How Children Are Assessed for Mental Health With CGAS

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The Children's Global Assessment Scale (CGAS) is a tool used to assess the global level of functioning and severity of mental illness in children and adolescents.

The CGAS is adapted from the Global Assessment Scale (GAS), which has now been widely replaced by the Global Assessment of Functioning (GAF) developed for the Diagnostic and Statistical Manual of Mental Disorders.

The CGAS uses various scales that assess a child's psychological, social, and occupational functioning. The scoring on the scales ranges from positive mental health to severe psychopathology.

Using a number system from 1 to 100, the CGAS assesses daily functioning and behaviors such as personal hygiene habits, sleep patterns, and risk for suicide. A lower score indicates more severe impairment in daily functioning.

Mental Health and CGAS

The CGAS is used to assess many common mental disorders in children and adolescents, including:

Depression (also referred to as major depressive disorder or clinical depression), for instance, can cause a child to have trouble functioning from day to day and may make them feel life isn't worth living. Since you can't just "snap out" of depression, it often requires long-term treatment that may involve medication, psychological counseling, or a combination of both.

If a child with major depressive disorder is rated by the CGAS with a score of 40, indicating major impairment in several areas, appropriate depression treatment can increase a child's score to 75, which indicates only slight impairment in functioning.

The CGAS is a useful tool for clinicians and researchers to assess a child's temporary state of being. However, the CGAS and other psychological assessments should only be used by professionals trained to use them.

Just knowing a child's score on the CGAS is not particularly useful for children and parents. Always ask your child's mental health provider to interpret the findings and what they mean for your child.

How CGAS Works

Doctors typically determine a child's CGAS score after talking to the child, interviewing the child's family or caregivers, reviewing the child's medical records, and police or court records detailing their behavioral history.

After these steps, the doctor will assign a child a score, which is based on functioning at home, at school, and with peers within the past month. Scoring for the CGAS ranges from 1, in need of constant supervision, to 100, superior functioning. Within these categories, there is a 10-point range used to rate the child’s level of functioning. 

  • 0-10: Extremely impaired (24-hour care)
  • 11-20: Very severely impaired (considerable supervision is required for safety)
  • 21-30: Severe problems (unable to function in most areas)
  • 31-40: Serious problems (major impairment in several areas and unable to function in one area)
  • 41-50: Obvious problems (moderate problems in all areas or a severe problem in one area)
  • 51-60: Some noticeable problems (in more than one area)
  • 61-70: Some problems (in one area only)
  • 71-80: Doing all right (minor impairment)
  • 81-90: Doing well
  • 91-100: Doing very well

How Doctors Use CGAS

Doctors use CGAS to determine how much a child's mental illness is impacting daily functioning and how much help the child needs in everyday life. In turn, this can help the doctor make an informed decision about whether your child needs round-the-clock supervision, for example, or daily counseling to cope with their mental illness and live a quality life.

It's important to note that CGAS scores can be subjective—two doctors can give the same child different scores—and they are independent of a specific mental illness diagnosis. In fact, the CGAS has been criticized for its lack of reliability between different scorers.

How to Know If Your Child Should Be Tested

If your child's mental illness is interfering with their school, social, or family life, consider asking your mental healthcare professional about CGAS. The consequences of mental illness can range from mild to severe and include relationship problems, academic decline, risky behavior, threats of suicide, substance misuse, or serious self-injury. This is yet another reason why it's imperative to get your child properly assessed and treated for mental illness.

If your child receives a low CGAS score, do your best to remain calm and remind yourself that having a mental health issue doesn't mean your child is "weak" or "crazy." Instead, it means your child needs medical attention and supervision to get the level of care needed to better cope with symptoms and stay safe. Mental illness is tough on the entire family, so it's also important to seek support for yourself so you can be best equipped to help your child.

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