Global Assessment of Child Psychopathology

doi:10.1097/00004583-198703000-00014

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 26, Issue 2, March 1987, Pages 203-206

https://doi.org/10.1097/00004583-198703000-00014 Get rights and content

Abstract

The Children's Global Assessment Scale (CGAS) was analyzed wih regard to interrater reliability, discriminant validity, and clinical usefulness in two different studies. Where interrater reliability and discriminant validity were high, stability varied for different psychiatric diagnoses. In a clinical sample, scores were dependent on diagnoses, mental retardation, and socioeconomic status. A cutoff score of 70 clearly differentiated normal functioning from more severe problems in need of treatment. The scale sensibly reflected change due to therapeutic interventions.

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Cited by (51)

Predictors of longitudinal psychosocial functioning in bipolar youth transitioning to adults
2019, Journal of Affective Disorders
Citation Excerpt :
To examine functional impairment in those who have symptomatic remissions, we limited our analyses to those in Class 1 Predominantly Euthymic and Class 3 Ill with Improving Course). We further selected those participants in these Classes who reported psychosocial fair/poor functioning operationalized as C-GAS/GAF < 70 (Jones et al., 1995; Shaffer et al., 1983; Steinhausen, 1987). Given that this symptomatic remission did not occur until the later years of follow-up for Class 3 Ill with Improving Course, we focused on the most recent follow-up, as this was a proxy for the current functioning status, when both Classes were in remission.
In a sample of participants diagnosed with Bipolar Disorder (BD) in youth, we aim: (1) to examine longitudinal psychosocial functioning; (2) to determine whether psychosocial impairment remains in those who remitted from mood disorders during later periods of follow-up; (3) to examine predictors of psychosocial impairment despite symptomatic remission.
A Course and Outcome of Bipolar Youth subsample of 367 (≥ 4 years follow-up data) were grouped into mood trajectories: Class 1 Predominantly Euthymic; Class 2 Moderately Euthymic; Class 3 Ill with Improving Course; Class 4 Predominantly Ill. Psychosocial functioning was assessed via Children's Global Assessment Scale (C-GAS) for those under age 22; Global Assessment of Functioning (GAF) scale after 22. Current school, employment, and disability status were examined. Established predictors of symptomatic impairment were analyzed.
The Predominantly Euthymic Class had better psychosocial functioning, and were more likely to be in school/employed. The Persistently Ill Class had worse psychosocial functioning, and were more likely to receive disability. However, 44% of Predominantly Euthymic and 93% of Ill with Improving Course participants continued to experience current psychosocial impairment. Early BD onset, low Socioeconomic Status (SES), and current comorbidity, predicted poor psychosocial functioning. Low SES, and current comorbidity, predicted no school enrollment/unemployment.
The study does not have a healthy control group to compare functioning findings.
In general, youth with persistent mood symptoms had worse psychosocial functioning, moreover, those with remitted symptoms still exhibited current psychosocial functioning deficits. High risk individuals with predictors of impairment should be targeted for functioning interventions.
Evolve Therapeutic Services: A 5-year outcome study of children and young people in out-of-home care with complex and extreme behavioural and mental health problems
2016, Children and Youth Services Review
Little evaluation research has been conducted on the effectiveness of services and intervention provided to children in out-of-home care. This study evaluated an innovative Queensland, Australia program employing a collaborative wrap-round model of care in combination with a flexible intervention approach, individually tailored to children and young people in out-of-home care presenting with complex and extreme behavioural and mental health problems.
The sample consisted of 664 children and young people. Two clinician-rated measures, the CGAS and HoNOSCA, were used to assess young people's functioning via a pre-post-treatment design.
Results revealed significant improvements across a range of problems areas: general functioning and adjustment; disruptive, antisocial and aggressive behaviour; overactivity, poor attention and concentration; non-accidental self-injury; problems with scholastic and language skills; non-organic somatic symptoms; emotional symptoms; peer and family relationships; self-care and independence; and school attendance.
Findings provide good evidence for the effectiveness of the therapeutic intervention program. Implications for future research are explored.
Psychological interventions for adolescent psychosis: A pilot controlled trial in routine care
2013, European Psychiatry
Citation Excerpt :
Total scores range from 16 to 112. This scale is widely used to rate psychosocial functioning in child and adolescent mental health research and has good psychometric properties [15]. A single global clinician rating from 1 (very poor) to 100 (no problem) is made based on emotional and behavioural difficulties, usually over the previous 3-month period.
Evidence for the recommendation to deliver Cognitive Behavioural Therapy (CBT) and Family Interventions (FI) to under-18s with psychosis derives from adult research, and no previous study has focused exclusively on an adolescent population. We evaluated adaptations of these therapies for adolescent inpatients with psychosis (CBTpA and FIpA), delivered as an adjunct to inpatient standard care (SC).
Thirty adolescent inpatients with psychotic symptoms on admission were sequentially allocated to receive CBTpA + SC (n = 10); FIpA + SC (n = 10) or SC alone (n = 10). Psychotic symptoms and functioning were measured at admission and discharge.
Group comparisons did not reach conventional significance, but effect sizes in this pilot study showed a promising impact of CBTpA compared to SC alone, in reducing symptoms (ES: d = 0.6), with smaller effect sizes for functioning (d = 0.2) and for FIpA (symptoms, d = 0.1 and functioning, d = 0.4). There was no advantage of either additional treatment in reducing length of stay, but self-report satisfaction ratings were higher for both psychological therapies.
The study is the first to focus on an exclusively adolescent population, using appropriately adapted therapy protocols. Findings suggest that the interventions are feasible, acceptable and helpful for adolescents with psychosis. Larger randomised controlled trials are now needed.
Differential effects of psychological maltreatment on children of mothers exposed to intimate partner violence
2011, Child Abuse and Neglect
Psychological maltreatment (PM) is the most prevalent form of child abuse, and is the core component of most of what is considered as child maltreatment. The aim of this work was to explore differential adverse outcomes of the different types of PM in the mental health and functioning of children living in homes in which they are exposed to intimate partner violence (IPV).
Participants were 168 children, aged between 4 and 17, whose mothers experienced IPV. They were assessed using different measures of psychopathology and functioning: Diagnostic Interview for Children and Adolescents-IV, Child Behavior Checklists and Child and Adolescent Functioning Assessment Scale. Furthermore, IPV was assessed with the Schedule for Assessment of Intimate Partner Violence Exposure in Children and the Index of Spouse Abuse. Statistical analyses were carried out with regression models adjusted by means of Generalized Estimating Equations.
Spurning was the PM subtype with the greatest global effect on the children, as it was significantly associated with internalizing and externalizing problems. Denying emotional responsiveness specifically increased the risk of internalizing psychopathology and impairment in the emotional area. Terrorizing was not significantly associated with a greater number of negative outcomes in children's psychopathology or functioning in this population.
The results suggest the importance of taking PM types into account in order to fully understand the problems of children exposed to IPV at home, and for the design of effective treatment and prevention programs.
Children's Global Assessment Scale (CGAS) in a naturalistic clinical setting: Inter-rater reliability and comparison with expert ratings
2010, Psychiatry Research
The Children's Global Assessment Scale (CGAS) is a tool to assess the overall level of functioning of children in Child and Adolescent Mental Health Services (CAMHS). Even though the use of this rating scale requires trained raters, it is commonly deployed without prior training in clinical settings. The aim of this study was to investigate the reliability and the agreement of CGAS ratings with an expert rating, in a clinical setting with untrained raters. Five experienced clinicians rated five vignettes to provide expert ratings. These vignettes were then rated by 703 health-care professionals representing 33 Swedish CAMHS. The health-care professionals rated the vignettes significantly higher (showing better global functioning) than the expert ratings. There was a wide range between the minimum and maximum ratings. The intraclass correlation coefficient was 0.73, which indicates moderate inter-rater reliability. Neither clinical experience nor earlier experience of using CGAS influenced the agreement with the expert ratings. The inter-rater reliability is moderate when CGAS is used in a clinical setting with untrained raters. Further, the untrained raters differed substantially from the experts. This stresses the importance of proper training in conjunction with the introduction of new rating scales.
Reliability of the GAF and CGAS with children exposed to trauma
2007, Child Abuse and Neglect
Citation Excerpt :
Studies of the reliability of these measures have yielded mixed results. Estimates of interrater reliability of the CGAS have ranged from .53 to .93 (Dyrborg et al., 2000; Green, Shirk, Hanze, & Wanstrath, 1994; Rey, Starling, Wever, Dossetor, & Plapp, 1995; Shaffer et al., 1983; Steinhausen, 1987). Likewise, studies of the interrater reliability of the GAF for children and adolescents yielded coefficients ranging from .54 to .92 (Beitchman et al., 2001; Gold, Sherra, & Clarkson, 1993; Manassis & Hood, 1998; Rey et al., 1995; Smith, Thienemann, & Steiner, 1992).

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: This article is based on papers presented at the VII Congress of the European Society of Child and Adolescent Psychiatry, Lausanne, Switzerland, July 4-8, 1983 and the 31st Annual Meeting of the American Academy of Child Psychiatry, Toronto, October 9-14, 1984.

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Scientific PapersGlobal Assessment of Child Psychopathology

Abstract

The child behavior profile: an empirically based system for assessing children's behavioral problem and competencies

Int. J. Ment. Hlth.

The global assessment scale. A procedure for measuring overall severity of psychiatric disturbance

Arch. Gen. Psychiatr.

Scientific Papers
Global Assessment of Child Psychopathology