The ratings in this section identify the behavioral health needs of the youth. While the CANS is not a diagnostic tool, it is designed to be consistent with diagnostic communication. In the DSM, a diagnosis is defined by a set of symptoms that is associated with either dysfunction or distress. This is consistent with the ratings of ‘2’ or ‘3’ as described by the action levels below.
Question to consider for this domain: What are the presenting social, emotional, and behavioral needs of the youth?
Basic Design for Rating Needs
| Rating | Level of Need | Appropriate Action |
| 0 | No evidence of need | No action needed |
| 1 | Significant history or possible need that is not interfering with functioning | Watchful waiting/prevention/additional assessment |
| 2 | Need interferes with functioning | Action/intervention required |
| 3 | Need is dangerous or disabling | Immediate action/Intensive action required |
PSYCHOSIS (THOUGHT DISORDER)
This item rates the symptoms of psychiatric disorders with a known neurological base, including schizophrenia spectrum and other psychotic disorders. The common symptoms of these disorders include hallucinations (i.e. experiencing things others do not experience), delusions (i.e. a false belief or an incorrect inference about reality that is firmly sustained despite the fact that nearly everybody thinks the belief is false or proof exists of its inaccuracy), disorganized thinking, and bizarre/idiosyncratic behavior.
Questions to Consider
- Has the youth ever talked about hearing, seeing, or feeling something that was not actually there?
- Has the youth ever done strange, bizarre, or nonsensical things?
ATTENTION/CONCENTRATION
Problems with attention, concentration and task completion would be rated here. These may include symptoms that are part of DSM-5 Attention Deficit Hyperactivity Disorder (ADHD). Inattention/distractibility not related to opposition would also be rated here.
Questions to Consider
- Does the youth have attention or concentration difficulties that are not appropriate for the youth’s age?
- Is the youth’s distractibility interfering with their functioning?
IMPULSIVITY/HYPERACTIVITY
Problems with impulse control and impulsive behaviors, including motoric disruptions, are rated here. This includes behavioral symptoms associated with Attention Deficit Hyperactivity Disorder (ADHD), Impulse-Control Disorders and mania as indicated in the DSM-5. Children with impulse problems tend to engage in behavior without thinking, regardless of the consequences. This can include compulsions to engage in gambling, violent behavior (e.g., road rage), sexual behavior, fire-starting or stealing. Manic behavior is also rated here.
Questions to Consider
- Does the youth’s impulsivity put them at risk?
- How has the youth’s impulsivity impacted their life?
- Is the child unable to sit still for any length of time?
- Is the youth able to control themselves?
- Does the youth report feeling compelled to do something despite negative consequences?
DEPRESSION
Symptoms included in this item are irritable or depressed mood, social withdrawal, sleep disturbances, weight/eating disturbances, and loss of motivation, interest or pleasure in daily activities. This item can be used to rate symptoms of the depressive disorders as specified in DSM-5.
Questions to Consider
- Is youth concerned about possible depression or chronic low mood and irritability?
- Has the youth withdrawn from normal activities?
- Does the youth seem lonely or not interested in others?
ANXIETY
This item rates symptoms associated with DSM-5 Anxiety Disorders characterized by excessive fear and anxiety and related behavioral disturbances (including avoidance behaviors). Panic attacks can be a prominent type of fear response.
Questions to Consider
- Does the youth have any problems with anxiety or fearfulness?
- Is the youth avoiding normal activities out of fear?
- Does the youth act frightened or afraid?
OPPOSITIONAL (Non-compliance with Authority)
This item rates the youth’s relationship with authority figures. Generally oppositional behavior is displayed in response to conditions set by a parent, teacher or other authority figure with responsibility for and control over the youth.
Questions to Consider
- Does the youth follow the parent’s rules?
- Have teachers or other adults reported that the youth does not follow rules or directions?
- Does the youth argue with adults when they try to get them to do something?
- Does the youth do things that the youth has been expressly told not to do?
CONDUCT
This item rates the degree to which a youth engages in behavior that is consistent with the presence of a Conduct Disorder.
Questions to Consider
- Is the youth seen as dishonest? How does the youth handle telling the truth/lies?
- Has the youth been part of any criminal behavior?
- Has the youth ever shown violent or threatening behavior towards others?
- Has the youth ever tortured animals?
- Does the youth disregard or is unconcerned about the feelings of others (lack empathy)?
SUBSTANCE USE
This item describes problems related to the use of alcohol and illegal drugs, the misuse of prescription medications, and the inhalation of any chemical or synthetic substance by a youth. This rating is consistent with DSM-5 Substance-Related and Addictive Disorders. This item does not apply to the use of tobacco or caffeine.
Questions to Consider
- Has the youth used alcohol or drugs on more than an experimental basis?
- Do you suspect the youth has an alcohol or drug use problem?
ATTACHMENT DIFFICULTIES
This item should be rated within the context of the youth’s significant parental or caregiver relationships.
Questions to Consider
- Does the youth struggle with separating from caregiver? Does the youth approach or attach to strangers in indiscriminate ways?
- Does the youth have the ability to make healthy attachments to appropriate adults or are their relationships marked by intense fear or avoidance?
- Does the child have separation anxiety issues that interfere with ability to engage in childcare or preschool?
EATING DISTURBANCE
This item rates problems with eating, including disturbances in body image, refusal to maintain normal body weight, recurrent episodes of binge eating, and hoarding food.
Questions to Consider
- How does the youth feel about his/ her body?
- Does the youth seem to be overly concerned about their weight?
- Does the youth ever refuse to eat, binge eat, or hoard food?
- Has the youth ever been hospitalized for eating related issues?
ANGER CONTROL
This item captures the youth’s ability to identify and manage anger when frustrated.
Questions to Consider
- How does the youth control their emotions?
- Does the youth get upset or frustrated easily?
- Does the youth overreact if someone criticizes or rejects them?
- Does the youth seem to have dramatic mood swings?
Supplemental Information: Everyone gets angry at times. This item is intended to identify individuals who are more likely than average to become angry and lose control in such a way that it leads to problems with functioning. A ‘3’ describes an individual whose anger has put themselves or others in physical peril within the rating period.