RESEARCH UPDATE REVIEW
Ten-Year Review of Rating Scales, VII: Scales Assessing Functional Impairment

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ABSTRACT

Objective

This is the seventh in a series of 10-year reviews of rating scales. Here the authors present scales measuring functional impairment, a sequela of mental illness. The measurement of functional impairment has assumed importance with the recognition that symptom resolution does not necessarily correlate with functional improvement.

Method

The authors reviewed functional impairment from multiple sources over the past 20 years. Thus, this article includes a variety of scales ranging from those that have been subject to critical review with strong psychometric support to those that have not been critically reviewed but are in widespread use to those that are still finding their niche.

Results

These scales represent a continuum of constructs from symptoms to functional impairment to contextual factors that affect youths' functioning. Most older scales have focused on developmentally delayed youths. Newer scales strive to measure functional impairment separate from symptomatology. Some newer scales are also keyed to determination of level of service need.

Conclusions

Scales measuring functional impairment can elucidate the impact of illness on youths, identify targets for treatment, determine service needs, and monitor treatment effectiveness. These scales are widely used in community mental health and health service delivery. They can assist in providing evidence-based treatment.

Section snippets

UNIDIMENSIONAL SCALES

Unidimensional, or global, scales of functional impairment assign a single summary score to describe the youth's overall functional impairment or adaptive functioning. The simplicity of a single score allows comparison of functional impairment between groups of patients with different diagnoses as well as ease of measuring functional change over time (Goldman et al., 1992; Skodol et al., 1988). However, global scales tend to confound functioning with diagnosis or symptomatology due to a

MULTIDIMENSIONAL SCALES

Multidimensional scales measuring functional impairment and adaptive functioning have been developed in response to the perception that global scales do not yield sufficiently specific information about youths' functioning. These scales are composed of multiple subscales that describe different aspects of youths' functioning that may be impaired by mental health problems. The specific functional domains included vary with each scale and reflect its intended use and target population. The

FUTURE DIRECTIONS

Scales measuring functional impairment have broad appeal in clinical, research, and administrative applications that seek to better use community resources for individual youths and to better tailor a continuum of services within a community. There are a number of areas in which further work is needed to advance this promising and rapidly evolving field. The first is additional theoretical work on the issues raised by Bird (1999) as to whether functional impairments should be specifically

REFERENCES (141)

  • SH Goodman et al.

    Major depression and dysthymia in children and adolescents: discriminant validity and differential consequences in a community sample

    J Am Acad Child Adolesc Psychiatry

    (2000)
  • TT Gorske et al.

    Adolescents in residential centers: characteristics and treatment outcome

    Child Youth Serv Rev

    (2003)
  • B Green et al.

    The Children's Global Assessment Scale in clinical practice: an empirical evaluation

    J Am Acad Child Adolesc Psychiatry

    (1994)
  • RW Greene et al.

    Toward a new psychometric definition of social disability in children with attention-deficit hyperactivity disorder

    J Am Acad Child Adolesc Psychiatry

    (1996)
  • JD Hamilton et al.

    Outcome at 6 months for 50 adolescents with major depression treated in a health maintenance organization

    J Am Acad Child Adolesc Psychiatry

    (1999)
  • SL Hans et al.

    Social adjustment of adolescents at risk for schizophrenia: the Jerusalem Infant Development Study

    J Am Acad Child Adolesc Psychiatry

    (2000)
  • ES Harris et al.

    A comparison of measures of adjustment, symptoms, and impairment among children with chronic medical conditions

    J Am Acad Child Adolesc Psychiatry

    (1996)
  • K Hoagwood et al.

    Outcomes of mental health care for children and adolescents: I. A comprehensive conceptual model

    J Am Acad Child Adolesc Psychiatry

    (1996)
  • JR Irwin et al.

    The social-emotional development of “late-talking” toddlers

    J Am Acad Child Adolesc Psychiatry

    (2002)
  • K John et al.

    The Social Adjustment Inventory for Children and Adolescents (SAICA): testing of a new semistructured interview

    J Am Acad Child Adolesc Psychiatry

    (1987)
  • CA King et al.

    Predictors of comorbid alcohol and substance abuse in depressed adolescents

    J Am Acad Child Adolesc Psychiatry

    (1996)
  • CA King et al.

    Prediction of positive outcomes for adolescent psychiatric inpatients

    J Am Acad Child Adolesc Psychiatry

    (1997)
  • CA King et al.

    Family functioning and suicidal behavior in adolescent inpatients with mood disorders

    J Am Acad Child Adolesc Psychiatry

    (1993)
  • BB Lahey et al.

    The NIMH Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) study: background and methodology

    J Am Acad Child Adolesc Psychiatry

    (1996)
  • SC Leon et al.

    Psychiatric hospital service utilization of children and adolescents in state custody

    J Am Acad Child Adolesc Psychiatry

    (1999)
  • JS Lyons et al.

    Strengths of children and adolescents in residential settings: prevalence and associations with psychopathology and discharge placement

    J Am Acad Child Adolesc Psychiatry

    (2000)
  • G Masi et al.

    Open trial of risperidone in 24 young children with pervasive developmental disorders

    J Am Acad Child Adolesc Psychiatry

    (2001)
  • F Muratori et al.

    A two-year follow-up of psychodynamic psychotherapy for internalizing disorders in children

    J Am Acad Child Adolesc Psychiatry

    (2003)
  • KM Myers et al.

    Ten-year review of rating scales. I: Overview of scale functioning, psychometric properties, and selection

    J Am Acad Child Adolesc Psychiatry

    (2002)
  • KM Myers et al.

    Ten-year review of rating scales. II: Scales for internalizing disorders

    J Am Acad Child Adolesc Psychiatry

    (2002)
  • EV Nunes et al.

    Psychopathology in children of parents with opiate dependence and/or major depression

    J Am Acad Child Adolesc Psychiatry

    (1998)
  • JL Ohan et al.

    Ten-year review of rating scales. IV: Scales assessing trauma and its effects

    J Am Acad Child Adolesc Psychiatry

    (2002)
  • TM Achenbach

    Manual for the Teacher's Report Form and 1991 Profile

    (1991)
  • TM Achenbach et al.

    Manual for the ASEBA School-Age Forms & Profiles

    (2000)
  • American Academy of Child and Adolescent Psychiatry Work Group on Systems of Care

    Child and Adolescent Level of Care Utilization System for Psychiatric and Addiction Services (CALOCUS), Version 1.1; Report to the AACAP Council

    (2001)
  • American Academy of Child and Adolescent Psychiatry Work Group on Systems of Care and American Association of Community Psychiatrists

    Child and Adolescent Level of Care Utilization System (CALOCUS) User's Manual, Version 1.3

    (2003)
  • American Association on Mental Retardation

    Mental Retardation: Definition, Classification, and Systems of Support

    (2002)
  • American Psychiatric Association

    Diagnostic and Statistical Manual of Mental Disorders

    (1994)
  • American Psychiatric Association

    Diagnostic and Statistical Manual of Mental Disorders)

    (2000)
  • American Psychiatric Association

    Handbook of Psychiatric Measures

    (2000)
  • RL Anderson et al.

    Reliability of the Child and Adolescent Needs and Strengths-Mental Health (CANS-MH) Scale

    J Child Fam Stud

    (2003)
  • JA Andrews et al.

    Psychometric properties of scales for the measurement of psychosocial variables associated with depression in adolescence

    Psychol Rep

    (1993)
  • G Balboni et al.

    Discriminant validity of the Vineland scales: score profiles of individuals with mental retardation and a specific disorder

    Am J Ment Retard

    (2001)
  • CC Barber et al.

    The target symptom rating: a brief clinical measure of acute psychiatric symptoms in children and adolescents

    J Clin Child Adolesc Psychol

    (2002)
  • MP Bates

    The Child and Adolescent Functional Assessment Scale (CAFAS): review and current status

    Clin Child Fam Psychol Rev

    (2001)
  • KM Belsito et al.

    Lamotrigine therapy for autistic disorder: a randomized, double-blind, placebo-controlled trial

    J Autism Dev Disord

    (2001)
  • L Bickman

    The evaluation of a children's mental health managed care demonstration

    J Ment Health Admin

    (1996)
  • HR Bird

    The assessment of functional impairment

  • HR Bird et al.

    Global measures of impairment for epidemiological and clinical use with children and adolescents

    Int J Methods Psychiatr Res

    (1996)
  • HR Bird et al.

    Estimates of the prevalence of childhood maladjustment in a community survey in Puerto Rico

    Arch Gen Psychiatry

    (1988)

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    Correspondence to Dr. Kathleen M. Myers, Division of Child and Adolescent Psychiatry, 6F-1, Children's Hospital and Regional Medical Center, Box 5371, 4800 Sand Point Way, NE, Seattle, WA 98105; e-mail: [email protected].

    Disclosure: The authors have no financial relationships to disclose.

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    Copyright © 2005 The American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.