Child and Adolescent Symptom Inventory

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Child and Adolescent Symptom Inventory
Purposeassess ADHD (among other disorders)

The Child and Adolescent Symptom Inventory (CASI) is a behavioral rating checklist created by Kenneth Gadow and Joyce Sprafkin that evaluates a range of behaviors related to common emotional and behavioral disorders identified in the Diagnostic and Statistical Manual of Mental Disorders (DSM), including attention deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder, generalized anxiety disorder, social phobia, separation anxiety disorder, major depressive episode, mania, dysthymic disorder (pervasive depressive disorder in DSM-5), schizophrenia, autism spectrum, Asperger syndrome, anorexia, and bulimia. In addition, one or two key symptoms from each of the following disorders are also included: obsessive-compulsive disorder, specific phobia, panic attack, motor/vocal tics (uncontrolled sudden, repetitive movements or sounds), and substance use. [1] CASI combines the Child Symptom Inventory (CSI) and the Adolescent Symptom Inventory (ASI), letting it apply to both children and adolescents, aged from 5 to 18. The CASI is a self-report questionnaire completed by the child's caretaker or teacher to detect signs of psychiatric disorders in multiple settings. Compared to other widely used checklists for youths, the CASI maps more closely to DSM diagnoses, with scoring systems that map to the diagnostic criteria as well as providing a severity score. Other measures are more likely to have used statistical methods, such as factor analysis, to group symptoms that often occur together; if they have DSM-oriented scales, they are often later additions that only include some of the diagnostic criteria.

Contents

Overview

The number of items in the inventory vary by version, but all versions report four separate scores:

There are both parent and teacher versions, completed by each, that are submitted to the professional working with the youth at his/her appointment. [1] It is important to acquire information from both of these sources because there are different demands placed on youth in different environments and the different settings bring out different aspects of symptoms for different disorders. Furthermore, one care provider may be better at accurately evaluating symptoms in the youth over others. Lastly, knowing the different settings in which the symptoms manifest in the youth is essential in adapting the most successful treatment plan. The teacher version differs from the parent version in many ways. The main difference is the addition of items that address information regarding behavior in educational settings as well as academic performance to the teacher version. Furthermore, the teacher version excludes disorders that develop primarily in the home setting (i.e., separation anxiety, oppositional defiant disorder), as well as items in the parent checklist that the teacher would be unable to answer (i.e., regarding sleep, eating habits, activity at night). In order to compare the versions most accurately, the teacher version was not renumbered, but instead excludes the items that don't pertain to it. The wording of both version's was made user friendly by replacing psychiatric jargon of the DSM with more easily understood phrases by the care providers.

Versions

Development and history

The Clinical Assessment of Symptoms for Individuals (CASI) originated as dual measures intended to aid clinicians in gathering information from caregivers about youths. Developed in the 1980s, these measures aimed to align with psychiatric diagnostic systems, providing a clearer connection to the diagnostic approach used in psychiatry and other professions. The creators sought to create a symptom checklist based on the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), enabling information collection for children in special education services. The goal was to categorize them based on learning and behavioral problems relevant to conventional psychiatric diagnoses, helping clinicians form diagnostic impressions. The checklist also incorporated symptom severity ratings, generating a severity score to guide treatment target selection.

Originally intended for research and data collection in schools, the measures showed potential for clinical use. This led to the development of the Stony Brook Child Symptom Inventory-3 (CSI-3) and CSI-3R in 1986–87, accommodating both teacher and parent checklists. The teacher checklist concentrated on behaviors more likely to occur in a school setting. In 1990, Dr. Gabrielle Carlson adapted the parent checklist from the CSI-3R for adolescent use, creating the first version of the Adolescent Symptom Inventory (ASI-3R).

With the publication of the DSM-IV in 1994, the CSI-4 emerged to accommodate changes. Available in both Spanish and English, the CSI-4 addressed the modifications in the DSM. Similarly, in 1995, the Adolescent Symptom Inventory (ASI) was updated to ASI-4 in response to DSM changes. [4]

Impact

The inventories provide a low cost way of gathering information efficiently and organizing it in a way that maps to diagnostic classifications. [1]

The checklists also make it straightforward to collect and compare information from multiple informants. Teachers and parents oftentimes spend much more time with the youth than the clinician does. There are both parent and teacher checklists available. Clinicians can look at both the Symptom Count scores and the Symptom Severity scores and analyze them in order to determine whether or not it surpasses the Clinical Cutoff score. [3]

The assessment can be used to measure symptoms over the course of treatment. The CASI-PM, also known as the assessment's progress monitor, is a facet of the inventory that is used to both monitor and analyze certain outstanding symptoms to see if there are disorders that are comorbid with other disorders that already exist within the patient. Thus, this part of the inventory can be used to track change in symptoms as the child or adolescent develops. [1]

Use in other populations

The most recent version of the inventory has thus far only been used in the United States. The YI-4, the ECI-4, the CSI-4 and the ASI-4 are all available in the Spanish language. According to the website, the creators of the inventory intend to make it even more accessible by translating it into more languages. [1]

Limitations

The assessment is commercially distributed; see details on the official website. [1] Published versions are currently limited to English and Spanish language. The changes made to DSM-5 required some alterations in content and scoring of the CASI. Because it is so new, less research is available about the version that corresponds with the DSM-5.

See also

Other checklists for assessing emotional and behavioral problems in children and adolescents are:

Related Research Articles

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The Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood-Revised is a developmentally based diagnostic manual that provides clinical criteria for categorizing mental health and developmental disorders in infants and toddlers. It is organized into a five-part axis system. The book has been translated into several languages, and its model is utilized for the assessment of children up to five years of age.

<span class="mw-page-title-main">Disruptive mood dysregulation disorder</span> Medical condition

Disruptive mood dysregulation disorder (DMDD) is a mental disorder in children and adolescents characterized by a persistently irritable or angry mood and frequent temper outbursts that are disproportionate to the situation and significantly more severe than the typical reaction of same-aged peers. DMDD was added to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) as a type of depressive disorder diagnosis for youths. The symptoms of DMDD resemble many other disorders, thus a differential includes attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), anxiety disorders, and childhood bipolar disorder, intermittent explosive disorder (IED), major depressive disorder (MDD), and conduct disorder.

The Vanderbilt ADHD Diagnostic Rating Scale (VADRS) is a psychological assessment tool for attention deficit hyperactivity disorder (ADHD) symptoms and their effects on behavior and academic performance in children ages 6–12. This measure was developed by Mark L Wolraich at the Oklahoma Health Sciences Center and includes items related to oppositional defiant disorder, conduct disorder, anxiety, and depression, disorders often comorbid with ADHD.

The ADHD Rating Scale (ADHD-RS) is a parent-report or teacher-report inventory created by George J. DuPaul, Thomas J. Power, Arthur D. Anastopoulos, and Robert Reid consisting of 18–90 questions regarding a child's behavior over the past 6 months. The ADHD Rating Scale is used to aid in the diagnosis of attention deficit hyperactivity disorder (ADHD) in children ranging from ages 5–17.

The Hypomania Checklist (HCL-32) is a questionnaire developed by Dr. Jules Angst to identify hypomanic features in patients with major depressive disorder in order to help recognize bipolar II disorder and other bipolar spectrum disorders when people seek help in primary care and other general medical settings. It asks about 32 behaviors and mental states that are either aspects of hypomania or features associated with mood disorders. It uses short phrases and simple language, making it easy to read. The University of Zurich holds the copyright, and the HCL-32 is available for use at no charge. More recent work has focused on validating translations and testing whether shorter versions still perform well enough to be helpful clinically. Recent meta-analyses find that it is one of the most accurate assessments available for detecting hypomania, doing better than other options at recognizing bipolar II disorder.

The Screen for Child Anxiety Related Emotional Disorders (SCARED) is a self-report screening questionnaire for anxiety disorders developed in 1997. The SCARED is intended for youth, 9–18 years old, and their parents to complete in about 10 minutes. It can discriminate between depression and anxiety, as well as among distinct anxiety disorders. The SCARED is useful for generalized anxiety disorder, social anxiety disorder, phobic disorders, and school anxiety problems. Most available self-report instruments that measure anxiety in children look at general aspects of anxiety rather than Diagnostic and Statistical Manual of Mental Disorders (DSM) categorizations. The SCARED was developed as an instrument for both children and their parents that would encompass several DSM-IV and DSM-5 categorizations of the anxiety disorders: somatic/panic, generalized anxiety, separation anxiety, social phobia, and school phobia.

The Mood Disorder Questionnaire (MDQ) is a self-report questionnaire designed to help detect bipolar disorder. It focuses on symptoms of hypomania and mania, which are the mood states that separate bipolar disorders from other types of depression and mood disorder. It has 5 main questions, and the first question has 13 parts, for a total of 17 questions. The MDQ was originally tested with adults, but it also has been studied in adolescents ages 11 years and above. It takes approximately 5–10 minutes to complete. In 2006, a parent-report version was created to allow for assessment of bipolar symptoms in children or adolescents from a caregiver perspective, with the research looking at youths as young as 5 years old. The MDQ has become one of the most widely studied and used questionnaires for bipolar disorder, and it has been translated into more than a dozen languages.

The Child Mania Rating Scales (CMRS) is a 21-item diagnostic screening measure designed to identify symptoms of mania in children and adolescents aged 9–17 using diagnostic criteria from the DSM-IV, developed by Pavuluri and colleagues. There is also a 10-item short form. The measure assesses the child's mood and behavior symptoms, asking parents or teachers to rate how often the symptoms have caused a problem for the youth in the past month. Clinical studies have found the CMRS to be reliable and valid when completed by parents in the assessment of children's bipolar symptoms. The CMRS also can differentiate cases of pediatric bipolar disorder from those with ADHD or no disorder, as well as delineating bipolar subtypes. A meta-analysis comparing the different rating scales available found that the CMRS was one of the best performing scales in terms of telling cases with bipolar disorder apart from other clinical diagnoses. The CMRS has also been found to provide a reliable and valid assessment of symptoms longitudinally over the course of treatment. The combination of showing good reliability and validity across multiple samples and clinical settings, along with being free and brief to score, make the CMRS a promising tool, especially since most other checklists available for youths do not assess manic symptoms.

The University of California at Los Angeles Posttraumatic Stress Disorder Reaction Index for DSM-5 is a psychiatric assessment tool used to assess symptoms of PTSD in children and adolescents. This assessment battery includes four measures: the Child/Adolescent Self-Report version; the Parent/Caregiver Report version; the Parent/Caregiver Report version for Children Age 6 and Younger; and a Brief Screen for Trauma and PTSD. Questions may differ among the indexes depending on the target age, however the indexes are identical in format. The target age groups for this assessment are children and adolescents between 7-18 and children age 6 and younger. Versions of the UCLA PTSD Reaction Index for DSM-5 have been translated into many languages, including Spanish, Japanese, Simplified Chinese, Korean, German, and Arabic. The DSM-IV version of the UCLA PTSD Reaction Index Index has been updated for DSM-5.

The General Behavior Inventory (GBI) is a 73-question psychological self-report assessment tool designed by Richard Depue and colleagues to identify the presence and severity of manic and depressive moods in adults, as well as to assess for cyclothymia. It is one of the most widely used psychometric tests for measuring the severity of bipolar disorder and the fluctuation of symptoms over time. The GBI is intended to be administered for adult populations; however, it has been adapted into versions that allow for juvenile populations, as well as a short version that allows for it to be used as a screening test.

The Clinically Administered PTSD Scale (CAPS) is an in-person clinical assessment for measuring posttraumatic stress disorder (PTSD). The CAPS includes 30 items administered by a trained clinician to assess PTSD symptoms, including their frequency and severity. The CAPS distinguishes itself from other PTSD assessments in that it can also assess for current or past diagnoses of PTSD.

The Child PTSD Symptom Scale (CPSS) is a free checklist designed for children and adolescents to report traumatic events and symptoms that they might feel afterward. The items cover the symptoms of posttraumatic stress disorder (PTSD), specifically, the symptoms and clusters used in the DSM-IV. Although relatively new, there has been a fair amount of research on the CPSS due to the frequency of traumatic events involving children. The CPSS is usually administered to school children within school boundaries, or in an off-site location to assess symptoms of trauma. Some, but not all, people experience symptoms after a traumatic event, and in serious cases, these people may not get better on their own. Early and accurate identification, especially in children, of experiencing distress following a trauma could help with early interventions. The CPSS is one of a handful of promising measures that has accrued good evidence for reliability and validity, along with low cost, giving it good clinical utility as it addresses a public health need for better and larger scale assessment.

The Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) is a semi-structured interview aimed at early diagnosis of affective disorders such as depression, bipolar disorder, and anxiety disorder. There are different versions of the test that have use different versions of diagnostic criteria, cover somewhat different diagnoses and use different rating scales for the items. All versions are structured to include interviews with both the child and the parents or guardians, and all use a combination of screening questions and more comprehensive modules to balance interview length and thoroughness.

The Achenbach System of Empirically Based Assessment (ASEBA), created by Thomas Achenbach, is collection of questionnaires used to assess adaptive and maladaptive behavior and overall functioning in individuals. The system includes report forms for multiple informants – the Child Behavior Checklist (CBCL) is used for caregivers to fill out ratings of their child's behavior, the Youth Self Report Form (YSR) is used for children to rate their own behavior, and the Teacher Report Form (TRF) is used for teachers to rate their pupil's behavior. The ASEBA seeks to capture consistencies or variations in behavior across different situations and with different interaction partners.

References

  1. 1 2 3 4 5 6 7 "Child & Adolescent Symptom Inventory-4R". Checkmate Plus. 23 January 2016. Archived from the original on 21 December 2016. Retrieved 2016-11-03.
  2. Ong, Mian-Li; Youngstrom, Eric A.; Chua, Jesselyn Jia-Xin; Halverson, Tate F.; Horwitz, Sarah M.; Storfer-Isser, Amy; Frazier, Thomas W.; Fristad, Mary A.; Arnold, L. Eugene (2016-07-01). "Comparing the CASI-4R and the PGBI-10 M for Differentiating Bipolar Spectrum Disorders from Other Outpatient Diagnoses in Youth". Journal of Abnormal Child Psychology. 45 (3): 611–623. doi:10.1007/s10802-016-0182-4. ISSN   0091-0627. PMC   5685560 . PMID   27364346.
  3. 1 2 3 "CHILD & ADOLESCENT SYMPTOM INVENTORY-5".
  4. Gadow, Kenneth D.; Sprafkin, Joyce (1997). Adolescent Symptom Inventory 4: Screening Manual. Stony Brook, NY: Checkmate Plus, LTD. pp. 1, 9–11.