The Child and Adolescent Functional Assessment Scale (CAFAS) is a multidimensional measure of degree of impairment in functioning. Interrater reliability data are presented for lay raters, graduate students, and frontline staff. Reliability was high for the total score and behaviorally-oriented scales. Construct, concurrent, and discriminant validity were assessed with the sample of children and adolescents evaluated at the Fort Bragg Demonstration Evaluation Project. Youth and their caregivers were evaluated via interview and selfcompleted instruments at four time points. Significant correlations were found between the CAFAS and other related constructs. Concurrent validity was demonstrated by logistic regression analyses examining the relationship between CAFAS ratings and problematic behaviors endorsed on measures completed by parents, teachers, or the youth. Youth with higher CAFAS total scores were much more likely to have poor social relationships, difficulties in schoo~ and problems with the law. Discriminant validity was assessed with a repeated measures analysis of variance with intensity of care at intake and time as factors. Youth who were inpatients or in residential treatment centers at intake had higher CAFAS scores than those who were outpatients. These findings provide strong evidence for the reliability and validity of the CAFAS.

The validity of the Children's Depression Inventory (GDI), the Revised Children's Manifest Anxiety Scale (RCMAS), and the Trait Scale of the State-Trait Anxiety Inventory for Children (STAIC) were examined. Scores on these measures were compared to diagnoses and symptom scores derived from the Child Assessment Schedule (CAS). The subjects were 70 psychiatric inpatient children, with a mean age of 10 years. Evidence was found for the convergent and discriminant validity of both the GDI and the STAIC. Scores for both depressed and anxious children were elevated on the RCMAS. The sensitivity for all three measures was too low for diagnostic purposes. Generally, these results support the use of these self-report questionnaires as screening measures and symptom inventories.

The Child Assessment Schedule (CAS) was developed to address the need for a standardized child interview that could be used for research and clinical purposes. The CAS has several distinguishing characteristics: (1) Questions and responses are standardized, (2) the format was designed to enhance rapport with the child, and (3) information necessary for DSM III childhood diagnoses is explicitly solicited. The CAS was administered to 32 child outpatients, 18 inpatients, and 37 normal controls. Derived scores were obtained for total psychopathology, 11 content areas, and 9 symptom complexes. Interrater reliability for the total CAS score was quite high. The CAS was able to discriminate among the three groups in total score indicating degree of psychopathology, on 9 of the 11 content areas, and on 8 of the 9 symptom complexes. Significant correlations were found between the CAS and maternal report of child behavior and between the CAS and child self-report of internal affects. It was concluded that the CAS has adequate reliability and validity, although further research is indicated.

No abstract

This study examined the relationship between symptom type and parent-child agreement, as reflected in symptom scores on a structured diagnostic interview, the Child Assessment Schedule (CAS). Forty-eight psychiatric inpatients (mean age 10 years) were administered the CAS. Their mothers were interviewed independently with the parent form. The average time between interviews was 12 days. High parent-child agreement was found for conduct/behavioral problems and moderate agreement for affective symptoms. Parents reported more conduct-related problems; children reported more anxiety and somatic symptoms and more family problems. The pattern of parent-child differences was the same as observed for other interviews.

No abstract

Structured interviews provide a valuable means of obtaining and quantifying information about the mental status of children. This review indicates that children can reliably self-report and that the information they provide can concur with the opinion of adults knowledgeable about them. However, considerably more research is warranted before it may be assumed that these interviews are adequately reliable and valid. In general, it appears that the task of documenting the psychometric soundness of these interviews has not been taken seriously, as if content validity were sufficient. For example, except for the CAS and the DISC, there has been little effort to study contrast group validity (i.e. whether the interview even differentiates "known groups"). More specifically, review of the reliability and validity data relevant to DSM-III-R diagnoses provides support for the CAS, DICA, ISC and K-SADS, with the validity data for the DICA being weaker than for the others. One limitation of these data for the DICA, ISC and K-SADS is that the diagnoses were clinician-generated, rather than algorithm-generated. Unfortunately the processes for generating clinical diagnoses were not specified, except for criterion reference to DSM-III-R. The findings for the DISC and the DISC-R are notably weak. There is no evidence for DISC reliability, except for adolescents, and the validity studies have demonstrated only weak relationships. There has been limited study of the psychometric properties of symptom scales. In fact, for two interviews (i.e. DICA and ISC), there are no data available. Reliability for the DISC scales is adequate only for adolescents. Psychometric data have been generated for the CAS and the K-SADS, with considerably more studies conducted with the CAS. The relative paucity of interest in scale scores is striking given that they provide a continuous variable which can indicate extent of symptoms. Other measures of mental status, besides presence/absence of diagnosis, will become increasingly important as research in child psychopathology progresses toward more sophisticated studies (i.e. treatment effects, risk factors). These interviews are labor intensive and costly to the researcher as well as time-consuming and tedious for the children and parents. Given this commitment, researchers should invest in developing other ways of exploiting the richness of the data generated. An example is the CAS "content" scales, which generate scores reflecting on the child's functioning in various areas (e.g. school, friends, family). As the evolution of these interviews continues, it will be important to remain attentive to the developmental limitations of children.(ABSTRACT TRUNCATED AT 400 WORDS)

This article discusses how the Child and Adolescent Functional Assessment Scale (CAFAS) can be used as an outcome measure in clinical settings. Outcome data from two clinical samples are provided: a small community mental health center located in Michigan and a large referred sample from the Fort Bragg Evaluation Project. Outcome indicators for assessing change over time included overall level of dysfunction, percentage of respondents with severe impairment, mean total score, mean scores for individual CAFAS subscales, and change in total score at the client level. Implications of the findings were discussed from several perspectives: improving services to individual clients, developing databases at the local level that can be used for the agency's continuing self-scrutiny, and pooling databases across sites that can be used to study broader issues within a managed care environment.