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

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RADS-2RADS-2Reynolds Adolescent Reynolds Adolescent

Depression Scale – Depression Scale – 22ndnd Edition Edition

William M. Reynolds, PhDWilliam M. Reynolds, PhD

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The Problem of The Problem of Depression in Depression in AdolescentsAdolescents

IntroductionIntroduction

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Depression in Depression in AdolescentsAdolescents

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

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Depression is an Depression is an internalizing disorderinternalizing disorder in that in that most of the symptoms of most of the symptoms of depression are depression are covertcovert, , subjective in intensitysubjective in intensity,, andand internalinternal to the individual.to the individual.

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Depression in adolescents is Depression in adolescents is often often comorbidcomorbid with other with other internalizing as well as internalizing as well as externalizing disorders, and externalizing disorders, and may be overlooked due to may be overlooked due to diagnostic overshadowingdiagnostic overshadowing ..

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Depression in AdolescentsDepression in Adolescents

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

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A Biopsychosocial Model of A Biopsychosocial Model of DepressionDepression

PSYCHOLOGICAL INFLUENCESPSYCHOLOGICAL INFLUENCESCognitive AppraisalCognitive Appraisal

Behavioral and Coping ResponseBehavioral and Coping ResponseSelf-Esteem / Interpersonal SkillsSelf-Esteem / Interpersonal Skills

Social AdaptationSocial AdaptationFunctional and Dysfunctional CognitionsFunctional and Dysfunctional Cognitions

SOCIAL INFULENCESSOCIAL INFULENCES BIOLOGICAL BIOLOGICAL INFLUENCESINFLUENCES

Major Life EventsMajor Life Events Genetic LoadingGenetic LoadingFamilial Attachment, Nurturance, & SupportFamilial Attachment, Nurturance, & Support Nervous System ActivationNervous System Activation

Daily HasslesDaily Hassles Neuroendocrine FunctioningNeuroendocrine Functioning Interpersonal RelationshipsInterpersonal Relationships Biological VulnerabilityBiological Vulnerability Social Systems - Life StressorsSocial Systems - Life Stressors Organic/Nutritional Organic/Nutritional

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Depression in AdolescentsDepression in Adolescents

National Comorbidity Study (NIMHNational Comorbidity Study (NIMH))

12 Month Depression Prevalence Rates12 Month Depression Prevalence Rates

MajorMajor Minor Minor Depression DepressionDepression Depression

15-16 yr olds15-16 yr olds 13.0%13.0% 6.5% 6.5%

17-18 yr olds17-18 yr olds 12.2%12.2% 11.2% 11.2%

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DSM IV MOOD DSM IV MOOD DISORDERSDISORDERS

Major Depressive DisorderMajor Depressive Disorder

Single EpisodeSingle Episode RecurrentRecurrent

Dysthymic Disorder Dysthymic Disorder (early onset)(early onset)

Bipolar DisorderBipolar Disorder

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Assessment of Depression in Assessment of Depression in AdolescentsAdolescents

For the evaluation of depression, For the evaluation of depression, we can we can diagnose depressiondiagnose depression according to a classification according to a classification system such as system such as DSM-IVDSM-IV, or we , or we can assess the can assess the severity of the severity of the symptoms of depressionsymptoms of depression and and obtain a score, with the higher obtain a score, with the higher the score the more clinically the score the more clinically severe the depressionsevere the depression..

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Assessment of Depression Assessment of Depression in Adolescentsin Adolescents

The primary methods used to The primary methods used to assess the severity of assess the severity of depression are depression are self-report self-report measuresmeasures and and clinical clinical interviewsinterviews..

Teacher, peer and parent Teacher, peer and parent reports are reports are notnot viable methods viable methods..

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Reynolds Adolescent Depression Reynolds Adolescent Depression Scale – 2Scale – 2ndnd Edition Edition RADS-2RADS-2

Requires a Requires a third-gradethird-grade reading level. reading level. Allows for scores on Allows for scores on fourfour subscales. subscales. Development included large samples of Development included large samples of

school-based (9,000+) and clinical (250+) school-based (9,000+) and clinical (250+) adolescents. adolescents.

Norms based on a Norms based on a national standardizationnational standardization sample of 3,300 adolescents.sample of 3,300 adolescents.

Norms extended to ages Norms extended to ages 11 to 20 years11 to 20 years. . 2525 years of school, clinical, and research years of school, clinical, and research

applications. applications.

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RADS-2 Depression FactorsRADS-2 Depression Factors

Dysphoric Anhedonia/Dysphoric Anhedonia/ MoodMood Negative AffectNegative Affect

RADS-2RADS-2 Total Scale Total Scale

Negative Self- Somatic Negative Self- Somatic Evaluation Complaints Evaluation Complaints

RADS-2 SubscalesRADS-2 Subscales

Dysphoric Mood (DM)Dysphoric Mood (DM)The 8 item The 8 item DMDM subscale evaluates subscale evaluates

symptoms of dysphoric mood and symptoms of dysphoric mood and related symptoms, including: sadness, related symptoms, including: sadness, crying behavior, loneliness, irritability, crying behavior, loneliness, irritability, worry, and self-pity. worry, and self-pity.

Dysphoric mood represents a prototypic Dysphoric mood represents a prototypic dimension of depression as a dimension of depression as a disturbance of mood (disturbance of mood (DSM-IVDSM-IV) and may ) and may be viewed as a negative emotional state.be viewed as a negative emotional state.

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Anhedonia/Negative Affect (AN)Anhedonia/Negative Affect (AN)The 7 item The 7 item ANAN subscale evaluates subscale evaluates

depressive symptoms associated with depressive symptoms associated with anhedonia with several items of anhedonia with several items of negative affect. High scores on this negative affect. High scores on this subscale represent limited or lack of subscale represent limited or lack of interest in pleasurable activities. interest in pleasurable activities.

ANAN items include symptoms of items include symptoms of disinterest in having fun, engaging in disinterest in having fun, engaging in pleasant activities, and disinterest in pleasant activities, and disinterest in talking with others and eating meals. talking with others and eating meals.

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Negative Self-Evaluation (NS)Negative Self-Evaluation (NS)The 8 The 8 NSNS items evaluate negative feelings items evaluate negative feelings

about oneself. Items deal with low self-about oneself. Items deal with low self-worth, self-denigration, feelings of self-worth, self-denigration, feelings of self-harm, that parents and others do not like or harm, that parents and others do not like or care about them, and thoughts of running care about them, and thoughts of running away, and feeling there is nothing they can away, and feeling there is nothing they can do that will help the situation. do that will help the situation.

In some adolescents, this negative self-In some adolescents, this negative self-evaluation is internalized as reflected in evaluation is internalized as reflected in thoughts of self-harm, feelings of pervasive thoughts of self-harm, feelings of pervasive helplessness and suicidal thoughts or helplessness and suicidal thoughts or behaviors. behaviors.

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Somatic Complaints (SC)Somatic Complaints (SC)The 7 SC items evaluate somatic and The 7 SC items evaluate somatic and

vegetative complaints (classic vegetative complaints (classic symptoms), along with general symptoms), along with general feelings of malaise (boredom, life feelings of malaise (boredom, life is unfair) and irritability. is unfair) and irritability. Symptoms include stomachaches, Symptoms include stomachaches, feeling ill, fatigue, and sleep feeling ill, fatigue, and sleep disturbance.disturbance.

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Characteristics of the Characteristics of the RADS-2RADS-2 Normative Sample Normative Sample

Size of sampleSize of sample 3,3003,300 Gender (n)Gender (n) MalesMales 1,6501,650 FemalesFemales 1,6501,650

Age GroupsAge Groups (n)(n) Ethnicity (%)Ethnicity (%) 11 – 1311 – 13 1,1001,100 CaucasianCaucasian

70.570.5 14 – 1614 – 16 1,1001,100 African AmerAfrican Amer 12.112.1 17 – 2017 – 20 1,1001,100 HispanicHispanic 11.811.8

AsianAsian 4.3 4.3Native AmerNative Amer 1.3 1.3

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Reliability of RADS-2 Scales

Internal Consistency Internal Consistency

Test-retestTest-retestRADS-2RADS-2 scale scale Clinical Standardization ClinicalClinical Standardization Clinical

Dysphoric Mood Dysphoric Mood .86 .85.86 .85 .87 .87

Anhedonia/Negative AffectAnhedonia/Negative Affect .85 .89.85 .89 .81 .81

Negative Self-EvaluationNegative Self-Evaluation .87 .86.87 .86 .85 .85

Somatic Complaints Somatic Complaints .81 .79.81 .79 .81 .81

RADS-2 Depression Total .94 .92 .89

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RADS Research with Special PopulationsRADS Research with Special PopulationsBaker, 1995Baker, 1995 Gifted & exceptionally gifted Gifted & exceptionally gifted Brand, et al., 1996Brand, et al., 1996 Major Depression & sexual abuseMajor Depression & sexual abuse

Brown, et al., 1991Brown, et al., 1991 Suicide attempters Suicide attempters

Cauce et al., 2000Cauce et al., 2000 Homeless adolescentsHomeless adolescents

Cunniff et al., 1995Cunniff et al., 1995 Turner syndromeTurner syndrome

Dalley et al., 1992Dalley et al., 1992 Learning disabled Learning disabled

D’Imperio et al., 2000 D’Imperio et al., 2000 Disadvantaged urban cityDisadvantaged urban city

Ghaziuddin et al., 1999 Ghaziuddin et al., 1999 Psychiatric inpatientsPsychiatric inpatientsGraves & Reynolds,1985 Graves & Reynolds,1985 Behavior disordersBehavior disorders

Gutierrez, 1999 Gutierrez, 1999 Parentally bereaved studentsParentally bereaved students

Hagborg, 1992Hagborg, 1992 Seriously emotionally disturbedSeriously emotionally disturbed

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RADS Research with Special RADS Research with Special PopulationsPopulationsHein & Dell, 1995Hein & Dell, 1995 HIV+(+) in medical settingsHIV+(+) in medical settings

King et al., 1995aKing et al., 1995a Psychiatric inpatients Psychiatric inpatients

King et al., 1995bKing et al., 1995b Psychiatric inpatientsPsychiatric inpatients

King et al., 1996King et al., 1996 Inpatients w/ major depression Inpatients w/ major depression

King, et al, 1997 King, et al, 1997 Psychiatric inpatientsPsychiatric inpatients

Manikam, et al 1995Manikam, et al 1995 Mental retardation Mental retardation

Matson & Nieminen,1987 Matson & Nieminen,1987 Behavior disordered Behavior disordered

MacLean et al., 1999MacLean et al., 1999 Homeless adolescentsHomeless adolescents

Navarrete, 1999Navarrete, 1999 Learning disabled Learning disabled

Nieminen & Matson,1989Nieminen & Matson,1989 Conduct disordered Conduct disordered

Ott & Reynolds, 2001Ott & Reynolds, 2001 Mental retardationMental retardation

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RADS Research with Special RADS Research with Special PopulationsPopulations

Perks & Jameson 1999 Perks & Jameson 1999 Witness domestic violence /St. Lucia Witness domestic violence /St. Lucia Reid, et al., 1995Reid, et al., 1995 Adolescents with diabetesAdolescents with diabetesReinecke & Schultz,1995 Reinecke & Schultz,1995 Psychiatric outpatientsPsychiatric outpatientsRyan, et al., 2000Ryan, et al., 2000 Homeless abused and nonabused Homeless abused and nonabused Sadowski & Kelley,1993 Sadowski & Kelley,1993 Suicide attemptersSuicide attemptersShain, et al, 1990Shain, et al, 1990 Inpatients w/ Major DepressionInpatients w/ Major DepressionShain, et al., 1991Shain, et al., 1991 Psychiatric inpatients Psychiatric inpatients Sinclair et al., 1995Sinclair et al., 1995 Sexually abused adolescents Sexually abused adolescents Spirito, et al., 1987Spirito, et al., 1987 Hospitalized suicide attempters Hospitalized suicide attempters Spirito, et al., 1993Spirito, et al., 1993 Suicide attempters Suicide attempters Williams et al, 1998Williams et al, 1998 Incarcerated adolescentsIncarcerated adolescents

Wurzbacher, et al 1991Wurzbacher, et al 1991 Prostitution-involved youthProstitution-involved youth

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RADS-2RADS-2 Clinical Severity Clinical Severity

T-ScoreT-Score %ile %ile Clinical Clinical RangeRange range range Description Description

Below 61Below 61 1 – 81 1 – 81 Normal Range Normal Range

61 to 6461 to 64 82 – 92 82 – 92 Mild clinical depression range Mild clinical depression range

65 to 6965 to 69 93 – 96 93 – 96 Moderate clinical depression Moderate clinical depression

70 & above70 & above 97+ 97+ Severe clinical depression Severe clinical depression

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RADS-2 Scores for School RADS-2 Scores for School and Clinical Samplesand Clinical Samples

The RADS-2 has a possible range of 30 to 120, The RADS-2 has a possible range of 30 to 120, although raw scores above 100 are rare. although raw scores above 100 are rare.

The average RADS-2 Total The average RADS-2 Total raw scoreraw score for the for the restandardization sample was approximately 60. restandardization sample was approximately 60.

The average raw score for the clinical sample of The average raw score for the clinical sample of 297 adolescent psychiatric inpatients and 297 adolescent psychiatric inpatients and outpatients with formal DSM diagnoses was outpatients with formal DSM diagnoses was approximately 75. approximately 75.

The average Total The average Total raw scoreraw score for a sample of 107 for a sample of 107 adolescents with Major Depressive Disorder was adolescents with Major Depressive Disorder was 90, equivalent to a standard score of 7090, equivalent to a standard score of 70TT. .

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Clinical Levels of DepressionClinical Levels of Depression

TT-Score-Score Raw Raw Clinical Clinical Score Score Description Description

Below 61Below 61 30-75 30-75 Normal Range Normal Range61 to 6461 to 64 76-81 76-81 Mild clinical depression range Mild clinical depression range65 to 6965 to 69 82-88 82-88 Moderate clinical depression Moderate clinical depression70 & above70 & above 89+ 89+ Severe clinical depression Severe clinical depression

Based on the total normative sample Based on the total normative sample NN = 3,330 = 3,330

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Comparisons withComparisons with Normative Data Normative Data

Primary comparison group for Primary comparison group for converting raw scores to converting raw scores to standard scores is the total standard scores is the total standardization sample (standardization sample (NN = = 3,300).3,300).

Secondary comparisons may Secondary comparisons may be made with gender, age, and be made with gender, age, and gender within age group gender within age group standardization groups.standardization groups.

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InterpretationInterpretation

Dysphoric Mood (DM)Dysphoric Mood (DM)

High High DMDM scores are suggestive of a scores are suggestive of a distinct disturbance of mood and are distinct disturbance of mood and are often associated with feelings of often associated with feelings of subjective misery and distress. subjective misery and distress. Some adolescents with high scores Some adolescents with high scores may be overly worried or anxious, an may be overly worried or anxious, an aspect of dysphoric mood noted in aspect of dysphoric mood noted in DSM-IVDSM-IV..

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Anhedonia/Negative Affect Anhedonia/Negative Affect (AN)(AN)

High scores on this subscale suggest a High scores on this subscale suggest a reduced engagement in pleasant reduced engagement in pleasant activities and a generalized negative activities and a generalized negative affect to self. High scores may affect to self. High scores may reflect low motivation and affect, as reflect low motivation and affect, as well as social withdrawal, a well as social withdrawal, a characteristic of anhedonia noted in characteristic of anhedonia noted in DSM-IVDSM-IV..

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Negative Self-EvaluationNegative Self-Evaluation ( (NSNS))

It is important to recognize that high scores It is important to recognize that high scores on the NS subscale are indicative of more on the NS subscale are indicative of more than negative self-esteem and in some, than negative self-esteem and in some, may reflect extreme negative feelings may reflect extreme negative feelings toward self including thoughts of self-harm toward self including thoughts of self-harm (self-mutilation, suicidal ideation, suicidal (self-mutilation, suicidal ideation, suicidal acts). The scale measures broad acts). The scale measures broad symptoms of negative self-evaluation symptoms of negative self-evaluation (unrealistic negative self-appraisal, (unrealistic negative self-appraisal, feelings of worthlessness, self-blame), not feelings of worthlessness, self-blame), not just negative self-concept.just negative self-concept.


Somatic Complaints (SC)Somatic Complaints (SC)Adolescents with elevated scores Adolescents with elevated scores

generally show somatic involvement generally show somatic involvement in their depression, with very high in their depression, with very high scores suggesting the potential for a scores suggesting the potential for a depressive episode. It is important to depressive episode. It is important to rule out the presence of a prior rule out the presence of a prior physical illness that would mimic physical illness that would mimic somatic complaints .somatic complaints .

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Critical ItemsCritical ItemsServe as a double-check if the Depression Serve as a double-check if the Depression

Total is below the clinical cutoff, yet Total is below the clinical cutoff, yet may be at risk for depression or require may be at risk for depression or require additional evaluation. The general rule additional evaluation. The general rule is if four or more or endorsed, further is if four or more or endorsed, further assessment should be done. They are assessment should be done. They are NOT meaningful indicators of NOT meaningful indicators of depression in isolation or meant to be depression in isolation or meant to be used as a screener.used as a screener.

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Treatment of Depression in Treatment of Depression in AdolescentsAdolescents

The research on the treatment The research on the treatment of depression in adolescents of depression in adolescents has focused on has focused on

pharmacologicalpharmacological

and and

psychologicalpsychological interventions interventions..

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PharmacotherapyPharmacotherapyMost of the antidepressant drugs developed and Most of the antidepressant drugs developed and

tested with adults have also been used, with tested with adults have also been used, with varying degrees of clinical efficacy, with varying degrees of clinical efficacy, with children and adolescents. children and adolescents.

In 1993 the FDA approved the first antidepressant In 1993 the FDA approved the first antidepressant for the treatment of major depressive disorders for the treatment of major depressive disorders in young people. in young people. The American Academy of The American Academy of Child and Adolescent PsychiatryChild and Adolescent Psychiatry estimates that estimates that 5%5% of the pediatric population -- or of the pediatric population -- or 3.4 million 3.4 million children and adolescentschildren and adolescents under the age of 18 -- under the age of 18 -- suffer from depressionsuffer from depression. . This is probably an This is probably an underestimate.underestimate.

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PsychotherapyPsychotherapyThe efficacy of psychotherapeutic The efficacy of psychotherapeutic

interventions for depression in interventions for depression in adolescents has been examined in a adolescents has been examined in a number of studies. Most of these studies number of studies. Most of these studies have used treatment procedures have used treatment procedures developed for adults with modifications developed for adults with modifications made for adolescents.made for adolescents.

Core empirical Core empirical studiesstudies::Reynolds & Coats, (1986)Reynolds & Coats, (1986)Kahn, et al., (1990)Kahn, et al., (1990)Lewinsohn, et al., (1990)Lewinsohn, et al., (1990)

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A Comparison of Cognitive-A Comparison of Cognitive-Behavioral Therapy and Relaxation Behavioral Therapy and Relaxation

Training for the Treatment of Training for the Treatment of Depression in AdolescentsDepression in Adolescents

Journal of Consulting and Clinical Journal of Consulting and Clinical Psychology Psychology (1986)(1986)

William M. Reynolds & Kevin I. CoatsWilliam M. Reynolds & Kevin I. Coats

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PharmacotherapyPharmacotherapy The primary classes of antidepressantsThe primary classes of antidepressants:: Tricyclic antidepressants (Tricyclic antidepressants (TCAsTCAs),), Monoamine Oxidase Inhibitors Monoamine Oxidase Inhibitors

((MAOIsMAOIs),), Selective Serotonin Reuptake Selective Serotonin Reuptake

Inhibitors (Inhibitors (SSRIsSSRIs),), and several newer classes of drugs and several newer classes of drugs

that do not fit these categoriesthat do not fit these categories..

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SummarySummary Depression and depressive disorders Depression and depressive disorders

are are prevalentprevalent among adolescents. among adolescents. Young people typically Young people typically do not get betterdo not get better

without intervention of some kind.without intervention of some kind. The foremost need is for the The foremost need is for the

identificationidentification of adolescents who are at of adolescents who are at risk and subsequent risk and subsequent referral for referral for treatmenttreatment..

There is a need for schools and There is a need for schools and communities to be communities to be proactiveproactive in the in the identificationidentification and and referral for treatmentreferral for treatment of at-risk youth.of at-risk youth.

Documents

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