Schedule for Affective Disorders and Schizophrenia for School-Age Children – Present and Lifetime Version (K-SADS-PL), DSM-5 update: translation into Brazilian Portuguese

The use of structured and semi-structured diagnostic instruments allows objective assessment of DSM categories by professionals involved in child and adolescent mental health evaluation, which has been essential to the advancement of clinical and epidemiological research in the field. Over the years, several semi-structured diagnostic instruments have been developed and tested for reliability and validity, such as the Diagnostic Interview for Children and Adolescents (DICA)¹; the Development and Well-Being Assessment (DAWBA)²; and the Schedule for Affective Disorders and Schizophrenia for School-age Children (K-SADS).³

The K-SADS is among the most widely used instruments in child and adolescent psychiatry. The first version was the K-SADS present state (K-SADS-P), developed by J. Puig-Antich and W. Chambers in 1978. Updates and adaptations were published in the following decades: the K-SADS-P IIIR in accordance to DSM-IIIR criteria, as well as the K-SADS epidemiologic (K-SADS-E), which collects lifetime diagnoses for epidemiologic purposes. After publication of the DSM-IV in 1994, Kaufman, Birmaher, Brent, Rao, and Ryan introduced the K-SADS present and lifetime version (K-SADS-PL), which was the most comprehensive version developed to date.³ The K-SADS-E and K-SADS-PL have been translated into Brazilian Portuguese, and have been used extensively by researchers and clinicians ever since.⁴,⁵

In 2013, the American Psychiatry Association launched the fifth edition of the DSM, with relevant changes to the psychiatric classification of disorders affecting children and adolescents.⁶,⁷ Soon after, a revised version of the instrument (K-SADS-PL-DSM-5) was developed to keep the instrument up to date with the new classification system. However, this instrument has not yet been translated into Brazilian Portuguese, hindering the advancement of child and adolescent psychiatry research in the country. On that account, we endeavored to translate the revised K-SADS-PL-DSM-5 from English into Brazilian Portuguese.

In this letter, we describe the careful process of translation of the latest version of the K-SADS-PL, now updated according to current DSM-5 criteria (K-SADS-PL-DSM-5), for use in Brazil. We invited specialists in each diagnostic area covered by the instrument (Table 1) to translate the respective section. The entire text was then revised by two child and adolescent psychiatrists (TBR and CK) and standardized by an independent professional (RK, a pediatrician and child neurologist with a background in linguistics). Subsequently, the translators of each area approved the final version of the document.

Table 1
Diagnostic categories covered in K-SADS-PL-DSM-5

Depressive and bipolar related disorders

Depressive disorders

Mania

Disruptive mood dysregulation disorder

Schizophrenia spectrum and other psychotic disorders

Psychosis

Anxiety, obsessive-compulsive, and trauma-related disorders

Panic disorder

Agoraphobia

Separation anxiety disorder

Social anxiety disorder and selective mutism

Specific phobia

Generalized anxiety disorder

Post-traumatic stress disorder

Obsessive-compulsive disorder

Neurodevelopmental, disruptive and conduct disorders

Attention-deficit/hyperactivity disorder

Oppositional defiant disorder

Conduct disorder

Tic disorders

Autism spectrum disorder

Eating disorders and substance-related disorders

Eating disorders

Tobacco use disorder

Alcohol use disorder

Substance use disorder

Others

Enuresis

Encopresis

We regard this as a much-needed and relevant accomplishment, which should be followed by validation of this translated version. Scientific research is asymmetrically scarce in low- and middle-income countries,⁸ where the health demands of children and adolescents are mostly unmet.⁹ While many factors operate in this equation, we believe that the availability of up-to-date translated and validated versions of psychometric instruments used worldwide is an important step towards equality of means.

References

• ¹
  Reich W. Diagnostic interview for children and adolescents (DICA). J Am Acad Child Adolesc Psychiatry. 2000;39:59-66.
• ²
  Goodman R, Ford T, Richards H, Gatward R, Meltzer H. The development and well-being assessment: description and initial validation of an integrated assessment of child and adolescent psychopathology. J Child Psychol Psychiatry. 2000;41:645-55.
• ³
  Ambrosini PJ. 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. 2000;39:49-58.
• ⁴
  Mercadante MT, Asbarh F, Rosário MC, Ayres AM, Ferrari MC, Assumpção FB, et al. K-SADS, entrevista semi-estruturada para diagnóstico em psiquiatria da infância, versão epidemiológica. São Paulo: PROTOC - Hospital das Clínicas da FMUSP; 1995.
• ⁵
  Brasil HHA. Development of the Brazilian version of K-SADS-PL (Schedule for Affective Disorders and Schizophrenia for School Aged Children Present and Lifetime Version) and study of psychometric properties [dissertation]. São Paulo: Universidade Federal de São Paulo; 2013.
• ⁶
  American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Arlington: American Psychiatric Publishing; 2013.
• ⁷
  Machado JD, Caye A, Frick PJ, Rohde LA. DSM-5. Major changes for child and adolescent disorders [Internet]. In: Rey JM, editor. IACAPAP e-textbook of child and adolescent mental health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions; 2013. [cited 2016 Dec 21]. http://iacapap.org/wp-content/uploads/A.9-DSM-5-2013.pdf
  » http://iacapap.org/wp-content/uploads/A.9-DSM-5-2013.pdf
• ⁸
  Nature. Country outputs [Internet]. Nature Index. 2016 Jun 1 [cited 2016 Dec 21]. www.natureindex.com/country-outputs
  » www.natureindex.com/country-outputs
• ⁹
  Kieling C, Baker-Henningham H, Belfer M, Conti G, Ertem I, Omigbodun O, et al. Child and adolescent mental health worldwide: evidence for action. Lancet. 2011;378:1515-25.

Publication Dates

• Publication in this collection
  Dec 2017

History

• Received
  25 Apr 2017
• Accepted
  17 Sept 2017