Transcript RADS-2 - Psychological Assessment Resources, Inc.

RADS-2
Reynolds Adolescent
Depression Scale –
nd
2 Edition
William M. Reynolds, PhD
1
Introduction
The Problem of Depression
in Adolescents
2
Depression in Adolescents
Depression is one of the
most prevalent mental
health problems in adults
and adolescents, and is a
significant problem in
children.
3
Depression in Adolescents
Depression is an
internalizing disorder in that
most of the symptoms of
depression are covert,
subjective in intensity, and
internal to the individual.
4
Depression in Adolescents
Depression in adolescents is
often comorbid with other
internalizing as well as
externalizing disorders, and
may be overlooked due to
diagnostic overshadowing .
5
Depression in Adolescents
Depression is an insidious
and complex mental health
problem with multiple
etiologies, courses, types,
and potential treatments.
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A Biopsychosocial Model of
Depression
PSYCHOLOGICAL INFLUENCES
Cognitive Appraisal
Behavioral and Coping Response
Self-Esteem / Interpersonal Skills
Social Adaptation
Functional and Dysfunctional Cognitions
SOCIAL INFULENCES
Major Life Events
Familial Attachment, Nurturance, & Support
Daily Hassles
Interpersonal Relationships
Social Systems - Life Stressors
BIOLOGICAL INFLUENCES
Genetic Loading
Nervous System Activation
Neuroendocrine Functioning
Biological Vulnerability
Organic/Nutritional
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Depression in Adolescents
National Comorbidity Study (NIMH)
12 Month Depression Prevalence Rates
Major
Depression
Minor
Depression
15-16 yr olds
13.0%
6.5%
17-18 yr olds
12.2%
11.2%
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DSM IV MOOD DISORDERS
 Major Depressive Disorder
Single Episode
Recurrent
 Dysthymic Disorder
(early onset)
 Bipolar Disorder
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Assessment of Depression
in Adolescents
For the evaluation of depression,
we can diagnose depression
according to a classification
system such as DSM-IV, or we
can assess the severity of the
symptoms of depression and
obtain a score, with the higher
the score the more clinically
severe the depression.
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Assessment of Depression
in Adolescents
The primary methods used to
assess the severity of
depression are self-report
measures and clinical
interviews.
Teacher, peer and parent
reports are not viable methods.
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Reynolds Adolescent Depression
nd
Scale – 2 Edition RADS-2
 Requires a third-grade reading level.
 Allows for scores on four subscales.
 Development included large samples of
school-based (9,000+) and clinical (250+)
adolescents.
 Norms based on a national standardization sample
of 3,300 adolescents.
 Norms extended to ages 11 to 20 years.
 25 years of school, clinical, and research
applications.
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RADS-2 Depression Factors
Dysphoric
Mood
Anhedonia/
Negative Affect
RADS-2 Total Scale
Negative SelfEvaluation
Somatic
Complaints
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RADS-2 Subscales
Dysphoric Mood (DM)
The 8 item DM subscale evaluates symptoms
of dysphoric mood and related symptoms,
including: sadness, crying behavior,
loneliness, irritability, worry, and self-pity.
Dysphoric mood represents a prototypic
dimension of depression as a disturbance of
mood (DSM-IV) and may be viewed as a
negative emotional state.
14
RADS-2 Subscales
Anhedonia/Negative Affect (AN)
The 7 item AN subscale evaluates depressive
symptoms associated with anhedonia with
several items of negative affect. High
scores on this subscale represent limited
or lack of interest in pleasurable activities.
AN items include symptoms of disinterest in
having fun, engaging in pleasant activities,
and disinterest in talking with others and
eating meals.
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RADS-2 Subscales
Negative Self-Evaluation (NS)
The 8 NS items evaluate negative feelings about
oneself. Items deal with low self-worth, selfdenigration, feelings of self-harm, that parents
and others do not like or care about them, and
thoughts of running away, and feeling there is
nothing they can do that will help the situation.
In some adolescents, this negative self-evaluation
is internalized as reflected in thoughts of selfharm, feelings of pervasive helplessness and
suicidal thoughts or behaviors.
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RADS-2 Subscales
Somatic Complaints (SC)
The 7 SC items evaluate somatic and
vegetative complaints (classic
symptoms), along with general feelings of
malaise (boredom, life is unfair) and
irritability. Symptoms include
stomachaches, feeling ill, fatigue, and
sleep disturbance.
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Characteristics of the
RADS-2 Normative Sample
Size of sample 3,300
Gender (n)
Males
1,650
Females 1,650
Age Groups
11 – 13
14 – 16
17 – 20
Ethnicity (%)
Caucasian
African Amer
Hispanic
Asian
Native Amer
(n)
1,100
1,100
1,100
70.5
12.1
11.8
4.3
1.3
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Reliability of RADS-2 Scales
RADS-2 scale
Internal Consistency Test-retest
Clinical Standardization
Clinical
Dysphoric Mood
Anhedonia/Negative Affect
Negative Self-Evaluation
Somatic Complaints
.86
.85
.87
.81
.85
.89
.86
.79
.87
.81
.85
.81
RADS-2 Depression Total
.94
.92
.89
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RADS Research with Special Populations
Baker, 1995
Brand, et al., 1996
Brown, et al., 1991
Cauce et al., 2000
Cunniff et al., 1995
Dalley et al., 1992
D’Imperio et al., 2000
Ghaziuddin et al., 1999
Graves & Reynolds,1985
Gutierrez, 1999
Hagborg, 1992
Gifted & exceptionally gifted
Major Depression & sexual abuse
Suicide attempters
Homeless adolescents
Turner syndrome
Learning disabled
Disadvantaged urban city
Psychiatric inpatients
Behavior disorders
Parentally bereaved students
Seriously emotionally disturbed
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RADS Research with Special Populations
Hein & Dell, 1995
King et al., 1995a
King et al., 1995b
King et al., 1996
King, et al, 1997
Manikam, et al 1995
Matson & Nieminen,1987
MacLean et al., 1999
Navarrete, 1999
Nieminen & Matson,1989
Ott & Reynolds, 2001
HIV+(+) in medical settings
Psychiatric inpatients
Psychiatric inpatients
Inpatients w/ major depression
Psychiatric inpatients
Mental retardation
Behavior disordered
Homeless adolescents
Learning disabled
Conduct disordered
Mental retardation
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RADS Research with Special Populations
Perks & Jameson 1999
Reid, et al., 1995
Reinecke & Schultz,1995
Ryan, et al., 2000
Sadowski & Kelley,1993
Shain, et al, 1990
Shain, et al., 1991
Sinclair et al., 1995
Spirito, et al., 1987
Spirito, et al., 1993
Williams et al, 1998
Wurzbacher, et al 1991
Witness domestic violence /St. Lucia
Adolescents with diabetes
Psychiatric outpatients
Homeless abused and nonabused
Suicide attempters
Inpatients w/ Major Depression
Psychiatric inpatients
Sexually abused adolescents
Hospitalized suicide attempters
Suicide attempters
Incarcerated adolescents
Prostitution-involved youth
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RADS-2 Clinical Severity
T-Score
Range
%ile
range
Below 61
1 – 81
61 to 64
82 – 92
65 to 69
93 – 96
70 & above 97+
Clinical
Description
Normal Range
Mild clinical depression range
Moderate clinical depression
Severe clinical depression
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RADS-2 Scores for School
and Clinical Samples
 The RADS-2 has a possible range of 30 to 120,
although raw scores above 100 are rare.
 The average RADS-2 Total raw score for the
restandardization sample was approximately 60.
 The average raw score for the clinical sample of
297 adolescent psychiatric inpatients and
outpatients with formal DSM diagnoses was
approximately 75.
 The average Total raw score for a sample of 107
adolescents with Major Depressive Disorder was
90, equivalent to a standard score of 70T.
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Clinical Levels of Depression
T-Score
Raw
Score
Clinical
Description
Below 61
61 to 64
65 to 69
70 & above
30-75
76-81
82-88
89+
Normal Range
Mild clinical depression range
Moderate clinical depression
Severe clinical depression
Based on the total normative sample N = 3,330
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Comparisons with
Normative Data
 Primary comparison group for
converting raw scores to
standard scores is the total
standardization sample (N =
3,300).
 Secondary comparisons may
be made with gender, age, and
gender within age group
standardization groups.
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Interpretation
Dysphoric Mood (DM)
High DM scores are suggestive of a distinct
disturbance of mood and are often
associated with feelings of subjective
misery and distress. Some adolescents
with high scores may be overly worried or
anxious, an aspect of dysphoric mood
noted in DSM-IV.
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Interpretation
Anhedonia/Negative Affect (AN)
High scores on this subscale suggest a
reduced engagement in pleasant activities
and a generalized negative affect to self.
High scores may reflect low motivation and
affect, as well as social withdrawal, a
characteristic of anhedonia noted in DSM-IV.
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Interpretation
Negative Self-Evaluation (NS)
It is important to recognize that high scores on
the NS subscale are indicative of more than
negative self-esteem and in some, may reflect
extreme negative feelings toward self
including thoughts of self-harm (selfmutilation, suicidal ideation, suicidal acts).
The scale measures broad symptoms of
negative self-evaluation (unrealistic negative
self-appraisal, feelings of worthlessness, selfblame), not just negative self-concept.
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Interpretation
Somatic Complaints (SC)
Adolescents with elevated scores generally
show somatic involvement in their
depression, with very high scores
suggesting the potential for a depressive
episode. It is important to rule out the
presence of a prior physical illness that
would mimic somatic complaints .
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Interpretation
Critical Items
Serve as a double-check if the Depression
Total is below the clinical cutoff, yet may be
at risk for depression or require additional
evaluation. The general rule is if four or
more or endorsed, further assessment
should be done. They are NOT meaningful
indicators of depression in isolation or
meant to be used as a screener.
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Treatment of Depression in
Adolescents
The research on the treatment
of depression in adolescents
has focused on
pharmacological
and
psychological interventions.
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Treatment of Depression in
Adolescents
Pharmacotherapy
Most of the antidepressant drugs developed and
tested with adults have also been used, with
varying degrees of clinical efficacy, with
children and adolescents.
In 1993 the FDA approved the first antidepressant
for the treatment of major depressive disorders
in young people. The American Academy of
Child and Adolescent Psychiatry estimates that
5% of the pediatric population -- or 3.4 million
children and adolescents under the age of 18 -suffer from depression. This is probably an
underestimate.
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Treatment of Depression in
Adolescents
Psychotherapy
The efficacy of psychotherapeutic interventions
for depression in adolescents has been
examined in a number of studies. Most of
these studies have used treatment procedures
developed for adults with modifications made
for adolescents.
Core empirical studies:
Reynolds & Coats, (1986)
Kahn, et al., (1990)
Lewinsohn, et al., (1990)
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A Comparison of CognitiveBehavioral Therapy and Relaxation
Training for the Treatment of
Depression in Adolescents
Journal of Consulting and Clinical
Psychology (1986)
William M. Reynolds & Kevin I. Coats
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Treatment of Depression in
Adolescents
 Pharmacotherapy
The primary classes of antidepressants:
 Tricyclic antidepressants (TCAs),
 Monoamine Oxidase Inhibitors (MAOIs),
 Selective Serotonin Reuptake Inhibitors
(SSRIs),
and several newer classes of drugs that
do not fit these categories.
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Summary
Depression and depressive disorders are
prevalent among adolescents.
 Young people typically do not get better
without intervention of some kind.
 The foremost need is for the identification
of adolescents who are at risk and
subsequent referral for treatment.
 There is a need for schools and
communities to be proactive in the
identification and referral for treatment
of at-risk youth.

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