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The PHQ-A is what you reach for when a teenage client walks in and you want a quick, validated read on depression severity. It’s the adolescent version of the PHQ-9 — same nine symptom items, written for younger clients, plus a functional-impairment question and four suicidality items the adult PHQ-9 doesn’t carry.

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What it measures

Nine DSM-aligned depression symptoms over the past two weeks (anhedonia, mood, sleep, appetite, energy, self-worth, concentration, psychomotor change, and suicidal ideation). The wording is adolescent-appropriate — “feeling down, depressed, irritable, or hopeless” includes the irritability presentation that’s common in teens — and the prompts about school work, family, and friends keep it grounded in a young client’s day-to-day. A tenth item captures functional impairment (“how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people”). Four more items ask directly about past-month suicidal thoughts, lifetime attempts, past-year attempts, and past-month attempts.

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When to use it

  • Intake with any client ages 11-17 where depression is on the table
  • Routine progress tracking through a course of treatment
  • A check-in any time mood symptoms shift or a parent raises a concern
  • Anywhere you’d use the PHQ-9 in an adult — this is the adolescent equivalent

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How clients fill it out

Two to three minutes in-session, on the practitioner’s device or the client’s phone. Quiet enough that you can read it aloud if a younger client prefers, but most 13+ clients complete it independently.

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Scoring and severity cutoffs

Sum of items 1-9, range 0-27. The functional-impairment item and the four suicidality items don’t add to the depression total — they surface separately. The adolescent cutoff is ≥11, not the ≥10 used for adults. Richardson et al. (2010) validated that the adolescent-specific threshold for clinically significant depression sits one point higher.
Item 9 (thoughts of being better off dead or hurting yourself) and items 11-14 (the suicidality probe) carry a sensitive flag. Any endorsement triggers a separate signal regardless of the total score — follow up clinically in the same session. A “minimal” total with a positive Item 9 is still a clinical event.

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Tracking over time

The PHQ-A trends week-over-week the same way the PHQ-9 does for adults. A drop of 5 or more points across sessions is a meaningful clinical change. Use it to anchor the conversation about whether the treatment plan is working, especially with a young client who may have trouble articulating change in their own words.

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PHQ-A vs PHQ-9

Same nine symptoms, rewritten for adolescents, plus two items on functional impairment and a direct question about serious thoughts of ending life. The important difference is the threshold: the adolescent cutoff is 11, not the adult 10, which came out of validation work in adolescent primary care. Use the PHQ-A for ages 11 to 17 and the PHQ-9 from 18. Running the adult version with a fifteen-year-old will usually still detect depression, but you’d be reading it against a threshold that wasn’t set for them. If anxiety or broader difficulties are also in the picture, the RCADS covers depression and five anxiety disorders in one parent-report instrument, and the SDQ gives a broad screen across conduct, hyperactivity and peer relationships as well as mood.

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Is it free to use?

Yes. The PHQ-A falls under Pfizer’s 2010 free-public release of the PHQ family.

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Citation

Johnson, J. G., Harris, E. S., Spitzer, R. L., & Williams, J. B. W. (2002). The Patient Health Questionnaire for Adolescents: Validation of an instrument for the assessment of mental disorders among adolescent primary care patients. Journal of Adolescent Health, 30(3), 196-204. Adolescent cutoff: Richardson, L. P., McCauley, E., Grossman, D. C., McCarty, C. A., Richards, J., Russo, J. E., Rockhill, C., & Katon, W. (2010). Evaluation of the Patient Health Questionnaire-9 Item for detecting major depression among adolescents. Pediatrics, 126(6), 1117-1123. The PHQ family is copyright Pfizer Inc., released for free public use without restriction.

PHQ-9 (adult)

The adult depression measure. Same structure, ≥10 cutoff, no adolescent-specific wording.

SDQ (self-report 11-17)

Broader adolescent mental-health screen — emotional symptoms, conduct, hyperactivity, peers, prosocial.

Risk flagging

How sensitive items surface in the conversation and what to do with the signal.