Are CAFAS Subscales and Item Weights Valid? A Preliminary Investigation of the Child and Adolescent Functional Assessment Scale

Abstract

Presents a psychometric analysis of the Child and Adolescent Functional Assessment Scale (CAFAS), one of the most commonly used measures of functional impairment in youths with emotional and behavioral disorders. Specific aims of the current investigation were to (a) examine the conceptual organization of the CAFAS items, (b) explore its scaling properties, and (c) investigate its construct validity. In Phase 1, a group of advanced graduate students and clinicians rated CAFAS items with respect to the degree that they reflect the originally assigned subscales. In Phase 2, additional raters assigned severity values to the subset of CAFAS items selected from Phase 1. Items were then scaled using simplified successive intervals scaling techniques. Results show differences between new empirically derived item weights and the original scoring method. This investigation highlights the benefits of continued examination and critique of level-of-functioning scaling for diagnosis, treatment, and prognosis in children and adolescents.

Functional Impairment in Children With Externalizing Behavior Disorders: Psychometric Properties of the Weiss Functional Impairment Rating Scale–Parent Report in a German Clinical Sample

“…Compared with global rating scales, which provide an overall score indicating functional impairment across several domains, multidimensional scales cover different domains of functioning. They have the advantage that they include more discrete and observable variables than global scales and, as a result, are less susceptible to rater bias (Bates, Furlong, & Green, 2006), more sensitive to change over time, and of greater usefulness for prevention and treatment planning (Canino, Costello, & Angold, 1999). However, they are less cost- and time-efficient (e.g., Winters et al, 2005).…”

A Proposed Functional Abilities Classification Tool for Developmental Disorders Affecting Learning and Behaviour

“…Functional classification systems are already standard in the field of cerebral palsy (i.e., Gross Motor Function Classification System and Manual Abilities Classification System) (Rosenbaum et al, 2014). Tools to measure functional abilities related to DDALB have been developed (Simeonsson et al, 1995;Bates et al, 2006;Greenspan and Wieder, 2008;Castro and Pinto, 2015); however, widespread practical implementation (e.g., in schools) continues to present a challenge. The exhaustiveness of the ICF itself limits applicability for this purpose (Berry and O'Connor, 2009).…”

“…Furthermore, support for children with DDALB is not specific to medical or psychological diagnosis, but rather depends on the relationship of a child's abilities to the features of the environment (e.g., demand on functional skills, physical features, attitudes, etc.) (Bates et al, 2006;Lillvist and Granlund, 2010;Garner, 2016;Foster-Cohen and Mirfin-Veitch, 2017). For example, the label of LD does not guide specific instructional practices for an individual student (Kauffman et al, 2017).…”

“…Disruptive behaviour should not be considered a diagnosis, but rather a sign of an overwhelmed biopsychosocial system that may have multiple contributing (transactional) factors. Disruptive behaviour is, therefore, a symptom of a stressed system pointing to a problematic interaction of the individual and environment (Bates et al, 2006). Children (humans) have a finite ability to control behaviour in the face of stress (i.e.…”

Differences in Levels of Functional Impairment and Rates of Serious Emotional Disturbance Between Youth With Internalizing and Externalizing Disorders When Using the CAFAS or GAF to Assess Functional Impairment

“…As with any measure of functional impairment, specific concerns with the CAFAS and GAF exist that have been detailed elsewhere (Bates, 2001; Bates, Furlong, & Green, 2006; Winters et al, 2005). For example, it has been suggested that unidimensional measures of functional impairment might equate functioning with symptomatology (Winters et al, 2005).…”