Childrens Global Assessment Scale (CGAS)

David Shaffer, M.D., Madelyn S. Gould, Ph.D. ector !ird, M.D., Prudence "isher, !.A. Ada#tation of the Adult Global Assessment Scale ($obert %.
S#it&er, M.D., 'athan Gibbon, M.S.(., )ean *ndicott, Ph.D.)
PLEASE RECORD A CGAS SCORE EVEN IF THIS IS BASED ON YOUR MEMORY OF THE YOUNG PERSONS FUNCTIONING AT
THE TIME OF REFERRAL. THE DATE OF RATING IS REQUIRED ONLY IF THIS WAS RECORDED CLOSE TO THE TIME OF THE
INDEX REFERRAL.
43a
DATE OF CGAS RATING: ++..,++..,++.. OR FROM MEMORY PLEASE INDICATE AS APPROPRIATE!
IF RECORDED CLOSE TO TIME OF INDEX REFERRAL!
"##$%"
DOING VERY WELL
Su#erior functionin- in all areas (at home, at school and .ith #eers), involved in a ran-e of activities and has many interests
(e.-. has hobbies or #artici#ates in e/tracurricular activities or belon-s to an or-anised -rou# such as Scouts, etc.).
%i0eable, confident, everyday .orries never -et out of hand. Doin- .ell in school. 'o sym#toms.
%# & '"
DOING WELL
Good functionin- in all areas. Secure in family, school, and .ith #eers. 1here may be transient difficulties and 2everyday2
.orries that occasionally -et out of hand (e.-. mild an/iety associated .ith an im#ortant e/am, occasionally 2blo.3u#s2 .ith
siblin-s, #arents or #eers).
'# & ("
DOING ALL RIGHT &)*+,- *).a*-)/+0
'o more than sli-ht im#airment in functionin- at home, at school or .ith #eers. Some disturbance of behaviour or emotional
distress may be #resent in res#onse to life stresses (e.-. #arental se#arations, deaths, birth of a siblin-) but these are brief
and interference .ith functionin- is transient4 such children are only minimally disturbin- to others and are not considered
deviant by those .ho 0no. them.
(# & 1"
SOME PROBLEMS $ *+ ,+/ a-/a ,+23
Some difficulty in a sin-le area, but -enerally functionin- #retty .ell, (e.-. s#oradic or isolated antisocial acts such as
occasionally #layin- hoo0y, #etty theft4 consistent minor difficulties .ith school .or0, mood chan-es of brief duration, fears
and an/ieties .hich do not lead to -ross avoidance behaviour4 self3doubts). as some meanin-ful inter#ersonal
relationshi#s. Most #eo#le .ho do not 0no. the child .ell .ould not consider him,her deviant but those .ho do 0no.
him,her .ell mi-ht e/#ress concern.
1# & 4"
SOME NOTICEABLE PROBLEMS & *+ ),-/ 05a+ ,+/ a-/a
5ariable functionin- .ith s#oradic difficulties or sym#toms in several but not all social areas. Disturbance .ould be
a##arent to those .ho encounter the child in a dysfunctional settin- or time but not to those .ho see the child in other
settin-s.
4# & 4"
OBVIOUS PROBLEMS & ),6/-a0/ *).a*-)/+0 *+ ),70 a-/a7 ,- 7/8/-/ *+ ,+/ a-/a
Moderate de-ree of interference in functionin- in most social areas or severe im#airment functionin- in one area, such as
mi-ht result from, for e/am#le, suicidal #reoccu#ations and ruminations, school refusal and other forms of an/iety,
obsessive rituals, ma6or conversion sym#toms, fre7uent an/iety attac0s, fre7uent e#isodes of a--ressive or other antisocial
behaviour .ith some #reservation of meanin-ful social relationshi#s.
4# & 3"
SERIOUS PROBLEMS & )a9,- *).a*-)/+0 *+ 7/8/-a2 a-/a7 a+6 :+a;2/ 0, <:+=0*,+ *+ ,+/ a-/a
Ma6or im#airment in functionin- in several areas and unable to function in one of these areas, i.e. disturbed at home, at
school, .ith #eers or in the society at lar-e, e.-. #ersistent a--ression .ithout clear insti-ation4 mar0edly .ithdra.n and
isolated behaviour due to either mood or throu-h disturbance, suicidal attem#ts .ith clear lethal intent. Such children are
li0ely to re7uire s#ecial schoolin- and,or hos#italisation or .ithdra.al from school (but this is not a sufficient criterion for
inclusion in this cate-ory).
3# & >"
SEVERE PROBLEMS $ :+a;2/ 0, <:+=0*,+ *+ a2),70 a22 7*0:a0*,+7
8nable to function in almost all areas, e.-. stays at home, in .ard or in bed all day .ithout ta0in- #art in social activities 9$
severe im#airment in reality testin- 9$ serious im#airment in communication (e.-. sometimes incoherent or ina##ro#riate).
># & ""
VERY SEVERELY IMPAIRED $=,+7*6/-a;2/ 7:./-8*7*,+ *7 -/?:*-/6 <,- 7a</03
'eeds considerable su#ervision to #revent hurtin- others or self, e.-. fre7uently violent, re#eated suicide attem#ts 9$ to
maintain #ersonal hy-iene: 9$ -ross im#airment in all forms of communication, e.-. severe abnormalities in verbal and
-estural communication, mar0ed social aloofness, stu#or, etc.
"# & "
EXTREMELY IMPAIRED $ =,+70a+0 7:./-8*7*,+ *7 -/?:*-/6 <,- 7a</03
'eeds constant su#ervision (;<3hour care) due to severely a--ressive or self3destructive behaviour or -ross im#airment in
reality testin-, communication, co-nition, affect or #ersonal hy-iene.
S#ecified time #eriod= > month
43;
CGAS SCORE @


Global Assessment Scale #entru co#ii (CGAS)
David Shaffer, MD, Madelyn S. Gould, Ph.D. ector !ird, MD, Prudence "isher, !A Ada#tarea Adult Scale Global Assessment ($obert %. S#it&er, MD,
'athan Gibbon, MS(, )ean *ndicott, Ph.D.)

VA -:BA) 7A C+-/B*70-a * :+ 7=,- CGAS CHIAR DACD a=/a70a 7/ ;aE/aEA C+ )/),-*a 6/ <:+= *,+a-/ 0F+A-:2 2a ),)/+0:2 6/ 2a
7/7*Ea-/. DATA DE RATING /70/ +/=/7a-A +:)a* 6a=A a=/a70a a <,70 INREGISTRAT a.-,a./ 6/ ),)/+0:2 7/7*EA-** a GINDEXG.

43a
DATA O F CGAS EVALUARE: ........ , ........ , ........ Sa: 6*+ )/),-*a 8A -:BA) 7A *+6*=a *H 6:.A =aE!
Da=A / C+-/B*70-a0A a.-,a./ C+ 0*). 6/ 2a 7/7*Ea-/ GINDEXG!
"##$%"
Fa=/ <,a-0/ ;*+/
"unc ionare su#erioar? @n toate domeniile (acas?, la coal? i cu cole-ii), im#licate @ntr3o serie de activit? i i are multe
interese (de e/em#lu, are hobby3uri sau #artici#? la activit? i e/tracurriculare sau a#artine unui -ru# or-ani&at, cum ar fi
cerceta i, etc). Gri6ile #l?cut, @ncre&?tori, de &i cu &i nu ie i din mAn?. "ace bine la coal?. 'ici un sim#tom.
%#$'"
Fa=/ ;*+/
!una func ionare @n toate domeniile. Asi-ura @n familie, coal?, i cu cole-ii. Pot e/ista dificult? i tran&itorii i de -ri6ile de &i
cu &i 22, care a6un-e uneori de sub control (de e/em#lu, an/ietate usoara asociata cu un e/amen im#ortant, oca&ional 2sufla3
u#3uri2, cu fra ii, #?rin ii sau cole-ii).
'#$("
A <a=/ 0,a0/ 6/.-/=*/-/ DREAPTA$)*+,-
'u mai mult de de#reciere u oar? @n func ionare acas?, la coal? sau cu cole-ii. 8nele tulbur?ri de com#ortament sau de
stres emotional #ot fi #re&ente ca r?s#uns la solicit?rile de via ? (de e/em#lu, se#ar?ri #arentale, decese, na terea unui frate),
dar acestea sunt de scurt? durat? i de interferen ? cu func ionarea este tran&itorie4 astfel de co#ii sunt doar minimal deran6a
#entru al ii i nu sunt considerate deviante de c?tre cei care le cunosc.
(#$1"
U+/2/ .-,;2/)/ $ C+0-$, E,+A +:)a*
8nele dificult? i @ntr3o sin-ur? &on?, dar, @n -eneral, func ionea&? destul de bine, (fa#te antisociale de e/em#lu, s#oradice sau
i&olate, cum ar fi redarea oca&ional hoo0y, furturi marunte, dificult? i minore @n concordan ? cu activitatea colar?, modific?ri
ale dis#o&i iei de scurt? durat?, temeri i an/iet? i care nu duc la Com#ortamentul brut evitare4 auto3@ndoieli). Are unele rela ii
inter#ersonale semnificative. Cei mai multi oameni care nu cunosc co#ilul bine, nu l3ar lua @n considerare , ei deviant, dar cei
care nu cunosc el , ea bine s3ar #utea e/#rima @n-ri6orarea.
1#$4"
U+/2/ .-,;2/)/ +,0a;*2/ $ C+ )a* ):20 6/ :+ 6,)/+*:
"unc ionare variabil cu dificult? i s#oradice sau sim#tome @n mai multe, dar nu toate domeniile sociale. Perturbare ar fi
evidente #entru cei care se confrunt? cu co#ilul @ntr3un cadru disfunctionale sau tim#, dar nu #entru cei care v?d co#ilul in alte
setari.
4#$4"
P-,;2/)/ /8*6/+0/ $ *+7:<*=*/+ A C+ =/2/ )a* ):20/ E,+/ 7a: 7/8/-/H C+0-$, E,+A
Grad moderat de interferen ? @n care func ionea&? @n cele mai multe domenii sociale sau de func ionare #entru afectare
sever? @ntr3un sin-ur domeniu, cum ar fi ar #utea re&ulta de la, de e/em#lu, #reocu#?ri de sinucidere i medita iile, refu&ul de
coal? i alte forme de an/ietate, ritualuri obsesive, sim#tome de conversie mari, atacuri de an/ietate frecvente , e#isoade
frecvente de com#ortament antisocial a-resiv sau alta, cu unele #?strarea rela iilor sociale semnificative.
4#$3"
PROBLEME GRAVE $ a0*+B/-/ )a9,-A C+ )a* ):20/ 6,)/+** * C+ *).,7*;*2*0a0/a 6/ a <:+= *,+a C+0-$, E,+A
De#reciere ma6or? @n care func ionea&? @n mai multe domenii i @n im#osibilitatea de a func iona @ntr3una din aceste &one, de
e/em#lu, #erturbate acas?, la coal?, cu cole-ii sau @n societate, la a-resiune de mare, de e/em#lu, #ersistent f?r? insti-are
clar?4 semnificativ retras i i&olat de com#ortament din cau&a, fie starea de s#irit sau #rin tulbur?ri, tentative de sinucidere, cu
inten ie letal? clar. Astfel de co#ii sunt susce#tibile de a solicita colari&area s#ecial? i , sau de s#itali&are sau de retra-ere
de la coal? (dar acest lucru nu este un criteriu suficient #entru a fi incluse @n aceast? cate-orie).
3#$>"
P-,;2/)/ B-a8/ $ C+ *).,7*;*2*0a0/a 6/ a <:+= *,+a C+ a.-,a./ 0,a0/ 7*0:a **2/
Bn im#osibilitatea de a func iona @n a#roa#e toate domeniile, de e/em#lu, st? acas?, @n salon sau @n #at toat? &iua f?r? a lua
#arte la activit? i sociale sau de insuficien ? renal? sever? @n testarea realitate sau insuficienta -rave @n comunicare (de
e/em#lu, uneori incoerent sau ne#otrivit).
>#$""
S:.-a8/B5/-/ <,a-0/ 7/8/-AH =,+7*6/-a;*2 /70/ +/=/7a- ./+0-: 7*B:-a+ A
Are nevoie de su#rave-here considerabil #entru a @m#iedica #e al ii r?ni i sau de sine,, tentative de suicid re#etate de
e/em#lu frecvent violent sau de a men ine i-iena #ersonal?: Sau insuficienta brut @n toate formele de comunicare, de
e/em#lu, anomalii -rave @n comunicarea verbal? i -estual, marcat detasarea sociala, stu#oare, etc
"#$"
EXTREM DE 6/.-/=*a0/ $ 7:.-a8/B5/-/ =,+70a+0A /70/ +/=/7a-A ./+0-: 7*B:-a+ a
Are nevoie de su#rave-here #ermanent? (de in-ri6ire ;< de ore), din cau&a com#ortamentului a-resiv sever sau auto3
distructive sau insuficienta brut @n testarea realitate, comunicare, cunoa tere, afecta sau de i-ien? #ersonal?.


Perioada de tim# s#ecificat?= > luna


43;

CGAS SCOR @

Care sunt cele cinci axe ale DSM-IV?
Axa 1 descrie tulburrile clinice i "alte stri psihice care pot intra n centrul ateniei
clinice". Acestea sunt de obicei probleme care necesit o atenie imediat din partea unui
clinician.
Axa 2 se centreaz pe tulburrile de personalitate i pe evaluarea retardului mintal, cu
ajutorul unei scale specifice. Aceste probleme nu pot solicita asisten imediat, dar ele
pot complica tratamentul i ar trebui luate n considerare de ctre orice clinician care
trateaz un pacient.
Axa 3 eticheteaz orice problem medical general. Acestea sunt importante chiar i
atunci cnd o problem doar pare ca fiind mental sau comportamental, pentru c,
uneori, problemele psihologice sunt produsul secundar al unei boli cum ar fi diabetul sau
bolile de inim.
Axa 4 specific "probleme psihosociale i de mediu", cum ar fi srcia, familiile
disfuncionale, precum i ali factori din mediul pacientului, care ar putea avea un anumit
impact asupra capacitii de funcionare psihologic, social i profesional! a persoanei.
Axa 5 este denumit "Scala Evalurii Globale a Funcionrii". "ste o evaluare de
ansamblu a capacitii unei persoane de a face fa problemelor vieii normale.
#uncionarea psihologic, social i profesional este considerat pe un continuum
ipotetic de sntate$maladie mental!. "valuarea merge de la scoruri mici, cum ar fi %&
"pericol persistent de vtmare grav a sa sau a altora"!, pn la %&& "funcionarea
superioar ntr$o gam larg de activiti"!.