Form CRS Adult and Adol CRS Adult and Adol CRS Adult and Adolescents Questioonaire

National Mental Health Study (NMHS) Field Test

NMHS OMB_PDF 04

Clinical Interview

OMB: 0930-0380

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National Mental Health Study Field Test,
Supporting Statement
Attachment A-3 – CRS Adult and Adolescent
Questionnaire Specifications

Adult Clinical Interview Modules
for the National Mental Health Study (NMHS)
Clinical Reappraisal Study (CRS) Field Test

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OMB #
Expiration Date:

SCID-RV for DSM-5®
Version 1.0.0

Overview Module

Michael B. First, M.D., Janet B. W. Williams, Ph.D.,
Rhonda S. Karg, Ph.D., Robert L. Spitzer, M.D.

Modified for the National Mental Health Study

Interviewer ID:

QUESTID:

Date of Interview:
NOTICE: Public reporting burden for this collection of information is estimated to
average 60 minutes per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information. Send comments regarding
this burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden, to SAMHSA Reports Clearance Officer,
Paperwork Reduction Project (XXXX-XXXX); Room 15E57B; 5600 Fishers Lane,
Rockville, MD 20857. An agency may not conduct or sponsor, and a person is not
required to respond to, a collection of information unless it displays a currently valid
OMB control number. The OMB control number for this project is XXXX-XXXX,
expiration date XX/XX/XX.

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Overview Module

Introduction to Clinical Interview
Before you place call, be prepared to:
• Review the assignment information provided including the respondent name,
telephone number, as well as the date of the initial interview.
• Have your schedule available (in case you need to schedule an appointment).
• Have all interviewing materials available.
VERIFY NUMBER AND LOCATE RESPONDENT
Hi, my name is _______________ and I’m calling on behalf of the U.S. Department of
Health and Human Services. Is this [PHONE NUMBER]?
YES: PROCEED BELOW.
NO: I apologize. I need to double-check my records. Thank you for your time. END
CALL.
I’m trying to reach [FIRST NAME] who agreed to take part in a telephone interview
we’re conducting. May I speak to [FIRST NAME]?
IF R NOT HOME OR UNAVAILABLE
When would be a good time to call again? ENTER CODE 52 AND DETAILS IN CMS.
Thank you for your time. END CALL.
IF R AVAILABLE
(Hi, my name is _______________.) You recently completed an interview in your home
with an interviewer working on the National Mental Health Study. I am the interviewer
you were told would contact you for a follow-up telephone interview. Do you recall
completing the first interview?
YES: PROCEED BELOW.
NO: VERIFY FIRST NAME OF PERSON YOU ARE SPEAKING TO. IF NOT
SPEAKING TO CORRECT RESPONDENT, ASK TO SPEAK TO RESPONDENT.
IF NAME IS CORRECT AND RESPONDENT DOESN’T RECALL INITIAL INTERVIEW,
REMIND OF DATE OF INITIAL INTERVIEW.
IF CORRECT RESPONDENT STILL NOT FOUND: I apologize. I need to double-check
my records. Thank you for your time. END CALL. ENTER CODE 59 AND
INVESTIGATE.

Overview Module

Are you in a place where you can safely talk on the phone and answer my questions?
YES: PROCEED.
NO: Are you able to move to a place where you can safely talk?
YES: PAUSE, THEN CONTINUE.
NO: When would be a good time to call again? ENTER CODE 50 AND DETAILS IN
CMS. Thank you for your time. END CALL.
Is now a good time to complete this interview?
YES: PROCEED. BE SURE TO READ VERBATIM.
NO: When would be a good time to call again? ENTER CODE 50 AND DETAILS IN
CMS. Thank you for your time. END CALL.
PRIVACY
Because you may not want others to hear the responses to some of our questions, I’d
like to be sure you’re in a private area. Where are you right now? Are you at home, at
work, or somewhere else? Are you in an area where you can answer these questions
privately?
YES: PROCEED.
NO: Please consider moving to a more private area. Do you need more time?
YES: PAUSE, THEN CONTINUE.
NO: CONTINUE.
INFORMED CONSENT
Before we begin, I would like to remind you of the study details. This study, sponsored
by the U.S. Department of Health and Human Services, asks questions about various
mental health issues such as depression, anxiety, post-traumatic stress disorder, and
substance dependence. Although there is no benefit to you personally, knowledge
gained from this study will improve our ability to describe and understand mental health
issues in the United States. While the interview has some personal questions, federal
law keeps your answers private. The only exception to this promise of confidentiality is if
you tell me that you intend to seriously harm yourself or someone else; in this situation I
may need to notify a mental health professional or other authorities.
Your participation is voluntary. You may consider some of the questions to be sensitive
in nature and some of the questions may also make you feel certain emotions, such as
sadness. Remember that you can refuse to answer any questions that you do not want
to answer, and you can stop the interview at any time. If you become upset at any time
during the interview and wish to speak to a mental health professional about how you
are feeling, I will provide you with the toll-free hotline numbers that are printed on your
payment receipt from the first interview. It is important for you to keep in mind that I will
not be providing you with a psychological diagnosis or any mental health advice or
counseling. The information we are collecting today is only for research purposes.

Overview Module

These study details are also included on the Follow-Up Study Description you received
from the interviewer who met with you in your home. Do you have any questions before
we begin? ANSWER ANY RESPONDENT QUESTIONS.
Is it OK to continue with the interview?
YES: PROCEED TO NEXT PAGE.
NO: BASED ON CONVERSATION:
What sort of concerns do you have about participating?
OR
Are there other questions that I could answer for you?
IF R STILL UNWILLING TO PARTICIPATE: Thank you for your time. END CALL.
RECORDING PERMISSION
In order to ensure that I am conducting this interview accurately and properly, I would
like to make an electronic audio recording of this interview. This is done strictly for quality
control purposes. The recording will only be listened to by staff members on the project
who have signed confidentiality pledges. The recording will be stored in a secure manner
and will not contain your name—only a random number that will be assigned to this
case. To help maintain confidentiality, we ask that you not give your name or any other
identifying information, such as an address or place of business, during the interview. All
recordings will be permanently destroyed within 18 months after the end of the data
collection period. You can still do the interview if you do not want me to record it.
Do you agree to allow me to record the interview?
YES: I will now begin recording. START RECORDING AND SAY: “This is [YOUR
FIRST AND LAST NAME] conducting telephone interview [QUEST ID] on [DATE].”
NO: DON’T RECORD.
Ok, let’s get started.

Overview Module

Module Start Time: ____ ____ : ____ ____ AM/PM
I’m going to be asking you about problems or difficulties you may have had, and I’ll be making
some notes as we go along. Do you have any questions before we begin?
NOTE: Any current suicidal thoughts, plans, or actions should be thoroughly assessed by the
clinician and action should be taken if necessary.

Demographic Data
GENDER: 1 Male

AOV1

2 Female
3 Other (e.g., transgendered)
What’s your date of birth?

Are you married?

DOB: _____ _____ ______
month day year

AOV2

AGE: ___ ___

AOV3

MARITAL STATUS (most recent):

AOV4

IF NO: Do you live with someone
as if you are married?

Married or living with someone as
if married

IF NO: Were you ever married?

Widowed

How long have you been (MARITAL
STATUS)?

Divorced or annulled

Separated

Never married

IF EVER MARRIED: How many times
have you been married?
Do you have any children?
IF YES: How many? (What are their
ages?)
With whom do you live? (How many
children under the age of 18 live in
your household?)
In what kind of place do you live? (A
house, an apartment, a shelter, a
halfway house, or some other living
arrangement? Are you homeless?)

________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________

Overview Module

Education and Work History
How far did you go in school?

EDUCATION:
1

Grade 6 or less

Grades 7 to 12 (without
graduating high school)

Graduated high school or high
school equivalent

Part college/trade school

Graduated 2-year college or
trade school

Graduated 4-year college

Part graduate/professional school

Completed graduate/professional
school

IF FAILED TO COMPLETE A
PROGRAM IN WHICH THEY WERE
ENROLLED: Why did you leave?

________________________________

What kind of work do you do? (Do you
work outside of your home?)

________________________________

Have you always done that kind of
work?

________________________________

IF NO: What other kind of work
have you done in the past?
What’s the longest you’ve worked at
one place?

________________________________

________________________________
________________________________

AOV5

Overview Module

Education and Work History (continued)
Are you currently employed (getting
paid)?
IF YES: Do you work part time or
full time?
IF PART TIME: How many hours
do you typically work each
week? (Why do you work part
time instead of full time?)
IF NO: Why is that? When was the
last time you worked? How are you
supporting yourself now?
IF DISABLED: Are you currently
receiving disability payments?
What are you receiving disability
for?

PRIMARY EMPLOYMENT STATUS:
1

Full-time job

Part-time job

Keeping house or care giving full
time

In school/training

Retired

Unemployed, looking for work

Unemployed, not looking for work

Disabled

________________________________
________________________________

IF EMPLOYED: How long have you
worked at your current job?

________________________________

IF LESS THAN 6 MONTHS: Why
did you leave your last job?

________________________________

IF UNKNOWN: Has there ever been a
period of time when you were unable
to work or go to school?
IF YES: Why was that?
Have you ever been arrested,
involved in a lawsuit, or had other
legal trouble?

AOV6

Overview Module

Current and Past Periods of Psychopathology
Have you ever seen anybody for
emotional or psychiatric problems?
IF YES: What was that for? (What
treatment did you get? Any
medications? When was that?
When was the first time you ever
saw someone for emotional or
psychiatric problems?)
IF NO: Was there ever a time when
you, or someone else, thought you
should see someone because of
the way you were feeling or acting?
(Tell me more.)
Have you ever seen anybody for
problems with alcohol or drugs?
IF YES: What was that for? (What
treatment[s] did you get? Any
medications? When was that?)
Have you ever attended a self-help
group, like Alcoholics Anonymous,
Gamblers Anonymous, or Overeaters
Anonymous?
IF YES: What was that for? When
was that?

Overview Module

Hospitalization History
Have you ever been a patient in a
psychiatric hospital?
IF YES: What was that for? (How
many times?)
IF AN INADEQUATE ANSWER IS
GIVEN, CHALLENGE GENTLY:
For example: Wasn't there
something else? People don't
usually go to psychiatric hospitals
just because they are tired or
nervous.
Have you ever been in a hospital for
treatment of a medical problem?
IF YES: What was that for?
Thinking back over your whole life,
when were you the most upset?
(Why? What was that like? How were
you feeling?)

Number of previous hospitalizations (do
not include transfers):
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________

Overview Module

*Other Current Problems*
Have you had any other problems in
the past month? (How are things
going at work, at home, and with other
people?)

________________________________

What has your mood been like?

________________________________

How has your physical health been?
(Have you had any medical
problems?)

________________________________

Do you take any medications,
vitamins, nutritional supplements, or
natural health remedies (other than
those you’ve already told me about?)

________________________________

IF YES: How much and how often
do you take (MEDICATION)? (Has
there been any change in the
amount you have been taking?)

________________________________

In the past month, how much have
you been drinking?
When you drink, who are you usually
with? (Are you usually alone or out
with other people?)
In the past month, have you been
using any illegal or recreational
drugs? How about taking more of your
prescription drugs than was
prescribed or running out early?

________________________________
________________________________

________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________

How have you been spending your
free time?

________________________________

Who do you spend time with?

________________________________

Module End Time: ____ ____ : ____ ____ AM/PM
GO TO NEXT MODULE

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SCID-RV for DSM-5®
Version 1.0.0

Mood Disorders Module

Michael B. First, M.D., Janet B. W. Williams, Ph.D.,
Rhonda S. Karg, Ph.D., Robert L. Spitzer, M.D.

Modified for the National Mental Health Study

Interviewer ID:

Date of Interview:

QUESTID:

This page has been intentionally left blank.

Mood Disorders Module

1
Module Start Time: ____ ____ : ____ ____ AM/PM

*LIFETIME MAJOR
DEPRESSIVE EPISODE*
IF CASE IS IDENTIFIED AS
HAVING BEEN A POSITIVE
SCREEN FOR DEPRESSION:
You told us in the previous
interview that you’d had a time in
your life when you felt sad,
hopeless, discouraged, or
disinterested most of the time. I’d
like to ask you some questions
now about times when you may
have felt that way.

MAJOR DEPRESSIVE
EPISODE CRITERIA

Have you ever had a period when
you were feeling depressed or
down most of the day nearly
every day? (Did anyone say that
you looked sad, down, or
depressed?)

A. Five or more of the
following symptoms have
been present during the
same 2-week period and
represent a change from
previous functioning; at
least one of the
symptoms was either (1)
depressed mood or (2)
loss of interest or
pleasure.

__________________________
__________________________

IF NO: How about feeling sad,
empty, or hopeless, most of the
day nearly every day?
IF YES TO EITHER OF ABOVE:
What was that like? When was
that? How long did it last? (As
long as 2 weeks?)
__________________________
__________________________

? = inadequate information

1. Depressed mood most of
the day, nearly every
day, as indicated by
either subjective report
(e.g., feels sad, empty,
hopeless) or observation
made by others (e.g.,
appears tearful)

AMO1

NOTE: In children and
adolescents, can be irritable
mood.

1 = absent or false

2 = subthreshold

3 = threshold or true

Mood Disorders Module

IF PREVIOUS ITEM CODED
“3”: During that time, did you
lose interest or pleasure in
things you usually enjoyed?
(What was that like?)
IF PREVIOUS ITEM NOT
CODED “3” Have you ever had
a period when you lost interest
or pleasure in things you
usually enjoyed? (What was
that like?)
IF YES: When was
that? Was it nearly every
day? How long did it last?
(As long as 2 weeks?)
Have you had more than one
time like that? (Which time was
the worst?)

2. Markedly diminished
interest or pleasure in all,
or almost all, activities
most of the day, nearly
every day (as indicated
either by subjective
account or observation)

AMO2

IF NEITHER ITEM
AMO1 NOR AMO2
IS CODED “3,” GO
TO *LIFETIME
MANIC EPISODE*
ON PAGE 9

NOTE: If there is evidence
for more than one past
episode, select the “worst”
one for your inquiry about
past Major Depressive
Episode. If there was a likely
Major Depressive Episode in
the past year, ask about that
episode even if it was not
the worst.

IF UNCLEAR: Have you had any
times like that in the past year,
since (1 YEAR AGO)?
__________________________
__________________________
__________________________
__________________________

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

Mood Disorders Module

FOR THE FOLLOWING
QUESTIONS, FOCUS ON THE
WORST 2 WEEKS OF THE
PAST MAJOR DEPRESSIVE
EPISODE THAT YOU ARE
INQUIRING ABOUT.

NOTE: When rating the
following items, code “1” if
clearly directly due to a
general medical condition
(e.g., insomnia due to
severe back pain).

During that (2-WEEK PERIOD)…
…how was your appetite? (What
about compared to your usual
appetite? Did you have to force
yourself to eat? Eat [less/more]
than usual? Was that nearly
every day? Did you lose or gain
any weight? How much?
IF YES: Were you trying to
[lose/gain] weight?)

3. Significant weight loss
when not dieting, or
weight gain (e.g., a
change of more than 5%
of body weight in a
month) or decrease or
increase in appetite
nearly every day

AMO3

Check if:

__________________________
__________________________

…how were you sleeping?
(Trouble falling asleep, waking
frequently, trouble staying asleep,
waking too early, OR sleeping too
much? How many hours of sleep
[including naps] had you been
getting? How many hours of
sleep did you typically get before
you got [depressed/OWN
WORDS]?) Has it been nearly
every night?

____ weight loss or
decreased appetite

AMO3a

____ weight gain or
increased appetite

AMO3b

4. Insomnia or
hypersomnia nearly
every day

AMO4

Check if:
____ insomnia

AMO4a

____ hypersomnia

AMO4b

__________________________
__________________________

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

Mood Disorders Module

…were you so fidgety or restless
that you were unable to sit still?
What about the opposite—talking
more slowly, or moving more
slowly than was normal for you,
as if you were moving through
molasses or mud? (In either
instance, was it so bad that other
people have noticed it? What did
they notice? Was that nearly
every day?)
__________________________

5. Psychomotor agitation or
retardation nearly every
day (observable by
others, not merely
subjective feelings of
restlessness or being
slowed down)

AMO5

Check if:
____ psychomotor agitation

AMO5a

____ psychomotor
retardation

AMO5b

__________________________
…what was your energy level
like? (Tired all the time? Nearly
every day?)

6. Fatigue or loss of energy
nearly every day

AMO6

7. Feelings of
worthlessness or
excessive or
inappropriate guilt (which
may be delusional)
nearly every day (not
merely self-reproach or
guilt about being sick)

AMO7

__________________________
__________________________
…were you feeling worthless?
Did you feel guilty about things
you had done or not done?
IF YES: What things? (Was this
only because you couldn’t take
care of things since you have
been sick?)
IF YES TO EITHER OF
ABOVE: Nearly every day?

Check if:

__________________________
__________________________
…did you have trouble thinking or
concentrating? Was it hard to
make decisions about everyday
things? (What kinds of things did
it interfere with?) Nearly every
day?

____ worthlessness

AMO7a

____ inappropriate guilt

AMO7b

8. Diminished ability to
think or concentrate, or
indecisiveness, nearly
every day (either by
subjective account or as
observed by others)

AMO8

__________________________
__________________________

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

Mood Disorders Module

During that (2-WEEK PERIOD)…
…were things so bad that you
thought a lot about death or that you
would be better off dead? Did you
think about taking your own life?
IF YES: Did you do something about
it? (What did you do? Did you make
a specific plan? Did you take any
action to prepare for it? Did you
actually make a suicide attempt?)
__________________________

9. Recurrent thoughts of
death (not just fear of
dying), recurrent suicidal
ideation without a specific
plan, or a suicide attempt or
a specific plan for
committing suicide

AMO9

NOTE: Code “1” for selfmutilation without suicidal
intent.
Check if:

__________________________

___

thoughts of own death

AMO9a

___

suicidal ideation

AMO9b

___

specific plan

AMO9c

___

suicide attempt

AMO9d

AT LEAST FIVE OF THE
ABOVE SXS (AMO1-AMO9)
ARE CODED “3” AND AT
LEAST ONE OF THESE IS
ITEM AMO1 OR AMO2.

AMO10

IF NOT ALREADY ASKED: Has
there been any other time when you
were (depressed/OWN WORDS)
and had even more of the symptoms
that I just asked you about?
__________________________
__________________________
IF YES: RETURN TO *LIFETIME
MAJOR DEPRESSIVE
EPISODE* ON PAGE 1, AND
CHECK WHETHER THERE
HAVE BEEN ANY OTHER
MAJOR DEPRESSIVE
EPISODES THAT WERE MORE
SEVERE AND/OR CAUSED
MORE SYMPTOMS. IF SO, ASK
ABOUT THAT EPISODE.

CONTINUE WITH
NEXT ITEM,
CRITERION B,
ON NEXT PAGE

IF NO: GO TO *LIFETIME MANIC
EPISODE* ON PAGE 9
__________________________
__________________________

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

Mood Disorders Module

IF UNKNOWN: What effect did
(DEPRESSIVE SXS) have on your life?
ASK THE FOLLOWING QUESTIONS AS
NEEDED TO RATE CRITERION B:

The symptoms cause clinically
significant distress or
impairment in social,
occupational, or other
important areas of functioning.

AMO11

How did (DEPRESSIVE SXS) affect your
relationships or your interactions with
other people? (Did this cause you any
problems in your relationships with your
family, romantic partner or friends?)
How did (DEPRESSIVE SXS) affect your
work/school? (How about your
attendance at work or school? Did
[DEPRESSIVE SXS] make it more
difficult to do your work/schoolwork? How
did [DEPRESSIVE SXS] affect the quality
of your work/schoolwork?)
How did (DEPRESSIVE SXS) affect your
ability to take care of things at home?
(How about doing simple everyday things
like getting dressed, bathing, or brushing
your teeth? How about doing other things
that are important to you like religious
activities, physical exercise, or hobbies?
Did you avoid doing anything because
you felt like you weren’t up to it?)
Did (DEPRESSIVE SXS) affect any other
important part of your life?
IF DID NOT INTERFERE WITH LIFE:
How much were you bothered or upset
by having (DEPRESSIVE SXS)?

__________________________

IF NOT ALREADY ASKED: Has
there been any other time when you
were (depressed/OWN WORDS)
and it caused even more problems
than the time I just asked you about?
__________________________
__________________________
IF YES: RETURN TO *LIFETIME
MAJOR DEPRESSIVE EPISODE*
ON PAGE 1, AND CHECK
WHETHER THERE HAVE BEEN
ANY OTHER MAJOR DEPRESSIVE
EPISODES THAT WERE MORE
SEVERE AND/OR CAUSED MORE
SYMPTOMS. IF SO, ASK ABOUT
THAT EPISODE.

CONTINUE
ON NEXT
PAGE

IF NO: GO TO *LIFETIME MANIC
EPISODE* ON PAGE 9

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

Mood Disorders Module

IF UNKNOWN: When did this period of
(depression/OWN WORDS) begin?
Just before this began, were you
physically ill?
IF YES: What did the doctor say?
Just before this began, were you using
any medications?
IF YES: Any change in the amount you
were using?
Just before this began, were you drinking
or using any drugs?

__________________________
__________________________

[Primary Depressive Episode:]
The episode is not attributable
to the physiological effects of a
substance (e.g., a drug of
abuse, medication) or to
another medical condition
(e.g., hypothyroidism).

IF THERE IS ANY INDICATION
THAT THE DEPRESSION MAY
BE SECONDARY (I.E., A
DIRECT PHYSIOLOGICAL
CONSEQUENCE OF GMC OR
SUBSTANCE), GO TO PAGE 5
OF GMC/SUBSTANCE FOR
MOOD DISORDER MODULE,
AND THEN RETURN HERE TO
MAKE A RATING OF “1” OR “3.”

AMO12

PRIMARY
DEPRESSIVE
EPISODE

DUE TO
SUBSTANCE
USE OR GMC

NOTE: Refer to lists of etiological
medical conditions and
substances/medications below:

IF UNKNOWN: Has there been any other
time when you were having
(DEPRESSIVE SXS) like this but were
not (using SUBSTANCE/MEDICATION/ill
with GMC)?

__________________________
__________________________
IF YES: GO TO *LIFETIME MAJOR
DEPRESSIVE EPISODE* ON PAGE
1 AND CHECK WHETHER THERE
HAS BEEN ANY OTHER MAJOR
DEPRESSIVE EPISODE NOT DUE
TO A SUBSTANCE/MEDICATION
OR ANOTHER MEDICAL
CONDITION. IF SO, ASK ABOUT
THAT EPISODE.
IF NO: GO TO *LIFETIME MANIC
EPISODE* ON PAGE 9

? = inadequate information

Etiological medical conditions
include stroke, Huntington’s
disease, Parkinson’s disease,
traumatic brain injury, Cushing’s
disease, hypothyroidism, multiple
sclerosis, and systemic lupus
erythematosus.
Etiological substances/medications
include alcohol (I/W), phencyclidine
(I), hallucinogens (I), inhalants (I),
opioids (I/W), sedative, hypnotics
or anxiolytics (I/W), amphetamine
and other stimulants (I/W), cocaine
(I/W), antiviral agents (etavirenz),
cardiovascular agents (clonodine,
guanethidine, methyldopa,
reserpine), retinoic acid derivatives
(isotretinoin), antidepressants,
anticonvulsants, anti-migraine
agents (triptans), antipsychotics,
hormonal agents (corticosteroids,
oral contraceptives, gonadotropinreleasing hormone agonists,
tamoxifen), smoking cessation
agents (varenicline) and
immunological agents (interferon).

1 = absent or false

2 = subthreshold

CONTINUE
WITH NEXT
ITEM

3 = threshold or true

Mood Disorders Module

MAJOR DEPRESSIVE
EPISODE CRITERIA A, B,
AND C ARE CODED “3.”

How old were you when (PAST
MAJOR DEPRESSIVE
EPISODE) started?

AMO13

GO TO
*LIFETIME
MANIC
EPISODE* ON
PAGE 9

PAST MAJOR
DEPRESSIVE
EPISODE

Age at onset of Past Major
Depressive Episode coded
above

____ ____

AMO14

Total number of Major
Depressive Episodes
(CODE 99 IF TOO
NUMEROUS OR
INDISTINCT TO COUNT)

____ ____

AMO15

__________________________
__________________________
How many separate times in your
life have you been
(depressed/OWN WORDS)
nearly every day for at least 2
weeks and had several of the
symptoms that you described like
(SXS OF WORST EPISODE)?
__________________________
__________________________

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

Mood Disorders Module

9
MANIC EPISODE
CRITERIA

*LIFETIME MANIC EPISODE*
IF CASE IS IDENTIFIED AS
HAVING BEEN A POSITIVE
SCREEN FOR MANIA: You told us
in the previous interview that you’d
had a time in your life when you felt
much more excited and full of energy
or much more irritable and grumpy
than usual. I’d like to ask you some
questions now about times when you
may have felt that way.
Have you ever had a period of time
when you were feeling so good,
“high,” excited, or “on top of the
world” that other people thought you
were not your normal self?
__________________________
__________________________
IF YES: What was it like? (Was
that more than just feeling good?)
Did you also feel like you were
“hyper” or “wired” and had an
unusual amount of energy? Were
you much more active than is
typical for you? (Did other people
comment on how much you were
doing?)
IF NO: Have you ever had a
period of time when you were
feeling irritable, angry, or shorttempered for most of the day,
every day, for at least several
days? What was that like? (Was
that different from the way you
usually are?)
IF YES: Did you also feel like
you were “hyper” or “wired”
and had an unusual amount of
energy? Were you much more
active than is typical for you?
(Did other people comment on
how much you were doing?)

A. A distinct period [lasting at
least several days] of
abnormally and persistently
elevated, expansive, or
irritable mood and
abnormally and persistently
increased […] activity or
energy

AMO16

RECORD
MODULE END
TIME ON PAGE
15 AND
CONTINUE

Check if:
___ elevated, expansive mood

AMO16a

___ irritable mood

AMO16b

When was that?
__________________________
__________________________

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

Mood Disorders Module

How long did that last? (As long as 1
week?)
IF LESS THAN 1 WEEK: Did you
need to go into the hospital to protect
you from hurting yourself or
someone else, or from doing
something that could have caused
serious financial or legal problems?)
Did you feel (high/irritable/OWN
WORDS) for most of the day, nearly
every day during this time?
Have you had more than one time
like that? (Which time was the most
extreme?)
IF UNCLEAR: Have you had any
times like that in the past year, since
(1 YEAR AGO)?

…lasting at least 1 week and
present most of the day, nearly
every day (or any duration if
hospitalization is necessary).

AMO17

RECORD
MODULE
END TIME ON
PAGE 15 AND
CONTINUE

NOTE: If elevated mood lasts
less than 1 week, check
whether irritable mood lasts at
least 1 week before skipping to
page 15.
NOTE: If there is evidence for
more than one past episode,
select the worst episode that
occurred in the prior year; if
none of the past episodes
occurred in the prior year,
select the worst episode that
occurred regardless of the time
it occurred.

__________________________
__________________________
FOCUS ON THE WORST PERIOD
OF THE EPISODE THAT YOU ARE
INQUIRING ABOUT.
IF UNCLEAR: During (EPISODE),
when were you the most
(high/irritable/OWN WORDS)?
During that time…

…how did you feel about yourself?
(More self-confident than usual? Did
you feel much smarter or better than
everyone else? Did you feel like you
had any special powers or abilities?)

B. During the period of mood
disturbance and increased
energy or activity, three (or
more) of the following
symptoms have persisted
(four if the mood is only
irritable) and have been
present to a significant
degree and represent a
noticeable change from
usual behavior:
1. Inflated self-esteem or
grandiosity

AMO18

2. Decreased need for sleep
(e.g., feels rested after only
3 hours of sleep)

AMO19

__________________________
__________________________
…did you need less sleep than
usual? (How much sleep did you
get?)
IF YES: Did you still feel rested?
__________________________
__________________________

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

Mood Disorders Module

…were you much more talkative than
usual? (Did people have trouble
stopping you or understanding you?
Did people have trouble getting a
word in edgewise?)

3. More talkative than usual or
pressure to keep talking

AMO20

4. Flight of ideas or subjective
experience that thoughts
are racing

AMO21

5. Distractibility (i.e., attention
too easily drawn to
unimportant or irrelevant
external stimuli) as reported
or observed

AMO22

6. Increase in goal-directed
activity (either socially, at
work or school, or sexually)
or psychomotor agitation
(i.e., purposeless non-goaldirected activity)

AMO23

__________________________
__________________________
…did you have thoughts racing
through your head? (What was that
like?)
__________________________
__________________________
…were you so easily distracted by
things around you that you had
trouble concentrating or staying on
one track? (Give me an example of
that.)
__________________________
__________________________
…how did you spend your time?
(Work, friends, hobbies? Were you
especially busy during that time?)
(Did you find yourself more
enthusiastic at work or working
harder at your job? Did you find
yourself more engaged in school
activities or studying harder?)

Check if:

(Were you more sociable during that
time, such as calling on friends or
going out with them more than you
usually do or making a lot of new
friends?)

___ increase in activity

AMO23a

___ psychomotor agitation

AMO23b

(Were you spending more time
thinking about sex or involved in
doing something sexual, by yourself
or with others? Was that a big
change for you?)
(Were you physically restless during
this time, doing things like pacing a
lot, or being unable to sit still?)
(How bad was it?)
__________________________
__________________________

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

Mood Disorders Module

During that time…
…did you do anything that could
have caused trouble for you or your
family?
(Spending money on things you
didn’t need or couldn’t afford? How
about giving away money or valuable
things? Gambling with money you
couldn’t afford to lose?)

7. Excessive involvement in
activities which have a high
potential for painful
consequences (e.g.,
engaging in unrestrained
buying sprees, sexual
indiscretions, or foolish
business investments)

AMO24

AMO25

(Anything sexual that was likely to
get you in trouble? Driving
recklessly?)
(Did you make any risky or impulsive
business investments or get involved
in a business scheme that you
wouldn’t normally have done?)
__________________________
__________________________
AT LEAST THREE “B” SXS
ARE CODED “3” (FOUR IF
MOOD ONLY IRRITABLE).
IF NOT ALREADY ASKED: Has
there been any other time when you
were (high/irritable/OWN WORDS)
and had even more of the symptoms
that I just asked you about?

CONTINUE
ON NEXT
PAGE

__________________________
__________________________
IF YES: RETURN TO *LIFETIME
MANIC EPISODE* ON PAGE 9,
AND INQUIRE ABOUT WORST
EPISODE.
IF NO: RECORD MODULE END
TIME ON PAGE 15 AND
CONTINUE

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

Mood Disorders Module

IF UNKNOWN: What effect did these
(MANIC SXS) have on your life?
IF UNKNOWN: Did you need to go
into the hospital to protect you from
hurting yourself or someone else, or
from doing something that could
have caused serious financial or
legal problems?

C. The mood disturbance is
sufficiently severe to cause
marked impairment in
social or occupational
functioning or to
necessitate hospitalization
to prevent harm to self or
others or there are
psychotic features.

AMO26

ASK THE FOLLOWING
QUESTIONS AS NEEDED TO RATE
CRITERION C.
How did (MANIC SXS) affect your
relationships or your interactions with
other people? (Did (MANIC SXS)
cause you any problems in your
relationships with your family,
romantic partner, or friends?)
How did (MANIC SXS) affect your
work/school? (How about your
attendance at work or school? Did
[MANIC SXS] make it more difficult
to do your work/schoolwork? How
did [MANIC SXS] affect the quality of
your work/schoolwork?)
How did (MANIC SXS) affect your
ability to take care of things at
home?

CONTINUE
ON NEXT
PAGE

__________________________

IF NOT ALREADY ASKED: Has
there been any other time when you
were (high/irritable/OWN WORDS)
and had (ACKNOWLEDGED MANIC
SYMPTOMS) and you got into
trouble with people or were
hospitalized?
IF YES: RETURN TO *LIFETIME
MANIC EPISODE* ON PAGE 9,
AND INQUIRE ABOUT OTHER
EPISODE.
IF NO: RECORD MODULE END
TIME ON PAGE 15 AND
CONTINUE.

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

Mood Disorders Module

IF UNKNOWN: When did this period of being
(high/irritable/OWN WORDS) begin?
Just before this began, were you physically ill?
IF YES: What did the doctor say?
Just before this began, were you taking any
medications?
IF YES: Any change in the amount you were
taking?
Just before this began, were you drinking or
using any drugs?
____________________________________
____________________________________
____________________________________
____________________________________

[Primary Manic Episode:] The
episode is not attributable to the
physiological effects of a
substance (e.g., a drug of abuse,
medication) or to another medical
condition.

IF THERE IS ANY INDICATION
THAT THE MANIA MAY BE
SECONDARY (I.E., A DIRECT
PHYSIOLOGICAL
CONSEQUENCE OF GMC OR
SUBSTANCE), GO TO PAGE 1 OF
THE *GMC/SUBSTANCEINDUCED MOOD MODULE* AND
RETURN HERE TO MAKE A
RATING OF “1” OR “3.”

AMO27

DUE TO
SUBSTANCE
USE OR
GMC

PRIMARY
MANIC
EPISODE

NOTE: A full Manic Episode that
emerges during antidepressant
treatment (e.g., medication,
electroconvulsive therapy) but persists
at a fully syndromal level beyond the
physiological effect of that treatment is
sufficient evidence for a Manic Episode
and therefore a Bipolar I diagnosis.
NOTE: Refer to lists of etiological
medical conditions and
substances/medications below:
Etiological medical conditions include
Alzheimer’s disease, vascular
dementia, HIV-induced dementia,
Huntington’s disease, Lewy body
disease, Wernicke-Korsakoff syndrome,
Cushing’s disease, multiple sclerosis,
ALS, Parkinson’s disease, Pick’s
disease, Creutzfeldt-Jakob disease,
stroke, traumatic brain injuries, and
hyperthyroidism.

CONTINUE
WITH
NEXT ITEM

Etiological substances/medications
include alcohol (I/W), phencyclidine (I),
hallucinogens (I), sedatives, hypnotics,
anxiolytics (I/W), amphetamines (I/W),
cocaine (I/W), corticosteroids,
androgens, isoniazid, levodopa,
interferon alpha, varenicline,
procarbazine, clarithromycin, and
ciprofloxacin.

IF UNKNOWN: Has there been any other time
when you were (high/irritable/OWN WORDS)
and were not (using SUBSTANCE/fill with
GMC)?
IF YES: RETURN TO *LIFETIME MANIC
EPISODE* ON PAGE 9, AND INQUIRE
ABOUT OTHER EPISODE.
IF NO: RECORD MODULE END TIME ON
PAGE 15 AND CONTINUE.

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

Mood Disorders Module

MANIC EPISODE CRITERIA
A, B, C, AND D ARE
CODED “3.”

AMO28

RECORD
MODULE END
TIME BELOW
AND
CONTINUE

PAST MANIC
EPISODE

How old were you when (PAST
MANIC EPISODE) started?

Age at onset of Lifetime
Manic Episode coded above

____ ____

AMO29

__________________________
__________________________

Module End Time: ____ ____ : ____ ____ AM/PM

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

Mood Disorders Module

MOOD DISORDERS
IF THERE HAVE NEVER BEEN ANY CLINICALLY SIGNIFICANT MOOD
SYMPTOMS, CIRCLE 1 HERE AND GO TO THE NEXT MODULE. OTHERWISE,
CIRCLE 3 AND CONTINUE
NO

YES

1
*BIPOLAR I DISORDER*
PRESENCE OF A MANIC
EPISODE IS INDICATED BY A
RATING OF “3” ON AMO28 ON
PAGE 15.

BIPOLAR I DISORDER
CRITERIA
A. Criteria have been met
for at least one Manic
Episode.

B. The occurrence of the
Manic and Major
Depressive Episode(s) is
not better explained by
Schizoaffective Disorder,
Schizophrenia,
Schizophreniform
Disorder, Delusional
Disorder, or Other
Specified or Unspecified
Schizophrenia Spectrum
and Other Psychotic
Disorder.

AMO30

AMO31

AMO32

GO TO
*MAJOR
DEPRESSIVE
DISORDER*
ON PAGE 17

1
GO TO
*MAJOR
DEPRESSIVE
DISORDER*
ON PAGE 17

BIPOLAR I
DISORDER

GO TO NEXT MODULE

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

Mood Disorders Module

*MAJOR DEPRESSIVE DISORDER*
PRESENCE OF A MAJOR
DEPRESSIVE EPISODE IS
INDICATED BY A RATING OF “3”
ON AMO13 ON PAGE 8.

MAJOR DEPRESSIVE
DISORDER CRITERIA
[At least one Major Depressive
Episode (i.e., meeting criteria
A–C for a Major Depressive
Episode in Module A).]

D. The occurrence of the
Major Depressive
Episode(s) is not better
explained by
Schizoaffective Disorder,
Schizophrenia,
Schizophreniform Disorder,
Delusional Disorder, or
Other Specified or
Unspecified Schizophrenia
Spectrum and Other
Psychotic Disorder.
E. There has never been a
Manic or Hypomanic
Episode.
Note: This exclusion does not
apply if all of the manic-like or
hypomanic-like episodes are
substance/medication-induced
or are attributable to the
physiological effects of another
medical condition.

AMO33

AMO34

AMO35

GO TO
NEXT
MODULE

1
GO TO
NEXT
MODULE

MAJOR
DEPRESSIVE
DISORDER

NOTE: Code “3” if there have
never been any Manic or
Hypomanic Episodes, or if all
manic-like and hypomanic-like
episodes are attributable to a
substance/medication
(excluding an antidepressant)
or to a general medical
condition.
Indicate type: (circle the appropriate number)
1.

Single Episode

Recurrent (i.e., to be considered recurrent,
there must be an interval of at least 2
consecutive months between separate
episodes in which criteria are not met for a
Major Depressive Episode)

AMO36

GO TO NEXT MODULE

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

This page has been intentionally left blank.

SCID-RV for DSM-5®
Version 1.0.0

Psychotic Screening Module

Michael B. First, M.D., Janet B. W. Williams, Ph.D.,
Rhonda S. Karg, Ph.D., Robert L. Spitzer, M.D.

Modified for the National Mental Health Study

Interviewer ID:

Date of Interview:

QUESTID:

This page has been intentionally left blank.

Psychotic Screening Module

1
Module Start Time: ____ ____ : ____ ____ AM/PM

For each psychotic symptom coded “3,” describe the actual content and indicate the period of
time during which the symptom was present. Moreover, for any psychotic symptom coded “3,”
determine whether the symptom is definitely “primary” or whether there is a possible or definite
etiological substance (including medication) or general medical condition. Refer to page 8 for a
list of possible etiological general medical conditions and substances/medications.
The following questions may be useful if the Overview has not already provided the information.
Just before (PSYCHOTIC SXS) began, were you using drugs? …were you taking any
medications? …did you drink much more than usual or stop drinking after you had been drinking
a lot for a while? …were you physically ill?
IF YES TO ANY: Has there been a time when you had (PSYCHOTIC SXS) and were not (USING
DRUGS/TAKING MEDICATION/CHANGING YOUR DRINKING HABITS/ILL)?
HALLUCINATIONS
Now I’d like to ask you about
unusual experiences that people
sometimes have.

A perception-like experience with the clarity and
impact of a true perception, but without the
external stimulation of the relevant sensory organ.
The person may or may not have insight into the
nonveridical nature of the hallucination (i.e., one
hallucinating person may recognize the false
sensory experience, whereas another may be
convinced that the experience is grounded in
reality).
NOTE: Code “2” for hallucinations that are so
transient as to be without diagnostic significance.
Code “1” for hypnagogic or hypnopompic
hallucinations.

Did you ever hear things that
other people couldn’t, such as
noises or the voices of people
whispering or talking? (Were you
awake at the time?)
IF YES: What did you hear? How
often did you hear it?

Auditory hallucinations
(i.e., involving the perception
of sound, most commonly of
voice) when fully awake,
heard either inside or
outside of one’s head

1
1

3
3

POSS/DEF PRIMARY
SUBST/GMC

APS1
APS1a

DESCRIBE:

__________________________

_______________________

__________________________

_______________________

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

Psychotic Screening Module

Did you have visions or see
things that other people couldn’t
see? (Tell me about that. Were
you awake at the time?)
NOTE: DISTINGUISH FROM AN
ILLUSION (I.E., A
MISPERCEPTION OF A REAL
EXTERNAL STIMULUS).

Visual hallucinations (i.e.,
a hallucination involving
sight, which may consist of
formed images, such as of
people or of unformed
images, such as flashes of
light)
_______________________

__________________________

_______________________

What about strange sensations
on your skin, like feeling like
something is creeping or crawling
on or under your skin? How
about the feeling of being
touched or stroked? (Tell me
about that.)

Tactile hallucinations (i.e.,
a hallucination involving the
perception of being touched
or of something being under
one’s skin)

__________________________
What about having unusual
sensations inside a part of your
body, like a feeling of electricity?
(Tell me about that.)
__________________________
__________________________

3
3

POSS/DEF PRIMARY
SUBST/GMC

APS2
APS2a

DESCRIBE:

__________________________

3
3

POSS/DEF PRIMARY
SUBST/GMC

APS3
APS3a

DESCRIBE:
_______________________
_______________________
Somatic hallucinations
(i.e., a hallucination involving
the perception of physical
experience localized within
the body [e.g., a feeling of
electricity])

3
3

POSS/DEF PRIMARY
SUBST/GMC

APS4
APS4a

DESCRIBE:
_______________________
_______________________

How about eating or drinking
something that you thought
tasted bad or strange even
though everyone else who tasted
it thought it was fine? (Tell me
about that.)
__________________________
__________________________
What about smelling unpleasant
things that other people couldn’t
smell, like decaying food or dead
bodies? (Tell me about that.)
__________________________
__________________________
? = inadequate information

Gustatory hallucinations
(i.e., a hallucination involving
the perception of taste
[usually unpleasant])

3
3

POSS/DEF PRIMARY
SUBST/GMC

DESCRIBE:

APS5
APS5a

_______________________
_______________________
Olfactory hallucinations
(i.e., a hallucination involving
the perception of odor)
DESCRIBE:
_______________________

1
1

3
3

POSS/DEF PRIMARY
SUBST/GMC

APS6
APS6a

_______________________

1 = absent or false

2 = subthreshold

3 = threshold or true

Psychotic Screening Module

DELUSIONS
A false belief based on incorrect inference about
external reality that is firmly held despite what
almost everyone else believes and despite what
constitutes incontrovertible and obvious proof or
evidence to the contrary. The belief is not one
ordinarily accepted by other members of the
person’s culture or subculture. When a false belief
involves a value judgment, it is regarded as a
delusion only when the judgment is so extreme as
to defy credibility. Code overvalued ideas
(unreasonable and sustained beliefs that are
maintained with less than delusional intensity) as
“2.”
Has it ever seemed like people
were talking about you or taking
special notice of you? (What do
you think they were saying about
you?)
IF YES: Were you convinced they
were talking about you or did you
think it might have been your
imagination?
Did you ever have the feeling that
something on the radio, TV, or in
a movie was meant especially for
you? (…not just that it was
particularly relevant to you, but
that it was specifically meant for
you)

Delusion of reference (i.e.,
events, objects, or other
persons in the individual’s
immediate environment are
seen as having a particular
and unusual significance)

1
1

3
3

POSS/DEF PRIMARY
SUBST/GMC

APS7
APS7a

DESCRIBE:
_______________________
_______________________
_______________________
_______________________

Did you ever have the feeling that
the words in a popular song were
meant to send you a special
message? (…not just that they
were particularly relevant to you,
but that they were specifically
meant for you)
Did you ever have the feeling that
what people were wearing was
intended to send you a special
message?
Did you ever have the feeling that
street signs or billboards had a
special meaning for you?
__________________________
__________________________

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

Psychotic Screening Module

What about anyone going out of
their way to give you a hard time,
or trying to hurt you? (Tell me
about that.)
Have you ever had the feeling
that you were being followed,
spied on, manipulated, or plotted
against?
Did you ever have the feeling that
you were being poisoned or that
your food had been tampered
with?

Persecutory delusion (i.e.,
the central theme is that one
[or someone to whom one is
close to] is being attacked,
harassed, cheated,
persecuted, or conspired
against)

3
3

POSS/DEF PRIMARY
SUBST/GMC

APS8
APS8a

DESCRIBE:
_______________________
_______________________
_______________________

__________________________
__________________________
Have you ever thought that you
were especially important in
some way, or that you had
special powers or knowledge?
(Tell me about that.)
Did you ever believe that you had
a special or close relationship
with a celebrity or someone else
famous?
__________________________
__________________________

Grandiose delusion (i.e.,
content involves inflated
worth, power, knowledge
identity, or a special
relationship to a deity or
famous person)

3
3

POSS/DEF PRIMARY
SUBST/GMC

APS9
APS9a

DESCRIBE:
_______________________
_______________________
_______________________

Have you ever been convinced
that something was very wrong
with your physical health even
though your doctor said nothing
was wrong…like you had cancer
or some other disease? (Tell me
about that.)

Somatic delusion (i.e.,
main content pertains to the
appearance or functioning of
one’s body)

Have you ever felt that something
strange was happening to parts
of your body?

_______________________

DESCRIBE:

1
1

3
3

POSS/DEF PRIMARY
SUBST/GMC

APS10
APS10a

_______________________

__________________________
__________________________

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

Psychotic Screening Module

Have you ever felt that you had
committed a crime or done
something terrible for which you
should be punished? (Tell me
about that.)
Have you ever felt that something
you did, or should have done but
did not do, caused serious harm
to your parents, children, other
family members, or friends?
What about feeling responsible
for a disaster such as a fire,
flood, or earthquake?

Delusion of guilt (i.e., a
belief that a minor error in
the past will lead to disaster,
or that he or she has
committed a horrible crime
and should be punished
severely, or that he or she is
responsible for a disaster
[e.g., an earthquake or fire]
with which there can be no
possible connection)

__________________________

_______________________

Have you ever been convinced
that your spouse or partner was
being unfaithful to you?

Jealous delusion (i.e., that
one’s sexual partner is
unfaithful)

IF YES: How did you know they
were being unfaithful? (What
clued you into this?)

DESCRIBE:

Did you ever have a “secret
admirer” who, when you tried to
contact them, denied that they
were in love with you? (Tell me
about that.)
Were you ever romantically
involved with someone famous?
(Tell me about that.)
__________________________

3
3

POSS/DEF PRIMARY
SUBST/GMC

APS11
APS11a

_______________________
_______________________

__________________________

DESCRIBE:

__________________________

3
3

POSS/DEF PRIMARY
SUBST/GMC

_______________________

APS12
APS12a

_______________________
_______________________
Erotomanic delusion (i.e.,
that another person, usually
of higher status, is in love
with the individual)
DESCRIBE:

1
1

3
3

POSS/DEF PRIMARY
SUBST/GMC

APS13
APS13a

_______________________
_______________________
_______________________

__________________________

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

Psychotic Screening Module

Are you a religious or spiritual
person?
IF YES: Have you ever had
any religious or spiritual
experiences that the other
people in your religious or
spiritual community have not
experienced?

Religious delusion (i.e., a
delusion with a religious or
spiritual content)

DESCRIBE:

3
3

POSS/DEF PRIMARY
SUBST/GMC

_______________________

APS14
APS14a

_______________________
_______________________

IF YES: Tell me about your
experiences. (What did they
think about these
experiences of yours?)
IF NO: Have you ever felt
that God, the devil, or some
other spiritual being or
higher power has
communicated directly with
you? (Tell me about that.
Do others in your religious
or spiritual community also
have such experiences?)
IF NO: Have you ever felt that
God, the devil, or some other
spiritual being or higher power
has communicated directly
with you? (Tell me about that.
Do others in your religious or
spiritual community also have
such experiences?)
__________________________
__________________________
Did you ever feel that someone
or something outside yourself
was controlling your thoughts or
actions against your will? (Tell
me about that.)
__________________________
__________________________

Delusion of being
controlled (i.e., feelings,
impulses, thoughts, or
actions are experienced as
being under the control of
some external force rather
than under one’s own
control)

1
1

3
3

POSS/DEF PRIMARY
SUBST/GMC

APS15
APS15a

DESCRIBE:
_______________________
_______________________

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

Psychotic Screening Module

Did you ever feel that certain
thoughts that were not your own
were put into your head? (Tell me
about that.)

Thought insertion (i.e., that
certain thoughts are not
one’s own, but rather are
inserted into one’s mind)

__________________________

DESCRIBE:

__________________________

_______________________

3
3

POSS/DEF PRIMARY
SUBST/GMC

APS16
APS16a

_______________________
What about thoughts being taken
out of your head? (Tell me about
that.)
__________________________
__________________________

Thought withdrawal (i.e.,
that one’s thoughts have
been “removed” by some
outside force)

3
3

POSS/DEF PRIMARY
SUBST/GMC

DESCRIBE:

APS17
APS17a

_______________________
_______________________
Did you ever feel as if your
thoughts were being broadcast
out loud so that other people
could actually hear what you
were thinking? (Tell me about
that.)
__________________________

Thought broadcasting (i.e.,
the delusion that one’s
thoughts are being
broadcast out loud so that
others can perceive them)

3
3

POSS/DEF PRIMARY
SUBST/GMC

APS18
APS18a

_______________________
_______________________

Did you ever believe that
someone could read your mind?
(Tell me about that.)

Other delusions (e.g., that
others can read the person’s
mind, a delusion that one
has died several years ago)

__________________________

DESCRIBE:

__________________________

1
1

3
3

POSS/DEF PRIMARY
SUBST/GMC

DESCRIBE:

APS19
APS19a

_______________________
_______________________
ANY ITEM CODED "3" IN
"PRIMARY" SECTION

APS20

A PRIMARY
PSYCHOTIC SX HAS
BEEN PRESENT

Module End Time: ____ ____ : ____ ____ AM/PM
GO TO NEXT MODULE

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

Psychotic Screening Module

Etiological general medical conditions include:
Neurological conditions (e.g., neoplasms, cerebrovascular disease, Huntington's disease,
multiple sclerosis, epilepsy, auditory or visual nerve injury or impairment, deafness, migraine,
central nervous system infections), endocrine conditions (e.g., hyper- and hypothyroidism,
hyper- and hypoparathyroidism, hyper- and hypoadrenocorticism), metabolic conditions
(e.g., hypoxia, hypercarbia, hypoglycemia), fluid or electrolyte imbalances, hepatic or renal
diseases, and autoimmune disorders with central nervous system involvement (e.g.,
systemic lupus erythematosus).
Etiological substances/medications include:
Alcohol (during intoxication or withdrawal); cannabis (during intoxication); hallucinogens
(during intoxication), phencyclidine (and related substances (during intoxication); inhalants
(during intoxication); sedatives, hypnotics, and anxiolytics (during intoxication or withdrawal);
and stimulants (including cocaine) (during intoxication).
Other substances and medications that can cause psychotic symptoms include anesthetics
and analgesics, anticholinergic agents, anticonvulsants, antihistamines, antihypertensive and
cardiovascular medications, antimicrobial medications, antiparkinsonian medications,
chemotherapeutic agents (e.g., cyclosporine, procarbazine), corticosteroids, gastrointestinal
medications, muscle relaxants, nonsteroidal anti-inflammatory medications, other over-thecounter medications (e.g., phenylephrine, pseudoephedrine), antidepressant medication,
and disulfiram. Toxins include anticholinesterase, organophosphate insecticides, sarin and
other nerve gases, carbon monoxide, carbon dioxide, and volatile substances such as fuel or
paint.

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

SCID-RV for DSM-5®
Version 1.0.0

PTSD Module

Michael B. First, M.D., Janet B. W. Williams, Ph.D.,
Rhonda S. Karg, Ph.D., Robert L. Spitzer, M.D.

Modified for the National Mental Health Study

Interviewer ID:

Date of Interview:

QUESTID:

This page has been intentionally left blank.

PTSD Module

1
Module Start Time: ____ ____ : ____ ____ AM/PM

Trauma- and Stressor-Related Disorders
Trauma History
IF CASE IS IDENTIFIED AS HAVING BEEN A POSITIVE SCREEN FOR PTSD:
You told us in the previous interview that you’d had one or more highly stressful
experiences at some time during your life.
I’d now like to ask about some things that may have happened to you that may have
been extremely upsetting. People often find that talking about these experiences
can be helpful. I’ll start by asking if these experiences apply to you, and if so, I’ll ask
you to briefly describe what happened and how you felt at the time.
SCREEN FOR EACH TYPE OF TRAUMA USING QUESTIONS BELOW; THEN,
ON PAGES 3–5, REVIEW AND INQUIRE IN DETAIL FOR UP TO THREE PAST
EVENTS (E.G., THREE WORST EVENTS).
Have you ever been in a life-threatening situation like a major disaster or fire,
combat, or a serious car or work-related accident?
__________________________________________________________________
__________________________________________________________________
What about being physically or sexually assaulted or abused, or threatened with
physical or sexual assault?
__________________________________________________________________
__________________________________________________________________
How about seeing another person being physically or sexually assaulted or abused,
or threatened with physical or sexual assault?
__________________________________________________________________
__________________________________________________________________
Have you ever seen another person killed or dead, or badly hurt?
__________________________________________________________________
__________________________________________________________________
How about learning that one of these things happened to someone you are close
to?
__________________________________________________________________
__________________________________________________________________
IF UNKNOWN: Have you ever been the victim of a serious crime?
__________________________________________________________________
__________________________________________________________________

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

PTSD Module

Trauma History
IF NO EVENTS ENDORSED: What would you say has been the most stressful or
traumatic experience you have had over your life?
__________________________________________________________________
__________________________________________________________________
IF NO EVENTS ACKNOWLEDGED, CIRCLE 1, RECORD MODULE END TIME ON
PAGE 17, AND GO TO NEXT MODULE. IF ONE OR MORE SUCH EVENTS,
CIRCLE 3 AND CONTINUE.

? = inadequate information

YES

1 = absent or false

2 = subthreshold

APT1

3 = threshold or true

PTSD Module

DETAILS FOR PAST EVENT #1
IF DIRECT EXPOSURE TO
TRAUMA:

Description of traumatic event:
________________________________

What happened? Were you afraid of
dying or being seriously hurt? Were
you seriously hurt?
IF WITNESSED TRAUMATIC
EVENT HAPPENING TO OTHERS:
What happened? What did you see?
How close were you to (TRAUMATIC
EVENT)? Were you concerned about
your own safety?

________________________________
Indicate type of traumatic event:
(check all that apply)
___ Death, actual
___ Death, threatened
___ Serious injury, actual
___ Serious injury, threatened
___ Sexual violence, actual
___ Sexual violence, threatened

IF LEARNED ABOUT TRAUMATIC
EVENT:

Indicate mode of exposure to traumatic
event: (check all that apply)

What happened? Who did it involve?
(How close [emotionally] were you to
them? Did it involve violence, suicide,
or a bad accident?)

___ Directly experienced

___ Witnessed happening to others in
person
___ Learning about actual or
threatened violence or accidental
death of a close family member or
friend
___ Repeated or extreme exposure to
aversive details of traumatic
events (e.g., police officers
repeatedly exposed to details of
child abuse)
Age at time of event: ____

_______________________________
_______________________________
IF UNKNOWN: Did this happen more
than once?

Indicate type of exposure: (circle the
appropriate number)

_______________________________

1 – Single event

_______________________________

2 – Prolonged or repeated exposure to
same trauma (e.g., witnessing
repeated episodes of parental
domestic violence over years)

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

PTSD Module

DETAILS FOR PAST EVENT #2
IF DIRECT EXPOSURE TO
TRAUMA:

Description of traumatic event:
________________________________

What happened? Were you afraid of
dying or being seriously hurt? Were
you seriously hurt?
IF WITNESSED TRAUMATIC
EVENT HAPPENING TO OTHERS:
What happened? What did you see?
How close were you to
(TRAUMATIC EVENT)? Were you
concerned about your own safety?

IF LEARNED ABOUT TRAUMATIC
EVENT:

Indicate mode of exposure to traumatic
event: (check all that apply)

What happened? Who did it involve?
(How close [emotionally] were you to
them? Did it involve violence,
suicide, or a bad accident?)

___ Directly experienced

_______________________________
_______________________________
IF UNKNOWN: Did this happen more
than once?

Indicate type of exposure: (circle the
appropriate number)

_______________________________

1 – Single event

_______________________________

2 – Prolonged or repeated exposure to
same trauma (e.g., witnessing
repeated episodes of parental
domestic violence over years)

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

PTSD Module

DETAILS FOR PAST EVENT #3
IF DIRECT EXPOSURE TO
TRAUMA:

Description of traumatic event:
________________________________

What happened? Were you afraid of
dying or being seriously hurt? Were
you seriously hurt?
IF WITNESSED TRAUMATIC
EVENT HAPPENING TO OTHERS:
What happened? What did you see?
How close were you to
(TRAUMATIC EVENT)? Were you
concerned about your own safety?

IF LEARNED ABOUT TRAUMATIC
EVENT:

Indicate mode of exposure to traumatic
event: (check all that apply)

What happened? Who did it involve?
(How close [emotionally] were you to
them? Did it involve violence,
suicide, or a bad accident?)

___ Directly experienced

_______________________________
_______________________________
IF UNKNOWN: Did this happen more
than once?

Indicate type of exposure: (circle the
appropriate number)

_______________________________

1 – Single event

_______________________________

2 – Prolonged or repeated exposure to
same trauma (e.g., witnessing
repeated episodes of parental
domestic violence over years)

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

PTSD Module

*POSTTRAUMATIC STRESS POSTTRAUMATIC STRESS
DISORDER*
DISORDER CRITERIA
FOR FOLLOWING QUESTIONS, FOCUS ON THE THREE MOST SEVERE
TRAUMATIC EVENT(S) DESCRIBED ON PAGES 3–5.
IF ALL TRAUMAS ARE CONFINED TO THE PAST MONTH, CIRCLE 1 HERE,
RECORD MODULE END TIME ON PAGE 17, AND GO TO NEXT MODULE. IF ONE
OR MORE EVENTS PRIOR TO THE PAST MONTH, CIRCLE 3 AND CONTINUE.
NO

YES

APT2

A. Exposure to actual or
threatened death,
serious injury, or sexual
violence in one (or more)
of the following ways:
IF MORE THAN ONE
TRAUMATIC EVENT IS
REPORTED: Which of these do
you think affected you the most?
IF SELECTED EVENT IS
ULTIMATELY NOT
ASSOCIATED WITH THE FULL
PTSD SYNDROME, CONSIDER
RE-ASSESSING THE ENTIRE
PTSD CRITERIA SET (PAGES
6–16) FOR OTHER REPORTED
TRAUMAS.
___________________________
___________________________

1. Directly experiencing the
traumatic event(s)

APT3

2. Witnessing, in person,
the event(s) as it
occurred to others

APT4

3. Learning that the
traumatic event(s)
occurred to a close
family member or close
friend. In cases of actual
or threatened death of a
family member or friend,
the event(s) must have
been violent or
accidental.

APT5

4. Experiencing repeated
or extreme exposure to
aversive details of the
traumatic event(s) (e.g.,
first responders
collecting human
remains; police officers
repeatedly exposed to
details of child abuse)

APT6

Note: Criterion A.4 does not
apply to exposure through
electronic media, television,
movies, or pictures, unless
the exposure is work
related.

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

PTSD Module

AT LEAST ONE A ITEM IS
CODED “3.”

APT7

RECORD
MODULE END
TIME ON PAGE
17 AND GO TO
NEXT MODULE

Now I’d like to ask a few
questions about specific ways that
(TRAUMATIC EVENT) may have
affected you at any time since
(TRAUMATIC EVENT).

B. Presence of one (or
more) of the following
intrusion symptoms
associated with the
traumatic events),
beginning after the
traumatic event(s)
occurred:

For example, since (TRAUMATIC
EVENT)…

1. Recurrent, involuntary,
and intrusive distressing
memories of the
traumatic event(s)

APT8

2. Recurrent distressing
dreams in which the
content and/or affect of
the dream are related to
the traumatic event

APT9

3. Dissociative reactions
(e.g., flashbacks) in
which the individual feels
or acts as if the
traumatic event(s) were
recurring. (Such
reactions may occur on
a continuum, with the
most extreme
expression being a
complete loss of
awareness of present
surroundings.)

APT10

…have you had memories of
(TRAUMATIC EVENT), including
feelings, physical sensations,
sounds, smells, or images, when
you didn’t expect to or want to?
(How often has this happened?)
__________________________
__________________________
…what about having upsetting
dreams that reminded you of
(TRAUMATIC EVENT)? Tell me
about that.
__________________________
__________________________
Since (TRAUMATIC EVENT)…
…what about having found
yourself acting or feeling as if you
were back in the situation? (Have
you had “flashbacks” of
[TRAUMATIC EVENT]?)
__________________________
__________________________

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

PTSD Module

…have you had a strong
emotional or physical reaction
when something reminded you of
(TRAUMATIC EVENT)? Give me
some examples of the kinds of
things that would have triggered
this reaction. (Things like…
seeing a person who resembles
the person who attacked you,
hearing the screech of brakes if
you were in a car accident,
hearing the sound of helicopters if
you were in combat, any kind of
physical intimacy with someone
who was raped.)

4. Intense or prolonged
psychological distress at
exposure to internal or
external cues that
symbolize or resemble
an aspect of the
traumatic event(s)

APT11

5. Marked physiological
reactions to internal or
external cues that
symbolize or resemble
an aspect of the
traumatic event(s)

APT12

NOTE: IF DENIES EMOTIONAL
OR PHYSICAL REACTION TO
REMINDERS, CODE “1” FOR
BOTH B.4 (EMOTIONAL
REACTION) AND B.5
(PHYSICAL REACTION).
IF YES: What kind of reaction did
you have? Did you get very upset
or stay upset for a while, even
after the reminder had gone
away?
__________________________
__________________________
__________________________
IF ACKNOWLEDGES STRONG
EMOTIONAL OR PHYSICAL
REACTION: What about having
physical symptoms—like breaking
out in a sweat, breathing heavily
or irregularly, or feeling your heart
pound or race when something
reminded you of (TRAUMATIC
EVENT)? How about feeling
tense or shaky?
__________________________
__________________________

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

PTSD Module

AT LEAST ONE “B” SX IS
CODED “3.”

APT13

APT14

RECORD
MODULE END
TIME ON PAGE
17 AND GO TO
NEXT MODULE

Since (TRAUMATIC EVENT)…

C. Persistent avoidance of
stimuli associated with
the traumatic event(s),
beginning after the
traumatic event(s)
occurred, as evidenced
by one or both of the
following:

…have you done things to avoid
remembering or thinking about
(TRAUMATIC EVENT), like
keeping yourself busy, distracting
yourself by playing computer or
video games or watching TV, or
using drugs or alcohol to “numb”
yourself or try to forget what
happened? (Since [TRAUMATIC
EVENT], how long has this gone
on?)

1. Avoidance of, or efforts
to avoid, distressing
memories, thoughts, or
feelings about or closely
associated with the
traumatic event(s)

IF NO: How about doing things to
avoid having feelings similar to
those you had during
(TRAUMATIC EVENT)? (Since
[TRAUMATIC EVENT], how long
has this gone on?)
__________________________
__________________________
__________________________

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

PTSD Module

…have there been things, places,
or people that you have tried to
avoid because they brought up
upsetting memories, thoughts, or
feelings about (TRAUMATIC
EVENT)? (Since [TRAUMATIC
EVENT], how long has this gone
on?)
IF NO: How about avoiding
certain activities, situations, or
topics of conversation? (Since
[TRAUMATIC EVENT], how long
has this gone on?)

2. Avoidance of, or efforts
to avoid, external
reminders (people,
places, conversations,
activities, objects,
situations) that arouse
distressing memories,
thoughts, or feelings
about or closely
associated with the
traumatic event(s)

APT15

APT16

APT17

__________________________
__________________________
__________________________
AT LEAST ONE “C” SX IS
CODED “3.”

1
RECORD
MODULE END
TIME ON PAGE
17 AND GO TO
NEXT MODULE

Since (TRAUMATIC EVENT)…

D. Negative alterations in
cognitions and mood
associated with the
traumatic event(s),
beginning or worsening
after the traumatic
event(s) occurred, as
evidenced by two (or
more) of the following:

…have you been unable to
remember some important part of
what happened? (Tell me about
that.)

1. Inability to remember an
important aspect of the
traumatic event(s)
(typically due to
dissociative amnesia
and not to other factors
such as head injury,
alcohol, or drugs)

IF YES: Did you get a head injury
during (TRAUMATIC EVENT)?
Were you drinking a lot or taking
any drugs at the time of
(TRAUMATIC EVENT)?

__________________________
__________________________

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

PTSD Module

…has there been a change in
how you think about yourself?
(Like feeling you are “bad,” or
permanently damaged or
“broken”? Tell me about that.
Since this started, have you felt
this way most of the time?)
IF NO: Has there been a change
in how you see other people or
the way the world works? (Like
you can’t trust anyone anymore?
Like the world is a completely
dangerous place? Tell me about
that. Since this started, have you
felt this way most of the time?)

2. Persistent and
exaggerated negative
beliefs or expectations
about oneself, others, or
the world (e.g., “I am
bad,” “No one can be
trusted,” “The world is
completely dangerous,”
“My whole nervous
system is permanently
ruined”)

APT18

3. Persistent, distorted
cognitions about the
cause or consequences
of the traumatic event(s)
that lead the individual to
blame himself/herself or
others

APT19

__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
…have you blamed yourself for
the (TRAUMATIC EVENT) or how
it affected your life? (Like feeling
that [TRAUMATIC EVENT] was
your fault or that you should have
done something to prevent it? Like
feeling that you should have
gotten over it by now?)
IF YES: Tell me about that.
(Since this started, have you
felt this way most of the time?)
IF NO: Have you blamed
someone else for
(TRAUMATIC EVENT)? Tell
me about that. (What did they
have to do with [TRAUMATIC
EVENT]?)
________________________
________________________
________________________
________________________
________________________

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

PTSD Module

…have you had bad feelings
much of the time, like feeing sad,
angry, afraid, guilty, ashamed, “in
shock”? (Tell me about that.)

4. Persistent, negative
emotional state (e.g.,
fear, horror, anger, guilt,
or shame)

APT20

5. Markedly diminished
interest or participation
in significant activities

APT21

6. Feelings of detachment
or estrangement from
others

APT22

7. Persistent inability to
experience positive
emotions (e.g., inability
to experience
happiness, satisfaction,
or loving feelings)

APT23

IF YES: Is this different from the
way you were before
(TRAUMATIC EVENT)?
__________________________
__________________________
Since (TRAUMATIC EVENT)…
…have you been less interested
in things that you were interested
in before (TRAUMATIC EVENT),
like spending time with family or
friends, reading books, watching
TV, cooking, or sports? (Tell me
about that.)
IF NO LOSS OF INTEREST: Are
you still doing as many activities
as you used to?
__________________________
__________________________
…have you felt distant or
disconnected from others or have
you closed yourself off from other
people? (Tell me about that.)
__________________________
__________________________
…have you been unable to
experience good feelings, like
feeling happy, joyful, satisfied,
loving, or tender toward other
people? (Tell me about that.)
IF YES: Is this different from the
way you were before
(TRAUMATIC EVENT)?
__________________________
__________________________

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

PTSD Module

AT LEAST THREE “D” SXS
ARE CODED “3.”

APT24

APT25

RECORD
MODULE END
TIME ON PAGE
17 AND GO TO
NEXT MODULE

Since (TRAUMATIC EVENT)…

E. Marked alterations in
arousal and reactivity
associated with the
traumatic event(s),
beginning or worsening
after the traumatic
event(s) occurred, as
evidenced by two (or
more) of the following:

…have you lost control of your
anger, so that you threatened or
hurt someone or damaged
something? Tell me what
happened. (Was it over
something little or even nothing at
all?)

1. Irritable behavior and
angry outbursts (with
little or no provocation),
typically expressed as
verbal or physical
aggression toward
people or objects

IF NO: Since (TRAUMATIC
EVENT), have you been more
quick-tempered or had a shorter
“fuse” than before?
IF YES TO EITHER: How
different is this from the way you
were before (TRAUMATIC
EVENT)?
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

PTSD Module

Since (TRAUMATIC EVENT)…
…have you done reckless things,
like driving dangerously, or
drinking or using drugs without
caring about the consequences?
IF NO: How about hurting yourself
on purpose or trying to kill
yourself? (What did you do?)

APT26

3. Hypervigilance

APT27

4. Exaggerated startle
response

APT28

5. Problems with
concentration

APT29

2. Reckless or selfdestructive behavior
NOTE: Any current suicidal
thoughts, plans, or actions
should be thoroughly
assessed by the clinician
and action should be taken
if necessary.

IF YES TO EITHER: How
different is this from the way you
were before (TRAUMATIC
EVENT)?
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
…have you noticed that you have
been more watchful or on guard?
(What are some examples?)
IF NO: Have you been extra
aware of your surroundings and
your environment?
__________________________
__________________________
…have you been jumpy or easily
startled, like by sudden noises?
(Is this a change from before
[TRAUMATIC EVENT]?)
__________________________
__________________________
…have you had trouble
concentrating? (What are some
examples? (Is this a change from
before [TRAUMATIC EVENT]?)
__________________________
__________________________

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

PTSD Module

…how have you been sleeping
since (TRAUMATIC EVENT)? (Is
this a change from before
[TRAUMATIC EVENT]?)

6. Sleep disturbances (e.g.,
difficulty falling or
staying asleep or
restless sleep)

APT30

APT31

APT32

__________________________
__________________________
AT LEAST TWO “E” SXS
ARE CODED “3.”

1
RECORD
MODULE END
TIME ON PAGE
17 AND GO TO
NEXT MODULE

About how long did these (PTSD
SYMPTOMS CODED “3”) last
altogether?
__________________________

F. Duration of the
disturbance (symptoms
in criteria B, C, D, and E)
is more than 1 month.

__________________________

? = inadequate information

1 = absent or false

1
RECORD
MODULE END
TIME ON PAGE
17 AND GO TO
NEXT MODULE

2 = subthreshold

3 = threshold or true

PTSD Module

IF UNKNOWN: What effect did
(PTSD SXS) have on your life?
ASK THE FOLLOWING
QUESTIONS AS NEEDED TO
RATE CRITERION G:
How have (PTSD SXS) affected
your relationships or your
interactions with other people?
(Have they caused you any
problems in your relationships
with your family, romantic partner,
or friends?)

G. The disturbance causes
clinically significant
distress or impairment in
social, occupational, or
other important areas of
functioning.

APT33

APT34

CRITERION H HAS BEEN
OMITTED.

How have (PTSD SXS) affected
your work/schoolwork? (How
about your attendance at work or
school? Have they affected the
quality of your work/schoolwork?)
How have they affected your
ability to take care of things at
home? What about being involved
in things that are important to you
like religious activities, physical
exercise, or hobbies?
Have (PTSD SXS) affected any
other important part of your life?
IF HAVE NOT INTERFERED
WITH LIFE: How much have you
been bothered or upset by (PTSD
SXS)?
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
POSTTRAUMATIC
STRESS DISORDER
CRITERIA A, B, C, D, E, F,
AND G ARE CODED “3.”

? = inadequate information

1 = absent or false

1
RECORD
MODULE END
TIME ON PAGE
17 AND GO TO
NEXT MODULE

2 = subthreshold

POSTTRAUMATIC
STRESS
DISORDER

3 = threshold or true

PTSD Module

When did you last have (ANY
SXS OF PTSD)?
__________________________

Number of months prior to
interview when last had a
symptom of PTSD

____ ____ ____

APT35

Age at onset of
Posttraumatic Stress
Disorder (CODE 99 IF
UNKNOWN)

____ ____

APT36

__________________________
IF UNKNOWN: How old were you
when you first started having
(SXS OF PTSD)?
__________________________
__________________________

Module End Time: ____ ____ : ____ ____ AM/PM
GO TO NEXT MODULE

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

This page has been intentionally left blank.

SCID-RV for DSM-5®
Version 1.0.0

Panic Disorder Module

Michael B. First, M.D., Janet B. W. Williams, Ph.D.,
Rhonda S. Karg, Ph.D., Robert L. Spitzer, M.D.

Modified for the National Mental Health Study

Interviewer ID:

Date of Interview:

QUESTID:

This page has been intentionally left blank.

Panic Disorder Module

1
Module Start Time: ____ ____ : ____ ____ AM/PM

*PANIC DISORDER*
IF CASE IS IDENTIFIED AS
HAVING BEEN A POSITIVE
SCREEN FOR PANIC
DISORDER: You told us in the
previous interview that you have
had a panic or anxiety attack. I’d
like to ask you some questions
about those kinds of
experiences.

PANIC DISORDER CRITERIA

Have you ever had an intense
rush of anxiety, or what
someone might call a “panic
attack,” when you suddenly felt
very frightened or anxious
or suddenly developed a lot of
physical symptoms?
Tell me about that.
When was the last bad one?
What was it like? How did it
begin?
__________________________
__________________________
__________________________
A panic attack is an abrupt
surge of intense fear or
intense discomfort that
reaches a peak within
minutes.

IF UNKNOWN: Did the
symptoms come on suddenly?
IF YES: How long did it take
from when it began to when it
got really bad? (Did it happen
within a few minutes?)
__________________________

Note: The abrupt surge can
occur from a calm state or an
anxious state.

APD1

APD2

RECORD
MODULE END
TIME ON PAGE
7 AND GO TO
NEXT MODULE

__________________________
__________________________
During that attack…
…did your heart race, pound, or
skip?

1. Palpitations, pounding
heart, or accelerated heart
rate

__________________________
__________________________
__________________________
? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

Panic Disorder Module

…did you sweat?

2. Sweating

APD3

…did you tremble or shake?

3. Trembling or shaking

APD4

4. Sensations of shortness of
breath or smothering

APD5

5. Feelings of choking

APD6

6. Chest pain or discomfort

APD7

7. Nausea or abdominal
distress

APD8

8. Feeling dizzy, unsteady,
lightheaded, or faint

APD9

__________________________
__________________________
__________________________
…were you short of breath?
(Have trouble catching your
breath? Feel like you were being
smothered?)
__________________________
__________________________
__________________________
…did you feel as if you were
choking?
__________________________
__________________________
__________________________
…did you have chest pain or
pressure?
__________________________
__________________________
__________________________
…did you have nausea or upset
stomach or the feeling that you
were going to have diarrhea?
__________________________
__________________________
__________________________
…did you feel dizzy, unsteady,
or like you might faint?
__________________________
__________________________
__________________________

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

Panic Disorder Module

…did you have flushes, hot
flashes, or chills?

9. Chills or heat sensations

APD10

10. Paresthesias (numbness
or tingling sensations)

APD11

11. Derealization (feelings of
unreality) or
depersonalization (being
detached from oneself)

APD12

12. Fear of losing control or
“going crazy”

APD13

13. Fear of dying

APD14

__________________________
__________________________
__________________________
During that attack…
…did you have tingling or
numbness in parts of your
body?
__________________________
__________________________
__________________________
…did you have the feeling that
you were detached from your
body or mind, that time was
moving slowly, or that you were
an outside observer of your own
thoughts or movements?
IF NO: How about feeling that
everything around you was
unreal or that you were in a
dream?
__________________________
__________________________
__________________________
…were you afraid you were
going crazy or might lose
control?
__________________________
__________________________
__________________________
…were you afraid that you were
dying?
__________________________
__________________________
__________________________

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

Panic Disorder Module

AT LEAST FOUR ITEMS ARE
CODED “3” AND REACHED
THEIR PEAK WITHIN
MINUTES.

APD15

PANIC
ATTACK;
CONTINUE
WITH NEXT
ITEM

Besides the one you just
described, have you had any
other attacks that had even
more of the symptoms that I just
asked you about?
IF YES: GO BACK TO PAGE 1 AND
ASSESS THE SYMPTOMS OF
THAT ATTACK.
IF NO: RECORD MODULE END
TIME ON PAGE 9 AND GO TO
NEXT MODULE.

A. Recurrent unexpected
panic attacks

Have any of these attacks ever
come on out of the blue—in
situations where you didn’t
expect to be nervous or
uncomfortable?
IF YES: What was going on
when the attack(s) happened?
(What were you doing at the
time? Were you already nervous
or anxious at the time, or rather
were you relatively calm or
relaxed?)

APD16

RECORD
MODULE END
TIME ON PAGE
7 AND GO TO
NEXT MODULE

CONTINUE ON
NEXT PAGE

IF NO: How about the very first
one you had. What were you
doing at the time? (Were you
already nervous or anxious at
the time, or rather were you
relatively calm or relaxed?)
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
IF ATTACK IS UNEXPECTED:
How many of these kinds of
attacks have you had? (At least
two?)
__________________________
__________________________
? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

Panic Disorder Module

B. At least one of the attacks
has been followed by 1
month (or more) of one or
both of the following:

After any of these attacks…
…were you concerned or
worried that you might have
another attack or worried that
you would feel like you were
having a heart attack again, or
worried that you would lose
control or go crazy?

APD17

APD18

APD19

1. Persistent concern or
worry about additional
attacks or their
consequences (e.g., losing
control, having a heart
attack, “going crazy”)

IF YES: How long did that
concern or worry last? (Did it
last at least a month? Nearly
every day?)
__________________________
__________________________
__________________________
…did you do anything differently
because of the attacks (like
avoiding certain places or not
going out alone)? (What about
avoiding certain activities like
exercise? What about things like
always making sure you’re near
a bathroom or exit?)

2. A significant maladaptive
change in behavior related
to the attacks (e.g.,
behaviors designed to
avoid having panic attacks,
such as avoidance of
exercise or unfamiliar
situations)

IF YES: How long did that last?
(As long as a month?)
__________________________
__________________________
__________________________
CRITERION B.1 OR B.2 IS
CODED “3.”

1
RECORD
MODULE END
TIME ON PAGE
7 AND GO TO
NEXT MODULE

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

Panic Disorder Module

IF UNKNOWN: When did your
panic attacks start?
Just before you began having
panic attacks, were you taking
any drugs, caffeine, diet pills, or
other medicines?
(How much coffee, tea, or
caffeinated beverages do you
drink a day?)
Just before the attacks, were
you physically ill?
IF YES: What did the doctor
say?
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________

C. [Primary Anxiety Disorder]:
The disturbance is not
attributable to the
physiological effects of a
substance (e.g., a drug of
abuse, a medication) or to
another medical condition
(e.g., hyperthyroidism,
cardiopulmonary
disorders).
IF THERE IS ANY INDICATION THAT
PANIC ATTACKS MAY BE
SECONDARY (I.E., A DIRECT
PHYSIOLOGICAL CONSEQUENCE OF
A GMC OR SUBSTANCE/
MEDICATION), GO TO
GMC/SUBSTANCE FOR ANXIETY
DISORDER MODULE AND THEN
RETURN HERE TO MAKE A RATING
OF “1” OR “3.”

APD20

PRIMARY
ANXIETY
DISORDER

ALL DUE TO
SUBSTANCE
USE OR GMC;
RECORD
MODULE END
TIME ON PAGE 7
AND GO TO
NEXT MODULE

Etiological medical conditions
include endocrine disease (e.g.,
hyperthyroidism,
pheochromocytoma,
hypoglycemia,
hyperadrenocortisolism),
cardiovascular disorders (e.g.,
congestive heart failure,
pulmonary embolism, arrhythmia
such as atrial fibrillation),
respiratory illness (e.g., chronic
obstructive pulmonary disease,
asthma, pneumonia), metabolic
disturbances (e.g., vitamin B 12
deficiency, porphyria), and
neurological illness (e.g.,
neoplasms, vestibular dysfunction,
encephalitis, seizure disorders).
Etiological substances/
medications include alcohol (I/W);
caffeine (I); cannabis (I); opioids
(W); phencyclidine (I); other
hallucinogens (I); inhalants and
stimulants (including cocaine)
(I/W); sedatives, hypnotics, and
anxiolytics (W); anesthetics and
analgesics; sympathomimetics or
other bronchodilators;
anticholinergics; insulin; thyroid
preparations; oral contraceptives;
antihistamines; antiparkinsonian
medications; corticosteroids;
antihypertensive and
cardiovascular medications;
anticonvulsants; lithium carbonate;
antipsychotic medications;
antidepressant medications; and
exposure to heavy metals and
toxins such as organophosphate
insecticide, nerve gases, carbon
monoxide, carbon dioxide, and
volatile substances such as
gasoline and paint.

? = inadequate information

1 = absent or false

2 = subthreshold

CONTINUE
WITH NEXT
ITEM

3 = threshold or true

Panic Disorder Module

MAKE A NOTE BELOW IF YOU
SUSPECT THAT SYMPTOMS
REPORTED ARE BETTER
EXPLAINED BY ANOTHER
DISORDER.
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________

D. The disturbance is not
better explained by
another mental disorder
(e.g., the panic attacks do
not occur only in response
to feared social situations,
as in Social Anxiety
Disorder; in response to
circumscribed phobic
objects or situations, as in
Specific Phobia; in
response to obsessions,
as in ObsessiveCompulsive Disorder; in
response to reminders of
traumatic events, as in
Posttraumatic Stress
Disorder; or in response to
separation from
attachment figures, as in
Separation Anxiety
Disorder).

CRITERIA A, B, C, AND D
ARE CODED “3.”

APD21

APD22

RECORD
MODULE END
TIME BELOW
AND GO TO
NEXT MODULE

1
RECORD
MODULE
END TIME
BELOW
AND GO
TO NEXT
MODULE

LIFETIME
PANIC
DISORDER

*PAST PANIC DISORDER*
When did you last have (ANY
SXS OF PANIC DISORDER)?
__________________________

Number of months prior to
interview when last had a
symptom of Panic Disorder

____ ____ ____

APD23

____ ____

APD24

__________________________
IF UNKNOWN: How old were
you when you first started
having panic attacks?

Age at onset of Panic Disorder
(CODE 99 IF UNKNOWN)

__________________________
__________________________

Module End Time: ____ ____ : ____ ____ AM/PM
GO TO NEXT MODULE

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

This page has been intentionally left blank.

SCID-RV for DSM-5®
Version 1.0.0

Social Anxiety Disorder Module

Michael B. First, M.D., Janet B. W. Williams, Ph.D.,
Rhonda S. Karg, Ph.D., Robert L. Spitzer, M.D.

Modified for the National Mental Health Study

Interviewer ID:

Date of Interview:

QUESTID:

This page has been intentionally left blank.

Social Anxiety Disorder Module

1
Module Start Time: ____ ____ : ____ ____ AM/PM

*SOCIAL ANXIETY DISORDER*
IF CASE IS IDENTIFIED AS
HAVING BEEN A POSITIVE
SCREEN FOR SOCIAL ANXIETY:
You told us in the previous
interview that you have felt afraid,
anxious, or extremely shy in social
or performance situations. I’d like
to ask you some questions about.
Have you been especially nervous
or anxious in social situations like
having a conversation or meeting
unfamiliar people?
IF NO: Is there anything that you
have been afraid to do or felt very
uncomfortable doing in front of
other people, like speaking, eating,
writing, or using a public
bathroom?
__________________________
__________________________
IF YES TO ANY OF ABOVE: Tell
me about that. Give me some
examples of when this has
happened. (Situations like having
a conversation; meeting people
you don’t know; being observed
eating, drinking, or going to the
bathroom; or performing in front of
others?)

SOCIAL ANXIETY
DISORDER CRITERIA

A. Marked fear or anxiety
about one or more social
situations in which the
person is exposed to
possible scrutiny by
others. Examples
include social
interactions (e.g., having
a conversation, meeting
unfamiliar people), being
observed (e.g., eating or
drinking), and
performing in front of
others (e.g., giving a
speech).

ASO1

RECORD
MODULE END
TIME ON PAGE
7 AND GO TO
NEXT MODULE

NOTE: Code “1” if fear or
anxiety is limited to public
speaking and is within
normal limits.

__________________________
__________________________

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

Social Anxiety Disorder Module

What were you afraid would
happen when you were in
(SOCIAL OR PERFORMANCE
SITUATION)? (Were you afraid of
being embarrassed because of
what you might say or how you
might act? Were you afraid that
this would lead to your being
rejected by other people? How
about making others
uncomfortable or offending them
because of what you said or how
you acted?)

B. The individual fears that
he or she will act in a
way or show anxiety
symptoms that will be
negatively evaluated
(i.e., will be humiliating
or embarrassing, will
lead to rejection or
offend others).

C. The social situations
almost always provoke
fear or anxiety.

D. The social situations are
avoided or endured with
intense fear or anxiety.

E. The fear or anxiety is out
of proportion to the
actual threat posed by
the social situation and
to the sociocultural
context.

ASO2

ASO3

ASO4

ASO5

RECORD
MODULE END
TIME ON PAGE
7 AND GO TO
NEXT MODULE

__________________________
__________________________
Have you almost always felt
frightened when you would be in
(FEARED SOCIAL OR
PERFORMANCE SITUATIONS)?
__________________________
__________________________
IF UNKNOWN: Did you go out of
your way to avoid (FEARED
SOCIAL OR PERFORMANCE
SITUATIONS)?
IF NO: How hard was it for you to
be in (FEARED SOCIAL
SITUATION)?

RECORD
MODULE END
TIME ON PAGE
7 AND GO TO
NEXT MODULE

__________________________
__________________________
IF UNKNOWN: What would you
say would be the likely outcome of
(PERFORMING POORLY IN
SOCIAL SITUATIONS)? (Were
these situations actually
dangerous in some way, like
avoiding being bullied or
tormented by someone?)
__________________________
__________________________

? = inadequate information

RECORD
MODULE END
TIME ON PAGE
7 AND GO TO
NEXT MODULE

NOTE: Code “3” if no threat
is posed by social situation
or is out of proportion to
actual threat or sociocultural
context.

1 = absent or false

2 = subthreshold

3 = threshold or true

Social Anxiety Disorder Module

IF UNCLEAR: How long have
(SXS OF SOCIAL ANXIETY
DISORDER) lasted? (Have they
lasted for at least 6 months or
more?)

F. The fear, anxiety, or
avoidance is persistent,
typically lasting for 6
months or more.

__________________________

ASO6

RECORD
MODULE END
TIME ON PAGE
7 AND GO TO
NEXT MODULE

__________________________

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

Social Anxiety Disorder Module

IF UNKNOWN: What effect have
(SOCIAL ANXIETY SXS) had on
your life?
ASK THE FOLLOWING
QUESTIONS AS NEEDED TO
RATE CRITERION G:

G. The fear, anxiety, or
avoidance causes
clinically significant
distress or impairment
in social, occupational,
or other important areas
of functioning.

ASO7

RECORD
MODULE END
TIME ON PAGE
7 AND GO TO
NEXT MODULE

How have (SOCIAL ANXIETY
SXS) affected your ability to have
friends or meet new people? (How
about dating?) How have (SOCIAL
ANXIETY SXS) affected your
interactions with other people,
especially unfamiliar people?
How have (SOCIAL ANXIETY
SXS) affected your ability to do
things at school or at work that
require interacting with other
people? (How about making
presentations or giving talks?)
Have you avoided going to school
or to work if you think you will be
put in a situation that makes you
uncomfortable?
How have (SOCIAL ANXIETY
SXS) affected your ability to work,
take care of your family or
household needs, or be involved in
things that are important to you like
religious activities, physical
exercise, or hobbies?
Have (SOCIAL ANXIETY SXS)
affected any other important part of
your life?
IF HAVE NOT INTERFERED
WITH FUNCTIONING: How much
have you been bothered or upset
by having (SOCIAL ANXIETY
SXS)?
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

Social Anxiety Disorder Module

IF UNKNOWN: When did you
begin having (SOCIAL ANXIETY
SXS)?
Just before you began having
(SOCIAL ANXIETY SXS), were
you taking any drugs, caffeine, diet
pills, or other medicines?
(How much coffee, tea, or
caffeinated beverages did you
drink a day?)
Just before (SOCIAL ANXIETY
SXS) began, were you physically
ill?
IF YES: What did the doctor say?
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________

H. [Primary Anxiety
Disorder]: The fear,
anxiety, or avoidance is
not attributable to the
physiological effects of
a substance (e.g., a
drug of abuse, a
medication) or to
another medical
condition.
IF THERE IS ANY INDICATION
THAT THE ANXIETY MAY BE
SECONDARY (I.E., A DIRECT
PHYSIOLOGICAL
CONSEQUENCE OF A GMC OR
SUBSTANCE/MEDICATION), GO
TO GMC/SUBSTANCE FOR
ANXIETY DISORDER MODULE
AND THEN RETURN HERE TO
MAKE A RATING OF “1” OR “3.”

ASO8

PRIMARY
ANXIETY
DISORDER

ALL DUE TO
SUBSTANCE
USE OR GMC;
RECORD
MODULE END
TIME ON PAGE 7
AND GO TO
NEXT MODULE
CONTINUE
WITH NEXT
ITEM

Etiological medical conditions
include endocrine disease (e.g.,
hyperthyroidism,
pheochromocytoma,
hypoglycemia,
hyperadrenocortisolism),
cardiovascular disorders (e.g.,
congestive heart failure, pulmonary
embolism, arrhythmia such as
atrial fibrillation), respiratory illness
(e.g., chronic obstructive
pulmonary disease, asthma,
pneumonia), metabolic
disturbances (e.g., vitamin B 12
deficiency, porphyria), and
neurological illness (e.g.,
neoplasms, vestibular dysfunction,
encephalitis, seizure disorders).
Etiological substances/
medications include alcohol (I/W);
caffeine (I); cannabis (I); opioids
(W); phencyclidine (I); other
hallucinogens (I); inhalants and
stimulants (including cocaine)
(I/W); sedatives, hypnotics, and
anxiolytics (W); anesthetics and
analgesics; sympathomimetics or
other bronchodilators;
anticholinergics; insulin; thyroid
preparations; oral contraceptives;
antihistamines; antiparkinsonian
medications; corticosteroids;
antihypertensive and
cardiovascular medications;
anticonvulsants; lithium
carbonate; antipsychotic
medications; antidepressant
medications; and exposure to
heavy metals and toxins such as
organophosphate insecticide,
nerve gases, carbon monoxide,
carbon dioxide, and volatile
substances such as gasoline and
paint.

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

Social Anxiety Disorder Module

The fear, anxiety, or
avoidance is not better
explained by the
symptoms of another
mental disorder such as
Panic Disorder,
Separation Anxiety
Disorder, Body
Dysmorphic Disorder, or
Autism Spectrum
Disorder.

ASO9

ASO10

ASO11

RECORD
MODULE END
TIME ON PAGE
7 AND GO TO
NEXT MODULE

__________________________
__________________________

IF A GENERAL MEDICAL
CONDITION OR MENTAL
DISORDER CHARACTERIZED BY
POTENTIALLY EMBARRASSING
SYMPTOMS IS PRESENT: Has
your avoidance of (SOCIAL
SITUATIONS) been related to your
(MEDICAL CONDITION OR
MENTAL DISORDER)?
IF YES: How have you dealt with
your condition?

J. If another medical
condition (e.g.,
Parkinson’s disease,
obesity, disfigurement
from burns or injury) [or
potentially
embarrassing mental
disorder] is present, the
fear, anxiety, or
avoidance is clearly
unrelated or is
excessive.

RECORD
MODULE END
TIME ON PAGE
7 AND GO TO
NEXT MODULE

__________________________
__________________________
SOCIAL ANXIETY
DISORDER CRITERIA A,
B, C, D, E, F, G, H, I, AND
J ARE CODED “3.”

IF UNKNOWN: How old were you
when you first started having (SXS
OF SOCIAL ANXIETY
DISORDER)?

1
RECORD
MODULE
END TIME
ON PAGE
7 AND GO
TO NEXT
MODULE

Age at onset of Social
Anxiety Disorder (CODE 99
IF UNKNOWN)

SOCIAL
ANXIETY
DISORDER

____ ____

ASO12

__________________________
__________________________
Specify if:
____

? = inadequate information

ASO13

Performance only: if the fear is restricted
to speaking or performing in public

1 = absent or false

2 = subthreshold

3 = threshold or true

Social Anxiety Disorder Module

When did you last have (ANY SXS
OF SOCIAL ANXIETY
DISORDER)?
__________________________

Number of months prior to
interview when last had a
symptom of Social Anxiety
Disorder

____ ____ ____

ASO14

Age at onset of Social
Anxiety Disorder (CODE 99
IF UNKNOWN)

____ ____

ASO15

__________________________
IF UNKNOWN: How old were you
when you first started having (SXS
OF SOCIAL ANXIETY
DISORDER)?
__________________________
__________________________

Module End Time: ____ ____ : ____ ____ AM/PM
GO TO NEXT MODULE

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

This page has been intentionally left blank.

SCID-RV for DSM-5®
Version 1.0.0

Generalized Anxiety Disorder Module

Michael B. First, M.D., Janet B. W. Williams, Ph.D.,
Rhonda S. Karg, Ph.D., Robert L. Spitzer, M.D.

Modified for the National Mental Health Study

Interviewer ID:

Date of Interview:

QUESTID:

This page has been intentionally left blank.

Generalized Anxiety Disorder Module

1
Module Start Time: ____ ____ : ____ ____ AM/PM

*GENERALIZED ANXIETY
DISORDER*
IF CASE IS IDENTIFIED AS
HAVING BEEN A POSITIVE
SCREEN FOR GENERALIZED
ANXIETY: You told us in the
previous interview that you have
felt anxious, nervous, or worried at
some time in your life. I’d like to ask
you some questions about.

GENERALIZED ANXIETY
DISORDER CRITERIA

Have you ever had a time lasting at
least several months in which you
were feeling anxious and worried for
a lot of the time? (Tell me about that
time.)

A. Excessive anxiety and
worry (apprehensive
expectation), occurring
more days than not for
at least 6 months,
about a number of
events or activities
(such as work or
school performance)

What kinds of things did you worry
about? (What about your job, your
health, your family members, your
finances, or other smaller things like
being late for appointments?) How
much did you worry about (EVENTS
OR ACTIVITIES)? What else did
you worry about?

AGA1

RECORD
MODULE END
TIME ON PAGE
6 AND GO TO
NEXT MODULE

Did you worry about (EVENTS OR
ACTIVITIES) even when there was
no reason? (Did you worry more
than most people would in your
circumstances? Did anyone else
think you worried too much? Did
you worry more than you should
have given your actual
circumstances?)
When was that? How long did it
last? (At least 6 months?) During
that time, were you worrying more
days than not?
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

Generalized Anxiety Disorder Module

When you were worrying, did you
find that it was hard to stop
yourself?

B. The person finds it
difficult to control the
worry.

__________________________
__________________________
Now I am going to ask you some
questions about symptoms that
often go along with being nervous or
worried.
Thinking about those times during
(6-MONTH PERIOD OF ANXIETY
AND WORRY NOTED ABOVE)
when you were feeling nervous,
anxious, or worried…
…did you often feel physically
restless, like you can’t sit still?

AGA2

RECORD
MODULE END
TIME ON PAGE
6 AND GO TO
NEXT MODULE

C. The anxiety and worry
are associated with
three (or more) of the
following six symptoms
(with at least some
symptoms present for
more days than not for
the past 6 months):

1. Restlessness or feeling
keyed up or on edge

AGA3

2. Being easily fatigued

AGA4

3. Difficulty concentrating
or mind going blank

AGA5

4. Irritability

AGA6

5. Muscle tension

AGA7

…did you often feel keyed up or on
edge?
__________________________
__________________________
__________________________
…did you often tire easily?
__________________________
__________________________
…did you often have trouble
concentrating or did your mind often
go blank?
__________________________
__________________________
…were you often irritable?
__________________________
__________________________
…were your muscles often tense?
__________________________
__________________________

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

Generalized Anxiety Disorder Module

…did you often have trouble falling
or staying asleep? How about often
feeling tired when you woke up
because you didn’t get a good
night’s sleep?

6. Sleep disturbance
(difficulty falling or
staying asleep, or
restless, unsatisfying
sleep)

AGA8

AT LEAST THREE “C”
SXS ARE CODED “3.”

AGA9

__________________________
__________________________
__________________________
IF UNCLEAR: Did at least some of
these symptoms like (SXS CODED
“3”) happen for more days than not
over the (6-MONTH PERIOD OF
ANXIETY AND WORRY)?
__________________________

RECORD
MODULE END
TIME ON PAGE
6 AND GO TO
NEXT MODULE

__________________________

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

Generalized Anxiety Disorder Module

IF UNKNOWN: What effect did
(GAD SXS) have on your life?
ASK THE FOLLOWING
QUESTIONS AS NEEDED TO
RATE CRITERION D:
How did (GAD SXS) affect your
relationships or your interactions
with other people? (Did [GAD SXS]
cause you any problems in your
relationships with your family,
romantic partner, or friends?)

D. The anxiety, worry, or
physical symptoms
cause clinically
significant distress or
impairment in social,
occupational, or other
important areas of
functioning.

AGA10

RECORD
MODULE END
TIME ON PAGE
6 AND GO TO
NEXT MODULE

How did (GAD SXS) affect your
work/schoolwork? (How about your
attendance at work or school? Did
[GAD SXS] make it more difficult to
do your work/schoolwork)? How did
[GAD SXS] affect the quality of your
work/schoolwork?)
How did (GAD SXS) affect your
ability to take care of things at
home? How about doing other
things that are important to you like
religious activities, physical
exercise, or hobbies? Did you avoid
doing anything because you felt like
you weren’t up to it?
Did your anxiety or worry affect any
other important part of your life?
IF HAS NOT INTERFERED WITH
LIFE: How much were you bothered
or upset by having (GAD SXS)?
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

Generalized Anxiety Disorder Module

IF UNKNOWN: When did (GAD
SXS) begin?
Just before you began having (GAD
SXS), were you taking any drugs,
caffeine, diet pills, or other
medicines?
(How much coffee, tea, or
caffeinated soda did you drink a
day?)
Just before (GAD SXS) began, were
you physically ill?
IF YES: What did the doctor say?
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________

E. [Primary Anxiety
Disorder]: The
disturbance is not
attributable to the
physiological effects of
a substance (e.g., a
drug of abuse, a
medication) or to
another medical
condition.
IF THERE IS ANY INDICATION
THAT THE ANXIETY MAY BE
SECONDARY (I.E., A DIRECT
PHYSIOLOGICAL
CONSEQUENCE OF A GMC OR
SUBSTANCE/MEDICATION), GO
TO GMC/SUBSTANCE FOR
ANXIETY DISORDER MODULE
AND THEN RETURN HERE TO
MAKE A RATING OF “1” OR “3.”

AGA11

PRIMARY
ANXIETY
DISORDER

ALL DUE TO
GMC OR
SUBSTANCE/
MEDICATION
USE; RECORD
MODULE END
TIME ON PAGE 6
AND GO TO
NEXT MODULE

Etiological medical conditions
include endocrine disease (e.g.,
hyperthyroidism,
pheochromocytoma,
hypoglycemia,
hyperadrenocortisolism),
cardiovascular disorders (e.g.,
congestive heart failure,
pulmonary embolism, arrhythmia
such as atrial fibrillation),
respiratory illness (e.g., chronic
obstructive pulmonary disease,
asthma, pneumonia), metabolic
disturbances (e.g., vitamin B 12
deficiency, porphyria), and
neurological illness (e.g.,
neoplasms, vestibular
dysfunction, encephalitis, seizure
disorders).
Etiological substances/
medications include alcohol
(I/W); caffeine (I); cannabis (I);
opioids (W); phencyclidine (I);
other hallucinogens (I); inhalants
and stimulants (including
cocaine) (I/W); sedatives,
hypnotics, and anxiolytics (W);
anesthetics and analgesics;
sympathomimetics or other
bronchodilators; anticholinergics;
insulin; thyroid preparations; oral
contraceptives; antihistamines;
antiparkinsonian medications;
corticosteroids; antihypertensive
and cardiovascular medications;
anticonvulsants; lithium
carbonate; antipsychotic
medications; antidepressant
medications; and exposure to
heavy metals and toxins such as
organophosphate insecticide,
nerve gases, carbon monoxide,
carbon dioxide, and volatile
substances such as gasoline
and paint.

? = inadequate information

1 = absent or false

2 = subthreshold

CONTINUE
WITH NEXT
ITEM

3 = threshold or true

Generalized Anxiety Disorder Module

F. The disturbance is not
better explained by
another mental
disorder (e.g., anxiety
or worry about having
a panic attack in Panic
Disorder, negative
evaluation in Social
Anxiety Disorder,
contamination or other
obsessions in
Obsessive-Compulsive
Disorder, separation
from attachment
figures in Separation
Anxiety Disorder,
gaining weight in
Anorexia Nervosa,
physical complaints in
Somatic Symptom
Disorder, perceived
appearance flaws in
Body Dysmorphic
Disorder, having a
serious illness in
Illness Anxiety
Disorder, or the
content of delusional
beliefs in
Schizophrenia or
Delusional Disorder).
GENERALIZED ANXIETY
CRITERIA A, B, C, D, E,
AND F ARE CODED “3.”

*AGE AT ONSET*
IF UNKNOWN: How old were you
when you first started having (GAD
SXS)?
__________________________

AGA12

AGA13

RECORD
MODULE END
TIME BELOW
AND GO TO
NEXT MODULE

1
RECORD
MODULE END
TIME BELOW
AND GO TO
NEXT MODULE

Age at onset of
Generalized Anxiety
Disorder (CODE 99 IF
UNKNOWN)

PAST
GENERALIZED
ANXIETY
DISORDER

____ ____

AGA14

__________________________

Module End Time: ____ ____ : ____ ____ AM/PM
GO TO NEXT MODULE
? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

SCID-RV for DSM-5®
Version 1.0.0

Eating Disorders Module

Michael B. First, M.D., Janet B. W. Williams, Ph.D.,
Rhonda S. Karg, Ph.D., Robert L. Spitzer, M.D.

Modified for the National Mental Health Study

Interviewer ID:

Date of Interview:

QUESTID:

This page has been intentionally left blank.

Eating Disorders Module

1
Module Start Time: ____ ____ : ____ ____ AM/PM

*BULIMIA NERVOSA*
BULIMIA NERVOSA CRITERIA
IF CASE IS IDENTIFIED AS HAVING BEEN A POSITIVE SCREEN FOR BINGE EATING: You
told us in the previous interview that you’d had a time in your life when you ate a lot of food
during a short period of time at least once a week. I’d like to ask you some questions about times
when you may have done that.
Have you had eating binges, that is,
times when you couldn’t resist eating
a lot of food or stop eating once you
started? Tell me about those times.
__________________________

A. Recurrent episodes of
binge eating occur. An
episode of binge eating is
characterized by BOTH of
the following:

__________________________
During these times, were you unable
to control what or how much you
were eating?
__________________________
__________________________

2. A sense of lack of control
over eating during the
episode (e.g., a feeling that
one cannot stop eating or
control what or how much
one is eating)

AEA1

AEA2

AEA3

RECORD
MODULE END
TIME ON PAGE
4 AND GO TO
NEXT MODULE

NOTE: Criterion A.2 (lack of
control) precedes criterion A.1
to tie in with screening
question.
During those times, how much did
you eat? Over what period of time?
What’s the most you might eat at
such times? (Does this only happen
during celebrations or holidays?)
__________________________
__________________________

1. Eating, in a discrete period
of time (e.g., within any 2hour period), an amount of
food that is definitely larger
than what most people
would eat during a similar
period of time and under
similar circumstances

RECORD
MODULE END
TIME ON PAGE
4 AND GO TO
NEXT MODULE

__________________________
__________________________
CRITERIA A.2 AND A.1 ARE
CODED “3.”

1
RECORD
MODULE END
TIME ON PAGE
4 AND GO TO
NEXT MODULE

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

Eating Disorders Module

B. Recurrent inappropriate
compensatory behavior
occurs in order to prevent
weight gain, such as selfinduced vomiting; misuse of
laxatives, diuretics,
enemas, or other
medications; fasting; or
excessive exercise.

C. The binge eating and
inappropriate
compensatory behaviors
both occur, on average, at
least once a week for 3
months.

D. Self-evaluation is unduly
influenced by body shape
and weight.

IF UNKNOWN: Do you binge eat and E. The disturbance does not
occur exclusively during
then (ENGAGE IN COMPENSATORY
episodes of Anorexia
BEHAVIOR) only when your weight is
Nervosa.
very low?

Have you ever done anything to
keep yourself from gaining weight
because of the binge eating (like
making yourself vomit; taking
laxatives, enemas, water pills, or
thyroid hormone; strict dieting or
fasting; or exercising a lot)? Tell me
about that. How often did this occur?
__________________________

AEA4

AEA5

AEA6

AEA7

AEA8

RECORD
MODULE END
TIME ON PAGE
4 AND GO TO
NEXT MODULE

BULIMIA
NERVOSA

GO TO *BINGEEATING
DISORDER* ON
PAGE 3

__________________________
How often were you binge eating and
(COMPENSATORY BEHAVIOR[S])?
(At least once a week for at least 3
months?)
__________________________

GO TO *BINGEEATING
DISORDER* ON
PAGE 3

__________________________
Has your body shape and weight
ever been an important factor in how
you felt about yourself?

IF YES: How important?
__________________________
__________________________

__________________________
__________________________
BULIMIA NERVOSA CRITERIA
A, B, C, D, AND E ARE
CODED “3.”

When did you last have (ANY SXS
OF BULIMIA NERVOSA)?
__________________________

Number of months prior to
interview when last had a
symptom of Bulimia Nervosa

RECORD
MODULE END
TIME ON PAGE
4 AND GO TO
NEXT MODULE

____ ____ ____

AEA9

____ ____

AEA10

__________________________
*AGE AT ONSET*
IF UNKNOWN: How old were you
when you first started having (SXS
OF BULIMIA NERVOSA)?

Age at onset of Bulimia
Nervosa (CODE 99 IF
UNKNOWN)

__________________________
__________________________

? = inadequate information

1 = absent or false

RECORD
MODULE END
TIME ON PAGE
4 AND GO TO
NEXT MODULE

2 = subthreshold

3 = threshold or true

Eating Disorders Module

*BINGE-EATING DISORDER*
During these binges did you…

BINGE-EATING DISORDER CRITERIA
NOTE: Criterion A has already
been rated “3” in the context of
the Bulimia Nervosa evaluation,
page 1.
B. The binge-eating episodes
are associated with three
(or more) of the following:

…eat much more rapidly than
normal?

1. Eating much more rapidly
than normal

AEA11

2. Eating until feeling
uncomfortably full

AEA12

3. Eating large amounts of
food when not feeling
physically hungry

AEA13

4. Eating alone because of
being embarrassed by how
much one is eating

AEA14

5. Feeling disgusted with
oneself, depressed, or very
guilty afterward

AEA15

AEA16

AEA17

__________________________
__________________________
…ever eat until you felt
uncomfortably full?
__________________________
__________________________
…ever eat large amounts of food
when you didn’t feel physically
hungry?
__________________________
__________________________
…ever eat alone because you were
embarrassed by how much you were
eating?
__________________________
__________________________
…ever feel disgusted with yourself,
depressed, or feel very guilty after
overeating?
__________________________
__________________________
AT LEAST 3 “B” SXS ARE
CODED “3.”
Was it very upsetting to you that you
couldn’t stop eating or control what
or how much you were eating?

C. Marked distress regarding
binge eating is present.

__________________________
__________________________

? = inadequate information

1 = absent or false

1
?

RECORD
MODULE END
TIME ON PAGE
4 AND GO TO
NEXT MODULE

2 = subthreshold

3 = threshold or true

Eating Disorders Module

IF UNKNOWN: How often did you
binge eat? (For how long a period of
time? At least once a week for at
least 3 months?)

D. The binge eating occurs, on
average, at least once a
week for 3 months.

E. The binge eating is not
associated with the
recurrent use of
inappropriate
compensatory behaviors as
in Bulimia Nervosa and
does
not occur exclusively during
the course of Bulimia
Nervosa or Anorexia
Nervosa.

__________________________
__________________________
IF UNKNOWN OR UNCLEAR: Did
you ever do anything to keep
yourself from gaining weight because
of the binge eating (like making
yourself vomit; taking laxatives,
enemas, water pills, or thyroid
hormone; strict dieting or fasting; or
exercising a lot)?
IF UNKNOWN: Do you binge eat
only when your weight is very low?
__________________________

AEA18

AEA19

AEA20

RECORD
MODULE END
TIME BELOW
AND GO TO
NEXT MODULE

NOTE: Code “3” if no recurrent
inappropriate compensatory
behaviors.

__________________________

BINGE-EATING DISORDER
CRITERIA A, B, C, D, AND E
ARE CODED “3.”
NOTE: Criterion A for BingeEating Disorder has already
been coded “3” as part of the
assessment for Bulimia
Nervosa, page 1.
When did you last have (ANY SXS
OF BINGE-EATING DISORDER)?
__________________________

Number of months prior to
interview when last had a
symptom of Binge-Eating
Disorder

1
RECORD
MODULE END
TIME BELOW
AND GO TO
NEXT MODULE

BINGEEATING
DISORDER

____ ____ ____

AEA21

____ ____

AEA22

__________________________
*AGE AT ONSET*
IF UNKNOWN: How old were you
when you first started having (SXS
OF BINGE-EATING DISORDER)?

Age at onset of Binge-Eating
Disorder (CODE 99 IF
UNKNOWN)

__________________________
__________________________

Module End Time: ____ ____ : ____ ____ AM/PM
GO TO NEXT MODULE

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

IPDE
Borderline Personality Disorder Module

World Health Organization

Modified for the National Mental Health Study

Interviewer ID:

Date of Interview:

QUESTID:

This page has been intentionally left blank.

Borderline Personality Disorder Module

1
Module Start Time: ____ ____ : ____ ____ AM/PM

Now let me ask some questions
about the kind of person you are.

Disturbances in and
uncertainty about
self-image

ABP1

How would you describe your
personality?
__________________________
__________________________
__________________________
Have you always been like that?
IF NO: When did you change?
What were you like before?
Do you think one of your problems
is that you're not sure what kind of
person you are?
IF YES: How does that affect your
life?
Do you behave as though you
don't know what to expect of
yourself?
IF YES: Are you so different with
different people or in different
situations that you don't behave
like the same person?
IF YES: Give me some examples.
IF NO: Have others told you that
you're like that?
IF YES: Why do you think they've
said that?
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________

? = inadequate information

0 = absent or false

1 = subthreshold

2 = threshold

Borderline Personality Disorder Module
What would you like to accomplish
during your life?
Do your ideas about this change
often?
IF YES: Tell me about it.
(NOT ASKED OF
HOUSEWIVES/HOMEMAKERS,
ADOLESCENTS, STUDENTS,
AND THOSE WHO NEVER OR
ALMOST NEVER WORKED):
Do you often wonder whether
you've made the right choice of job
or career?
IF YES: How does that affect you?
(ASKED ONLY OF
HOUSEWIVES/HOMEMAKERS):
Do you often wonder whether
you've made the right choice in
becoming a housewife/
homemaker?
IF YES: How does that affect you?
(ASKED ONLY OF
ADOLESCENTS, STUDENTS,
AND THOSE WHO NEVER OR
ALMOST NEVER WORKED):
Have you made up your mind
about what kind of job or career
you would like to have?
IF NO: How does that affect you?
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________

Disturbances in and
uncertainty about
aims

ABP2

The requirements for
this criterion may be
fulfilled in any one of
several different ways.
Subjects may report
that they cannot
decide about their
long-term goals or
career choice, and
that this has an
obvious effect on the
way they lead their
lives. They may deny
that they are uncertain
about them, but it may
be obvious from their
behavior, which is
characterized by
persistently erratic or
fluctuating
consideration or
selection of strikingly
different careers or
long-term goals.
Persons 30 years of
age or older who have
not embarked on a
career path (when one
is available to them),
or insist that they have
no idea at all about
what their long-term
goals are, should
receive a score of 2.
The criterion should
be scored
conservatively with
adolescents and not
usually given to them.
2 = Obvious and welldocumented
persistent uncertainty
about long-term goals
or career choice
1 = Probable but less
well documented or
persistent uncertainty
about long-term goals
or career choice
0 = Absent, doubtful,
or not supported by
convincing examples

? = inadequate information

0 = absent or false

1 = subthreshold

2 = threshold

Borderline Personality Disorder Module
Do you have trouble deciding
what's important in life?

Disturbance in and
uncertainty about
internal preferences

IF YES: How does that affect you
or the way you live your life?
Do you have trouble deciding
what's morally right and wrong?
IF YES: How does that affect you
or the way you live your life?
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________

3
?

ABP3

In this context
"internal preferences"
refers both to issues
of ethics and morality
("right and wrong")
and to values (what is
important in life). For a
positive score both are
not required. Subjects
may qualify for either
in two ways. They
may report that they
are so uncertain about
internal preferences
that it causes
subjective distress or
problems in social or
occupational
functioning. Or they
may, with or without
acknowledgment or
awareness of any
uncertainty,
demonstrate the
phenomenon by
extremely erratic or
inconsistent behavior
indicative of uncertain
values.
2 = Obvious and welldocumented
persistent uncertainty
about internal
preferences
1 = Probable but less
well documented or
persistent uncertainty
about internal
preferences
0 = Absent, doubtful,
or not well supported
by convincing
examples

? = inadequate information

0 = absent or false

1 = subthreshold

2 = threshold

Borderline Personality Disorder Module
Do you have trouble sticking with a
plan or course of action if you don’t
get something out of it right away?
IF YES: Does that ever cause
problems for you or get you into
trouble?
IF YES: Give me some examples.
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________

Difficulty in
maintaining any
course of action that
offers no immediate
reward

ABP4

This refers to
impatience and lack of
perseverance when
there is no immediate
reward. To be scored
positively there must
be evidence from
convincing examples
that this results in
subjective distress or
problems in social or
occupational
functioning.
Impatience associated
with the pursuit of
minor, everyday
matters is not within
the scope of the
criterion.
2 = Frequently has
difficulty maintaining
any course of action
that offers no
immediate reward.
This sometimes
causes subjective
distress or problems in
social or occupational
functioning.
1 = Occasionally has
difficulty maintaining
any course of action
that offers no
immediate reward.
This sometimes
causes subjective
distress or problems in
social or occupational
functioning.
0 = Denied, rare, or
unconvincing
examples

? = inadequate information

0 = absent or false

1 = subthreshold

2 = threshold

Borderline Personality Disorder Module

Do you have a lot of trouble
deciding what type of friends you
should have?

Disturbances in and
uncertainty about
internal preferences

IF YES: Does that have an effect
on your life or cause any problems
for you?

This aspect of the
criterion is met when
subjects report that
they are so uncertain
about what type of
friends they desire
that this causes
significant distress or
problems in their
relations with others.
A positive score is
also given when
subject describes
frequent or erratic
changes in the type of
friends they have,
even if they don't
acknowledge
uncertainty about the
type of friends to
have. Doubt about
whether to have a
particular person as a
friend is not within the
scope of the criterion,
unless it is a particular
instance of the more
general uncertainty
about the type of
friends to have.

IF YES: Give me some examples.
Does the kind of people you have
as friends keep changing?
IF YES: Tell me about it.
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________

ABP5

2 = Obvious and welldocumented
persistent uncertainty
about type of friends
to have
1 = Probable but less
well documented or
persistent uncertainty
about type of friends
to have
0 = Absent, doubtful,
or not supported by
convincing examples

? = inadequate information

0 = absent or false

1 = subthreshold

2 = threshold

Borderline Personality Disorder Module

Do you get into intense and stormy
relationships with other people with
lots of ups and downs? I mean
where your feelings about them
run "hot" and "cold" or change from
one extreme to the other.

Liability to become
involved in intense
and unstable
relationships often
leading to emotional
crises

IF YES: In those relationships do
you often find yourself alternating
between admiring and despising
the same person?

For a positive score
three features must be
present: instability,
strong feelings, and
alternation between
over-idealization and
devaluation. The latter
does not require
continuous switching
from over-idealization
to devaluation. If the
other requirements
are met, it does not
matter whether the
behavior is confined to
specific types of
relationships (e.g.,
those with parents,
members of the
opposite sex, etc.).

IF YES: Give me some examples.
In how many different relationships
has this happened?
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________

ABP6

2 = Examples
illustrating a pattern of
unstable and intense
relationships (more
than one or two)
characterized by
alternating between
the extremes of overidealization and
devaluation
1 = Examples
illustrating that one or
two relationships were
unstable, intense, and
characterized by
alternating between
the extremes of overidealization and
devaluation
0 = Denied or not
supported by
convincing examples
? = inadequate information

0 = absent or false

1 = subthreshold

2 = threshold

Borderline Personality Disorder Module
Do you have a habit of getting into
arguments and disagreements?
IF YES: When are you likely to
behave like that? Give me some
examples.
IF NO: Have people told you that
you argue or disagree too much?
IF YES: Why do you think they've
said that?
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________

Marked tendency for ?
quarrelsome
behavior and conflict
with others,
especially when
impulsive acts are
thwarted or criticized

ABP7

To receive a positive
score there must be
evidence from
examples that the
quarrelsome behavior
and conflicts occur
especially when the
subject's impulsive
acts are prevented,
condemned, or
criticized.
2 = Frequently
engages in
quarrelsome behavior
and conflicts with
others, especially
when impulsive acts
are prevented,
condemned, or
criticized
1= Occasionally
engages in
quarrelsome behavior
and conflicts with
others, especially
when impulsive acts
are prevented,
condemned, or
criticized.
0 = Denied, rare, not
in relation to impulsive
acts, or not supported
by convincing
examples

? = inadequate information

0 = absent or false

1 = subthreshold

2 = threshold

Borderline Personality Disorder Module
Do you sometimes get angrier than
you should, or feel very angry
without a good reason?
IF YES: Give me some examples.
IF NO: Have people ever told you
that you're a very angry person?
IF YES: Why do you think they've
said that?
Do you ever lose your temper and
have tantrums or angry outbursts?
IF YES: Do you yell and scream in
an uncontrolled way?
IF YES: Give me some examples.
Do you ever throw, break, or
smash things?
IF YES: Give me some examples.
Do you ever hit or assault people?
IF YES: Give me some examples.
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________

Liability to outbursts
of anger or violence,
with inability to
control the resulting
behavioral
explosions

ABP8

The subjective
experience of intense
anger or
psychodynamically
inferred anger are not
within the scope of the
criterion. The anger
must be either
inappropriate or
intense and
uncontrolled. Overt
verbal or physical
displays of anger are
required.
2 = Frequently
verbally displays
inappropriate or
intense, uncontrolled
anger. Occasionally
indulges in extreme
physical displays of
inappropriate or
intense, uncontrolled
anger.
1 = Occasionally
verbally displays
inappropriate or
intense, uncontrolled
anger. On one or two
occasions indulged in
extreme physical
displays of
inappropriate or
intense, uncontrolled
anger.
0 = Denied

? = inadequate information

0 = absent or false

1 = subthreshold

2 = threshold

Borderline Personality Disorder Module
Do you often feel empty inside?
IF YES: Does that upset you or
cause any problems for you?
IF YES: Tell me about it.
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________

Chronic feelings of
emptiness

ABP9

For a positive score
there must be
evidence that the
emptiness is obviously
distressing to the
subject or leads to
maladaptive behavior
(e.g., substance
abuse, self-mutilation,
suicidal gestures,
impulsive sexual
activity, etc.).
2 = Frequent feelings
of emptiness that are
obviously distressing
or sometimes lead to
maladaptive behavior
1 = Occasional
feelings of emptiness
that are obviously
distressing or
sometimes lead to
maladaptive behavior
0 = Denied, rare, or
not associated with
obvious distress or
maladaptive behavior

? = inadequate information

0 = absent or false

1 = subthreshold

2 = threshold

Borderline Personality Disorder Module
Do you ever find yourself frantically
trying to stop someone close to
you from leaving you?
IF YES: Give me some examples.
__________________________
__________________________
__________________________
__________________________

Excessive efforts to
avoid abandonment

ABP10

This has to do with
efforts on the part of
the subject to avoid
real or imagined
abandonment. The
efforts should be
associated with
obvious feelings of
anxiety or agitation.
2 = Frequent frantic
efforts to avoid real or
imagined
abandonment
1 = Occasional frantic
efforts to avoid real or
imagined
abandonment
0 = Denied, rare,
occurs only in
association with
suicidal or selfmutilating behavior, or
not supported by
convincing examples

? = inadequate information

0 = absent or false

1 = subthreshold

2 = threshold

Borderline Personality Disorder Module
Do you often change from your
usual mood to feeling very irritable,
very depressed, or very nervous?
IF YES: When that happens, how
long do you usually stay that way?
Give me some examples of what
it's like when you're feeling that
way.
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________

Unstable and
capricious mood

ABP11

The subject need not
report instability of all
three moods:
depression, irritability,
and anxiety. For a
positive score the
description and
examples should
establish that the
mood changes are not
only frequent and
short-lived (a few
hours or days) but
also of some intensity.
2 = Frequently
experiences affective
instability
1 = Occasionally
experiences affective
instability
0 = Denied, rare, or
not supported by
convincing examples

? = inadequate information

0 = absent or false

1 = subthreshold

2 = threshold

Borderline Personality Disorder Module
THE INTERVIEWER SHOULD
EXERCISE DISCRETION ABOUT
INQUIRING ABOUT SEXUAL
BEHAVIOR IN CERTAIN
CULTURES. WHERE THIS
MIGHT BE INAPPROPRIATE,
THE ITEM SHOULD BE SCORED
“?”.
Have you ever been uncertain
whether you prefer a sexual
relationship with a man or a
woman?
IF YES: Tell me about it.
Does this ever upset you or cause
any problems for you?
IF YES: Tell me about it.
__________________________
__________________________
__________________________

Disturbances in and
uncertainty about
internal preferences
(including sexual)

ABP12

Homosexuality or
bisexuality as such
are not within the
scope of the criterion,
unless they are
associated with
significant doubt or
uncertainty about
one's sexual
orientation. This doubt
or uncertainty causes
subjective distress or
problems with others.
2 = Has considerable
doubt or uncertainty
about sexual
orientation. This
frequently causes
subjective distress.

__________________________
__________________________
__________________________

1 = Has considerable
doubt or uncertainty
about sexual
orientation. This
sometimes causes
subjective distress.
0 = Denied, rare, does
not cause subjective
distress, or not
supported by subject's
account

? = inadequate information

0 = absent or false

1 = subthreshold

2 = threshold

Borderline Personality Disorder Module
Some people have a habit of doing
things suddenly or unexpectedly
without giving any thought to what
might happen. Are you like that?
IF YES: What kind of things have
you done?
__________________________
__________________________
__________________________

Marked tendency to
act unexpectedly
and without
consideration of the
consequences

ABP13

This refers to the
consequences of
acting suddenly and
unexpectedly on
impulse. It is scored
positively only if the
subject can produce
convincing examples
of problems that have
arisen or could have
arisen as a result of
this tendency.
2 = Frequently acts
suddenly and
unexpectedly on
impulse. This
sometimes causes
problems or could
cause problems.
1 = Occasionally acts
suddenly and
unexpectedly on
impulse. This
sometimes causes
problems or could
cause problems.
0 = Denied, rare, or
not supported by
convincing examples

? = inadequate information

0 = absent or false

1 = subthreshold

2 = threshold

Borderline Personality Disorder Module

Have you ever threatened to
commit suicide?

Recurrent threats or
acts of self-harm

IF YES: How many times? Tell me
about it.

The mere sharing of
one's suicidal
thoughts with another
person does not
ordinarily constitute a
threat. There must be
communication of an
intent to commit
suicide. The motive for
making the threat is
irrelevant. Suicidal
gestures are counted
whether or not they
were serious or
accompanied by a
genuine wish to die.
Acts of self-harm
include wrist cutting,
deliberately breaking
glass with one's body,
burning oneself, headbanging, and other
deliberate forms of
self-injury of a nonsuicidal nature.

Have you ever actually made a
suicide attempt or gesture?
IF YES: How many times? Tell me
about it.
Have you ever deliberately cut
yourself, smashed your fist through
a window, burned yourself, or hurt
yourself in some other way (not
counting suicide attempts or
gestures)?
IF YES: Tell me about it.
__________________________
__________________________
__________________________

ABP14

2 = On several
occasions engaged in
suicidal threats,
gestures, or acts of
self-harm
1 = Once or twice
engaged in suicidal
threats, gestures, or
acts of self-harm
0 = Denied

? = inadequate information

0 = absent or false

1 = subthreshold

2 = threshold

Borderline Personality Disorder Module
REVIEW ABP1, ABP2, ABP3,
ABP5, AND ABP12.

Uncertainty about
?
self-image, aims, etc.

ABP15

ABP1 = ______
ABP2 = ______
ABP3 = ______
ABP5 = ______
ABP12 = ______
2 = 2 OR MORE OF
ABP1, ABP2, ABP3,
ABP5, AND ABP12
ARE EQUAL TO 2
1 = 1 OF ABP1,
ABP2, ABP3, ABP5,
AND ABP12 IS
EQUAL TO 2
1 = NONE OF ABP1,
ABP2, ABP3, ABP5,
AND ABP12 ARE
EQUAL TO 2, AND
SUM OF ABP1,
ABP2, ABP3, ABP5,
AND ABP12 IS
GREATER THAN OR
EQUAL TO 3
0 = ALL OTHERS
REVIEW ABP13, ABP7, ABP8,
ABP4, AND ABP11.

ABP13 = ______
ABP7 = ______

NUMBER OF ABP13,
ABP7, ABP8, ABP4,
AND ABP11 EQUAL TO
2: ___________

ABP16

ABP8 = ______
ABP4 = ______
ABP11 = ______

? = inadequate information

0 = absent or false

1 = subthreshold

2 = threshold

Borderline Personality Disorder Module
REVIEW ABP15, ABP6, ABP10,
ABP14, AND ABP9.

ABP15 = ______
ABP6 = ______

NUMBER OF ABP15,
ABP6, ABP10, ABP14,
AND ABP9 EQUAL TO
2: ___________

ABP17

ABP18

ABP10 = ______
ABP14 = ______
ABP9 = ______
0 = NONE OF ABP13,
ABP7, ABP8, ABP4,
ABP11, ABP15,
ABP6, ABP10,
ABP14, AND ABP9
EQUAL TO 2

0 = ABP16 IS LESS
THAN 2, AND ABP17
IS LESS THAN 2
2 = ABP16 IS
GREATER THAN OR
EQUAL TO 3, AND
ABP17 IS GREATER
THAN OR EQUAL TO
2
1 = ALL OTHERS
Module End Time: ____ ____ : ____ ____ AM/PM
GO TO NEXT MODULE

? = inadequate information

0 = absent or false

1 = subthreshold

2 = threshold

SCID-RV for DSM-5®
Version 1.0.0

End of Interview/Interviewer Debriefing Module

Michael B. First, M.D., Janet B. W. Williams, Ph.D.,
Rhonda S. Karg, Ph.D., Robert L. Spitzer, M.D.

Modified for the National Mental Health Study

Interviewer ID:

Date of Interview:

QUESTID:

This page has been intentionally left blank.

End of Interview/Interviewer Debriefing Module

Module Start Time: ____ ____ : ____ ____ AM/PM

That was my last question. Thank you for your time and cooperation in completing this
interview.
Sometimes the personal issues we’ve discussed cause people to become upset and in need of
speaking with a counselor. If you are feeling upset or disturbed by the personal issues we have
discussed in this interview and would like to talk with someone about your feelings, we suggest
you call your doctor, counselor, or other treatment provider if you are currently under someone’s
care. If not, there is also a National Lifeline Network number you can call. This number is on the
receipt for the $40 you received for this interview from the interviewer who met with you earlier.
Do you still have that receipt?
IF NO: We would like to give you the hotline number for the National Lifeline Network, where
counselors are available to talk at any time of the day or night. They can also give you
information about (additional) mental health services in your area. Their toll-free number is
1-800-273-8255.
IF YES: OK. Please know that counselors at the National Lifeline Network are available to talk
at any time of the day or night. They can also give you information about mental health services
in your area if you request that information.
Do you have any additional questions you’d like to ask me before we end our call?
Thank you again for your time, and have a good (day/afternoon/evening).

Module End Time: ____ ____ : ____ ____ AM/PM

End of Interview/Interviewer Debriefing Module

INTERVIEWER DEBRIEFING SECTION
Distressed Respondent Protocol

Was the Distressed Respondent Protocol used?

Yes

AEI1
AEI2

Specify problems:
_____________________________________________________
_____________________________________________________
_____________________________________________________

Cognitive Impairment Screener

Was the Short Blessed Scale used?

Yes

AEI3
IF AEI3 =
1, SKIP
AEI4 and
AEI4a

Specify problems:

AEI4

________
(0-28)

AEI4a

End of Interview/Interviewer Debriefing Module

Comprehension Rating
Estimate the respondent’s understanding of the interview:

Circle
Response

No difficulty—no language or comprehension problem

Just a little difficulty—almost no language or comprehension
problems

A fair amount of difficulty—some language or comprehension
problems

A lot of difficulty—considerable language or comprehension
problems

Extreme problems with language or comprehension

Specify problems:

AEI5

AEI6

_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

Cooperation Rating
Rate how cooperative the respondent was during the interview:

Circle
Response

Very cooperative

Fairly cooperative

Not very cooperative

Uncooperative

Openly hostile

Specify problems:
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

AEI7

AEI8

End of Interview/Interviewer Debriefing Module

Privacy Rating
Indicate on a scale of 1 through 5 how private the interview was:

Circle
Response

Completely private—no one who could overhear any part of the
interview appeared present

Minor distractions—other person(s) seemed present or listening
for less than 1/3 of the time

Moderate distractions—others seemed present about 1/3 of the
time

Severe distractions—interruptions of privacy more than half the
time

Constant presence of other person(s)

Specify problems:

AEI9

AEI10

_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

Global Validity Rating
Rate the overall validity of the interview:

Circle
Response

Excellent—no reason to suspect invalid responses

Good—factors present that may adversely affect validity

Fair—factors present that definitely reduce validity

Poor—substantially reduced validity

Invalid responses, severely impaired mental status, or possible
deliberate “faking bad” or “faking good”

AEI11

AEI12

End of Interview/Interviewer Debriefing Module

CLINICAL SUPERVISOR’S RATINGS
Clinical Supervisor: Global Validity Rating
Rate the overall validity of the interview:

Circle
Response

Excellent—no reason to suspect invalid responses

Good—factors present that may adversely affect validity

Fair—factors present that definitely reduce validity

Poor—substantially reduced validity

Invalid responses, severely impaired mental status, or possible
deliberate “faking bad” or “faking good”

AEI13

AEI14

This page has been intentionally left blank.

SCID-RV for DSM-5®
Version 1.0.0

GMC/Substance/Medication-Induced Mood Disorders
Supplemental Module

Michael B. First, M.D., Janet B. W. Williams, Ph.D.,
Rhonda S. Karg, Ph.D., Robert L. Spitzer, M.D.

Modified for the National Mental Health Study

Interviewer ID:

Date of Interview:

QUESTID:

This page has been intentionally left blank.

GMC/Substance/Medication-Induced Mood Disorders Supplemental
Module

*BIPOLAR DISORDER DUE TO
BIPOLAR DISORDER DUE TO
ANOTHER MEDICAL
ANOTHER MEDICAL
CONDITION*
CONDITION CRITERIA
IF SYMPTOMS ARE NOT TEMPORALLY ASSOCIATED WITH A GENERAL MEDICAL
CONDITION, CHECK HERE ___ AND GO TO *SUBSTANCE/MEDICATION-INDUCED
BIPOLAR DISORDER* ON PAGE 3.
CODE BASED ON
INFORMATION ALREADY
OBTAINED.

? = inadequate information

B/C. There is evidence from the ?
1
2
history, physical
examination, or laboratory
NOT GMC
findings that the disturbance INDUCED
GO TO
is the direct physiological
*SUBSTANCE/
consequence of another
MEDICATIONmedical condition and the
INDUCED
BIPOLAR
disturbance is not better
DISORDER* ON
accounted for by another
PAGE 3
mental disorder.

A. A prominent and persistent
period of abnormally
elevated, expansive, or
irritable mood and
abnormally increased activity
or energy that predominates
in the clinical picture.

1 = absent or false

2 = subthreshold

3 = threshold or true

GMC/Substance/Medication-Induced Mood Disorders Supplemental
Module
Did the (BIPOLAR SXS) change
after (GMC) began? Did
(BIPOLAR SXS) start or get
much worse only after (GMC)
began? How long after (GMC)
began did (BIPOLAR SXS) start
or get much worse?
IF GMC HAS RESOLVED: Did
the (BIPOLAR SXS) get better
once the (GMC) got better?
__________________________
__________________________
__________________________
__________________________

NOTE: The following factors
should be considered and, if
present, support the conclusion
that a general medical condition
is etiologic to the bipolar
symptoms.
1. There is evidence from the
literature of a wellestablished association
between the general medical
condition and the bipolar
symptoms. Refer to list of
etiological medical
conditions below:
Etiological medical conditions
include Alzheimer’s disease,
vascular dementia, HIV-induced
dementia, Huntington’s disease,
Lewy body disease, WernickeKorsakoff syndrome, Cushing’s
disease, multiple sclerosis, ALS,
Parkinson’s disease, Pick’s
disease, Creutzfeldt-Jakob
disease, stroke, traumatic brain
injuries, and hyperthyroidism.

2
?

3
GMC-INDUCED
BIPOLAR
DISORDER

GO TO
*SUBSTANCE/
MEDICATIONINDUCED BIPOLAR
DISORDER* ON
NEXT PAGE

2. There is a close temporal
relationship between the
course of the bipolar
symptoms and the course of
the general medical
condition.
3. The bipolar symptoms are
characterized by unusual
presenting features (e.g.,
late age at onset).
4. The absence of alternative
explanations (e.g., bipolar
symptoms as a
psychological reaction to the
stress of being diagnosed
with a general medical
condition).

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

GMC/Substance/Medication-Induced Mood Disorders Supplemental
Module

SUBSTANCE/MEDICATION*SUBSTANCE/MEDICATIONINDUCED BIPOLAR
INDUCED BIPOLAR DISORDER* DISORDER CRITERIA
IF SYMPTOMS ARE NOT TEMPORALLY ASSOCIATED WITH
SUBSTANCE/MEDICATION USE, CHECK HERE ___ AND
RETURN TO THE MOOD DISORDERS MODULE ON PAGE 14,
CONTINUING WITH THE ITEM FOLLOWING “THE EPISODE IS
NOT ATTRIBUTABLE TO THE PHYSIOLOGICAL EFFECTS OF A
SUBSTANCE OR TO ANOTHER MEDICAL CONDITION.”
CODE BASED ON
INFORMATION ALREADY
OBTAINED.

A. A prominent and persistent
disturbance in mood that
predominates in the clinical
picture and is characterized
by elevated, expansive, or
irritable mood, with or
without depressed mood, or
markedly diminished interest
or pleasure in all, or almost
all, activities.

IF UNKNOWN: When did the
(BIPOLAR SXS) begin? Were
you already using
(SUBSTANCE/MEDICATION) or
had you just stopped or cut down
your use?

B. There is evidence from the
history, physical
examination, or laboratory
findings of both (1) and (2):

IF UNKNOWN: How much
(SUBSTANCE/MEDICATION)
were you using when you began
to have (BIPOLAR SXS)?
__________________________
__________________________
__________________________

1. The symptoms in Criterion A
developed during or soon
after substance intoxication
or withdrawal or exposure to
a medication.

NOTE: Refer to list of etiological

substances/medications below:

__________________________

Etiological substances/medications
include alcohol (I/W), phencyclidine
(I), hallucinogens (I), sedatives,
hypnotics, anxiolytics (I/W),
amphetamines (I/W), cocaine (I/W),
corticosteroids, androgens,
isoniazid, levodopa, interferon
alpha, varenicline, procarbazine,
clarithromycin, and ciprofloxacin.

? = inadequate information

RETURN TO
MOOD
DISORDERS
MODULE,
PAGE 14

2. The involved substance/
medication is capable of
producing the symptoms in
Criterion A.

__________________________
__________________________

NOT
SUBSTANCE
INDUCED

1 = absent or false

2 = subthreshold

3 = threshold or true

GMC/Substance/Medication-Induced Mood Disorders Supplemental
Module
ASK ANY OF THE FOLLOWING
QUESTIONS AS NEEDED TO
RULE OUT A NONSUBSTANCE-INDUCED
ETIOLOGY:
IF UNKNOWN: Which came first,
the (SUBSTANCE/MEDICATION
USE) or the (BIPOLAR SXS)?
IF UNKNOWN: Have you had a
period of time when you stopped
using (SUBSTANCE/
MEDICATION)?
IF YES: After you stopped using
(SUBSTANCE/MEDICATION) did
the (BIPOLAR SXS) go away or
get better?
IF YES: How long did it take for
them to get better? Did they go
away within a month of stopping?
IF UNKNOWN: Have you had
any other episodes of (BIPOLAR
SXS)?
IF YES: How many? Were you
using (SUBSTANCE/
MEDICATION) at those times?
__________________________
__________________________
__________________________
__________________________

C. The disturbance is NOT
better accounted for by a
bipolar or related disorder
that is not substance
induced. Such evidence of
an independent bipolar or
related disorder could
include the following:

4
?

3
SUBSTANCE/
MEDICATIONINDUCED
BIPOLAR
DISORDER

NOTE: The following three
statements constitute evidence
that the bipolar symptoms are
not substance induced. Code “1”
if any are true. Code “3” only if
none are true.
1. The symptoms precede the
onset of the
substance/medication use;
2. The symptoms persist for a
substantial period of time
(e.g., about 1 month) after
the cessation of acute
withdrawal or severe
intoxication; or
3. There is other evidence
suggesting the existence of
an independent nonsubstance/medicationinduced bipolar and related
disorder (e.g., a history of
recurrent nonsubstance/medicationrelated episodes).

RETURN TO
MOOD
DISORDERS
MODULE,
PAGE 14

__________________________
__________________________

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

GMC/Substance/Medication-Induced Mood Disorders Supplemental
Module

*GMC/SUBSTANCE CAUSING DEPRESSIVE SYMPTOMS*
DEPRESSIVE DISORDER
*DEPRESSIVE DISORDER DUE
DUE TO ANOTHER
TO ANOTHER MEDICAL
MEDICAL CONDITION
CONDITION*
CRITERIA
IF SYMPTOMS ARE NOT TEMPORALLY ASSOCIATED WITH A GENERAL MEDICAL
CONDITION, CHECK HERE ___ AND GO TO *SUBSTANCE/MEDICATION-INDUCED
DEPRESSIVE DISORDER* ON PAGE 7.
CODE BASED ON
INFORMATION ALREADY
OBTAINED.

? = inadequate information

A. A prominent and
persistent period of
depressed mood or
markedly diminished
interest or pleasure in all,
or almost all, activities
that predominates in the
clinical picture.

1 = absent or false

2 = subthreshold

3 = threshold or true

GMC/Substance/Medication-Induced Mood Disorders Supplemental
Module
B/C. There is evidence from
the history, physical
examination, or laboratory
findings that the
disturbance is the direct
physiological
consequence of another
medical condition and the
disturbance is not better
accounted for by another
mental disorder.
Did the (DEPRESSIVE SXS)
change after (GMC) began? Did
(DEPRESSIVE SXS) start or get
much worse only after (GMC)
began? How long after (GMC)
began did (DEPRESSIVE SXS)
start or get much worse?
IF GMC HAS RESOLVED: Did
the (DEPRESSIVE SXS) get
better once the (GMC) got better?
__________________________
__________________________
__________________________

6
?

GO TO
*SUBSTANCE/
MEDICATIONINDUCED
DEPRESSIVE
DISORDER* ON
PAGE 7

NOTE: The following factors
should be considered and, if
present, support the conclusion
that a general medical
condition is etiologic to the
depressive symptoms:
1. There is evidence from the
literature of a wellestablished association
between the general
medical condition and the
depressive symptoms.
Refer to list of etiological
general medical conditions
below:
Etiological medical conditions
include stroke, Huntington’s
disease, Parkinson’s disease,
traumatic brain injury, Cushing’s
disease, hypothyroidism, multiple
sclerosis, and systemic lupus
erythematosus.
2. There is a close temporal
relationship between the
course of the depressive
symptoms and the course of
the general medical condition.
3. The depressive symptoms are
characterized by unusual
presenting features (e.g., late
age at onset).
4. The absence of alternative
explanations (e.g., depressive
symptoms as a psychological
reaction to the stress of being
diagnosed with a general
medical condition).

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

GMC/Substance/Medication-Induced Mood Disorders Supplemental
Module
*SUBSTANCE/MEDICATION-INDUCED
DEPRESSIVE DISORDER*

SUBSTANCE/MEDICATIONINDUCED DEPRESSIVE
DISORDER CRITERIA

IF SYMPTOMS ARE NOT TEMPORALLY ASSOCIATED WITH SUBSTANCE/MEDICATION USE, CHECK
HERE ___ AND RETURN TO PAGE 7 OF THE MOOD DISORDERS MODULE, CONTINUING WITH THE
ITEM FOLLOWING “THE EPISODE IS NOT ATTRIBUTABLE TO THE PHYSIOLOGICAL EFFECTS OF A
SUBSTANCE OR TO ANOTHER MEDICAL CONDITION.”
CODE BASED ON INFORMATION
ALREADY OBTAINED.

A prominent and persistent
disturbance in mood that
predominates in the clinical
picture and is characterized by
depressed mood or markedly
diminished interest or pleasure
in all, or almost all, activities.

IF UNKNOWN: When did the
(DEPRESSIVE SXS) begin? Were you
already using (SUBSTANCE/
MEDICATION) or had you just stopped
or cut down your use?

There is evidence from the
history, physical examination,
or laboratory findings of both
(1) and (2):

The symptoms in Criterion A
developed during or soon after
substance intoxication or
withdrawal or exposure to a
medication.

The involved
substance/medication is
capable of producing the
symptoms in Criterion A.

IF UNKNOWN: How much
(SUBSTANCE/MEDICATION) were you
using when you began to have
(DEPRESSIVE SXS)?

NOT
SUBSTANCE
INDUCED

SUBSTANCE/
MEDICATIONINDUCED
DEPRESSIVE
DISORDER

NOTE: Refer to list of etiological
substances/medications below:
Etiological substances/medications
include alcohol (I/W), phencyclidine
(I), hallucinogens (I), inhalants (I),
opioids (I/W), sedative, hypnotics
or anxiolytics (I/W), amphetamine
and other stimulants (I/W), cocaine
(I/W), antiviral agents (etavirenz),
cardiovascular agents (clonodine,
guanethidine, methyldopa,
reserpine), retinoic acid derivatives
(isotretinoin), antidepressants,
anticonvulsants, anti-migraine
agents (triptans), antipsychotics,
hormonal agents (corticosteroids,
oral contraceptives, gonadotropinreleasing hormone agonists,
tamoxifen), smoking cessation
agents (varenicline), and
immunological agents (interferon).

? = inadequate information

1 = absent or false

RETURN TO PAGE 7
OF MOOD
DISORDERS
MODULE

2 = subthreshold

3 = threshold or true

This page has been intentionally left blank.

SCID-RV for DSM-5®
Version 1.0.0

GMC/Substance/Medication-Induced Anxiety Disorder
Supplemental Module

Michael B. First, M.D., Janet B. W. Williams, Ph.D.,
Rhonda S. Karg, Ph.D., Robert L. Spitzer, M.D.

Modified for the National Mental Health Study

Interviewer ID:

Date of Interview:

QUESTID:

This page has been intentionally left blank.

GMC/Substance/Medication-Induced Anxiety Disorder Supplemental
Module

*GMC/SUBSTANCE AS ETIOLOGY FOR ANXIETY SYMPTOMS*
*ANXIETY DISORDER DUE TO
ANXIETY DISORDER DUE
ANOTHER MEDICAL
TO ANOTHER MEDICAL
CONDITION*
CONDITION CRITERIA
IF SYMPTOMS ARE NOT TEMPORALLY ASSOCIATED WITH A GENERAL
CONDITION, CHECK HERE ___ AND GO TO *SUBSTANCE/MEDICATION-INDUCED
ANXIETY DISORDER* ON PAGE 3.
CODE BASED ON
INFORMATION ALREADY
OBTAINED

Did the (ANXIETY SXS) start or
get much worse only after (GMC)
began? How long after (GMC)
began did (ANXIETY SXS) start
or get much worse?
IF GMC HAS RESOLVED: Did
the (ANXIETY SXS) get better
once the (GMC) got better?
__________________________
__________________________
__________________________
__________________________

? = inadequate information

A. Panic attacks or anxiety
is predominant in the
clinical picture.

B/C. There is evidence from
this history, physical
examination, or
laboratory findings that
the disturbance is the
direct physiological
consequence of
another medical
condition AND the
disturbance is not
better accounted for by
another mental
disorder.

NOTE: The following factors
should be considered and, if
present, support the
conclusion that a general
medical condition is etiologic
to the anxiety symptoms:

GMC-INDUCED
ANXIETY
DISORDER

GO TO *SUBSTANCE/
MEDICATION-INDUCED
ANXIETY DISORDER*
ON PAGE 3

1. There is evidence from
the literature of a wellestablished association
between the general
medical condition and
the anxiety symptoms.
Refer to list of etiological
general medical
conditions:

1 = absent or false

2 = subthreshold

3 = threshold or true

GMC/Substance/Medication-Induced Anxiety Disorder Supplemental
Module

Etiological medical
conditions include endocrine
disease (e.g.,
hyperthyroidism,
pheochromocytoma,
hypoglycemia,
hyperadrenocortisolism),
cardiovascular disorders
(e.g., congestive heart
failure, pulmonary embolism,
arrhythmia such as atrial
fibrillation), respiratory
illness (e.g., chronic
obstructive pulmonary
disease, asthma,
pneumonia), metabolic
disturbances (e.g., vitamin
B12 deficiency, porphyria),
and neurological illness
(e.g., neoplasms, vestibular
dysfunction, encephalitis,
seizure disorders).
2. There is a close
temporal relationship
between the course of
the anxiety symptoms
and the course of the
general medical
condition.
3. The anxiety symptoms
are characterized by
unusual presenting
features (e.g., late age at
onset).
4. The absence of
alternative explanations
(e.g., anxiety symptoms
as a psychological
reaction to the stress of
being diagnosed with a
general medical
condition).

? = inadequate information

1 = absent or false

2 = subthreshold

3 = threshold or true

GMC/Substance/Medication-Induced Anxiety Disorder Supplemental
Module
*SUBSTANCE/MEDICATION-INDUCED
ANXIETY DISORDER*

SUBSTANCE/MEDICATIONINDUCED ANXIETY DISORDER
CRITERIA

IF SYMPTOMS NOT TEMPORALLY ASSOCIATED WITH
SUBSTANCE/MEDICATION USE, CHECK HERE ___ AND RETURN TO
DISORDER BEING EVALUATED, CONTINUING WITH THE ITEM
FOLLOWING “SYMPTOMS ARE NOT ATTRIBUTABLE TO THE
PHYSIOLOGICAL EFFECTS OF A SUBSTANCE OR ANOTHER MEDICAL
CONDITION.”

EPISODE BEING
EVALUATED:
Panic
Social Anxiety Disorder
GAD

CODE BASED ON INFORMATION
ALREADY OBTAINED

Panic attacks or anxiety is
predominant in the clinical
picture.

IF NOT KNOWN: When did the
(ANXIETY SXS) begin? Were you
already using (SUBSTANCE/
MEDICATION) or had you just stopped
or cut down your use?

There is evidence from the
history, physical examination,
or laboratory findings of both
(1) and (2):

IF UNKNOWN: How much
(SUBSTANCE/MEDICATION) were you
using when you began to have
(ANXIETY SXS)?
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________

? = inadequate information

The symptoms in Criterion A
developed during or soon after
substance intoxication or
withdrawal or exposure to a
medication.

NOT
SUBSTANCE
INDUCED
RETURN TO
DISORDER
BEING
EVALUATED

The involved substance/
medication is capable of
producing the symptoms in
Criterion A.

NOTE: Refer to list of substances/
medications:
Etiological substances/medications
include alcohol (I/W); caffeine (I);
cannabis (I); opioids (W);
phencyclidine (I); other
hallucinogens (I); inhalants and
stimulants (including cocaine)
(I/W); sedatives, hypnotics, and
anxiolytics (W); anesthetics and
analgesics; sympathomimetics or
other bronchodilators;
anticholinergics; insulin; thyroid
preparations; oral contraceptives;
antihistamines; antiparkinsonian
medications; corticosteroids;
antihypertensive and
cardiovascular medications;
anticonvulsants; lithium carbonate;
antipsychotic medications;
antidepressant medications; and
exposure to heavy metals and
toxins such as organophosphate
insecticide, nerve gases, carbon
monoxide, carbon dioxide, and
volatile substances such as
gasoline and paint.

1 = absent or false

2 = subthreshold

3 = threshold or true

GMC/Substance/Medication-Induced Anxiety Disorder Supplemental
Module
ASK ANY OF THE FOLLOWING
QUESTIONS AS NEEDED TO
RULE OUT A NONSUBSTANCE/MEDICATIONINDUCED ETIOLOGY:
IF UNKNOWN: Which came first,
the (SUBSTANCE/MEDICATION
USE) or the (ANXIETY SXS)?
IF UNKNOWN: Have you had a
period of time when you stopped
using (SUBSTANCE/
MEDICATION)?
IF YES: After you stopped using
(SUBSTANCE/MEDICATION) did
the (ANXIETY SXS) go away or
get better?
IF YES: How long did it take for
them to get better? Did they go
away within a month of stopping?
IF UNKNOWN: Have you had
any other episodes of (ANXIETY
SXS)?
IF YES: How many? Were you
using (SUBSTANCE/
MEDICATION) at those times?
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________

? = inadequate information

C. The disturbance is NOT
better accounted for by
an anxiety disorder that
is not substance
induced. Such evidence
of an independent
anxiety disorder could
include the following:

4
?

SUBSTANCE/
MEDICATIONINDUCED
ANXIETY
DISORDER

NOTE: The following three
statements constitute
evidence that the anxiety
symptoms are not substance
induced. Code “1” if any are
true. Code “3” only if none
are true.
1. The symptoms precede
the onset of the
substance/medication
use.
2. The symptoms persist
for a substantial period
of time (e.g., about 1
month) after the
cessation of acute
withdrawal or severe
intoxication.
3. There is other evidence
suggesting the existence
of an independent nonsubstance/medicationinduced anxiety disorder
(e.g., a history of
recurrent non-substance/
medication-related
episodes).

1 = absent or false

RETURN TO
DISORDER
BEING
EVALUATED

2 = subthreshold

3 = threshold or true

SCID-RV for DSM-5®
Version 1.0.0

Cognitive Impairment Protocol

Modified for the National Mental Health Study

Interviewer ID:

Date of Interview:

QUESTID:

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Cognitive Impairment Protocol

1
SHORT BLESSED SCALE EXAM

THE SHORT BLESSED SCALE IS TO BE COMPLETED AT ANY POINT DURING THE
INTERVIEW IF THE RESPONDENT APPEARS TO BE COGNITIVELY IMPAIRED.

ERROR SCORES
SB-1.

What year is it now? _____________
CIRCLE 4 FOR ANY ERROR ........................................................0 4

SB-2.

What month is it now? _______________
CIRCLE 3 FOR ANY ERROR ........................................................0 3
Please repeat this phrase after me: John Brown, 42 Market Street, Chicago.
NO SCORE – FOR ITEM SB-6.

SB-3.

About what time is it? _______________
CIRCLE 3 FOR ANY ERROR ........................................................0 3

SB-4.

Please count backwards from 20 to 1.
[20, 19, 18, 17, 16, 15, 14, 13, 12, 11, 10, 9, 8, 7, 6, 5, 4, 3, 2, 1]
2 PER ERROR ..............................................................................0 2 4

SB-5.

Please say the months of the year in reverse order.
[DEC, NOV, OCT, SEP, AUG, JUL, JUN, MAY, APR, MAR, FEB, JAN]
2 PER ERROR ..............................................................................0 2 4

SB-6.

Please repeat the phrase I asked you to repeat before.
[JOHN BROWN / 42 MARKET STREET / CHICAGO]
2 PER ERROR ..............................................................................0 2 4 6 8 10

TOTAL NUMBER OF ERRORS IN SB-1 TO SB-6: ....................._______
IF THE TOTAL NUMBER OF ERRORS IS GREATER THAN 10, TERMINATE THE
INTERVIEW.

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Adolescent Clinical Interview Modules
for the National Mental Health Study (NMHS)
Clinical Reappraisal Study (CRS) Field Test

This page has been intentionally left blank.

National Mental Health Study

INTRODUCTION

K-SADS INTRODUCTORY QUESTIONS:
CHILD INTERVIEW

Module Start Time: ____ ____ : ____ ____ AM/PM
Thank you for chatting today. I’d like to start by learning a little bit more about you. For some
questions, you may be thinking, “I just answered these a few weeks ago.” I realize that may be
the case. I don’t want to assume anything, which is why you may hear some questions again. I
really want to hear from you what your life is like and how things are going for you.

How old are you?
_________ years

CDM1

When is your birthday?
DOB:

_____ [RANGE: 01–12] _____ [RANGE: 01–31] _____ [RANGE: 1900–2015] CDM2

ENTER: MM-

DD-

YYYY

INTERVIEWER NOTE: The following questions are not coded; they are used to build rapport
and provide key information for K-SADS modules. E.g., if a father figure is not in the child’s life,
follow-up queries in K-SADS screening and supplements should be focused on the mother figure
(or primary caregiver). Answers to these questions will also provide some starting information
about the adolescent’s functioning to help assess functional impairment later in the
interview. These questions should take no longer than 10 minutes. If the adolescent is slow
to warm up (e.g., provides yes/no responses only), additional follow-ups should be asked. If the
adolescent is very talkative, follow-up questions may not be necessary.

Family
Who do you live with?
•

Obtain information on who lives in the home and the relationship to the child (e.g.,
biological parent, guardians, siblings, and extended family members), ages of siblings,
whereabouts of non-residing parent(s) and visitation.

Who are you closet to in your family? How well do you get along with family members?
•

Notes:

National Mental Health Study

INTRODUCTION

School
What grade are you in?
What kind of grades do you usually get?
What do you like about school? What do you dislike about school?
•

Notes:

Peer Relations
What is your group of friends like?
Do you have a best friend? If yes, how long have you been friends?
•

Notes:

Transition: For the rest of the interview, I will be asking you about a lot of different feelings and
problems kids sometimes have. Let’s get started with some of those questions.

K-SADS-PL 2013:
ATTENTION DEFICIT HYPERACTIVITY DISORDER
(ADHD)
Advanced Center for Intervention and Services Research (ACISR) for Early
Onset Mood and Anxiety Disorders
Western Psychiatric Institute and Clinic
Child and Adolescent Research and Education (CARE) Program
Yale University
Modified for the National Mental Health Study

Interviewer ID:

Date of Interview:

QUESTID:

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K-SADS-PL 2013 – Modified for the National Mental Health Study

ADHD

K-SADS Screen Interview: ATTENTION DEFICIT HYPERACTIVITY DISORDER

If CIDI screen = positive (+) or subthreshold: Say, “In your earlier interview, you said that you
have had trouble with concentration or restlessness in the past. The next questions are about that.”
Then proceed with ADHD screen.
If CIDI screen = negative (-): Proceed with ADHD screen.

Compared to other children/adolescents this age, how would parent/adult rate this child/
adolescent? Ask if teachers or others have complained about particular symptoms or behaviors.
If the child is being treated with stimulants, rate for most severe period prior to medication or during
drug holidays and note in margin which symptoms are improved with medication.
Determine the age of onset for first positively endorsed ADHD symptom. If the symptoms are
episodic, consider the presence of a mood disorder or other causes (e.g., alcohol, drugs or medical
problems).
Probe: For how long has _____ been a problem? Has it been a problem since kindergarten? First
grade? Did the problem start even earlier? Note: According to the DSM-5, onset of ADHD
symptoms can appear up to age 12.
P

0 – No information.

1 – Not present.

2 – Subthreshold:
Occasionally has
difficulty sustaining
attention on tasks or
play activities. Problem
has only minimal effect
on functioning.

3 – Threshold: Often (47 days/week) has
difficulty sustaining
attention. Problem has
significant effect on
functioning.

Difficulty Sustaining Attention on
Tasks or Play Activities
Has there ever been a time when
you had trouble paying attention in
school? Did it affect your school
work? Did you get into trouble
because of this?
When you were working on your
homework, did your mind wander?
What about when you were playing
games? Did you forget to go when it
was your turn? Did teachers
complain?
Note: Rate based on data
reported by informant.
3

NOTE: DO NOT RATE
POSITIVELY IF OCCURS ONLY
DURING MOOD EPISODE,
PSYCHOSIS, EPISODES OF
DRUG USE, OR SECONDARY TO
A MEDICAL CONDITION.

P = Parent Rating C = Child Rating

S = Summary Rating

ADH1

K-SADS-PL 2013 – Modified for the National Mental Health Study

ADHD

0 – No information.

1 – Not present.

2 – Subthreshold:
Occasionally
distractible. Problem
has only minimal effect
on functioning.

3 – Threshold: Attention
often (4-7 days/week)
disrupted by minor
distractions other kids
would be able to ignore.
Problem has significant
effect on functioning.

Easily Distracted
Was there ever a time when little
distractions would make it very hard
for you to keep your mind on what
you were doing?
Like if another kid in class asked the
teacher a question while the class
was working quietly, was it hard for
you to keep your mind on your
work?
When there was an interruption, like
when the phone rang, was it hard to
get back to what you were doing
before the interruption?
Were there times when you could
keep your mind on what you were
doing, and little noises and things
didn't bother you?
How often were they a problem?
Did teachers complain?
Note: Rate based on data
reported by informant.
NOTE: DO NOT RATE
POSITIVELY IF OCCURS ONLY
DURING MOOD EPISODE,
PSYCHOSIS, EPISODES OF
DRUG USE, OR SECONDARY TO
A MEDICAL CONDITION.

P = Parent Rating C = Child Rating

S = Summary Rating

ADH2

K-SADS-PL 2013 – Modified for the National Mental Health Study

ADHD

0 – No information.

1 – Not present.

2 – Subthreshold:
Occasionally has
difficulty remaining
seated when required to
do so. Problem has only
minimal effect on
functioning.

3 – Threshold: Often (47 days/week) has
difficulty remaining
seated when required to
do so. Problem has
significant effect on
functioning.

0 – No information.

1 – Not present.

2 – Subthreshold:
Occasionally impulsive.
Problem has only
minimal effect on
functioning

3 – Threshold: Often (47 days/week) impulsive.
Problem has significant
effect on functioning.

Difficulty Remaining Seated
Was there ever a time when you got
out of your seat a lot at school?
Did you get into trouble for this?
Was it hard to stay in your seat at
school? What about dinner time?
Parents: When your child was
young, were you able to take
him/her out in public, like
restaurants? Were these difficulties
beyond what you would expect for a
child his/her age?
Note: Rate based on data
reported by informant.
Take into account that these
symptoms tend to improve with
age. Carefully check if this
symptom was present when the
child was younger.

ADH3

Impulsivity
Do you act before you think, or think
before you act?
Has there ever been a time when
these kinds of behaviors got you into
trouble? Give some examples.

P = Parent Rating C = Child Rating

S = Summary Rating

ADH4

K-SADS-PL 2013 – Modified for the National Mental Health Study

ADHD

IF RECEIVED A SCORE OF 3 ON ANY OF THE PREVIOUS ITEMS, COMPLETE THE
ATTENTION DEFICIT HYPERACTIVITY DISORDER SUPPLEMENT AFTER FINISHING
THE SCREENING INTERVIEW.

IF A SCORE OF 1 or 2, STOP INTERVIEW, RECORD TIME.

NOTE: (RECORD DATES OF POSSIBLE CURRENT AND PAST ATTENTION DEFICIT
HYPERACTIVITY DISORDER).

P = Parent Rating C = Child Rating

S = Summary Rating

K-SADS-PL 2013 – Modified for the National Mental Health Study

ADHD

K-SADS Supplement: ATTENTION DEFICIT HYPERACTIVITY DISORDER
If child is on medication for ADHD, rate behavior when not on medication. NOTE: DO NOT
RATE SYMPTOMS POSITIVELY IF THEY ARE EXCLUSIVELY ACCOUNTED FOR BY MAJOR
DEPRESSIVE EPOSIDE, BIPOLAR DISORDER, DYSTHYMIA, AN ANXIETY DISORDER,
SUBSTANCE ABUSE, PSYCHOSIS, OR AUTISM SPECTRUM DISORDER.
P

0 – No information.

1 – Not present.

2 – Subthreshold:
Occasionally makes
careless mistakes.
Problem has only
minimal effect on
functioning.

3 – Threshold: Often (47 days/week) makes
careless mistakes.
Problem has significant
effect on functioning.

0 – No information

1 – Not present.

2 – Subthreshold:
Occasionally doesn't
listen. Problem has only
minimal effect on
functioning.

Makes a Lot of Careless Mistakes
Do you make a lot of careless
mistakes at school?
Do you often get problems wrong on
tests because you didn't read the
instructions right?
Do you often leave some questions
blank by accident?
Forget to do the problems on both
sides of a handout?
How often do these types of things
happen?
Has your teacher ever said you
should pay more attention to detail?

ADH5

Doesn’t Listen
Is it hard for you to remember what
your parents and teachers say?
Do your parents or teachers
complain that you don't listen to
them when they talk to you?
Do you "tune people out"? Do you
get into trouble for not listening?
Note: Rate based on data
reported by informant.

P = Parent Rating C = Child Rating

3 – Threshold: Often (47 days/week) doesn't
listen. Problem has
significant effect on
functioning.

S = Summary Rating

ADH6

K-SADS-PL 2013 – Modified for the National Mental Health Study

ADHD

0 – No information.

1 – Not present.

2 – Subthreshold:
Occasionally has
difficulty following
instructions. Problem
has only minimal effect
on functioning.

3 – Threshold: Often (47 days/week) has
difficulty following
instructions. Problem
has significant effect on
functioning.

0 – No information.

1 – Not present.

2 – Subthreshold:
Occasionally
disorganized.
Problem has only
minimal effect on
functioning.

3 – Threshold: Often (47 days/week)
disorganized.
Problem has significant
effect on functioning.

Difficulty Following Instructions
Do your teachers complain that you
don't follow instructions?
When your parents or your teacher tell
you to do something, is it sometimes
hard to remember what they said to
do?
Does it get you into trouble?
Do you lose points on your
assignments for not following
directions or not completing the work?
Do you forget to do your homework or
forget to turn it in?
Do you get in to trouble at home for
not finishing your chores or other
things your parents ask you to do?
How often?

ADH7

Difficulty Organizing Tasks
Is your desk or locker at school a
mess?
Does it make it hard for you to find
the things you need?
Does your teacher complain that
your assignments are messy or
disorganized?
When you do your worksheets, do
you usually start at the beginning
and do all the problems in order, or
do you like to skip around?
Do you often miss problems?
Do you have a hard time getting
ready for school in the morning?

P = Parent Rating C = Child Rating

S = Summary Rating

ADH8

K-SADS-PL 2013 – Modified for the National Mental Health Study

ADHD

0 – No information.

1 – Not present.

2 – Subthreshold:
Occasionally avoids
tasks that require
sustained attention,
and/or expresses mild
dislike for these tasks.
Problem has only
minimal effect on
functioning.

Dislikes/Avoids Tasks Requiring
Attention
Do you hate or dislike doing things
that require a lot of
concentration/effort?
Like certain assignments, homework
or reading a book?
Are there some kinds of school work
you hate doing more than others?
Which ones? Why?
Do you try to get out of doing your
___ assignments?
About how many times a week do
you not do your ___ homework?
NOTE: IN CHILDREN/TEENS WITH
ADHD, ABILITY TO SUSTAIN
ATTENTION TO VERY REWARDING
ACTIVITES LIKE COMPUTER OR
VIDEO GAMES MAY NOT BE
IMPAIRED.

ADH9

3 – Threshold: Often (47 days/week) avoids
tasks that require
sustained attention,
and/or expresses
moderate dislike for
these tasks. Problem
has significant effect on
functioning.
P

0 – No information.

1 – Not present.

2 – Subthreshold:
Occasionally loses
things. Problem has
only minimal effect on
functioning.

3 – Threshold: Often
loses things (e.g. once
a week or more).
Problem has significant
effect on functioning.

Loses Things
Do you lose things a lot? Your
pencils at school? Homework
assignments?
Things around home?
About how often does this happen?

P = Parent Rating C = Child Rating

S = Summary Rating

ADH10

K-SADS-PL 2013 – Modified for the National Mental Health Study

ADHD

0 – No information.

1 – Not present.

2 – Subthreshold:
Occasionally forgetful.
Problem has only
minimal effect on
functioning.

3 – Threshold: Often (47 days/week) forgetful.
Problem has significant
effect on functioning.

Forgetful in Daily Activities
Do you often leave your homework
at home, or your books or coats on
the bus? Do you leave your things
outside by accident?
How often do these things happen?
Has anyone ever complained that
you are too forgetful?

P = Parent Rating C = Child Rating

S = Summary Rating

ADH11

K-SADS-PL 2013 – Modified for the National Mental Health Study

ADHD

0 – No information.

1 – Not present.

2 – Subthreshold:
Occasionally fidgets
with hands or feet or
squirms in seat.
Problem has only
minimal effect on
functioning.

3 – Threshold: Often (47 days/week) fidgets
with hands or feet or
squirms in seat.
Problem has significant
effect on functioning.

Fidgets
Consider restlessness, tapping
fingers, chewing things, squirming,
"ants in pants", etc.
Do people often tell you to sit still, to
stop moving, or stop squirming in
your seat? Your teachers? Parents?
Do you sometimes get into trouble
for squirming in your seat or playing
with little things at your desk? Do
you have a hard time keeping your
arms and legs still? How often?
For parents about children: When
you take your child to places like
church or a restaurant, do you have
to bring a lot of games or toys?
About adolescents: When your
child was younger, were you able to
take him/her to places like church or
a restaurant? Were these difficulties
beyond what you would expect for a
child his/her age?
Take into account that these
symptoms tend to improve with
age. Carefully check if this
symptom was present when the
child was younger.
Note: Rate based on data
reported by informant.

P = Parent Rating C = Child Rating

S = Summary Rating

ADH12

K-SADS-PL 2013 – Modified for the National Mental Health Study

ADHD

0 – No information.

1 – Not present.

2 – Subthreshold:
Occasionally runs about
or climbs excessively.
Problem has only
minimal effect on
functioning. (In
adolescents, may be
limited to a subjective
feeling of restlessness)

3 – Threshold: Often (47 days/week) runs
about or climbs
excessively. Problem
has significant effect on
functioning. (In
adolescents, may be
limited to a subjective
feeling of restlessness)

Runs or Climbs Excessively
Do you get into trouble for running
down the hall in school?
Does your parent often have to
remind you to walk instead of run
when you are out together?
Do your parents or your teacher
complain about you climbing things
you shouldn't?
What kinds of things? How often does
this happen?
Adolescents: Do you feel restless a
lot? Feel like you have to move
around, or that it is very hard to stay in
one place?
Note: Rate based on data
reported by informant.

P = Parent Rating C = Child Rating

S = Summary Rating

ADH13

K-SADS-PL 2013 – Modified for the National Mental Health Study

ADHD

0 – No information.

1 – Not present.

2 – Subthreshold:
Occasionally, minimal
effect on functioning.

3 – Threshold: Often (47 days/week) acts as if
"driven by a motor."
Significant effect on
functioning.

0 – No information.

1 – Not present.

2 – Subthreshold:
Occasionally has
difficulty playing quietly.
Problem has only
minimal effect on
functioning.

3 – Threshold: Often (47 days/week) has
difficulty playing quietly.
Problem has significant
effect on functioning.

On the Go/Acts like Driven by
Motor
Do people tell you that your motor is
always running?
Is it hard for you to slow down?
Can you stay in one place for long,
or are you always on the go?
How long can you sit and watch TV
or play a game?
Do people tell you to slow down a
lot?

ADH14

Difficulty Playing Quietly
Do your parents or teachers often
tell you to quiet down when you are
playing?
Do you have a hard time playing
quietly?

P = Parent Rating C = Child Rating

S = Summary Rating

ADH15

K-SADS-PL 2013 – Modified for the National Mental Health Study

ADHD

0 – No information.

1 – Not present.

2 – Subthreshold:
Occasionally talks out of
turn. Problem has only
minimal effect on
functioning.

3 – Threshold: Often (47 days/week) talks out
of turn. Problem has
significant effect on
functioning.

0 – No information.

1 – Not present.

2 – Subthreshold:
Occasionally has
difficulty waiting his/her
turn. Problem has only
minimal effect on
functioning.

3 – Threshold: Often (47 days/week) has
difficulty waiting his/her
turn. Problem has
significant effect on
functioning.

Blurts Out Answers
At school, do you sometimes call out
the answers before you are called
on?
Do you talk out of turn at home?
Answer questions your parents ask
your siblings? How often?

ADH16

Difficulty Waiting Turn
Is it hard for you to wait your turn in
games?
What about in line in the cafeteria or
at the water fountain?

P = Parent Rating C = Child Rating

S = Summary Rating

ADH17

K-SADS-PL 2013 – Modified for the National Mental Health Study

ADHD

0 – No information.

1 – Not present.

2 – Subthreshold:
Occasionally interrupts
others.

3 – Threshold: Often (47 days/week) interrupts
others.

0 – No information.

1 – Not present.

2 – Subthreshold:
Occasionally talks
excessively.

3 – Threshold: Often (4talks excessively.

Interrupts or Intrudes
Do you get into trouble for talking
out of turn at school?
Do your parents, teachers, or any of
the kids you know complain that you
cut them off when they are talking?
Do kids complain that you break in
on games? Does this happen a lot?
Note: Rate based on data
reported by informant.

Talks Excessively
Do people say you talk too much?
Do you get into trouble at school for
talking when you are not supposed
to?
Do people in your family complain
that you talk too much?
What about humming or always
making noises?

Do not rate vocal tics positively.
Note: Rate based on data
reported by informant.

ADH18

ADH19

Codes: 0 = No information. 1 = No. 2 = Yes.
P

Duration
For how long have you
had trouble (list symptoms
that were positively
endorsed)?

Criteria to rate “yes”: 6
months or more.

P = Parent Rating C = Child Rating

S = Summary Rating

ADH20

K-SADS-PL 2013 – Modified for the National Mental Health Study

ADHD

Codes: 0 = No information. 1 = No. 2 = Yes.
P

Age of Onset
How old were you when
you started to have these
problems?
Did you have these
problems in kindergarten?
First Grade? Middle
school?

ADH21

Specify:
Criteria to rate “yes”:
Some symptoms present
before age 12.

Impairment
Must be present
in two settings.
A. Socially (with peers)

ADH22

B. With family

ADH23

C. In school

ADH24

P = Parent Rating C = Child Rating

S = Summary Rating

K-SADS-PL 2013 – Modified for the National Mental Health Study

ADHD

Codes: 0 = No information. 1 = No. 2 = Yes.
Lifetime
Evidence of ADHD

ADH25

DSM-5-Criteria
A. A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with
functioning or development, as characterized by (1) and/or (2):
(1) Inattention: Six or more of the following symptoms have persisted for at least 6
months to a degree that is inconsistent with developmental level and that negatively
impacts directly on social and academic/occupational activities.
a. Makes a lot of careless mistakes
b. Difficulty sustaining attention on tasks or play activities
c. Doesn’t listen
d. Difficulty following instructions
e. Difficulty organizing tasks
f. Dislikes/avoids tasks requiring attention
g. Loses things
h. Easily distracted
i. Forgetful in daily activities
(2) Hyperactivity/Impulsivity: Six or more of the following nine symptoms have persisted for
at least 6 months: NOTE: For older adolescents and adults (age 17 and older),
only five symptoms are required)
a. Fidgets
b. Difficulty remaining seated
c. Runs or climbs excessively
d. Difficulty playing quietly
e. On the go/acts as if driven by a motor
f. Talks excessively
g. Blurts out answers
h. Difficulty waiting turn
i. Often interrupts or intrudes
B. Some symptoms that caused impairment present before the age of 12.
C. Several symptoms must be present in two or more situations (e.g., school and home)
D. Clinically significant impairment
E. Symptoms do not occur exclusively during the course of psychotic disorder and not better
accounted for by another mental disorder (e.g., mood disorder, anxiety disorder,
dissociation, personality disorder).

NOTE: Autism Spectrum Disorder is no longer a rule out for the diagnosis of ADHD.

K-SADS-PL 2013 – Modified for the National Mental Health Study

ADHD

Codes: 0 = No information. 1 = No. 2 = Yes.
Lifetime/Ever
Predominately Inattentive Presentation
Meets criterion A (1), but not criterion A (2)

ADH26

ADH27

ADH28

ADH29

Predominately Hyperactive-Impulsive Type
Meets criterion A (2), but not criterion A (1)
Combined Type
Both criteria A (1) and A (2) are met
Other Specified ADHD
Prominent symptoms of inattention or
hyperactivity- impulsivity that do not meet criteria
for Attention Deficit Hyperactivity Disorder

K-SADS-PL 2013 – Modified for the National Mental Health Study

ADHD

Codes: 0 = No information. 1 = Not present. 2 = Probable. 3 = Definite.
Probable Diagnosis:
1. Meets criteria for core symptoms of the disorder.
2. Meets all but one, or a minimum of 75% of the remaining criteria required for the diagnosis
3. Evidence of functional impairment
ADHD Predominately Inattentive Presentation - Lifetime Diagnosis:
______________

ADH30

ADHD Predominately Inattentive Presentation - Age of Onset:
______________

ADH31

ADHD Predominately Hyperactive-Impulsive Type - Lifetime Diagnosis:
______________

ADH32

ADHD Predominately Hyperactive-Impulsive Type - Age of Onset:
______________

ADH33

Combined Type - Lifetime Diagnosis:
______________

ADH34

Combined Type - Age of Onset:
______________

ADH35

Other Specified - Lifetime Diagnosis:
______________

ADH36

Other Specified ADHD - Age of Onset:
______________

ADH37

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K-SADS PL 2013:
EATING DISORDERS - BINGE EATING DISORDER
Advanced Center for Intervention and Services Research (ACISR) for Early
Onset Mood and Anxiety Disorders
Western Psychiatric Institute and Clinic
Child and Adolescent Research and Education (CARE) Program
Yale University

Modified for the National Mental Health Study

Interviewer ID:

Date of Interview:

QUESTID:

This page has been intentionally left blank.

K-SADS-PL 2013 – Modified for the National Mental Health Study

EATING DISORDERS – BINGE EATING DISORDER

K-SADS Screen Interview: EATING DISORDERS - BINGE EATING DISORDER

If CIDI screen = positive (+) or subthreshold: Say, “In your earlier interview, you mentioned that
there was a time in your life when you were very worried about your weight. The next questions are
about that.” Then proceed with Eating Disorder screen.
If CIDI screen = negative (-): Proceed with Eating Disorder screen.

Begin this section with a brief (2-3 minute) semi-structured interview to obtain information
about eating habits:
Are you happy with your weight?
Do you eat regular meals? Do you diet?
Has there ever been a time when you weighed a lot more or a lot less?
What was your weight? What did you want your weight to be?
Fear of Becoming Obese
Has there ever been a time when you were afraid
of getting fat?
Did you believe you were fat?
Have you ever been really overweight?
Did you watch what you ate and think about what
you ate all the time?
Were you afraid of eating certain foods because
you were afraid they'd make you fat? What foods?
How much time did you spend thinking about food
and worrying about getting fat?
If you saw that you had gained a pound or two, did
you change your eating habits?
Fast for a day or do anything else?

0 – No information
1 – Not present
2 – Subthreshold: Intense and
persistent fear of becoming fat,
which defies prior weight history
and/or present weight,
reassurance, etc. Fears have
only moderate impact on
behavior and/or functioning (e.g.,
weight loss methods utilized at
least once a month, but less than
once a week).
3 – Threshold: Intense and
persistent fear of becoming fat
that has severe impact on
behavior and/or functioning (e.g.,
constantly pre-occupied with
weight concerns; or use of weight
loss methods 1 time a week or
more).

EAT1

K-SADS-PL 2013 – Modified for the National Mental Health Study

EATING DISORDERS – BINGE EATING DISORDER

Emaciation
Weight is proportionally lower than ideal weight for
height.

0 – No information
1 – Not present

NOTE: DO NOT RATE POSITIVELY IF WEIGHT
LOSS IS DUE TO A MEDICAL CONDITION,
MOOD DISORDER, OR FOOD SCARCITY
RELATED TO POVERTY.

2 – Subthreshold: Weight below
90% of ideal.
3 – Threshold: Weight below 85%
of ideal.

EAT2

K-SADS-PL 2013 – Modified for the National Mental Health Study

EATING DISORDERS – BINGE EATING DISORDER

Weight Loss Methods
Have you ever used diet pills to control your
weight?
How about laxatives, or water pills to lose
weight?
Did you sometimes make yourself throw up?
Did you exercise a lot, more than was usual for
you, in order to lose weight? How much? How
many hours a day?
Did you have periods of at least 1 week during
which you had nothing but liquids with no
calories (teas, diet sodas, coffee, water)?

Criteria:
0 = No Information
1 = Not present
2 = Less than one time a week
3 = One or more times a week

Lifetime/Most Severe Episode

A. Using diet pills

EAT3

B. Taking laxatives

EAT4

C. Taking water pills

EAT5

D. Throwing up

EAT6

E. Exercising a lot

EAT7

EAT8

EAT9

F. Taking only non-caloric fluids for
a week or more; restricting energy (e.g.,
food) intake

G. Combined frequency weight loss methods

K-SADS-PL 2013 – Modified for the National Mental Health Study

EATING DISORDERS – BINGE EATING DISORDER

Eating Binges or Attacks
Binge eating episode associated with three or more of
the following:
1) Eating much more rapidly than normal.
2) Eating until feeling uncomfortably full.
3) Eating large amounts of food when not
physically hungry.
4) Eating alone because of being embarrassed.
5) Feeling disgusted, depressed, or very guilty
after overeating

0 – No information

Has there ever been a time when you had "eating
attacks" or binges?
What's the most you ever ate at one time?
Have there ever been times you ate so much you felt
sick? How often did it happen?
(ascertain all details in definition)
What triggered a binge?
What did you usually eat when you binged?
What was the most food you have eaten during a
binge?
Did you ever make yourself throw up after a binge?
How did you feel after you binged?
Did you usually binge alone or with other people?
Did other people know you binged?

3 – Threshold: Eating
binges occur once a week
or more.

EAT10

1 – Not present
2 – Subthreshold: Eating
binges that occur less than
once a week or have fewer
than three associated
features.

NOTE: ONLY RATE EATING BINGES THAT ARE
PATHOLOGICAL (e.g. hidden from family members
and peers, followed by depressed mood, and/or
throwing up behavior). DO NOT RATE TYPICAL
ADOLESCENT EVENTS/PARTIES THAT INVOLVE
EATING (e.g. outings with friends for pizza and ice
cream).

IF A SCORE OF 3 ON EATING BINGES OR ATTACKS, COMPLETE THE
EATING DISORDERS SUPPLEMENT AFTER FINISHING THE SCREEN
INTERVIEW.

IF A SCORE OF 1 OR 2 ON EATING BINGES OR ATTACKS OR ANY SCORE (0, 1, 2)
ON ANY OTHER QUESTIONS, STOP INTERVIEW, RECORD TIME.
NOTES: (RECORD DATES OF POSSIBLE CURRENT AND PAST BINGE EATING
DISORDER)

K-SADS-PL 2013 – Modified for the National Mental Health Study

EATING DISORDERS – BINGE EATING DISORDER

K-SADS Supplement: EATING DISORDERS – BINGE EATING DISORDER
When we were talking before you talked about your concerns about your weight and your eating
habits.
Review weight loss methods (check all that apply):
_____ Using diet pills
_____ Taking laxatives
_____ Taking water pills
_____ Throwing up
_____ Exercising a lot
_____ Taking only non-caloric fluids for a day or more; restriction of energy (e.g., food) intake
Review binge eating episode features (check all that apply):
_____ Eating much more rapidly than normal.
_____ Eating until feeling uncomfortably full.
_____ Eating large amounts of food when not physically hungry.
_____ Eating alone because of being embarrassed.
_____ Feeling disgusted, depressed, or very guilty after overeating.

Disturbance of Body Image
Do you feel fat even when everyone else tells you
that you don't look it?
Do you wish you were thinner?
Are there any parts of your body that feel
especially fat?
Does it bother you that you have lost so much
weight and you still feel fat?
Do you think you have actually lost weight or just
that other people think so but they are wrong?
How are they wrong?

0 - No information

EAT11

1 - Not present
2 - Subthreshold: Reports feels
fat, and is often bothered by these
thoughts, although that s/he is not
fat by objective standards.
3 – Threshold: Perceptions of self
as fat are unaltered by objective
evidence to the contrary.

Lack of Control
Do you feel like you don't have any control over
your binges?
Can you stop eating once you've started?

0 - No information
1 - Not present
2 - Subthreshold: Often can
control urges to binge or can stop
binging once it begins (e.g., at
least 50% of the time).
3 – Threshold: Sometimes can
control urges to binge, usually
cannot. Usually has difficulty
stopping a binge once it begins.

EAT12

K-SADS-PL 2013 – Modified for the National Mental Health Study

EATING DISORDERS – BINGE EATING DISORDER

Codes: 0 = No information. 1 = No. 2 = Yes.
Lifetime
Self-Evaluation Influenced by Weight
Do you feel like your self-worth is totally tied to
your weight?
Duration of Eating Disturbance (in weeks)

_______________

EAT13

EAT14

Codes: 0 = No information. 1 = No. 2 = Yes.
Lifetime/Most Severe Episode
Evidence of Binge Eating Disorder

EAT15

DSM-5-Criteria
A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of
the following:
1) Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food
that is definitely larger than most people would eat during a similar period of time and
under similar circumstances.
2) A sense of lack of control over eating during the episode (e.g., a feeling that one cannot
stop eating or control what or how much one is eating)
B. Binge eating episodes are associated with three or more of the following:
1) Eating much more rapidly than normal
2) Eating until feeling uncomfortably full
3) Eating large amounts of food when not feeling physically hungry
4) Eating alone because of feeling embarrassed by how much one is eating
5) Feeling disgusted with oneself, depressed, or very guilty afterward
C. Marked distress regarding binge eating is present.
D. The binge eating occurs, on average, at least once a week for 3 months
E. Binge eating is not associated with inappropriate compensatory behavior and does not
occur exclusively during Bulimia or Anorexia Nervosa.

K-SADS-PL 2013 – Modified for the National Mental Health Study

EATING DISORDERS – BINGE EATING DISORDER

Severity of Binge Eating Disorder
Rate severity for Binge-Eating Disorder based on
number of binge eating episodes per week:

_____________________

EAT16

1 - Mild (1-3)
2 - Moderate (4-7)
3 - Severe (8-13)
4 - Extreme (14+)

Codes: 0 = No information. 1 = Not present. 2 = Probable. 3 = Definite.
Probable Diagnosis:
1. Meets criteria for core symptoms of the disorder.
2. Meets all but one, or a minimum of 75% of the remaining criteria required for the diagnosis
3. Evidence of functional impairment
Binge Eating Disorder Lifetime Diagnosis: __________

EAT17

Binge Eating Disorder Age of Onset: _________

EAT18

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K-SADS-PL 2013:
CONDUCT DISORDER
Advanced Center for Intervention and Services Research (ACISR) for Early
Onset Mood and Anxiety Disorders
Western Psychiatric Institute and Clinic
Child and Adolescent Research and Education (CARE) Program
Yale University

Modified for the National Mental Health Study

Interviewer ID:

Date of Interview:

QUESTID:

This page has been intentionally left blank.

K-SADS-PL 2013 – Modified for the National Mental Health Study

CONDUCT DISORDER

K-SADS Screen Interview: CONDUCT DISORDER

The essential feature of Conduct Disorder is a repetitive and persistent pattern of behavior in which
the basic rights of others or major age appropriate societal rules are violated. Three behaviors
must have been present during the past 12 months with at least one present in the past 6 months.
Keep in mind differential diagnoses of mood disorders, ADHD, psychosis, substance abuse. If
symptoms occur only during manic episode, consider NOT giving both diagnoses.
If CIDI screen = positive (+) or subthreshold: Say, “In your earlier interview you mentioned that
you have had times when you felt either irritable or in a bad mood, or you felt full of energy with a
better mood than usual for more than few days. The next questions are about that.” Then proceed
with Conduct Disorder screen.
If CIDI screen = negative (-): Proceed with Conduct Disorder screen.

0 – No information.

1 – Not present.

2 – Subthreshold:
Occasionally lies. Likes
more often than a
typical child his/her age.

3 – Threshold: Lies
often, multiple times per
week or more (to con
or cheat).

Lies
Everybody lies. Some kids tell lies
to exaggerate, some kids tell lies
to get out of trouble, while others
tell lies to con/cheat others.
Do you ever tell lies?
What type of lies do you tell?
Who do you lie to?
Have people ever called you a
liar?
What's the worst lie you ever told?
Did you lie to get other people to
do things for you?
Did you lie to get out of paying
people back money or some favor
you owe them?
Has anyone ever called you a
con?
Complained that you broke
promises a lot?
How often did you lie?
NOTE: Only rate positive
evidence of lying to cheat or
“con.”

P = Parent Rating C = Child Rating

S = Summary Rating

CDO1

K-SADS-PL 2013 – Modified for the National Mental Health Study

CONDUCT DISORDER

0 – No information.

1 – Not present.

2 – Subthreshold:
Truant on one isolated
incident.

3 – Threshold: Truant
on numerous occasions
(e.g. 2 or more days or
numerous partial
days).

Truant
Has there ever been a time when
you skipped a whole day of school
when your parents didn't know
about it?
Did you ever go to school and
leave early when you were not
really supposed to? How about
going in late?
Did you sometimes miss or skip
classes in the morning?
Did you get into trouble? How
often?
For adolescents: How old were
you when you first started to play
hooky?
NOTE: Only rate positive
incidents of truancy beginning
before the age of 13. In addition,
truancy is actively missing part
of all of a school day regardless
of parent ability to enforce
attendance.

P = Parent Rating C = Child Rating

S = Summary Rating

CDO2

K-SADS-PL 2013 – Modified for the National Mental Health Study

CONDUCT DISORDER

0 – No information.

1 – Not present.

2 – Subthreshold: Fights
with peers only. No fight
has resulted in serious
injury to peer (e.g. no
medical intervention
required, stitches, etc.).

3 – Threshold: Reports
at least one physical
fight involving an adult
(e.g. teacher, parent)
OR reports starting
frequent fights, with one
or more fights resulting
in serious injury to a
peer, or frequent fights
not resulting in injury (at
least 1-2 times per
month).

Initiates Physical Fights
Has there ever been a time when
you got into many fist fights?
Who usually started the fights?
What's the worst fight you ever got
into? What happened? Did anyone
get hurt?
Who did you usually fight with?
Have you ever hit a teacher? One
of your parents? Another adult?
How often did you fight?
Have you ever tried or wanted to
kill someone?
NOTE: Take into account
culture, background, and
neighborhood.

INQUIRE ABOUT:
A. Gang involvement. Are you or
your friends in a gang? The
Crips? Bloods? Another gang?
____ Check here if evidence of
gang involvement.
B. Homicidal intent. Have you
ever thought about wanting to
kill someone or a group of
people? Do you have a gun or
any other weapons?
____ Check here if evidence of
homicidal intent.

P = Parent Rating C = Child Rating

S = Summary Rating

CDO3

K-SADS-PL 2013 – Modified for the National Mental Health Study

CONDUCT DISORDER

0 – No information.

1 – Not present.

2 – Subthreshold:
Occasionally bullies,
threatens or intimidates.

3 – Threshold: Bullies,
threatens, or intimidates
others on multiple
occasions, daily, almost
daily, or at least several
times per week.

Bullies, Threatens, or Intimidates
Others
Do you ever try to bully kids or
threaten kids to get them to do
something you want them to do?
How often do you do these things?
Call names or make fun of other
kids
Threaten to hurt other kids
Push
Trip
Come up from behind and slap or
knock kids down
Knock items out of kids’ hands
Make other kids do things for you
NOTE: Do not count trivial
sibling rivalry.

CDO4

IF RECEIVED A SCORE OF 3 ON ANY OF THE PREVIOUS ITEMS, COMPLETE THE
CONDUCT DISORDER SUPPLEMENT AFTER FINISHING THE SCREEN INTERVIEW.

IF A SCORE OF 1 or 2, STOP INTERVIEW, RECORD TIME.

NOTES: (RECORD DATES OF POSSIBLE CURRENT AND PAST CONDUCT DISORDER.
MAKE NOTES ABOUT GANG INVOLVEMENT).

P = Parent Rating C = Child Rating

S = Summary Rating

K-SADS-PL 2013 – Modified for the National Mental Health Study

CONDUCT DISORDER

K-SADS Supplement: CONDUCT DISORDER
The essential feature of Conduct Disorder is a repetitive and persistent pattern of behavior in which
the basic rights of others or major age-appropriate social rules are violated. Three behaviors must
have been present during the past 12 months with at least one present in the past 6 months. Keep
in mind differential diagnoses of bipolar disorder, MDE, ADHD, psychosis, substance
abuse.
If symptoms occur only during mood disorders, consider NOT giving both diagnoses.
However, in persistent depression/dysthymia, it may be impossible to disentangle and you
might consider giving both diagnoses.

0 – No information.

1 – Not present.

2 – Subthreshold: Minor
acts of deliberate
destruction of other
people's property on
rare occasions (e.g.,
breaks another's toy on
purpose) OR one or two
occasions of significant
destruction of property.

3 – Threshold: Three or
more instances of
moderate to severe
vandalism/destruction of
property.

Vandalism, Destroyed Others’
Property
Do you ever break other people's
things on purpose? Like breaking
windows? Kicking in doors,
smashing windows, destroying
school property?
Have you ever destroyed furniture,
walls, floors, doors, etc. at home
or school?
How about when you were very
angry?
How often do you destroy others'
property?

P = Parent Rating C = Child Rating

S = Summary Rating

CDO5

K-SADS-PL 2013 – Modified for the National Mental Health Study

CONDUCT DISORDER

0 – No information.

1 – Not present.

2 – Subthreshold: Has
been with friends who
broke into a house, car,
store, or building, but
did not actively
participate.

3 – Threshold: Has
broken into a house,
car, store, or building 1
or more times.

0 – No information.

1 – Not present.

2 – Subthreshold: Has
been with friends who
aggressively stole, but
did not actively
participate.

3 – Threshold: Mugging,
purse-snatching,
extortion, armed
robbery, etc. on 1 or
more occasions.

Breaking and Entering
Have you or any of your friends
ever broken into any cars?
Houses? Any stores?
Warehouses? Other buildings?
About how many times have you
broken into a house, car, store, or
other building?
Have you or any of your friends
done any of the following: Broken
into houses; cars; other vehicles;
abandoned houses or buildings; a
store(s); a building(s)?

CDO6

Aggressive Stealing
Have you or any of your friends
robbed anyone?
Snatched their purse?
Held them up?
How often?

P = Parent Rating C = Child Rating

S = Summary Rating

CDO7

K-SADS-PL 2013 – Modified for the National Mental Health Study

CONDUCT DISORDER

0 – No information.

1 – Not present.

2 – Subthreshold:
Match/lighter play. No
intent to cause damage,
and fire(s) not started
out of anger.

3 – Threshold: Set 1 or
more fires with the
intent to cause damage,
or out of anger.

0 – No information.

1 – Not present.

2 – Subthreshold:
Stayed out all night, or
several hours past
curfew, on 1-2 isolated
occasions (despite
parent's prohibitions).

3 – Threshold: Stayed
out all night, or several
hours past curfew, on
several occasions (3 or
more times).

Firesetting
Have you set any fires?
Why did you set the fire?
Were you playing with matches
and did you start the fire by
accident, or did you start it on
purpose?
Were you angry?
Were you trying to cause a lot of
damage or to get back at
someone?
What's the most damage you ever
caused by starting a fire?
About how many fires have you
set?

CDO8

Often Stays out at Night
What time are you supposed to
come home at night?
Do you often stay out past your
curfew?
What is the latest you ever stayed
out?
Have you ever stayed out all
night?
How many times have you done
that?
Note: Only rate positive
incidents of staying out if it
begins before the age of 13.

P = Parent Rating C = Child Rating

S = Summary Rating

CDO9

K-SADS-PL 2013 – Modified for the National Mental Health Study

CONDUCT DISORDER

0 – No information.

1 – Not present.

2 – Subthreshold: Ran
away overnight only one
time, or ran away for
shorter periods of time
on several occasions.

3 – Threshold: Ran
away overnight 2 or
more times or once for
at least 2 or more nights
(lengthy period of time).

0 – No information.

1 – Not present.

2 – Subthreshold: Has
threatened use of a
weapon, but has never
used one.

3 – Threshold: Used a
weapon that can cause
serious harm on 1 or
more occasions (e.g.,
knife, brick, broken
bottle, gun).

Ran Away Overnight
Have you ever run away? Why?
Was there something going on at
home that you were trying to get
away from?
How long did you stay away?
How many times did you do this?

NOTE: Do not score positively if
child ran away to avoid physical
or sexual abuse.

CDO10

Use of a Weapon
Have you ever used an object or
item to hit/hurt someone?
Have you ever carried a weapon?
Have you ever used or threatened
to use to hurt someone (check all
that apply):
____kitchen knife or pocket knife
____gun
____brick, rocks
____broken bottles
____bat
____brick

CDO11

What about in self-defense?

P = Parent Rating C = Child Rating

S = Summary Rating

K-SADS-PL 2013 – Modified for the National Mental Health Study

CONDUCT DISORDER

0 – No information.

1 – Not present.

2 – Subthreshold: Has
been physical cruelty on
one or two occasions.
No significant injuries.

3 – Threshold: Has
been physically cruel to
an individual on 3 or
more occasions, or on
one occasion
intentionally causing
significant injury.

0 – No information.

1 – Not present.

2 – Subthreshold:
Forced or attempted to
force someone to
participate in mild
sexual activity (e.g.,
non-genital fondling) on
one or more occasions.

3 – Threshold: Forced
someone to participate
in severe sexual activity
(e.g. genital fondling,
oral sex, vaginal
intercourse and/or anal
intercourse) on one or
more occasions.

Physical Cruelty to Persons
Have you ever beaten someone
up for no reason?
How bad?
Was it just because the other
person was different than you or
because of the way they looked?
Did they get hurt?
NOTE: Do not count trivial
sibling rivalry.

CDO12

Forced Sexual Activity
Have you ever forced anyone to
kiss you or touch you in your
private parts?
Have you every forced another kid
to touch you outside your clothes?
Has anyone ever said you forced
another kid/person to go farther
than they wanted? What did they
say?

P = Parent Rating C = Child Rating

S = Summary Rating

CDO13

K-SADS-PL 2013 – Modified for the National Mental Health Study

CONDUCT DISORDER

0 – No information.

1 – Not present.

2 – Subthreshold: Has
repeatedly been mildly
cruel to an animal (e.g.,
kick dog).

3 – Threshold: Has
killed or tortured an
animal on one or more
occasions, or repeatedly
caused moderate to
severe injuries to an
animal.

Cruelty to Animals
Some kids like to hurt or torture
animals. Have you hurt or tried to
hurt an animal on purpose? What
did you do?
About how many times have you
hurt an animal on purpose in the
last six months?
NOTE: Do not score traditional
hunting outings. Pay careful
attention to the community
setting (rural, farm, etc.).

CDO14

Codes: 0 = No information. 1 = No. 2 = Yes.
P

Impairment
A. Socially (with peers)

CDO14

B. With family

CDO15

C. In school

CDO16

P = Parent Rating C = Child Rating

S = Summary Rating

K-SADS-PL 2013 – Modified for the National Mental Health Study

CONDUCT DISORDER

Codes: 0 = No information. 1 = No. 2 = Yes.
P

Duration
For how long did you (list
positively endorsed
conduct symptoms)?

CDO17

CDO18

CDO19

Criteria to rate “yes”: 6
months or more.
NOTE: Per DSM-5, "the
Conduct Disorder
diagnosis should be
applied only when the
behavior in question is
symptomatic of an
underlying dysfunction
within the individual and
not simply a reaction to
the immediate social
context."
P

Childhood Onset Type
How old were you when
you first started to (list
positively endorsed
items)?

Criteria to rate “yes”:
Onset of at least one
conduct problem prior
to age 10.

Adolescent Onset Type
Did you do any of
these things before
you were 10?

Criteria to rate “yes”:
No conduct problems
prior to age 10.

P = Parent Rating C = Child Rating

S = Summary Rating

K-SADS-PL 2013 – Modified for the National Mental Health Study

CONDUCT DISORDER

Lifetime
Evidence of Conduct Disorder

CDO20

DSM-5-Criteria
A. A repetitive and persistent pattern of behavior in which the basic rights of others or major
age-appropriate societal norms or rules are violated, as manifested by the presence of
three (or more) of the following 15 criteria in the past 12 months from any of the categories
below, with at least one criterion present in the past 6 months:
Aggression to People and Animals
1. Often bullies, threats, or intimidates others
2. Often initiates physical fights
3. Has used a weapon that can cause serious physical harm to others (e.g., a bat,
brick, broken bottle, knife, gun)
4. Has been physically cruel to people
5. Has been physically cruel to animals
6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion,
armed robbery)
7. Has forced someone into sexual activity
Destruction of Property
8. Has deliberately engaged in fire setting with the intention of causing serious damage
9. Has deliberately destroyed others’ property (other than by firesetting)
Deceitfulness or Theft
10. Has broken into someone else’s house, building or car
11. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others)
12. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but
without breaking and entering, forgery)
Serious Violation of Rules
13. Often stays out at night despite parental prohibitions, beginning before age 13 years
14. Has run away overnight at least twice while living in parental or parental surrogate
home (or once without returning for a lengthy period)
15. Is often truant from school, beginning before age 13 years
B. The disturbance in behavior causes clinically significant impairment in social, academic or
occupational functioning.
C. If the individual is age 18 years or older, criteria are not met for Antisocial Personality
Disorder.

K-SADS-PL 2013 – Modified for the National Mental Health Study

CONDUCT DISORDER

Lifetime
0

Specify: with Limited Prosocial Emotion:

CDO21

Criteria: Displays at least two of the following characteristics persistently over at least 12
months and in multiple relationships and settings:
1. Lack of remorse or guilt – does not feel bad or guilty when he or she does something
wrong; the individual shows a general lack of concern about the negative consequences
of his or her actions;
2. Callous, lack of empathy – disregards and is unconcerned about the feelings of
others; the individual is described as cool and uncaring;
3. Unconcerned about performance at school, work, or in other important activities – the
individual does not put forth the effort necessary to perform well, even when
expectations are clear, and typically blames other for his or her poor performance;
4. Shallow or deficient affect – does not express feelings or show emotions to others
except in ways that seem shallow, insincere or superficial or when emotional
expressions are used for gain.

Lifetime
Mild

Severity:

Moderate

Severe

CDO22

Criteria:
•
•
•

Mild: Few problems in excess of those required for the diagnosis; problems cause
relatively minor problems to others (e.g., lying, truancy, staying out after dark without
permission);
Moderate: Intermediate severity (e.g., stealing without confronting a victim, vandalism);
Severe: Many problems in excess of those required for the diagnosis, or problems
cause considerable harm to others (e.g., forced sex, physical cruelty, use of weapon,
stealing while confronting victim, breaking and entering).
Codes: 0 = No information. 1 = Not present. 2 = Probable. 3 = Definite.

Probable Diagnosis:
1. Meets criteria for core symptoms of the disorder.
2. Meets all but one, or a minimum of 75% of the remaining criteria required for the diagnosis
3. Evidence of functional impairment
Conduct Disorder Lifetime Diagnosis: __________

CDO23

Conduct Disorder Age of Onset: __________

CDO24

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K-SADS-PL 2013:
DEPRESSION & MANIA/HYPOMANIA
Advanced Center for Intervention and Services Research (ACISR) for Early
Onset Mood and Anxiety Disorders
Western Psychiatric Institute and Clinic
Child and Adolescent Research and Education (CARE) Program
Yale University
Modified for the National Mental Health Study

Interviewer ID:

Date of Interview:

QUESTID:

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K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

K-SADS Screen Interview: DEPRESSION

If CIDI screen = positive (+) or subthreshold: Say, “In your earlier interview you mentioned that
you have had times when you felt either irritable or in a bad mood, or you felt full of energy with a
better mood than usual for more than few days. The next questions are about that.” Then proceed
with Depression and Mania screens. If CIDI screen = negative (-): Proceed with Depression and
Mania screens.
P

0 – No information.

1 – Not present. Not at
all or less than once a
week.

2 – Subthreshold:
Depressed mood at
least 2-3 days/ week, for
much of the day.

3 – Threshold:
Depressed mood at
least 2-3 days/ week, for
much of the day.

Depressed Mood
[DSM-5 DR# 6: Felt down,
depressed]
Have you ever felt sad, blue, down,
or empty? Did you feel like crying?
When was that? Do you feel ___
now? Was there ever another time
you felt ___?
Did you have any other bad
feelings? Did you have a bad feeling
all the time that you couldn't get rid
of? Did you cry or were you tearful?
Did you feel ___ all the time? Some
of the time? (Percent of awake time:
summation of % of all labels if they
do not occur simultaneously).
(Assessment of diurnal variation
can secondarily clarify daily
duration of depressive mood)
Did it come and go? How often?
Every day? How long did it last?
What do you think brought it on?
Could other people tell that you
were sad?
Duration of Depressed Mood – # of
weeks (most severe episode):

____________ weeks

DMA1

DMA2

NOTE: Sometimes the child will initially give a negative answer at the start of the interview
but will become obviously sad as the interview goes on. Then these questions should be
repeated eliciting the present mood and using it as an example to determine its frequency.
NOTE: When a child or parent reports frequent short periods of sadness throughout the
day, it is likely that the child is always sad and only reports the exacerbations, in which
case the rating of depressive mood will be 3. Thus, it is always essential to ask about the
rest of the time: "Besides these times when you felt ___, during the rest of the time, did you
feel happy or were you more sad than your friends?"
P = Parent Rating C = Child Rating

S = Summary Rating

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

0 – No information.

1 – Not present. Not at
all or less than once a
week.

2 – Subthreshold: Feels
definitely more angry or
irritable than called for
by the situation at least
(2-3 days/week), for
much of the day.

3 – Threshold: Feels
irritable/angry more
days than not (4-7 days/
week), most of the day
(at least 50% of awake
time.).

Irritability and Anger
Was there ever a time when you got
annoyed, irritated, or cranky at little
things?
Did you ever have a time when you
lost your temper a lot? When was
that?
Are you like that now? Was there
ever another time you felt ___?
What kinds of things made you ___?
Were you feeling mad or angry also
(even if you didn't show it)?
How angry? More than before?
What kinds of things made you feel
angry? Did you sometimes feel
angry, irritable, and/or cranky and
didn't know why?
Did this happen often?
Did you lose your temper? With your
family? Your friends? Who else? At
school? What did you do? Did
anybody say anything about it?
How much of the time did you feel
angry, irritable, and/or cranky? All of
the time? Lots of the time? Just now
and then? None of the time?

DMA3

When you got mad, what did you
think about?
Did you think about killing others or
hurting yourself? Or about hurting
them or torturing them? Whom? Did
you have a plan? How?

Duration of Irritable Mood
(most severe episode):

__________________

NOTE: IRRITABILITY MAY BE
DUE TO OTHER DISORDERS,
e.g., BIPOLAR DISORDER, ADHD,
ODD, CD, SUBSTANCE ABUSE,
ASD.

P = Parent Rating C = Child Rating

S = Summary Rating

DMA4

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

0 – No information.

1 – Not present.

2 – Subthreshold:
Several activities
definitely less
pleasurable or
interesting. Or bored or
apathetic at least 3
times a week during
activities.

3 – Threshold: Most
activities much less
pleasurable or
interesting. Or bored or
apathetic daily, or
almost daily, at least
50% of the time.

Anhedonia, Lack of Interest,
Apathy, Low Motivation, or
Boredom
[DSM-5 DR# 5: Has less fun doing
things]
Boredom is a term all children
understand and which frequently
refers to loss of ability to enjoy
(anhedonia) or to loss of interest or
both. Loss of pleasure and loss of
interest are not mutually exclusive
and may coexist.
What are the things you do for fun?
Enjoy? (Get examples: Nintendo,
sports, friends, favorite games,
school subjects, outings, family
activities, favorite TV programs,
computer or video games, music,
dancing, playing alone, reading,
going out, etc.). Has there ever been
a time you felt bored a lot of the
time? When? Do you feel bored a lot
now?
Was there another time you felt
bored a lot? Did you feel bored
when you thought about doing the
things you usually like to do for fun?
(Give examples mentioned above).
Did this stop you from doing those
things? Did you (also) feel bored
while you were doing things you
used to enjoy?
Anhedonia refers to partial or
complete (pervasive) loss of ability
to get pleasure, enjoy, have fun
during participation in activities
which have been attractive to the
child like the ones listed above. It
also refers to basic pleasures like
those resulting from eating favorite
foods and, in adolescents, sexual
activities.
Did you look forward to doing the
things you used to enjoy? (Give
examples) Did you try to get into
them? Did you have to push
yourself to do your favorite
activities? Did they interest you?
P = Parent Rating C = Child Rating

S = Summary Rating

DMA5

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

Anhedonia, Lack of Interest,
Apathy, Low Motivation, or
Boredom, CONTINUED.
Did you get excited or enthusiastic
about doing them? Why not? Did
you have as much fun doing them
as you used to before you began
feeling (sad, etc.)? If less fun, did
you enjoy them a little less? Much
less? Not at all? Did you have as
much fun as your friends? How
many things are less fun now than
they used to be (use concrete
examples provided earlier by child)?
How many were as much fun? More
fun? Did you do _____ less than you
used to? How much less?
In adolescents: (if sexually active)
Do you enjoy sex as much as you
used to? Are you less sexually
active than you used to be?
This item does not refer to
inability to engage in activities
(loss of ability to concentrate on
reading, games, TV, or school
subjects)
Two comparisons should be made in each assessment: Enjoyment as compared to that of
peers and/or enjoyment as compared to that of child when not depressed. The second is not
possible in episodes of long duration because normally children's preferences change with age.
Severity is determined by the number of activities which are less enjoyable to the child, and by
the degree of loss of ability to enjoy.
Do not confuse with lack of opportunity to do things which may be due to excessive
parental restrictions.

Duration of Anhedonia in weeks
(most severe episode):

P = Parent Rating C = Child Rating

____________ weeks

S = Summary Rating

DMA6

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

0 – No information.

1 – Not present. Not at
all or less than once a
week.

2 – Subthreshold:
Infrequent thoughts of
death (e.g. less than
once per month, vague,
non-specific).

3 – Threshold:
Recurrent thoughts of
death, “I would be better
off dead” or “I wish I
were dead.”

0 – No information.

1 – Not at all.

2 – Subthreshold:
Infrequent or vague
thoughts of suicide
(e.g., less than once per
month).

3 – Threshold:
Recurrent thoughts of
suicide.

Recurrent Thoughts of Death
Sometimes children who get upset
or feel bad, wish they were dead or
feel they'd be better off dead.
Have you ever had these type of
thoughts? When?
Do you feel that way now?
Was there ever another time you felt
that way?

DMA7

Suicidal Ideation
[DSM-5 DR# 24: Thoughts of
committing suicide]
Sometimes children who get upset
or feel bad think about dying or even
killing themselves.
Have you ever had such thoughts?
How would you do it?
Did you have a plan?

P = Parent Rating C = Child Rating

S = Summary Rating

DMA8

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

0 – No information.

1 – No attempt.

2 – Subthreshold:
Preparations with no
actual intent to die (e.g.,
held pills in hand) or
planned attempt but did
not follow through or
engage in self harming
behavior.

3 – Threshold: Self
injurious behavior with
ANY suicidal intent. (If
subject endorses even a
1% intent to die, code
as threshold here).

Suicidal Acts - Intent
DSM-5 DR# 25: Ever tried to kill
self:
Have you actually tried to kill
yourself? When?
What did you do?
Did you do anything else?
Did you truly want to die?
How close did you come to doing it?
Was anybody in the room? In the
apartment? Did you tell them in
advance? How were you found?
Did you ask for any help after you
did it?
NOTE: CODE SELF-HARMING
BEHAVIOR WITH NO INTENT TO
DIE AS NON-SUICIDAL, SELFINJURIOUS BEHAVIOR (see
DMA13) - NOT AS SUICIDAL
BEHAVIOR.

DMA9

Ever Attempted Suicide
1 – No

DMA10

2 – Yes

Number of Lifetime Attempts
Meeting Threshold of (3):
___________________

P = Parent Rating C = Child Rating

S = Summary Rating

DMA11

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

0 – No information.

1 – No attempt or
engaged in behavior
with no intent to die
(e.g., held pills in
hand). No medical
damage.

2 – Subthreshold:
Superficial cuts, scratch
to wrist, took a couple
of extra pills.

3 – Threshold: Medical
intervention occurred or
was indicated; or
significant cut with
bleeding, or took more
than a couple of pills.

Suicidal Acts – Medical Lethality
Actual medical threat to life or
physical condition following the most
serious suicidal act. Take into
account the method, impaired
consciousness at time of being
rescued, seriousness of physical
injury, toxicity of ingested material,
reversibility, amount of time needed
for complete recovery and how
much medical treatment needed.
How close were you to dying after
your (most serious suicidal act)?
What did you do when you tried to
kill yourself?
What happened to you after you
tried to kill yourself?
NOTE: CODE SELF-HARMING
BEHAVIOR WITH NO INTENT TO
DIE AS NON-SUICIDAL, SELFINJURIOUS BEHAVIOR (see
DMA13) - NOT AS SUICIDAL
BEHAVIOR.

P = Parent Rating C = Child Rating

S = Summary Rating

DMA12

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

0 – No information.

1 – Not present.

2 – Subthreshold:
Once. Has engaged in
the behavior on 1-4
occasions. Has never
caused serious injury to
self.

3 – Threshold:
Repetitive. Has
engaged in the
behavior more than 5
times and/or has
engaged in the
behavior with
significant injury
to self (e.g., burn left
scar, cut required
stitches).

Non-suicidal, Self-injurious
Behavior
Refers to intentional self-inflicted
damage to the surface of the body,
of a sort likely to induce bleeding or
pain for purposes that are not
socially sanctioned AND done
without intent of killing himself, with
the expectation that the injury will
lead to only minor or moderate
physical harm.
Have you ever tried to hurt yourself?
Have you ever burned yourself with
matches or candles? Or scratched
yourself with needles, a knife or your
nails? Or put hot pennies on your
skin? Anything else? Why did you
do it? How often?
Do you have many accidents? What
kind? How often?
Some kids do these types of things
because they want to kill
themselves, and other kids do them
because it makes them feel a little
better afterwards. Why do you do
these things?

ALL WILL RECEIVE THE NEXT SCREENING MODULE, MANIA/HYPOMANIA,
REGARDLESS OF ABOVE RESPONSES.

IF RECEIVED A SCORE OF 3 ON ANY OF THE PREVIOUS ITEMS,

DMA13

CHECK HERE: ________
AND ADMINISTER THE DEPRESSION SUPPLEMENT AFTER COMPLETING THE
MANIA SCREENING MODULE.

NOTE: (RECORD DATES OF POSSIBLE DEPRESSIVE DISORDERS).

P = Parent Rating C = Child Rating

S = Summary Rating

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

K-SADS Screen Interview: MANIA/HYPOMANIA
P

0 – No information.

1 – Not present.

2 – Subthreshold:
Definitely elevated and
optimistic outlook that
is somewhat out of
proportion to the
circumstances (above
and beyond what is
expected in a child of
the subject's age).
Occurs less than 4
hours in a day and/or
for fewer than 3
separate days.

3 – Threshold: Mood
and outlook are clearly
out of proportion to
circumstances.
Noticeable to others
and perceived as odd
or exaggerated. Occurs
for at least 4 hours out
of a day for at least 2
consecutive days or on
at least 3 separate
days within one week.

Elevated, Elated or Expansive
Mood
Elevated mood and/or excessively
optimistic attitude which is out of
proportion to circumstances and
above and beyond what is expected
in children of the same age or same
developmental level. Differentiate
from normal mood in chronically
depressed subjects. Do not rate
positive if mild elation is reported
in situations like Christmas,
birthdays, going to amusement
parks, which normally
overstimulate and make children
very excited.
NOTE: DO NOT SCORE
POSITIVELY IF ELATED MOOD IS
EXCLUSIVELY DUE TO DRUGS,
MEDICATIONS, OR ANY OTHER
PSYCHIATRIC OR MEDICAL
CONDITION.
Has there ever been a time when
you felt super happy or on top-of-the
world? Way more than your normal
happy feeling? Did the super-happy
feeling seem to come out of the
blue? Have there been times when
you were super silly, much sillier
than everyone else around you?
Were you laughing about things that
normally you would not find funny?
Did it feel like you couldn't stop
laughing? Did it seem like you were
drunk or high, even though you
weren't taking drugs or alcohol? Did
other people notice?

DMA14

Have your friends ever said anything to you about being way too happy, too silly or too high?
Did you feel super-positive, like nothing could go wrong? Did you have the feeling that
everything was terrific and would turn out just the way you wanted? Did you feel really excited or
full of enthusiasm but there really was not a reason to feel this way? Can you give examples?
How long did this feeling usually last? Would it come and go throughout the day? Did you ever
have problems or get in trouble for being too happy or high?
Ask Parent/Caregiver: Was this above and beyond what you would see in his/her friends or
other kids of the same age or developmental level in the same circumstances?
P = Parent Rating C = Child Rating

S = Summary Rating

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

0 – No information.

1 – Not present.

2 – Subthreshold:
Definite periods of
excessively irritable/
angry mood. Anger/
irritability is out of
proportion for the
situation and occurs for
much of the day or
intensely for a brief
period (< 1 hour).

3 – Threshold:
Episodes of explosive
irritability / anger that
are far out of proportion
to any stressor or
stimuli - has associated
aggressive behavior
(e.g. threats, property
destruction or physical
aggression). Occurs on
at least 2 consecutive
days or on at least 3
separate days within
one week.

Explosive Irritability/Anger
[DSM-5 DR# 8: Felt angry or lost
your temper]
Was there ever a time you were so
irritable and angry that you
exploded?
When you are feeling really mad, do
you throw things or break things?
Tear your room apart?
Have you ever punched a hole in
the wall when you were angry?
When you got really angry, did you
ever threaten or actually hurt a
parent or a teacher? What about
other kids or pets?
What was going on at the time when
this happened? What set you off?
Have there been times when you
got super angry without knowing
why or over little things that you
normally would not get upset about?
NOTE: Only rate irritability and
explosiveness in this item that
occurs during distinct episode(s)
and represents a change from
baseline. Do not rate chronic
irritability of one year duration or
longer unless there was a marked
change in intensity during a
distinct period of time.

P = Parent Rating C = Child Rating

S = Summary Rating

DMA15

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

0 – No information.

1 – Not present.

2 – Subthreshold: Brief
period(s) of increased
energy, or mild
intensification from
baseline (or) likely
caused by
environmental stimulus;
of questionable clinical
significance.

3 – Threshold: Definite
episodes of clear
increased energy or
activity, well beyond
baseline or far in
excess of same age
peers in the same
situation.

Increased Energy or Activity
[DSM-5 DR #9: Starting lots more
projects]
Has there ever been a time where
you had much more energy than
usual, so much energy that it felt like
too much?
What kinds of things were you doing
when that happened? Was there a
change in how much you were
doing? Did it seem like you were
doing too many things or were super
hyper? How long did that feeling
last? Did other people notice it? Did
you feel differently than other people
around you?
Did anything seem to cause that
feeling? Was there anything else
different about you during the time
of high energy - your speed of
talking, thinking, anything else?
NOTE: IF THE CHILD HAS ADHD
OR IS VERY ACTIVE AND
ENERGETIC AT BASELINE, ONLY
RATE POSITIVE IF THIS IS A
DISTINCT PERIOD OF
SUBSTANTIAL INCREASE IN
ENERGY.
NOTE: The (hypo)manic symptom
of increased energy should only
be rated as positive if it is
associated with an abnormal
mood (e.g., elation or irritability).
If the symptom is only
questionably associated with an
abnormal mood, then it should be
rated as subthreshold.

P = Parent Rating C = Child Rating

S = Summary Rating

DMA16

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

0 – No information.

DSM-5 DR 10: Sleeping less than
usual, still have energy]

1 – Not present.

Less sleep than usual yet still feels
rested (average for several days
when needs less sleep).

2 – Subthreshold: At
least 1 1/2 hours less
than usual without
feeling tired, for at least
2 consecutive days, or
at least 3 separate
days.

3 – Threshold: At least
3 hours less than usual
because he/she felt
energetic or high and
did not feel tired.
Occurs for at least 2
consecutive days, or on
at least 3 separate
days within one week.

Decreased Need for Sleep
[DSM-5 DR 3: Problems falling
asleep, staying asleep, or waking
early

Have you ever needed less sleep
than usual to feel rested? How much
sleep do you ordinarily need? How
much had you been sleeping? Did
you stay up because you felt
especially high or energetic? Were
you with friends or by yourself? Had
you taken any drugs? Were you up
busy doing things? What time did
you wake up? Were you tired the
next day, or did you have plenty of
energy and did not seem to need
the sleep?
NOTE: DO NOT SCORE
POSITIVELY IF DECREASED
NEED FOR SLEEP TRIGGERED
BY SOCIAL EVENT OR
ACADEMIC COMMITMENTS OR
DRUG USE, OR REFLECTIVE OF
TYPICAL IRREGULAR
ADOLESCENT SLEEP PATTERN.

P = Parent Rating C = Child Rating

S = Summary Rating

DMA17

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

0 – No information.

1 – Not present.

2 – Subthreshold:
Isolated, brief incidents
of mildly inappropriate
sexual behavior, of
questionable clinical
significance.

3 – Threshold: Definite
episodes of clearly
inappropriate sexual
behavior.

Hypersexuality
[Excessive Involvement in High Risk
Pleasurable Activities]
NOTE: HYPERSEXUALITY IN THE
ABSENCE OF SEXUAL ABUSE
OR INAPPROPRIATE EXPOSURE
TO SEXUAL BEHAVIOR OR
MEDIA IS A SYMPTOM FAIRLY
SPECIFIC TO MANIA/
HYPOMANIA. IT IS NOT A
SEPARATE DSM-5 DIAGNOSTIC
CRITERION, BUT WHEN
PRESENT, IT CAN POTENTIALLY
FULFILL EITHER BOTH THE
INCREASED GOAL-DIRECTED
ACTIVITY AND THE RISKY,
PLEASURE-SEEKING
BEHAVIOR B CRITERION.
For younger children ask
parent/caregiver:
Have there been times when your
child was excessively focused on
sex, nudity, his/her private parts or
touching others' private parts? Did
your child show an unusual increase
in touching their privates in public or
dressing in an inappropriate or
sexual manner? Would your child
kiss or touch you in a sexual way or
be way too affectionate instead of
their usual way of showing
affection? What was his/her mood
like during these times? Did
anything happen to cause these
changes?

DMA18

For adolescents:
Have there been times when you suddenly got much more interested in sex than usual or that
your sex drive seemed to go way up? Did you do anything differently when this happened (dress
in a revealing way, talk about sex a lot or ask other people to be intimate / have sex with you)?
Were there times when you were driven to have sex much more than usual or with many
different partners?
NOTE: IF ENDORSED POSITIVE, NEED TO RULE OUT SEXUAL ABUSE OR
INAPPROPRIATE EXPOSURE TO SEXUAL MATERIAL OR BEHAVIOR.

P = Parent Rating C = Child Rating

S = Summary Rating

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

ENSURE THAT ALL RECEIVED THE DEPRESSION SCREENER.

IF RECEIVED A SCORE OF 3 ON ANY OF THE PREVIOUS MANIA SCREENING ITEMS,
CHECK HERE: ________
AND ADMINISTER THE MANIA SUPPLEMENT AFTER COMPLETING THE SCREENER.

IF SCORES OF ONLY 0, 1 OR 2, ON BOTH THE DEPRESSION AND MANIA/
HYPOMANIA SCREENING STOP INTERVIEW, RECORD TIME.

NOTES: (RECORD DATES OF POSSIBLE CURRENT AND PAST HYPOMANIA OR MANIA).

P = Parent Rating C = Child Rating

S = Summary Rating

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

K-SADS Supplement: DEPRESSION
P

0 – No information.

1 – Not at all or less
than once a week.

2 – Subthreshold:
Depressed and/or
irritable mood, at least
2-3 days per week for
much of the day.

3 – Threshold:
Depressed and/or
irritable mood, nearly
every day (5-7 days/
week), most of the day
(or > 1/2 of awake
time).

Reassessment of Depressed and
Irritable Mood
The interviewer should reassess
depressed and irritable mood. For
children and adolescents the mood
criteria can be fulfilled by adding
together the duration of the reported
depressed and irritable moods, for
the past month. For example, the
child could be irritable 3 days per
week and depressed on the other
days. Therefore, the child has had
depressed and/or irritable mood
nearly every day for the past month.
In the past, you said that you started
feeling depressed and that the sad
mood lasted ________. Around that
time, were you feeling irritable or
angry as well? How often?
Currently, you said that you started
feeling depressed and that the sad
mood lasted ________. Around this
time, were you feeling irritable or
angry as well? How often?

Duration of Depressed/Irritable
Mood (Most Severe Episode) (in
weeks):

P = Parent Rating C = Child Rating

___________ weeks

S = Summary Rating

DMA19

DMA20

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

0 – No information.

1 – Not present.

2 – Subthreshold:
Insomnia at least 2-3
days per week.

3 – Threshold:
Insomnia nearly every
night (5-7 nights per
week). See below for
type of insomnia (initial,
middle and/or terminal).

0 – No information.

1 – Not present.

2 – Subthreshold: More
than 30 minutes but
less than 1 1/2 hours at
least 2-3 nights per
week.

Threshold: At least 1
1/2 hours nearly every
night (5-7 nights per
week).

Insomnia
Sleep disorder, including initial,
middle and terminal difficulty in
getting to sleep or staying asleep.
Do not rate if he/she feels no need
for sleep. Take into account the
estimated number of hours slept and
the subjective sense of lost sleep.
Normally a 6 - 8 year old child
should sleep about 10 hours +/- one
hour. 9 -12 years, 9 hours +/- 1
hour. 12 - 16 years, 8 hours +/- one
hour.
NOTE: DO NOT RATE IF
INSOMNIA IS EXCLUSIVELY DUE
TO ADHD, OPPOSITIONALITY,
MEDICAL PROBLEMS, SLEEP
DISORDER, OR OTHER
PSYCHIATRIC DISORDERS.

DMA21

A. Initial Insomnia
When you are feeling down/
depressed, do you have trouble
falling asleep? How long does it take
you to fall asleep?

P = Parent Rating C = Child Rating

S = Summary Rating

DMA22

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

0 – No information.

1 – Not present.

2 – Subthreshold: Less
than 30 minutes awake
during the middle of the
night or trying to fall
back asleep, at least 23 nights per week.

3 – Threshold: More
than 30 minutes, nearly
every night (5-7
nights/week).

0 – No information.

1 – Not present.

2 – Subthreshold:
Waking up less than 30
minutes earlier, at least
2-3 days per week.
Problem has only
minimal effect on
functioning.

3 – Threshold: Waking
up less than 30 minutes
earlier, at least 2-3
days per week.

B. Middle Insomnia
When you are feeling
down/depressed, do you wake up in
the middle of the night? How many
times? How long does it take you to
fall back asleep?

DMA23

C. Terminal Insomnia
When you are feeling down or
depressed, what time do you wake
up in the mornings? Do you wake up
earlier than you need to?

P = Parent Rating C = Child Rating

S = Summary Rating

DMA24

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

0 – No information.

1 – Not present.

2 – Subthreshold: Often
sleeps at least 1 hour
more than usual (at
least 2-3 times per
week).

3 – Threshold: Most
nights (5-7 nights/week)
sleeps at least 2 hours
more than usual.

Hypersomnia
Increased need to sleep, sleeping
more than usual. Inquire about
hypersomnia even if insomnia was
rated 2-3. Sleeping more than
norms in 24 hour period.
Do not rate positive if daytime
sleep time plus nighttime true
sleep equals normal sleep time
(compensatory naps). Do not
include "catch-up" sleep on
weekends and/or holidays if child
is not getting sufficient sleep on
school nights.
Are you sleeping longer than usual?
Do you go back to sleep after you
wake up in the morning?
When did you start sleeping longer
than usual?
Did you used to take naps before?
When did you start to take naps?
How many hours did you use to
sleep before you started to feel so
(sad)?
Parents may say that if child was
not awakened he/she would
regularly sleep > 11-12 hours and
he/she actually does so, every
time he/she is left on his/her own.
This should be rated 3.
NOTE: DO NOT RATE IF
HYPERSOMNIA IS EXCLUSIVELY
DUE TO NARCOLEPSY, MEDICAL
PROBLEMS (e.g., infection), OR
OTHER PSYCHIATRIC
DISORDERS.

P = Parent Rating C = Child Rating

S = Summary Rating

DMA25

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

0 – No information.

1 – Not present.

2 – Subthreshold: Often
tired or without energy
(2-3 days/week).

3 – Threshold: Tired or
without energy most of
the day, nearly every
day (5-7 days/week).

Fatigue, Lack of Energy, and
Tiredness
This is a subjective feeling. (Do not
confuse with lack of interest)
(Rate presence even if subject feels
it is secondary to insomnia).
Have you been feeling tired? How
often?
Do you feel tired all of the time, most
of the time, some of the time, or now
and then?
When did you start feeling so tired?
Was it after you started feeling
____?
Do you take naps because you feel
tired? How much?
Do you have to rest?
Do your limbs feel heavy?
Is it very hard to get going? .... to
move your legs?
Do you feel like this all the time?
NOTE: DO NOT RATE
POSITIVELY IF EXCLUSIVELY
DUE TO MEDICAL PROBLEMS,
OTHER PSYCHIATRIC
PROBLEMS (e.g., GAD),
MEDICATIONS OR USE OF
DRUGS OR ALCOHOL.

P = Parent Rating C = Child Rating

S = Summary Rating

DMA26

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

A. Decreased Concentration or
Slow Thinking

0 – No information.

Complaints (or evidence from
teacher) of diminished ability to think
or concentrate which was not
present to the same degree before
onset of present episode.
Distinguish from lack of interest
or motivation. Do not include if
associated with formal thought
disorder.

1 – Not present.

2 – Subthreshold:
Definitely aware of
limited attention span or
slowed thinking, at least
2-3 days/week.

3 – Threshold:
Interferes with school
work. Forgetful. Takes
substantially increased
effort in schoolwork
nearly every day (5-7
days/week) or causes
significant drop in
grades.

Cognitive Disturbances

Sometimes children have a lot of
trouble concentrating. For instance,
they have to read a page from a
book, and can't keep their mind on it
so it takes much longer to do it or
they just can't do it, can't pay
attention.
Have you been having this kind of
trouble? When did it begin? Is your
thinking slowed down? If you push
yourself very hard can you
concentrate? Does it take longer to
do your homework? When you try to
concentrate on something, does
your mind drift off to other thoughts?
Can you pay attention in school?
Can you pay attention when you
want to do something you like?
Do you forget about things a lot
more? What things can you pay
attention to? Is it that you can't
concentrate? Or is it that you are not
interested, or don't care? Did you
have this kind of trouble before?
When did it start?
NOTE: IF CHILD HAS ATTENTION
DEFICIT DISORDER, DO NOT
RATE POSITIVELY, UNLESS
THERE WAS A WORSENING OF
THE CONCENTRATION
PROBLEMS ASSOCIATED WITH
THE ONSET OF DEPRESSED
MOOD.

P = Parent Rating C = Child Rating

S = Summary Rating

DMA27

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

0 – No information.

1 – Not present.

2 – Subthreshold: Often
has difficulty making
decisions (at least 2-3
days/week).

B. Indecision
When you were feeling sad, was it
hard for you to make decisions?
Like did you find recess was over
before you could decide what you
wanted to do?
Rate based on data reported by
informant (e.g., parent).

3 – Threshold: Nearly
every day (5-7 days/
week) has difficulty
making decisions; has
significant effect on
functioning.

P = Parent Rating C = Child Rating

S = Summary Rating

DMA28

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

0 – No information.

1 – Not present.

2 – Subthreshold: Often
has decrease in
appetite (at least 2-3
days/week). (Regular
snacks not consumed)

Appetite/Weight
A. Decreased Appetite
Appetite compared to usual or to
peers if episode is of long duration.
Make sure to differentiate between
decrease of food intake because of
dieting and because of loss of
appetite.
Rate here loss of appetite only.
How is your appetite? Do you feel
hungry often? Are you eating more
or less than before? Do you leave
food on your plate? When did you
begin to lose your appetite? Do you
sometimes have to force yourself to
eat? When was the last time you felt
hungry? Are you on a diet? What
kind of diet?

P = Parent Rating C = Child Rating

3 – Threshold: Clear
decrease in appetite
every or nearly every
day (5-7 days/week)
(e.g., regular snacks not
consumed, eats smaller
meals than usual, some
meals missed).

S = Summary Rating

DMA29

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

0 – No information.

1 – No weight loss
(stays in same
percentile grouping).

2 – Subthreshold:
Questionable weight
loss.

3 – Threshold: Clear
loss of weight during
mood disturbance.

B. Weight Loss
Total weight loss from usual weight
since onset of the present episode
(or maximum of 12 months). Make
sure he/she has not been dieting. In
the assessment of weight loss it is
preferable to obtain recorded
weights from old hospital charts or
the child's pediatrician. Rate this
item even if later he/she regained
weight or became overweight. If
possible, rater should have verified
weights available at time of
interview. Consider looking at BMI.
Have you lost any weight since you
started feeling sad? How do you
know? Do you find your clothes are
looser now? When was the last time
you were weighed? How much did
you weigh then? What about now?
(Measure it).
NOTE: DO NOT RATE
POSITIVELY IF WEIGHT LOSS IS
MAINLY ACCOUNTED FOR BY
ANOREXIA NERVOSA. WEIGHT
LOSS MUST BE DUE TO MOOD
AND NOT OTHER FACTORS
(MEDICAL PROBLEMS,
MEDICATIONS, SUBSTANCE
USE, ETC.)

P = Parent Rating C = Child Rating

S = Summary Rating

DMA30

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

0 – No information.

1 – Not at all - normal or
decreased.

2 – Subthreshold: Often
snacks somewhat more
than usual, or eats
somewhat bigger meals
(at least 2-3 days/
week).

3 – Threshold: Nearly
every day (5-7 days/
week) snacks notably
more or eats bigger
meals than usual.

C. Increased Appetite
As compared to usual. Inquire about
this item even if anorexia and/or
weight loss were rated 2 - 3.
Have you been eating more than
before? Since when? Is it like you
feel hungry all the time? Do you feel
this way every day? Do you eat less
than you would like to eat? Why?
Do you have cravings for sweets?
What do you eat too much of?

P = Parent Rating C = Child Rating

S = Summary Rating

DMA31

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

0 – No information.

1 – No weight gain
(stays in same
percentile).

2 – Subthreshold:
Questionable
inappropriate weight
gain.

3 – Threshold: Clear
weight gain during
mood disturbance
beyond expected
growth.

D. Weight Gain
Total weight gain from usual weight
during present episode (or a
maximum of the last 12 months) not
including gaining back weight
previously lost or not gained
according to the child's usual
percentile for weight.
Have you gained any weight since
you started feeling sad? How do you
know? Have you had to buy new
clothes because the old ones did not
fit any longer? How much did you
used to weigh? When were you last
weighed?
NOTE: DO NOT RATE
POSITIVELY IF WEIGHT GAIN IS
RELATED TO OTHER FACTORS
(MEDICAL PROBLEMS,
MEDICATIONS, SUBSTANCE
USE, ETC.) WEIGHT GAIN MUST
BE DUE TO MOOD
DISTURBANCE.

P = Parent Rating C = Child Rating

S = Summary Rating

DMA32

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

0 – No information.

1 – Not at all, retarded,
or associated with
manic syndrome.

2 – Subthreshold: Often
unable to sit quietly in a
chair; often fidgeting,
pulling and/or rubbing or
pacing (at least 2-3
days/week).

3 – Threshold: Nearly
every day (5-7 days per
week) is unable to sit
still in class; frequently
fidgeting, pulling and/or
rubbing or pacing, etc.

Psychomotor Disturbances
A. Agitation
Includes inability to sit still, pacing,
fidgeting, repetitive lip or finger
movement, wringing of hands,
pulling at clothes, and non-stop
talking. To be rated positive, such
activities should occur while the
subject feels depressed, not
associated with the manic
syndrome, and not limited to
isolated periods when discussing
something upsetting. Do not
include subjective feelings of
tension or restlessness which are
often incorrectly called agitation.
To arrive at your rating, take into
account your observations during
the interview, the child's report and
the parent's report about the child's
behavior during the episode.

DMA33

Since you've felt sad, are there
times when you can't sit still, or you
have to keep moving and can't stop?
Do you walk up and down? Do you
wring your hands? Do you pull or
rub on your clothes, hair, skin or
other things? Do people tell you not
to talk so much?
Did you do this before you began to
feel (sad)? When you do these
things, is it that you are feeling (sad)
or do you feel high or great?
If someone was taking videos of you while you were eating breakfast and talking to your
(mother), and they took these movies before you got (depressed) and again while you were
(depressed) would I be able to see a difference? What would it be? What would I see?
Probe: Would it take longer before or while you were (depressed)? A little longer? Much longer?
If I saw a videotape or heard an audiotape of your child at home while he/she was depressed and
another when he/she wasn't depressed, could I tell the difference? If yes, what would
I see (hear) different?
Make sure it does not refer to content of speech or acts or to facial expression. Refer only
to speed and tempo.

P = Parent Rating C = Child Rating

S = Summary Rating

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

NOTE: IF CHILD HAS ATTENTION DEFICIT DISORDER, DO NOT RATE THE
PSYCHOMOTOR AGITATION ITEM POSITIVELY UNLESS THERE WAS A WORSENING OF
AGITATION THAT CORRESPONDED WITH THE ONSET OF THE DEPRESSED MOOD.
P

0 – No information.

1 – Not at all.

2 – Subthreshold: Often
(2-3 days/week)
conversation is
noticeably retarded and
/or body movement is
slowed.

3 – Threshold: Nearly
every day, noticeably
retarded speech or
movement.

B. Psychomotor Retardation
Visible, generalized slowing down of
physical movement, reactions and
speech. It includes long speech
latencies. Make certain that slowing
down actually occurred and is not
merely a subjective feeling. To
arrive at your rating take into
account your observations during
the interview, the child's report and
the parent's report about the child's
behavior during the episode.
Since you started feeling (sad) have
you noticed that you can't move as
fast as before? Have you found it
hard to start talking? Has your
speech slowed down? Do you talk a
lot less than before? Since you
started feeling sad, have you felt like
you are moving in slow motion?
Have other people noticed it?
If someone was taking movies of
you while you were eating breakfast
and talking to your (mother), and
they took these movies before you
got (depressed) and again while you
were (depressed) would I be able to
see a difference? What would it be?
What would I see? What would I
hear?
Probe: Would it take longer before
or while you were (depressed)? A
little longer? Much longer?
If I saw a videotape or heard an
audiotape of your child at home
while he/ she was depressed and
another when he/she wasn't
depressed, could I tell the
difference? If yes, what would I see
(hear) different?

P = Parent Rating C = Child Rating

S = Summary Rating

DMA34

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

0 – No information.

Includes feelings of inadequacy,
inferiority, failure and worthlessness,
self-depreciation, self-belittling.

1 – Not at all.

Rate with disregard of how
"realistic" the negative selfevaluation is.

2 – Subthreshold: Often
feels inadequate or
does not like him/herself
(2-3 days/week).

3 – Threshold: Feels
like a failure or
worthless, or unable to
identify any positive
attribute nearly every
day (5-7 days/week).

Self-Perceptions
A. Worthlessness/Negative
Self-Image

How do you feel about yourself? Do
you like yourself? Why? Or why not?
Do you ever think of yourself as
pretty or ugly? Do you think you are
bright or stupid? Do you like your
personality, or do you wish it were
different? How often do you feel this
way about yourself?

P = Parent Rating C = Child Rating

S = Summary Rating

DMA35

K-SADS-PL 2013 – Modified for the National Mental Health Study

B. Excessive or Inappropriate
Guilt...and self-reproach, for
things done or not done,
including delusions of guilt.
Rate according to proportion
between intensity of guilt feelings
or severity of punishment child
think she deserves and the actual
misdeeds.
When people say or do things that
are good, they usually feel good,
and when they say or do something
bad they feel bad about it. Do you
feel bad about anything you have
done? What is it? How often do you
think about it? When did you do
that?
What does it mean if I said I feel
guilty about something? How much
of the time do you feel like this: Most
of the time, a lot of the time, a little
of the time, or not at all? What kind
of things do you feel guilty about?
Do you feel guilty about things you
have not done? Do you feel guilty
about things that are actually not
your fault? Do you feel guilty about
things your parents or others do? Do
you feel you cause bad things to
happen? Do you think you should be
punished for this? What kind of
punishment do you feel you
deserve? Do you want to be
punished? How do your parents
usually punish you? Do you think it's
enough?

DEPRESSION & MANIA/HYPOMANIA

0 – No information.

1 – Not at all.

2 – Subthreshold:
Sometimes (2-3 days/
week) feels very guilty
about past actions, the
significance of which he
exaggerates, and which
most children would
have forgotten about.

DMA36

3 – Threshold: Nearly
every day feels guilt
which he cannot explain
or about things which
objectively are not his
fault. (Except feeling
guilty about parental
separation and/or
divorce which is
normative and should
not lead by and of itself
to a positive guilt rating
in this score, except if it
persists after repeated
appropriate discussions
with the parents)

For many young children it is preferable to give a concrete example such as: "I am going to
tell you about three children and you tell me which one is most like you. The first is a child who
does something wrong, then feels bad about it, goes and apologizes to the person, the apologies
are accepted, and he just forgets about it from then on. The second child is like the first but after
his apologies are accepted, he just cannot forget about what he had done and continues to feel
bad about it for one to two weeks. The third is a child who has not done much wrong, but who
feels guilty for all kinds of things which are really not his fault like... Which one of these three
children is like you?"
It is also useful to double check the child's understanding of the questions by asking him
to give an example, like the last time he felt guilty "like the child in the story."
P = Parent Rating C = Child Rating

S = Summary Rating

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

Codes: 0 = No information. 1 = No. 2 = Yes.
P

Other Criteria
Evidence of a Precipitant
(specify):

Symptoms Occur or
Worsen with Monthly
Menstruation

DMA37

DMA38

(For Adolescent Females):
Do you notice any
connection between your
menstrual cycle and your
moods? Do you get really
depressed each month
right before or after you
start your period?

Impairment
Must be present
in two settings.
A. Socially (with peers)

DMA39

B. With family

DMA40

C. In school

DMA41

P = Parent Rating C = Child Rating

S = Summary Rating

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

Codes: 0 = No information. 1 = No. 2 = Yes.
Lifetime
Evidence of Major Depressive Disorder

DMA42

DSM-5-Criteria
A. Meets criteria (score 3) for five or more of the depressive symptoms listed in the table
below; the symptoms have been present during the same two week period and represent a
change from previous functioning; and at least one of the symptoms is either: 1) Depressed
Mood; 2) Irritable Mood; or 3) Anhedonia/Loss of Interest or Pleasure (subjective or
observed).
B. The symptoms do not meet criteria for a Mixed Episode.
C. The symptoms cause clinically significant distress or impairment in social, occupational, or
other important areas of functioning.
D. An organic (pharmacological) etiology has been ruled out.
E. At no time have there been delusions or hallucinations for at least two weeks in the
absence of prominent affective symptoms; and
F. Did not meet criteria for Schizophrenia or Schizophreniform Disorder.

Symptom

K-SADS Score

Depressed Mood

Anhedonia/Diminished Interest or Pleasure

Decreased Appetite OR Weight Loss OR
Increased Appetite OR Weight Gain

Insomnia OR Hypersomnia

Psychomotor Agitation OR Retardation

Fatigue OR Loss of Energy

Feelings of Worthlessness OR Excessive OR
Inappropriate Guilt

Decreased Concentration, Slowed Thinking, OR
Indecisiveness

Recurrent Thoughts of Death, Recurrent
Suicidal Ideation (with or without plan) OR
Suicide Attempt

P = Parent Rating C = Child Rating

Yes

S = Summary Rating

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

Codes: 0 = No information. 1 = Not present. 2 = Probable. 3 = Definite.
Probable Diagnosis:
1. Meets criteria for core symptoms of the disorder.
2. Meets all but one, or a minimum of 75% of the remaining criteria required for the diagnosis
3. Evidence of functional impairment
Major Depressive Disorder Lifetime Diagnosis: __________

DMA43

Major Depressive Disorder Age of Onset: __________

DMA 44

P = Parent Rating C = Child Rating

S = Summary Rating

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

K-SADS Supplement: MANIA/HYPOMANIA
Reassessment of Duration of
Distinct Period of Elated/Elevated
and/or Irritable Mood (with
Associated Potential Manic
Symptomatology)
The interviewer should assess the duration (in number of days at threshold) of elated/elevated
and irritable mood that occurs in the context of potential (hypo)manic symptoms. Irritability can
frequently co-occur with elevated/elated mood during (hypo)mania, especially when the
individual's desires or goal-directed behaviors are thwarted. In addition, it is very common for
depressive symptoms to be intermixed at varying degrees of intensity with elated/elevated mood
and extreme irritability during a period of (hypo)mania, so it not uncommon for elevated and
manic irritable mood to be present for different periods throughout the day and dysphoria and
depression for much of the other time.
IT IS EXTREMELY IMPORTANT TO ONLY RATE THE DURATION OF DISTINCT PERIODS
OF ABNORMALLY ELEVATED/ELATED AND/OR IRRITABLE MOOD AND NOT CHRONIC
IRRITABILITY.
Episodes can occur against a background of chronic mood disturbance but only the distinct
episodes that are associated with (hypo)manic symptoms should be rated. In some cases, the
episode can be long, but it is a distinct change from baseline.
The interviewer should reassess elated and irritable moods that occur in the context of other
manic symptoms. For children and adolescents the mood duration criteria can be fulfilled by
adding together the duration of the reported elated and irritable moods, as long as they occur in
the context of manic symptomatology (i.e., if a child has 1 hr of elated mood and 3 hrs of very
irritable mood, this would equal 4 hrs of mood disturbance and 1 day at threshold).
NOTE: IF HISTORY OF CURRENT OR PAST SUBSTANCE USE DISORDER, CAREFULLY
ASSESS THE RELATIONSHP BETWEEN SUBSTANCE USE AND MANIC-LIKE SYMPTOMS.

P = Parent Rating C = Child Rating

S = Summary Rating

K-SADS-PL 2013 – Modified for the National Mental Health Study

Determine Duration of Longest
Episode of Abnormally
Elevated/Elated/Extreme Irritable
Mood
Maximum episode duration of
abnormal elevated/elated and/or
irritable mood with associated
(hypo)manic symptoms (number
consecutive days with 4 hours or
more hours of elevated and/or irritable
mood throughout the day).
You said that you were feeling
revved/hyper/sped up (use the child's
or parent's terminology) and were
feeling super high/super happy/super
angry. How much of the time were
you in either a super happy or super
angry mood? Would you have these
moods more than once a day? What
else was different about you when you
had these super high/super
happy/super angry moods? Were
there any changes in your energy,
speed of thinking or talking, speed of
moving, or how much sleep you would
get? Any difference in how you would
act with other people or the kinds of
things you would do? How long would
these moods (elated and/or angry)
last for altogether in a given day? How
many days in a row would you be in a
super high/super happy/super angry
mood for much of the day or night?

DEPRESSION & MANIA/HYPOMANIA

Lifetime/Most Severe
Episode

0 – 1 day. (present for
at least 4 hours total
within the day)

1 – Distinct mood
episodes last 2-3 days.

2 – Distinct mood
episodes last 4-6 days.

3 – Distinct mood
episodes last greater
than or equal to 7 days.

Indicate whether
mood is:

0 – Irritable only.

1 - Elevated/elated
only.

2 – Elevated/elated and
irritable.

DMA45

DMA46

P = Parent Rating C = Child Rating

S = Summary Rating

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

0 – No information.

1 – Not present. Not at
all, or decreased selfesteem.

2 – Subthreshold: Is
much more confident
about him/herself than
most people in his/her
circumstances but only
of possible clinical
significance.

3 – Threshold: During
mood disturbance,
persistently and
disproportionately
inflated self-esteem that
is exaggerated and out
of context.

Grandiosity/Inflated Self-Esteem
Increased self-esteem and appraisal
of his/her worth, power, or knowledge
(up to grandiose delusions*) as
compared with usual level.
When you were feeling (super high /
super happy/ super angry) were you
feeling more self-confident than
usual? When that happens, do you
believe you have any special talents
or think you have special power?
Have you felt as if you are much
better than others? ....smarter?
...stronger? Why?
Have you won any awards or honors
for ____? Have you felt that you are a
particularly important person?
NOTE: BE SURE TO DETERMINE
WHETHER THE CHILD REALLY
HAS THE "SPECIAL TALENTS" OR
NOT BEFORE RATING THIS ITEM.
ALSO, KEEP IN MIND NORMAL
DEVELOPMENTAL LEVELS. RATE
IF GRANDIOSITY IS ABOVE AND
BEYOND WHAT WOULD BE
EXPECTED FOR SUBJECT'S AGE,
NOT JUST BRAGGING. MUST BE
EXAGGERATED AND OUT OF
CONTEXT. MUST NOT BE DUE TO
SUBSTANCE USE.

Does grandiosity appear to be of
delusional intensity? Please note
and describe:

0 – No

1 - Yes

P = Parent Rating C = Child Rating

S = Summary Rating

DMA47

DMA48

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

0 – No information.

1 – Not present. Not at
all, or retarded speech.

More Talkative or Pressured
Speech
When you were feeling super high /
super happy / super angry, were there
times that you spoke very rapidly or
talked on and on and could not be
stopped?

2 – Subthreshold: Brief
or mild rapid speech
that is of questionable
clinical significance.

Have people said you were talking too
fast or talking too much? Have people
had trouble understanding you?

Rate based on data reported by
informant or observational data.

0 – No information.

1 – Not present.

2 – Subthreshold:
Possible increase in
rate of thinking; or
thinking about many
more things than usual.
Brief and not of clear
clinical significance.

3 – Threshold: Racing
thoughts are
persistently
present during the mood
disturbance or cause
significant distress or
impairment.

NOTE: IF CHILD MEETS CRITERIA
FOR ADHD ONLY RATE
POSITIVELY IF THERE WAS AN
INCREASE IN TALKATIVENESS
ASSOCIATED WITH THE ONSET
OF MOOD SYMPTOMS.

DMA49

3 – Threshold: During
the mood disturbance is
persistently and
noticeably more
verbose than normal or
speech is noticeably
pressured.

Racing Thoughts
When you were feeling super high /
super happy / super angry, were
there times that you spoke very
rapidly or talked on and on and
could not be stopped?
Have people said you were talking
too fast or talking too much? Have
people had trouble understanding
you?
Rate based on data reported by
informant or observational data.
NOTE: IF CHILD MEETS
CRITERIA FOR ADHD ONLY
RATE POSITIVELY IF THERE
WAS AN INCREASE IN
TALKATIVENESS
ASSOCIATED WITH THE ONSET
OF MOOD SYMPTOMS.

P = Parent Rating C = Child Rating

S = Summary Rating

DMA50

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

0 – No information.

1 – Not present.

2 – Subthreshold:
Possible increase in
rate of thinking; or
thinking about many
more things than usual.
Brief and not of clear
clinical significance.

3 – Threshold: Racing
thoughts are
persistently present
during the mood
disturbance or cause
significant distress or
impairment.

Flight of Ideas
Accelerated speech with abrupt
changes from topic to topic usually
based on understandable
associations, distracting stimuli or play
on words. In rating severity, consider
speed of associations, inability to
complete ideas and sustain attention
in a goal-directed manner. When
severe, complete or partial sentences
may be galloping on each other so
fast that apparent sentence-tosentence derailment and/or sentence
incoherence may also be present.
When you were super high/ super
happy/ super angry, were there times
when people could not understand
you because you jumped from subject
to subject or talked about so many
different things? Were there times
when they said you did not make
sense or had trouble following your
train of thought? Can you give me an
example?

P = Parent Rating C = Child Rating

S = Summary Rating

DMA51

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

0 – No information.

1 – Not present or slight
increase.

2 – Subthreshold:
During mood
disturbance, increase in
general activity level
involving at least one
area (e.g. school, work,
socially, sexually or
activities during free
time) but is not
persistent and only of
possible clinical
significance.

3 – Threshold: During
mood disturbance,
persistent and
significant increase in
general activity level
involving 2 or more
areas, or marked
increased in one area.
Activity involvement
and/or sociability is
excessive and much
more that what would
be expected by a typical
child his /her age.

Increased Goal-Directed
Activity/Sociability
As compared with usual level.
Consider changes in scholastic,
social, sexual or leisure involvement
or activity level associated with work,
family, friends, new projects, interests,
or activities (e.g., telephone calls,
letter writing).
During the times when you were
feeling super high / super happy /
super angry were you more active or
involved in more things than usual?
Were you working on many more
projects at home or at school? Busy
cleaning many things, rearranging
furniture or reorganizing your room?
Feeling much more social and really
outgoing, talking to many people,
suddenly feeling super friendly?
For adolescents: Were you much
more sexually active than usual?
NOTE: ONLY SCORE POSITIVELY
IF INCREASED ACTIVITY
SOCIABILITY OCCURS DURING A
PERIOD OF MOOD CHANGE (e.g.,
elation, irritability) AND ACTIVITY /
SOCIABILITY IS A CHANGE FROM
BASELINE.

P = Parent Rating C = Child Rating

S = Summary Rating

DMA52

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

0 – No information.

1 – Not present, not at
all or retarded.

2 – Subthreshold: Brief
or mild increase in
physical restlessness or
hyperactivity of
questionable clinical
significance.

3 – Threshold: During
the mood disturbance is
persistently unable to
stay in seat, pacing,
fidgeting, excessive
movement, etc., almost
always disruptive to
some degree.

Psychomotor Agitation
Visible manifestations of generalized
motor hyperactivity, which occurred
during a period of abnormally
elevated, expansive, or irritable mood.
Make certain that the hyperactivity
actually occurred and was not merely
a subjective feeling of restlessness.
Make sure it is not chronic but
episodic hyperactivity.
When you are feeling super high /
super happy / super angry, do you
notice a change in how active you are
or how much you move? Are there
times when you can't sit still, or you
have to keep moving and can't stop?
Do you feel like you need to keep
walking back and forth? Do you move
very fast or are you really
hyperactive? Tell me what you are
doing at these times.
NOTE: IF CHILD MEETS CRITERIA
FOR ADHD, ONLY RATE
POSITIVELY IF THERE WAS AN
INCREASE IN RESTLESSNESS
ASSOCIATED WITH THE ONSET
OF MOOD SYMPTOMS.

P = Parent Rating C = Child Rating

S = Summary Rating

DMA53

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

0 – No information.

1 – Not present.

Excessive Involvement in HighRisk Pleasurable Activities
Excessive involvement in
pleasurable/ thrill-seeking/ exciting
activities that have a high potential
for painful consequences.
When you were feeling high/ super
happy/ super angry did you do
things that caused trouble for you or
your family or friends? Did you do
things you normally would not have
done... like staying out all night,
spending a lot of money, taking trips
unexpectedly, or doing something
really risky for fun?
Did you do anything that you now
think you should not have done?
Were you drinking or using drugs at
the time? Has this ever happened
when you weren't drinking or using
drugs?

(For Adolescents) What about
getting involved in relationships
quickly, having a lot of one night
stands, or doing other dangerous
things like driving recklessly?
(For Pre-adolescents) What about
jumping from really high places,
going on long trips on your bicycle,
or playing serious pranks in school?

2 – Subthreshold:
Transient or mild
increase in risk-taking/
pleasure-seeking
behavior of only
questionable clinical
significance.
3 – Threshold: During
the mood disturbance,
persistently involved in
risk taking/pleasure seeking activities with
potentially negative
consequences that
show poor judgment
(e.g., driving recklessly,
having casual affairs,
disinhibited
interpersonal relations,
spending sprees, giving
away money or
personal belongings).

Also consider inappropriate
sexual behavior.

P = Parent Rating C = Child Rating

S = Summary Rating

DMA54

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

0 – No information.

1 – Not present.

2 – Subthreshold:
Transient or mild
increase in risk-taking/
pleasure-seeking
behavior of only
questionable clinical
significance.

3 – Threshold: During
the mood disturbance,
persistently involved in
risk taking/pleasure seeking activities with
potentially negative
consequences that
show poor judgment
(e.g., driving recklessly,
having casual affairs,
disinhibited
interpersonal relations,
spending sprees, giving
away money or
personal belongings).

Distractibility
Child presents evidence of difficulty
focusing his/her attention on the
questions of the interviewer, jumps
from one thing to another, cannot
keep track of his/her answers, and is
drawn to irrelevant stimuli he/she
cannot shut out. Not to be confused
with avoidance of uncomfortable
themes.
Since you have been feeling super
high/ super happy/ super angry have
you noticed any change in your
concentration? Have you had trouble
sticking to what you are supposed to
do? Do you start things that you just
don't finish? Do you get distracted
easily? Have you been having trouble
paying attention in class?
Rate based on data reported by
informant (e.g., parent).
NOTE: IF CHILD MEETS CRITERIA
FOR ADHD, ONLY RATE
POSITIVELY IF THERE WAS AN
INCREASE IN DISTRACTIBILITY
ASSOCIATED WITH THE ONSET
OF MOOD SYMPTOMS.

P = Parent Rating C = Child Rating

S = Summary Rating

DMA55

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

0 – No information.

1 – Manic symptoms
never occur under the
influence of drugs.

2 – Manic symptoms
occur sometimes but
not always under the
influence of alcohol or
drugs. At least once
was manic or
hypomanic without prior
drug or alcohol use.

3 – Manic symptoms
present only under the
influence of alcohol or
drugs.

0 – No information.

1 – One day (> 4 hours
during the day)

2 – Two-three days.

3 – Four-six days

4 – Seven to fourteen
days

5 – Multiple weeks.

6 – Two-Six months

7 – Greater than six
months

Influence of Drugs or Alcohol
Did you feel super high/ super
happy/ super angry or do these
things only when you have been
drinking or taking drugs or
medicine? What kinds? How much?
Do you ever have the super high/
super happy/ super angry moods at
times when you are not drinking or
using drugs? Which came first, the
drug or the high?
Do you drink a lot of coffee or other
caffeinated drinks? About how much
do you drink? Have you ever felt
high like you described earlier when
you weren't drinking tons of
caffeine?

DMA56

Patterning of Manic Symptoms
Inquire about episodes in which
subject had persistently abnormally
elevated, expansive or irritable mood
plus 3 associated (hypo)manic
symptoms (4 if irritable only), that
were not caused by drugs,
medications or alcohol, or other
psychiatric disorders.
A. Longest Duration of
Hypomanic Episodes
What is the longest period of time in
hours, or days in a row that you felt
super high / super happy / super
angry (other endorsed symptoms)?
NOTE: Mood change and
symptoms should be present for
a significant part of the day (> 4
hours total) in order to reach
threshold unless very severe in a
given day.

P = Parent Rating C = Child Rating

S = Summary Rating

DMA57

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

0 – No information.

1 – One day (> 4 hours
during the day)

2 – Two-three days.

3 – Four-six days

4 – Seven to fourteen
days

5 – Multiple weeks.

6 – Two or more
months.

0 – No information.

1 – Not present in the
past year.

2 – One-three discrete
episodes per year.

3 – Four or more
episodes per year.

B. Typical Duration of
Hypomanic Episodes
DMA58

How long do these episodes usually
last when they do occur?

C. Number of Episodes Per
Year
In this past year, how many discrete
episodes of these symptoms have
you had? (Specify below)

________ #/year

________#/month

P = Parent Rating C = Child Rating

S = Summary Rating

DMA59

K-SADS-PL 2013 – Modified for the National Mental Health Study

D. Longest Duration of
Euthymic Mood
Since you first started having these
changes in mood, what is the
longest period of time that you have
felt like your old self and have not
been bothered by any of these
problems?

E. Total Lifetime Duration of
Mania/Hypomania
In the subject's lifetime, what are the
estimated total Number of Days (not
necessarily consecutive) in which
subject had persistently abnormally
elevated, expansive or irritable
mood plus 3 associated
(hypo)manic symptoms (4 if irritable
only), that was not caused by drugs,
medications or alcohol.

DEPRESSION & MANIA/HYPOMANIA

0 – No information.

1 – No significant
periods of euthymic
mood.

2 – Euthymic mood
lasted 3-6 days.

3 – Euthymic mood
lasted 1-2 weeks.

4 – Euthymic mood
lasted 2-8 weeks.

5 – Euthymic mood
lasted greater than 2
months.

0 – No information.

1 – One-three days

2 – Four-ten days

3 – Ten-twenty days

4 – More than twenty
days

Age of Onset:

_________ years old

P = Parent Rating C = Child Rating

S = Summary Rating

DMA60

DMA61

DMA62

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

Impairment

A. Socially (with peers)

DMA63

B. With family

DMA64

C. In school

DMA65

D. Hospitalization (for
mania)

DMA66

E. Other (e.g., police,
other adults, etc.)

DMA67

P = Parent Rating C = Child Rating

S = Summary Rating

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

Codes: 0 = No information. 1 = No. 2 = Yes.
Lifetime
Evidence of Manic Episode

DMA68

DSM-5-Criteria
A. Distinct period of abnormally and persistently elevated, expansive, or irritable mood and
abnormally and persistently increased activity or energy (e.g., increased goal-directed
activity socially, at work, school, or sexually or psychomotor agitation).
B. During the mood disturbance and increased energy or activity, at least three of the
symptoms below (four if mood is only irritable) have persisted.
C. During the mood disturbance, marked impairment or hospitalization.
D. Duration at least one week (or any duration if hospitalization is necessary)
E. Not attributable to the physiological effects of a substance. NOTE: A full manic episode that
emerges during anti-depressant treatment but persists is sufficient evidence for a manic
episode, and therefore, bipolar I disorder.

Symptom

K-SADS
Score

Distinct period of abnormally and persistently elevated, expansive, or
irritable mood lasting at least one week (or any duration if
hospitalized), AND

Abnormally increased activity lasting at least one week (or any
duration if hospitalized)

Yes

During the mood disturbance and increased energy or activity, at
least three of the symptoms below (four if mood is only irritable) have
persisted:
1. Inflated self-esteem or grandiosity

2. Decreased need for sleep (e.g., feels rested after only 3 hours
of sleep)

3. More talkative than usual or pressure to keep talking

4. Flight of ideas or subjective experience that thoughts are
racing.
5. Distractibility (i.e., attention too easily drawn to unimportant or
irrelevant external stimuli).

3
3

6. Increase in goal directed activity OR psychomotor agitation

7. Excessive involvement in pleasurable activities that have a
high potential for painful consequences (e.g., engaging in
unrestrained buying sprees, sexual indiscretions, or foolish
business investments).

Note: At least one lifetime manic episode is required for the diagnosis of bipolar I disorder. Note:
Increased goal directed activity is required as a Criterion A symptom, but can also be counted as
one of the Criterion B symptoms according to the DSM-5.

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

DMA69

Mania Age of Onset: __________

DMA70

K-SADS-PL 2013 – Modified for the National Mental Health Study

DEPRESSION & MANIA/HYPOMANIA

Codes: 0 = No information. 1 = No. 2 = Yes.
Lifetime
Evidence of Bipolar I Disorder

DMA71

For a diagnosis of bipolar I disorder, it is necessary to meet the criteria for a manic episode. The
manic episode may have been preceded by and may be followed by hypomanic or major
depressive episodes.
DSM-5-Criteria
A. Criteria have been met for at least one manic episode (Criteria A-D under “Manic Episode”
above.
B. The occurrence of the manic and major depressive episode(s) is not better explained by
schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or
other specified or unspecified schizophrenia spectrum or other psychotic disorder.

DMA72

Bipolar I Disorder Age of Onset: __________

DMA73

K-SADS-PL 2013:
GENERALIZED ANXIETY DISORDER
Advanced Center for Intervention and Services Research (ACISR) for Early
Onset Mood and Anxiety Disorders
Western Psychiatric Institute and Clinic
Child and Adolescent Research and Education (CARE) Program
Yale University

Modified for the National Mental Health Study

Interviewer ID:

Date of Interview:

QUESTID:

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K-SADS-PL 2013 – Modified for the National Mental Health Study

GENERALIZED ANXIETY DISORDER

K-SADS Screen Interview: GENERALIZED ANXIETY DISORDER
If CIDI screen = positive (+) or subthreshold: Say, “In your earlier interview you mentioned
having a history of anxiety or worry. The next questions are about that.” Then proceed with
Generalized Anxiety Disorder screen.
If CIDI screen = negative (-): Proceed with Generalized Anxiety Disorder screen.

Excessive Worries
DSM-5 DR# 12: Not been able to stop worrying.

0 – No information

Are you a worrier? Do you think worry too much?
Do you worry more than other kids your age? Have
people said you worry too much?
Has there ever been a time when you worried about
things before they happened?
Can you give me some examples?

1 – Not present

NOTE: IF THE ONLY WORRIES THE CHILD
BRINGS UP RELATE TO THE ATTACHMENT
FIGURE OR A SIMPLE PHOBIA, DO NOT SCORE
HERE. ONLY RATE POSITIVELY IF THE CHILD
WORRIES ABOUT MULTIPLE THINGS.

3 – Threshold: Most days of
the week is excessively
worried about at least two
different life circumstances or
anticipated events or current
behavior.

GAD1

2 – Subthreshold: Frequently
worries somewhat
excessively (at least 3 times
per week) about anticipated
events or current behavior.

In order to rate positively, child must worry above and
beyond other children of the same age. Worries must
be exaggerated and out of context.

Somatic Complaints
0 – No information
DSM-5 DR# 1: Bothered by stomachaches, etc.
DSM-5 DR# 2: Worried about getting sick.
Do you worry a lot about your health?
Do you get a lot of headaches? Stomachaches?
Have a lot of aches and pains?
Do you worry that you might have a serious illness?
NOTE: DO NOT COUNT IF SYMPTOMS
ARE KNOWN TO BE CAUSED BY A
REAL MEDICAL ILLNESS.

1 – Not present
2 – Subthreshold: Occasional
worries/complaints.
Symptoms/complaints more
severe and more often than
experienced by a typical child
his/her age.
3 – Threshold: Frequent
worries/complaints. Worries
about health preoccupy child
and cause distress.

GAD2

K-SADS-PL 2013 – Modified for the National Mental Health Study

GENERALIZED ANXIETY DISORDER

IF A SCORE OF 3 ON EITHER OF THE PREVIOUS ITEMS, COMPLETE THE
GENERALIZED ANXIETY DISORDER SUPPLEMENT AFTER FINISHING
THE SCREEN INTERVIEW.

IF A SCORE OF 1 OR 2, STOP INTERVIEW, RECORD TIME.

NOTES: (RECORD DATES OF POSSIBLE CURRENT AND PAST GENERALIZED ANXIETY
DISORDER)

K-SADS-PL 2013 – Modified for the National Mental Health Study

GENERALIZED ANXIETY DISORDER

K-SADS Supplement: GENERALIZED ANXIETY DISORDER

Preoccupation with Appropriateness of Past
Behavior
Do you think a lot about things that already
happened?
For example, do you worry about whether you
gave the right answer in school?
After you talk to friends, do you keep
wondering if you said the right things?
NOTE: IN ORDER TO RATE POSITIVELY,
CHILD MUST WORRY ABOVE AND
BEYOND OTHER CHILDREN OF THE SAME
AGE. WORRIES MUST BE EXAGGERATED
AND OUT OF CONTEXT.

GAD3

0 - No information
1 - Not present
2 - Subthreshold: Frequently
worries somewhat excessively (at
least 1 time per week) about past
events/ behavior.
3 – Threshold: Most days of the
week is excessively worried about
past events/ behaviors.

Marked Self-Consciousness
Some kids worry a lot about what other people
think about them. Is this true of you?
Has there ever been a time when you thought
about what you were going to say before you
said it?
Did you worry that other people thought you
were stupid or that you did things funny?
NOTE: IN ORDER TO RATE POSITIVELY,
CHILD MUST WORRY ABOVE AND
BEYOND OTHER CHILDREN OF THE SAME
AGE. WORRIES MUST BE EXAGGERATED
AND OUT OF CONTEXT.

GAD4

K-SADS-PL 2013 – Modified for the National Mental Health Study

GENERALIZED ANXIETY DISORDER

Overconcern about Competence
Is it really important to you to be good at
everything?
Do you get upset if you miss a few questions
on a test even though you get a good grade?
Do you worry a lot about how well you play
sports or do other things?
Do you think a lot about every mistake you
make?
NOTE: IN ORDER TO RATE POSITIVELY,
CHILD MUST WORRY ABOVE AND
BEYOND OTHER CHILDREN OF THE SAME
AGE. WORRIES MUST BE EXAGGERATED
AND OUT OF CONTEXT.

GAD5

0 - No information
1 - Not present
2 - Subthreshold: Frequently
somewhat concerned (at least 3
times per week) about
competence in at least two areas.
3 – Threshold: Most days of the
week is excessively concerned
about competence in several
areas.

Worries about the Future
Do you often worry about things far off in the
future like where and if you will get into
college? What you will do for a career? Other
things?

0 - No information
1 - Not present
2 - Subthreshold: Frequently
somewhat concerned (at least 3
times per week) about the future.
3 – Threshold: Most days of the
week is excessively concerned
about the future.

GAD6

K-SADS-PL 2013 – Modified for the National Mental Health Study

GENERALIZED ANXIETY DISORDER

Codes: 0 = No information. 1 = No. 2 = Yes.
Lifetime/Most Severe Episode
Inability to Control Worries
0

1. Feels restless or feeling keyed up or on
edge

2. Being easily fatigued

3. Difficulty concentrating or mind going blank

4. Sleep disturbance (e.g., difficulty falling
asleep, staying asleep, or restless
unsatisfying sleep)

5. Muscle tension, aches, or soreness

6. Irritability

Do you sometimes wish you didn't worry so
much?
Can you control or shut off your worries?

GAD7

Other Symptoms of Generalized Anxiety
Disorder
One of the following is true:
GAD8

GAD9

GAD10

GAD11

GAD12

GAD13

Notes:

Duration (specify):
____________________________________
Criteria: 3 months or longer

GAD14

K-SADS-PL 2013 – Modified for the National Mental Health Study

GENERALIZED ANXIETY DISORDER

Codes: 0 = No information. 1 = No. 2 = Yes.
Lifetime/Most Severe Episode
Evidence of Impairment or Distress
A. Socially (with peers)

GAD15

B. With Family

GAD16

C. In School

GAD17

Evidence of Precipitant (specify)

GAD18

Evidence of Generalized Anxiety Disorder

GAD19

DSM-5 Criteria
A. Excessive anxiety and worry (apprehensive expectation), more days than not, for at least
six months, about a number of events or activities (e.g., school, peers, sports, etc.)
B. Individual finds it difficult to control the worries
C. Anxiety associated with three (or more) of the following symptoms (with at least some
symptoms present more days than not for the past six months).
NOTE: Only one of these six items is required in children.
(1) Restlessness or feeling keyed up or on edge;
(2) Being easily fatigued;
(3) Difficulty concentrating or mind going blank;
(4) Irritability;
(5) Muscle tension;
(6) Sleep disturbance (e.g., difficulty falling asleep, staying asleep, or restless, unsatisfying
sleep).
D. Clinically significant distress or impairment.
E. Not attributable to the physiological effects of a substance or another medical condition
F. Not better accounted for by another mental disorder (e.g., anxiety about having a panic
attack, separation from attachment figure, etc.)

K-SADS-PL 2013 – Modified for the National Mental Health Study

GENERALIZED ANXIETY DISORDER

GAD20

Age of Onset Generalized Anxiety Disorder: __________

GAD21

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K-SADS-PL 2013:
PANIC DISORDER
Advanced Center for Intervention and Services Research (ACISR) for Early
Onset Mood and Anxiety Disorders
Western Psychiatric Institute and Clinic
Child and Adolescent Research and Education (CARE) Program
Yale University

Modified for the National Mental Health Study

Interviewer ID:

Date of Interview:

QUESTID:

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K-SADS-PL 2013 – Modified for the National Mental Health Study

PANIC DISORDER

K-SADS Screen Interview: PANIC DISORDER
Panic Attacks
Have you ever had a time when, all of a sudden, out of
the blue, for no reason at all, you suddenly felt anxious,
nervous, or frightened? Tell me about it.
The first time you had an attack like this, what did you
think brought it on? Did the feeling come from out of the
blue?
What was it like?
How long did it
last?
After the first time this happened, did you worry about it
happening again?
If specific symptoms are not elicited
spontaneously when describing attacks, ask about
each of the following symptoms:
Associated Symptoms:
1. heart palpitations,
2. sweating,
3. trembling or shaking,
4. sensations of shortness of breath, or
smothering sensations,
5. feelings of choking,
6. chest pains,
7. nausea or abdominal distress,
8. dizziness or lightheadedness,
9. heat sensations or chills,
10. numbing of hands or feet,
11. depersonalization or derealization,
12. fear of losing control,
13. fear of dying.

1 – Not present

CPD1

2 – Subthreshold:
Occasional unanticipated
attacks, or less than four
of the associated
symptoms

3 – Threshold; recurrent
unexpected attacks with
four or more associated
symptoms

Note: DSM-5 does not
have threshold criteria for the
minimum number of attacks.

NOTE: DO NOT COUNT IF LASTS ALL DAY OR DIRECTLY CAUSED BY DRUGS OR
MEDICATIONS.
-

IF A SCORE OF 3, COMPLETE THE PANIC DISORDER SUPPLEMENT
AFTER FINISHING THE SCREEN INTERVIEW.

IF A SCORE OF 1 or 2, STOP INTERVIEW, RECORD TIME.

K-SADS-PL 2013 – Modified for the National Mental Health Study

PANIC DISORDER

K-SADS Supplement: PANIC DISORDER
Criteria: 0 = No information. 1 = Not present.
2 = Occasionally occurs during an attack. 3 = Always or almost always occurs during an attack.
Now I am going to ask you more about when you have those nervous or scary feelings. When you
have them do you...
Lifetime/Most Severe Episode
Shortness of Breath (Dyspena)
Feel like you can't breathe?
Or is it hard to get enough air?

CPD2

CPD3

CPD4

CPD5

CPD6

CPD7

Dizziness (Vertigo)/Faintness
Feel dizzy, like things are spinning around
you? Feel like you might fall or lose your
balance? Feel weak? Like you might faint/pass
out? Fall over?
Palpitations
Was your heart beating extra hard?
Fast? Could you feel it?
Trembling or Shaking
Do you shake or tremble all over? Like you
wouldn’t be able to hold a glass of water?
Sweating
Perspire, sweat?
Do your palms/face/neck feel wet?
Choking
Do you feel like you are choking?
Or that something is around your neck that
stops the air from getting in?

K-SADS-PL 2013 – Modified for the National Mental Health Study

PANIC DISORDER

Criteria: 0 = No information. 1 = Not present.
2 = Occasionally occurs during an attack. 3 = Always or almost always occurs during an attack.
Now I am going to ask you more about when you have those nervous or scary feelings. When you
have them do you...
Lifetime/Most Severe Episode
Nausea or Abdominal Distress
Does your stomach hurt?
Feel like you might throw up?

CPD8

CPD9

CPD10

CPD11

CPD12

CPD13

CPD14

Depersonalization/Derealization
Feel like things around you aren’t real or like
you are in the movies?
Feel like you are in a dream? Or like you are
outside your body?
Numbness/Tingling
Feel numbness or tingling in your hands or
feet?
Like there are pins and needles or like you
can’t feel them?
Heat or Chills
Do you feel hot all of a sudden or real cold?

Chest Pains
Does your chest hurt?
Or does it feel like something heavy is on it?
Fear of Dying
When you have these attacks, are you afraid
you might die?
Fear of Losing Control
Were you afraid that you were going crazy or
that you might do something crazy or
something you didn't want to do? Were you
afraid of losing control?

K-SADS-PL 2013 – Modified for the National Mental Health Study

PANIC DISORDER

Codes: 0 = No information. 1 = No. 2 = Yes.
Criteria

Lifetime/Most Severe
Episode

Circumscribed Stimuli
Do the attacks only happen in
a specific or certain situation?
Which ones?

Attacks do not only occur
prior to exposure or during
exposure to a specific
situation or object.

CPD15

Recurrent unexpected
attacks; does not occur
immediately before or after
a situation that almost
always causes anxiety.

CPD16

At least one attack with four
symptoms.

CPD17

Attack Unanticipated
When you have an attack,
does something happen that
triggers it, or does it feel like
it comes for no reason at all?
What were you doing the first
time you had one of these
attacks?
Minimum Symptom
Have you had one attack
where you had all those
different feelings you
described to me (list
symptoms child endorsed)?
What about with your first
attack?

Record maximum number of
attacks in a given month.

______________

CPD18

Record number of attacks in
past week.

______________

CPD19

Fear of Having Another Attack
After this happened, were
you worried or afraid that it
might happen again?
How much did you think
about it?
Did you avoid exercise or
other activities out of fear of
having another attack?

Criteria
One or more attacks
followed by at least onemonth of persistent fear of
another attack, or
maladaptive change in
behavior related to the
attacks

Lifetime/Most Severe
Episode

CPD20

K-SADS-PL 2013 – Modified for the National Mental Health Study

PANIC DISORDER

Codes: 0 = No information. 1 = No. 2 = Yes.
Criteria

Lifetime/Most Severe
Episode

Onset of Attacks
During at least one attack
four symptoms developed
suddenly and intensified
within 10 minutes.

CPD21

Travel restricted, or
companion needed when
away from home due to
fear of having an intense
anxiety experienced when
out.

CPD22

A. Socially (with peers)

CPD23

B. With Family

CPD24

C. In School

CPD25

How long does it take from
when you start to have the
scary feeling to when it's at
its worst (list positive
symptoms)?
How many minutes, usually?
Agoraphobia
Since you started having
these attacks, have you been
staying home more?
Have you been avoiding
crowds, being outside alone,
or traveling?
Have you started to dread
these things because you
are afraid you might have
one of these attacks?
When you do go out, do you
feel really scared thinking
about what might happen if
you do have another one of
these attacks?

Impairment

K-SADS-PL 2013 – Modified for the National Mental Health Study

PANIC DISORDER

Codes: 0 = No information. 1 = No. 2 = Yes.
Lifetime/Most Severe
Episode
Evidence of Panic Disorder

CPD26

DSM-5-Criteria
A. Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or
intense discomfort that reaches a peak within minutes, and during which time four (or more)
of the following occur:
(1) Palpitations, pounding heart, or accelerated heart rate; (2) Sweating; (3) Trembling or
Shaking; (4) Sensations of shortness of breath or smothering; (5) Feelings of choking;
(6) Chest pain or discomfort; (7) Nausea or abdominal distress; (8) Feeling dizzy,
unsteady, light-headed, or faint; (9) Chills or heat sensations; (10) Parethesias
(numbness or tingling sensations). (11) Derealization (feeling of unreality) or
depersonalization (being detached from oneself); (12) Fear of losing control or going
crazy"; (13) Fear of dying.
B. At least one of the attacks was followed by 1 month (or more) of one or both of the
following:
(1) Persistent concern about additional attacks or their consequences (e.g., losing control,
having a heart attack, going crazy)
(2) A significant maladaptive change in behavior related to the attacks
C. Disturbance not attributable to the physiological effects of a substance or another medical
condition (e.g., hyperthyroidism, cardiopulmonary)
D. Disturbance not better explained by another mental disorder (e.g., as in social anxiety; in
response to circumscribed phobic objects; reminders of traumas, etc.)
Codes: 0 = No information. 1 = Not present. 2 = Probable. 3 = Definite.
Probable Diagnosis:
1. Meets criteria for core symptoms of the disorder.
2. Meets all but one, or a minimum of 75% of the remaining criteria required for the diagnosis
3. Evidence of functional impairment
Lifetime/Most Severe Episode Diagnosis: __________

CPD27

Age of Onset: __________

CPD28

K-SADS-PL 2013:
POST-TRAUMATIC STRESS DISORDER
Advanced Center for Intervention and Services Research (ACISR) for Early
Onset Mood and Anxiety Disorders
Western Psychiatric Institute and Clinic
Child and Adolescent Research and Education (CARE) Program
Yale University

Modified for the National Mental Health Study

Interviewer ID:

Date of Interview:

QUESTID:

This page has been intentionally left blank.

K-SADS-PL 2013 – Modified for the National Mental Health Study

POST-TRAUMATIC STRESS DISORDER

K-SADS Screen Interview: POST-TRAUMATIC STRESS DISORDER

If CIDI screen = positive (+) or subthreshold: Say, “In your earlier interview you having one or
more highly stressful experiences in your lifetime. The next questions are about that.” Then
proceed with Post-Traumatic Stress Disorder screen.
If CIDI screen = negative (-): Proceed with Post-Traumatic Stress Disorder screen.
Codes: 0 = No information. 1 = No. 2 = Yes.
Traumatic Events
Probe: I am going to ask you about a number of bad things that sometimes happen to children your
age, and I want you to tell me if any of these things have ever happened to you. Be sure to tell me
if any of these things have ever happened, even if they only happened one time.
Criteria

Lifetime/Ever

Car Accident
Have you ever been in a bad
car accident?
What happened?
Were you hurt?
Was anyone else in the car
hurt?

Significant car accident in
which child or other
individual in car was injured
and required medical
intervention.

PTS1

Significant accident in
which child was injured and
required medical
intervention.

PTS2

Child close witness to fire
that caused significant
property damage or
moderate to severe
physical injuries.

PTS3

Other Accident
Have you ever been in any
other type of bad accidents?
What about a biking
accident?
Other accidents?
What happened?
Were you hurt?
Fire
Were you ever in a serious
fire?
Did your house or school ever
catch on fire?
Did you ever start a fire that
got out of control? What
happened?
Did anyone get hurt? Was
there a lot of damage?

K-SADS-PL 2013 – Modified for the National Mental Health Study

POST-TRAUMATIC STRESS DISORDER

Codes: 0 = No information. 1 = No. 2 = Yes.
Traumatic Events (continued)
Probe: I am going to ask you about a number of bad things that sometimes happen to children your
age, and I want you to tell me if any of these things have ever happened to you. Be sure to tell me
if any of these things have ever happened, even if they only happened one time.
Criteria

Lifetime/Ever

Witness of a Disaster
Have you ever been in a
really bad storm, like a
tornado or a hurricane?
Have you ever been caught in
floods with waters that were
deep enough to swim in?

Child witness to natural
disaster that
caused significant
devastation

PTS4

PTS5

PTS6

PTS7

Witness of a Violent Crime
Did you ever see someone
rob someone or shoot them?
Steal from a store or jump
someone?
Take someone hostage?
What happened?
Where were you when this
happened?
Was anyone hurt?

Child close witness to
threatening or violent crime.

Victim of a Violent Crime
Did anyone ever mug you or
attack you in some other
way? What happened? Were
you hurt?

Child victim of seriously
threatening or violent crime.

Confronted with Traumatic News
Have you ever gotten some
really bad news
unexpectedly? Like found out
someone you loved just died
or was sick and would never
get better?

Learned about sudden,
unexpected death of a
loved one, or that loved one
has life-threatening
disease.

K-SADS-PL 2013 – Modified for the National Mental Health Study

POST-TRAUMATIC STRESS DISORDER

Lifetime/Ever

Terrorism Related Trauma
Were you affected by the
events of Boston Marathon
bombing or any other terrorist
attack?

Loved one missing for
extended period of time or
seriously injured or killed by
terrorist attack.

PTS8

PTS9

War Zone Trauma
Have you ever lived in a war
zone?
Had your home attacked?
Witnessed the killing or rape
of others?
Seen everything around you
set on fire?
Protective Services: Has your
family ever received services
from CYS/DCF?

Lived in war zone.
Witnessed death and mass
destruction.

Current:

PTS10

Past:

PTS11

Witness to Domestic Violence
Some kids' parents have a lot of
nasty fights. They call each other
bad names, throw things,
threaten to do bad things to each
other, or sometimes really hurt
each other.
Did your parents (or does your
mother or father and his or her
partner) ever get in really bad
fights? Tell me about the worst
fight you remember your parents
having. What happened?

Child witness to explosive
arguments involving
threatened or actual harm
to parent.

PTS12

K-SADS-PL 2013 – Modified for the National Mental Health Study

POST-TRAUMATIC STRESS DISORDER

Lifetime/Ever

Physical Abuse
Did a grown-up at home (who
took care of you) ever hit you
when they got mad at you?
This could be a parent,
babysitter, or other grown-up
who watches you. Have you
ever been hit so that you had
bruises or marks on your
body, or were hurt in some
way? What happened?

Bruises sustained on more
than one occasion, or more
serious injury sustained.

PTS13

Isolated or repeated
incidents of genital
fondling, oral sex, or
vaginal or anal intercourse.

PTS14

Has a life-threatening
disease.

PTS15

Caused someone else
serious suffering, injury, or
death.

PTS16

Sexual Abuse
Did anyone ever touch you in
your private parts when they
shouldn't have? What
happened? Has someone
ever touched you in a way
that made you feel bad?
Has anyone who shouldn't
have ever made you undress,
touch you between the legs,
make you get in bed with
him/her, or make you play
with his private parts? Was
CYF ever involved with your
family?
Illness
Have you ever had a lifethreatening illness? Have you
ever found out you were sick
and would not get better?
Harm to Others
Have you ever caused
someone else to have serious
suffering, injury, or death?
What happened?

K-SADS-PL 2013 – Modified for the National Mental Health Study

POST-TRAUMATIC STRESS DISORDER

Lifetime/Ever

Other
Is there anything else that
happened to you that was
really bad, or something else
you saw that was really scary,
that you want to tell me
about?

Record incident below:

If parental substance abuse
and/or neglect known or
suspected: Has there ever
been a time when your mom
or dad went on a drug binge
and left you and your siblings
alone for a day or longer?
Were you worried they
wouldn't come home or that
something bad happened to
them?

______________________

PTS17

______________________
______________________
______________________

IF EVIDENCE OF PAST TRAUMA (A SCORE OF "2" ON ANY ITEM), COMPLETE THE
POST-TRAUMATIC STRESS DISORDER QUESTIONS ON THE FOLLOWING PAGE.

IF NO EVIDENCE OF PAST TRAUMA, END THE SCREENING INTERVIEW. RECORD
TIME.

NOTE: (RECORD DATES OF PAST TRAUMATIC EVENTS).

K-SADS-PL 2013 – Modified for the National Mental Health Study

POST-TRAUMATIC STRESS DISORDER

Codes: 0 = No information. 1 = No. 2 = Yes.
NOTE: If more than one traumatic event was endorsed, inquire about symptom presence in
relation to ANY of the traumas.
NOTE: In discussing traumatic events with children, it is important to use their language in
your dialogue (e.g., do you think about when he stuck his pee-pee up your bum often?)
Lifetime/Ever
Recurrent Memories, Thoughts or Images
Has there ever been a time when you kept
seeing _____ again and again?
How often did this happen?
Did what happen keep coming into your mind?
Did you think about it a lot?

PTS18

PTS19

PTS20

PTS21

Feelings of Detachment
Is it hard for you to trust other people?
Do you feel like being alone more often than
before?
Like you just don't feel like being around
people now that you used to like being around
before?
Do you feel alone even when you are with
other people?
Efforts to Avoid Activities or Situations that
Remind you of the Trauma
Are there places or thigs that remind you of
____? Do you try to avoid them? You said
before that ___ sometimes reminds you of
what happened. Do you try to avoid ___?
Nightmares
Has there ever been a time when you had a lot
of nightmares?
Did you ever dream about _____? How often?
Do you have other scary dreams?
Note: In children content of dreams may be
frightening without directly relating to
trauma.

K-SADS-PL 2013 – Modified for the National Mental Health Study

POST-TRAUMATIC STRESS DISORDER

Codes: 0 = No information. 1 = No. 2 = Yes.
NOTE: If more than one traumatic event was endorsed, inquire about symptom presence in
relation to ANY of the traumas.
NOTE: In discussing traumatic events with children, it is important to use their language in
your dialogue (e.g., do you think about when he stuck his pee-pee up your bum often?)
Lifetime/Most Severe Episode
Hypervigilance
Since ____ happened, are you more careful?
Do you feel like you always have to watch
what's going on around you? Do you double
check the doors or windows to make sure they
are locked?

PTS22

IF RECEIVED A SCORE OF 2 ON ANY OF THE PRECEDING ITEMS, COMPLETE THE
POST-TRAUMATIC STRESS DISORDER ITEMS IN THE SUPPLEMENT.

IF ALL ITEMS ARE MARKED 0 OR 1, STOP INTERVIEW, RECORD TIME.

NOTE: (RECORD DATES OF POSSIBLE CURRENT AND PAST POST-TRAUMATIC
STRESS DISORDER).

K-SADS-PL 2013 – Modified for the National Mental Health Study

POST-TRAUMATIC STRESS DISORDER

K-SADS Supplement: POST-TRAUMATIC STRESS DISORDER
Codes: 0 = No information. 1 = No. 2 = Yes.
Lifetime/Most Severe Episode
Dissociative Episodes
Do people say that you daydream a lot?
Look spaced-out?
Do you lose track of time a lot?
Have hours gone by and you've felt unsure of
what you did during that time?

PTS23

PTS24

PTS25

PTS26

PTS27

Flashbacks
Do you sometimes have flashbacks – see
images of what happened?
Has there ever been a time when you felt like
was happening again?
Negative Emotions
Since happened, have you been feeling sad or
anxious? Angry? Overcome with fear, shame,
or guilt?
Sleep Disturbance
After ____ happened, did you have trouble
falling or staying asleep?
How long did it take you to fall asleep? Did you
wake up in the middle of the night? Does your
sleep feel restless?
Irritability or Outburst of Anger
After ____ happened, did you feel cranky or
grouchy a lot?
Were you having a lot of temper tantrums?
Have you been more aggressive?

K-SADS-PL 2013 – Modified for the National Mental Health Study

POST-TRAUMATIC STRESS DISORDER

Codes: 0 = No information. 1 = No. 2 = Yes.
Lifetime/Most Severe Episode
Psychological Distress when Exposure to
Stimuli that Resemble or Symbolize Event
Has there ever been a time when you felt bad
when you were somewhere that reminded you
of what happened?
Did you sometimes see people on the street
that reminded you of _____?
When you saw someone that reminded you of
_____, did it make you feel like it was
happening again?
Were there other things that made you feel like
it was happening again?
Special dates or times of the day that reminded
you of _____, and made you feel like it was
happening again?

PTS28

PTS29

PTS30

PTS31

PTS32

Inability to Recall an Important Aspect of the
Trauma
Do you remember everything that happened to
you, or does it seem like parts of it are gone
from your mind?
Are there parts or details you just can't
remember?
Anhedonia/Decreased Interest in Activities
Since _____ happened, have you been feeling
bored a lot?
Are things not as much fun as before?
Efforts to Avoid Memories, Thoughts or
Feelings of Traumatic Event
What kind of things do you do or have you
done to keep from thinking about _____?
To get rid of bad thoughts, some kids, read, do
things to keep busy, or go to sleep. Did you
ever do any of these things or other things to
get rid of those bad thoughts and/or feelings?
Restricted Affect
Do you sometimes feel like a robot?
Is it hard for you to tell how you feel?
When something sad happens, do you feel
sad? When something good happens, do you
feel happy? As happy as before or less so?

K-SADS-PL 2013 – Modified for the National Mental Health Study

POST-TRAUMATIC STRESS DISORDER

Codes: 0 = No information. 1 = No. 2 = Yes.
Lifetime/Most Severe Episode
Sense of Foreshortened Future
What do you think things will be like for you
when you grow up?
Do you think you will grow up?
Is it hard for you to imagine getting older?

PTS33

PTS34

PTS35

PTS36

PTS37

PTS38

PTS39

Difficulty Concentrating
Do you have trouble keeping your mind on
what you are doing?
Is it harder for you to do your homework or
read since ____happened?
Negative Beliefs and Expectation
Since _____ happened, do you expect bad
things to happen? Do you feel like the world is
not safe? Feel people can’t be trusted?
Exaggerated Startle Response
Since ____ happened, are you more jumpy?
Do little noises really scare you?
Physiologic Reactivity Upon Exposure to
Events that Symbolize Traumatic Event
When you are in a place that reminds you of
_____, does your heart start beating extra hard, or
your stomach start to feel like you might throw up?
Reckless/Self-Destructive
Since ___ happened have you been doing any
risky things? Driving reckless? Sleeping
around with people you don't really know?
Cutting yourself? Hurting yourself in other
ways?
No Positive Emotions
Since ___ happened do you feel like nothing
makes you happy anymore? Like you can't feel
love anymore, even from people you know
care about you?

K-SADS-PL 2013 – Modified for the National Mental Health Study

POST-TRAUMATIC STRESS DISORDER

Codes: 0 = No information. 1 = No. 2 = Yes.
Lifetime/Most Severe Episode
Impairment
A. Socially (with peers)

PTS40

B. With family

PTS41

C. In school/work

PTS42

Duration (in weeks):
_______________________________________

PTS43

K-SADS-PL 2013 – Modified for the National Mental Health Study

POST-TRAUMATIC STRESS DISORDER

Codes: 0 = No information. 1 = No. 2 = Yes.
Lifetime/Most Severe Episode
Evidence of Post-Traumatic Stress Disorder

PTS44

DSM-5-Criteria
A. Exposure to actual or threatened death, serious injury, or sexual violence in one or more of
the following ways: (1) Directly experiencing the traumatic event(s); (2) Witnessing, in
person, the event(s) as it occurred to others; (3) Learning that traumatic event(s) occurred
to close family member or friend. In cases of actual or threatened death of a family member
or friend, the event(s) must have been violent or accidental; (4) Experiencing repeated or
extreme exposure to aversive details of traumatic events (e.g. first responders collecting
human remains). Note: Criterion A4 does not apply to exposure through electronic
media, television, movies, or pictures, unless this exposure is work related.
B. Presence of one (or more) of the following intrusion symptoms beginning after traumatic
event occurred: (1) Recurrent, involuntary and intrusive memories (Note: May be
repetitive play with trauma themes); (2) Recurrent distressing dreams (Note: In
children content of dreams may be frightening without directly relating to trauma);
(3) Dissociative reactions in which the individual feels or acts as if the traumatic event(s)
were reoccurring (e.g. flashbacks; may include trauma-reenactment in children's play);
(4) Intense or prolonged psychological distress at exposure to internal or external cues
that symbolize traumatic event; (5) Marked physiological reactions to internal and
external cues that symbolize or resemble aspect of the traumatic event.
C. Persistent avoidance of stimuli associated with the traumatic event(s), as evidenced by one
or both of the following:
(1) Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or
closely associated with the traumatic event(s);
(2) Avoidance of or efforts to avoid external reminders (e.g., people, places) that arouse
distressing memories, thoughts, or feelings about or closely associated with the traumatic
event(s).
D. Negative alterations in cognitions and mood associated with the traumatic events(s), as
evidenced by two (or more) of the following: (1) Inability to recall important aspects of the
traumatic event(s); (2) Persistent and exaggerated negative beliefs and expectations (e.g.,
“I am bad,” “The world is unsafe”); (3) Distorted cognitions about the causes or
consequences of the traumatic event (e.g. blame self); (4) Persistent negative emotional
states (e.g., anger, fear, guilt, shame); (5) Markedly diminished interest or participation in
significant activities; (6) Feelings of detachment or estrangement from others; (7) Persistent
inability to experience positive emotions (e.g. love, happiness).
E. Marked alterations in arousal and reactivity associated with the traumatic event, as
evidenced by two (or more) of the following: (1) Irritable or aggressive behaviors, (2)
Reckless or self-destructive behavior, (3) Hypervigilance, (4) Exaggerated startle response;

K-SADS-PL 2013 – Modified for the National Mental Health Study

POST-TRAUMATIC STRESS DISORDER

(5) Concentration problems; (6) Sleep disturbance (e.g., difficulty falling or staying asleep,
restless sleep).
F. Duration of the disturbance (Criteria B, C, D, and E) I more than one month.
G. Evidence of functional impairment or clinically significant distress.
H. Disturbance is not attributed to a substance or another medical condition.

Codes: 0 = No information. 1 = Not present. 2 = Probable. 3 = Definite. 4 = In partial
remission*
Probable Diagnosis:
1. Meets criteria for core symptoms of the disorder.
2. Meets all but one, or a minimum of 75% of the remaining criteria required for the diagnosis
3. Evidence of functional impairment
Lifetime/Most Severe Episode Diagnosis: __________

PTS45

Age of Onset Post-Traumatic Stress Disorder: ___________

PTS46

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K-SADS-PL 2013:
SOCIAL ANXIETY DISORDER
Advanced Center for Intervention and Services Research (ACISR) for Early
Onset Mood and Anxiety Disorders
Western Psychiatric Institute and Clinic
Child and Adolescent Research and Education (CARE) Program
Yale University

Modified for the National Mental Health Study

Interviewer ID:

Date of Interview:

QUESTID:

This page has been intentionally left blank.

K-SADS-PL 2013 – Modified for the National Mental Health Study

SOCIAL ANXIETY DISORDER

K-SADS Screen Interview: SOCIAL ANXIETY DISORDER

If CIDI screen = positive (+) or subthreshold: Say, “In your earlier interview you said that you
have felt really, really shy with other people before. The next questions are about that.” Then
proceed with Social Anxiety Disorder screen.
If CIDI screen = negative (-): Proceed with Social Anxiety Disorder screen.

Fear of Social Situations
Are you a very shy person?
Have you ever felt nervous, self-conscious or shy
around people that you didn't know very well?
Is it difficult for you to be with other kids - even kids you
know?
What kind of situations make you feel uncomfortable?
__ Speaking in front of others (e.g. answering
questions in class, giving oral reports, show & tell)?
__ Eating in front of others (e.g. school cafeteria, fast
food restaurant)?
__ Writing in front of others (e.g. at chalkboard, taking
tests)?
__ Using public bathrooms when others are around?
__ Performance situations (e.g. gym class, recess,
sports activities)?
__ Changing clothes when others are present (e.g., in
gym/pool locker room)?
__ Going to parties or social events?
How old were you when you first started to feel this
way?
For how long have you been feeling this way?

NOTE: SHYNESS AND FEAR OF SOCIAL
SITUATIONS MUST BE SIGNIFICANTLY
AFFECTING THE CHILD. DO NOT RATE
POSITIVELY IF EXCLUSIVELY ACCOUNTED FOR
BY ANOTHER PSYCHIATRIC DISORDER (i.e.,
AUTISM SPECTRUM DISORDER)

0 – No information
1 – Not present
2 – Subthreshold: Clearly selfconscious and uncomfortable
in social performance
situations; avoids only 1 or 2
activities that are not critical to
the child's well-being (e.g.,
avoiding large parties where
child knows no one).
3 – Threshold: Considerable
self-consciousness that makes
the child uncomfortable in
several social settings; at least
1 activity is avoided (e.g.,
repeatedly and persistently
refusing to answer questions
in class, avoiding gatherings
where child does not know
everyone). A marked and
persistent fear of social
performance situations - fears
acting in a way (or showing
anxiety symptoms) that will be
humiliating or embarrassing.
DO NOT CODE AS
THRESHOLD IF THE
CHILD'S ONLY FEAR IS
GIVING ORAL
PRESENTATIONS AT
SCHOOL.

SAD1

K-SADS-PL 2013 – Modified for the National Mental Health Study

SOCIAL ANXIETY DISORDER

IF A SCORE OF 3 ON THE ABOVE ITEM, COMPLETE THE SOCIAL
ANXIETY SUPPLEMENT AFTER FINISHING THE SCREEN INTERVIEW.

IF A SCORE OF 1 or 2, STOP INTERVIEW, RECORD TIME.

NOTES: (RECORD DATES OF POSSIBLE CURRENT AND PAST SOCIAL ANXIETY.

K-SADS-PL 2013 – Modified for the National Mental Health Study

SOCIAL ANXIETY DISORDER

K-SADS Supplement: SOCIAL ANXIETY DISORDER
Codes: 0 = No information. 1 = No. 2 = Yes.
Lifetime/Most Severe Episode
Review Situations that Elicit Distress.
_____ Talking in class
_____ Writing on the chalkboard
_____ Going to parties/social events
_____ Performance situations
_____ Eating in front of others
_____ Using public restrooms
_____ Changing in front of others
_____ Talking in any social situation
_____ Other (specify)

SAD2

SAD3

SAD4

Exposure Almost Always Elicits Anxiety
Do you get really stressed when (inquire about
social situations that were identified)? When
_____ does your hear race? Do you feel
lightheaded? Do you sometimes freeze of find
you cannot speak? Do you cry or have temper
tantrums?

Avoidance or Endures with Severe Anxiety
Have you ever avoided doing any of these
things that we've talked about because you felt
shy or worried about what other people would
think or say about you?
How often (daily, once a week, etc.)?
Were you very uncomfortable every time or
almost every time that you were in these
situations?
How uncomfortable were you?
Do you continue to do these things even
though they make you feel uncomfortable or
nervous?
In what ways does your nervousness or
discomfort show (e.g., shaky hands or voice,
rash)?

K-SADS-PL 2013 – Modified for the National Mental Health Study

SOCIAL ANXIETY DISORDER

Fears Humiliation, Embarrassment or
Rejection
0

SAD5

A. Socially (with peers)

SAD6

B. With Family:

SAD7

C. In School:

SAD8

SAD9

Do you worry about being embarrassed or
worry about kids rejecting you?
Impairment

Fear is Out of Proportion to Actual Threat

Duration (record duration in months)
SAD10

How long has this been going on?
___________________________
Criteria:
Social Anxiety Disorder: six or more months

Evidence of a Precipitant
(specify)

SAD11

K-SADS-PL 2013 – Modified for the National Mental Health Study

SOCIAL ANXIETY DISORDER

Codes: 0 = No information. 1 = No. 2 = Yes.
Lifetime/Most Severe Episode
Evidence of Social Anxiety Disorder

SAD12

DSM-5-Criteria
A. Marked fear or anxiety about one or more social situations in which the individual is
exposed to possible scrutiny by others.
NOTE: In children, the anxiety must occur in peer settings and not just in interactions with
adults.
B. Fears that he or she will show anxiety symptoms that will be negatively evaluated (e.g.,
embarrassing, lead to rejection or offend others).
C. Exposure to feared situation almost always provoke anxiety (may be expressed as crying,
tantrums, freezing, clinging, shrinking or failure to speak).
D. Social situations are avoided or endured with intense anxiety.
E. Fear is out of proportion to actual threat and the sociocultural context.
F. Persistent fear, anxiety or avoidance is persistent, lasting for at least 6 months or more.
G. Significant distress or impairment in social, academic, occupational, or other important
areas of functioning.
H. Not attributable to the physiological effects of a substance or another medical condition.
I. The fear and anxiety not better explained by the symptoms of another mental disorder,
such as panic disorder or autism spectrum disorder.
J. If another medical condition (e.g., disfigurement from burns or injury) is present, the fear,
anxiety, or avoidance is clearly unrelated or excessive.
Specify if:
Performance ONLY: if the fear is restricted to
speaking or performing in public.

SAD13

Codes: 0 = No information. 1 = Not present. 2 = Probable. 3 = Definite.
Probable Diagnosis:
1. Meets criteria for core symptoms of the disorder.
2. Meets all but one, or a minimum of 75% of the remaining criteria required for the diagnosis
3. Evidence of functional impairment
Social Anxiety Lifetime/Most Severe Episode Diagnosis: __________

SAD14

Social Anxiety Age of Onset: __________

SAD15

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National Mental Health Study

END MODULE

K-SADS END MODULE:
CHILD INTERVIEW

That was my last question. Thank you for your time and willingness to talk to me about how
things have been going for you.
Sometimes the kind of things we just talked about can make people feel upset. You might also
feel like you would like to talk with a counselor. If you are feeling upset by the personal things we
have talked about today and you would like to speak to someone about your feelings, I suggest
you talk with your parent, doctor, a school counselor, or any other adult in your life who you trust.
There is also a phone number you can call to talk with someone who can help you any hour of
the day or night. This number is on the receipt for the $30 you received from the interviewer who
met with you earlier. Do you still have that receipt?
IF NO: I would like to give you the hotline number for the Boys Town National Hotline, where
counselors are available to talk at any time of the day or night. They help both boys and girls.
They can also give you information about where to get help and find someone to talk to in your
city/town. Do you have something to write with? Their toll-free number is 1-800-448-3000. Can
you read that number back to me?
IF YES: OK. Please know that counselors available through this phone number can talk to you at
any time of the day or night. They can also give you information about where to get help and find
someone to talk to in your city/town.
Do you have any more questions you’d like to ask me before we end our call?
Thank you again, and have a good (day/afternoon/evening).

Module End Time: ____ ____: ____ ____ AM/PM

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Author	allewis
File Modified	2017-04-13
File Created	2017-04-13