Child and Adolescent Symptom Inventory

The Child and Adolescent Symptom Inventory (CASI) is a behavioral rating checklist created by Dr. Kenneth Gadow and Dr. Joyce Sprafkin that assesses a range of behaviors related to common emotional and behavior disorders identified in the Diagnostic and Statistical Manual for 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 (now pervasive depressive disorder in DSM-5), schizophrenia, autistic spectrum disorder, anorexia, and bulimia. In addition, one or two key symptoms of each of the following disorders are also included: obsessive-compulsive disorder, specific phobia, panic attack, motor tics, vocal tics, 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 ages 5 to 18. The CASI is a self-report questionnaire completed by the child's caregiver 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. It is not yet clear scientifically whether a statistical or DSM-oriented approach is more useful at a clinical level. The CASI provides a low burden way of gathering a lot of information quickly about common problems, helping the clinician and family decide where to focus attention during interviews and treatment.

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

Reliability

Reliability refers to whether the scores are reproducible. A variety of things can influence the reliability of scores, so the concept of reliability applies to scores from tests given to groups of people (such as English-reading youths and their caregivers or teachers) in particular settings (such as a special education classroom or a community mental health clinic). Reliability is not considered an intrinsic, unchanging property of tests because it could change when used under different conditions or in a different context than where it had been studied before.

Evaluation of norms and reliability for the Child and Adolescent Symptom Inventory[lower-alpha 1]
Criterion Rating (adequate, good, excellent, too good*) Explanation with references
Norms Good Multiple convenience samples and research studies, including both clinical and nonclinical samples
Internal consistency (Cronbach's alpha, split half, etc.) Adequate to excellent, depending on scale
Inter-rater reliability N/A N/A
Test-retest reliability (stability) Adequate Manual has r values for each disorder covered over 6 weeks.
Repeatability or agreement Unknown Repeatability refers to the scores not changing on average with repetition, or being calibrated well against a gold-standard

Validity

Validity describes the evidence that an assessment tool measures what it was supposed to measure. There are many different ways of checking validity. For screening measures, diagnostic accuracy and discriminative validity are probably the most useful ways of looking at validity.

Evaluation of validity and utility for the Child and Adolescent Symptom Inventory[lower-alpha 1]
Criterion Rating (adequate, good, excellent, too good*) Explanation with references
Content validity Excellent Covers both DSM diagnostic symptoms and a range of associated features
Construct validity (e.g., predictive, concurrent, convergent, and discriminant validity) Excellent Shows convergent validity with other symptom scales
Discriminative validity Excellent Multiple studies show that scores discriminate cases with unipolar and bipolar mood disorders from other clinical disorders; effect sizes are among the largest of existing scales[6]
Validity generalization Good Used as self-report, teacher- and caregiver report; translated into multiple languages with good reliability
Treatment sensitivity Unknown N/A
Clinical utility Good Strong psychometrics, published research base. Biggest concerns are cost and length

Development and history

The CASI began as two separate measures that were developed to assist clinicians in obtaining information about youths from their caregivers. Although a variety of checklists were already available, most were not clearly connected to the diagnostic system used by psychiatry and many other professions. The authors saw this need and began to create a symptom checklist in 1984 that was based on the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Their goal was to obtain information about children who were receiving special education services so that they could assign them into groups based on their learning and behavioral problems that were more relevant to conventional psychiatric diagnoses (need citation). In this way, the measures helped gather information that helped the clinician form a diagnostic impression. The items also rated the severity of the symptoms. Adding them created a severity score that help guide selection of treatment targets. The original motivation for developing the checklist was to aid with research and gathering of fairly large amounts of data in schools; however, the creators soon saw the possible application of these symptom inventories in clinical settings. To that end, they began work in 1986 on an instrument that would be used by teachers and parents to give a comprehensive look at a youth's emotional and behavioral symptoms. This led to the earliest measure related to the CASI- the Stony Brook Child Symptom Inventory-3 (CSI-3). In 1987 this was followed by the CSI-3R based on the revised third edition of the DSM (DSM-III-R). The CSI-3R included both teacher and parent checklists. The teacher checklist focused on youth behaviors more likely take place in a school setting. In 1990, Dr. Gabrielle Carlson adapted the parent checklist from the CSI-3R for use with adolescents, which became the first version of the Adolescent Symptom Inventory (ASI-3R). After the fourth edition of the DSM was published in 1994, the CSI-4 was developed in response to those changes. The CSI-4 was available in both Spanish and English. In 1995, the ASI was also updated to the ASI-4 to account for modifications in the DSM.[7]

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]

Research

Research has been performed concerning certain scale from the checklist, including evaluating the depression scale for identifying cases with depression, and the mania scale for discriminating cases with bipolar disorder.[2]

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

There are many other checklists available for assessing emotional and behavioral problems in children and adolescents. These include:

Notes

  1. 1 2 Table from Youngstrom et al.,[4] extending Hunsley & Mash, 2008[5]

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. 1 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: 1–13. ISSN 0091-0627. doi:10.1007/s10802-016-0182-4.
  3. 1 2 3 "CHILD & ADOLESCENT SYMPTOM INVENTORY-5".
  4. ↑ Youngstrom, Eric. "Evidence-based Assessment".
  5. ↑ Hunsley, John; Mash, Eric (2008). A Guide to Assessments that Work. New York, NY: Oxford Press. pp. 1–696. ISBN 978-0195310641.
  6. ↑ Youngstrom, Eric A.; Genzlinger, Jacquelynne E.; Egerton, Gregory A.; Van Meter, Anna R. (16 November 2015). "Multivariate meta-analysis of the discriminative validity of caregiver, youth, and teacher rating scales for pediatric bipolar disorder: Mother knows best about mania". Archives of Scientific Psychology. 3 (1): 112–137. doi:10.1037/arc0000024.
  7. ↑ Gadow, Kenneth D.; Sprafkin, Joyce (1997). Adolescent Symptom Inventory 4: Screening Manual. Stony Brook, NY: Checkmate Plus, LTD. pp. 1, 9–11.
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