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

Oregon Health and Science University, Portland, USA.
Journal of the American Academy of Child & Adolescent Psychiatry (Impact Factor: 7.26). 05/2005; 44(4):309-38; discussion 339-42. DOI: 10.1097/
Source: PubMed


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.
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.
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.
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.

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    • "These three domains of functioning were included in this measure from a review of the literature on the assessment of functioning for adolescents (Winters et al., 2005). These three constructs have been used in other global functioning measures such as the CGAS and the GAF (Bird, 1999; Bird et al., 1987; Winters et al., 2005). In addition, the inclusion of a dimensional assessment of personality functioning into the Overall Functioning Scale (OFS) was supported by work showing how personality pathology affects overall functioning (Kuurmann and Hilsenroth, 2012; Peters et al., 2005; Stein et al., 2009; Westen and Arkowitz- Westen, 1998; Zittel-Conklin and Westen, 2005). "
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    ABSTRACT: The current study looks to evaluate the validity and reliability of a brief measure of overall functioning for adolescents. Clinicians were asked to complete the Overall Functioning Scale for 72 adolescents consecutively admitted to the adolescent psychiatric inpatient service of a community safety net medical center. The results revealed that this new measure is related to the patients’ length of stay, clinician-rated measures of social cognition and object relations, Global Assessment of Functioning score at admission, and global rating of engagement in individual psychotherapy. Results also showed that the OFS was related to patients’ history of non-suicidal self-harm as well as treatment outcome as assessed by measures of psychological health and well-being and symtomatology. Hierarchical regressions reveal that the OFS shows incremental validity above the admission GAF score in predicting length of stay. The results also showed that the OFS demonstrates inter-rater reliability in the excellent range (ICC 1,2) of .88. Clinical implications of the use of this tool as well as areas of future research are discussed.
    Journal of Nervous & Mental Disease 08/2014; 202(11). DOI:10.1097/NMD.0000000000000200 · 1.69 Impact Factor
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    • "A cluster of depressive symptoms does not meet DSM or ICD criteria for depressive disorder unless there is clinically significant impairment. Surveys that have devised ways to incorporate severity or level of impairment into the operational definition of “caseness” for mental disorders reduce rates of disorder by two- or threefold [7]. When translating mental disorder classification and diagnosis into different cultures, this component of disability becomes an important audit of the translation of the symptom clusters and disease classifications in the new context. "
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    ABSTRACT: The World Health Organization Disability Assessment Schedule for children (WHODAS-Child) is a disability assessment instrument based on the WHO's International Classification of Functioning, Disability and Health for children and youth. It is modified from the original adult version specifically for use with children. The aim of this study was to assess the WHODAS-Child structure and metric properties in a community sample of children with and without reported psychosocial problems in rural Rwanda. The WHODAS-Child was first translated into Kinyarwanda through a detailed committee translation process and back-translation. Cognitive interviewing was used to assess the comprehension of the translated items. Test-retest reliability was assessed in a group of 64 children. The translated WHODAS-Child was then administered to a final sample of 367 children in southern Kayonza district in rural southeastern Rwanda within a larger psychosocial assessment battery. The latent structure was assessed through confirmatory factor analysis. Reliability was evaluated in terms of internal consistency (Cronbach's alpha) and test-retest reliability (Pearson's correlation coefficient). Construct validity was explored by examining convergence between WHODAS-Child scores and mental disorder status, and divergence of WHODAS-Child scores with protective factors and prosocial behaviors. Concordance between parent and child scores was also assessed. The six-factor structure of the WHODAS-Child was confirmed in a population sample of Rwandan children. Test-retest and inter-rater reliability were high (r = .83 and ICC = .88). WHODAS-Child scores were moderately positively correlated with presence of depression (r = .42, p<.001) and post-traumatic stress disorder (r = .31, p<.001) and moderately negatively correlated with prosocial behaviors (r = .47, p<.001). The Kinyarwanda version of the WHODAS-Child was found to be a reliable and acceptable self-report tool for assessment of functional impairment among children largely referred for psychosocial problems in the study district in rural Rwanda. Further research in low-resource settings and with more general populations is recommended.
    PLoS ONE 03/2013; 8(3):e57725. DOI:10.1371/journal.pone.0057725 · 3.23 Impact Factor
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    • "Anchors at 10-point intervals include descriptors of functioning for each interval. The instrument has been validated against many different psychiatric assessment scales [34], and it is good at distinguishing cases from non-cases [35,36]. "
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    ABSTRACT: Background Individuals with ADHD have been associated with more employment difficulties in early adulthood than healthy community controls. To examine whether this association is attributable specifically to disturbance of activity and attention (ADHD) or to psychopathology in general, we wanted to extend existing research by comparing the rate of mid-adulthood working disabilities for individuals diagnosed with ADHD as children with the rate for clinical controls diagnosed with either conduct disorder, emotional disorder or mixed disorder of conduct and emotions. Methods Former Norwegian child-psychiatric in-patients (n = 257) were followed up 17–39 years after hospitalization by record linkage to the Norwegian national registry of disability pension (DP) awards. Based on the hospital records, the patients were re-diagnosed according to ICD-10. Associations between the diagnoses, other baseline factors and subsequent DP were investigated using Kaplan–Meier survival analyses and logrank testing. Results At follow-up, 19% of the participants had received a DP award. In the logrank testing, ADHD was the only disorder associated with a subsequent DP, with 30% being disabled at follow-up (p = 0.01). Low psychosocial functioning (assessed by the Children’s Global Assessment Scale) at admission uniquely predicted future DP (p = 0.04). Conclusions ADHD in childhood was highly associated with later receiving a DP. Our finding of worse prognosis in ADHD compared with other internalizing and externalizing disorders in mid-adulthood supports the assumption of ADHD being specifically linked to working disability. Assessment of psychosocial functioning in addition to diagnostic features could enhance prediction of children who are most at risk of future disability.
    BMC Psychiatry 10/2012; 12(1):174. DOI:10.1186/1471-244X-12-174 · 2.21 Impact Factor
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