Behavioral, Developmental, and Mental Health Care
Behavioral items test screening, first-line management, and safety. Expect to name the tool, the age at which it is used, and the escalation step.
Screening and diagnosis
- Autism: M-CHAT-R/F at 18 and 24 months; refer for full evaluation on a positive screen.
- ADHD: symptoms before age 12, at least six across two settings; assess school and home function; monitor growth, blood pressure, sleep, and appetite on stimulants.
- Adolescent depression: PHQ-A or PHQ-9 modified. Ask directly about suicide - asking does not plant the idea.
- Anxiety, eating disorders, and substance use each need a structured screen.
Management principles
- Behavioral therapy first for mild symptoms; medication combined with therapy for moderate-severe.
- Stimulants are first-line for ADHD; atomoxetine and guanfacine are alternatives.
- SSRIs are first-line for adolescent depression; monitor for activation and suicidal ideation early in treatment.
- Trauma-informed care: explain what will happen, offer choices, avoid restraint and seclusion unless there is imminent danger.
Eating disorders
- Medical instability criteria: bradycardia, orthostatic hypotension, hypothermia, electrolyte abnormalities, rapid weight loss.
- Refeeding syndrome risk requires slow advancement and electrolyte monitoring.
Worked example
A 15-year-old with two weeks of low mood, poor sleep, and declining grades scores 15 on the PHQ-A - moderately severe. Ask directly about suicidal ideation and plan, assess safety and means restriction, avoid promising confidentiality you cannot keep, involve the guardian, and refer for therapy with consideration of an SSRI.
Traps
- Dismissing symptoms as “just puberty.”
- Missing somatic complaints that mask depression.
- Sending an adolescent with active suicidal ideation home without a safety plan.
- Starting a stimulant without a baseline growth plot.