Kiddie-Sads-Present and Lifetime Version
(K-SADS-PL)

Getting the Instrument

K-SADS-PL in Adobe PDF format (553K bytes, Version 1.0 of October 1996)

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.

This is a single file which contains the base instrument plus the 5 required diagnostic supplements which are completed depending on the results of the base screening. They are:

• Supplement #1: Affective Disorders
• Supplement #2: Psychotic Disorders
• Supplement #3: Anxiety Disorders
• Supplement #4: Behavioral Disorders
• Supplement #5: Substance Abuse and Other Disorders
   

Permitted Usage

This instrument is copyrighted. 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. Joan Kaufman, 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

The latest version of the instrument, a pointer to the author’s electronic mail address, and other useful information can be found at the following WorldWide Web URL: http:\\www.wpic.pitt.edu\ksads (this page).
 

About the K-SADS-PL

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 is a semi-structured diagnostic interview designed to assess current and past episodes of psychopathology in children and adolescents according to DSM-III-R and DSM-IV criteria. Probes and objective criteria are provided to rate individual symptoms. The primary diagnoses assessed with the K-SADS-PL include: Major Depression, Dysthymia, Mania, Hypomania, Cyclothymia, Bipolar Disorders, Schizoaffective Disorders, Schizophrenia, Schizophreniform Disorder, Brief Reactive Psychosis, Panic Disorder, Agoraphobia, Separation Anxiety Disorder, Avoidant Disorder of Childhood and Adolescence, Simple Phobia, Social Phobia, Overanxious Disorder, 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, and Adjustment Disorders.

The K-SADS-PL 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 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, begin with them. When there are discrepancies between different sources of information, the rater will have to use his/her best clinical judgement. 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 disa

Administration of the K-SADS-PL 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 Diagnoses Checklist; and 6) the Children's Global Assessment Scale (C-GAS) ratings. The K-SADS-PL is completed with each informant separately initially, then the Summary Lifetime Diagnoses Checklist and C-GAS ratings are completed after synthesizing all the data and resolving discrepancies in informants' reports. If there is no suggestion of current or past psychopathology, no assessments beyond the Screen Interview will be necessary. 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 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 are extremely important, as they provide 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. 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 for current and past episodes of the disorder. A space is provided to indicate if the child met the skip out criteria, or if the child has clinical manifestations of the primary symptoms associated with the specific diagnosis. If the child failed to meet the skip out criteria for some diagnoses, the appropriate supplements should be administered after the Screen Interview is completed.

Supplement Completion Checklist. The Supplement Completion Checklist is on the last page of this Screen Interview. It should be torn off before starting the interview. Supplements requiring completion should be noted in the spaces provided, together with the dates of possible current and past episodes of disorder.

Diagnostic Supplements. There are five Diagnostic Supplements included with the K-SADS-PL:

• Supplement #1: Affective Disorders
• Supplement #2: Psychotic Disorders
• Supplement #3: Anxiety Disorders
• Supplement #4: Behavioral Disorders
• Supplement #5: Substance Abuse and Other Disorders

The diagnoses surveyed in each of these supplements are outlined in the Supplement Completion Checklist, and in the Table of Contents at the beginning of each supplement. The skip out criteria in the Screening Interview specify which supplements, if any, should be completed. Each supplement has a list of symptoms, probes, and criteria to assess current (CE) and most severe past (MSP) episodes of disorder. Criteria required to make DSM-III-R and DSM-IV diagnoses are provided for each diagnosis.

Supplements should be administered in the order that symptoms for the different diagnoses appeared. For example, if the child had evidence of Attention Deficit Hyperactivity Disorder (ADHD) beginning at age 5, and possible Major Depression (MDD) beginning at age 9, the Supplement for ADHD should be completed before the supplement for MDD. If the child had a history of attention difficulties associated with ADHD, when inquiring about concentration difficulties in assessing MDD, it is important to find out if the onset of depressive symptoms was associated with a worsening of the long standing concentration difficulties. If there was no change in attention problems with the onset of the depressive symptoms, the symptom concentration difficulties should not be rated positively in the MDD supplement.

When the time course of disorders overlap, supplements for disorders that may influence the course of other disorders should be completed first. For example, if there is evidence of substance use and possible Mania, the substance abuse supplement should be completed first, and care should be taken to assess the relationship between substance use and manic symptoms.