Introduction
The use of structured and semi-structured diagnostic interviews is of paramount importance in child and adolescent psychiatry, as it allows the objective assessment and diagnosis by decreasing sources of variability. Initially designed as research tools, diagnostic interviews are widely used to assess the course of disorders and response to treatment, thereby improving the reliability of clinical information. One of the most commonly used semi-structured psychiatric interviews is the Kiddie Schedule for Affective Disorders and Schizophrenia, Present and Lifetime version (K-SADS-PL) for children and adolescents aged 6–18 years [
1]. The K-SADS-PL is designed to correspond to the Diagnostic and Statistical Manual for Mental Disorders fourth edition (DSM-IV) [
2], assessing current and past episodes of psychopathology across a broad spectrum of psychiatric diagnoses.
Following the publication of DSM-5 [
3], Kaufman et al. [
4] modified the K-SADS-PL to adapt to the changes made to the latest edition (K-SADS-PL DSM-5). Specifically, diagnostic categories have been added [disruptive mood dysregulation disorder (DMDD), avoidant restrictive food intake disorder (ARFID) and binge eating disorder (BED)], while others [autism spectrum disorder (ASD), intermittent explosive disorder (IED) and social anxiety disorder (SAD)] suggest modified versions of diagnoses that were already in the DSM-IV. Furthermore, clinical conditions, such as non-suicidal self-injury (NSSI) and limited prosocial emotions (LPE), have also been included.
K-SADS-PL DSM-IV has been translated and adapted into over 20 different languages, with fair-to-excellent reliability and validity. Studies of the Spanish and Hebrew adaptations revealed good inter-rater reliability (κ ≥ 0.6) for most diagnostic categories [
5,
6]. As for convergent validity, the Korean and Brazilian-Portuguese version determined significant correlations between K-SADS-PL DSM-IV and Child Behavior Checklist (CBCL) [
7,
8]. Furthermore, an Icelandic study partially confirmed the screen criteria of K-SADS-PL DSM IV for major depressive disorder, given the high comorbidity among the sample [
9]. Regarding the empirical validation of the K-SADS-PL DSM-5, several studies have been reported. Studies of the Turkish, Spanish and Icelandic K-SADS-PL DSM-5 revealed good reliability (κ ≥ 0.6) and generally good construct validity [
10‐
12]. In concordance with these findings, the Portuguese adaptation of the K-SADS-PL DSM-5 showed fair-to-excellent inter-rater reliability (κ = 0.44–0.93) for all diagnosed disorders [
13]. Consensual validity has been examined by Nishiyama et al. [
14] for the Japanese version of K-SADS-PL DSM-5. They found good to excellent inter-rated reliability (κ = 0.89–1.00) for all disorders and acceptable consensual validity. Next to the emphasis of comprehensiveness across a wide range of disorders, the K-SADS-PL DSM-5 has showed good reliability and validity on single syndromes such as Attention Deficit-Hyperactivity Disorder (ADHD), Post-Traumatic Stress Disorder (PTSD), and DMDD) [
15‐
17].
To date, studies of the Greek version of the K-SADS-PL DSM-5 are lacking. The only study that addressed psychometric properties is our previous study using the Greek version of the K-SADS-PL [
18]. The study revealed excellent inter-rater reliability for depressive (κ = 0,90), anxiety (κ = 0.80) and conduct disorders (κ = 0.90). In the present study, therefore, we investigated the inter-rater reliability, consensual validity, and construct validity of the Greek version of K-SADS-PL DSM-5. This is the first study on the reliability and validity of the K-SADS-PL DSM-5 in Greece.
Discussion
The present study aimed to evaluate the psychometric properties of the K-SADS-PL DSM-5 version in a Greek sample, specifically examining inter-rater reliability, consensual validity, and construct validity. This is the first study investigating the reliability and validity of the K-SADS-PL DSM-5 version in Greece.
In line with previous studies on K-SADS-PL DSM-IV in other languages [
5,
6,
10‐
12,
14], our findings revealed good to excellent inter-rater reliability for the Greek version of K-SADS-PL DSM-5. This is consistent with our previous study using the Greek version of the K-SADS-PL [
18]. These findings support the applicability of the K-SADS-PL DSM-5 as a reliable diagnostic tool in Greek-speaking populations.
Consensual validity, evaluated by comparing K-SADS-PL DSM-5 diagnoses with clinical diagnoses, demonstrated good to excellent consensual validity across most psychiatric diagnoses, with the exception of panic disorder, which showed fair validity. These results are consistent with previous studies that have reported good consensual validity for the K-SADS-PL DSM-5 [
14]. The higher prevalence of disorders in the Greek version of K-SADS-PL DSM-5 compared to clinical diagnoses may reflect the comprehensive assessment of symptomatology provided by the K-SADS-PL DSM-5, potentially leading to increased diagnostic accuracy. Diagnostic efficiency, measured by sensitivity, specificity, positive and negative predictive values, showed consistently high specificity and negative predictive validity across all diagnostic categories. However, positive predictive validity was found to be medium to low, except for major depressive disorder. These findings suggest that the K-SADS-PL DSM-5 may be more effective in ruling out psychiatric disorders than in confirming their presence, particularly in cases of comorbidity.
Construct validity was assessed by examining correlations between the Greek version of K-SADS-PL DSM-5 diagnoses and scores on the CDI and SCARED scales. Our results showed medium to strong convergent validity coefficients between the K-SADS-PL DSM-5 and the CDI for mood disorders, with large effect sizes. However, convergent validity evidence for anxiety disorders relative to the SCARED scale was found to be poor. These findings may be attributed to differences in the assessment methods used for anxiety disorders (K-SADS-PL-GR-5 interview versus SCARED self-report) or to differences in the specific anxiety disorders included in the K-SADS-PL DSM-5. In terms of divergent validity, mood disorders did not show significant correlations with the SCARED scale, and anxiety disorders displayed poor correlations with the CDI scale.
There are several limitations to the present study. First, the utilization of an unstructured clinical interview as a gold standard for validating the K-SADS-PL DSM-5 may have led to an unreliable estimate of diagnosis, due to subjective judgement and incomplete elicitation of diagnostic information. However, clinician’s judgment during all diagnostic procedures was complemented by additional use of available data sources (information provided from a caregiver and a teacher of the patient previous records, psychological assessments). Second, the study did not include test-retest reliability or assessment of the screen criteria for the K-SADS-PL DSM-5, which could provide further evidence for its reliability and validity. Finally, the small number of cases with clinical diagnoses provided allowed to establish only 11 Kappa values, might support limited information on consensual validity of the K-SADS-PL DSM-5.
Despite these limitations, our findings provide initial support for the psychometric properties of the Greek version of the K-SADS-PL DSM-5. The good to excellent inter-rater reliability, consensual validity, and construct validity suggest that the Greek version of K-SADS-PL DSM-5 may be a useful diagnostic tool in Greek-speaking populations. Further research is needed to examine the test-retest reliability, screen criteria, and psychometric properties of the Greek version of K-SADS-PL DSM-5 in larger, more diverse samples and various clinical settings. Moreover, future studies should explore the utility of the K-SADS-PL DSM-5 in detecting psychiatric comorbidities and predicting treatment outcomes.
In conclusion, the present study provides preliminary evidence supporting the use of the K-SADS-PL DSM-5 as a reliable and valid diagnostic tool for assessing psychiatric disorders in Greek-speaking populations. Our findings contribute to the growing body of literature on the psychometric properties of the K-SADS-PL DSM-5 across different languages and cultural contexts. By validating the K-SADS-PL DSM-5 in the Greek context, we hope to improve the early identification and accurate diagnosis of psychiatric disorders in Greek-speaking children and adolescents, ultimately leading to more effective treatment and better outcomes.
Acknowledgements
The authors would like to thank our colleagues who contributed to the translation of the K-SADS-Pl-5 in Greek i.e., Maria Daveroni, MD, Nefeli Karakitsou, MD, Christina Katsioni, MD, Christina Tsoukala, MD, and Evangelia Chrysikou, MD. The authors would also like to thank all the children, adolescents and their parents who participated in the study.
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