by Dr. Adam Klapperich, DO

Recently the Psychiatric Assistance Line (PAL) team was asked about validated screening measure and scales for use within the primary care setting. Scales such as the PHQ-9 and the GAD-7 are routinely used in primary care settings, but are these sensitive/specific and validated for children and adolescents? This is a valid(ity) question.

There are multiple screening tools available to the primary care provider for several different mental health concerns and situations. The PHQ-9 does have a “modified” version for the teenager, the PHQ-A. After carefully comparing this with the PHQ-9, the only discernable difference is that the PHQ-A includes “irritability” as a possible symptom of depression, otherwise the two scales are identical. There are additional questions regarding suicidal symptoms on the PHQ-A. A 2012 study did find the PHQ-9 as valid for screening adolescents ages 12-18. Sensitivity and specificity each ranged from 85-88% depending on the source (1,4,7). Other “free” options for screening depression in a pediatric setting include the KADS, with 92% sensitivity and 71% specificity (4,7). Proprietary scales such as the Beck Depression inventory and the Child Depression Inventory are also validated child depression scales, the BDI with sensitivity and specificity of 91% (4,7).

Regarding generalized anxiety disorder, the GAD-7 is a well-validated scale for ages 13 and over (4). The Beck Anxiety Inventory, which is proprietary, has also shown validity and reliability for ages 14-18 (3). The Spence Children’s Anxiety Scale also is found to be valid from ages 8-18, and additionally has subscales for panic, social phobia, and OCD, as well as GAD (4).

As far as ADHD, the Vanderbilt assessment scale is a psychometrically reliable and valid scale using parent and teacher questionnaires. The VADPRS (parent Vanderbilt scale) produced a sensitivity of .80, and a specificity of .75 (2).

This summary of free assessment measures may be a useful tool to identify scales that may work well for your clinic. Also, this guideline for depression treatment of adolescents in primary care has information on screening, diagnosis, safety assessment, therapy, medication algorithms, and parent information, as well as a nice summary of the FDA black box warning on antidepressant medications.  

Sources:

1. Allgaier AK, et al. Screening for depression in adolescents: validity of the patient health questionnaire in pediatric care. Depress Anxiety. 2012 Oct;29(10):906-13.
2. Bard DE, et al. The psychometric properties of the Vanderbilt attention-deficit hyperactivity disorder diagnostic parent rating scale in a community population. J Dev Behav Pediatr. 2013 Feb;34(2):72-82
3. Grant MM. Beck Anxiety Inventory. See here.
4. Mental Health Screening and Assessment Tool For Primary Care.
5. Guidelines for Adolescent Depression in Primary Care Tool Kit
6. Center for School Mental Health Summary of Free Assessment Measures.
7. Adolescent Depression—enhancing the outcomes in primary care. http://www.acpm.org/?AdDepresTTClinRef