Implementing the semi-structured interview Kiddie-SADS-PL into an in-patient adolescent clinical setting: impact on frequency of diagnoses. The K-SADS is a semi-structured diagnostic interview designed to assess current and past episodes of psychopathology in children and adolescents according. The K-SADS-III-R is compatible with DSM-III-R criteria. This version of the SADS provides 31 diagnoses within affective disorders (including depression, bipolar.
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Different diagnostic interviews in child and adolescent psychiatry have been developed in English but valid translations of instruments to other languages are still scarce especially in developing countries, limiting the comparison of child mental health data across different cultures.
Significant differences in CBCL mean T-scores were observed between disordered and non-disordered children. Reliable epidemiological data on the prevalence of psychiatric disorders among children and adolescents, risk and protective factors, comorbidity, and service utilization is highly relevant for service planning and health policy decisions in any country [ 1 – 4 ].
However, there is need for greater attention kirdie the development of epidemiological assessment tools to suit local conditions [ 5 ]. Research tools and methods should not be imported from one country to another without careful analysis of the influence and effect of cultural factors on their reliability and validity.
In addition, scientific tools need to be further developed to allow valid international comparisons that will help in understanding the commonalities and differences in the nature of mental disorders and their management across different cultures [ 6 ].
Regarding child psychopathology research, it is important for every country to have screening and diagnostic instruments that show convergent validity. In order to reduce costs of large epidemiological studies, child mental health evaluation is usually performed in two consecutive phases.
First, a screening instrument is applied to the entire sample to identify suspected cases, and second, a diagnostic instrument is applied to all positive children a smaller number and to a representative sample of negative children a bigger number.
This strategy favors the study feasibility, but kidie the screening and the diagnostic instruments do not have convergent validity, the quality of data collected may be compromised.
Its development occurred under rigorous methodological requirements zads translation, back-translation, cultural adaptation and study of psychometric properties [ 8 ]. This is the first study conducted in Brazil to examine the convergent validity of a psychiatric diagnostic interview for children and adolescents Brazilian version of K-SADS-PL by comparison with a parental screening instrument for child and adolescent emotional and behavioral problems that is internationally recognized by its quality and usefulness CBCL.
Because children with high values on behavior problem scales have a high probability of being classified as a case by kidcie psychiatrist [ 9 ], we hypothesize that CBCL scores will be correlated to K-SADS-PL results. When seeing how closely our measure of child psychopathology K-SADS-PL is related to other measures of the same construct to which it should be related CBCL consists in the assessment of convergent validity [ iiddie ].
That university outpatient clinic is a public service free of charge that typically assists children from low-income families. Because sources of referral include health professionals, schools, social services, and parents themselves, the group of children scheduled for first appointment is heterogeneous in terms of psychopathology, including children without disorders and clinical cases of different severity levels.
The following exclusion criteria were applied: A current episode of disorder refers to the period of maximum severity within the episode symptom free period not greater than two months. The skip-out criteria in the screen interview specify which sections of the supplements, if any, should be completed.
The skip-out criteria take into account the threshold of symptom severity from each of the 82 screening items for 20 diagnostic areas. Just one screening item from determined diagnostic area achieving the threshold indicates the need of further assessment with complementary items from the same diagnostic area that are included in the related aads.
When none of the 82 symptoms achieve the threshold, no supplement is applied, and we can consider absent the related 20 psychiatric diagnoses major depression, dysthymia, mania, hypomania, psychotic disorders, social phobia, agoraphobia, specific phobia, obsessive-compulsive disorder, separation anxiety disorder, generalized anxiety disorder, panic disorder, posttraumatic stress disorder, ADHD, conduct disorder, oppositional defiant disorder, substance abuse, tic disorders, eating disorders, and elimination disorders.
The administration technique involves first the clinical interview with the parent alone to obtain the parent screening interview score, and second the same interview with the child alone applied by the same clinician to obtain the child screening interview score.
As a semi-structured diagnostic interview to be used in child psychiatry clinical practice and child mental health research, it requires clinical experience and extensive training. Clinical skills on the part of interviewers depend on acquired knowledge about child development and psychopathology.
Clinicians must be aware of the importance of using their best clinical judgment when integrating information from children and caregivers, and of taking into account familial and socio-cultural factors when interpreting informant answers. The Brazilian version of K-SADS-PL was developed from the original English version 7 using recommended procedures for translation, back-translation and cultural adaptation [ 13 – 16 ]. Three Brazilian experienced professionals two child psychiatrists and one psychologist were responsible for the translation to Portuguese with special attention to different dimensions of equivalence including cultural adaptation.
Extensive field-testing helped find adequate wording understandable by children and low-educated parents. Once translation and back-translation were completed, validity of the instrument was examined within the new context as recommended by Streiner and Norman [ 10 ].
All scales’ raw scores were transformed into T-scores, which were used as continuous variables in the analysis. All children provided oral consent and assent to participate.
Affective disorders included depressive disorders, dysthymia, mania, hypomania, and bipolar disorder. Anxiety disorders included social phobia, agoraphobia, specific phobias, separation anxiety disorder, generalized anxiety disorder, obsessive compulsive disorder, panic disorder, acute stress disorder, and posttraumatic stress disorder.
Kiddie Schedule for Affective Disorders and Schizophrenia
Disruptive disorders included oppositional defiant disorder and conduct disorder. Study participants included 26 girls mean age In that sample, Only eight out of 20 children with no K-SADS-PL final diagnoses were also negative in all 20 diagnostic areas of the clinician’s screening interview. However, even those eight children were kidfie asymptomatic since sub-threshold scores were obtained in two to seven items from the clinician’s screening interview.
This is especially true for anxiety disorders and disruptive behavior disorders including ADHD. For instance, the clinician considered 27 children positive for specific kicdie in the screen interview, but only 13 had specific phobia confirmed as a final diagnosis.
The same was noted for the group of children with one or more positive diagnostic areas in the clinician screen interview compared to subjects with negative clinician screen results mean T-scores: Higher mean externalizing T-scores were also observed in children positive in one or more disruptive diagnostic areas in the clinician screen interview compared to children negative in these investigated areas according to the clinician Positive diagnostic areas according to parent or clinician screen interviewand final DSM-IV diagnoses.
It is important to highlight that jiddie children according to K-SADS-PL final diagnoses included sadx only asymptomatic children but also sub-threshold children. Child mental health research conducted with valid and reliable standardized methods of assessment contributes to data reliability, and increases the possibility of adequate cross-cultural comparisons.
Valid diagnostic instruments are fundamental to accurately identify children in need of specialized mental health treatment, and to establish health policies based on the prevalence of mental disorders in different child and adolescent populations.
In addition, learning about childhood disorders outside the English-language sphere of influence is very important for establishing service-delivery needs in those regions. In validity studies involving the use of instruments to evaluate child psychopathology, child psychiatric diagnoses obtained from structured or semi-structured interviews have been compared to behavior checklists’ scores based on parental information [ 19 ].
Significant relations between CBCL data and results from different diagnostic interviews in child and adolescent psychiatry has long been reported [ 91120 – 23 ], suggesting a substantial convergence between two different approaches used to assess child psychopathology.
According to Kasius et al. Despite the important content differences at the item-symptom level between available problem checklists and criteria for psychiatric disorders used by many clinicians and researchers [ 3 ], both approaches are needed, useful and complementary. Although our sample can be considered small, it is compatible with sample sizes of other validity studies regarding psychiatric interview schedules for children and adolescents [ 25 ].
In addition, the lack of children from the general population in the study sample to increase the number of non-disordered children is a study limitation that must be recognized, since study results could have varied as a consequence of sample composition. However, this limitation is minimized by the fact that not only professionals but parents themselves were sources of referral in the current study, resulting in a heterogeneous sample of children with the presence of children without disorders and clinical cases of different severity levels.
In the study of Kaufman et al. In our sample, the only non-significant p value. In Israel, Shanee et al. The authors reported good to excellent validity of diagnoses based on kappa statistics. In Iran, Ghanizadeh et al. That sample included 96 psychiatric outpatients and 13 normal controls. In Korea, Kim et al. That sample included 80 psychiatric outpatients with a variety of disorders, and 11 controls with no past or current psychiatric disorders.
Based on kappa statistics, consensual validity of threshold and sub-threshold diagnoses were good to excellent for ADHD, fair for tic and oppositional defiant disorder, and poor to fair for anxiety and depressive disorders. A Korean version of CBCL, standardized inwas applied to identify children with internalizing and externalizing behavior problems.
Finally, in the Netherlands, Wassenberg et al. A systematic review of the literature assessed the screening efficiency of CBCL in community and clinical samples using published data [ 31 ]. A total of 29 studies met the review inclusion criteria, but only a study conducted in Korea [ 28 ] applied the K-SADS-PL as a source of comparison diagnosis.
According to this systematic review, the estimated sensitivity of the three broad-band CBCL scales were: In addition, according to this review, the estimated specificity of the three broad-band CBCL scales were: However, further research is needed to find the appropriate CBCL cut-off T-score to identify children and adolescents free of psychopathology in community samples.
However, further research needs to address the external validity of the instrument in community-based samples of different regions of Brazil. In addition, when the study sample includes low-educated mothers, the CBCL should be applied by a trained interviewer who may be a lay person. Self-fulfillment must be restricted to samples in which all informants completed at least grade eight. Both authors planned the study, participated in data analysis, data interpretation, drafting and critical review of this manuscript, and have read and approved the final manuscript.
The authors are also grateful to all study participants and their families, and all research team members for their valuable collaboration. National Center for Biotechnology InformationU. Published online Oct Author information Article notes Copyright and License information Disclaimer. Received Mar 8; Accepted Oct This article has been cited by other articles in PMC.
Abstract Background Different diagnostic interviews in child and adolescent psychiatry have been developed in English but valid translations of instruments to other languages are still scarce especially in developing countries, limiting the comparison of child mental health data across different cultures. Background Reliable epidemiological data on the prevalence of psychiatric disorders among children and adolescents, risk and protective factors, comorbidity, and service utilization is highly relevant for service planning and health policy decisions in any country [ 1 – 4 ].
Results Study participants included 26 girls mean age Open in a separate window. Table 4 Pearson correlation r: Discussion Child mental health research conducted with valid and reliable standardized methods of assessment contributes to data reliability, and increases the possibility of adequate cross-cultural comparisons.
Competing interests The authors declare that they have no competing interests. Authors’ contributions Both authors planned the study, participated in data analysis, data interpretation, drafting and critical review of this manuscript, and have read and approved the final manuscript.
Pre-publication history The pre-publication history for this paper can be accessed here: Epidemiology and child psychiatry: Child psychiatry in developing countries. Evaluation of the revised Ontario Child Health Study scales. J Child Psychol Psychiat.
Epidemiology of childhood disorders in a cross-cultural context. Is it possible to carry out high-quality epidemiological research in psychiatry with limited resources?
K-SADS-PL – Kiddie-Sads-Present and Lifetime Version
The kiddje consistency and concurrent validity of a Spanish translation of the Child Behavior Checklist. J Abnormal Child Psychol. Diagnostic and Statistical Manual of Mental Disorders.