CES-DC Scoring · Center for Epidemiologic Studies Depression Scale for Children
The CES-DC (Center for Epidemiologic Studies Depression Scale for Children) is a 20-item self-report screener for depressive symptoms over the past week in children and adolescents. Items rated 0–3, total 0–60, positive screen ≥15.
For professional reference, research, and education only. Not for diagnosis or medical advice.
CES-DC Score Interpreter (20-item, 0–60)
Enter a total score to see its range.
A total of ≥15 is the screening threshold suggested for current depressive disorder in children and adolescents (Fendrich et al., 1990). The CES-DC has limited diagnostic specificity, so a positive screen warrants a full clinical evaluation — it is a screening result, not a clinical conclusion.
CES-DC total Interpretation 15+ Positive screen (≥15)At or above the screening threshold; supports referral for full evaluation. 0–14 Below screening threshold (0–14)Depressive symptoms not elevated on the CES-DC. Center for Epidemiologic Studies Depression Scale for Children (Weissman et al., 1980; Fendrich et al., 1990). Screening reference only.
The CES-DC (Center for Epidemiologic Studies Depression Scale for Children) is a 20-item self-report screener for depressive symptoms in children and adolescents, adapted from the adult CES-D [1].
What does the CES-DC measure?
The Center for Epidemiologic Studies Depression Scale for Children was adapted by Myrna Weissman and colleagues from the adult Center for Epidemiologic Studies Depression Scale (CES-D), itself developed by Lenore Radloff [1]. The child version keeps the same 20-item structure but rephrases the items in plain language a young person can answer about how they have felt over the past week.
It is a self-report screen for school-age children and adolescents, and it is used in schools, primary care, and epidemiological research. The CES-DC measures depressive symptom burden rather than confirming any condition.
The CES-DC covers the core symptom areas of depression as experienced over the past week (depressed mood, loss of interest, feelings of worthlessness, appetite and sleep disturbance, fatigue, and difficulty concentrating), together with a few positively framed items about positive affect. It is a severity and screening measure, not a structured clinical interview.
How do you give the CES-DC?
The CES-DC is completed by the young person. Non-clinical staff can administer it, but a licensed clinician interprets the score alongside history, development, and functional context. For younger children, pair self-report with caregiver observation, since self-report reliability is lower below adolescence [3].
How do you score and interpret the CES-DC?
How to score the CES-DC
Each item is rated 0 (Not At All), 1 (A Little), 2 (Some), or 3 (A Lot) for the past week.
Four positively worded items (covering positive affect, such as feeling happy, hopeful, or enjoying life) are reverse-scored, then all 20 items are summed for a total ranging 0–60. Higher scores indicate greater depressive symptom burden. Use the interpreter above to place a total against the screening threshold.
CES-DC cut-points
| Range | Interpretation |
|---|---|
| 0–14 | Below screening threshold |
| ≥15 | Positive screen: supports referral for full evaluation |
A total of ≥15 is the screening threshold suggested for current depressive disorder [2]. The scale has limited specificity: many children scoring above 15 will not meet criteria for a depressive disorder on full assessment, so the cut-off is best read as a trigger for closer evaluation, applied with clinical judgement. A positive screen is a screening result, not a clinical conclusion.
Psychometric properties
- Community validation. In children, adolescents and young adults aged 6 to 23 at high or low risk for depression, the main validation study supported the CES-DC's reliability and validity as a measure of depressive symptoms, especially for girls and for those aged 12 to 18. It lacked diagnostic specificity, since young people with a range of diagnoses had elevated scores [2].
- Psychiatric inpatients. In 148 child and adolescent inpatients, test-retest reliability, internal consistency and concurrent validity were adequate, but scores did not discriminate between diagnoses; the scale performed poorly in children but well in adolescents [3].
Its main weakness is limited specificity, which is why it is positioned as a screen rather than a confirmatory measure.
Limitations
- Screening, not a clinical conclusion. A positive CES-DC indicates symptoms consistent with depression and warrants full evaluation.
- Limited specificity. Elevated scores also occur with anxiety and other distress, producing false positives.
- Age and reliability. Self-report is less reliable in younger children; caregiver input matters below adolescence.
For adolescent depression with parent-report options, consider the MFQ; for adults, use the PHQ-9; for co-occurring anxiety in youth, the SCARED.
Billing the CES-DC (CPT 96127)
CES-DC administration qualifies for reimbursement under CPT code 96127 (brief emotional/behavioural assessment) when it is scored and documented with clinical interpretation. Medicare's Medically Unlikely Edit caps 96127 at 4 units per date of service; commercial payer limits vary, so confirm your contract.
For individuals: This page is a clinical reference, not a diagnostic tool. If you have concerns about your own symptoms, bring this information to a qualified mental health professional.
Related
Billing
In the US, the CES-DC Scoring · Center for Epidemiologic Studies Depression Scale for Children is usually billed under these CPT codes. Payer rules vary.
Assessments
- BDI-II Scoring Guide · Beck Depression Inventory
- CES-D: Center for Epidemiologic Studies Depression Scale
- DASS-21 Scoring & Interpretation · Calculator + Severity Bands
- Beck Anxiety Inventory (BAI) Scoring & Interpretation
- GAD-7 Scoring and Interpretation
- HAM-A: Hamilton Anxiety Rating Scale
Dot size shows how strongly each scale's condition is linked to this one in HiBoop's co-occurrence map.
FAQ
What is the CES-DC?
The CES-DC is a 20-item self-report screener for depressive symptoms in children and adolescents, adapted by Myrna Weissman and colleagues from the adult Center for Epidemiologic Studies Depression Scale (CES-D). It asks how often the young person has felt or acted a certain way over the past week and is a common depression screen for school-age children and adolescents.
How is the CES-DC scored?
Each of the 20 items is rated 0 (Not At All), 1 (A Little), 2 (Some), or 3 (A Lot) for the past week. Four positively worded items are reverse-scored, then all items are summed for a total ranging 0–60. Higher scores indicate more depressive symptoms.
What is the cut-off score for the CES-DC?
A total score of 15 or higher is the screening threshold suggested for current depressive disorder in children and adolescents in the main validation study. The CES-DC has limited specificity, so many children who score above 15 will not have a depressive disorder on full assessment. A positive screen warrants a full clinical evaluation, not a screening result treated as a conclusion.
What ages is the CES-DC for?
The CES-DC was validated in young people aged 6 to 23, with the evidence supporting it most strongly for those aged 12 to 18 and for girls; a study in psychiatric inpatients found poor reliability and validity in younger children but good psychometric properties in adolescents. For younger children, caregiver input is important; for adults, use the PHQ-9.
References
- 1.Weissman MM, Orvaschel H, Padian N. Children's symptom and social functioning self-report scales: comparison of mothers' and children's reports. J Nerv Ment Dis. 1980;168(12):736-740.
- 2.Fendrich M, Weissman MM, Warner V. Screening for depressive disorder in children and adolescents: validating the Center for Epidemiologic Studies Depression Scale for Children. Am J Epidemiol. 1990;131(3):538-551.
- 3.Faulstich ME, Carey MP, Ruggiero L, et al. Assessment of depression in childhood and adolescence: an evaluation of the Center for Epidemiological Studies Depression Scale for Children (CES-DC). Am J Psychiatry. 1986;143(8):1024-1027.
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