Screening for personality disorder in incarcerated adolescent boys: preliminary validation of an adolescent version of the standardised assessment of personality – abbreviated scale (SAPAS-AV)

Abstract

BackgroundPersonality disorder (PD) is associated with significant functional impairment and an elevated risk of violent and suicidal behaviour. The prevalence of PD in populations of young offenders is likely to be high. However, because the assessment of PD is time-consuming, it is not routinely assessed in this population. A brief screen for the identification of young people who might warrant further detailed assessment of PD could be particularly valuable for clinicians and researchers working in juvenile justice settings.MethodWe adapted a rapid screen for the identification of PD in adults (Standardised Assessment of Personality – Abbreviated Scale; SAPAS) for use with adolescents and then carried out a study of the reliability and validity of the adapted instrument in a sample of 80 adolescent boys in secure institutions. Participants were administered the screen and shortly after an established diagnostic interview for DSM-IV PDs. Nine days later the screen was readministered.ResultsA score of 3 or more on the screening interview correctly identified the presence of DSM-IV PD in 86% of participants, yielding a sensitivity and specificity of 0.87 and 0.86 respectively. Internal consistency was modest but comparable to the original instrument. 9-days test-retest reliability for the total score was excellent. Convergent validity correlations with the total number of PD criteria were large.ConclusionThis study provides preliminary evidence of the validity, reliability, and usefulness of the screen in secure institutions for adolescent male offenders. It can be used in juvenile offender institutions with limited resources, as a brief, acceptable, staff-administered routine screen to identify individuals in need of further assessment of PD or by researchers conducting epidemiological surveys.

The influence of personality disorder on outcome in adolescent self-harm

“…The study also adds to the literature in general in personality disorder in adolescent psychopathology; for instance, rates of personality disorder between 28% and 64% have been found in anorexia and 25% in eating disorder not otherwise specified, 23,24 and rates of between 36% and 88% for psychopathy and callous and unemotional traits within adolescent forensic populations. 25 Such rates are thus broadly comparable with our findings in adolescent self-harm.…”

Validation of the standardised assessment of personality - abbreviated scale in a general population sample

“…Figure displays the ROC curve for the SAPAS as a screen for a SCID‐II criterion diagnosis of any PD in the sample. The ROC curve for a well‐performing test deviates significantly from the 45° reference line (AUC = 0.5), where no discrimination exists, and approaches the ‘ideal test point’ (AUC = 1), where sensitivity and specificity both equal 100% and the false positive rate is 0% (Kongerslev et al, ; Kraemer, ). In our sample, the ROC curve for the sample was statistically highly significantly different ( p < 0.001) from the 45° reference line.…”

A comparison of Cohen’s Kappa and Gwet’s AC1 when calculating inter-rater reliability coefficients: a study conducted with personality disorder samples

“…As shown by Day and Schriger [14], small numbers deviate more from the percentage agreement regression line, while higher numbers deviate less. This is why some researchers use at least 5 cases per cell for their analyses – leaving some criteria with a low prevalence despite the fact that both raters have a high level of agreement [4,6,15-17]. In such cases, some investigators have reported good percentage agreement accompanied by an undesirable Cohen’s Kappa [14]; however, this situation does not occur when using Gwet’s AC1.…”