Parent-youth agreement on symptoms and diagnosis: assessment with a diagnostic interview in an adolescent inpatient clinical population.

Diagnostic information on adolescents may be elicited from both youths and their parents, especially for depressive and suicidal symptomatology. The objective of this study was to examine the degree of agreement between parent and adolescent reports of major psychiatric disorders, at the diagnostic and at the symptom level, in a severely affected inpatient clinical population. 64 parent-adolescent pairs were interviewed separately with the semi-structured diagnostic interview Kiddie-SADS-PL. Symptomatology was also assessed with 11 self-report and parent-report scales, all translated, adapted and in most cases validated in Iceland. A total of 25 subscales were included to assess emotional dimensions such as depression or anxiety and cognitive dimensions such as attention deficit or self-concept. Good agreement was found for social phobia and fair agreement for generalized anxiety disorder. Although parent-youth agreement was poor in most cases at the symptoms level, significant correlations indicated consistency for most severity scores, except those related to depressive symptomatology, attention deficit, separation anxiety or conduct disorder. The low agreement between reports of suicidal ideation is in line with results from previous studies and suggests that parents might under- or over-estimate this symptomatology. The combination of data obtained with diagnostic interviews and rating-scales confirmed results from prior empirical work, giving greater weight to parents' reports of observable behavior and to adolescents' reports of subjective experiences, especially depressive symptomatology. Our findings suggest that both parent and child informants are necessary to obtain adequate assessments in adolescents. Further research should explore the correspondence between discrepant diagnoses and external criteria such as parental psychopathology or parent-child relationships and attachment. Psychoanalysis could benefit from cognitive neuroscience and use cognitive assessments as interesting tools. Thus, cognitive assessments can show discrepant results according to parents' or adolescents' reports and can therefore shed light on the parent-child interaction and relational dynamics. Inversely, cognitive neuroscience could benefit from psychoanalysis by taking into account, when interpretating the scores, the relational dynamics and the personal history of the rater.

Validity of K-SADS-PL (Schedule for Affective Disorders and Schizophrenia for School-Age Children--Present and Lifetime Version) depression diagnoses in an adolescent clinical population.

BACKGROUND: Validity studies of the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS) interview are modest in number given the international acceptance and extensive use of this instrument in epidemiological and treatment research. The results are somewhat mixed and limited, particularly for adolescent depression. AIMS: The objective of this study was to assess the convergent-divergent validity of the screen criteria and depression diagnoses (major depressive episode) generated with the diagnostic interview Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL). METHODS: Participants were 86 consecutively admitted inpatients aged 12-17 years and their parents. Both convergent and divergent validity of the depression diagnoses were assessed against 11 standard self-report or parent-report rating scales, all of which had been translated, adapted and in most cases validated in Iceland. A total of 25 subscales were included in calculations. RESULTS: Convergent validity was confirmed, with adolescents who screened positive or met criteria for major depressive episode scoring higher than other patients did on scales assessing depressive symptoms. However, divergent validity was only partially supported in this highly comorbid inpatient sample. Severity based on number of diagnostic criteria met had a generally substantial correlation with the rating scales. CONCLUSIONS: This study provides a substantial additional amount of convergent-divergent validity data related to this extensively used diagnostic instrument.

An Icelandic version of the Kiddie-SADS-PL: translation, cross-cultural adaptation and inter-rater reliability.

The development of structured diagnostic instruments has been an important step for research in child and adolescent psychiatry, but the adequacy of a diagnostic instrument in a given culture does not guarantee its reliability or validity in another population. The objective of the study was to describe the process of cross-cultural adaptation into Icelandic of the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (Kiddie-SADS-PL) and to test the inter-rater reliability of the adapted version. To attain cross-cultural equivalency, five important dimensions were addressed: semantic, technical, content, criterion and conceptual. The adapted Icelandic version was introduced into an inpatient clinical setting, and inter-rater reliability was estimated both at the symptom and diagnoses level, for the most frequent diagnostic categories in both international diagnostic classification systems (DSM-IV and ICD-10). The cross-cultural adaptation has provided an Icelandic version allowing similar understanding among different raters and has achieved acceptable cross-cultural equivalence. This initial study confirmed the quality of the translation and adaptation of Kiddie-SADS-PL and constitutes the first step of a larger validation study of the Icelandic version of the instrument.

Implementing the semi-structured interview Kiddie-SADS-PL into an in-patient adolescent clinical setting: impact on frequency of diagnoses.

BACKGROUND: Research is needed to establish the utility of diagnostic interviews in clinical settings. Studies comparing clinical diagnoses with diagnoses generated with structured instruments show generally low or moderate agreement and clinical diagnostic assignment (e.g. admission or chart diagnoses) are often considered to underdiagnose disorders. The objective of this study was to evaluate the impact of implementing the Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime Version (Kiddie-SADS-PL) into an in-patient adolescent clinical setting. METHODS: Participants were all adolescents admitted through the years 2001-2004 (N = 333 admissions, age 12-17 years). The authors reviewed the charts of the previous three years of consecutive admissions, patients being evaluated using routine psychiatric evaluation, before the Kiddie-SADS-PL was introduced. They then reviewed the charts of all consecutive admissions during the next twelve months, patients being evaluated by adding the instrument to routine practice. RESULTS: The rates of several main diagnostic categories (depressive, anxiety, bipolar and disruptive disorders) increased considerably, suggesting that those disorders were likely underreported when using non-structured routine assessment procedures. The rate of co-morbidity increased markedly as the number of diagnoses assigned to each patient increased. CONCLUSION: The major differences in diagnostic assignment rates provide arguments for the utility of diagnostic interviews in inpatient clinical settings but need further research, especially on factors that affect clinical diagnostic assignment in "real world" settings.