Cited by 3,716Psychological Testing and AssessmentChild and Adolescent Psychosocial and Emotional DevelopmentPsychometric Methodologies and Testing

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A Children's Global Assessment Scale (CGAS)

Shaffer, David·1983·Archives of General Psychiatry

DOI 10.1001/archpsyc.1983.01790100074010

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Abstract

We evaluated the Children's Global Assessment Scale (CGAS), an adaptation of the Global Assessment Scale for adults. Our findings indicate that the CGAS can be a useful measure of overall severity of disturbance. It was found to be reliable between raters and across time. Moreover, it demonstrated both discriminant and concurrent validity. Given these favorable psychometric properties and its relative simplicity, the CGAS is recommended to both clinicians and researchers as a complement to syndrome-specific scales.

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The Global Assessment Scale: A Procedure for Measuring Overall Severity of Psychiatric Disturbance
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“Tics 14 (41) Waking unrefreshed and daytime fatigue, total score ≥3 16 (47)”
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“Any mood disorder 15 (20.0) 5 (35.7) 4.7 (1.4, 15.3)** 4.48 (1.22,18.17)* 4.1 (1.1, 11.1)* Any anxiety 25 (32.5) 4 (28.6) 0.92 (0.23, 3.63) 0.67 (0.20, 2.36) 0.53 (0.23, 1.18) CGAS score 80.1 (10.1) 75.5 (11.6) -8.3 (3.1) **, -6.3 (3.5)?, -7.1 (3.2)*, G3 diagnoses (descriptives) MDD 8 (10.4) 3 (21.4) Dysthymia 7 (9.1)…”
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“A score of 100 represents superior functioning in all areas including at home, at school, and with peers, and a score of 1 signals the need for constant supervision due to severe impairment (Shaffer et al., 1983).”
Background
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“To assess functioning, we used the lay-administered version of the Child Global Assessment Scale (C-GAS; Bird et al., 1990; Green et al., 1994; Shaffer et al., 1983).”
Method
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Bjureberg, J., Ojala, O., Hesser, H., Häbel, H., Sahlin, H., Gratz, K. L., Tull, M. T., Claesdotter Knutsson, E., Hedman-Lagerlöf, E., Ljótsson, B., et al. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.22069 · Cited by 59
Childhood maltreatment disrupts HPA-axis activity under basal and stress conditions in a dose–response relationship in children and adolescents
Marqués-Feixa, L., Palma‐Gudiel, H., Romero, S., Moya-Higueras, J., Rapado‐Castro, M., Castro-Quintas, Á., Zorrilla, E. P., Muñoz, M. J., Ramírez, M., Mayoral, M., et al. (2021) · Psychological Medicine · doi:10.1017/s003329172100249x · Cited by 67
Inter-rater Reliability of Clinician-rated Outcome Measures in Child and Adolescent Mental Health Services
Hanssen-Bauer, K., Aalen, O., Ruud, T., & Heyerdahl, S. (2007) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-007-0134-y · Cited by 55
“CGAS has been evaluated in several studies and is widely used to assess outcome (Shaffer et al., 1983; Rey, Starling, Wever, Dossetor, & Plapp, 1995).”
Method
Lack of Effect of Stimulant Combination with Second-Generation Antipsychotics on Weight Gain, Metabolic Changes, Prolactin Levels, and Sedation in Youth with Clinically Relevant Aggression or Oppositionality
Penzner, J. B., Dudas, M. M., Saito, E., Olshanskiy, V., Parikh, U. H., Kapoor, S., Chekuri, R., Gadaleta, D. J., Avedon, J., Sheridan, E. M., et al. (2009) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2009.0051 · Cited by 57
“…Side Effect Scale (TESS) (Guy 1976), and broad effectiveness measures, such as changes in the Children’s Global Assessment Scale (CGAS) scale (Shaffer et al. 1983), Clinical Global Impressions–Illness Severity (CGI-S) scale (Guy 1976) (see legend of Table 1, below, for the scaling on these…”
Psychometric Properties of the Alabama Parenting Questionnaire-Preschool Revision (APQ-Pr) in 3 Year-Old Spanish Preschoolers
de la Osa, N., Granero, R., Penelo, E., Domenech, J. M., & Ezpeleta, L. (2013) · Journal of Child and Family Studies · doi:10.1007/s10826-013-9730-5 · Cited by 58
“The Children’s Global Assessment Scale (CGAS; Shaffer et al. 1983) was used to assess global functional impairment based on children’s psychopathology.”
Aripiprazole Monotherapy in Children and Young Adolescents with Pervasive Developmental Disorders
Masi, G., Cosenza, A., Millepiedi, S., Muratori, F., Pari, C., & Salvadori, F. (2009) · CNS Drugs · doi:10.2165/00023210-200923060-00005 · Cited by 58
Depressed adolescents demonstrate greater subgenual anterior cingulate activity
Yang, T. T., Simmons, A. N., Matthews, S. C., Tapert, S. F., Frank, G., Bischoff‐Grethe, A., Lansing, A. E., Wu, J., Brown, G. G., & Paulus, M. P. (2009) · Neuroreport · doi:10.1097/wnr.0b013e3283262e10 · Cited by 58
Efficacy and acceptability of interpersonal psychotherapy for depression in adolescents: A meta-analysis of randomized controlled trials
Pu, J., Zhou, X., Liu, L., Zhang, Y., Yang, L., Yuan, S., Zhang, H., Han, Y. K., Zou, D., & Xie, P. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.03.023 · Cited by 58
“…improvement (QoL/functioning) using the mean change score from baseline to post-treatment for validated scales, such as the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q, Endicott et al., 1993) and the Children’s Global Assessment Scale (CGAS, Shaffer et al., 1983).”
Method
Negative Symptoms in Early-Onset Psychosis and Their Association With Antipsychotic Treatment Failure
Downs, J. M., Dean, H., Lechler, S., Sears, N., Patel, R., Shetty, H., Hotopf, M. H., Ford, T. J., Kyriakopoulos, M., Díaz‐Caneja, C. M., et al. (2018) · Schizophrenia Bulletin · doi:10.1093/schbul/sbx197 · Cited by 58
Evaluation of Improvement in Externalizing Behaviors and Callous-Unemotional Traits in Children with Disruptive Behavior Disorder: A 1-Year Follow Up Clinic-Based Study
Muratori, P., Milone, A., Manfredi, A., Polidori, L., Ruglioni, L., Lambruschi, F., Masi, G., & Lochman, J. E. (2015) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-015-0660-y · Cited by 62
Long-Term Experience With Citalopram in the Treatment of Adolescent OCD
Thomsen, P. H., Ebbesen, C., & PERSSON, C. (2001) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-200108000-00010 · Cited by 58
Psychosocial Support for War-Traumatized Child and Adolescent Refugees: Evaluation of a Short-Term Treatment Program
Möhlen, H., Parzer, P., Resch, F., & Brunner, R. (2005) · Australian & New Zealand Journal of Psychiatry · doi:10.1080/j.1440-1614.2005.01513.x · Cited by 91
“The CGAS score prior to traumatization correlated significantly with the improvement in psychological functioning during the intervention (r = 0.673, p = 0.033).”
MethodInfluential
The efficacy of a group-based, disorder-specific treatment program for childhood GAD - A randomized controlled trial
Holmes, M. C., Donovan, C. L., Farrell, L. J., & March, S. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.08.002 · Cited by 57
“Children’s overall level of functioning was assessed using the Children's Global Assessment Scale (CGAS; Shaffer et al., 1983).”
Influential
Long-Term Safety of Divalproex Sodium Extended-Release in Children and Adolescents with Bipolar I Disorder
Redden, L., DelBello, M. P., Wagner, K. D., Wilens, T. E., Malhotra, S., Wozniak, P., Vigna, N., Greco, N., Kovacs, X., Abi‐Saab, W., et al. (2009) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2008.0106 · Cited by 57
“Improvements from baseline to ﬁ-nal visit were also observed in C-GAS, CGI-S, CDRS-R, and CGSQ scores (Table 4).”
Reengagement With Education: A Multidisciplinary Home-School-Clinic Approach Developed in Australia for School-Refusing Youth
McKay-Brown, L., Mcgrath, R., Dalton, L., Graham, L., Smith, A., Ring, J., & Eyre, K. (2019) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2018.08.003 · Cited by 46
Cognitive-behavioural treatment of functional neurological symptoms (conversion disorder) in children and adolescents: A case series
McFarlane, F. A., Allcott-Watson, H., Hadji-Michael, M., McAllister, E., Stark, D. L., Reilly, C. J., Bennett, S. D., McWilliams, A., & Heyman, I. (2018) · European Journal of Paediatric Neurology · doi:10.1016/j.ejpn.2018.12.002 · Cited by 57
“Children's Global Assessment Scale (CGAS): The CGAS is a global clinician rating used to assess young people's social, emotional and behavioural functioning from 0 (very poor functioning) to 100 (very high functioning).(21) The CGAS has been reported to have good concurrent and discriminative validity and reliability…”
Method
Psychosocial health in adolescents and young adults with gender dysphoria before and after gender-affirming medical interventions: a descriptive study from the Hamburg Gender Identity Service
Becker-Hébly, I., Fahrenkrug, S., Campion, F., Richter‐Appelt, H., Schulte‐Markwort, M., & Barkmann, C. (2020) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-020-01640-2 · Cited by 57
Association between gut microbiota and psychiatric disorders: a systematic review
Valle, C. G.-D., Fernández, J., Solá, E., Montoya‐Castilla, I., Morillas, C., & Bañuls, C. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1215674 · Cited by 66
“Finally, the Children’s Global Assessment Scale (CGAS) (Shaffer, 1983), with a score between 1 and 100, assesses aspects related to a child’s psychological and social functioning, and the ADHD Rating Scale IV (ADHD-RS-IV) (Zhang et al.”
BackgroundMethodInfluential
Risperidone Augmentation in the Treatment of Severe Adolescent OCD in SSRI-refractory Cases: A Case-series
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Psychiatric assessment of children with nonsyndromic cleft lip and palate
Demir, T., Karaçetin, G., Bağhaki, S., & Aydın, Y. (2011) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2011.06.006 · Cited by 57
“The CGAS has been shown to be a good, reliable estimate of the overall severity of disturbance (range, 0– 100) [40].”
Comorbid Anxiety in Children and Adolescents With Bipolar Spectrum Disorders
Sala, R., Axelson, D., Castro‐Fornieles, J., Goldstein, T. R., Ha, W., Liao, F., Gill, M. K., Iyengar, S., Strober, M. A., Goldstein, B. I., et al. (2010) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.09m05845gre · Cited by 60
Psychotic phenomena in 257 young children and adolescents with bipolar I disorder: delusions and hallucinations (benign and pathological)
Tillman, R., Geller, B., Klages, T., Corrigan, M., Bolhofner, K., & Zimerman, B. (2008) · Bipolar Disorders · doi:10.1111/j.1399-5618.2008.00480.x · Cited by 57
Loss of Temper and Irritability: The Relationship to Tantrums in a Community and Clinical Sample
Carlson, G. A., Danzig, A. P., Dougherty, L. R., Bufferd, S. J., & Klein, D. N. (2016) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2015.0072 · Cited by 61
“…and aggression for community ‡180 and clinic ‡ 201 samples); 4) rates of diagnosis; 5) impairment via the Children’s Global Assessment Scale (CGAS) (Shaffer et al. 1983); and 6) the quality of tantrums (e.g., length of tantrum > 30 minutes, and whether tantrums were destructive with…”
Background
Empirically derived patterns of psychiatric symptoms in youth: A latent profile analysis
Kircanski, K., Zhang, S., Stringaris, A. K., Wiggins, J. L., Towbin, K. E., Pine, D. S., Leibenluft, E., & Brotman, M. A. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.09.016 · Cited by 59
“Children’s Global Assessment Scale (CGAS; Shaffer et al., 1983).”
Influential
Lithium for the Maintenance Treatment of Bipolar I Disorder: A Double-Blind, Placebo-Controlled Discontinuation Study
Findling, R. L., McNamara, N., Pavuluri, M. N., Frazier, J. A., Rynn, M. A., Scheffer, R. E., Kafantaris, V., Robb, A. S., DelBello, M. P., Kowatch, R. A., et al. (2018) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2018.07.901 · Cited by 58
Usefulness of the Health of the Nation Outcome Scales
Stein, G. S. (1999) · The British Journal of Psychiatry · doi:10.1192/bjp.174.5.375 · Cited by 57
‘More than 100 years of silence’, elective mutism
Sharkey, L., & McNicholas, F. (2008) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-007-0658-4 · Cited by 56
Factors associated with caregiver burden in a child and adolescent psychiatric facility in Lagos, Nigeria: a descriptive cross sectional study
Dada, M. U., Okewole, N., Ogun, O. C., & Bello-Mojeed, M. A. (2011) · BMC Pediatrics · doi:10.1186/1471-2431-11-110 · Cited by 56
Escitalopram in the Treatment of Adolescent Depression: A Randomized, Double-Blind, Placebo-Controlled Extension Trial
Findling, R. L., Robb, A., & Bose, A. (2013) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2012.0023 · Cited by 57
Psychiatric morbidity in two low birth weight groups assessed by diagnostic interview in young adulthood
Lund, L., Vik, T., Skranes, J. S., Brubakk, A., & Indredavik, M. S. (2010) · Acta Paediatrica · doi:10.1111/j.1651-2227.2010.02111.x · Cited by 56
“Of these Anxiety disorders 8 (19)** 7 (13)* 2 (3)”
MethodInfluential
Multidimensional Treatment Foster Care for Adolescents in English care: randomised trial and observational cohort evaluation
Green, J., Biehal, N., Roberts, C., Dixon, J., Kay, C., Parry, E., Rothwell, J., Roby, A., Kapadia, D., Scott, S., et al. (2013) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.113.131466 · Cited by 56
Treatment Foster Care for Improving Outcomes in Children and Young People: A Systematic Review
Turner, W., & Macdonald, G. M. (2011) · Research on Social Work Practice · doi:10.1177/1049731511400434 · Cited by 56
“Chamberlain and Reid (1991) used the Child Global Assessment Scale ([CGAS] Shaffer et al., 1983) to assess the severity of the emotional disturbance of the psychiatrically hospitalized girls in this study.”
Method
Suicidal Ideation in Anxiety‐Disordered Youth
O’Neil, K. A., Puleo, C. M., Wolk, C. B., Podell, J. L., & Kendall, P. C. (2012) · Suicide and Life-Threatening Behavior · doi:10.1111/j.1943-278x.2012.00091.x · Cited by 56
The Bi-Directional Relationship Between Parent–Child Conflict and Treatment Outcome in Treatment-Resistant Adolescent Depression
Rengasamy, M. L., Mansoor, B., Hilton, R., Porta, G., He, J., Emslie, G. J., Mayes, T. L., Clarke, G. N., Wagner, K. D., Keller, M. B., et al. (2013) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2013.01.012 · Cited by 56
Clinical predictors of antipsychotic use in children and adolescents with autism spectrum disorders: a historical open cohort study using electronic health records
Downs, J. M., Hotopf, M. H., Ford, T. J., Simonoff, E. A., Jackson, R., Shetty, H., Stewart, R. J., & Hayes, R. D. (2015) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-015-0780-7 · Cited by 59
“Children’s adaptive functioning was rated using Children’s Global Assessment Scale (CGAS) [27], except for those children with significant ID, where the Developmental Disabilities CGAS was used in some cases [28].”
Method
ADORE ? Attention?Deficit Hyperactivity Disorder Observational Research in Europe
Ralston, S. J., Lorenzo, M. J., & and the ADORE study group (2004) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-004-1004-8 · Cited by 56
Swedish High-Risk Study: Sample Characteristics at Age 6
McNeil, T. F., & Kaij, L. (1987) · Schizophrenia Bulletin · doi:10.1093/schbul/13.3.373 · Cited by 56
Treated depression in adolescents: predictors of outcome at 28 weeks
Wilkinson, P., Dubicka, B., Kelvin, R., Roberts, C., & Goodyer, I. (2009) · British Journal of Psychiatry · doi:10.1192/bjp.bp.108.052381 · Cited by 55
Results from the Child/Adolescent Anxiety Multimodal Longitudinal Study (CAMELS): Functional outcomes
Swan, A. J., Kendall, P. C., Olino, T., Ginsburg, G., Keeton, C., Compton, S., Piacentini, J., Peris, T., Sakolsky, D., Birmaher, B., et al. (2018) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000334 · Cited by 56
“Logistic regressions were conducted separately for each outcome variable, and all analyses controlled for age at time of assessment, sex, ethnicity, CAMS Site, and CAMS baseline: SES, CGAS, and CGI-S scores.”
Influential
Mental disorders in preadolescent children at familial high‐risk of schizophrenia or bipolar disorder – a four‐year follow‐up study
Gregersen, M., Søndergaard, A., Brandt, J. M., Ellersgaard, D., Rohd, S. B., Hjorthøj, C. R., Ohland, J., Krantz, M. F., Wilms, M., Andreassen, A. K., et al. (2021) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13548 · Cited by 55
Pharmacological and non‐drug treatment of child bipolar I disorder during prospective eight‐year follow‐up
Geller, B., Tillman, R., Bolhofner, K., & Zimerman, B. (2010) · Bipolar Disorders · doi:10.1111/j.1399-5618.2010.00791.x · Cited by 55
“, elation and/or grandiosity), and (v) a Children's Global Assessment Scale (CGAS) score ≤ 60, which indicates definite clinical impairment (10,11).”
BackgroundMethod

Authors: Shaffer, D.
Affiliations: Columbia University (US)
Corresponding author: Shaffer, David
Venue: Archives of General Psychiatry
Publisher: American Medical Association (AMA)
Published: 1983-11-01
Volume: 40
Issue: 11
Pages: 1228
ISSN: 0003-990X (ISSN-L)
DOI: 10.1001/archpsyc.1983.01790100074010
OpenAlex: W2114776324
Cited by: 3,716
References: 5
Citations by year: 2026: 114 · 2025: 102 · 2024: 134 · 2023: 138 · 2022: 178 · 2021: 204 · 2020: 185 · 2019: 156 · 2018: 143 · 2017: 137 · 2016: 171 · 2015: 165 · 2014: 174 · 2013: 163 · 2012: 142
FWCI: 11.25
Type: journal article
Language: en
Open access: closed
Locations: Archives of General Psychiatry (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Psychology › Applied Psychology › Psychological Testing and Assessment
Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
Keywords: Children's Global Assessment Scale, Global Assessment Scale, child psychiatry, psychometric properties, inter-rater reliability, test-retest reliability, discriminant validity, concurrent validity
MeSH terms: Adolescent, Age Factors, Ambulatory Care, Attention Deficit Disorder with Hyperactivity, Mental Disorders, Child, Child, Preschool, Hospitalization, Humans, Male, Parents, Psychiatric Status Rating Scales, Psychometrics

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A Children's Global Assessment Scale (CGAS)

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