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A. Screen Interview
B. Supplements
I. 'HSUHVVLYHDQG%LSRODU5HODWHG Disorders Supplement
II. 6FKL]RSKUHQLD6SHFWUXPDQG2WKHUPsychotic Disorders Supplement
III. Anxiety2EVHVVLYH&RPSXOVLYHDQG7UDXPD5HODWHG Disorders Supplement
IV. 1HXURGHYHORSPHQWDO'LVUXSWLYHDQG&RQGXFW Disorders Supplement
V. (DWLQJ'LVRUGHUVDQGSubstance5HODWHG Disorders Supplement

Advanced Center for Intervention and Services Research (ACISR)


for Early Onset Mood and Anxiety Disorders
Western Psychiatric Institute and Clinic

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TABLE OF CONTENTS
Screen Interview
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Schedule for Affective Disorders and Schizophrenia SDJHLRI[LY
for School Aged Children (6-18 Years)

Kiddie-SADS - Lifetime Version (K-SADS-PL '601RYHPEHU)

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20 KSADS-PL SCREEN INTERVIEW:
Introduction SDJHLLRI[LY

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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\.

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6XEWKUHVKROG6\PSWRPVWhile 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.

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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
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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 WKHsubjects 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) Figure
Fi B depicts
d i t a child
hild who
h 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

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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


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With whom is subject currently living (choose one)?


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KSADS-PL SCREEN INTERVIEW:
20
Caregiver Information SDJHYLRI[LY

PARENTAL PARTICIPATION:
Who is the informant/reporter for this interview?
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First Name:  OLYHVZLWKVXEMHFWLIDSSOLFDEOH Last Name:

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SUBJECT'S 6(&21'$5<&$5(*,9(5
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First Name: OLYHVZLWKVXEMHFWLIDSSOLFDEOH Last Name:

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20 KSADS-PL SCREEN INTERVIEW:
Caretaker / Sibling Information SDJHYLLRI[LY

%,2/2*,&$/)$7+(5

First Name: Last Name:

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SUBJECT'S SIBLINGS
First Name: Last Name:

Age:
Quality of Relationship between Sibling and Subject:
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First Name: Last Name:

Age: Quality of Relationship between Sibling and Subject:


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Age: Quality of Relationship between Sibling and Subject:


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20 KSADS-PL SCREEN INTERVIEW:
Health Screen SDJHYLLLRI[LY

CHILD AND ADOLESCENT HEALTH SCREEN


PREGNANCY AND BIRTH:
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VDJHDWELUWKRIFKLOG

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20 KSADS-PL SCREEN INTERVIEW:
Medical / Developmental History SDJHL[RI[LY

MEDICAL AND SURGICAL HISTORY cont:


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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)

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1XPEHURI3V\FKLDWULF+RVSLWDOL]DWLRQV OVERALL RELIABILITY OF


INFORMATION:

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Medication listing
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KSADS-PL SCREEN INTERVIEW:
20 School Information SDJH[LLLRI[LY

School Information

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KSADS-PL SCREEN INTERVIEW:
20
Peer / Activities Information SDJH[LYRI[LY

Peer Relations

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KSADS-PL SCREEN INTERVIEW:
20
Depression SDJHRI

P C S
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(Assessment of diurnal variation can secondarily clarify daily duration
of depressive mood)
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&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
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20
KSADS-PL SCREEN INTERVIEW:
Depression SDJHRI

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NOTE: IRRITABILITY MAY BE DUE TO OTHER DISORDERS


e.g., BIPOLAR DISORDER, ADHD, ODD, CD, SUBSTANCE ABUSE,
$87,60635(&7580',625'(5 .

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20
KSADS-PL SCREEN INTERVIEW:
Depression SDJHRI

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RXWLQJVIDPLO\DFWLYLWLHVIDYRULWH79SURJUDPVFRPSXWHURUYLGHRJDPHV DSDWKHWLFGDLO\RUDOPRVWGDLO\DWOHDVWRI
PXVLFGDQFLQJSOD\LQJDORQHUHDGLQJJRLQJRXWHWF  WKHWLPH

+DVWKHUHHYHUEHHQDWLPH\RXIHOWERUHGDORWRIWKHWLPH":KHQ" PAST:
'R\RXIHHOERUHGDORWQRZ"
:DVWKHUHDQRWKHUWLPH\RXIHOWERUHGDORW"
'LG\RXIHHOERUHGZKHQ\RXWKRXJKWDERXWGRLQJWKHWKLQJV\RXXVXDOO\OLNHWR 3 & 6
GRIRUIXQ" *LYHH[DPSOHVPHQWLRQHGDERYH 
'LGWKLVVWRS\RXIURPGRLQJWKRVHWKLQJV"
'LG\RX DOVR IHHOERUHGZKLOH\RXZHUHGRLQJWKLQJV\RXXVHGWRHQMR\"

AnhedoniaUHIHUVWRSDUWLDORUFRPSOHWH SHUYDVLYH ORVVRIDELOLW\WRJHW


SOHDVXUHHQMR\KDYHIXQGXULQJSDUWLFLSDWLRQLQDFWLYLWLHVZKLFKKDYHEHHQ
Duration of Anhedonia:
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.

'UDIW
6XEMHFW
20
KSADS-PL SCREEN INTERVIEW:
Suicide SDJHRI

P C S
D5HFXUUHQW7KRXJKWVRI'HDWK 0 -1RLQIRUPDWLRQ

6RPHWLPHVFKLOGUHQZKRJHWXSVHWRUIHHOEDGZLVKWKH\ZHUHGHDGRUIHHO 1 -1RWSUHVHQW
WKH\
GEHEHWWHURIIGHDG
+DYH\RXHYHUKDGWKHVHW\SHRIWKRXJKWV":KHQ" 2 -6XEWKUHVKROG,QIUHTXHQWWKRXJKWVRIGHDWK HJ
'R\RXIHHOWKDWZD\QRZ" OHVVWKDQRQFHSHUPRQWKYDJXH
:DVWKHUHHYHUDQRWKHUWLPH\RXIHOWWKDWZD\" QRQVSHFLILF 

3 - 7KUHVKROG5HFXUUHQWWKRXJKWVRIGHDWK,
ZRXOGEHEHWWHURIIGHDGRU,ZLVK,ZHUH
GHDG

PAST:

3 & 6

P C S

E6XLFLGDO,GHDWLRQ 0 -1RLQIRUPDWLRQ

'60'57KRXJKWVRIFRPPLWWLQJVXLFLGH 1 -1RWDWDOO

3DUHQW5DWLQJBBBBBBBBBBB&KLOG5DWLQJBBBBBBBBBBBBBB 2 - 6XEWKUHVKROG,QIUHTXHQWRUYDJXHWKRXJKWVRI
VXLFLGH HJOHVVWKDQRQFHSHUPRQWK 
6RPHWLPHVFKLOGUHQZKRJHWXSVHWRUIHHOEDGWKLQNDERXWG\LQJRUHYHQ
NLOOLQJWKHPVHOYHV 3 -7KUHVKROG5HFXUUHQWWKRXJKWVRIVXLFLGH
+DYH\RXHYHUKDGVXFKWKRXJKWV"
+RZZRXOG\RXGRLW"
'LG\RXKDYHDSODQ" PAST:

3 & 6

P C S

F6XLFLGDO$FWV,QWHQW 0 -1RLQIRUPDWLRQ

'60'5(YHUWULHGWRNLOOVHOI 1 -1RDWWHPSW

3DUHQW5DWLQJBBBBBBBBBBB&KLOG5DWLQJBBBBBBBBBBBBBB 2 -6XEWKUHVKROG3UHSDUDWLRQVZLWKQRDFWXDOLQWHQW
WRGLH HJKHOGSLOOVLQKDQG RUSODQQHG
DWWHPSWEXWGLGQRWIROORZWKURXJKRUHQJDJHLQ
+DYH\RXDFWXDOO\WULHGWRNLOO\RXUVHOI":KHQ" VHOIKDUPLQJEHKDYLRU
:KDWGLG\RXGR"
$Q\RWKHUWKLQJV"
+RZFORVHGLG\RXFRPHWRGRLQJLW" 3 -7KUHVKROG6HOILQMXULRXVEHKDYLRUZLWK$1<
:DVDQ\ERG\LQWKHURRP",QWKHDSDUWPHQW" VXLFLGDOLQWHQW ,IVXEMHFWHQGRUVHVHYHQD
'LG\RXWHOOWKHPLQDGYDQFH" LQWHQWWRGLHFRGHDVWKUHVKROGKHUH 
+RZZHUH\RXIRXQG"'LG\RXUHDOO\ZDQWWRGLH"
'LG\RXDVNIRUDQ\KHOSDIWHU\RXGLGLW" PAST:

NOTE: CODE SELF-HARMING BEHAVIOR WITH NO INTENT TO DIE AS 3 & 6


NON-SUICIDAL, SELF-INJURIOUS BEHAVIOR - NOT AS SUICIDAL
BEHAVIOR.

Ever attempted suicide: <HV 1R

Number of lifetime attempts


meeting threshold of (3):

'UDIW
6XEMHFW
KSADS-PL SCREEN INTERVIEW:
20
Suicide SDJHRI

P C S
G6XLFLGDO$FWV0HGLFDO/HWKDOLW\ 0 -1RLQIRUPDWLRQ
$FWXDOPHGLFDOWKUHDWWROLIHRUSK\VLFDOFRQGLWLRQIROORZLQJWKHPRVWVHULRXV 1 -1RDWWHPSWRUHQJDJHGLQEHKDYLRUZLWKQRLQWHQW
VXLFLGDODFW7DNHLQWRDFFRXQWWKHPHWKRGLPSDLUHGFRQVFLRXVQHVVDW WRGLH HJKHOGSLOOVLQKDQG 1RPHGLFDO
WLPHRIEHLQJUHVFXHGVHULRXVQHVVRISK\VLFDOLQMXU\WR[LFLW\RILQJHVWHG GDPDJH
PDWHULDOUHYHUVLELOLW\DPRXQWRIWLPHQHHGHGIRUFRPSOHWHUHFRYHU\DQG
KRZPXFKPHGLFDOWUHDWPHQWQHHGHG 2 - 6XEWKUHVKROGVXSHUILFLDOFXWVVFUDWFKWRZULVW
WRRNDFRXSOHRIH[WUDSLOOV
+RZFORVHZHUH\RXWRG\LQJDIWHU\RXU PRVWVHULRXVVXLFLGDODFW "
:KDWGLG\RXGRZKHQ\RXWULHGWRNLOO\RXUVHOI" 3 - 7KUHVKROG0HGLFDOLQWHUYHQWLRQRFFXUUHGRU
:KDWKDSSHQHGWR\RXDIWHU\RXWULHGWRNLOO\RXUVHOI" ZDV LQGLFDWHGRUVLJQLILFDQWFXWZLWKEOHHGLQJ
RUWRRNPRUHWKDQDFRXSOHRISLOOV
NOTE: CODE SELF-HARMING BEHAVIOR WITH NO INTENT TO DIE
AS NON-SUICIDAL, SELF-INJURIOUS BEHAVIOR - NOT AS SUICIDAL
BEHAVIOR. PAST:

3 & 6

P C S
H1RQVXLFLGDO6HOI,QMXULRXV%HKDYLRU 0 -1RLQIRUPDWLRQ
5HIHUVWRLQWHQWLRQDOVHOILQIOLFWHGGDPDJHWRWKHVXUIDFHRIWKHERG\RID
1 - 1RWSUHVHQW
VRUWOLNHO\WRLQGXFHEOHHGLQJRUSDLQIRUSXUSRVHVWKDWDUHQRWVRFLDOO\
VDQFWLRQHG$1'GRQHZLWKRXWLQWHQWRINLOOLQJKLPVHOIZLWKWKHH[SHFWDWLRQ
2 - 6XEWKUHVKROG2QFH+DVHQJDJHGLQWKH
WKDWWKHLQMXU\ZLOOOHDGWRRQO\PLQRURUPRGHUDWHSK\VLFDOKDUP
EHKDYLRURQRFFDVLRQV+DVQHYHU
FDXVHGVHULRXVLQMXU\WRVHOI
'LG\RXHYHUWU\WRKXUW\RXUVHOI"
+DYH\RXHYHUEXUQHG\RXUVHOIZLWKPDWFKHVFDQGOHV" 3 - 7KUHVKROG5HSHWLWLYH+DVHQJDJHGLQWKH
2UVFUDWFKHG\RXUVHOIZLWKQHHGOHVDNQLIH"<RXUQDLOV" EHKDYLRUPRUHWKDQWLPHVDQGRUKDV
2USXWKRWSHQQLHVRQ\RXUVNLQ" HQJDJHGLQWKHEHKDYLRUZLWKVLJQLILFDQWLQMXU\
$Q\WKLQJHOVH" WRVHOI HJEXUQOHIWVFDUFXWUHTXLUHG
:K\GLG\RXGRLW" VWLWFKHV 
+RZRIWHQ" PAST:
'R\RXKDYHPDQ\DFFLGHQWV"
:KDWNLQG"
+RZRIWHQ" 3 & 6

6RPHNLGVGRWKHVHW\SHVRIWKLQJVEHFDXVHWKH\ZDQWWRNLOOWKHPVHOYHV
DQG RWKHUNLGVGRWKHPEHFDXVHLWPDNHVWKHPIHHODOLWWOHEHWWHUDIWHUZDUGV
:K\GR\RXGRWKHVHWKLQJV"

IF RECEIVED A SCORE OF 3 ON CURRENT RATING OF ANY OF THE PREVIOUS ITEMS, COMPLETE THE
DEPRESSIVE/DYSTH<0,&',6ORDERS (CURRENT) SECTION OF THE '(35(66,9($1'%,32/$55(/$7('
',625'(56 SUPPLEMENT, AFTERFINISHING THE SCREEN INTERVIEW.

IF RECEIVED A SCORE OF 3 ON PAST RATING OF ANY OF THE PREVIOUS ITEMS, COMPLETE THE
DEPRESSIVE/DYSTHYMIC DISORDERS (PAST) SECTION OF '(35(66,9($1'%,32/$55(/$7('
',625'(56SUPPLEMENT, AFTER FINISHINGTHE SCREEN INTERVIEW.

NO EVIDENCE OF DEPRESSIVE/DYSTHYMIC DISORDER.

NOTE: (RECORD DATES OF POSSIBLE CURRENT AND PAST DEPRESSIVE DISORDERS).

'UDIW
6XEMHFW
KSADS-PL SCREEN INTERVIEW:
20
Mania / Hypomania SDJHRI

P C S
 (OHYDWHG(ODWHGRU([SDQVLYH0RRG 0 - 1RLQIRUPDWLRQ
(OHYDWHGPRRGDQGRUH[FHVVLYHO\RSWLPLVWLFDWWLWXGHZKLFKLVRXWRI 1 - 1RWSUHVHQW
SURSRUWLRQWRFLUFXPVWDQFHVDQGDERYHDQGEH\RQGZKDWLVH[SHFWHGLQ
FKLOGUHQRIWKHVDPHDJHRUVDPHGHYHORSPHQWDOOHYHODifferentiate from
normal mood in chronically depressed subjects. Do not rate positive 2 - 'HILQLWHO\HOHYDWHGDQGRSWLPLVWLFRXWORRNWKDWLV
ifmild elation is reported in situations like Christmas, birthdays,going VRPHZKDWRXWRISURSRUWLRQWRWKH
to amusement parks, which normally overstimulate and makechildren FLUFXPVWDQFHV DERYHDQGEH\RQGZKDWLV
very excited. H[SHFWHGLQDFKLOGRIWKHVXEMHFW
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OHVVWKDQKRXUVLQDGD\DQGRUIRUIHZHUWKDQ
NOTE: DO NOT SCORE POSITIVELY IF ELATED MOOD IS VHSDUDWHGD\V
EXCLUSIVELY DUE TO '58*6MEDICATIONS OR ANY OTHER
PSYCHIATRICOR MEDICAL CONDITION. 3 -0RRGDQGRXWORRNDUHFOHDUO\RXWRISURSRUWLRQWR
FLUFXPVWDQFHV1RWLFHDEOHWRRWKHUVDQG
+DVWKHUHHYHUEHHQDWLPHZKHQ\RXIHOWVXSHUKDSS\RURQWRSRIWKH SHUFHLYHGDVRGGRUH[DJJHUDWHG2FFXUVIRUDW
ZRUOG":D\PRUHWKDQ\RXUQRUPDOKDSS\IHHOLQJ" OHDVWKRXUVRXWRIDGD\IRUDWOHDVW
'LGWKHVXSHUKDSS\IHHOLQJVHHPWRFRPHRXWRIWKHEOXH" FRQVHFXWLYHGD\VRURQDWOHDVWVHSDUDWHGD\V
+DYHWKHUHEHHQWLPHVZKHQ\RXZHUHVXSHUVLOO\PXFKPRUHVLOO\WKDQ ZLWKLQRQHZHHN
HYHU\RQHHOVHDURXQG\RX" PAST:
:HUH\RXODXJKLQJDERXWWKLQJVWKDWQRUPDOO\\RXZRXOGQRWILQGIXQQ\"
'LGLWIHHOOLNH\RXFRXOGQ
WVWRSODXJKLQJ"
'LGLWVHHPOLNH\RXZHUHGUXQNRUKLJKHYHQWKRXJK\RXZHUHQ
WWDNLQJ 3 & 6
GUXJVRUDOFRKRO"
'LGRWKHUSHRSOHQRWLFH"
+DYH\RXUIULHQGVHYHUVDLGDQ\WKLQJWR\RXDERXWEHLQJZD\WRRKDSS\WRR
VLOO\RUWRRKLJK"
'LG\RXIHHOVXSHUSRVLWLYHOLNHQRWKLQJFRXOGJRZURQJ"
'LG\RXKDYHWKHIHHOLQJWKDWHYHU\WKLQJZDVWHUULILFDQGZRXOGWXUQRXWMXVW
WKHZD\\RXZDQWHG"
'LG\RXIHHOUHDOO\H[FLWHGRUIXOORIHQWKXVLDVPEXWWKHUHUHDOO\ZDVQRWD
UHDVRQWRIHHOWKLVZD\"
&DQ\RXJLYHPHVRPHH[DPSOHV"
+RZORQJGLGWKLVIHHOLQJXVXDOO\ODVW"
:RXOGLWFRPHDQGJRWKURXJKRXWWKHGD\"
'LG\RXHYHUKDYHSUREOHPVRUJHWLQWURXEOHIRUEHLQJWRRKDSS\RUKLJK"

Ask Parent/Caregiver: :DVWKLVDERYHDQGEH\RQGZKDW\RXZRXOGVHHLQ


KLVKHUIULHQGVRURWKHUNLGVRIWKHVDPHDJHRUGHYHORSPHQWDOOHYHOLQWKH
VDPHFLUFXPVWDQFHV"

P C S
 ([SORVLYH,UULWDELOLW\$QJHU 0 -1RLQIRUPDWLRQ

'60'5)HOWDQJU\RUORVW\RXUWHPSHU 1 -1RWSUHVHQW

3DUHQW5DWLQJBBBBBBBBBBB&KLOG5DWLQJBBBBBBBBBBBBBB
2 -6XEWKUHVKROG'HILQLWHSHULRGVRIH[FHVVLYHO\
:DVWKHUHHYHUDWLPH\RXZHUHVRLUULWDEOHDQGDQJU\WKDW\RXH[SORGHG" LUULWDEOHDQJU\PRRG$QJHU,UULWDELOLW\LVRXWRI
:KHQ\RXDUHIHHOLQJUHDOO\PDGGR\RXWKURZWKLQJVRUEUHDNWKLQJV" SURSRUWLRQIRUWKHVLWXDWLRQDQGRFFXUVIRU
7HDU\RXUURRPDSDUW" PXFKRIWKHGD\RULQWHQVHO\IRUDEULHISHULRG
+DYH\RXHYHUSXQFKHGDKROHLQWKHZDOOZKHQ\RXZHUHDQJU\" KRXU 
:KHQ\RXJRWUHDOO\DQJU\GLG\RXHYHUWKUHDWHQRUDFWXDOO\KXUWDSDUHQWRU
DWHDFKHU":KDWDERXWRWKHUNLGVRUSHWV" 3 - 7KUHVKROG(SLVRGHVRIH[SORVLYHLUULWDELOLW\
:KDWZDVJRLQJRQDWWKHWLPHZKHQWKLVKDSSHQHG":KDWVHW\RXRII" DQJHUWKDWDUHIDURXWRISURSRUWLRQWRDQ\
+DYHWKHUHEHHQWLPHVZKHQ\RXJRWVXSHUDQJU\ZLWKRXWNQRZLQJZK\RU VWUHVVRURUVWLPXOLKDVDVVRFLDWHGDJJUHVVLYH
RYHUOLWWOHWKLQJVWKDW\RXQRUPDOO\ZRXOGQRWJHWXSVHWDERXW" EHKDYLRU HJWKUHDWVSURSHUW\GHVWUXFWLRQRU
SK\VLFDODJJUHVVLRQ 2FFXUVRQDWOHDVW
FRQVHFXWLYHGD\VRURQDWOHDVWVHSDUDWH
127(2QO\UDWHLUULWDELOLW\DQGH[SORVLYHQHVVLQWKLVLWHPWKDW GD\VZLWKLQRQHZHHN
RFFXUVGXULQJGLVWLQFWHSLVRGH V DQGUHSUHVHQWVDFKDQJHIURP
EDVHOLQH'RQRWUDWHFKURQLFLUULWDELOLW\RIRQH\HDUGXUDWLRQRU
PAST:
ORQJHUXQOHVVWKHUHZDVDPDUNHGFKDQJHLQLQWHQVLW\GXULQJD
GLVWLQFWSHULRGRIWLPH
3 & 6

'UDIW
6XEMHFW
20
KSADS-PL SCREEN INTERVIEW:
Mania / Hypomania SDJHRI

P C S
 ,QFUHDVHG(QHUJ\RU$FWLYLW\ 0 - 1RLQIRUPDWLRQ

'60'56WDUWLQJORWVPRUHSURMHFWV 1 -1RWSUHVHQW

3DUHQW5DWLQJBBBBBBBBB&KLOG5DWLQJBBBBBBBBB 2 - 6XEWKUHVKROG%ULHISHULRG V RILQFUHDVHG


HQHUJ\RUPLOGLQWHQVLILFDWLRQIURPEDVHOLQH
+DVWKHUHHYHUEHHQDWLPHZKHUH\RXKDGPXFKPRUHHQHUJ\WKDQXVXDO RU OLNHO\FDXVHGE\HQYLURQPHQWDOVWLPXOXVRI
VRPXFKHQHUJ\WKDWLWIHOWOLNHWRRPXFK":KDWNLQGVRIWKLQJVZHUH\RX TXHVWLRQDEOHFOLQLFDOVLJQLILFDQFH
GRLQJZKHQWKDWKDSSHQHG"
:DVWKHUHDFKDQJHLQKRZPXFK\RXZHUHGRLQJ" 3 -7KUHVKROG'HILQLWHHSLVRGHVRIFOHDULQFUHDVHG
'LGLWVHHPOLNH\RXZHUHGRLQJWRRPDQ\WKLQJVRUZHUHVXSHUK\SHU" HQHUJ\RUDFWLYLW\ZHOOEH\RQGEDVHOLQHRUIDULQ
+RZORQJGLGWKDWIHHOLQJODVW"'LGRWKHUSHRSOHQRWLFHLW" H[FHVVRIVDPHDJHSHHUVLQWKHVDPH
:DVLWGLIIHUHQWWKDQRWKHUSHRSOHDURXQG\RX" VLWXDWLRQ
'LGDQ\WKLQJVHHPWRFDXVHWKDWIHHOLQJ"
:DVWKHUHDQ\WKLQJHOVHGLIIHUHQWDERXW\RXGXULQJWKHWLPHRIKLJKHQHUJ\
\RXUVSHHGRIWDONLQJWKLQNLQJDQ\WKLQJHOVH"
PAST:

NOTE: IF THE CHILD HAS ADHD OR IS VERY ACTIVE AND


ENERGETIC AT BASELINE, ONLY RATE POSITIVE IF THIS IS A
3 & 6
DISTINCT PERIOD OF SUBSTANTIAL INCREASE IN ENERGY.

127(7KH K\SR PDQLFV\PSWRPRILQFUHDVHGHQHUJ\VKRXOGRQO\EHUDWHGDVSRVLWLYHLILWLVDVVRFLDWHGZLWKDQDEQRUPDOPRRG HJ


HODWLRQRULUULWDELOLW\ ,IWKHV\PSWRPLVRQO\TXHVWLRQDEO\DVVRFLDWHGZLWKDQDEQRUPDOPRRGWKHQLWVKRXOGEHUDWHGDVVXEWKUHVKROG

 'HFUHDVHG1HHGIRU6OHHS
P C S
'60'53UREOHPVIDOOLQJDVOHHSVWD\LQJDVOHHSRUZDNLQJHDUO\ 0 -1RLQIRUPDWLRQ
3DUHQW5DWLQJBBBBBBBBB&KLOG5DWLQJBBBBBBBB
1 - 1RWSUHVHQW

'60'56OHHSLQJOHVVWKDQXVXDOVWLOOKDYHHQHUJ\ 2 -$WOHDVWKRXUVOHVVWKDQXVXDOZLWKRXW
IHHOLQJWLUHGIRUDWOHDVWFRQVHFXWLYHGD\VRU
3DUHQW5DWLQJBBBBBBBBB &KLOG5DWLQJBBBBBBBBB DWOHDVWVHSDUDWHGD\V

3 -$WOHDVWKRXUVOHVVWKDQXVXDOEHFDXVHKHVKH
/HVVVOHHSWKDQXVXDO\HWVWLOOIHHOVUHVWHG DYHUDJHIRUVHYHUDOGD\VZKHQ IHOWHQHUJHWLFRUKLJKDQGGLGQRWIHHOWLUHG
QHHGVOHVVVOHHS  2FFXUVIRUDWOHDVWFRQVHFXWLYHGD\VRURQDW
OHDVWVHSDUDWHGD\VZLWKLQRQHZHHN

+DYH\RXHYHUQHHGHGOHVVVOHHSWKDQXVXDOWRIHHOUHVWHG"
+RZPXFKVOHHSGR\RXRUGLQDULO\QHHG" PAST:
+RZPXFKKDG\RXEHHQVOHHSLQJ"
'LG\RXVWD\XSEHFDXVH\RXIHOWHVSHFLDOO\KLJKRUHQHUJHWLF":HUH\RX
ZLWKIULHQGVRUE\\RXUVHOI"+DG\RXWDNHQDQ\GUXJV":HUH\RXXSEXV\
3 & 6
GRLQJWKLQJV"
:KDWWLPHGLG\RXZDNHXS"
:HUH\RXWLUHGWKHQH[WGD\RUGLG\RXKDYHSOHQW\RIHQHUJ\DQGGLGQRW
VHHPWRQHHGWKHVOHHS"

NOTE: DO NOT SCORE POSITIVELY IF DECREASED NEED FOR


SLEEP TRIGGERED BY SOCIAL EVENT OR $&$'(0,&
&200,70(17625DRUG USE, ORREFLECTIVE OF TYPICAL
IRREGULAR ADOLESCENT SLEEPPATTERN.

'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).

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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)

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KSADS-PL SCREEN INTERVIEW:
20
Psychosis SDJHRI

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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.

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NOTE: TAKE INTO ACCOUNT CULTURAL BACKGROUND OF THESUBJECT.

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20
Psychosis SDJHRI

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PAST:
Ask about each of the delusions surveyed below:

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+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).

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6XEMHFW
KSADS-PL SCREEN INTERVIEW:
20
Panic Disorder SDJHRI

P C S
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PAST:
If specific symptoms are not elicited spontaneously when describing
attacks, ask about each of the following symptoms:
3 & 6
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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).

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6XEMHFW
KSADS-PL SCREEN INTERVIEW:
20
Agoraphobia SDJHRI

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'LGWKHVHIHHOLQJVODVWIRUVHYHUDOPRQWKVRUORQJHU"
NOTE: RATE POSITIVELY ONLY IF BEHAVIOR IS ABOVE AND 3 & 6
BEYOND WHAT WOULD BE EXPECTED IN CHILDREN OF SAME AGE
AND DEVELOPMENTAL LEVEL.

Do 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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PAST:

3 & 6

IF RECEIVED A SCORE OF 3 ON THE CURRENT RATINGS ON EITHER OF THE PREVIOUS ITEMS, COMPLETE THE
AGORAPHOBIA (CURRENT) SECTION OF THE $1;,(7<2%6(66,9(&2038/6,9($1'75$80$5(/$7('
DISORDERS SUPPLEMENT AFTER FINISHING THE SCREENINTERVIEW.

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   2 0 ,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.

P C S

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PAST:

3 & 6

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PAST:

3 & 6

P C S
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+RZRIWHQGLG\RXPLVVVFKRRORUGLG\RXOHDYHVFKRROHDUO\" SHUVXDGHGWRJRPLVVHGQRPRUHWKDQGD\
LQZHHNV
NOTE: ONLY COUNT IF SCHOOL AVOIDED IN ORDER TO STAY WITH
ATTACHMENT FIGURE 3 -7KUHVKROG3URWHVWVLQWHQVHO\DERXWJRLQJWR
VFKRRORUVHQWKRPHRUUHIXVHVWRJRDW
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PAST:

3 & 6

'UDIW
6XEMHFW
KSADS-PL SCREEN INTERVIEW:
20
Separation Anxiety SDJHRI

P C S

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PAST:

3 & 6

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PAST:

3 & 6

IF RECEIVED A SCORE OF 3 ON THE CURRENT RATINGS OF ANY OF THE PRECEDING ITEMS, COMPLETE THE
SEPARATION ANXIETY DISORDER (CURRENT) SECTION IN THE $1;,(7<2%6(66,9(&2038/6,9($1'
75$80$5(/$7(' DISORDERS SUPPLEMENT AFTERFINISHING THE SCREEN INTERVIEW.

IF RECEIVED A SCORE OF 3 ON THE PAST RATINGS OF ANY OF THE PRECEDING ITEMS, COMPLETE THE
SEPARATION ANXIETY DISORDER (PAST) SECTION IN THE $1;,(7<2%6(66,9(&2038/6,9($1'75$80$
5(/$7(' DISORDERS SUPPLEMENT AFTER FINISHINGTHE SCREEN INTERVIEW.

NO EVIDENCE OF SEPARATION ANXIETY DISORDER.

NOTE: (RECORD DATES OF POSSIBLE CURRENT AND PAST SEPARATION ANXIETY DISORDER)

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20 KSADS-PL SCREEN INTERVIEW:
Social $Q[LHW\6HOHFWLYH0XWLVP'LVRUGHU SDJHRI

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PAST:

3 & 6

IF RECEIVED A SCORE OF 3 ON THE CURRENT RATINGS OF THE PREVIOUS ITEM, COMPLETE THESOCIAL
$1;,(7<',625'(56(/(&7,9(087,60 (CURRENT) SECTION IN THE $1;,(7<2%6(66,9(&2038/6,9(
$1'75$80$5(/$7('DISORDERS SUPPLEMENT AFTER COMPLETING THESCREEN INTERVIEW.

IF RECEIVED A SCORE OF 3 ON THE PAST RATINGS OF (,7+(5 ITEM, COMPLETE THE SOCIAL$1;,(7<
',625'(56(/(&7,9(087,60 (PAST) SECTION IN THE$1;,(7<2%6(66,9(&2038/6,9($1'75$80$
5(/$7(' DISORDERS SUPPLEMENT AFTER COMPLETING THE SCREEN INTERVIEW.

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. P C S


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PAST:

3 & 6

Specify most intense phobia:

Specify other phobias:

IF RECEIVED A SCORE OF 3 ON THE CURRENT RATINGS OF EITHER OF THE PREVIOUS ITEMS, COMPLETE THE
SPECIFIC PHOBIA (CURRENT) SECTION IN THE $1;,(7<2%6(66,9(&2038/6,9($1'75$80$5(/$7('
DISORDERS SUPPLEMENT AFTER COMPLETING THE SCREENINTERVIEW.
IF RECEIVED A SCORE OF 3 ON THE PAST RATINGS OF EITHER OF THE PREVIOUS ITEMS, COMPLETE THE SPECIFIC
PHOBIA (PAST) SECTION IN THE $1;,(7<2%6(66,9(&2038/6,9($1'75$80$5(/$7(' DISORDERS
SUPPLEMENT AFTER COMPLETING THE SCREEN INTERVIEW.

NO EVIDENCE OF SPECIFIC PHOBIAS

NOTES: (RECORD DATES OF POSSIBLE CURRENT AND PAST SPECIFIC PHOBIC DISORDERS)

'UDIW
6XEMHFW
KSADS-PL SCREEN INTERVIEW:
20
Generalized Anxiety Disorder SDJHRI

P C S
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NOTE: IF THE ONLY WORRIES THE CHILD BRINGS UP RELATE TO
THE ATTACHMENT FIGURE OR A SIMPLE PHOBIA, DO NOT SCORE
HERE. ONLY RATE POSITIVELY IF THE CHILD WORRIES ABOUT 3 & 6
MULTIPLE THINGS.

,QRUGHUWRUDWHSRVLWLYHO\FKLOGPXVWZRUU\DERYHDQGEH\RQGRWKHU
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PAST:

3 & 6

NOTE: DO NOT COUNT IF SYMPTOMS ARE KNOWN TO BE CAUSED BY A REAL MEDICAL ILLNESS.

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'UDIW

'DWH   2 0 ,QWHUYLHZHU
KSADS-PL SCREEN INTERVIEW:
20 SDJHRI
Generalized Anxiety Disorder

IF RECEIVED A SCORE OF 3 ON THE CURRENT RATINGS OF (,7+(5 OF THE PREVIOUS ITEMS, COMPLETE
THE GENERALIZED ANXIETY DISORDER (CURRENT) SECTION IN THE $1;,(7< 2%6(66,9( &2038/6,9(
$1'75$80$5(/$7(' DISORDERS SUPPLEMENT AFTERFINISHING THE SCREEN INTERVIEW.

IF RECEIVED A SCORE OF 3 ON THE PAST RATINGS OF (,7+(5 OF THE PREVIOUS ITEMS, COMPLETE THE
GENERALIZED ANXIETY DISORDER (PAST) SECTION IN THE $1;,(7<2%6(66,9(&2038/6,9($1'75$80$
5(/$7(' DISORDERS SUPPLEMENT AFTER FINISHINGTHE SCREEN INTERVIEW.

NO EVIDENCE OF GENERALIZED ANXIETY DISORDER.

NOTES: RECORD DATES OF POSSIBLE CURRENT AND PAST GENERALIZED ANXIETY DISORDER).

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6XEMHFW
20
KSADS-PL SCREEN INTERVIEW:
Obsessive-Compulsive Disorder SDJHRI

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5HFXUUHQWDQGLQWUXVLYHWKRXJKWVLPSXOVHVRULPDJHVWKDWDUHGLVWUHVVLQJDQG 3 & 6
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NOTE: DO NOT SCORE OBSESSIONS ITEMS POSITIVELY IF IDEAS /THOUGHTS ARE DELUSIONAL, OR ARE EXCLUSIVELY DUE TO
ANOTHER AXIS I DISORDER (e.g. thoughts of food in the presence ofan eating disorder; thoughts that parents will get harmed in the
presence of a separation anxiety disorder; increased worries from GAD). DO NOT RATE POSITIVELY IF SAYS, "I cannot stop thinking
about boy/girlfriend or music."

WKDW\RXPLJKWJHWLOOIURP GLUWRUJHUPV"

'UDIW
6XEMHFW
20 KSADS-PL SCREEN INTERVIEW:
Obsessive-Compulsive Disorder SDJHRI

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VHHPHGVLOO\RYHUDQGRYHURUWKLQJVZKLFK\RXFRXOGQRWUHVLVWUHSHDWLQJOLNH
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+DYHRWKHUSHRSOHHYHUFRPPHQWHGDERXWWKHVHKDELWV"

NOTE: DO NOT RATE POSITIVELY IF BEHAVIOR IS EXCLUSIVELYACCOUNTED FOR BY ANOTHER DISORDER (e.g., PDD, Asperger's,tics,
psychosis, eating disorder).

IF RECEIVED A SCORE OF 3 ON CURRENT RATINGS OF EITHER OBSESSIONS OR COMPULSIONS ITEM, COMPLETE


OBSESSIVE COMPULSIVE DISORDER (CURRENT) SECTION IN THE $1;,(7<2%6(66,9(&2038/6,9($1'
75$80$5(/$7(' DISORDERS SUPPLEMENT AFTERFINISHING SCREEN INTERVIEW.

IF RECEIVED A SCORE OF 3 ON PAST RATINGS OF EITHER OBSESSIONS OR COMPULSIONS ITEM, COMPLETE


OBSESSIVE COMPULSIVE DISORDER (PAST) SECTION IN THE $1;,(7<2%6(66,9(&2038/6,9($1'75$80$
5(/$7('DISORDERS SUPPLEMENT AFTER FINISHINGSCREEN INTERVIEW.

NO EVIDENCE OF OBSESSIVE COMPULSIVE DISORDER.

NOTES: (RECORD DATES OF POSSIBLE CURRENT AND PAST OBSESSIVE COMPULSIVE DISORDER).

'UDIW
6XEMHFW
20
KSADS-PL SCREEN INTERVIEW:
Enuresis SDJHRI

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3 & 6
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3 & 6

IF RECEIVED A SCORE OF  OR ABOVE ON THE CURRENT RATINGS OF ANY OF THE PREVIOUS ITEMS, COMPLETE
THE QUESTIONS ON THE FOLLOWING PAGE.

IF RECEIVED A SCORE OF  OR ABOVE ON THE PAST RATINGS OF ANY OF THE PREVIOUS ITEMS, COMPLETE THE
QUESTIONS ON THE FOLLOWING PAGE.

IF NO EVIDENCE OF ENURESIS, GO TO ENCOPRESIS SECTION ON PAGE 24.

6XEMHFW
'UDIW

'DWH   2 0 ,QWHUYLHZHU
KSADS-PL SCREEN INTERVIEW:
20
Enuresis SDJHRI

Distress

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% 7KHEHKDYLRULVFOLQLFDOO\VLJQLILFDQWDVPDQLIHVWHGE\HLWKHUDIUHTXHQF\RIWZLFHDZHHNIRUDWOHDVWWKUHHFRQVHFXWLYHPRQWKVRUWKHSUHVHQFHRIFOLQLFDOO\
VLJQLILFDQWGLVWUHVVRULPSDLUPHQWLQVRFLDODFDGHPLF RFFXSDWLRQDO RURWKHULPSRUWDQWDUHDVRIIXQFWLRQLQJ
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GLDEHWHVVSLQD ELILGDDVHL]XUHGLVRUGHU 

MEETS DSM- CRITERIA FOR ENURESIS (CURRENT). (Scored 3 plus impairment).

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MEETS DSM- CRITERIA FOR ENURESIS (3$67). (Scored 3 plus impairment).

6SHFLI\1RFWXUQDO2QO\BBBBB'LXUQDO2QO\BBBBB1RFWXUQDODQG'LXUQDOBBBBBBBB

NOTES: (RECORD DATES OF CURRENT AND PAST ENURESIS).

'UDIW
6XEMHFW
20
KSADS-PL SCREEN INTERVIEW:
Encopresis SDJHRI

 5HSHDWHG3DVVDJHRI)HFHV

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IF RECEIVED A SCORE OF 3 ON THE CURRENT RATINGS OF ANY OF THE PREVIOUS ITEMS, COMPLETE THE
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6XEMHFW
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'DWH   2 0 ,QWHUYLHZHU
KSADS-PL SCREEN INTERVIEW:
20
Autism Spectrum Disorders SDJHRI

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20 KSADS-PL SCREEN INTERVIEW:
Past Traumatic Events SDJHRI

Codes for the Following Items: 0 1R,QIRUPDWLRQ 1 1R 2 <HV

Parent Parent Child Child Summary Summary


CE MSP CE MSP CE MSP

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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).

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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

Related Interests