Here a judgement is made on a nine-point dimensional scale ranging from superior social functioning to profound and pervasive social disability. Unlike other axes, ratings of disability are not independent, but have to be judged as due to a psychiatric or developmental disorder on Axes I to III. Thus, impairment arising from adverse circumstances cannot be coded—it must arise from intraindividual factors. This rule therefore excludes recognition of psychosocial interventions which aid functioning, from reduction of parental expressed emotion to changing schools. DSM-IV studies often use the Children's Global Assessment Scale, (28 an adaptation of the Global Assessment of Functioning used in adults. An advantage of the Children's Global Assessment Scale is that it is rated without impairment having to be caused by psychiatric disorder. A disadvantage is that psychiatric symptoms, rather than impairment alone, contribute to the rating. Reliability is reasonable. (29)
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