K-SADS-PL
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K-SADS-PL To the Editor: We applaud the excellent review of the development of the K-SADS provided in the article titled “Historical Develop- ment and Present Status of the Schedule for Affective Disor- ders and Schizophrenia for School-Age Children (K-SADS)” (Ambrosini, 2000). Please note, however, that the user infor- mation for the K-SADS-PL was incorrectly supplied in the article. For information on the K-SADS-PL, readers should contact Joan Kaufman, Ph.D., Yale University, University Towers, Suite 2H, 100 York Street, New Haven, CT 06511; fax: (203) 764-9990; e-mail: [email protected]. The interview can also be downloaded from the Internet at www.wpic.pitt.edu or www.info.med.yale.edu/psych. The administration time of the K-SADS-PL was also incor- rectly noted. When the K-SADS-PL is administered to normal controls, the parent and child interviews each take approx- imately 35 to 45 minutes. When the K-SADS-PL is admin- istered to psychiatric patients, depending on the range and severity of psychopathology, parent and child interviews each take approximately 1.25 hours—or 2.5 hours total to collect the data from both informants. We would also like to provide some additional information about the K-SADS-PL that may be helpful to readers. The K- SADS-PL includes an initial 82-item screen interview that sur- veys key symptoms for current and past episodes of 20 different diagnostic areas, skip-out criteria that determine whether addi- tional interviewing is necessary, and supplemental diagnostic sections to be completed if indicated. As noted by Ambrosini, the screen interview and skip-out criteria shorten administra- tion time. The screen interview also provides a diagnostic over- view of lifetime psychopathology that facilitates differential diagnoses by permitting more targeted probing of relevant symptoms. For example, if after completing the screen interview a child appears to meet possible criteria for attention-deficit/ hyperactivity disorder (ADHD) beginning at age 5, and major depression (MDD) beginning at age 9, interviewers are in- structed to complete the supplement for ADHD before the supplement for MDD. If the child was found to have a history of attention difficulties associated with ADHD, when inquiring about concentration difficulties in assessing MDD, interviewers are instructed to find out whether the onset of depressed mood was associated with a worsening of the long-standing concen- tration difficulties. If there was no change in attention problems with the onset of depressive symptoms, the symptom concen- tration difficulties would not be rated positively in the MDD supplement. Likewise, information about a possible substance abuse disorder obtained in the screen interview can be quite helpful when inquiring about supplemental symptoms of depression and mania and finalizing diagnoses of the affective disorders. The screen interview and diagnostic supplement for- mat is unique to the K-SADS-PL, and it greatly facilitates administration of the instrument with normal controls and patient populations. Joan Kaufman, Ph.D. Yale University New Haven, CT Boris Birmaher, M.D. David A. Brent, M.D. Neal D. Ryan, M.D. Western Psychiatric Institute and Clinic University of Pittsburgh Medical Center Uma Rao, M.D. University of California Los Angeles Ambrosini PJ (2000), Historical development and present status of the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS). J Am Acad Child Adolesc Psychiatry 39:49–58 SEVERE LEUKOPENIA WITH VALPROATE To the Editor: Valproate (divalproex sodium, Depakote ® ) is increasingly being used in child and adolescent psychiatry. Although leu- kopenia with use of valproate has been reported, treating 2 patients with severe leukopenia in 1 year reminded me of the need for alertness to this possibility. Patient A., a nearly 13-year-old African-American boy, had been hospitalized twice and was placed in a residential treatment center for about 6 months prior to returning to a special school placement. He was receiving no medications. He was living with his elderly great-grandmother, who was unsure of his history except that his biological mother had a history of “ups and downs.” He had no reported allergies and was in good health. Prior reported problems with his temper and fighting resurfaced. He became “mad at people because they lie on me; teacher acts too smart!” The patient and his guardian agreed to a valproate trial after a risk-benefit discussion that included the court- LETTERS TO THE EDITOR 1208 J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 39:10, OCTOBER 2000
Transcript of K-SADS-PL
K-SADS-PL
To the Editor:
We applaud the excellent review of the development of theK-SADS provided in the article titled “Historical Develop-ment and Present Status of the Schedule for Affective Disor-ders and Schizophrenia for School-Age Children (K-SADS)”(Ambrosini, 2000). Please note, however, that the user infor-mation for the K-SADS-PL was incorrectly supplied in thearticle. For information on the K-SADS-PL, readers shouldcontact Joan Kaufman, Ph.D., Yale University, UniversityTowers, Suite 2H, 100 York Street, New Haven, CT 06511;fax: (203) 764-9990; e-mail: [email protected]. Theinterview can also be downloaded from the Internet atwww.wpic.pitt.edu or www.info.med.yale.edu/psych.
The administration time of the K-SADS-PL was also incor-rectly noted. When the K-SADS-PL is administered to normalcontrols, the parent and child interviews each take approx-imately 35 to 45 minutes. When the K-SADS-PL is admin-istered to psychiatric patients, depending on the range andseverity of psychopathology, parent and child interviews eachtake approximately 1.25 hours—or 2.5 hours total to collectthe data from both informants.
We would also like to provide some additional informationabout the K-SADS-PL that may be helpful to readers. The K-SADS-PL includes an initial 82-item screen interview that sur-veys key symptoms for current and past episodes of 20 differentdiagnostic areas, skip-out criteria that determine whether addi-tional interviewing is necessary, and supplemental diagnosticsections to be completed if indicated. As noted by Ambrosini,the screen interview and skip-out criteria shorten administra-tion time. The screen interview also provides a diagnostic over-view of lifetime psychopathology that facilitates differentialdiagnoses by permitting more targeted probing of relevantsymptoms. For example, if after completing the screen interviewa child appears to meet possible criteria for attention-deficit/hyperactivity disorder (ADHD) beginning at age 5, and majordepression (MDD) beginning at age 9, interviewers are in-structed to complete the supplement for ADHD before thesupplement for MDD. If the child was found to have a historyof attention difficulties associated with ADHD, when inquiringabout concentration difficulties in assessing MDD, interviewersare instructed to find out whether the onset of depressed moodwas associated with a worsening of the long-standing concen-tration difficulties. If there was no change in attention problems
with the onset of depressive symptoms, the symptom concen-tration difficulties would not be rated positively in the MDDsupplement. Likewise, information about a possible substanceabuse disorder obtained in the screen interview can be quitehelpful when inquiring about supplemental symptoms ofdepression and mania and finalizing diagnoses of the affectivedisorders. The screen interview and diagnostic supplement for-mat is unique to the K-SADS-PL, and it greatly facilitatesadministration of the instrument with normal controls andpatient populations.
Joan Kaufman, Ph.D.Yale University
New Haven, CTBoris Birmaher, M.D.David A. Brent, M.D.
Neal D. Ryan, M.D.Western Psychiatric Institute and ClinicUniversity of Pittsburgh Medical Center
Uma Rao, M.D.University of California Los Angeles
Ambrosini PJ (2000), Historical development and present status of theSchedule for Affective Disorders and Schizophrenia for School-AgeChildren (K-SADS). J Am Acad Child Adolesc Psychiatry 39:49–58
SEVERE LEUKOPENIA WITH VALPROATE
To the Editor:
Valproate (divalproex sodium, Depakote®) is increasinglybeing used in child and adolescent psychiatry. Although leu-kopenia with use of valproate has been reported, treating 2patients with severe leukopenia in 1 year reminded me of theneed for alertness to this possibility.
Patient A., a nearly 13-year-old African-American boy, hadbeen hospitalized twice and was placed in a residential treatmentcenter for about 6 months prior to returning to a special schoolplacement. He was receiving no medications. He was living withhis elderly great-grandmother, who was unsure of his historyexcept that his biological mother had a history of “ups anddowns.” He had no reported allergies and was in good health.Prior reported problems with his temper and fighting resurfaced.He became “mad at people because they lie on me; teacher actstoo smart!” The patient and his guardian agreed to a valproatetrial after a risk-benefit discussion that included the court-
L E T T E R S T O T H E E D I T O R
1208 J . AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 39 :10 , OCTOBER 2000
