Assessing children and adolescents in mental health

Technique

How to assess a child's or teenager's mental health: several informants, development in mind, play, school and safety.

Updated Nov 13, 2026

Key points

Use several informants: the child, parents or carers, teachers; discrepancies between them are expected because each sees a different setting.
Judge behaviour against developmental norms: behaviour expected at a young age may indicate a psychiatric disorder if it is present at an older age.
In some children with depression the main mood is irritability rather than sadness; school performance may fall and the child may withdraw.
Adolescents are also interviewed alone, after an honest explanation of confidentiality and its limits (harm to self or others, abuse).
Ask every child and adolescent specifically about abuse, and screen for self-harm, bullying, substance use and suicidal behaviour; abuse is not kept within confidentiality.
Comorbidity is common: 15 to 35 % of children with ADHD also have an anxiety disorder.

What it is

Assessing a child or adolescent differs from assessing an adult because children often cannot describe their symptoms, behaviour must be judged against what is normal for the age, and the family and school are part of the picture. The clinician combines direct observation and interview of the child with information from parents, teachers and other carers, and checks development, health, family stress and safety. Many adult mental disorders begin in childhood or adolescence, so early recognition matters.

How it is done

Include adolescents in the first family interview, then speak with them separately; adapt the setting to the age.
Take the history of the problem from each informant, including when and where it happens (home, school, both).
Review pregnancy, birth, development, health, hearing and vision, and family psychiatric history.
With young children, use play and drawing to build rapport and observe; interview adolescents alone as well.
Request information from teachers and, when useful, rating scales to quantify symptom severity.
Assess safety: self-harm, suicidal behaviour, abuse, neglect and violence at home.
Do a physical examination, and refer for developmental, neurological or IQ testing when learning or development is unclear.
Feed back the findings to the family in plain words and agree a plan, communicating with the school.

How common problems can look in children and adolescents

Problem	How it may present
Depression	Irritability rather than sadness, profound boredom, falling grades, social withdrawal
Anxiety	Often comes with ADHD (15 to 35 % of children with ADHD) or with depression
Disruptive behaviour	Worsens with both over-authoritative and over-permissive parenting; ask about violence or substance use at home
Psychosis	Schizophrenia and related psychotic disorders are much less common in children
Suicidal risk	Recurrent thoughts of death; screen for ideation, gestures and attempts

Clinical notes

Children living with family violence or a carer’s substance use may superficially appear to have one or more psychiatric disorders.
Persistent irritability with frequent outbursts suggests disruptive mood dysregulation disorder.
Schizophrenia and related psychotic disorders are much less common in children; catatonia in a child often occurs with a medical condition such as an infection or a metabolic disorder.

Test yourself

Think of the answer, then tap the question to see it.

Why are several informants needed when assessing a child?

Children often cannot describe their symptoms, and behaviour may differ between home and school; parents, teachers and direct observation complete the picture.

How may depression present in a child or adolescent?

With irritability rather than sadness, falling school performance, profound boredom and social withdrawal.

What must be explained to an adolescent before interviewing them alone?

Confidentiality, honestly, with its limits: harm to self or others and abuse.

Is a suspicion of abuse kept within the clinician–child confidentiality agreement?

No. Abuse is asked about specifically in every child and adolescent, and it is one of the issues taken out of confidentiality.

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Educational content on behavior and the clinical relationship; not a diagnostic or treatment guide and no substitute for assessment by a health professional. If you or someone near you is at risk, seek help now from an emergency service or a mental-health helpline.

Sources: Overview of Psychiatric Disorders in Children and Adolescents (MSD Manual Professional Edition, 2025); Initial Psychiatric Assessment (MSD Manual Professional Edition, 2024); Clinical Practice Guidelines for Assessment of Children and Adolescents (Indian Journal of Psychiatry, PubMed Central, 2019); Depressive Disorders in Children and Adolescents (MSD Manual Professional Edition, 2026).

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