, 8
- A shorter 25-item version (RCADS-25) is available with comparable psychometric properties for more rapid screening 9
Alternative Anxiety Screening Option
- Screen for Child Anxiety Related Disorders-5 (SCARED-5): Mentioned as a brief anxiety-specific screen that can be incorporated into broader behavioral health screening 1
Practical Implementation Considerations
Combined Screening Approach
- The RCADS has the unique advantage of simultaneously assessing both anxiety and depression symptoms, which may be efficient for a 12-year-old presenting with either concern 2, 8
- However, avoid overwhelming clinicians with too much information from multidimensional screening packets, as positive depression or anxiety findings may be overlooked in the "morass of issues" 1
Parent Report Considerations
- The RCADS-Parent Version (RCADS-P) is validated for children as young as age 3 and demonstrates strong psychometric properties in clinical samples 2, 7
- Agreement between teacher/parent reports and child self-reports is typically low for internalizing problems, even when children score above the 90th percentile, emphasizing the critical need to obtain the child's self-report directly 3
- Interview both the patient and collateral sources (parents, caregivers) separately, as patients frequently minimize symptom severity 5