PMHS cheat sheet

Developmental screening tools: Ages & Stages Questionnaires (ASQ-3) for communication, gross/fine motor, problem-solving, personal-social; M-CHAT-R/F for autism at 18 and 24 months; PSC-17 and SDQ for broad emotional/behavioral screening.

PHQ-A (PHQ-9 modified for adolescents) scores: 0–4 none, 5–9 mild, 10–14 moderate, 15–19 moderately severe, 20–27 severe; item 9 (suicidal ideation) positive requires immediate safety assessment regardless of total.

DSM-5-TR ADHD requires ≥6 inattentive and/or ≥6 hyperactive-impulsive symptoms for children <17, present before age 12, across ≥2 settings, causing impairment; for adolescents 17+ threshold is 5 symptoms.

ADHD subtypes: predominantly inattentive, predominantly hyperactive-impulsive, combined. Use Vanderbilt or Conners rating scales from both parent and teacher to document cross-setting impairment.

Autism Spectrum Disorder DSM-5-TR: persistent deficits in social communication/interaction plus ≥2 of 4 restricted/repetitive behavior domains; symptoms in early developmental period; M-CHAT-R/F positive triggers diagnostic evaluation, not diagnosis.

Anxiety in children: separation anxiety disorder, selective mutism, social anxiety, generalized anxiety. Screen with SCARED (child and parent forms); scores ≥25 suggest clinically significant anxiety.

Depression in preschoolers is rare but possible; irritability may substitute for depressed mood in children. Use DSM-5-TR duration criteria: ≥2 weeks for MDD, ≥1 year for persistent depressive disorder in children/adolescents.

Differential rule: new-onset behavioral change, academic decline, or regression warrants evaluation for medical causes (thyroid, anemia, sleep apnea, medication effects, substance use) before psychiatric diagnosis.

Cultural and linguistic factors: use validated translations, interpreter services, and consider that teacher ratings may reflect cultural mismatch; avoid overpathologizing normative developmental variation.

ADHD first-line pharmacotherapy: stimulants (methylphenidate, amphetamine salts). Preschoolers (4–5) start with behavioral parent training before medication per AAP; school-age may combine behavioral and medication.

Stimulant monitoring: baseline height, weight, blood pressure, heart rate; recheck at each dose change and every visit. Watch for appetite loss, sleep delay, tics, and cardiovascular symptoms.

SSRIs in pediatric depression/anxiety: fluoxetine and escitalopram are FDA-approved for adolescent MDD; sertraline and fluoxetine have evidence for pediatric OCD. Start low (e.g., fluoxetine 10 mg), titrate slowly.

Black box warning: antidepressants increase risk of suicidality in patients <25; provide education, close follow-up (weekly early), and safety planning; do not withhold treatment when indicated.

Discontinuation syndrome: taper SSRIs gradually; fluoxetine's long half-life makes it less prone to withdrawal. Avoid abrupt cessation.

Suicide risk assessment: ask directly about ideation, plan, intent, means; use C-SSRS or ASQ; remove lethal means (firearms, medications); document safety plan and follow-up.

Behavioral interventions with strong evidence: parent-child interaction therapy (PCIT) for disruptive behavior in young children; parent management training (PMT); CBT for anxiety and depression; exposure-based CBT for OCD.

School accommodations: 504 plan for ADHD/anxiety; IEP when special education eligibility exists; communicate with school counselors and teachers to coordinate behavioral plans.

Crisis resources: 988 Suicide and Crisis Lifeline; mobile crisis teams; emergency department for imminent risk; mandatory reporting for suspected abuse/neglect per state law.

Comorbidity patterns: ADHD frequently co-occurs with ODD, anxiety, learning disorders, and tic disorders; depression often co-occurs with anxiety and substance use in adolescents; screen broadly rather than anchoring on one diagnosis.

Autism comorbidities: intellectual disability, epilepsy, anxiety, ADHD, sleep disorders, GI problems. Screen for seizures and sleep issues; avoid diagnosing ADHD in autism without documenting cross-setting impairment beyond autism symptoms.

Trauma and adversity: screen for ACEs; PTSD in children may present as regression, aggression, hypervigilance, or somatic complaints; trauma-focused CBT (TF-CBT) is first-line psychotherapy.

Anxiety in young children: separation anxiety is normative in toddlers; disorder requires developmentally inappropriate, persistent distress impairing functioning (≥4 weeks in DSM-5-TR for separation anxiety).

Sleep disorders: rule out obstructive sleep apnea (snoring, daytime sleepiness) before attributing sleep problems to anxiety or ADHD; sleep hygiene and behavioral sleep interventions are first-line.

Substance use: screen adolescents with CRAFFT; brief intervention and referral to treatment; avoid stigmatizing language, use motivational interviewing.

Eating disorders: anorexia nervosa, bulimia nervosa, binge-eating disorder, ARFID; monitor weight, vital signs, electrolytes; medical instability (bradycardia, hypotension, hypothermia) warrants urgent referral.

Developmental regression or loss of skills at any age warrants urgent evaluation for autism, seizure disorder, or neurodegenerative conditions; do not attribute to behavioral problems without workup.

Transition planning: adolescents with mental health conditions need transition plans to adult care by age 18; coordinate with school, family, and adult providers.