The Children's Global Assessment Scale in Clinical Practice: An Empirical Evaluation

doi:10.1097/00004583-199410000-00011

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 33, Issue 8, October 1994, Pages 1158-1164

https://doi.org/10.1097/00004583-199410000-00011 Get rights and content

ABSTRACT

Objective

The purpose of this study was to examine characteristics of the Children's Global Assessment Scale (CGAS) in the context of clinical practice.

Method

Ninety-five children admitted to a psychiatric inpatient unit were rated by their attending psychiatrist and by milieu staff on the CGAS. Measures of severity and type of symptomatology; social, behavioral, and school competence; intellectual level; social relatedness; and family stress were completed by parents and staff raters.

Results

Results indicated that there was significant convergence in CGAS ratings by independent raters. CGAS ratings were unrelated to measures of symptomatology but were significantly related to indices of children's competence.

Conclusions

This pattern of results diverged from findings from highly controlled research settings and indicated that CGAS ratings obtained in clinical contexts may reflect evaluations of functional competence rather than severity of symptomatology.

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Standard assessment of pediatric obsessive-compulsive disorder (OCD) patients includes ratings of insight, avoidance, indecisiveness, sense of responsibility, pervasive slowness, pathological doubting, and obsession-free intervals. The present study aims to identify pre-treatment associations of these clinical features to symptom severity and symptom dimensions as well as to describe and analyze the long-term levels and distribution in different treatment responder groups. Method: Severity ratings as well as clinical feature ratings were evaluated in 268 pediatric OCD patients using the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) at seven time points before, during, and up to three years after first-line cognitive-behavioral therapy. The CY-BOCS auxiliary items were evaluated on the basis of three symptom severity trajectory classes: acute, slow, and limited responders. Results: Insight, avoidance, pervasive slowness, and obsession-free intervals were positively associated with pre-treatment symptom severity. Symptom dimensions were associated with different auxiliary items. At three-year follow-up, the limited responder class had higher scores than the acute and slow responder classes on all items except for responsibility. Conclusion: The CY-BOCS auxiliary items are closely related to symptom dimensions and partly to symptom severity. The features appear to be dynamic concepts prone to change, yet, less so in patients showing limited long-term treatment response.
The Clinician Affective Reactivity Index: Validity and Reliability of a Clinician-Rated Assessment of Irritability
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Citation Excerpt :
Children’s Global Assessment Scale (CGAS; Bird, Canino, Rubio-Stipec, & Ribera, 1987; Shaffer et al., 1983) measures global impairment in functioning. The measure assesses function relative to peers over the past month (1 = lowest, 100 = highest) and has strong psychometric properties (Green, Shirk, Hanze, & Wanstrath, 1994). Pediatric Anxiety Rating Scale (PARS, Research Units on Pediatric Psychopharmacology Anxiety Study Group, 2002) assesses the frequency and severity of symptoms common to pediatric anxiety disorders, including separation, social, and generalized anxiety symptoms over the past week.
Irritability is impairing in youth and is the core feature of disruptive mood dysregulation disorder (DMDD). Currently, there are no established clinician-rated instruments to assess irritability in pediatric research and clinical settings. Clinician-rated measures ensure consistency of assessment across patients and are important specifically for treatment research. Here, we present data on the psychometric properties of the Clinician Affective Reactivity Index (CL-ARI), the first semistructured interview focused on pediatric irritability. The CL-ARI was administered to a transdiagnostic sample of 98 youth (M age = 12.66, SD = 2.47; 41% female). With respect to convergent validity, CL-ARI scores were (a) significantly higher for youth with DMDD than for any other diagnostic group, and (b) showed uniquely strong associations with other clinician-, parent-, and youth-report measures of irritability compared to measures of related constructs, such as anxiety. The three subscales of the CL-ARI (temper outbursts, irritable mood, impairment) showed excellent internal consistency. Test-retest reliability of the CL-ARI was adequate. These data support that irritability can be feasibly, validly, and reliably assessed by clinicians using the CL-ARI. A validated, gold-standard assessment of pediatric irritability is critical in advancing research and treatment efforts.
Sleep spindle density is associated with worry in children with generalized anxiety disorder and healthy controls
2020, Journal of Affective Disorders
Childhood generalized anxiety disorder (GAD), characterized by uncontrollable worry, is associated with long-term psychopathology risk, yet understanding of developmental trajectories is limited. Despite common complaints about sleep, ‘macro’ sleep abnormalities have not been identified. Emerging findings suggest micro-architectural features of sleep, including sleep spindles, differentiate various psychiatric populations. The current study investigated sleep spindle density during non-rapid eye movement (NREM) sleep among youth with GAD and healthy controls, including relationships with anxiety, worry, global functioning, and subjective sleep quality.
58 pre-pubertal children, n = 26 with GAD and n = 32 matched healthy controls, aged 7–11 years (M = 8.86, SD=1.47), completed diagnostic assessments and a week of actigraphy monitoring prior to a night of polysomnography (PSG) either at home or in a sleep laboratory. NREM spindle activity was detected in frontal and central regions.
Sleep spindle activity did not differ based on diagnostic group or sex. Sleep spindles were unassociated with anxiety and sleep quality but showed a significant positive association with worry in all youth. Among youth with GAD, global functioning was negatively associated with spindle density in frontal regions during NREM stage 3. Spindle density was significantly greater during in-lab compared to at-home PSG.
The small sample size and reliance on only one night of PSG necessitate additional studies.
The identified link between spindle activity and worry in pre-pubertal children highlights a need for investigations on transdiagnostic features of child psychopathology rather than specific disorders. Longitudinal studies are needed to explore spindle characteristics and affective risk across development.
An exploratory examination of reappraisal success in depressed adolescents: Preliminary evidence of functional differences in cognitive control brain regions
2018, Journal of Affective Disorders
Most neuroimaging studies of adolescent depression employ tasks not designed to engage brain regions necessary for the cognitive control of emotion, which is central to many behavioral therapies for depression. Depressed adults demonstrate less effective activation of these regions and greater amygdala activation during cognitive reappraisal; we examined whether depressed adolescents show similar patterns of brain activation.
We collected functional magnetic resonance imaging (fMRI) data during cognitive reappraisal in 41 adolescents with major depressive disorder (MDD) and 34 matched controls (ages 13–17). We examined group differences in (1) activations associated with reappraisal and reappraisal success (i.e., negative affect reduction during reappraisal) using whole brain and amygdala region-of-interest analyses, and (2) functional connectivity of regions from the group-by-reappraisal success interaction.
We found no significant group differences in whole brain or amygdala analyses during reappraisal. In the group-by-reappraisal success interaction, activations in the left dorsomedial prefrontal cortex (dmPFC) and left dorsolateral PFC (dlPFC) were associated with reappraisal success in healthy controls but not depressed adolescents. Depressed adolescents demonstrated reduced connectivity between the left dmPFC and the anterior insula/inferior frontal gyri bilaterally (AI/IFG) and between left dlPFC and left AI/IFG.
Our results should be considered exploratory given our less conservative statistical threshold in the group-by-reappraisal interaction.
We find preliminary evidence that depressed adolescents engage cognitive control regions less efficiently than healthy controls, suggesting delayed maturation of regulatory prefrontal cortex regions; more research is needed to determine whether cognitive therapies improve functioning of these regions in depressed youth.
Have Phobias, Will Travel: Addressing One Barrier to the Delivery of an Evidence-Based Treatment
2018, Behavior Therapy
Citation Excerpt :
The CGAS was a clinic-reported measure of the youth’s overall level of functioning across domains. The CGAS has been described as a reliable and valid tool to capture broader functioning in both clinical practice and research (Bird, Canino, Rubio-Stipec, & Ribera, 1987; Green, Shirk, Hanze, & Wanstrath, 1994). For the present study, the CGAS was administered at all assessment time points.
Although a host of evidence-based treatments exist for youth with anxiety disorders, less than 30% of youth and their families receive these treatments. One of the main barriers to receiving these treatments is the lack of access to care, due largely to the absence of mental health professionals who have expertise in the delivery of these treatments in certain geographic locales. The current study examined whether a brief intensive treatment for specific phobias (SPs), Augmented One-Session Treatment (OST-A), would result in comparable treatment gains for families who traveled a considerable distance to receive this treatment when compared to families who resided in our local community. Participants included 76 youth with a clinically confirmed diagnosis of SP (38 local families and an age- and sex-matched sample of 38 nonlocal families). Although SP severity at pretreatment was significantly greater for the nonlocal youth than the local youth, both nonlocal and local youth showed commensurate improvement and maintenance of treatment gains over a 6-month period across several clinical outcome measures. Findings from this study show that OST-A is effective when families choose to travel for treatment, addressing at least one of the barriers to use of this evidence-based treatment.
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: The authors gratefully recognize John Sadler, M.D., Cliff Siegel, M.D., Joyce Trygstad-Nelson, the Burlington-Northern Foundation, and the Department of Psychiatry and Behavioral Sciences at The Children's Hospital for their financial support of this project. Chris Saiz, Alison Papadakis-Colalancia, Bruce Fritz, and the staff of the child inpatient service are appreciated for their efforts in data collection and Beverly Petrick and Teri Deines for data entry and manuscript preparation.

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ARTICLESThe Children's Global Assessment Scale in Clinical Practice: An Empirical Evaluation

ABSTRACT

Objective

Method

Results

Conclusions

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

Manual for the Child Behavior Checklist and Revised Child Behavior Profile

Child/adolescent behavioral and emotional problems: implications of cross-informant correlations for situational specificity

Psychol Bull

Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III)

Diagnostic and Statistical Manual of Mental Disorders, 3rd edition-revised (DSM-III-R)

Refining the diagnosis of schizophreniform disorder

Am J Psychiatry

Further measures of the psychometric properties of the Children's Global Assessment Scale

Arch Gen Psychiatry

Psychiatric disorders in pediatric primary care

Arch Gen Psychiatry

The Global Assessment Scale: a procedure for measuring overall severity of psychiatric disturbance

Arch Gen Psychiatry

ARTICLES
The Children's Global Assessment Scale in Clinical Practice: An Empirical Evaluation