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7KH6FUHHQ,QWHUYLHZ7KH6FUHHQ,QWHUYLHZVXUYH\VWKHSULPDU\V\PSWRPVRIWKHGLIIHUHQWGLDJQRVHVDVVHVVHGLQWKH .6$'63/'601RYHPEHU6SHFLILFSUREHVDQGVFRULQJFULWHULDDUHSURYLGHGWRDVVHVVHDFKV\PSWRP7KH UDWHULVQRWREOLJHGWRUHFLWHWKHSUREHVYHUEDWLPRUXVHDOOWKHSUREHVSURYLGHGMXVWDVPDQ\DVLVQHFHVVDU\WRVFRUH HDFKLWHP3URELQJVKRXOGEHDVQHXWUDODVSRVVLEOHDQGOHDGLQJTXHVWLRQVVKRXOGEHDYRLGHG HJ 'UDIW 6XEMHFW 2013 KSADS-PL SCREEN INTERVIEW: Introduction SDJHLLLRI[LY The diagnoses assessed with the screen interview do not have to be surveyed in order. The interviewer may begin inquiring about relevant diagnoses suggested by the presenting complaint information obtained during the unstructured interview. All sections of the Screen Interview must be completed, however, and most people find it easiest to proceed from start to finish. 6NLS2XW&ULWHULDAfter the primary symptoms associated with each diagnosis are surveyedLQWKH6FUHHQ,QWHUYLHZ, skip out criteria are delineated for current and past episodes of the disorder. A space is provided to indicate if the child met the skip out criteria, or if the child has clinical manifestations of the primary symptoms associated with the specific diagnosis. If the child failed to meet the skip out criteria for some diagnoses, the appropriate supplements should be administered after the Screen Interview is completedLQLWVHQWLUHW\. 6FRULQJ:KLOHLQWHUYLHZHUVDUHIUHHWRXWLOL]HODWLWXGHLQWKHPDQQHULQZKLFKV\PSWRPVDUHTXHULHGWKHVFRULQJFULWHULDDUH WREHDSSOLHGULJLGO\7KHPDMRULW\RIWKHLWHPVLQWKH.6$'63/'601RYHPEHUDUHVFRUHGXVLQJD±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hile 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. If subthreshold scores are attained on multiple items within a given diagnostic section of the Screen Interview, the supplement for that section can be completed to further assess relevant clinical symptomatology. 6XSSOHPHQW&RPSOHWLRQ&KHFNOLVW 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. 'LDJQRVWLF6XSSOHPHQWV7KHUHDUHILYH'LDJQRVWLF6XSSOHPHQWVLQFOXGHGZLWKWKH.6$'63/ 6XSSOHPHQW 'HSUHVVLYHDQG%LSRODU5HODWHG'LVRUGHUV 6XSSOHPHQW 6FKL]RSKUHQLD6SHFWUXPDQG2WKHU3V\FKRWLF 'LVRUGHUV 6XSSOHPHQW $Q[LHW\2EVHVVLYH&RPSXOVLYHDQG7UDXPD5HODWHG'LVRUGHUV 6XSSOHPHQW 1HXURGHYHORSPHQWDO'LVUXSWLYHDQG&RQGXFW'LVRUGHUV 6XSSOHPHQW (DWLQJ'LVRUGHUVDQG6XEVWDQFH5HODWHG'LVRUGHUV 7KHIRUPDWRIWKH.6$'6ZLWKLWV6FUHHQ,QWHUYLHZDQGILYH'LDJQRVWLF6XSSOHPHQWVLVGHVLJQHGWRIDFLOLWDWHGLIIHUHQWLDO GLDJQRVHVZLWKWKH6FUHHQ,QWHUYLHZSURYLGLQJDJRRGRYHUYLHZRISRWHQWLDOO\UHOHYDQWGLDJQRVWLFFDWHJRULHVEHIRUHVXUYH\LQJ V\PSWRPVDVVRFLDWHGZLWKWKHGLIIHUHQWGLVRUGHUVLQGHWDLO 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. /LNHLQWKH6FUHHQ,QWHUYLHZHach supplement has a list of symptoms, probes, and criteria to assess current (CE) and most severe past (MSP) episodes of disorder. 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 'LIILFXOW\ &RQFHQWUDWLQJ 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 or Psychosis, the substance abuse supplement should be completed first, and care should be taken to assess the relationship between substance use and SRVVLEOHmanic and/or psychotic symptoms. 2013 KSADS-PL SCREEN INTERVIEW: Introduction page iv of xiv 6) The Summary Lifetime Diagnostic Checklist is a template that 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). The Follow-up Summary Diagnostic Checklist is a template designed to record longitudinal course of illness. 7KHVHWHPSODWHFKHFNOLVWVDUHLQFOXGHGDWWKHHQGRIWKHVXSSOHPHQWVRIWKH.6$'6 Using the K-SADS in Longitudinal Studies. When the KSADS is used to monitor subjects longitudinally, it is important to be sure that the symptoms and diagnoses are being scored since the last interview. The timeframe for the Current ratings needs to be defined, based on the aims of the study. For example, the Current period could be the month prior to the interview (or 2 weeks, or 2 months, etc.). Then symptoms and diagnoses are rated for the most symptomatic time during the current period. Past symptoms and diagnoses are rated based on the most severe symptomatology between the last interview and whatever time is defined as the Current rating period. These rules are more relevant for episodic disorders such as depression and mania/hypomania. It is recommended that each study define a priori the timeframes to be used in administering the KSADS for longitudinal assessments. Results from the follow-up interviews can then be recorded on the Longitudinal Summary Diagnostic Checklist. The longitudinal summary diagnostic checklist may require some modifications by Investigators to accommodate the aims, methodology, and outcome definitions ( e.g., remission, recovery, remission, recurrence) utilized in each study. As depicted below, the KSADS can be used to characterize WKHsubject’s longitudinal course of illness. The space between the first two lines on the left side of each diagram below depicts the course of illness since the last assessment up to the “current episode” timeframe, and the space on the right side of each diagram depicts the characterization of the current (e.g., last two months) symptomatology. Legend. A) Figure A depicts a child with a chronic course of illness from the last interview; B) FigureFi B depictsd i t a childhild whoh met full criteria during the last interview and continued to meet criteria during his most severe past episode during the follow-up interval, then met partial remission criteria during the “current” time frame assessed at follow-up; C) Figure C depicts a child who was in partial remission but never went into full remission during the “past” or “current” follow-up intervals, and is currently in partial remission: D) Figure D depicts a child who had no diagnosis at the initial interview, and then had an onset of a full diagnosis during the follow-up, but met for partial remission during the “current” follow-up interval. Guidelines for the Administration of the Introductory Unstructured Interview The unstructured interview should take at least 15 minutes to administer. The aim of the unstructured interview is to establish rapportDQG obtain information about presenting complaints, prior psychiatric problems, and the child's global functioning. It is helpful to spend a few minutes in general conversation in order to make the child and parent feel at ease. The interview opens with questions about basic demographics. This is a very easy thing for most people to talk about, and the information helps to orient the interviewer to the child's life circumstances. Health and developmental history data should also be obtained from the parent, as this information may be helpful in making differential diagnoses. The child does not need to be queried about these things. Draft Subject 20 KSADS-PL SCREEN INTERVIEW: Subject Information SDJHYRI[LY ,QGLVFXVVLQJRQVHWDQGFRXUVHRIV\PSWRPVPDQ\FKLOGUHQZLOOEHXQDEOHWRSURYLGHUHOLDEOHWLPHGDWD7KLVLV GHYHORSPHQWDOO\QRUPDO,IWKHFKLOGGRHVQRWSURYLGHVXFKGDWDLQWKHILUVWTXHVWLRQLQJVKHZLOOSUREDEO\QRWSURYLGHLWDWDOO ,QLQWHUYLHZLQJWKHSDUHQWPRGLI\WKHTXHVWLRQVWRUHIHUWRWKHFKLOG ,QWKHLQWURGXFWRU\LQWHUYLHZDQGWKURXJKRXWWKH.6$'6LQWHUYLHZHUVDUHHQFRXUDJHGWRXVHODQJXDJHJHQHUDWHGE\WKHFKLOG DQGRUSDUHQWZKHQDVNLQJDERXWV\PSWRPV HJ)RUKRZORQJGLG\RXIHHOEXPPHG" $IWHUVXUYH\LQJWKHUHDVRQIRUUHIHUUDOREWDLQLQIRUPDWLRQDERXWWUHDWPHQWKLVWRU\7KHQDVNDERXWWKHFKLOG VVFKRRO DGDSWDWLRQDQGVRFLDOUHODWLRQV ,QLQWHUYLHZLQJFKLOGUHQLWLVQRWQHFHVVDU\DQGXVXDOO\QRWSURGXFWLYHWRWU\WRFRPSOHWHDOORIWKHLQWURGXFWRU\LQWHUYLHZ 5HYLHZEDVLFGHPRJUDSKLFV HJDJHJUDGHIDPLO\FRQVWLWXWLRQVLEOLQJV QDPHVDQGDJHV SUHVHQWLQJFRPSODLQWV OLNHO\LQ OHVVGHWDLOWKDQZLWKWKHSDUHQW DQGIDPLO\VFKRRODGDSWDWLRQDQGSHHUUHODWLRQVLQIRUPDWLRQ7KHGLVFXVVLRQRIWKHVHODWWHU WRSLFVDUHH[WUHPHO\LPSRUWDQWDVLWSURYLGHVDFRQWH[WIRUHOLFLWLQJPRRGV\PSWRPV GHSUHVVLRQDQGLUULWDELOLW\ IURPFKLOGUHQ JHQHUDWHK\SRWKHVHVDERXWSRVVLEOHUHOHYDQWGLDJRQVWLFDUHDVDQGREWDLQSUHOLPLQDU\LQIRUPDWLRQWRHYDOXDWHIXQFWLRQDO LPSDLUPHQW SUBJECT INFORMATION First Name: Last Name: Date of Birth: Gender: 0DOH )HPDOH Ethnicity: +LVSDQLFRU/DWLQR 1RW+LVSDQLFRU/DWLQR Race (Mark all %ODFNRU$IULFDQ$PHULFDQ 1DWLYH+DZDLLDQRU3DFLILF,VODQGHU that apply): $VLDQ 1DWLYH$PHULFDQRU$ODVNDQ1DWLYH :KLWHRU&DXFDVLDQ 2WKHU6SHFLI\ With whom is subject currently living (choose one)? %RWKELRORJLFDOSDUHQWV %LRORJLFDOIDWKHURQO\ *URXSKRPH %RWKELRORJLFDOSDUHQWVEXWMRLQWFXVWRG\ 6WHSPRWKHURQO\ 5HVLGHQWLDO LQVWLWXWLRQ %LRORJLFDOPRWKHUDQGVWHSIDWKHU 6WHSIDWKHU RQO\ %RDUGLQJKRPH %LRORJLFDOIDWKHUDQGVWHSPRWKHU *UDQGSDUHQW 5XQDZD\ %LRORJLFDOPRWKHUDQGER\IULHQGJLUOIULHQG $GRSWLYH SDUHQW &ROOHJHVWXGHQW %LRORJLFDOIDWKHUDQGER\IULHQGJLUOIULHQG 2WKHU UHODWLYHIULHQG /LYHV LQGHSHQGHQWO\ %LRORJLFDOPRWKHURQO\ )RVWHUKRPH 2WKHU 6XEMHFW 'UDIW 'DWH 20 ,QWHUYLHZHU KSADS-PL SCREEN INTERVIEW: 20 Caregiver Information SDJHYLRI[LY PARENTAL PARTICIPATION: Who is the informant/reporter for this interview? %RWKELRORJLFDOSDUHQWV $GRSWLYH PRWKHU *UDQGSDUHQW %LRORJLFDO PRWKHU $GRSWLYH IDWKHU 2WKHU UHODWLYH %LRORJLFDO IDWKHU 6WHSPRWKHU 2WKHU %RWKDGRSWLYHSDUHQWV 6WHSIDWKHU ,I2WKHUSOHDVHVSHFLI\ SUBJECT'S 35,0$5<&$5(*,9(5 V First Name: OLYHVZLWKVXEMHFWLIDSSOLFDEOH Last Name: This is Subject's: %LRORJLFDO 0RWKHU %LR)DWKHU )RVWHU0RWKHU )RVWHU)DWKHU 1RQH 6WHSPRWKHU 6WHSIDWKHU $XQW 8QFOH 2WKHU6SHFLI\ $GRSWHG0RWKHU $GRSWHG)DWKHU *UDQGPRWKHU *UDQGIDWKHU SUBJECT'S 6(&21'$5<&$5(*,9(5 V First Name: OLYHVZLWKVXEMHFWLIDSSOLFDEOH Last Name: This is Subject's: %LRORJLFDO 0RWKHU %LR)DWKHU )RVWHU0RWKHU )RVWHU)DWKHU 1RQH 6WHSPRWKHU 6WHSIDWKHU $XQW 8QFOH 2WKHU6SHFLI\ $GRSWHG0RWKHU $GRSWHG)DWKHU *UDQGPRWKHU *UDQGIDWKHU %,2/2*,&$/027+(5 First Name: Last Name: 'RHVFKLOGOLYHZLWKELRORJLFDOPRWKHU: ,IQRGHVFULEHQDWXUHRIFRQWDFWUHODWLRQVKLS 0RWKHUGHFHDVHG Quality of Relationship ([FHOOHQW *RRG )DLU 3RRU 0RWKHUDOLYHUHJXODUYLVLWDWLRQ 0RWKHUDOLYHVSRUDGLFFRQWDFW 0RWKHUDOLYHEXWQRFRQWDFW 'UDIW 6XEMHFW 20 KSADS-PL SCREEN INTERVIEW: Caretaker / Sibling Information SDJHYLLRI[LY %,2/2*,&$/)$7+(5 First Name: Last Name: 'RHVFKLOGOLYHZLWKELRORJLFDOIDWKHU: ,IQRGHVFULEHQDWXUHRIFRQWDFWUHODWLRQVKLS Quality of Relationship )DWKHUGHFHDVHG )DWKHUDOLYHUHJXODUYLVLWDWLRQ ([FHOOHQW *RRG )DLU 3RRU )DWKHUDOLYHVSRUDGLFFRQWDFW )DWKHUDOLYHEXWQRFRQWDFW SUBJECT'S SIBLINGS First Name: Last Name: Age: Quality of Relationship between Sibling and Subject: +DOIVLEOLQJ )XOOVLEOLQJ ([FHOOHQW *RRG )DLU 3RRU First Name: Last Name: Age: Quality of Relationship between Sibling and Subject: +DOIVLEOLQJ )XOOVLEOLQJ ([FHOOHQW *RRG )DLU 3RRU First Name: Last Name: Age: Quality of Relationship between Sibling and Subject: +DOIVLEOLQJ )XOOVLEOLQJ ([FHOOHQW *RRG )DLU 3RRU 2IWKHSHRSOHLQ\RXUIDPLO\RUDPRQJWKHSHRSOH\RXOLYHZLWKZKRZRXOG\RXVD\\RXDUHFORVHVWWR"BBBBBBBBBBBBBBBBB BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB 'UDIW 6XEMHFW 20 KSADS-PL SCREEN INTERVIEW: Health Screen SDJHYLLLRI[LY CHILD AND ADOLESCENT HEALTH SCREEN PREGNANCY AND BIRTH: 0RWKHU VDJHDWELUWKRIFKLOG 'LGPRWKHUKDYHDQ\LOOQHVVRULQMXU\GXULQJ 'LGVKHWDNHDQ\PHGLFDWLRQVRWKHUWKDQ 'LGPRWKHUGULQNRUXVHHOLFLWGUXJVGXULQJ 'LGPRWKHUVPRNHGXULQJSUHJQDQF\" :DVWKHEDE\SUHPDWXUH" UHFRUGZNV BBBBBBB :KDWZDVWKHELUWKZHLJKW" OEV 'LGWKHEDE\KDYHDQ\WURXEOHDWELUWK" 'LGWKHEDE\KDYHDQ\RWKHUWURXEOH" -DXQGLFHLQIHFWLRQVRWKHU" +RZPDQ\GD\VGLGWKHEDE\VWD\LQWKHKRVSLWDODIWHU ELUWK" GD\V MEDICAL AND SURGICAL HISTORY: &XUUHQWKHLJKW IHHW LQFKHV :HLJKW OEV :KHUHGRHV\RXUFKLOGJRIRUPHGLFDO FDUH" 'DWHRIODVWPHGLFDOH[DP +DV\RXUFKLOGKDGDOOHUJLFUHDFWLRQVWRDQ\ $OOHUJLFUHDFWLRQVWRIRRGV" $OOHUJLFUHDFWLRQVWRLQVHFWELWHV" +DV\RXUFKLOGKDGDOOLPPXQL]DWLRQV" $Q\EDGUHDFWLRQVWRLPPXQL]DWLRQV" 'UDIW 6XEMHFW 20 KSADS-PL SCREEN INTERVIEW: Medical / Developmental History SDJHL[RI[LY MEDICAL AND SURGICAL HISTORY cont: $Q\KRVSLWDOL]DWLRQV",IYESIRUZKDW" $Q\VHULRXVLQMXULHV",IYESZKDWNLQG" $Q\KHDGLQMXULHV" ,QGLFDWHLI\RXUFKLOGORVW $Q\RWKHUFXUUHQWRUSDVWVLJQLILFDQWPHGLFDO DEVELOPMENTAL HISTORY: 3UREOHPVZLWKVRFLDOUHODWHGQHVVGXULQJLQIDQF\DQGHDUO\FKLOGKRRG 'HYHORSPHQWDOPLOHVWRQHVZLWKLQQRUPDOOLPLWV 'UDIW 6XEMHFW KSADS-PL SCREEN INTERVIEW: 20 Presenting Complaint SDJH[RI[LY Clinician Supervising Physician6XSHUYLVLQJ5HVHDUFKHU Date Presenting Complaint: 'UDIW 6XEMHFW KSADS-PL SCREEN INTERVIEW 2013 Family History for Biological Relatives SDJH[LRI[LY Probe: Have you or anyone else in \RXU family had psychiatric treatment before? For what sorts of problems? Criteria: 0 = No Information 1 = Not Present 2 = Probable 3 = Definite Mother Father Sibling Half-Sibling Grandparent Aunt/Uncle Other Psychiatric Tx 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 Depression 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 Mania 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 ADHD 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 Conduct/Antisocial 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 Schizophrenia 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 Other Psychosis 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 Alcohol Use Disorder 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 Substance Use Dis. 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 Autism Spectrum 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 Suicide Attempt 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 Suicide Completion 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 Other 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 20 KSADS-PL SCREEN INTERVIEW: Treatment / Medication Information SDJH[LLRI[LY LIFETIME TREATMENT HISTORY Age of first tx (in YEARS) (in MONTHS) 2XWSDWLHQW7UHDWPHQW 1RLQIR 1R 3V\FKLDWULF+RVSLWDOL]DWLRQ 1RLQIR 1R 3DUWLDO+RVSLWDOL]DWLRQ 1RLQIR 1R 5HVLGHQWLDO7UHDWPHQW)DFLOLW\ 1RLQIR 1R ,Q+RPH6HUYLFHV7[ HJ:UDS$URXQG)DPLO\ 1RLQIR 1R 1XPEHURI3V\FKLDWULF+RVSLWDOL]DWLRQV OVERALL RELIABILITY OF INFORMATION: *RRG )DLU 3RRU Medication listing 3DVW&XUUHQW 3DVW&XUUHQW 'UDIW 6XEMHFW KSADS-PL SCREEN INTERVIEW: 20 School Information SDJH[LLLRI[LY School Information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eer / Activities Information SDJH[LYRI[LY Peer Relations %HVWIULHQG V " \HV QR 5HODWLRQVZLWKSHHUVDWVFKRRO ([FHOOHQW *RRG )DLU 3RRU 5HODWLRQVZLWKSHHUVLQWKHQHLJKERUKRRG ([FHOOHQW *RRG )DLU 3RRU %XOOLHGE\RWKHUV" 1HYHU5DUHO\QRWDSUREOHP 6RPHWLPHVFDQEHDSUREOHP 2IWHQGHILQLWHSUREOHP 9HU\2IWHQPDMRUSUREOHP Other Activities / Interests 0DUNWKRVHWKDWDSSO\DQGVSHFLI\ +REELHV 3UHIHUUHG $FWLYLHVGXULQJ IUHHWLPH 6SRUWV 2UJDQL]DWLRQV 'UDIW 6XEMHFW KSADS-PL SCREEN INTERVIEW: 20 Depression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ssessment of diurnal variation can secondarily clarify daily duration of depressive mood) 'LGLWFRPHDQGJR" +RZRIWHQ"(YHU\G D\" +RZORQJGLGLWODVW" Duration of Depressed Mood: :KDWGR\RXWKLQNE URXJKWLWRQ" (current) &RXOGRWKHUSHRSOHWHOOWKDW\RXZHUHVDG" Duration of Depressed Mood: (most severe past) NOTE: SOMETIMES THE CHILD WILL INITIALLY GIVE A NEGATIVE ANSWER AT THE START OF THE INTERVIEW BUT WILL BECOME OBVIOUSLY SAD AS THE INTERVIEW GOES ON. THEN THESE QUESTIONS SHOULD BE REPEATED ELICITING THE PRESENT MOOD AND USING IT AS AN EXAMPLE TO DETERMINE ITS FREQUENCY. SIMILARLY, IF THE MOTHER'S REPORT IS THAT THE CHILD IS SAD MOST OF THE TIME AND THE CHILD DENIES IT, THE CHILD SHOULD BE CONFRONTED WITH THE MOTHER'S OPINION AND THEN ASKED WHY HE THINKS HIS MOTHER BELIEVES HE FEELS SAD SO OFTEN. NOTE: WHEN A CHILD OR PARENT REPORTS FREQUENT SHORT PERIODS OF SADNESS THROUGHOUT THE DAY, IT IS LIKELY THAT THIS CHILD IS ALWAYS SAD AND ONLY REPORTS THE EXACERBATIONS, IN WHICH CASE THE RATING OF DEPRESSIVE MOOD WILL BE 4. THUS, IT ISALWAYS ESSENTIAL TO ASK ABOUT THE REST OF THE TIME: "Besides these times when you felt (_____), during the rest of the time, did you feel happy or were you more sad than your friends?" 6XEMHFW 'UDIW 'DWH 20 ,QWHUYLHZHU 20 KSADS-PL SCREEN INTERVIEW: Depression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uration of Irritable Mood :KHQ\RXJRWPDGZKDWGLG\RXWKLQNDERXW" (most severe past) 'LG\RXWKLQNDERXWNLOOLQJRWKHUVRUKXUWLQJ\RXUVHOI"2UDERXWKXUWLQJWKHPRU WRUWXULQJWKHP":KRP"'LG\RXKDYHDSODQ"+RZ" NOTE: IRRITABILITY MAY BE DUE TO OTHER DISORDERS e.g., BIPOLAR DISORDER, ADHD, ODD, CD, SUBSTANCE ABUSE, $87,60635(&7580',625'(5 . 'UDIW 6XEMHFW 20 KSADS-PL SCREEN INTERVIEW: Depression SDJHRI P C S $QKHGRQLD/DFNRILQWHUHVW$SDWK\/RZ0RWLYDWLRQRU%RUHGRP 0 - 1RLQIRUPDWLRQ '60'5 +DVOHVVIXQGRLQJWKLQJV 1 -1RWSUHVHQW 3DUHQW5DWLQJ BBBBBBBBBBB&KLOG5DWLQJ BBBBBBBBBBBBBB 2 - 6XEWKUHVKROG 6HYHUDODFWLYLWLHVGHILQLWHO\OHVV SOHDVXUDEOHRULQWHUHVWLQJ2UERUHGRU Boredom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nhedonia UHIHUVWRSDUWLDORUFRPSOHWH SHUYDVLYH ORVVRIDELOLW\WRJHW Duration of Anhedonia: SOHDVXUHHQMR\KDYHIXQGXULQJSDUWLFLSDWLRQLQDFWLYLWLHVZKLFKKDYHEHHQ DWWUDFWLYHWRWKHFKLOGOLNHWKHRQHVOLVWHGDERYH,WDOVRUHIHUVWREDVLF (current) SOHDVXUHVOLNHWKRVHUHVXOWLQJIURPHDWLQJIDYRULWHIRRGVDQGLQDGROHVFHQWVVH[XDO DFWLYLWLHV 'LG\RXORRNIRUZDUGWRGRLQJWKHWKLQJV\RXXVHGWRHQMR\" *LYHH[DPSOHV 'LG\RXWU\WRJHWLQWRWKHP" 'LG\RXKDYHWRSXVK\RXUVHOIWRGR\RXUIDYRULWHDFWLYLWLHV" 'LGWKH\LQWHUHVW\RX" Duration of Anhedonia: 'LG\RXJHWH[FLWHGRUHQWKXVLDVWLFDERXWGRLQJWKHP":K\QRW" (past) 'LG\RXKDYHDVPXFKIXQGRLQJWKHPDV\RXXVHGWREHIRUH\RXEHJDQIHHOLQJ VDGHWF " ,IOHVVIXQGLG\RXHQMR\WKHPDOLWWOHOHVV"0XFKOHVV"1RWDWDOO" 'LG\RXKDYHDVPXFKIXQDV\RXUIULHQGV" +RZPDQ\WKLQJVDUHOHVVIXQQRZWKDQWKH\XVHGWREH XVHFRQFUHWH H[DPSOHVSURYLGHGHDUOLHUE\FKLOG " +RZPDQ\ZHUHDVPXFKIXQ"0RUHIXQ" 'LG\RXGRBBBBBOHVVWKDQ\RXXVHGWR"+RZPXFKOHVV" In adolescents: LIVH[XDOO\DFWLYH 'R\RXHQMR\VH[DVPXFKDV\RXXVHG WR"$UH\RXOHVVVH[XDOO\DFWLYHWKDQ\RXXVHGWREH" This item does not refer to inability to engage in activities ORVVRIDELOLW\WR FRQFHQWUDWHRQUHDGLQJJDPHV79RUVFKRROVXEMHFWV Two comparisons should be made in each assessment:(QMR\PHQWDV FRPSDUHGWRWKDWRISHHUV DQGRUHQMR\PHQWDVFRPSDUHGWRWKDWRIFKLOGZKHQQRW GHSUHVVHG7KHVHFRQGLVQRWSRVVLEOHLQHSLVRGHVRIORQJGXUDWLRQEHFDXVH QRUPDOO\FKLOGUHQ VSUHIHUHQFHVFKDQJHZLWKDJH6HYHULW\LVGHWHUPLQHGE\WKH QXPEHURIDFWLYLWLHVZKLFKDUHOHVVHQMR\DEOHWRWKHFKLOGDQGE\WKHGHJUHHRI ORVVRIDELOLW\WRHQMR\ Do not confuse with lack of opportunity to do things which may bedue to excessive parental restrictions. 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'UDIW 6XEMHFW 20 KSADS-PL SCREEN INTERVIEW: Mania / Hypomania SDJHRI +\SHUVH[XDOLW\ P C S >([FHVVLYH,QYROYHPHQWLQ+LJK5LVN3OHDVXUDEOH$FWLYLWLHV@ 0 -1RLQIRUPDWLRQ 1 - 1RWSUHVHQW NOTE: HYPERSEXUALITY IN THE ABSENCE OF SEXUAL ABUSE OR INAPPROPRIATE EXPOSURE TO SEXUAL BEHAVIOR OR MEDIA IS A 2 -,VRODWHGEULHILQFLGHQWVRIPLOGO\LQDSSURSULDWH SYMPTOM FAIRLY SPECIFIC TO MANIC/HYPOMANIA. IT IS NOT A VH[XDOEHKDYLRURITXHVWLRQDEOHFOLQLFDO SEPARATE DSM- DIAGNOSTIC CRITERION, BUT WHEN PRESENT, VLJQLILFDQFH IT CAN POTENTIALLY FULFILL EITHER BOTH THE INCREASED GOAL-DIRECTED ACTIVITY AND THE RISKY, PLEASURE-SEEKING BEHAVIOR B CRITERION. 3 -'HILQLWHHSLVRGHVRIFOHDUO\LQDSSURSULDWH VH[XDOEHKDYLRU For younger children ask parent/caregiver: PAST: +DYHWKHUHEHHQWLPHVZKHQ\RXUFKLOGZDVH[FHVVLYHO\IRFXVHGRQVH[ QXGLW\KLVKHUSULYDWHSDUWVRUWRXFKLQJRWKHUV SULYDWHSDUWV" 'LG\RXUFKLOGVKRZDQXQXVXDOLQFUHDVHLQWRXFKLQJWKHLUSULYDWHVLQSXEOLF RUGUHVVLQJLQDQLQDSSURSULDWHRUVH[XDOPDQQHU" 3 & 6 :RXOG\RXUFKLOGNLVVRUWRXFK\RXLQDVH[XDOZD\RUEHZD\WRR DIIHFWLRQDWHLQVWHDGRIWKHLUXVXDOZD\RIVKRZLQJDIIHFWLRQ" :KDWZDVKLVKHUPRRGOLNHGXULQJWKHVHWLPHV" 'LGDQ\WKLQJKDSSHQWRFDXVHWKHVHFKDQJHV" For adolescents: +DYHWKHUHEHHQWLPHVZKHQ\RXVXGGHQO\JRWPXFKPRUHLQWHUHVWHGLQVH[ WKDQXVXDORUWKDW\RXUVH[GULYHVHHPHGWRJRZD\XS" 'LG\RXGRDQ\WKLQJGLIIHUHQWO\ZKHQWKLVKDSSHQHG GUHVVLQDUHYHDOLQJ ZD\WDONDERXWVH[DORWRUDVNRWKHUSHRSOHWREHLQWLPDWHKDYHVH[ZLWK \RX " :HUHWKHUHWLPHVZKHQ\RXZHUHGULYHQWRKDYHVH[PXFKPRUHWKDQXVXDO RUZLWKPDQ\GLIIHUHQWSDUWQHUV" NOTE: IF ENDORSED POSITIVE, NEED TO RULE OUT SEXUAL ABUSE OR INAPPROPRIATE EXPOSURE TO SEXUAL MATERIAL OR BEHAVIOR. IF RECEIVED A SCORE OF 3 ON THE CURRENT RATINGS FOR $1<2)7+(35(9,286,7(06COMPLETE THE CURRENT MANIA/HYPOMANIA SECTION OF THE '(35(66,9($1'%,32/$55(/$7('',625'(56 SUPPLEMENT. IF RECEIVED A SCORE OF 3 ON THE PAST RATINGS FOR $1<2)7+(35(9,286,7(06COMPLETE THE PAST MANIA/HYPOMANIA SECTION OF THE '(35(66,9($1'%,32/$55(/$7('',625'(56 SUPPLEMENT. NO EVIDENCE OF (HYPO) MANIA NOTES: (RECORD DATES OF POSSIBLE CURRENT AND PAST HYPOMANIA OR MANIA). 'UDIW 6XEMHFW KSADS-PL SCREEN INTERVIEW: 20 SDJH RI 'LVUXSWLYH0RRG'\VUHJXODWLRQ'LVRUGHU P C S ,UULWDELOLW\ 0 -1RLQIRUPDWLRQ 'R\RXRIWHQIHHOFUDQN\LUULWDEOHRUDQJU\"+DYH\RXKDGWKHVH 1 -1RWSUHVHQW IHHOLQJVLQWKHSDVWIHZZHHNVDWDOO"+DYH\RXIHOWWKLVZD\PRVW GD\VLQWKHSDVW\HDU" ,IQRW +RZRIWHQGR\RXKDYHWKHVHIHHOLQJV" 2 - 6XEWKUHVKROG ,UULWDEOHPRRGSUHVHQWOHVVWKDQ +DVWKHUHEHHQDSHULRGRIWLPHZKHQ\RXGLGQ¶WKDYHWKRVHIHHOLQJV KDOIWKHGD\RUOHVVWKDQPRVWGD\VLQWKHSDVW IRUDVORQJDVDFRXSOHRIPRQWKVDWDWLPH" PRQWKVRUQRWVHYHUHHQRXJKWREHQRWLFHDEOHWR :KHQ\RXDUHIHHOLQJFUDQN\RUDQJU\KRZPXFKRIWKHGD\GR\RX RWKHUSHRSOH IHHOWKLVZD\" 'R\RXKDYHWKHVHIHHOLQJVDWKRPHDWVFKRRORUZKHQ\RXDUHZLWK RWKHUFKLOGUHQ"'RRWKHUSHRSOHQRWLFHWKHZD\\RXIHHO":KDWGR 3 -7KUHVKROG ,UULWDEOHDQGRUDQJU\PRRG \RXUSDUHQWVWHDFKHUVRUSHHUVVD\DERXWKRZ\RXDUHIHHOLQJ" SUHVHQWDWOHDVWKDOIWKHGD\PRVWGD\VIRUDWOHDVW PRQWKV6HYHULW\LVVXIILFLHQWWREHQRWLFHDEOH WRRWKHUSHRSOH SDUHQWVWHDFKHUVSHHUV 127( ,17+,66(&7,21&2'(6(9(5,7<2)&+521,& ,55,7$%,/,7<2)21(<($5'85$7,2125/21*(5 PAST: 3 & 6 P C S 5HFXUUHQW7HPSHU2XWEXUVWV 0 -1RLQIRUPDWLRQ ,VLWSUHWW\HDV\RUFRPPRQIRU\RXWREHFRPHLUULWDEOHDQJU\RUWR H[SORGH":KHQ\RXDUHIHHOLQJYHU\DQJU\GR\RX\HOORUVFUHDP"'R 1 -1RWSUHVHQW \RXVZHDUDORWFDOOSHRSOHQDPHVRUSXWWKHPGRZQ"'R\RXWKURZRU GHVWUR\WKLQJV"+DYH\RXHYHUWKUHDWHQHGRUDFWXDOO\KXUWDQRWKHU 2 -6XEWKUHVKROG 9HUEDORUSK\VLFDORXWEXUVWVKDYH SHUVRQ"'LG\RXSXQFKNLFNRUEHDWDQ\RQH" QRWRFFXUUHGDVRIWHQDVWLPHVDZHHNRUKDYHQRW :KDWZDVJRLQJRQDWWKHWLPHZKHQWKLVKDSSHQHG":KDWVHW\RXRII" SHUVLVWHGIRUDVORQJDVPRQWKV +DYH\RXIHOWVRLUULWDEOHDQGDQJU\IRUVRORQJWKDW\RXH[SORGHGDWOHDVW WLPHVDZHHNIRUWKHSDVW\HDURUHYHQORQJHU" 3 -7KUHVKROG 6XEMHFWKDVYHUEDOUDJHVDQGRU GLVSOD\VDJJUHVVLYHEHKDYLRUVWRZDUGSHRSOHRU SURSHUW\6XFKHYHQWVRFFXURQDYHUDJHDWOHDVW WLPHVDZHHNDQGKDYHEHHQFRQVLVWHQWO\ SUHVHQWRYHUWKHSDVWPRQWKV PAST: 3 & 6 IF RECEIVED A SCORE OF 3 ON THE CURRENT RATINGS ON EITHER OF THE PREVIOUS ITEMS, COMPLETE THE '<65837,9(022''<65(*8/$7,21',625'(5 (CURRENT) SECTION OF THE '(35(66,9($1'%,32/$5 5(/$7('',625'(56 SUPPLEMENT AFTER FINISHING THE SCREENINTERVIEW. IF RECEIVED A SCORE OF 3 ON THE PAST RATINGS ON EITHER OF THE PREVIOUS ITEMS, COMPLETE THE '<65837,9(022''<65(*8/$7,21',625'(5 (PAST) SECTION OF THE '(35(66,9($1'%,32/$5 5(/$7('',625'(56 SUPPLEMENT AFTER FINISHING THE SCREENINTERVIEW. NO EVIDENCE OF '<65837,9(022''<65(*8/$7,21',625'(5 NOTES: (RECORD DATES OF POSSIBLE CURRENT AND PAST '<65837,9(022''<65(*8/$7,21',625'(5) 6XEMHFW 'UDIW 'DWH 20 ,QWHUYLHZHU KSADS-PL SCREEN INTERVIEW: 20 Psychosis SDJHRI P C S +DOOXFLQDWLRQV 0 -1RLQIRUPDWLRQ 1 -1RWSUHVHQW '60'5 +HDUG9RLFHV 2 -6XEWKUHVKROG 6XVSHFWHGRUOLNHO\ 3DUHQW5DWLQJ BBBBBBBBBBB&KLOG5DWLQJ BBBBBBBBBBBBBB 3 -7KUHVKROG 'HILQLWHO\SUHVHQW '60'5 +DGYLVLRQV PAST: 3DUHQW5DWLQJ BBBBBBBBBBB&KLOG5DWLQJ BBBBBBBBBBBBBB 3 & 6 +DVWKHUHHYHUEHHQDWLPHZKHQ\RXUPLQGSOD\HGWULFNVRQ\RX"6RPHWLPHV FKLOGUHQPLJKWKHDUYRLFHVRUVHHWKLQJVRUVPHOOWKLQJVWKDWRWKHUSHRSOHFDQQRW KHDUVHHRUVPHOO +DVWKLVHYHUKDSSHQHGWR\RX"7HOOPHDERXWLW +DVWKHUHHYHUEHHQDWLPHZKHQ\RXKHDUGYRLFHVWKDWRWKHUSHRSOHFRXOGQRW KHDU" :KDWGLG\RXKHDU":KDWNLQGRIWKLQJVGLG\RXKHDU" 'LG\RXHYHUKHDUPXVLFZKLFKRWKHUSHRSOHFRXOGQRW" +DVWKHUHHYHUEHHQDWLPHZKHQ\RXVDZWKLQJVOLNHSHRSOHRUILJXUHVWKDWRWKHU SHRSOHFRXOGQRWVHH",I\HVFDQ\RXWHOOPHDERXWLW" :KDWGLG\RXVHH"+RZRIWHQGLGLWKDSSHQ":KHQGLGLWKDSSHQ" 'LGWKLVRQO\KDSSHQDWQLJKWZKLOH\RXZHUHWU\LQJWRVOHHSRUGLGLWKDSSHQLQ WKHGD\WLPHWRR" +DVWKHUHHYHUEHHQDWLPHZKHQ\RXVPHOOHGWKLQJVWKDWRWKHUSHRSOHFRXOGQRW VPHOORUIHOWWKLQJVWKDWZHUHQRWWKHUH" 127( ,)+$//8&,1$7,216$5(3266,%/<35(6(1735,25726&25,1*7+,6,7(0$66(667+(68%-(&7 6&219,&7,212) 7+(5($/,7<2)7+(+$//8&,1$7,216:,7+7+(352%(6%(/2: :KDWGLG\RXWKLQNLWZDV" 'LG\RXWKLQNLWZDV\RXULPDJLQDWLRQRUUHDO" 'LG\RXWKLQNLWZDVUHDOZKHQ\RX KHDUGVDZHWF LW" :KDWGLG\RXGRZKHQ\RX KHDUGVDZHWF LW" 7KHVHYRLFHV\RXKHDUG RURWKHUKDOOXFLQDWLRQV GLGWKH\RFFXUZKHQ\RXZHUHDZDNH RUDVOHHS"&RXOGLWKDYHEHHQDGUHDP" 'LGWKH\KDSSHQZKHQ\RXZHUHIDOOLQJDVOHHS":DNLQJXS"2QO\ZKHQLWZDVGDUN" 'LGWKH\KDSSHQDWDQ\RWKHUWLPHDOVR" :HUH\RXVLFNZLWKIHYHUZKHQWKH\RFFXUUHG" +DYH\RXHYHUEHHQGULQNLQJEHHUZLQHOLTXRU"2UWDNLQJDQ\GUXJVZKHQLW KDSSHQHG":DVLWOLNHDWKRXJKWRUPRUHOLNHDYRLFH QRLVH RUDYLVLRQ" NOTE: IF HALLUCINATIONS ARE PRESENT, CAREFULLY ASSESSTIMELINE TO DETERMINE IF IN RELATION TO MOOD SYMPTOMS OR INDEPENDENT OF MOOD SYMPTOMS. THIS WILL FACILITATEDIFFERENTIAL DIAGNOSIS. NOTE: DO NOT RATE AS POSITIVE IF ONLY ENDORSES HAVINGHEARD SOMEONE CALLING THEIR NAME OCCURRING ONLY ONCEOR TWICE. DON'T RATE ILLUSIONS POSITIVELY.,OOXVLRQVDUHGHILQHGDVIDOVHSHUFHSWLRQVEDVHGRQDUHDOVHQVRU\VWLPXOLZKLFKLVPRPHQWDULO\WUDQVIRUPHG7KH\ IUHTXHQWO\RFFXUGXHWRSRRUSHUFHSWXDOUHVROXWLRQ GDUNQHVVQRLV\ORFDOH RULQDWWHQWLRQDQGWKH\DUHLPPHGLDWHO\FRUUHFWHGZKHQDWWHQWLRQLVIRFXVHGRQWKH H[WHUQDOVHQVRU\VWLPXOXVRUSHUFHSWXDOUHVROXWLRQLPSURYHV NOTE: TAKE INTO ACCOUNT CULTURAL BACKGROUND OF THESUBJECT. 127( ,7,6,03257$1772127(,)7+(&+,/',6$&7,1*21+$//8&,1$7,216 'UDIW 6XEMHFW KSADS-PL SCREEN INTERVIEW: 20 Psychosis SDJHRI P C S 'HOXVLRQV 0 - 1RLQIRUPDWLRQ +DYH\RXHYHUKDGDQ\LGHDVDERXWWKLQJVWKDW\RXGLGQ WWHOODQ\RQHEHFDXVH 1 -1RWSUHVHQW \RXZHUHDIUDLGWKH\PLJKWQRWXQGHUVWDQG" :KDWZHUHWKH\" 2 -6XEWKUHVKROG 6XVSHFWHGRUOLNHO\GHOXVLRQDO 'R\RXKDYHDQ\VHFUHWWKRXJKWV"7HOOPHDERXWWKHP +DYH\RXHYHUEHOLHYHGLQWKLQJVWKDWRWKHUSHRSOHGLGQ WEHOLHYHLQ"/LNH ZKDW" 3 - 7KUHVKROG 'HILQLWHGHOXVLRQV PAST: Ask about each of the delusions surveyed below: +DVWKHUHHYHUEHHQDWLPH\RXIHOWWKDWVRPHRQHZDVRXWWRKXUW\RXRUWKDW 3 & 6 VRPHRQHZDVIROORZLQJ\RXRUVS\LQJRQ\RX":KR":K\" 'RHVDQ\RQHFRQWURO\RXUPLQGRUERG\ OLNHDURERW " 'LG\RXHYHUWKLQN\RXZHUHDQLPSRUWDQWRUJUHDWSHUVRQ" 'R\RXKDYHDQ\VSHFLDOSRZHUV" :KHQ\RXDUHZLWKSHRSOH\RXGRQRWNQRZGR\RXWKLQNWKDWWKH\DUH WDONLQJDERXW\RX" :DVWKHUHHYHUDWLPHZKHQ\RXIHOWVRPHWKLQJZDVKDSSHQLQJWR\RXUERG\" /LNHEHOLHYLQJLWZDVURWWLQJIURPWKHLQVLGHRUWKDWVRPHWKLQJZDVYHU\ZURQJ ZLWKLW" 'LG\RXHYHUIHHOFRQYLQFHGWKDWWKHZRUOGZDVFRPLQJWRDQHQG" +RZRIWHQGLG\RXWKLQNDERXWBBBBB" NOTE: IF DELUSIONS ARE PRESENT, CAREFULLY ASSESS THE TIMELINE TO DETERMINE IF IN RELATION TO MOOD SYMPTOMS OR INDEPENDENT OF MOOD SYMPTOMS. THIS WILL FACILITATE THE DIAGNOSIS. IF RECEIVED A SCORE OF 3 ON THE CURRENT RATINGS ON EITHER OF THE PREVIOUS ITEMS, COMPLETE THE CURRENT SECTION OF THE 6&+,=23+5(1,$63(&7580$1'27+(536<&+27,&',625'(56 SUPPLEMENT AFTER FINISHING THE SCREEN INTERVIEW. IF RECEIVED A SCORE OF 3 ON THE PAST RATINGS ON EITHER OF THE PREVIOUS ITEMS, COMPLETE THE PAST SECTION OF THE 6&+,=23+5(1,$63(&7580$1'27+(536<&+27,&',625'(56SUPPLEMENT AFTER FINISHING THE SCREEN INTERVIEW. NO EVIDENCE OF PSYCHOSIS. NOTES: (RECORD DATES OF POSSIBLE CURRENT AND PAST HALLUCINATIONS AND DELUSIONS). 'UDIW 6XEMHFW KSADS-PL SCREEN INTERVIEW: 20 Panic Disorder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f specific symptoms are not elicited spontaneously when describing attacks, ask about each of the following symptoms: 3 & 6 $VVRFLDWHG6\PSWRPV +HDUWSDOSLWDWLRQV 1RWH '609 GRHV QRW KDYH WKUHVKROG FULWHULD IRUWKHPLQLPXPQXPEHURIDWWDFNV 6ZHDWLQJ 7UHPEOLQJRUVKDNLQJ 6HQVDWLRQVRIVKRUWQHVVRIEUHDWKRUVPRWKHULQJVHQVDWLRQV )HHOLQJVRIFKRNLQJ &KHVWSDLQV 1DXVHDRUDEGRPLQDOGLVWUHVV 'L]]LQHVVRUOLJKWKHDGHGQHVV +HDWVHQVDWLRQVRUFKLOOV 1XPELQJRIKDQGVRUIHHW 'HSHUVRQDOL]DWLRQRUGHUHDOL]DWLRQ )HDURIORVLQJFRQWURO )HDURIG\LQJ NOTE: DO NOT COUNT IF LASTS ALL DAY OR DIRECTLY CAUSED BY DRUGS OR MEDICATIONS. IF A SCORE OF 3 ON CURRENT RATING OF PANIC ATTACK ITEM, COMPLETE THE PANIC DISORDER (CURRENT) SECTION OF THE $1;,(7<2%6(66,9(&2038/6,9($1'75$80$5(/$7(' DISORDERS SUPPLEMENT AFTER FINISHING THE SCREEN INTERVIEW. IF A SCORE OF 3 ON 3$67 RATING OF PANIC ATTACK ITEM, COMPLETE THE PANIC DISORDER (3$6T) SECTION OF THE $1;,(7<2%6(66,9(&2038/6,9($1'75$80$5(/$7(' DISORDERS SUPPLEMENT AFTER FINISHING THE SCREEN INTERVIEW. NO EVIDENCE OF PANIC DISORDER. NOTES: (RECORD DATES OF POSSIBLE CURRENT AND PAST PANIC DISORDER). 'UDIW 6XEMHFW KSADS-PL SCREEN INTERVIEW: 20 Agoraphobia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o not rate positively if exclusively accounted for by other psychiatric disorders (i.e. psychosis, depression)separation anxiety, social DQ[LHW\ or medical problems. 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IF RECEIVED A SCORE OF 3 ON THE PAST RATINGS ON EITHER OF THE PREVIOUS ITEMS, COMPLETE THE AGORAPHOBIA (PAST) SECTION OF THE $1;,(7<2%6(66,9(&2038/6,9($1'75$80$5(/$7(' DISORDERS SUPPLEMENT AFTER FINISHING THE SCREENINTERVIEW. NO EVIDENCE OF AGORAPHOBIA. NOTES: (RECORD DATES OF POSSIBLE CURRENT AND PAST AGORAPHOBIA) 6XEMHFW 'UDIW 'DWH 20 ,QWHUYLHZHU 20 KSADS-PL SCREEN INTERVIEW: Separation Anxiety SDJHRI NOTE: KEEP IN MIND THE DEVELOPMENTAL LEVEL OF THE CHILD. RATE POSITIVELY ONLY IF SYMPTOM IS ABOVE AND BEYOND WHAT WOULD BE EXPECTED IN A CHILD OF THE SAME AGE AND DEVELOPMENTAL LEVEL. 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NO EVIDENCE OF SOCIAL $1;,(7<',625'(5 NOTES: (RECORD DATES OF POSSIBLE CURRENT AND PAST SOCIAL $1;,(7<256(/(&7,9(087,60',625'(5) 'UDIW 6XEMHFW KSADS-PL SCREEN INTERVIEW: 20 Specific Phobias SDJHRI Only rate most intense phobia. 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THESE ITEMS SHOULD BE SURVEYED WITH THE CHILDREN, BUT GREATER WEIGHT GIVEN TO PARENT REPORT AND INTERVIEWER OBSERVATIONS WHEN SCORING INDIVIDUAL ITEMS. 6WHUHRW\SHGRU5HSHWLWLYH6SHHFK0RWRU0RYHPHQWVRU P C S 8VHRI2EMHFWV 0 -1RLQIRUPDWLRQ 1 -1RWSUHVHQW1RRGGKDQGRIILQJHUPDQQHULVPV 'RHV\RXUFKLOGKDYHDQ\XQXVXDOPRWRUPDQQHULVPVOLNHKDQG IODSSLQJKHDGZHDYLQJERG\URFNLQJRUERG\VSLQQLQJ" :KDWDERXWDSUHRFFXSDWLRQZLWKZLJJOLQJKLVKHUILQJHUV" 2 - 6XEWKUHVKROG $IHZLVRODWHGLQFLGHQWVUDUHO\ REVHUYHG 'RHV\RXUFKLOGUHSHDWZKDW\RXVD\"3DUURW\RXUVSHHFKRUWKH VSHHFKRIRWKHUV"5HSHDWHGO\XVHLGLRV\QFUDWLFSKUDVHV" 3 - 7KUHVKROG 2FFDVLRQDORUPRUHIUHTXHQWRFFXUUHQFH $Q\RWKHUUHSHWLWLYHKDELWV"0D\EHDQXQXVXDORURGGXVHRIDWR\RU KRXVHKROGREMHFW" PAST: Child: 'R\RXOLNHWRZDWFK\RXUKDQGVZKLOH\RXZLJJOH\RXUILQJHUV" 3 & 6 'RHVURFNLQJEDFNDQGIRUWKFDOP\RXZKHQ\RXDUHXSVHW" 'RSHRSOHHYHUWHOO\RXWRVWD\VWLOODQGVWRSVSLQQLQJ" NOTE: RATE BASED ON PARENT AND CHILD REPORT AND BEHAVIORAL OBSERVATION. 6XEMHFW 'UDIW 'DWH 20 ,QWHUYLHZHU KSADS-PL SCREEN INTERVIEW: 20 Autism Spectrum Disorders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hild: 'R\RXJHWUHDOO\XSVHWZKHQWKHUHLVDQXQH[SHFWHGFKDQJHLQ\RXU SODQVRUWKHZD\\RXXVXDOO\GRWKLQJVOLNHLIWKHUHLVDGHOD\LQWKHVWDUWRI VFKRROLIGLQQHULVDOLWWOHHDUOLHUWKDQXVXDORULI\RXKDYHWRGULYHKRPHD GLIIHUHQWZD\WKDQXVXDO" P C S +LJKO\5HVWULFWHG)L[DWHG,QWHUHVWVWKDWDUH$EQRUPDOLQ,QWHQVLW\ RU)RFXV 0 -1RLQIRUPDWLRQ 1 -1RWSUHVHQW 2IWHQWKHVHDUHSULPDULO\PDQLIHVWHGLQWKHGHYHORSPHQWRIHQFRPSDVVLQJ SUHRFFXSDWLRQVDERXWDFLUFXPVFULEHGWRSLFRULQWHUHVWDERXWZKLFKWKH 2 - 6XEWKUHVKROG 8QXVXDOSUHRFFXSDWLRQVWKDWGR LQGLYLGXDOFDQDPDVVDJUHDWGHDORIIDFWVDQGLQIRUPDWLRQ7KHVHLQWHUHVWV QRWFDXVHVLJQLILFDQWLPSDLUPHQWRUWDNH DQGDFWLYLWLHVDUHSXUVXHGZLWKJUHDWLQWHQVLW\RIWHQWRWKHH[FOXVLRQRIRWKHU H[FHVVLYHDPRXQWVRIWLPH DFWLYLWLHV5DWHIRFXVDQGRULQWHQVLW\ 3 -7KUHVKROG 'HILQLWHO\SUHRFFXSLHGZLWKRQHRU Parent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hild:,VWKHUHVRPHWKLQJVSHFLDO\RXDUHLQWHUHVWHGLQWKDW\RXUHDOO\OLNHWR WDONDERXWUHDGDERXWRUGR"7HOOPHDERXWLW 3 & 6 NOTE: RATE THIS AS POSITIVE IF IT IS INAPPROPRIATE FOR THE AGE AND CULTURE OF THE CHILD, AND IT IS EXAGGERATED. 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'RQRWUDWHSRVLWLYHO\LIEHKDYLRUUHODWHGWRRWKHUGLDJQRVLVVXFKDV2&'RUD SV\FKRVLV 'UDIW 6XEMHFW KSADS-PL SCREEN INTERVIEW: 20 Autism Spectrum Disorders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or school age children and adolescents:'RHVKHVKHXVHJHVWXUHVWR KHOSVKRZKRZVRPHWKLQJZRUNVRUZKLOHWKH\DUHH[SODLQLQJVRPHWKLQJ" 3 & 6 ,QGLFDWHSUREOHPDWLFDUHDVRIQRQYHUEDOEHKDYLRU *D]H ([SUHVVLRQV *HVWXUHV 1RWH 'RQRWUDWHSRVLWLYHLIGXHWRVK\QHVVRUDQ[LHW\DQGPRUHSURQRXQFHG ZLWKXQIDPLOLDURWKHUV IF RECEIVED A SCORE OF 3 ON CURRENT RATING OF ANY OF THE PREVIOUS ITEMS, COMPLETE THE AUTISM SPECTRUM DISORDERS (CURRENT) 6(&7,21,17+(1(852'(9(/230(17$/',65837,9($1'&21'8&7 ',625'(56SUPPLEMENT AFTER FINISHING THE SCREEN INTERVIEW. IF RECEIVED A SCORE OF 3 ON 3$67 RATING OF ANY OF THE PREVIOUS ITEMS, COMPLETE THE AUTISM SPECTRUM DISORDERS (3$6T) 6(&7,21,17+(1(852'(9(/230(17$/',65837,9($1'&21'8&7 ',625'(56SUPPLEMENT AFTER FINISHING THE SCREEN INTERVIEW. NO EVIDENCE OF $87,6063(&7580',625'(56 NOTE: (RECORD DATES OF POSSIBLE CURRENT AND PAST AUTISM SPECTRUM DISORDERS). 'UDIW 6XEMHFW KSADS-PL SCREEN INTERVIEW: 20 Tobacco Use SDJHRI Codes for the Following Items: 0 1R,QIRUPDWLRQ 1 1R 2 Parent Child Summary 8VH 0 1 2 0 1 2 0 1 2 $ (YHUVPRNHG % (YHUFKHZHGWREDFFR & (YHUVPRNHG RUFKHZHG WREDFFRGDLO\IRUPRQWKRUPRUH Notes: '60'5 6PRNHG" 3DUHQW5DWLQJ BBBBBBBBBBB&KLOG5DWLQJ BBBBBBBBBBBBBB IF EVER USED TOBACCO, COMPLETE QUESTIONS BELOW. IF NO EVIDENCE OF TOBACCO USE, GO TO ALCOHOL USE SECTION ON THE FOLLOWING PAGE. 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'UDIW 6XEMHFW 20 KSADS-PL SCREEN INTERVIEW: Alcohol 8se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IF NO EVIDENCE OF CURRENT OR PAST SUBSTANCE USE, GO TO POST-TRAUMATIC STRESS DISORDER SECTION ON PAGE 46. 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IF RECEIVED A SCORE OF 3 ON THE PAST FREQUENCY ITEM FOR ANY DRUG, COMPLETE THE SUBSTANCE ABUSE (PAST) SECTION IN THE ($7,1*',625'(56$1'68%67$1&(5(/$7('',625'(56 SUPPLEMENT AFTER FINISHING SCREENINTERVIEW. NO EVIDENCE OF SUBSTANCE USE',625'(5. NOTE: (RECORD DATE OF POSSIBLE CURRENT AND PAST SUBSTANCE ABUSE). 'UDIW 6XEMHFW 20 KSADS-PL SCREEN INTERVIEW: Post Traumatic Stress Disorder SDJHRI Codes for the Following Items: 0 1R,QIRUPDWLRQ 1 1R 2 7UDXPDWLF(YHQWV 3UREH ,DPJRLQJWRDVN\RXDERXWDQXPEHURIEDGWKLQJVWKDWVRPHWLPHVKDSSHQWRFKLOGUHQ\RXUDJHDQG,ZDQW\RXWRWHOOPHLIDQ\RIWKHVHWKLQJV KDYHHYHUKDSSHQHGWR\RX%HVXUHWRWHOOPHLIDQ\RIWKHVHWKLQJVKDYHHYHUKDSSHQHGHYHQLIWKH\RQO\KDSSHQHGRQHWLPH Parent Child Summary Criteria Ever Ever Ever $ &DU$FFLGHQW 0 1 2 0 1 2 0 1 2 +DYH\RXHYHUEHHQLQDEDGFDUDFFLGHQW" 6LJQLILFDQWFDUDFFLGHQWLQZKLFKFKLOGRU :KDWKDSSHQHG" RWKHULQGLYLGXDOLQFDUZDVLQMXUHGDQG :HUH\RXKXUW" UHTXLUHGPHGLFDOLQWHUYHQWLRQ :DVDQ\RQHHOVHLQWKHFDUKXUW" % 2WKHU$FFLGHQW 0 1 2 0 1 2 0 1 2 +DYH\RXHYHUEHHQLQDQ\RWKHUW\SHRI 6LJQLILFDQWDFFLGHQWLQZKLFKFKLOGZDV EDGDFFLGHQWV" LQMXUHGDQGUHTXLUHGPHGLFDOLQWHUYHQWLRQ :KDWDERXWDELNLQJDFFLGHQW" 2WKHUDFFLGHQWV" :KDWKDSSHQHG" :HUH\RXKXUW" & )LUH 0 1 2 0 1 2 0 1 2 :HUH\RXHYHULQDVHULRXVILUH" &KLOGFORVHZLWQHVVWRILUHWKDWFDXVHG 'LG\RXUKRXVHRUVFKRROHYHUFDWFKRQ VLJQLILFDQWSURSHUW\GDPDJHRUPRGHUDWHWR ILUH" VHYHUHSK\VLFDOLQMXULHV 'LG\RXHYHUVWDUWDILUHWKDWJRWRXWRI FRQWURO":KDWKDSSHQHG" 'LGDQ\RQHJHWKXUW" :DVWKHUHDORWRIGDPDJH" ' :LWQHVVRID'LVDVWHU 0 1 2 0 1 2 0 1 2 +DYH\RXHYHUEHHQLQDUHDOO\EDGVWRUP &KLOGZLWQHVVWRQDWXUDOGLVDVWHUWKDW OLNHDWRUQDGRRUDKXUULFDQH" FDXVHGVLJQLILFDQWGHYDVWDWLRQ +DYH\RXHYHUEHHQFDXJKWLQIORRGVZLWK ZDWHUVWKDWZHUHGHHSHQRXJKWRVZLPLQ" 'UDIW 6XEMHFW KSADS-PL SCREEN INTERVIEW: 20 Post Traumatic Stress Disorder SDJHRI Codes for the Following Items: 0 1R,QIRUPDWLRQ 1 1R 2 7UDXPDWLF(YHQWV FRQW 3UREH ,DPJRLQJWRDVN\RXDERXWDQXPEHURIEDGWKLQJVWKDWVRPHWLPHVKDSSHQWRFKLOGUHQ\RXUDJHDQG,ZDQW\RXWRWHOOPHLIDQ\RIWKHVHWKLQJV KDYHHYHUKDSSHQHGWR\RX%HVXUHWRWHOOPHLIDQ\RIWKHVHWKLQJVKDYHHYHUKDSSHQHGHYHQLIWKH\RQO\KDSSHQHGRQHWLPH Parent Child Summary Criteria Ever Ever Ever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ost Traumatic Stress Disorder SDJHRI Codes for the Following Items: 0 1R,QIRUPDWLRQ 1 1R 2 7UDXPDWLF(YHQWV FRQW 3UREH ,DPJRLQJWRDVN\RXDERXWDQXPEHURIEDGWKLQJVWKDWVRPHWLPHVKDSSHQWRFKLOGUHQ\RXUDJHDQG,ZDQW\RXWRWHOOPHLIDQ\RIWKHVHWKLQJVKDYH HYHUKDSSHQHGWR\RX%HVXUHWRWHOOPHLIDQ\RIWKHVHWKLQJVKDYHHYHUKDSSHQHGHYHQLIWKH\RQO\KDSSHQHGRQHWLPH Parent Child Summary Criteria Ever Ever Ever , :DU=RQH7UDXPD 0 1 2 0 1 2 0 1 2 +DYH\RXHYHUOLYHGLQDZDU]RQH" /LYHGLQZDU]RQH:LWQHVVHGGHDWKDQG +DG\RXUKRPHDWWDFNHG" PDVVGHVWUXFWLRQ :LWQHVVHGWKHNLOOLQJRUUDSHRIRWKHUV" 6HHQHYHU\WKLQJDURXQG\RXVHWRQILUH" 3URWHFWLYH6HUYLFHV +DV\RXUIDPLO\HYHUUHFHLYHGVHUYLFHVIURP&<6'&)" &XUUHQW 3DVW 0 1 2 0 1 2 0 1 2 - 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IF NO EVIDENCE OF PAST TRAUMA, END THE SCREENING INTERVIEW. COMPLETE PRELIMINARY LIFETIME DIAGNOSES WORKSHEET AND APPROPRIATE SUPPLEMENTS. NOTE: (RECORD DATES OF PAST TRAUMATIC EVENTS). 'UDIW 6XEMHFW KSADS-PL SCREEN INTERVIEW: 20 3RVW7UDXPDWLF6WUHVV'LVRUGHU SDJHRI Codes for the Following Items: 0 1R,QIRUPDWLRQ 1 1R 2 127( ,IPRUHWKDQRQHWUDXPDWLFHYHQWZDVHQGRUVHGLQTXLUHDERXWV\PSWRPSUHVHQFHLQUHODWLRQWR$1<RIWKHWUDXPDV NOTE: IN DISCUSSING TRAUMATIC EVENTS WITH CHILDREN, IT IS IMPORTANT TO USE THEIR LANGUAGE IN YOUR DIALOGUE. (e.g. Doyou think about when he stuck his pee-pee up your bum often?) Parent Parent Child Child Summary Summary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ast Traumatic Events SDJHRI Codes for the Following Items: 0 1R,QIRUPDWLRQ 1 1R 2 Parent Parent Child Child Summary Summary CE MSP CE MSP CE MSP +\SHUYLJLODQFH 0 1 2 0 1 2 0 1 2 0 1 2 0 1 2 0 1 2 6LQFHBBBBBKDSSHQHGDUH\RXPRUH FDUHIXO"'R\RXIHHOOLNH\RXDOZD\V KDYHWRZDWFKZKDW VJRLQJRQDURXQG \RX"'R\RXGRXEOHFKHFNWKHGRRUV RUZLQGRZVWRPDNHVXUHWKH\DUH ORFNHG" IF RECEIVED A SCORE OF 2 ON CURRENT RATINGS OF ANY OF THE PRECEDING ITEMS, COMPLETE THE CURRENT AND PAST POST-TRAUMATIC STRESS DISORDER ITEMS ,17+($1;,(7<2%6(66,9(&2038/6,9($1'75$80$ 5(/$7('',625'(566833/(0(17 IF RECEIVED A SCORE OF 2 ON 3$6T RATINGS OF ANY OF THE PRECEDING ITEMS, COMPLETE THE CURRENTAND PAST POST-TRAUMATIC STRESS DISORDER ITEMS ,17+($1;,(7<2%6(66,9(&2038/6,9($1'75$80$ 5(/$7('',625'(566833/(0(17 12(9,'(1&(2) POST-TRAUMATIC STRESS DISORDER NOTE: (RECORD DATES OF POSSIBLE CURRENT AND PAST POST-TRAUMATIC STRESS DISORDER). 'UDIW 6XEMHFW DIRECTIONS: Check the sections to be completed in each supplement. Note dates and/or ages of onset for each current and past possible disorder. Supplement #1: Depressive and Bipolar Related Disorders Supplement #4: Neurodevelopmental, Disruptive, and Conduct Disorders ______Depressive Disorders - Current ______Depressive Disorders - Past ______ADHD - Current ______Mania - Current ______ADHD - Past ______Mania - Past ______Oppositional Disorder -Current ______Disruptive Mood Dysregulation Disorder - Current ______Oppositional Disorder - Past ______Disruptive Mood Dysregulation Disorder - Past ______Conduct Disorder - Current ______Conduct Disorder Past ______Tic Disorders - Current Supplement #2: Schizophrenia Spectrum and Other ______Tic Disorders Past Psychotic Disorders ______Autism Spectrum Disorders - Current ______Autism Spectrum Disorders - Past ______Psychosis - Current ______Psychosis - Past Supplement #5: Eating Disorders and Supplement #3: Anxiety, Obsessive Compulsive, and Substance-Related Disorders Trauma-Related Disorders ______Eating Disorders - Current ______Panic Disorders - Current ______Eating Disorders - Past ______Panic Disorders - Past ______Alcohol Use Disorder - Current ______Agoraphobia - Current ______Alcohol Use Disorder - Past ______Agoraphobia - Past ______Substance Use Disorders - Current ______Separation Disorders - Current ______Substance Use Disorders - Past ______Separation Disorders Past ______Social Anxiety/Selective Mutism - Current ______Social Anxiety/Selective Mutism Past ______Specific Phobias - Current ______Specific Phobias - Past ______Generalized Disorders - Current ______Generalized Disorders - Past ______Obsessive Compulsive Disorder -Current ______Obsessive Compulsive Disorder Past ______Posttraumatic Stress Disorder - Current ______Posttraumatic Stress Disorder - Past