Assessment of affect integration: validation of the affect consciousness construct

Affect integration, or the capacity to utilize the motivational and signal properties of affect for personal adjustment, is assumed to be an important aspect of psychological health and functioning. Affect integration has been operationalized through the affect consciousness (AC) construct as degrees of awareness, tolerance, nonverbal expression, and conceptual expression of nine discrete affects. A semistructured Affect Consciousness Interview (ACI) and separate Affect Consciousness Scales (ACSs) have been developed to specifically assess these aspects of affect integration. This study explored the construct validity of AC in a Norwegian clinical sample including estimates of reliability and assessment of structure by factor analyses. External validity issues were addressed by examining the relationships between scores on the ACSs and self-rated symptom- and interpersonal problem measures as well as independent, observer-based ratings of personality disorder criteria and the Global Assessment of Functioning (GAF) scale from the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994).     

Assessment of Affect Integration: Validation of the Affect Consciousness Construct

Affect integration, or the capacity to utilize the motivational and signal properties of affect for personal adjustment, is assumed to be an important aspect of psychological health and functioning. Affect integration has been operationalized through the affect consciousness (AC) construct as degrees of awareness, tolerance, nonverbal expression, and conceptual expression of nine discrete affects. A semistructured Affect Consciousness Interview (ACI) and separate Affect Consciousness Scales (ACSs) have been developed to specifically assess these aspects of affect integration. This study explored the construct validity of AC in a Norwegian clinical sample including estimates of reliability and assessment of structure by factor analyses. External validity issues were addressed by examining the relationships between scores on the ACSs and self-rated symptom- and interpersonal problem measures as well as independent, observer-based ratings of personality disorder criteria and the Global Assessment of Functioning (GAF) scale from the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM–IV]; American Psychiatric Association, 1994).     

Clinical Validity of a Dimensional Assessment of Self- and Interpersonal Functioning in Adolescent Inpatients

The Social Cognition and Object Relations Scale–Global Version (SCORS–G) is a clinical rating system assessing 8 domains of self- and interpersonal relational experience that can be applied to narrative response data (e.g., Thematic Apperception Test [TAT; Murray, 1943], early memories narratives) or oral data (e.g., psychotherapy narratives, relationship anecdotal paradigms). In this study, 72 psychiatrically hospitalized adolescents consented and were rated by their individual and group therapist using the SCORS–G. Clinicians also rated therapy engagement, personality functioning, quality of peer relationships, school functioning, global assessment of functioning (GAF), history of eating-disordered behavior, and history of nonsuicidal self-injury. SCORS–G composite ratings achieved an acceptable level of interrater reliability and were associated with theoretically predicted variables (e.g., engagement in therapy, history of nonsuicidal self-injury). SCORS–G ratings also incrementally improved the prediction of therapy engagement and global functioning beyond what was accounted for by GAF scores. This study further demonstrates the clinical utility of the SCORS–G with adolescents.     

Large variations of global functioning over five years in treated patients with personality traits and disorders

The aim of this study was to examine the long-term course of global functioning in patients with personality disorders (PD) and investigate predictors of variation. The Global Assessment of Functioning (GAF) was repeated over five years in 352 patients with PDs of varying severity, all treated in psychotherapeutic day hospitals. Growth models were used for statistical analysis. Large variations in the long-term course of global functioning were evident in this clinical sample. At five-year follow-up, 46% reached a GAF-score above 60 with a mean GAF-score of 71. Their linear change-rate over the five years was estimated to be 4.4 GAF points per year. The average five-year GAF-score for the remaining subgroup (54%) was 50 and their linear yearly change-rate was 0.8 GAF points. Greater relief of symptom distress and interpersonal problems was typical of patients with functional improvement. The number of avoidant PD criteria was associated with slower functional change.     

Global Assessment of Relational Functioning Scale (GARF): I. Background and Rationale

The Committee on the Family of the Group for the Advancement of Psychiatry has introduced the Global Assessment of Relational Functioning (GARF), a scale that describes and quantifies the relational context within which patients live and problems occur. The GARF is intended to serve as a device that alerts clinicians to pay attention to the evaluation not only of individuals but also of relational functioning. In this article, we describe from a historical perspective the scientific and political context within which this scale was developed. The GARF is analogous to Axis V of the DSM GAF scale (Global Assessment of Functioning) that is used to assess individual functioning. The GARF is a composite derivative of three major dimensionalized constructs, namely, joint problem solving, organization, and emotional climate. We provide five clinical vignettes to illustrate the process of arriving at GARF ratings. Finally, we discuss caveats and limitations for use of the GARF at present, and make recommendations for research projects and training methods that may enhance the value of this instrument in the future.     

Moderating Effects of Neurocognitive Abilities on the Relationship between Temperament and Global Functioning

Clear links between temperament, psychopathology, and neuropsychological functioning exist; however the interrelations among temperament and neuropsychology, and their impact on functioning in typically developing children is not as well understood. This study examined the degree to which neuropsychological functioning, as measured by the NEPSY, moderates the impact of temperament on global functioning, as measured by the Children's Global Assessment Scale (CGAS), in 74 typically developing preschoolers. Temperament was assessed via parent ratings on the Children's Behavior Questionnaire (CBQ) and teacher ratings on the Temperament Assessment Battery for Children – Revised (TABC-R). Moderation analyses revealed significant interactions between verbal-executive skills and both child emotionality and lack of task persistence in predicting global functioning. The interaction patterns were mostly consistent across measures and indicated that when lower neurocognitive scores were coupled with higher levels of expressed negative emotions and more difficulties in task persistence, global functioning was at its lowest. In contrast better neurocognitive functioning mitigated the impact of high expressed emotions on global functioning. These findings support past literature and indicate that emotional and cognitive functioning interact to effect young children's global functioning.     

Predicting Response to Intensive Multimodal Inpatient Treatment: A Comparison of Single- and Multiple-Class Growth Modeling Approaches

In a modest body of research, personality functioning assessed via performance-based instruments has been found to validly predict treatment outcome and, to some extent, differential response to treatment. However, state-of-the-science longitudinal and mixture modeling techniques, which are common in many areas of clinical psychology, have rarely been used. In this article, we compare multilevel growth curve modeling (MLM) and latent class growth modeling (LCGM) approaches with the same data set to illustrate the different research questions that can be addressed by each method. Global Assessment of Functioning (GAF) scores collected at 6 points during the course of a long-term multimodal inpatient treatment of 58 severely and persistently mentally ill adults were used to model the trajectory of treatment outcome. Pretreatment Rorschach-based markers of personality functioning and other markers of psychiatric severity were examined as covariates in each modeling approach. The results of both modeling approaches generally indicated that more psychologically impaired clients responded less favorably to treatment. The LCGM approach revealed 2 unique trajectories of improvement (a persistently low group and a higher starting, improving group). Personality functioning and baseline psychiatric variables significantly predicted group membership and the rate of change within the groups. A side-by-side examination of these 2 methods was found to be useful in predicting differential treatment response with personality functioning variables.     

Relation of the Repeatable Battery for Assessment of Neuropsychological Status to measures of daily functioning in dementia

In the present study were examined relations of scores on the Repeatable Battery for the Assessment of Neuropsychological Status (Randolph, 1998) with measures of daily functioning in a sample with dementia. Participants (N=66) with various forms of dementia were seen at a dementia diagnostic clinic. All participants were administered the battery as part of a larger battery of neuropsychological measures. The participants' functional status was assessed by their primary caregivers, who completed the Physical Self-maintenance Scale and the Instrumental Activities of Daily Living scale (Lawton & Brody, 1969) as part of a social work interview. Analysis indicated that the Repeatable Battery for Assessment of Neuropsychological Status, particularly the Attention, Visuospatial/Constructional, and Immediate Memory indices, strongly correlated with measures of daily functioning. These results were supported by multiple regression analyses showing the RBANS Attention and Immediate Memory indices as significant predictors of functional abilities. One may conclude the RBANS should be favorably considered in understanding the functional problems of probable dementing patients.     

Examining the validity of self‐reports on scales measuring students' strategic processing

Background. Self‐report inventories trying to measure strategic processing at a global level have been much used in both basic and applied research. However, the validity of global strategy scores is open to question because such inventories assess strategy perceptions outside the context of specific task performance. Aims. The primary aim was to examine the criterion‐related and construct validity of the global strategy data obtained with the Cross‐Curricular Competencies (CCC) scale. Additionally, we wanted to compare the validity of these data with the validity of data obtained with a task‐specific self‐report inventory focusing on the same types of strategies. Sample. The sample included 269 10th‐grade students from 12 different junior high schools. Methods. Global strategy use as assessed with the CCC was compared with task‐specific strategy use reported in three different reading situations. Moreover, relationships between scores on the CCC and scores on measures of text comprehension were examined and compared with relationships between scores on the task‐specific strategy measure and the same comprehension measures. Results. The comparison between the CCC strategy scores and the task‐specific strategy scores suggested only modest criterion‐related validity for the data obtained with the global strategy inventory. The CCC strategy scores were also not related to the text comprehension measures, indicating poor construct validity. In contrast, the task‐specific strategy scores were positively related to the comprehension measures, indicating good construct validity. Conclusion. Attempts to measure strategic processing at a global level seem to have limited validity and utility.     

Validity of the Global Assessment of Relational Functioning (GARF) When Used By Community-Based Therapists

Construct validity of the Global Assessment of Relational Functioning (GARF) was assessed using a health services research approach, a mode of study that captures the naturalistic practice of health service providers. A sample of 395 couple/family cases with GARF scores assigned pre- and post-therapy by 222 community-based marriage and family therapists yielded these results: 1) pretreatment GARF scores were negatively correlated with severity of client problems; 2) GARF change scores were positively correlated with client reported changes in functioning; 3) GARF change scores were positively correlated with therapist-reported client change; 4) GARF change scores were positively correlated with client satisfaction; 5) pretreatment GARF scores were negatively correlated with number of therapy sessions; and 6) pretreatment GARF scores and client diagnoses showed no relationship. Given these results the GARF appears to have construct validity in community settings, and is a promising brief assessment tool for relational functioning.     

Parents of Adolescents with Mental Disorders: Improving Their Caregiving Experience

Several studies have demonstrated that the family members of adolescents with mental diseases experience distress, anxiety and depression, as well as economic strain, all of which contribute to physical and psychological caregiver morbidity. The aim of this study was to assess the effectiveness of intervention to improve the caregiving experience of the parents of mentally ill adolescents. The parents of 20 patients were assessed with the Experience of Caregiving Inventory (ECI) and the Working Alliance Inventory (WAI), while patients’ functioning and psychopathology were evaluated with the Global Assessment of Functioning (GAF) scale and the Child Behavior Check List (CBCL), respectively. Assessments were conducted over 9 months, comparing the experimental group receiving the intervention with a control group that received “standard” care. While there were no significant differences in the patients’ psychopathologies, the caregivers in the experimental group had better ECI and WAI scores. Intervention focusing on the parents seemed to improve the caregivers’ understanding of the disease’s impact on their lives irrespective of the severity of their children’s condition. This finding may be useful in developing adequate measures for the parents of adolescents with severe mental diseases to help contain their psychological distress.     

Integrating systems of care in California for youth with severe emotional disturbance. I. A descriptive overview of the California AB377 evaluation project

This paper presents an overview and an initial set of findings from an evaluation in three California counties of a replication of an integrated system of care for youth suffering from serious emotional disturbance. The development of the innovative system of care was pioneered in Ventura County, California, and the replications were legislatively enabled through AB377 (Assembly Bill 377). This paper focuses on one set of variables being studied in the evaluation: the characteristics of the youth enrolled in the care systems. This variable is important because personnel in the counties are explicitly deciding which youth are eligible for services given limited available public resources. Within the model system of care, clinical severity and risk status (being at-risk ofor in out-of-home placement) are used as the criteria for enrollment with the intent of serving those most in need as effectively as possible. The gender, age, clinical diagnosis, ethnicity, and global assessment of functioning (GAF) scores of these youth are presented. In general, the youth served are male, have low GAF scores, and predominantly receive clinical diagnoses of affective disorders and disruptive behavior disorders. African-Americans are overrepresented in the care systems relative to the general population and Asian-Americans are underrepresented.     

Self-reported interference with academic functioning and eating disordered symptoms: associations with multiple dimensions of body image

A sample of 1583 undergraduates completed a multidimensional measure of body image (Multidimensional Body-Self Relations Questionnaire, MBSRQ) and a new scale, the Eating and Body Image Disturbances Academic Interference Scale (EBIDAIS). All five subscales of the MBSRQ were related to higher levels of self-reported interference with academic functioning in correlational analyses. For the entire sample, a regression revealed that only the appearance orientation subscale of the MBSRQ did not explain unique variance associated with EBIDAIS scores. A few gender differences emerged when separate regressions were conducted, however, overweight preoccupation was the variable that predicted the largest unique variance for both genders. The results suggest that academic interference should be considered as a possible variable when evaluating the social and occupational problems associated with body image disturbance.     

Transition to young adulthood: A prospective study

In this paper, the authors report on the transition to young adulthood (18-25) in the highest functioning 18 individuals in our cohort (GAF 90) from a prospective longitudinal study of 76 lives followed from birth. These 18 individuals provide as clear a view as possible into the inner lives of people least distorted by psychopathology. This gives us a more crystalline photograph of psychic structure: the precipitant of family, society and psyche itself. Using a standard DSM IV criterion, Global Assessment Functioning (GAF), provides phenomenological homogeneity, but leaves us with heterogeneity of inner life. The 18 individuals had relatively rare drug or alcohol use and less sexual partners. Vocational functioning exceeded intimacy. Four had tumultuous pathways into adulthood. Nine were crossover cases, coming from sub-optimal mothering, with significant variation in gender distribution and intrapsychic structure. The paper discusses factors facilitating and inhibiting development and the nature of memories.     

Deficits in perceived social support associated with generalized social phobia

Social phobia is a common anxiety disorder associated with significant impairment in social and occupational functioning. To date, few studies have examined the relationship between social phobia and perceived social support, a construct with important relationships to physical and mental health. The present study examined data from 2 widely used measures of perceived social support administered to 132 individuals with DSM‐IV generalized social phobia. These data were compared with those obtained from a healthy control group and from several clinical and non‐clinical samples reported in the literature. Persons with generalized social phobia scored significantly lower on both measures of social support compared with all other groups. It is suggested that deficits in perceived social support associated with generalized social phobia may play a role in the development of co‐morbid problems and should be explicitly targeted by treatments for social phobia. Low correlations between perceived social support and social anxiety measures suggest that perceived support should be specifically evaluated in this population.     

Deficits in perceived social support associated with generalized social phobia

Social phobia is a common anxiety disorder associated with significant impairment in social and occupational functioning. To date, few studies have examined the relationship between social phobia and perceived social support, a construct with important relationships to physical and mental health. The present study examined data from 2 widely used measures of perceived social support administered to 132 individuals with DSM-IV generalized social phobia. These data were compared with those obtained from a healthy control group and from several clinical and non-clinical samples reported in the literature. Persons with generalized social phobia scored significantly lower on both measures of social support compared with all other groups. It is suggested that deficits in perceived social support associated with generalized social phobia may play a role in the development of co-morbid problems and should be explicitly targeted by treatments for social phobia. Low correlations between perceived social support and social anxiety measures suggest that perceived support should be specifically evaluated in this population.     

Psychometric properties of the Chinese version of the Family Awareness Scale

The author examined the reliability and validity of the Chinese Family Awareness Scale (C-FAS) in 2 studies. In Study 1, data from 361 adolescents (a) showed that the C-FAS was temporally stable and internally consistent and (b) supported the concurrent and construct validities of the scale. In Study 2, data from clinical (N = 281) and nonclinical (N = 451) groups of adolescents showed that the C-FAS scores discriminated between the 2 groups. C-FAS scores were also correlated significantly with other measures of family functioning and psychological well-being. Results of the 2 studies suggest that the C-FAS displayed generally good psychometric properties in different samples of Chinese adolescents.     

Ontario Child Health Study: reliability and validity of the general functioning subscale of the McMaster Family Assessment Device

The reliability and validity of the 12-item General Functioning (GF) subscale of the McMaster Family Assessment Device (FAD) is reported here. Psychometric properties of the FAD have been previously determined, but no independent assessment has been made of the GF subscale, which was used to measure family functioning in the Ontario Child Health Study (OCHS). Reliability was measured by Chronbach's alpha and split-half correlation. Validity was assessed by hypothesizing the relationships expected between the GF scores and other family variables included in the OCHS data set. The results indicate good reliability, and all hypotheses of validity were supported. The brevity and ease of administering the GF subscale recommend it for further use in survey research in which a global assessment of family functioning is required.     

Social cognition and real-life functioning in patient samples with 22q11.2 deletion syndrome with or without psychosis,compared to a large sample of patients with schizophrenia only and healthy controls

Patients with the 22q11.2 deletion syndrome (DS) show an increased risk of developing a psychotic illness lifetime. 22q11.2DS may represent a reliable model for studying the neurobiological underpinnings of schizophrenia. The study of social inference abilities in a genetic condition at high risk for psychosis, like 22q11.2DS, may shed light on the relationships between neurocognitive processes and patients' daily general functioning. The study sample consisted of 1736 participants, divided into four groups: 22q11.2DS patients with diagnosis of psychotic disorder (DEL SCZ, N = 20); 22q11.2DS subjects with no diagnosis of psychosis (DEL, N = 43); patients diagnosed with schizophrenia without 22q11.2DS (SCZ, N = 893); and healthy controls (HC, N = 780). Social cognition was assessed through The Awareness of Social Inference Test (TASIT) and general functioning through the Specific Levels of Functioning (SLoF) scale. We analysed data through regression analysis. The SCZ and DEL groups had similar levels of global functioning; they both had significantly lower SLoF Total scores than HC (p < .001); the DEL SCZ group showed significantly lower scores compared to the other groups (SCZ, p = .004; DEL, p = .003; HC, p < .001). A significant deficit in social cognition was observed in the three clinical groups. In the DEL SCZ and SCZ groups, TASIT scores significantly predicted global functioning (p < .05). Our findings of social cognition deficit in psychosis-prone patients point to the possible future adoption of rehabilitation programmes, like Social Skills Training and Cognitive Remediation, during premorbid stages of psychosis.     

Family Functioning and Social Support in Men and Women Diagnosed with Depression in China

Previous research has demonstrated the association between family functioning and depression. This study evaluated family functioning and perceived social support in men and women in Shanghai who had received a diagnosis of a major depressive disorder (N = 100), including sixty-six women and thirty-four men. The relationship between family functioning and social support of outpatients with major depressive disorders was explored using the Chinese Family Assessment Device and the Multidimensional Scale of Perceived Social Support. The scores from all dimensions of family functioning for both men and women indicated that depressed men and women all reported experiencing unhealthy family functioning. The clinical implications of these findings for the developing practice of family therapy in China are discussed.