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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BackgroundMethod
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Method
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“The children’s global assessment scale (CGAS; Shaffer et al., 1983).”
Background
Classroom Academic Performance: Improvement with both Methylphenidate and Dextroamphetamine in ADHD Boys
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“, 2011b) further identified associations between patterns of cortical surface contraction (at baseline and follow-up) and follow-up total SOPS score and degree of functional impairment as assessed by the Children’s Global Assessment Scale (Shaffer et al., 1983), while further analysis of data from a (differing) subsam…”
Method
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“While clinician interview tools, such as the Children’s Global Assessment Scale (CGAS) have shown validity for measuring functioning in children [3], a brief, standard scale that could be used to assess overall functioning in children was lacking.”
Method
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“…(CGI-S) (Guy 1976), the Scale for the Assessment of Negative Symptoms (SANS) (An-dreasen 1982), the Children’s Global Assessment Scale (C-GAS) (Shaffer et al. 1983), the Subjective Treatment Emer-gent Symptoms Scale (STESS) (modified to include side effects associated with clozapine)…”
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“The lowest CGAS score in the last year from either parents’ or children’s information was used.”
MethodInfluential
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“To enable additional evaluation, the ISAA was compared with the CARS[10-12] and the Developmental DisabilityChildren’s Global Assessment Scale (DD-CGAS)[13] among children diagnosed with autism and children with or without selected psychiatric disorders.”
Method
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“The Children’s Global Assessment Scale (Shaffer et al., 1983) was used to compare changes in the child’s functioning from admission to discharge across the three levels of family functioning.”
MethodInfluential
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“Children’s Global Assessment Scale (CGAS; Shaffer et al., 1983).”
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“26 To measure inhibition, 3 tasks were used (detailed in Schoemaker et al. 21 ).”
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MethodInfluential
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“†† Therapist secondary theoretical orientation refers to a secondary orientation other than CBT. Responder CGI-I scores 2; CGAS Children’s Global Assessment Scale; PARS Pediatric Anxiety Rating Scale; MASC Multidimensional Anxiety Scale for Children; CBCL Int Child Behavior Checklist Internalizing Scale; CBCL Anx/Dep…”
MethodInfluential
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Method
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“Furthermore, it has demonstrated both discriminant and concurrent validity [30].”
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“The Children’s Global Assessment Scale (CGAS) is a clinician scored scale of adaptive functioning that has good psychometric properties useful for incorporating a measure of impairment in the classification of childhood psychiatric disorders [4, 5, 49].”
Method
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Method
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“It has shown moderate to excellent inter-rater reliability, good stability over time, and good concurrent as well as discriminant validity (Bird, Canino, Rubio-Stipec, & Ribera, 1987; Lundh, Kowalski, Sundberg, & Landén, 2012; Schaffer et al., 1983).”
BackgroundMethod
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“…Teacher Rating Scale—Re-vised (CTRS-R; Conners 1997); evidence of clinically significant impairment in the child’s functioning based on the Children’s Global Assessment Scale (C-GAS; Shaffer et al. 1983) score of (cid:1) 60; and a full scale or nonverbal intelligence quotient (IQ) of 50 or above.”
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“The clinician could also quantify impressions using ratings such as the Children’s Global Assessment Scale (CGAS).(111) At the most intensive, the clinician could suggest doing prospective life charting.”
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“…family adjustment with the Global Assessment of Relational Functioning scale (GARF, Yingling et al., 1998), child adjustment with the Children’s Global Assessment Scale (CGAS, Shaffer et al., 1983), and parental adjustment with the Global Assessment of Functioning scale (GAF, Luborosky, 1962).”
Method
Longitudinal Course of Adolescent Depression: Neuroendocrine and Psychosocial Predictors
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Marker gene polymorphisms in hyperkinetic disorder – predictors of clinical response to treatment with methylphenidate?
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“Clinicians making the independent research diagnoses had access where available to clinician completed Children’s Global Assessment Scale scores (CGAS; Shaffer et al., 1983) and Swanson, Nolan and Pelham version IV (SNAP-IV; Swanson et al.”
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“…disorder based on a semi-structured diagnostic interview (K-SADS; Kaufman et al., 1997); (2) Children’s Global Assessment Scale’s score < 60 (CGAS; Shaffer et al., 1983); (3) Pediatric Anxiety Rating Scale score > 9 (RUPP, 2001); (4) desire for outpatient treatment; and (5) age between 9 and 17…”
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Aspvall, K., Andersson, E., Melin, K., Norlin, L., Eriksson, V., Vigerland, S., Jolstedt, M., Silverberg-Mörse, M., Wallin, L., Sampaio, F., et al. (2021) · JAMA · doi:10.1001/jama.2021.3839 · Cited by 66
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“The CGAS represents an assessment of the child’s overall severity of disturbance with scores ranging from 1 (lowest functioning) to 100 (excellent functioning) [26].”
Background
The Collaborative Lithium Trials (CoLT): specific aims, methods, and implementation
Findling, R. L., Frazier, J. A., Kafantaris, V., Kowatch, R. A., McClellan, J., Pavuluri, M. N., Sikich, L., Hlastala, S. A., Hooper, S. R., Demeter, C., et al. (2008) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/1753-2000-2-21 · Cited by 67
Intensive group behavioral treatment (IGBT) for children with selective mutism: A preliminary randomized clinical trial.
Cornacchio, D., Furr, J. M., Sanchez, A. L., Hong, N., Feinberg, L. K., Tenenbaum, R. B., del Busto, C. T., Bry, L. J., Poznanski, B., Miguel, E. M., et al. (2019) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000422 · Cited by 67
“—Overall functioning was measured using the Children’s Global Assessment Scale (CGAS; Shaffer et al., 1983).”
MethodInfluential
Comparison of Child–Parent and Parent-Only Cognitive-Behavioral Therapy Programs for Anxious Children Aged 5 to 7 Years: Short- and Long-Term Outcomes
Monga, S., Rosenbloom, B. N., Tanha, A., Owens, M., & Young, A. (2014) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2014.10.008 · Cited by 68
“The Children’s Global Assessment Scale (CGAS) is a clinician rating of adaptive functioning during the previous month for children and adolescents 4 to 16 years of age.(24) It demonstrates high interrater reliability and test–retest reliability.”
Method
Psychological Treatment of Obsessive-Compulsive Disorder in Children and Adolescents: a Meta-Analysis
Alcázar, A. I. R., Sánchez‐Meca, J., Rosa‐Alcázar, Á., Iniesta‐Sepúlveda, M., Rodríguez, J. O., & Parada-Navas, J. L. (2015) · The Spanish Journal of Psychology · doi:10.1017/sjp.2015.22 · Cited by 67
“Included in the category ‘other outcomes’ were such tests as the Global Assessment of Functioning Scale (GAF; Startup, Jackson, & Bendix, 2002) and the Children’s Global Assessment Scale (C-GAS; Shaffer et al., 1983).”
Method
Duration of untreated psychosis predicts functional and clinical outcome in children and adolescents with first-episode psychosis: A 2-year longitudinal study
Fraguas, D., Rey, A., Moreno, C., Castro‐Fornieles, J., Graell, M., Otero, S., González-Pinto, A. M., Moreno, D. M., Baeza, I., Martínez‐Cengotitabengoa, M., et al. (2013) · Schizophrenia Research · doi:10.1016/j.schres.2013.11.018 · Cited by 66
“The child version of the Global Assessment of Functioning scale, Children's Global Assessment of Functioning (C-GAF) scale (Shaffer et al., 1983), completed by the clinician, was used to assess psychosocial functioning.”
Method
Study protocol: longitudinal study of the transition of young people with complex health needs from child to adult health services
Colver, A. F., Merrick, H., Deverill, M., Couteur, A. S. L., Parr, J. R., Pearce, M. S., Rapley, T., Vale, L. D., Watson, R., & McConachie, H. (2013) · BMC Public Health · doi:10.1186/1471-2458-13-675 · Cited by 67
“Children’s Global Assessment Scale [46] Clinician Functional impairment Baseline”
Mental health problems of second generation children and adolescents with migration background
Çeri, V., Özlü-Erkilic, Z., Özer, Ü., Kadak, T., Winkler, D., Doğangün, B., & Akkaya-Kalayci, T. (2017) · International Journal of Psychiatry in Clinical Practice · doi:10.1080/13651501.2017.1291820 · Cited by 66
“A comparison of SGI girls and boys revealed that there were no statistically significant gender differences in their current and lifetime psychiatric disorder rates, comorbid disorder numbers and functionality scores that were assessed by the Children’s Global Assessment Scale.”
MethodInfluential
A Global Scale to Measure the Quality of the Family Environment
Rey, J. M. (1997) · Archives of General Psychiatry · doi:10.1001/archpsyc.1997.01830210061006 · Cited by 66
Frontocortical activity in children with comorbidity of tic disorder and attention-deficit hyperactivity disorder
Yordanova, J., Dumais-Huber, C., Rothenberger, A., & Woerner, W. (1997) · Biological Psychiatry · doi:10.1016/s0006-3223(96)00096-0 · Cited by 66
Fronto-limbic connectivity as a predictor of improvement in nonsuicidal self-injury in adolescents following psychotherapy
Santamarina-Perez, P., Romero, S., Mendez, I., Leslie, S. M., Packer, M. M., Sugranyes, G., Picado, M., Font, E., Moreno, E., Martinez, E., et al. (2019) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2018.0152 · Cited by 64
Treatment Gains Are Sustainable in Pediatric Obsessive-Compulsive Disorder: Three-Year Follow-Up From the NordLOTS
Melin, K., Skarphedinsson, G., Thomsen, P. H., Weidle, B., Torp, N. C., Valderhaug, R., Højgaard, D. R. M. A., Hybel, K. A., Nissen, J. B., Jensen, S., et al. (2020) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2019.01.010 · Cited by 65
Establishing a Pediatric Acute-Onset Neuropsychiatric Syndrome Clinic: Baseline Clinical Features of the Pediatric Acute-Onset Neuropsychiatric Syndrome Cohort at Karolinska Institutet
Gromark, C., Harris, R. A., Wickström, R., Horne, A., Silverberg-Mörse, M., Serlachius, E., & Mataix‐Cols, D. (2019) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2018.0127 · Cited by 68
“Themean CGAS and CGI-S values at presentation were 50 (SD 10.1, range 21–70) and 3.8 (SD 0.9, range 2–6), respectively.”
Influential
Two‐year diagnostic stability in early‐onset first‐episode psychosis
Castro‐Fornieles, J., Baeza, I., de la Serna, E., González-Pinto, A. M., Parellada, M., Graell, M., Moreno, D. M., Otero, S., & Arango, C. (2011) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2011.02443.x · Cited by 67
Atypical antipsychotics for psychosis in adolescents
Kumar, A., Datta, S. S., Wright, S., Furtado, V. A., & Russell, P. S. S. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009582.pub2 · Cited by 66
Screening Parents During Child Evaluations: Exploring Parent and Child Psychopathology in the Same Clinic
Vidair, H. B., Reyes, J. A., Shen, S., Parrilla-Escobar, M. A., Heleniak, C. M., Hollin, I. L., Woodruff, S. C., Turner, J. B., & Rynn, M. A. (2011) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2011.02.002 · Cited by 68
“Children’s Global Assessment Scale (CGAS).(24) The GAS, an adaptation of the Global Assessment Scale for dults, is a 100-point scale measuring psychological, ocial, and school functioning for children aged 6 hrough 17 years.”
Augmenting one-session treatment of children's specific phobias with attention training to positive stimuli
Waters, A. M., Farrell, L. J., Zimmer‐Gembeck, M. J., Oar, E. L., Tiralongo, E., Donovan, C. L., McConnell, H. W., Bradley, B. P., Mogg, K., & Ollendick, T. H. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.07.020 · Cited by 68
Validity of the health-related quality of life assessment in the ADORE study: Parent Report Form of the CHIP-Child Edition
Riley, A. W., Coghill, D., Forrest, C. B., Lorenzo, M. J., Ralston, S. J., Spiel, G., & ADORE Study Group* (2006) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-006-1009-6 · Cited by 65
Psychiatric diagnoses and cognitive impairment in pediatric multiple sclerosis
Weisbrot, D. M., Charvet, L. E., Serafin, D., Milazzo, M. C., Preston, T., Cleary, R., Moadel, T., Seibert, M., Belman, A. L., & Krupp, L. (2013) · Multiple Sclerosis Journal · doi:10.1177/1352458513504249 · Cited by 65
The relationship between child- and parent-reported shared decision making and child-, parent-, and clinician-reported treatment outcome in routinely collected child mental health services data
Edbrooke-Childs, J. H., Jacob, J., Argent, R., Patalay, P., Deighton, J., & Wolpert, M. (2015) · Clinical Child Psychology and Psychiatry · doi:10.1177/1359104515591226 · Cited by 65
“To measure clinician-reported functioning, the unidimensional Children’s Global Assessment Scale (CGAS; Shaffer et al., 1983) was used.”
Method
Effectiveness of Cognitive Behavioral Therapy for Individuals with Autism Spectrum Disorders and Comorbid Obsessive-Compulsive Disorder: A Review of the Research
Kose, L. K., Fox, L., & Storch, E. A. (2017) · Journal of Developmental and Physical Disabilities · doi:10.1007/s10882-017-9559-8 · Cited by 70
“Some other measures included the Child Behavior Checklist (CBCL; Achenbach and Rescorla 2001), the Children’s Global Assessment Scale (CGAS; Shaffer et al. 1983), the Repetitive Behavior Scale-Revised (RBS-R; Bodfish et al. 1999), and the Anxiety Disorder Interview Schedule for DSM-IV – Child and…”
Method
Sexual abuse of children in day care centers
Kelley, S. J., Brant, R., & Waterman, J. (1993) · Child Abuse & Neglect · doi:10.1016/0145-2134(93)90010-3 · Cited by 65
Psychopathology in Children of Parents With Opiate Dependence and/or Major Depression
Nunes, E. V., Weissman, M. M., Goldstein, R. B., McAvay, G., SERACINI, A. M., Verdeli, H., & WICKRAMARATNE, P. J. (1998) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-199811000-00013 · Cited by 65
Emotional Disorders in Young Offenders
Shelton, D. (2001) · Journal of Nursing Scholarship · doi:10.1111/j.1547-5069.2001.00259.x · Cited by 65
The Pediatric Symptom Checklist
Jellinek, M. S. (1995) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/archpedi.1995.02170200030004 · Cited by 66
Response of depressed adolescents to cognitive-behavioral treatment: Do differences in initial severity clarify the comparison of treatments?
Rohde, P., Lewinsohn, P. M., & Seeley, J. R. (1994) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.62.4.851 · Cited by 65
The Work and Social Adjustment Scale, Youth and Parent Versions: Psychometric Evaluation of a Brief Measure of Functional Impairment in Young People
Jassi, A., Lenhard, F., Krebs, G., Gumpert, M., Jolstedt, M., Andrén, P., Nord, M., Aspvall, K., Wahlund, T., Volz, C., et al. (2020) · Child Psychiatry & Human Development · doi:10.1007/s10578-020-00956-z · Cited by 66
Efficacy of a Danish version of the cool kids program: a randomized wait-list controlled trial
Arendt, K., Thastum, M., & Hougaard, E. (2016) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12448 · Cited by 64
“The following measures were also included in the study but not reported here: Children’s Automatic Thought Scale (CATS) (30), Self-Efficacy Questionnaire for Children (SEQ) (31), Depression Anxiety Stress Scales (DASS) (32) for parents, Rearing Behavior Questionnaire (RBQ) (33), Clinical Global Impression – Improvemen…”
Method
Cue‐Centered Treatment for Youth Exposed to Interpersonal Violence: A Randomized Controlled Trial
Carrión, V. G., Kletter, H., Weems, C. F., Berry, R. R., & Rettger, J. P. (2013) · Journal of Traumatic Stress · doi:10.1002/jts.21870 · Cited by 64
“91) and acceptable concurrent and discriminant validity (Schaffer et al., 1983).”
Background
A Randomized Controlled Trial of Combinatorial Pharmacogenetics Testing in Adolescent Depression
Voort, J. L. V., Orth, S. S., Shekunov, J., Romanowicz, M., Geske, J. R., Ward, J. A., Leibman, N. I., Frye, M. A., & Croarkin, P. E. (2021) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2021.03.011 · Cited by 69
Interpreting standardized and idiographic outcome measures in CAMHS : what does change mean and how does it relate to functioning and experience?
Edbrooke-Childs, J. H., Jacob, J., Law, D., Deighton, J., & Wolpert, M. (2015) · Child and Adolescent Mental Health · doi:10.1111/camh.12107 · Cited by 68
“To measure functioning, the unidimensional Children’s Global Assessment Scale (CGAS; Shaffer et al., 1983) was used.”
Method
Psychiatric disorders in 8–9-year-old children based on a diagnostic interview with the parents
Almqvist, F., Puura, K., Kumpulainen, K., Tuompo-Johansson, E., Henttonen, I., Huikko, E., Linna, S., Ikäheimo, K., Aronen, E. T., Katainen, S., et al. (1999) · European Child & Adolescent Psychiatry · doi:10.1007/pl00010699 · Cited by 64
“These children had a DSM-III-R diagnosis and the clinically significant impairment corresponds to 60 points or less in the CGAS classification (25, 41, 51, 53).”
Decreased amygdala–insula resting state connectivity in behaviorally and emotionally dysregulated youth
Bebko, G. M., Bertocci, M. A., Chase, H. W., Dwojak, A., Bonar, L. K., Almeida, J., Perlman, S. B., Versace, A., Schirda, C., Travis, M. J., et al. (2014) · Psychiatry Research Neuroimaging · doi:10.1016/j.pscychresns.2014.10.015 · Cited by 64
“Independent of diagnosis, high PGBI-10M scores (>12) were associated with worse overall functioning (assessed by the Children’s Global Assessment Scale (Shaffer et al., 1983)), higher rates of psychiatric diagnoses (Findling et al.”
BackgroundMethodInfluential
Screening for psychosocial dysfunction in economically disadvantaged and minority group children: Further validation of the Pediatric Symptom Checklist.
Murphy, J. M., & Jellinek, M. S. (1988) · American Journal of Orthopsychiatry · doi:10.1111/j.1939-0025.1988.tb01605.x · Cited by 64
The assessment of developmental trauma in children and adolescents: A systematic review
Denton, R., Frogley, C. L., Jackson, S., John, M., & Querstret, D. (2016) · Clinical Child Psychology and Psychiatry · doi:10.1177/1359104516631607 · Cited by 73
Community-Based Interventions in a System of Care and Outcomes Framework
Duchnowski, A. J., Kutash, K., & Friedman, R. M. (2002) · Oxford University Press eBooks · doi:10.1093/acprof:oso/9780195134575.003.0002 · Cited by 64
Essential Elements of the Assessment Process
Simeonsson, R. J., & Bailey, D. B. (1988) · Springer eBooks · doi:10.1007/978-1-4757-9306-2_2 · Cited by 64
Ultra high risk status and transition to psychosis in 22q11.2 deletion syndrome
Schneider, M., Armando, M., Pontillo, M., Vicari, S., Debbané, M., Schultze‐Lutter, F., & Eliez, S. (2016) · World Psychiatry · doi:10.1002/wps.20347 · Cited by 63
Global Assessment of Child Psychopathology
STEINHAUSEN, H.-C. (1987) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-198703000-00014 · Cited by 63

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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