Metrics details. In order to comply with the changes in DSM classification, the Spanish edition of the interview was in need of update and evaluation. Patients and their parents or guardians were interviewed and videotaped, and the videos were exchanged between raters. Factor analysis was performed and inter-rater reliability was calculated only in the case of diagnoses in which there were more than five patients. A total of 74 subjects were included. Kappa values for inter-rater agreement were larger than 0.
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Metrics details. In order to comply with the changes in DSM classification, the Spanish edition of the interview was in need of update and evaluation. Patients and their parents or guardians were interviewed and videotaped, and the videos were exchanged between raters.
Factor analysis was performed and inter-rater reliability was calculated only in the case of diagnoses in which there were more than five patients.
A total of 74 subjects were included. Kappa values for inter-rater agreement were larger than 0. The factor structure of diagnoses, made with the instrument was found to correspond to the DSM-5 disorder organization. The instrument showed good construct validity and inter-rater reliability, which makes it a useful tool for clinical research studies in children and adolescents.
Peer Review reports. Diagnostic clinical interviews are essential for child and adolescent psychiatric research, since they homogenize criteria and decrease sources of variability. The original version was examined for its inter-rater, test-retest reliability and concurrent validity [ 2 ]. The Spanish version reported inter-rater reliability [ 3 ].
The Icelandic version determined convergent and divergent validity in relation to the diagnosis of depression [ 5 ]. For the Iranian Farsi version, one study determined the validity by consensus as well as inter-rater and test-retest reliability [ 6 ], while a second study added concurrent validity of the instrument [ 7 ]. The organization of the categories was modified to include neurodevelopmental disorders.
In addition, new diagnoses have been added and others have been modified. Clinical conditions not considered categories, such as non suicidal self injury NSSI and limited prosocial emotions LPE were also included. Since these changes may have modified the internal structure of the interview, a factor analysis of the K-SADS-PL-5 could help to determine how the diagnostic groups are integrated in the schedule.
A factor analysis allows us to construct a dimensional view of the diagnoses and permits a better understanding of the taxonomic commonalities and clinical comorbidities [ 12 , 13 ]. Factor analysis of epidemiological data from structured clinical interviews has helped to identify factors explaining diagnostic groupings. Main factors have been termed as internalizing and externalizing: the former includes diagnoses of anxiety and depression, while the latter includes disruptive behaviors and substance use disorders [ 15 , 16 ].
Recently, a study using a large, epidemiological sample of adolescents, has further divided these two factors into four: distress disorders, fear disorders, behavioral disorders, and substance disorders. The first two grouped within the internalizing factor, while the last two clustered within the externalizing factor [ 17 ]. Seeking further definition, the authors explored a fifth factor, which applied only to eating disorders [ 18 ].
It is worth noting that most studies use epidemiological samples and therefore studies in clinical settings could help to understand diagnostic grouping in such scenarios. Inter-rater agreement is among the most important procedures for establishing reliability in regard to psychiatric interviews [ 19 ].
In general, these studies suggest that inter-rater reliability in pediatric population are often larger for externalizing disorders than for internalizing disorders. The objective of this study was to determine the construct validity and the inter-rater reliability of the K-SADS-PL-5 in an international multicenter study.
Written informed assent and consent were obtained from the parent or guardian and the child or adolescent. The sample was obtained from inpatient and outpatient services in four different Latin American countries. Venezuela and Argentina only participated in the inter-rater evaluation. The K-SADS-PL-5 is a semi-structured diagnostic interview designed to collect information from the child or adolescent as well as their parents or other informants.
A trained interviewer produces a better clinical estimate or summary for each symptom of all categories included. With this interview, it is possible to determine current episodes defined as episodes that have occurred within the last six months or past episodes.
The current study used only information regarding current episodes. Screening contains an introductory interview that covers the reason for consultation and general patient data as well as a screening section of the primary symptoms of each disorder. When at least one symptom is evaluated as definitive in the summary, the evaluation of the disorder is completed in the corresponding supplement. Supplement 1 includes depressive and bipolar disorders, supplement 2 includes psychotic disorders, supplement 3 includes anxiety, stress and obsessive compulsive disorders, supplement 4 includes disruptive behavior and impulse control disorders, supplement 5 includes substance use disorders and feeding and eating disorders, and the new supplement 6 includes neurodevelopmental disorders.
The first stage, carried out from January to June included the following steps, i a Latin American international clinical team comprising the current authors reviewed and adapted the K-SADS-PL Spanish version [ 3 ] to the DSM-5 structure followed by ii the inclusion of the six new or modified diagnoses under consensus and iii the text review and testing with clinicians, patients and parents in order to obtain a final version incorporating all comments and suggestions.
During the third stage, carried out from February to July , clinicians from each site sought to interview 10 subjects five children and five adolescents ; if this quota was not met, the number of patients was compensated by sites with greater capacity. This number of patients was chosen a priori in order to balance the number of children and adolescents from each site.
In every case, informed assent and consent was obtained previous to the interviews. Each of the sites was coordinated by a child psychiatrist with more than fifteen years of clinical experience. The rest of the raters were child psychiatrists and clinical psychologists.
Each site coordinator maintained supervision of the interviews and communication with the principal investigator with whom any doubt was resolved.
The fourth stage, carried out from August to February , consisted in the inter-site exchange and rating of the videotaped interviews, which was done every three weeks through a privately shared video system over the internet. The principal investigator randomly assigned every rated interview to at least two raters.
This resulted in three separate evaluations for each interview. The general demographic and diagnostic data of the subjects was described using percentages, medians and interquartile ranges. For the factor analysis, a polychoric correlation was performed on a dichotomous matrix of diagnoses obtained from the summary section of the K-SADS-PL-5 classified as either present or absent discarding those that were completely absent or had low prevalence tic disorder, cyclothymia, bipolar disorder, enuresis, anorexia disorder, bulimia disorder, avoidant restrictive food intake disorder, tobacco use disorder, substance use disorder schizophrenia.
With this criteria, we settled on six factors and proceeded to perform a factor analysis using the generalized least squares method with an oblimin rotation, as recommended by Stuart [ 20 ]. All analyses were performed in R [ 23 ].
Eighty children and adolescents from all venues were evaluated; six were excluded because they did not have complete screening or supplements.
Results are shown for 74 subjects. They presented a median number of comorbid diagnoses per patient of 3 1—5. Complete demographic and diagnostic clinical characteristics of the sample can be reviewed in a previous report [ 24 ].
The agreement between the disruptive behavior disorders was greater than that of anxiety and depressive disorders. We obtained a factor solution suggesting robust diagnostic groupings. Below, we discuss each factor independently. Even though NSSI is not a mood disorder per se, it is a phenomenon frequently related to affective disorders [ 25 , 26 ].
DMDD is a new disorder in the affective disorders chapter, and it has been shown in follow up studies to be associated with depression and anxiety [ 27 ]. The inclusion of SM in this factor could reflect its frequent comorbidity with depressive disorders [ 28 ].
Hyperarousal in social situations is a physiological characteristic that has been shown as a risk factor for later childhood symptoms of social anxiety and it has been proposed as a biological mechanism in the intergenerational transmission of SAD [ 29 ].
The relationship between anxiety disorders and BED has been demonstrated in adolescent clinical samples [ 30 ]. Essentially, the evidence shows that stress life events may represent the main axis of the SHF. These disorders are frequently comorbid [ 34 ]. These disorders are known to increment the global burden of disease and have an important implication in the functioning and wellbeing of individuals [ 37 ].
Several researchers have tried to study the interaction between them, for example, some studies have demonstrated that boys and girls with CD and meeting criteria for the LPE specifier showed more impairment in psychosocial areas [ 38 , 39 , 40 ].
Previous reports had described the integration of ODD symptoms grouping with emotional lability and irritability and not only with disruptive behaviors [ 45 ]. This highlights the repetitive component in these disorders [ 47 ]. Finally, the fact that encopresis constituted a single factor, could be related to its complex clinical characteristics and comorbidity [ 48 , 49 ].
This is further supported by the results of the five and seven factor analysis, in which it loaded on a miscellaneous factor in the former and did not load into any factor on the latter. The results of the current report correspond, at least in part, to previous reports describing epidemiological samples [ 15 , 16 , 17 ], particularly in regard to the integration of internalizing disorders as those included in the DF and SHF, as well as in the externalizing disorders, as shown in the DBF, IEF.
Clinical presentation of CD comprises behaviors that are usually easy for most people to recognize. These results are of relevance since these disorders are among the most common reason for psychiatric consultation in pediatric population.
The lowest Kappa values were for LPE 0. In terms of impact on clinical practice, these aspects may suggest that i the instrument format for these two clinical conditions could be improved and ii that in order to increase reliability, more accurate training may be needed. Interestingly, our study reports Kappa values above 0. This could be explained by several factors: i the clinical versus the school-based sample, ii the more severe symptomatology and iii easier recognition in the clinical population.
Some study limitations should be considered. Although it is a Latin American multi-center study, not all the centers provided an equal number of cases which limited hemispheric representation. Sample sizes in this range can be seen in other studies evaluating the psychometric properties of the interview [ 4 , 5 , 8 , 10 ]. To somewhat reduce this problem, we removed disorders with a low prevalence from the factor analysis.
Also, a good inter-rater reliability was obtained for major disorders. All these elements make it a useful tool for clinical research studies in children and adolescents. American Psychiatric Association. Google Scholar. Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version K-SADS-PL : initial reliability and validity data. Interrater reliability of the Spanish version of schedule for affective disorders and schizophrenia for school-age children--present and lifetime version K-SADS-PL.
Actas Esp Psiquiatr. Yonsei Med J. Parent-youth agreement on symptoms and diagnosis: assessment with a diagnostic interview in an adolescent inpatient clinical population. J Physiol Paris. Psychometric properties of the Farsi translation of the kiddie schedule for affective disorders and schizophrenia-present and lifetime version. BMC Psychiatry. Ghanizadeh A, Jafari P.
J Atten Disord. The mandarin version of the kiddie-schedule for affective disorders and schizophrenia-epidemiological version for DSM-5 - a psychometric study. J Formos Med Assoc.
Kiddie-Sads-Present and Lifetime Version (K-SADS-PL)
Metrics details. Research is needed to establish the utility of diagnostic interviews in clinical settings. Studies comparing clinical diagnoses with diagnoses generated with structured instruments show generally low or moderate agreement and clinical diagnostic assignment e. The authors reviewed the charts of the previous three years of consecutive admissions, patients being evaluated using routine psychiatric evaluation, before the Kiddie-SADS-PL was introduced. They then reviewed the charts of all consecutive admissions during the next twelve months, patients being evaluated by adding the instrument to routine practice. The rates of several main diagnostic categories depressive, anxiety, bipolar and disruptive disorders increased considerably, suggesting that those disorders were likely underreported when using non-structured routine assessment procedures. The rate of co-morbidity increased markedly as the number of diagnoses assigned to each patient increased.
Kiddie Schedule for Affective Disorders and Schizophrenia
One of the most significant contributions to the field by Department of Psychiatry investigators is the development and testing of diagnostic tools for research and clinical practice. Assessment of children and adolescents can present unique challenges. For example, mood symptoms are more challenging to evaluate in children than in adults. The K-SADS is a semi-structured interview to measure current and past symptoms of mood, anxiety, psychotic, and disruptive behavior disorders in children ages years old. Unlike other assessment instruments for children, it relies on answers to interview questions rather than only observations during games and interactions. Most versions of the K-SADS also include "probes" or examples of questions that elicit symptom information. If a primary symptom w is endorsed, further questions will be asked to determine whether diagnostic criteria are met.
The Kiddie Schedule for Affective Disorders and Schizophrenia K-SADS is a 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 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. 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.