Impairment of psychosocial functioning

Psychiatric disorders disrupt a child's ability to function at their highest level in the psychosocial environment, and it is vital to assess the degree to which such functioning is impaired. Here the main areas of concern are school (or work) performance and behaviour, peer relationships, social and spare-time activities, and relationships within the family. Two approaches have been adopted to measure impairment. The first considers the patient's overall level of functioning, by combining all information about psychosocial impairment into a single rating. The Children's Global Assessment Scale is a widely used example. (23> The second approach involves making separate judgements about the child's functioning in multiple domains at school, at home, and elsewhere. For clinical purposes, an overall rating is of little use in treatment planning because it does not indicate where it is necessary to invest treatment energy. Here the second approach is much more helpful, and key areas to address include self-care, educational attainment (see below), relationships with parents, siblings, peers, teachers, and other adults, and job performance (in those who have, or have had, jobs). Several structured interviews provide models for such assessments.(24)

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