Kiddie-Sads-Present and Lifetime Version (K-SADS-PL)
Getting the Instrument
K-SADS-PL 2009 Working Draft (1738K bytes)
This is a single file which contains the Screen Interview, the Summary Lifetime Diagnostic Checklist, and 8 diagnostic supplements which are completed depending on the results of the screening interview and further assess the following diagnostic categories. They are:
- Supplement #1: Affective Disorders (includes assessment of MDE, Dysthymic Disorder, Hypomania, and Mania)
- Supplement #2: Psychotic Disorders
- Supplement #3: Anxiety Disorders (includes assessment of Panic Disorder, Separation Anxiety Disorder, Social Phobia, Phobic Disorders, GAD, OCD, and PTSD)
- Supplement #4: Behavioral Disorders (includes assessment of ADHD, ODD, and Conduct Disorder)
- Supplement #5: Substance Abuse Disorders
- Supplement #6: Eating Disorders
- Supplement #7: Tic Disorders
- Supplement #8: Autism Spectrum Disorders (includes assessment of PDD NOS and Asperger’s Disorder)
If you don't already have it installed on your computer, you can get a free version of the Adobe Acrobat reader for various computer platforms including Windows and Mac from http://www.adobe.com/prodindex/acrobat/readstep.html. This will let you print out an exact copy of the K-SADS which is independent of computer or printer platform.
Usage is freely permitted without further permission for uses that meet one or more of the following:
- Clinical usage in a not-for-profit institution
- Usage in an IRB approved research protocol
All other uses require written permission of the principal author, Dr. David Axelson, including but not limited to the following:
- Redistribution of the instrument in printed, electronic or other forms
- Commercial use of the instrument
- Modification of the instrument
About the KSADS-PL 2009 Working Draft
The KSADS-PL 2009 Working Draft was adapted from the KSADS-PL. Revisions include the removal of all references to DSM-III-R, the refinement of questions and threshold anchors for most disorders, the addition of screen questions and supplement for Pervasive Development Disorders, and major revisions of the sections pertaining to bipolar disorders. This instrument was developed by David Axelson MD, Boris Birmaher MD, Jamie Zelazny RN, MPH, Joan Kaufman PhD, and Mary Kay Gill MSN with support provided by the Advanced Center for Intervention and Services Research (ACISR, MH66371) PI: David Brent MD. The authors extend appreciation to the many consultants who contributed to this instrument including Oscar Bukstein MD, John Campo MD, Carrie Christopher Fascetti, MSW, Andrew Gilbert MD, Benjamin Goldstein MD, Tina Goldstein PhD, Diane Goudreau, PhD, Megan Muir Grivas, MA, Ben Handen MD, Ami Klin, PhD, David Kolko PhD, Catherine Lord, PhD, Martin Lubetsky MD, Rita Scholle BA, and Eunice Torres, MS. Special thanks are given to Jason Lyons, MA for the extensive reformatting of the instrument.
The K-SADS-PL was adapted from the K-SADS-P (Present Episode Version), which was developed by William Chambers, M.D. and Joaquim Puig-Antich, M.D., and later revised by Joaquim Puig-Antich, M.D. and Neal Ryan, M.D. The K-SADS-PL was written by Joan Kaufman, Ph.D., Boris Birmaher, M.D., David Brent, M.D., Uma Rao, M.D., and Neal Ryan, M.D. The K-SADS-PL was designed to obtain severity ratings of symptomatology, and assess current and lifetime history of psychiatric disorders, including several disorders not surveyed in the K-SADS-P. The current instrument is greatly indebted to several other existing structured and semi-structured psychiatric instruments including the K-SADS-E (Orvaschel & Puig-Antich), the SADS-L (Spitzer and Endicott), the SCID (Spitzer, Williams, Gibbon, and First), the DIS (Robins and Helzer), the ISC (Kovacs), the DICA (Reich, Shayka, and Taibleson), and the DUSI (Tarter, Laird, Bukstein, and Kaminer). Guidelines for the introductory interview at the beginning of this instrument were provided by Michael Rutter, M.D. and Philip Graham, M.D., and modifications for the anxiety disorders section were provided by Cynthia Last, Ph.D. Other consultants include Oscar Bukstein, M.D., Walter Kaye, M.D., David Kolko, Ph.D., Rolf Loeber, Ph.D., William Pelham, Ph.D., David Rosenberg, M.D and John Walkup, M.D. Appreciation is extended to all contributors, as well as to Denise Carter-Jackson, for the word processing of this instrument.
The K-SADS-PL 2009 Working Draft is a semi-structured diagnostic interview designed to assess current and past episodes of psychopathology in children and adolescents according to DSM-IV criteria. Probes and objective criteria are provided to rate individual symptoms. The primary diagnoses assessed with the K-SADS-PL 2009 Working Draft include: Major Depression, Dysthymia, Mania, Hypomania, Cyclothymia, Bipolar Disorders, Schizoaffective Disorders, Schizophrenia, Schizophreniform Disorder, Brief Psychotic Disorder, Panic Disorder, Agoraphobia, Separation Anxiety Disorder, Simple Phobia, Social Phobia, Generalized Anxiety, Obsessive Compulsive Disorder, Attention Deficit Hyperactivity Disorder, Conduct Disorder, Oppositional Defiant Disorder, Enuresis, Encopresis, Anorexia Nervosa, Bulimia, Transient Tic Disorder, Tourette's Disorder, Chronic Motor or Vocal Tic Disorder, Alcohol Abuse, Substance Abuse, Post-Traumatic Stress Disorder, Adjustment Disorders, and Pervasive Developmental Disorders.
The K-SADS-PL 2009 Working Draft is a semi-structured interview. The probes that are included in the instrument do not have to be recited verbatim. Rather, they are provided to illustrate ways to elicit the information necessary to score each item. The interviewer should feel free to adjust the probes to the developmental level of the child, and use language supplied by the parent and child when querying about specific symptoms.
The K-SADS-PL 2009 Working Draft is administered by interviewing the parent(s), the child, and finally achieving summary ratings which include all sources of information (parent, child, school, chart, and other). When administering the instrument to pre-adolescents, conduct the parent interview first. In working with adolescents, generally begin with them unless they prefer to have the parent go first. When there are discrepancies between different sources of information, the rater will have to use his/her best clinical judgment. In the case of discrepancies between parents' and child's reports, the most frequent disagreements occur in the items dealing with subjective phenomena where the parent does not know, but the child is very definite about the presence or absence of certain symptoms. This is particularly true for items like guilt, hopelessness, interrupted sleep, hallucinations, and suicidal ideation. If the disagreements relate to observable behavior (e.g. truancy, fire setting, or a compulsive ritual), the examiner should query the parent(s) and child about the discrepant information. If the disagreement is not resolved, it is helpful to see the parent(s) and child together to discuss the reasons for the disagreement. Ultimately the interviewer will have to use his/her best clinical judgment in assigning the summary ratings.
Symptoms are rated for the current episode (CE) and the most severe past episode (MSP). The time frame for the CE and MSP may vary depending upon the needs of the specific study, and should be defined and noted on the front of the interview. Typically, the following guidelines are used for an initial diagnostic interview to obtain lifetime DSM-IV diagnoses:
- Current Diagnoses: In coding current episodes (CE) of disorders, symptoms should be rated for the time period when they were the most severe during the episode. Note in the margins if and when particular symptoms (e.g. insomnia) improved or resolved.
- Disorders Targeted with Medication: In coding disorders treated with medication (e.g. ADHD), use the ratings to describe the most intense severity of symptoms experienced prior to initiation of medication or during 'drug holidays'. Note in margins symptoms targeted effectively with medication.
- Past Diagnoses: In order for an episode to be considered 'resolved' or 'past', the child should have had a minimum of two months free from the symptoms associated with the disorder. Episodes rated in the past disorders section should represent the most severe past (MSP) episode experienced of that given disorder.
- Time Line: For children with a history of recurrent or episodic disorders, it is recommended that a time line be generated to chart lifetime course of disorder and facilitate scoring of symptoms associated with each episode of illness. In the process of completing the full interview, diagnoses initially believed to be 'past' may turn out to be current diagnoses in partial remission. Corrections in the coding of current and past severity ratings can be made after completion of the interview.
There are many potential situations where the time-frame for the CE and MSP ratings should be different, depending on the research questions of the study. For instance, for some studies, a subject may be required to meet full DSM-IV criteria for a particular disorder at the time of the interview (and not be in partial remission). In this case, the time frame for the CE could be the past week, past 2 weeks, or past month. For longitudinal studies when the KSADS P/L would be administered repeatedly, the MSP ratings may be the most severe episode since the last KSADS P/L interview.
However, in all uses of the KSADS P/L Working Draft, the symptom ratings are for a particular episode or defined period of time in which the symptoms were present concurrently. For example, if a child had severe insomnia 5 years ago with mild depressive symptoms, and had one past episode of Major Depression 2 years ago with mild insomnia, the MSP ratings should be from the MDE 2 years ago and the insomnia item should be rated mild.
Administration of the K-SADS-PL 2009 Working Draft requires the completion of: 1) an unstructured Introductory Interview; 2) a Diagnostic Screening Interview; 3) the Supplement Completion Checklist; 4) the appropriate Diagnostic Supplements; 5) the Summary Lifetime Diagnostic Checklist; and 6) the Children's Global Assessment Scale (C-GAS) ratings. The K-SADS-PL is initially completed with each informant separately. If there is no suggestion of current or past psychopathology, no assessments beyond the Screen Interview will be necessary. The Summary Lifetime Diagnostic Checklist and C-GAS ratings are completed after synthesizing all the data and resolving discrepancies in informants' reports. Each of the phases of the K-SADS-PL interview is discussed briefly below.
The Unstructured Introductory Interview. This section of the K-SADS-PL 2009 Working Draft takes approximately 10 to 15 minutes to complete. In this section, demographic, health, presenting complaint and prior psychiatric treatment data are obtained, together with information about the child's school functioning, hobbies, and peer and family relations. Discussion of these latter topics is extremely important, as it provides a context for eliciting mood symptoms depression and irritability), and obtaining information to evaluate functional impairment. This section of the K-SADS-PL should be used to establish rapport with the parent(s) and the child, and should never be omitted. Detailed guidelines for conducting the unstructured interview are contained on pages v-vi, and a scoring sheet to record information obtained during this portion of the interview is included thereafter.
The Screen Interview. The Screen Interview surveys the primary symptoms of the different diagnoses assessed in the K-SADS-PL 2009 Working Draft. Specific probes and scoring criteria are provided to assess each symptom. The rater is not obliged to recite the probes verbatim, or use all the probes provided, just as many as is necessary to score each item. Probing should be as neutral as possible, and leading questions should be avoided (e.g. "You don't feel sad, do you?")
Symptoms rated in the screen interview are surveyed for current (CE) and most severe past (MSP) episodes simultaneously. Begin by asking if the child has ever experienced the symptom. If the answer is no, rate the symptom negative for current and past episodes and proceed to the next question. If the answer is yes, find out when the symptom was present. If the symptom is endorsed for one time frame (e.g. currently), inquire if it was ever present at another time (e.g. past).
The diagnoses assessed with the screen interview do not have to be surveyed in order. The interviewer may begin inquiring about relevant diagnoses suggested by the presenting complaint information obtained during the unstructured interview. All sections of the Screen Interview must be completed, however, and most people find it easiest to proceed from start to finish.
After the primary symptoms associated with each diagnosis are surveyed, skip-out criteria are delineated. If skip-out criteria are not met, the appropriate supplements should be administered. In some situations, it may be best to proceed directly with the specific Diagnostic Supplement if the skip-out criteria are not met in the section of the Screen Interview, especially if a clear Time-Line of symptomatic periods has been established. However in cases where the time line is unclear or whether a symptom (e.g. irritability) should be considered as criterion for a specific diagnosis, it may be best to complete the entire Screen Interview, and then go to the appropriate Diagnostic Supplements.
Diagnostic Supplements. There are 8 diagnostic supplements as listed above. The skip-out criteria in the Screening Interview specify which, if any, should be completed. Each supplement has a list of symptoms, probes, and criteria to assess the current and most severe past episodes of disorder. Criteria required making DSM-IV diagnoses are provided for each diagnosis.
Scoring. The majority of the items in the K-SADS-PL 2009 Working Draft 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 subthreshold levels of symptomatology, and scores of 3 represent threshold criteria. The remaining items are rated on a 0-2 point rating scale on which 0 implies no information; 1 implies the symptom is not present; and 2 implies the symptom is present. When determining whether a symptom meets threshold vs. subthreshold level, it is important to assess the severity, frequency, and duration of the symptom, as well as impairment from the symptom. It is often helpful to ask for examples of specific behaviors or symptoms. While subthreshold manifestations of symptoms are not sufficient to count toward the diagnosis of a disorder, further inquiry may be warranted in certain cases. Subthreshold scores of psychotic symptoms or clusters of other symptoms associated with a given diagnosis should be brought to the attention of the attending physician or research supervisor.
The Summary Lifetime Diagnostic Checklist was designed to record basic lifetime and current diagnostic information. Clinicians / Investigators may wish to record additional, more specific information (e.g., dates of onset/offset or duration of additional episodes).