Kiddie Schedule for Affective Disorders and Schizophrenia

The Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) is an semi-structured interview aimed at early diagnosis of affective disorders such as depression, bipolar disorder, and anxiety disorder. There are currently four different versions of the test that are structured to include interviews with both the child and the parents or guardians.

The K-SADS serves to diagnose childhood mental disorders in school-aged children 6-18. The different adaptations of the K-SADS were written by different researchers and are used to screen for many affective and psychotic disorders. Versions of the K-SADS are semi-structured interviews administered by health care providers or highly trained clinical researchers, which gives more flexibility to the interviewer about how to phrase and probe items, while still covering a consistent set of disorders. Due to its semi-structured interview format, time to complete the administration varies based on the youth/adult being interviewed. Most versions of the K-SADS also include "probes", if these are endorsed, another diagnostic category will be reviewed. If the probe is not endorsed, additional symptoms for that particular disorder will not be queried.

The K-SADS has been found to be reliable and valid in multiple research and treatment settings.

Versions

KSADS-Present Version (KSADS-P)

The KSADS-P was the first version of the K-SADS, developed by Dr. Chambers & Dr. Puig-Antich in 1978 as a version of the Schedule for Affective Disorders and Schizophrenia, which was adapted for use with children and adolescents ages 6–19 years old. This version rephrased the SADS to make the wording of the questionnaire pertain to a younger age group.^[1] For example, mania symptoms in children might be manifest differently than in adulthood (e.g., children might have not have the same opportunity to spend money impulsively, nor would they likely have access to credit cards or checking accounts; instead, they might give away all their favorite toys or empty their parent's wallet to gain spending money).^[2] The KSADS-P is a structured interview given by trained clinicians or clinical researchers who interview both the child and the parent. This original version assesses symptoms that have occurred in the most current episode (within the week preceding the interview), as well as symptoms that have occurred within the last year (12 months).^[3] The KSADS-P has many limitations, including not assessing lifetime symptoms and history, not including many psychiatric diagnoses of interest in childhood (such as autistic spectrum disorders), and not including diagnosis specific impairment ratings.

KSADS-Present and Lifetime Version (KSADS-PL)

The K-SADS-PL is used to screen for affective and psychotic disorders as well as other disorders, including, but not limited to Major Depressive Disorder, Mania, Bipolar Disorders, Schizophrenia, Schizoaffective Disorder, Generalized Anxiety, Obsessive Compulsive Disorder, Attention Deficit Hyperactivity Disorder, Conduct Disorder, Anorexia Nervosa, Bulimia, and Post-Traumatic Stress Disorder.^[4] This semi-structured interview takes 45–75 minutes to administer.^[5] It was written by Joan Kaufman, Ph.D., Boris Birmaher, M.D., David Brent, M.D., Uma Rao, M.D., and Neal Ryan, M.D.^[4] The majority of items in the K-SADS-PL are scored using a 0–3 point rating scale. Scores of 0 indicate no information is available; scores of 1 suggest the symptom is not present; scores of 2 indicate sub-threshold presentation and scores of 3 indicate threshold presentation of symptoms. The KSADS-PL has six componenets below:^[5]

Unstructured Introductory Interview -- Developmental History

The first part of the interview asks about developmental history and the history of the presenting problem. The interviewer takes detailed notes on the record sheet. Prompts cover basic demographic information, physical and mental health history and prior treatments, current complaints, and the youth’s relations with friends, family, school, and hobbies. This section allows flexibility for the interviewer to collect more information on questions that need elaboration.^[5]

Diagnostic Screening Interview

The diagnostic screening interview reviews the most severe current and past symptoms. There are probes and scoring criteria for each symptom presented. Symptoms of disorders are grouped into modules. If the patient does not display any current or past symptoms for the screening questions, then the rest of the module's questions do not need to be asked.^[5]

Supplement Completion Checklist

A supplemental checklist is used to screen for additional disorders.^[5]

Appropriate Diagnostic Supplements

These supplements review presence/absence of symptoms for other disorders, including anxiety disorders, behavioral disorders, and substance abuse.^[5]

Summary Lifetime Diagnosis Checklist

Based on the previous sections, this section summarizes which disorders have been present from first episode to now.^[5]

Children’s Global Assessment Scale (C-GAS)

Scores the child’s level of functioning.^[5]

KSADS-Epidemiological (KSADS-E)

The KSADS-E, which is the epidemiological version of the KSADS, is a tool to interview parents about possible psychopathology from preschool onward in children.  It was developed by Puig-Antich J., Orvaschel, H., Tabrizi, M.A., Chambers, W in 1980 as a structured interview. The tool examines both past and current episodes, focusing on the most severe past episode and the most current episode. However, this tool does not rate symptom severity; it should only be used to assess presence or absence of symptomatology. This version of the K-SADS introduced screening questions, which, if negative, allowed skipping the remaining diagnostic probes. Furthermore, the K-SADS-E also includes “skip out” criteria when assessing other diagnostic disorders (ADHD, PTSD, ect.), allowing those that screen positive to immediately be interviewed for all of the symptoms regarding that diagnosis, and those that screened negative could “skip out” of being interviewed on the remaining symptoms.

WASHU-KSADS

The WASHU version of the K-SADS was written by Barbara Geller, M.D., and colleagues in 1996. It is a modified version of the K-SADS1986.^[1] This version is like many other versions of the K-SADS in that it is semi-structured, administered by clinicians to both parent and child separately, and assesses present episodes.  However, this version specifically expands the mania section in order to be more applicable to pre-pubertal mania.  In particular, it queries presence/absence of rapid cycling. It also includes a section on multiple other DSM-IV diagnoses, and examines both present and lifetime symptoms as well as symptom onset and offset items.^[1] These modifications made this specific version particularly useful for phenomenology studies.

KMRS

This abridged version of the K-SADS focuses on mania and is a combination/modification of the WASH-U-KSADS (Geller, MD) and the 4th revision of the KSADS-P (Joaquim Puig-Antich, M.D. and Neal Ryan, M.D.) Specifically, it assess 21 symptoms related to mania, hypomania, and rapid cycling. Each item is rated on a 0-6 rating scale.  Scores of 0 suggest no information is available; scores of 1 suggest the symptom is not present at al; scores of 2 suggest the symptom is slightly present; scores of 3 suggest the symptom is mildly severe; scores of 4 suggest the symptom is moderately severe; scores of 5 suggest the symptom is severe; and scores of 6 suggest the symptom is extremely severe. Items with scores of 4 or higher are clinically significant/maladaptive.  Trained clinicians or clinical researchers administer the assessment to both the child and the parent, which each provide their own separate score for each item (P and C), and the total score encompasses the sum of all of the items (S).

Reliability

Evaluating norms and reliability

Rubric for evaluating norms and reliability for assessments (extending Hunsley & Mash, 2008; *indicates new construct or category)

Criterion	K-SADS-P	K-SADS-E	K-SADS-PL	WASHU-K-SADS	K-SADS-MRS
Norms - As a diagnostic interview, norms and standardization samples would not be relevant.	Not applicable	Not applicable	Not applicable	Not applicable	Not applicable
Internal consistency (Cronbach's alpha, split half, etc.)	Not usually evaluated or reported, especially if using the "skip outs" and screening questions	Not applicable	Not applicable	Not applicable	Excellent: Cronbach's alpha= .94[6]
Inter-rater reliability	Percent agreement (inter-rater reliability) reported as 98% (range=93%-100%)[7]	Kappa coefficients for affective, anxiety, ADHD, and disruptive disorders were equal to or greater than .9 (p < .001)[8]	Percent agreement (inter-rater reliability) reported as 98% (range=93%-100%)[7]	Reported as 100%[1]	Intraclass correlation coefficient= .97[6]
Test-retest reliability (stability)	Good to Excellent: Major Depressive Disorder: k=.9[7] Bipolar Disorder: k=1.00[7] Generalized Anxiety Disorder: k=.78[7] Any Anxiety Disorder: k=.80[7] PTSD: k=.67[7] ADHD: k=.63[7] Oppositional Defiant Disorder: k=.74[7]	TBD	Major Depressive Disorder: k=1.00[7] Bipolar Disorder: k=1.00[7] Generalized Anxiety Disorder: k=.78[7] Any Anxiety Disorder: k=.60[7] PTSD: k=.60[7] ADHD: k=.55[7] Oppositional Defiant Disorder: k=.77[7]	TBD	TBD
*Repeatability	TBD	TBD	TBD	TBD	TBD

Development and history

The Schedule for Affective Disorders and Schizophrenia for School Aged Children, or K-SADS, was originally created as an adaptive version of the Schedule for Affective Disorders and Schizophrenia, a measure for adults. The K-SADS was written by Chambers, Puig-Antich, et al. in the late 1970s.^[9] The K-SADS was developed to promote earlier diagnosis of affective disorders and schizophrenia in children in a way that incorporates reports by both the child and parent and a “summary score” by the interviewer based on observations and teacher ratings.^[9]

The first version of the K-SADS differed from other tests on children because it relied on answers to interview questions rather than observances during games and interactions. The 1990s led to the creation of different versions of the K-SADS for different purposes, such as ascertaining lifetime diagnoses (K-SADS-E) or focusing on current episodes (K-SADS-P).^[9][10]

Impact

The K-SADS is used to measure previous and current symptoms of affective, anxiety, psychotic, and disruptive behavior disorders. The K-SADS has become one of the most widely used diagnostic interviews in research, particular for projects focused on mood disorders. Use in other populations

The K-SADS-PL has been written and translated into 16 different languages,^[11] including Korean, Hebrew, Turkish, Iclandic,^[12] and Persian/Farsi. The K-SADS-PL is also available in several Indian dialects including Kannada, Marathi, Tamil and Telugu.^[11]

Limitations

One limitation of the K-SADS is that it requires extensive training to give properly, including observation techniques, score calibration, and re-checks to test inter-rater reliability.^[7] It is less commonly used in clinical practice, and requires more training to be able to use consistently than other more structured alternatives. The greater degree of clinical judgment required has also made the K-SADS less suitable for large epidemiological projects, which usually need to use interviewers with little prior clinical experience.

Many versions of the test, including the translated versions, are not available as PDF's online. There are no meta-analytic reviews of the reliability or validity of many of the versions.

See also

• Pediatric bipolar disorder
• Schedule for Affective Disorders and Schizophrenia
• List of diagnostic classification and rating scales in psychiatry
• Classification of mental disorders

External links

• K-SADS-PL
• Version en español
• K-SADS-MRS

References

1. Geller, Barbara; Zimerman, Betsy; Williams, Marlene; Bolhofner, Kristine; Craney, James L.; DelBello, Melissa; Soutullo, Cesar (April 2001). "Reliability of the Washington University in St. Louis Kiddie Schedule for Affective Disorders and Schizophrenia (WASH-U-KSADS) Mania and Rapid Cycling Sections". Journal of the American Academy of Child and Adolescent Psychiatry. 40 (4): 450–455. doi:10.1097/00004583-200104000-00014. PMID 11314571.
2. Freeman, Andrew J.; Youngstrom, Eric A.; Freeman, Megan J.; Youngstrom, Jennifer Kogos; Findling, Robert L. (2011-10-01). "Is Caregiver-Adolescent Disagreement Due to Differences in Thresholds for Reporting Manic Symptoms?". Journal of Child and Adolescent Psychopharmacology. 21 (5): 425–432. doi:10.1089/cap.2011.0033. ISSN 1044-5463.
3. Ambrosini, Paul J. (January 2000). "Historical Development and Present Status of the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS)". Journal of American Academy of Child and Adolescent Psychiatry. 39 (1): 49–58. doi:10.1097/00004583-200001000-00016. PMID 10638067.
4. Kaufman, Joan; Birmaher, Boris; Brent, David; Rao, Uma; Ryan, Neal (1996). "Diagnostic Interview: Kiddie-Sads-Present and Lifetime Version" (PDF). Retrieved 2016-09-08.
5. Bergman, Hanna; Maayan, Nicola; Kirkham, Amanda J; Adams, Clive E; Soares-Weiser, Karla (2015-06-24). Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd. doi:10.1002/14651858.cd011733. ISSN 1465-1858.
6. Axelson, David; Birmaher, Boris J.; Brent, David; Wassick, Susan; Hoover, Christine; Bridge, Jeffrey; Ryan, Neal (2003-01-01). "A preliminary study of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children mania rating scale for children and adolescents". Journal of Child and Adolescent Psychopharmacology. 13 (4): 463–470. doi:10.1089/104454603322724850. ISSN 1044-5463. PMID 14977459.
7. Kaufman, Joan; Birmaher, Boris; Brent, David; Rao, Uma; Flynn, Cynthia; Moreci, Paula; Williamson, Douglas; Ryan, Neal (1997). "Schedule for Affective Disorders and Schizophrenia for school-age children-present and lifetime version (K-SADS-PL): Initial reliability and validity data". Journal of the American Academy of Child & Adolescent Psychiatry. 36 (7): 980–988. doi:10.1097/00004583-199707000-00021. PMID 9204677.
8. Polanczyk, Guilherme V.; Eizirik, Mariana; Aranovich, Victor; Denardin, Daniel; Silva, Tatiana L. da; Conceição, Tatiana V. da; Pianca, Thiago G.; Rohde, Luis Augusto (2003-06-01). "Interrater agreement for the schedule for affective disorders and schizophrenia epidemiological version for school-age children (K-SADS-E)". Revista Brasileira de Psiquiatria. 25 (2): 87–90. doi:10.1590/S1516-44462003000200007. ISSN 1516-4446.
9. Chambers, W. J.; Puig-Antich, J.; Hirsch, M.; Paez, P.; Ambrosini, P. J.; Tabrizi, M. A.; Davies, M. (1985). "The assessment of affective disorders in children and adolescents by semistructured interview. Test-retest reliability of the schedule for affective disorders and schizophrenia for school-age children, present episode version.". Archives of General Psychiatry. 42 (7): 696–702. PMID 4015311.
10. Shiner, R.L. (2007). "Personality Disorders". In Mash, Eric J.; Barkley, Russell A. Assessment of Childhood Disorders (4th ed.). New York, NY: Guilford Press. pp. 781–816. ISBN 978-1593854935.
11. Hersen, Michel (2004-01-01). Comprehensive Handbook of Psychological Assessment, Personality Assessment. John Wiley & Sons. ISBN 9780471416128.
12. Lauth, Bertrand; Magnússon, Páll; Ferrari, Pierre; Pétursson, Hannes. "An Icelandic version of the Kiddie-SADS-PL: Translation, cross-cultural adaptation and inter-rater reliability". Nordic Journal of Psychiatry. 62 (5): 379–385. doi:10.1080/08039480801984214.