RADS-2 Reynolds Adolescent Depression Scale – 2 nd Edition William M. Reynolds, PhD

1. RADS-2 Reynolds Adolescent Depression Scale – 2nd Edition William M. Reynolds, PhD

2. Introduction The Problem of Depression in Adolescents

3. Depression in Adolescents Depression is one of the most prevalent mental health problems in adults and adolescents, and is a significant problem in children.

4. Depression in Adolescents Depression is an internalizing disorder in that most of the symptoms of depression are covert, subjective in intensity,andinternalto the individual.

5. Depression in Adolescents Depression in adolescents is often comorbidwith other internalizing as well as externalizing disorders, and may be overlooked due to diagnostic overshadowing.

6. Depression in Adolescents Depression is an insidious and complex mental health problem with multiple etiologies, courses, types, and potential treatments.

7. A Biopsychosocial Model of Depression PSYCHOLOGICAL INFLUENCES Cognitive Appraisal Behavioral and Coping Response Self-Esteem / Interpersonal Skills Social Adaptation Functional and Dysfunctional Cognitions SOCIAL INFULENCESBIOLOGICAL INFLUENCES Major Life EventsGenetic Loading Familial Attachment, Nurturance, & SupportNervous System Activation Daily HasslesNeuroendocrine Functioning Interpersonal RelationshipsBiological Vulnerability Social Systems - Life StressorsOrganic/Nutritional

8. Depression in Adolescents National Comorbidity Study (NIMH) 12 Month Depression Prevalence Rates Major Minor Depression Depression 15-16 yr olds 13.0% 6.5% 17-18 yr olds 12.2% 11.2%

9. DSM IV MOOD DISORDERS • Major Depressive Disorder Single Episode Recurrent • Dysthymic Disorder (early onset) • Bipolar Disorder

10. 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.

11. 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.

12. Reynolds Adolescent Depression Scale – 2nd Edition RADS-2 • Requires a third-grade reading level. • Allows for scores on foursubscales. • 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.

13. RADS-2 Depression Factors Dysphoric Anhedonia/ MoodNegative Affect RADS-2 Total Scale Negative Self- Somatic Evaluation Complaints

14. 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.

15. 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.

16. RADS-2 Subscales Negative Self-Evaluation (NS) The 8 NS items evaluate negative feelings about oneself. Items deal with low self-worth, self-denigration, 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 self-harm, feelings of pervasive helplessness and suicidal thoughts or behaviors.

17. 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.

18. Characteristics of the RADS-2 Normative Sample Size of sample3,300 Gender (n) Males 1,650 Females 1,650 Age Groups (n) Ethnicity (%) 11 – 13 1,100 Caucasian 70.5 14 – 16 1,100 African Amer 12.1 17 – 20 1,100 Hispanic 11.8 Asian 4.3 Native Amer 1.3

19. Reliability of RADS-2 Scales Internal Consistency Test-retest RADS-2 scaleClinical Standardization Clinical Dysphoric Mood .86 .85 .87 Anhedonia/Negative Affect .85 .89 .81 Negative Self-Evaluation .87 .86 .85 Somatic Complaints .81 .79 .81 RADS-2 Depression Total .94 .92 .89

20. RADS Research with Special Populations Baker, 1995 Gifted & exceptionally gifted Brand, et al., 1996 Major Depression & sexual abuse Brown, et al., 1991 Suicide attempters Cauce et al., 2000 Homeless adolescents Cunniff et al., 1995 Turner syndrome Dalley et al., 1992 Learning disabled D’Imperio et al., 2000 Disadvantaged urban city Ghaziuddin et al., 1999 Psychiatric inpatients Graves & Reynolds,1985 Behavior disorders Gutierrez, 1999 Parentally bereaved students Hagborg, 1992 Seriously emotionally disturbed

21. RADS Research with Special Populations Hein & Dell, 1995 HIV+(+) in medical settings King et al., 1995a Psychiatric inpatients King et al., 1995b Psychiatric inpatients King et al., 1996 Inpatients w/ major depression King, et al, 1997 Psychiatric inpatients Manikam, et al 1995 Mental retardation Matson & Nieminen,1987 Behavior disordered MacLean et al., 1999 Homeless adolescents Navarrete, 1999 Learning disabled Nieminen & Matson,1989 Conduct disordered Ott & Reynolds, 2001 Mental retardation

22. RADS Research with Special Populations Perks & Jameson 1999 Witness domestic violence /St. Lucia Reid, et al., 1995 Adolescents with diabetes Reinecke & Schultz,1995 Psychiatric outpatients Ryan, et al., 2000 Homeless abused and nonabused Sadowski & Kelley,1993 Suicide attempters Shain, et al, 1990 Inpatients w/ Major Depression Shain, et al., 1991 Psychiatric inpatients Sinclair et al., 1995 Sexually abused adolescents Spirito, et al., 1987 Hospitalized suicide attempters Spirito, et al., 1993 Suicide attempters Williams et al, 1998 Incarcerated adolescents Wurzbacher, et al 1991 Prostitution-involved youth

23. RADS-2 Clinical Severity T-Score %ile Clinical Range range Description Below 61 1 – 81 Normal Range 61 to 64 82 – 92 Mild clinical depression range 65 to 69 93 – 96 Moderate clinical depression 70 & above 97+ Severe clinical depression

24. 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.

25. Clinical Levels of Depression T-Score Raw Clinical Score Description Below 61 30-75 Normal Range 61 to 64 76-81 Mild clinical depression range 65 to 69 82-88 Moderate clinical depression 70 & above 89+ Severe clinical depression Based on the total normative sample N = 3,330

26. 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.

27. 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.

28. 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.

29. 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 (self-mutilation, suicidal ideation, suicidal acts). The scale measures broad symptoms of negative self-evaluation (unrealistic negative self-appraisal, feelings of worthlessness, self-blame), not just negative self-concept.

30. 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 .

31. 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.

32. Treatment of Depression in Adolescents The research on the treatment of depression in adolescents has focused on pharmacological and psychological interventions.

33. 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.

34. 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)

35. A Comparison of Cognitive-Behavioral Therapy and Relaxation Training for the Treatment of Depression in Adolescents Journal of Consulting and Clinical Psychology (1986) William M. Reynolds & Kevin I. Coats

36. 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.

37. 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.