RADS-2

Reynolds Adolescent
Depression Scale –
2 Edition
nd

William M. Reynolds, PhD

1
 Introduction

The Problem of Depression

in Adolescents

2
Depression in Adolescents

Depression is one of the

most prevalent mental
health problems in adults
and adolescents, and is a
significant problem in
children.
3
 Depression in Adolescents
Depression is an
internalizing disorder in that
most of the symptoms of
depression are covert,
subjective in intensity, and
internal to the individual.
4
 Depression in Adolescents

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

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

6
 A Biopsychosocial Model of
Depression
PSYCHOLOGICAL INFLUENCES
Cognitive Appraisal
Behavioral and Coping Response
Self-Esteem / Interpersonal Skills
Social Adaptation
Functional and Dysfunctional Cognitions

SOCIAL INFULENCES BIOLOGICAL

INFLUENCES
Major Life Events Genetic Loading
Familial Attachment, Nurturance, & Support Nervous System Activation
Daily Hassles Neuroendocrine Functioning
Interpersonal Relationships Biological Vulnerability
Social Systems - Life Stressors Organic/Nutritional 7
Depression in Adolescents
National Comorbidity Study (NIMH)
12 Month Depression Prevalence Rates
Major Minor
Depression Depression
15-16 yr olds 13.0% 6.5%

17-18 yr olds 12.2% 11.2%

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

9
Assessment of Depression
in Adolescents
For the evaluation of depression, we
can diagnose depression according
to a classification system such as
DSM-IV, or we can assess the
severity of the symptoms of
depression and obtain a score, with
the higher the score the more
clinically severe the depression.
10
Assessment of Depression
in Adolescents
The primary methods used to
assess the severity of
depression are self-report
measures and clinical
interviews.
Teacher, peer and parent
reports are not viable methods.
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Reynolds Adolescent Depression
Scale – 2nd Edition RADS-2
 Requires a third-grade reading level.
 Allows for scores on four subscales.
 Development included large samples of school-
based (9,000+) and clinical (250+) adolescents.
 Norms based on a national standardization sample of
3,300 adolescents.
 Norms extended to ages 11 to 20 years.
 25 years of school, clinical, and research applications.

12
RADS-2 Depression Factors

Dysphoric Anhedonia/
Mood Negative Affect

RADS-2 Total Scale

Negative Self- Somatic
Evaluation Complaints

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 RADS-2 Subscales
Dysphoric Mood (DM)
The 8 item DM subscale evaluates symptoms of
dysphoric mood and related symptoms, including:
sadness, crying behavior, loneliness, irritability,
worry, and self-pity.
Dysphoric mood represents a prototypic dimension
of depression as a disturbance of mood (DSM-IV)
and may be viewed as a negative emotional state.

14
 RADS-2 Subscales
Anhedonia/Negative Affect (AN)
The 7 item AN subscale evaluates depressive
symptoms associated with anhedonia with
several items of negative affect. High scores on
this subscale represent limited or lack of interest
in pleasurable activities.
AN items include symptoms of disinterest in
having fun, engaging in pleasant activities, and
disinterest in talking with others and eating
meals.
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 RADS-2 Subscales
Negative Self-Evaluation (NS)
The 8 NS items evaluate negative feelings about oneself.
Items deal with low self-worth, self-denigration,
feelings of self-harm, that parents and others do not
like or care about them, and thoughts of running
away, and feeling there is nothing they can do that will
help the situation.
In some adolescents, this negative self-evaluation is
internalized as reflected in thoughts of self-harm,
feelings of pervasive helplessness and suicidal
thoughts or behaviors.
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 RADS-2 Subscales
Somatic Complaints (SC)
The 7 SC items evaluate somatic and vegetative
complaints (classic symptoms), along with
general feelings of malaise (boredom, life is
unfair) and irritability. Symptoms include
stomachaches, feeling ill, fatigue, and sleep
disturbance.

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 Characteristics of the
RADS-2 Normative Sample
Size of sample 3,300 Gender (n)
Males 1,650
Females 1,650
Age Groups (n) Ethnicity (%)
11 – 13 1,100 Caucasian 70.5
14 – 16 1,100 African Amer 12.1
17 – 20 1,100 Hispanic 11.8
Asian 4.3
Native Amer 1.3
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Reliability of RADS-2 Scales
Internal Consistency Test-retest
RADS-2 scale Clinical Standardization Clinical

Dysphoric Mood .86 .85 .87

Anhedonia/Negative Affect .85 .89 .81
Negative Self-Evaluation .87 .86 .85
Somatic Complaints .81 .79 .81
RADS-2 Depression Total .94 .92 .89

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RADS Research with Special Populations
Baker, 1995 Gifted & exceptionally gifted
Brand, et al., 1996 Major Depression & sexual abuse
Brown, et al., 1991 Suicide attempters
Cauce et al., 2000 Homeless adolescents
Cunniff et al., 1995 Turner syndrome
Dalley et al., 1992 Learning disabled
D’Imperio et al., 2000 Disadvantaged urban city
Ghaziuddin et al., 1999 Psychiatric inpatients
Graves & Reynolds,1985 Behavior disorders
Gutierrez, 1999 Parentally bereaved students
Hagborg, 1992 Seriously emotionally disturbed
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 RADS Research with Special Populations
Hein & Dell, 1995 HIV+(+) in medical settings
King et al., 1995a Psychiatric inpatients
King et al., 1995b Psychiatric inpatients
King et al., 1996 Inpatients w/ major depression
King, et al, 1997 Psychiatric inpatients
Manikam, et al 1995 Mental retardation
Matson & Nieminen,1987 Behavior disordered
MacLean et al., 1999 Homeless adolescents
Navarrete, 1999 Learning disabled
Nieminen & Matson,1989 Conduct disordered
Ott & Reynolds, 2001 Mental retardation
21
 RADS Research with Special Populations
Perks & Jameson 1999 Witness domestic violence /St. Lucia
Reid, et al., 1995 Adolescents with diabetes
Reinecke & Schultz,1995 Psychiatric outpatients
Ryan, et al., 2000 Homeless abused and nonabused
Sadowski & Kelley,1993 Suicide attempters
Shain, et al, 1990 Inpatients w/ Major Depression
Shain, et al., 1991 Psychiatric inpatients
Sinclair et al., 1995 Sexually abused adolescents
Spirito, et al., 1987 Hospitalized suicide attempters
Spirito, et al., 1993 Suicide attempters
Williams et al, 1998 Incarcerated adolescents
Wurzbacher, et al 1991 Prostitution-involved youth
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 RADS-2 Clinical Severity
T-Score %ile Clinical
Range range Description

Below 61 1 – 81 Normal Range

61 to 64 82 – 92 Mild clinical depression range
65 to 69 93 – 96 Moderate clinical depression
70 & above 97+ Severe clinical depression

23
 RADS-2 Scores for School
and Clinical Samples
 The RADS-2 has a possible range of 30 to 120,
although raw scores above 100 are rare.
 The average RADS-2 Total raw score for the
restandardization sample was approximately 60.
 The average raw score for the clinical sample of
297 adolescent psychiatric inpatients and
outpatients with formal DSM diagnoses was
approximately 75.
 The average Total raw score for a sample of 107
adolescents with Major Depressive Disorder was
90, equivalent to a standard score of 70 T.
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Clinical Levels of Depression
T-Score Raw Clinical
Score Description

Below 61 30-75 Normal Range

61 to 64 76-81 Mild clinical depression range
65 to 69 82-88 Moderate clinical depression
70 & above 89+ Severe clinical depression

Based on the total normative sample N = 3,330

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 Comparisons with
Normative Data
 Primary comparison group for
converting raw scores to
standard scores is the total
standardization sample (N =
3,300).
 Secondary comparisons may
be made with gender, age, and
gender within age group
standardization groups.
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 Interpretation

Dysphoric Mood (DM)

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

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 Interpretation
Anhedonia/Negative Affect (AN)
High scores on this subscale suggest a reduced
engagement in pleasant activities and a
generalized negative affect to self. High scores
may reflect low motivation and affect, as well as
social withdrawal, a characteristic of anhedonia
noted in DSM-IV.

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 Interpretation
Negative Self-Evaluation (NS)
It is important to recognize that high scores on the NS
subscale are indicative of more than negative self-
esteem and in some, may reflect extreme negative
feelings toward self including thoughts of self-harm
(self-mutilation, suicidal ideation, suicidal acts). The
scale measures broad symptoms of negative self-
evaluation (unrealistic negative self-appraisal,
feelings of worthlessness, self-blame), not just
negative self-concept.
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 Interpretation
Somatic Complaints (SC)
Adolescents with elevated scores generally show
somatic involvement in their depression, with very
high scores suggesting the potential for a
depressive episode. It is important to rule out the
presence of a prior physical illness that would
mimic somatic complaints .

30
 Interpretation
Critical Items
Serve as a double-check if the Depression Total is
below the clinical cutoff, yet may be at risk for
depression or require additional evaluation. The
general rule is if four or more or endorsed, further
assessment should be done. They are NOT
meaningful indicators of depression in isolation or
meant to be used as a screener.

31
Treatment of Depression in
Adolescents
The research on the treatment
of depression in adolescents
has focused on
pharmacological
and
psychological interventions.
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 Treatment of Depression in
Adolescents
 Pharmacotherapy
Most of the antidepressant drugs developed and
tested with adults have also been used, with
varying degrees of clinical efficacy, with
children and adolescents.
In 1993 the FDA approved the first antidepressant
for the treatment of major depressive disorders
in young people. The American Academy of
Child and Adolescent Psychiatry estimates that
5% of the pediatric population -- or 3.4 million
children and adolescents under the age of 18 --
suffer from depression. This is probably an
underestimate. 33
 Treatment of Depression in
Adolescents
Psychotherapy
The efficacy of psychotherapeutic interventions for
depression in adolescents has been examined in a
number of studies. Most of these studies have
used treatment procedures developed for adults
with modifications made for adolescents.
Core empirical studies:
Reynolds & Coats, (1986)
Kahn, et al., (1990)
Lewinsohn, et al., (1990)
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 A Comparison of Cognitive-
Behavioral Therapy and Relaxation
Training for the Treatment of
Depression in Adolescents

Journal of Consulting and Clinical

Psychology (1986)

William M. Reynolds & Kevin I. Coats

35
 Treatment of Depression in
Adolescents
 Pharmacotherapy
The primary classes of antidepressants:
 Tricyclic antidepressants (TCAs),
 Monoamine Oxidase Inhibitors (MAOIs),
 Selective Serotonin Reuptake Inhibitors
(SSRIs),
and several newer classes of drugs that do
not fit these categories.

36
 Summary
 Depression and depressive disorders are
prevalent among adolescents.
 Young people typically do not get better
without intervention of some kind.
 The foremost need is for the identification of
adolescents who are at risk and subsequent
referral for treatment.
 There is a need for schools and communities
to be proactive in the identification and
referral for treatment of at-risk youth.

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