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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“Other measures included the Conners Parent and Teacher Rating Scales [Goyette et al., 1978; Werry et al., 1975], Child *Correspondence to: Anjene Addington, Child Psychiatry Branch, National Institute of Mental Health, NIH, 10 Center Drive, Bldg. 10, Room 3N-202, Bethesda, MD 20892-1600.”
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“Children's Global Assessment Scale (CGAS; Shaffer et al., 1983) is a clinician assessment of global functioning, rated on a scale from 0 to 100, were higher scores indicate higher functioning.”
Background
Posterior structural brain volumes differ in maltreated youth with and without chronic posttraumatic stress disorder
De Bellis, M. D., Hooper, S. R., Chen, S. D., Provenzale, J. M., Boyd, B. D., Glessner, C. E., MacFall, J. R., Payne, M. E., Rybczynski, R., & Woolley, D. P. (2015) · Development and Psychopathology · doi:10.1017/s0954579415000942 · Cited by 75
“Children Global Assessment Scale (CGAS) score (Shaffer et al., 1983) was scored by the interviewer after assessment of all clinical data to provide a continuous measure of child function.”
Method
Investigating Bullying as a Predictor of Suicidality in a Clinical Sample of Adolescents with Autism Spectrum Disorder
Holden, R., Mueller, J., McGowan, J. F., Sanyal, J., Kikoler, M., Simonoff, E. A., Velupillai, S. U., & Downs, J. M. (2020) · Autism Research · doi:10.1002/aur.2292 · Cited by 77
Pediatric bipolar spectrum disorder and ADHD: comparison and comorbidity in the LAMS clinical sample
Arnold, L. E., Demeter, C., Mount, K. B., Frazier, T. W., Youngstrom, E. A., Fristad, M. A., Birmaher, B. B., Findling, R. L., Horwitz, S. M., Kowatch, R. A., et al. (2011) · Bipolar Disorders · doi:10.1111/j.1399-5618.2011.00948.x · Cited by 75
“Additional measures—Global functioning was measured by the Children’s Global Assessment Scale (CGAS) (31).”
Influential
Mood symptoms in children and adolescents with autism spectrum disorders
Mazzone, L., Postorino, V., Peppo, L. D., Fatta, L. M., Lucarelli, V., Reale, L., Giovagnoli, G., & Vicari, S. (2013) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2013.07.034 · Cited by 80
“Finally, clinical global functioning evaluation reported a significant difference among the three groups as shown by CGAS scores (p .001).”
MethodInfluential
Efficacy and Safety of Quetiapine in Adolescents with Schizophrenia Investigated in a 6-Week, Double-Blind, Placebo-Controlled Trial
Findling, R. L., McKenna, K., Earley, W. R., Stankowski, J. E., & Pathak, S. (2012) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2011.0092 · Cited by 75
“For secondary efﬁcacy measures, MMRM was used to analyze changes in PANSS subscales and CGI-S scores, generalized estimating equations (GEE) assessed response rate and CGI-I scores, and analysis of covariance (ANCOVA) was used to assess changes in CGAS and CGSQ scores.”
Influential
Improvement in Symptoms Versus Functioning: How Do Our Best Treatments Measure Up?
Becker, K. D., Chorpita, B. F., & Daleiden, E. L. (2011) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-010-0332-x · Cited by 75
Suicidal Ideation in Anxiety-Disordered Youth: Identifying Predictors of Risk
Rodriguez, K. A. O., & Kendall, P. C. (2013) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2013.843463 · Cited by 83
“Children’s Global Assessment Scale (CGAS; Shaffer et al., 1983).”
MethodInfluential
Olanzapine compared to quetiapine in adolescents with a first psychotic episode
Arango, C., Robles, O., Parellada, M., Fraguas, D., Ruíz-Sancho, A., Medina, Ó., Zabala, A., Bombín, I., & Moreno, D. M. (2009) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-009-0749-5 · Cited by 77
“The primary outcome measure for symptom reduction was the Positive and Negative Symptoms Scale (PANSS) [18] Secondary clinical outcome measures were: the Global Assessment Scale for Children (C-GAS) [35], Clinical Global Impression-Severity score (CGI-S) [14], Hamilton Depression Rating Scale (HDRS-21) [15], and the Y…”
Method
Using Multivariate Machine Learning Methods and Structural MRI to Classify Childhood Onset Schizophrenia and Healthy Controls
GREENSTEIN, D. K., Malley, J. D., Weisinger, B., CLASEN, L. S., & Gogtay, N. (2012) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2012.00053 · Cited by 82
“CLINICAL MEASURES We used age-appropriate versions of the Global Assessment of Functioning Scale (GAS; Shaffer et al., 1983; APA, 1994), the Scale for theAssessment of Positive Symptoms (SAPS;Andreasen,1984), and the Scale for the Assessment of Negative Symptoms (SANS; Andreasen, 1983) to assess clinical symptoms in C…”
Method
Use of a routine, self-report outcome measure (HoNOSCA–SR) in two adolescent mental health services
Gowers, S., Levine, W., Bailey-Rogers, S. J., Shore, A., & Burhouse, E. (2002) · The British Journal of Psychiatry · doi:10.1192/bjp.180.3.266 · Cited by 75
A Systematic Review of Psychosocial Factors Affecting Survival After Bone Marrow Transplantation
Hoodin, F., & Weber, S. (2003) · Psychosomatics · doi:10.1176/appi.psy.44.3.181 · Cited by 76
Prevention of Depression in At-Risk Adolescents: Predictors and Moderators of Acute Effects
Weersing, V. R., Shamseddeen, W. A., Garber, J., Hollon, S. D., Clarke, G. N., Beardslee, W. R., Gladstone, T. R. G., Lynch, F. L., Porta, G., Iyengar, S., et al. (2016) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2015.12.015 · Cited by 78
A 1-Year Open-Label Trial of Olanzapine in School-Age Children with Schizophrenia
Ross, R. G., Novins, D. K., Farley, G. K., & Adler, L. E. (2003) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/104454603322572633 · Cited by 75
“For all subjects, clinical symptomatology was assessed utilizing an anchored version of the Brief Psychiatric Rating Scale–Child version (BPRS-C; Gale et al. 1986; Overall and Pfeffer-baum 1982), the Scale for the Assessment of Positive Symptoms (Andreason 2000), the Scale for the Assessment of Negative Symptoms (An-d…”
Combination Lithium and Divalproex Sodium in Pediatric Bipolar Symptom Restabilization
Findling, R. L., McNamara, N., Stansbrey, R. J., Gracious, B., Whipkey, R. E., Demeter, C., Reed, M. D., Youngstrom, E. A., & Calabrese, J. R. (2006) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/01.chi.0000189135.05060.8a · Cited by 74
Parents Plus Systemic, Solution‐Focused Parent Training Programs: Description, Review of the Evidence Base, and Meta‐Analysis
Carr, A., Hartnett, D., Brosnan, E., & Sharry, J. (2016) · Family Process · doi:10.1111/famp.12225 · Cited by 74
“At posttreatment, the Working Things Out Program group showed significantly greater improvement on the clinician-completed Child Global Assessment Scale (Shaffer et al., 1983) compared with the control group.”
Method
Incidence of anorexia nervosa in young people in the UK and Ireland: a national surveillance study
Petkova, H., Simic, M., Nicholls, D., Ford, T. J., Prina, M. A., Stuart, R., Livingstone, N., Kelly, G. P., Macdonald, G. M., Eisler, I., et al. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-027339 · Cited by 74
A prospective 4–5 year follow‐up of juvenile onset bipolar disorder
Jairam, R., Srinath, S., Girimaji, S. C., & Seshadri, S. P. (2004) · Bipolar Disorders · doi:10.1111/j.1399-5618.2004.00149.x · Cited by 74
Diurnal Cortisol Levels and Cortisol Response in Youths with Obsessive-Compulsive Disorder
Gustafsson, P. E., Gustafsson, P. A., Ivarsson, T., & Nelson, N. (2008) · Neuropsychobiology · doi:10.1159/000123117 · Cited by 74
Developmental Disabilities Modification of the Children’s Global Assessment Scale
Wagner, A., Lecavalier, L., Arnold, L. E., Aman, M. G., Scahill, L. D., Stigler, K. A., Johnson, C. R., McDougle, C. J., & Vitiello, B. (2007) · Biological Psychiatry · doi:10.1016/j.biopsych.2007.01.001 · Cited by 73
Racial/Ethnic Differences in Caregiver Strain and Perceived Social Support Among Parents of Youth with Emotional and Behavioral Problems
McCabe, K. M., Yeh, M., Lau, A. S., Garland, A. F., & Hough, R. L. (2003) · Mental Health Services Research · doi:10.1023/a:1024439317884 · Cited by 75
“The CGAS has demonstrated acceptable reliability and validity (Shaffer et al., 1983).”
Background
What do parents and carers think about routine outcome measures and their use? A focus group study of CAMHS attenders
Moran, P., Kelesidi, K., Guglani, S., Davidson, S., & Ford, T. (2012) · Clinical Child Psychology and Psychiatry · doi:10.1177/1359104510391859 · Cited by 74
“The CGAS is designed to be rated by clinicians (Shaffer et al., 1983), but as some CAMHS collect only clinician-rated measures, we considered it important to elicit users’ views about this approach.”
BackgroundInfluential
Long‐Chain Omega‐3 Polyunsaturated Fatty Acids in the Blood of Children and Adolescents with Juvenile Bipolar Disorder
Clayton, E. H., Hanstock, T. L., Hirneth, S. J., Kable, C. J., Garg, M. L., & Hazell, P. (2008) · Lipids · doi:10.1007/s11745-008-3224-z · Cited by 73
“Global functioning was assessed using the Global Assessment Scale for Children (C-GAS [32]), where a higher score represents a higher level of functioning.”
Method
Child psychiatry across cultures
Hackett, L. (1999) · International Review of Psychiatry · doi:10.1080/09540269974410 · Cited by 74
Psychosocial factors and adequacy of services for children in children's homes
Hukkanen, R., Sourander, A., Bergroth, L., & Piha, J. (1999) · European Child & Adolescent Psychiatry · doi:10.1007/s007870050101 · Cited by 74
Diagnosis of Attention Deficit Disorders in DSM-IV: Scientific Basis and Implications for Education
McBurnett, K., Lahey, B. B., & Pfiffner, L. J. (1993) · Exceptional Children · doi:10.1177/001440299306000204 · Cited by 74
Internet-based guided self-help comprehensive behavioral intervention for tics (ICBIT) for youth with tic disorders: a feasibility and effectiveness study with 6 month-follow-up
Rachamim, L., Zimmerman‐Brenner, S., Rachamim, O., Mualem-Taylor, H., Zingboim, N., & Rotstein, M. S. (2020) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-020-01686-2 · Cited by 73
Aripiprazole Augmentation in 39 Adolescents With Medication-Resistant Obsessive-Compulsive Disorder
Masi, G., Pfanner, C., Millepiedi, S., & Berloffa, S. (2010) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0b013e3181fab7b1 · Cited by 73
“Furthermore, they presented a Clinical Global ImpressionVSeverity (CGI-S) score 4 or higher(20) and a Children’s Global Assessment Scale (CGAS) score 60 or less.(21) Exclusion criteria were a diagnosis of mental retardation and/or pervasive developmental disorder and/or schizophrenia.”
Psychopathology and temperament in parents and offspring: results of a family study
Merikangas, K. R., Swendsen, J. D., Preisig, M., & Chazan, R. Z. (1998) · Journal of Affective Disorders · doi:10.1016/s0165-0327(98)00157-8 · Cited by 73
Predicting time to recovery among depressed adolescents treated in two psychosocial group interventions.
Rohde, P., Seeley, J., Kaufman, N., Clarke, G., & Stice, E. (2006) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.74.1.80 · Cited by 78
“…(d) functional impairment, assessed by interviewer ratings of current functioning using the 100-point Children’s Global Adjustment Scale (CGAS; Shaffer et al., 1983); and (d) parent report of problem behaviors, assessed by total problem behavior scores on the Child Behavior Checklist (CBCL;…”
Method
Cortical morphology of adolescents with bipolar disorder and with schizophrenia
Janssen, J., Alemán‐Gómez, Y., Schnack, H. G., Balaban, E., Pina‐Camacho, L., Alfaro‐Almagro, F., Castro‐Fornieles, J., Otero, S., Baeza, I., Moreno, D. M., et al. (2014) · Schizophrenia Research · doi:10.1016/j.schres.2014.06.040 · Cited by 77
“Severity of disability and level of functioning were determined using the Children's Global Assessment of Functioning (C-GAF) scale (Shaffer et al., 1983).”
Method
Suffering in Silence: Why a Developmental Psychopathology Perspective on Selective Mutism Is Needed
Cohan, S. L., Price, J. M., & Stein, M. B. (2006) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/00004703-200608000-00011 · Cited by 73
Routine measurement of outcomes in Australia's public sector mental health services
Pirkis, J., Burgess, P. M., Dickson, R., Clarke, A., Jones-Ellis, D., & Coombes, T. (2005) · Australia and New Zealand Health Policy · doi:10.1071/hp050208 · Cited by 73
Mental Health and Psychosocial Functioning in Children with Recent Onset of Rheumatic Disease
Vandvik, I. H. (1990) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.1990.tb00837.x · Cited by 73
The Emotional Effects of Disaster on Children: A Review of the Literature
Aptekar, L., & Boore, J. A. (1990) · International Journal of Mental Health · doi:10.1080/00207411.1990.11449164 · Cited by 73
“In both studies, the children were given the Schedule of Affective Disorder and Schizophrenia [55] and the Childhood Global Assessment Scale Score [56] by native speakers.”
Method
Children of alcoholic parents in the community.
Rubio-Stipec, M., Bird, H., CANINO, G. J., Bravo, M., & Alegria, M. M. (1991) · Journal of Studies on Alcohol · doi:10.15288/jsa.1991.52.78 · Cited by 73
Depressive Symptoms and Clinical Status During the Treatment of Adolescent Suicide Attempters (TASA) Study
Vitiello, B., Brent, D. A., Greenhill, L. L., Emslie, G., Wells, K., Walkup, J. T., Stanley, B., Bukstein, O., Kennard, B. D., Compton, S., et al. (2009) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/chi.0b013e3181b5db66 · Cited by 72
A longitudinal study of adolescent mental health service use
Cuffe, S. P., Waller, J. L., Addy, C. L., McKeown, R. E., Jackson, K. L., Moloo, J., & Garrison, C. Z. (2001) · The Journal of Behavioral Health Services & Research · doi:10.1007/bf02287230 · Cited by 70
Burden of Illness
Tg, M., Wells, K. B., BRUCE, M. L., Miranda, J. M., Scheffler, R. M., Durham, M., Ford, D. E., & Lewis, L. (2002) · Mental Health Services Research · doi:10.1023/a:1020956313890 · Cited by 72
Obsessive-compulsive disorder in children and adolescents: Parental understanding, accommodation, coping and distress
Futh, A., Simonds, L. M., & Micali, N. (2012) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2012.02.012 · Cited by 72

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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