Yale Global Tic Severity Scale (YGTSS)

The Yale Global Tic Severity Scale (YGTSS) is a tool used to quantify the severity of Tic symptoms in individuals aged 6-17, and is currently one of the most commonly used tools in Tic assessments (Scahill, 2013). The YGTSS is made up of a semi-structured interview, followed by a questionnaire where individuals are asked to rate the severity of their Tic symptoms (both motor and vocal) in domains such as: number, frequency, intensity, complexity, and interference (Leckman et al., 1989). There is also an impairment scale, where the individual rates how the Tic impacts on their daily life and activities (Leckman et al., 1989).


When scoring the YGTSS, the tool gives ratings in 5 domains: Total Motor Tic Score, Total Verbal Tic Score, Total Tic Score (Motor + Verbal), Overall Impairment Rating, and Global Severity Score. When calculating the Global Severity score, it is found by adding together the total motor, verbal and impairment scores. The Total Tic Severity Score has a range of 0-50, and the Global Severity Score has a range of 0- 100. A higher score on all scales suggests a more severe Tic, or a greater impact the Tic has on the person’s life.

The tool is therefore designed to measure severity of an individual’s Tic, and not to diagnose or classify an individual’s Tic disorder. In clinical work, the YGTSS may be used to track changes in Tic behavior, or to investigate if a treatment is reducing symptoms (Storch et al., 2011).

Psychometric Properties

Reliability and Validity: Research into the YGTSS has shown that is possessed good convergent and discriminative reliability. Storch et al., compared scores on the YGTSS to other clinical ratings and found there was no significant relations to OCD severity (r .01–.15), parent ratings of externalizing and internalizing behavior (r.07–.20), child ratings of depression (r .02–.26) and anxiety (r .06 –.28)(2013) .

It has also been found to have good inter-rater reliability (Kircanski et al., 2010, Leckman et al., 1989, Storch et al. 2011). Internal consistency was also high, with Cronbach’s alpha reliability coefficients for the Total Motor Tic Score ( .92 and .92), Total Phonic Tic Score (.93 and .93), and Total Tic Score ( .93 and .94) at first and second administrations (Storch et al., 2013).

The YGTSS has been used widely, and has translated versions in Canada (French), Spanish and Polish. The YGTSS can also be administered to the parent and child jointly, to increase reliability of answers and reduce any bias.

Critical Analysis

Strengths: The YGTSS is a short, easy to use tool which asks individuals to reflect on their symptoms over the past 7-10 days, therefore it can also easily be used multiple times over the course of treatment to gauge how the individual is going. The multiple scales and interview used in the YGTSS enables a lot of information to be provided about the severity and interference the Tic symptoms are having on the individual (Storch, 2011).

Weaknesses: The YGTSS has only been used in a child and adolescent population (6-17 years old), its use with individuals over 17 years has not be psychometrically tested. The YGTSS is only a measure of the severity of Tic symptoms, and does not aid clinicians in deciding a treatment response for these symptoms (Storch, 2011). Bias can always play a role in self report measures, such as the YGTSS, and clinicians should be cautious of this.


Kircanski, K., Woods, D., Chang, S., Ricketts, E., & Piacentini, J. (2010). Cluster analysis of the Yale Global Tic Severity Scale (YGTSS): Symptom dimensions and clinical correlates in an outpatient youth sample. Journal of Abnormal Child Psychology, 38(6), 777-88.

Leckman, J. F., Riddle, M. A., Hardin, M. T., Ort, S. L., Swartz, K. L., Stevenson, J., et al. (1989). The Yale Global Tic Severity Scale: initial testing of a clinician-rated scale of tic severity. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 566–573.

Scahill, D. (2013). Yale Global Tic Severity Scale. Encyclopedia of Autism Spectrum Disorders. Springer New York. 3415.

Selles, R., Murphy, T., Obregon, D., Storch, E., & Lewin, A. (2013). Treatment decisions for chronic tic disorders. Clinical Practice, 10(6), 765-780.

Storch, E. A., Murphy, T. K., Fernandez, M., Krishnan, M., Geffken, G. R., Kellgren, A. R., & Goodman, W. K. (2007). Factor-analytic study of the Yale Global Tic Severity Scale. Psychiatry research, 149(1), 231-237.

Storch, E., De Nadai, A., Lewin, A., McGuire, J., Jones, A., Mutch, P., Murphy, T. (2011). Defining Treatment Response in Pediatric Tic Disorders: A Signal Detection Analysis of the Yale Global Tic Severity Scale. Journal of Child and Adolescent Psychopharmacology, 21(6), 621-7.

Storch, E. A., Murphy, T. K., Geffken, G. R., Sajid, M., Allen, P., Roberti, J. W., & Goodman, W. K. (2005). Reliability and validity of the Yale Global Tic Severity Scale. Psychological assessment, 17(4), 486.

Disruptive Behaviour Disorder Rating Scale (DBDRS)

The DBD parent/teacher rating scale is a screening tool designed to aid in the diagnostic process for a number of child psychopathologies, particularly externalising disorders. The DBD rating scale was initially created to further build upon an existing tool created by the same authors, the Swanston, Nolan and Pelham (SNAP) rating scale. The SNAP listed the DSM-III symptoms of attention-deficit disorder (ADD) in a rating scale format. The DSM-III-R brought changes to the diagnostic criteria for attention-deficit hyperactivity disorder (ADHD) and so the authors sought to create a new teacher rating scale to reflect these amendments that would be comparable to the original SNAP rating scale in its effectiveness for providing information required to aid in the diagnostic process. In addition, all three disruptive behaviour disorder categories were included in the new DBD rating scale.


The DBD rating scale consists of 42 items related to symptoms of Conduct disorder (16 items), ODD (8 items), ADHD-Inattention (9 items), ADHD- hyperactivity/ Impulsivity (9 items). These items relate directly to the 36 DSM-III-R diagnostic criteria for Conduct Disorder, Oppositional Defiance Disorder and Attention Deficit Hyperactivity Disorder and are randomly ordered across diagnostic categories. Each item is rated on a four-point scale ranging from not at all (0) to very much (3). Teachers also have the option to check “don’t know” for any item. The DBD rating scale can be used to aid in diagnosis of children in regular classroom settings. There are two ways to determine if a child meets the criteria for DSM diagnoses of Attention-Deficit/Hyperactivity Disorder, Oppositional Defiant Disorder, or Conduct Disorder. The first method involves counting symptoms for each disorder using the Disruptive Behaviour Disorders (DBD) rating scale. The second method involves comparing the target child’s factor scores on the DBD Rating Scale to established norms. The DBD rating scale has been translated and adapted for the assessment of childhood behavioural problems in Pakistani children. In addition the tool was translated into Georgian using back translation back-translation. The DBD rating scale was also used to generate normative values and percentile charts for Nigerian children.

Psychometric properties

A validation study used a sample of 931 boys that attended regular classrooms aged 5-14 years. Criterion and construct validity was found to be satisfactory. A factor analysis revealed three factors: one reflecting ODD and a number of CD symptoms, one comprised of ADHD impulsivity/overactivity symptoms and one on which ADHD symptoms of inattention loaded highly. Conditional probability analysis revealed several prominent symptoms of ADHD had poor predictive power; contrastively combinations of symptoms from the two ADHD factors had good predictive power. Combinations of ODD symptoms demonstrated very high predictive power.  Due to high teacher ratings of “don’t know”, conduct disorder was found to have lower predictive power. It is anticipated by the authors that the parent rating scale will have a higher predictive power on the CD symptoms. The study also noted that within the elementary school age range oppositional and certain CD symptoms demonstrated a high degree of covariation in the observations by teachers.

The DBD Rating Scale demonstrates good internal consistency for the DSM-III-R categories for Conduct Disorder, Oppositional Defiance Disorder and Attention Deficit Hyperactivity Disorder with coefficient alphas of .81, .95 and .95 respectively.


The tool can be accessed from a number of reputable websites including Researchgate and The Center for School Mental Health website as provided- http://csmh.umaryland.edu/media/SOM/Microsites/CSMH/docs/Resources/ClinicianTools/Summary-of-Free-Assessment-Measures—And-Google-Doc-Link-to-Measures-Saved.pdf

The rating scale is available as a free download, permission is not required, and access is unrestricted.


Bzhalava, V., & Inasaridze, K. (2017). Disruptive Behavior Disorder (DBD) Rating Scale for Georgian Population. arXiv preprint arXiv:1702.03409.

Loona, M. I., & Kamal, A. (2011). Translation and adaptation of disruptive behaviour disorder rating scale. Pakistan Journal of Psychological Research26(2), 149.

Ofovwe, G. E., & Ofovwe, C. E. (2010). Disruptive Behaviour Disorder (DBD) Rating Scale for Attention Deficit/Hyperactivity Disorder: Normative Values and Percentile Charts for Nigerian Children Aged 6 to 15 Years. Nigerian Hospital Practice6(1-2).

Pelham, W. E., Gnagy, E. M., Greenslade, K. E., & Milich, R. (1992). Teacher ratings of DSM-III-R symptoms for the disruptive behavior disorders. Journal of the American Academy of Child & Adolescent Psychiatry31(2), 210-218.

Child Anxiety Life Interference Scale (CALIS)

Commonly, clinical measures of children’s anxiety focus on the assessment of disorder symptoms to support formal diagnoses. This has led to assessments of anxiety symptom impact or “anxiety life interference” becoming less common, despite reductions in these impairments contributing to clients’ treatment satisfaction (Lyneham, et. al., 2013). Consequently, the Child Anxiety Life Interference Scale (CALIS; Lyneham, et. al., 2013) was developed to provide a psychometrically supported method of evaluating the impact that children’s anxiety has on their life, as well as on the life of their parents.

Developed at the Centre for Emotional Health at Macquarie University in Sydney, Australia, the CALIS consists of one 10-item scale administered to children, and two 9-item scales administered to parents. The scale administered to children evaluates self-reported anxiety life interference; the scales administered to parents evaluate child anxiety life interference relative to the child’s life, and child anxiety life interference relative to the parents’ life. All items, which relate to common activities (e.g. “being with friends outside of school” or “your career choice”), are rated on a five-point Likert scale (0 = not at all, 4 = a great deal), with higher scores indicating higher anxiety life interference.

Psychometric Properties

Currently, psychometric data for the CALIS is based exclusively on one evaluative study (Lyneham, et. al., 2013); this study administered the scale to 622 Australian or American children with anxiety disorders, aged between 6 and 17 years.

According to this study, the CALIS demonstrates moderate internal consistency, with Cronbach’s Alphas ranging from .84 for children to .90 for mothers. The CALIS also demonstrates moderate inter-rater reliability between parents and children, which is consistent with previous studies that have identified differences in children and parents’ perceptions of anxiety (Niditch & Varela, 2011). Lastly, the CALIS demonstrates strong test-retest reliability; pre- and post-waitlist administrations of the CALIS produced significant correlations.

Clinical Utility

The use of the CALIS in clinical settings is supported by psychometric data that indicates that it is a significant, valid and reliable measure of anxiety life interference. The CALIS contributes to the development of a comprehensive understanding of a child’s experience of anxiety by using multiple raters to evaluate its impact across multiple activities. Additionally, the CALIS can be used to inform treatment decisions by indicating the domains in which a child is most significantly impaired, as well as provide an indication of overall treatment efficacy. However, due to limited evaluations of the scale’s psychometric properties, the CALIS should be used and interpreted with caution; limited data relating to the impact that cultural differences may have on psychometric properties. Furthermore, Lyneham et. al. (2013) advise that the CALIS be used in conjunction with symptom-specific scales, as it cannot independently support a diagnosis of anxiety.

CALIS freely available from: http://www.mq.edu.au/


Lyneham, H., Sburlati, E., Abbott, M., Rapee, R., Hudson, J., Tolin, D., & Carlson, S. (2013). Psychometric properties of the Child Anxiety Life Interference Scale (CALIS). Journal of Anxiety Disorders, 27(7), 711-9.  doi: 10.1016/j.janxdis.2013.09.008

Niditch, L., & Varela, R. (2011). Mother-child disagreement in reports of child anxiety: Effects of child age and maternal anxiety. Journal of Anxiety Disorders, 25(3), 450-5. doi: 10.1016/j.janxdis.2010.11.009

Autism Treatment Evaluation Checklist (ATEC)

The Autism Treatment Evaluation Checklist (ATEC) is a 77-item diagnostic assessment tool that was developed by (Rimland & Edelson, 1999) at the Autism Research Institute. The ATEC was designed as a comparative subscale for ASD diagnosed individuals – that is to measure change in ASD individuals due to various interventions by difference between the initial (baseline) ATEC scores and later ATEC scores. The ATEC is to be completed by parents, teachers, or others who see the individual’s behaviour on a regular basis, this takes about 10–15 minutes to complete and is designed for use with children aged 5-12.


The ATEC consists of four subtest scales: Scale I. Speech/Language/Communication (14 items – score range 0 – 28), Scale II. Sociability (20 items – score range 0 – 40), Scale III. Sensory/Cognitive Awareness (18 items – score range 0 – 36), and Scale IV. Health/Physical Behavior (25 items- score range 0 – 75). The four subscale scores are used to calculate a total score (77 items – score range 0 to 180). Overall scores in each subscale and in total can be used to determine the severity of the participant with higher scores indicating more impairment and lower scores with less impairment.

Psychometric Properties

On evaluation of 1,358 participants the ATEC presented high Pearson split-half (internal consistency) coefficients with uncorrected r values: Scale I. Speech/Language/Communication (r = .92), Scale II. Sociability (r = .84), Scale III. Sensory/Cognitive Awareness (r = .88) and Scale IV. Health/Physical Behaviour (r = .82).  Overall the internal consistency reliability of the measure is high (r = .94) for the total score. The ATEC has high correlations with the Childhood Autism Rating Scale (CARS) indicating further support of validity (ρ = .71, p < .0001) (Geier, Kern & Geier, 2013). Furthermore this was also indicative in results with sensitivity, specificity, and accuracy between CARS and total ATEC domains with sensitivity equal to 0.96, specificity at 0.67 and accuracy at 0.82. (Gier et al., 2013).

Clinical Utility

Overall the ATEC is indicative to be a useful screening tool to measure treatment effects and progress over time in ASD (Jarusiewicz, 2002; Lonsdale, Shamberger, & Audhya, 2002; Magiati, Moss, Yates, Charman, & Howlin, 2011). Strengths of the ATEC include high correlation with physical symptoms and biomarkers in ASD, (Adams, Johansen, Powell, Quig, & Rubin, 2011; Kern, Geier, Adams, & Geier, 2010) including quantitative assessment of these features as well as providing domain specific scores with an overall score and percentage of ASD severity. Furthermore the ATEC is simple to administer, easily understood and quick to complete. Limitations include limited research of reliability and validity as well as being based on previous versions of the Diagnostic Statistical Manual of Mental Disorders (DSM) therefore the tool may not be representative of the recent changes to autism in the DSM-5.


Autism Research Institute Website: (http://www.autism.com/ind_atec_survey.asp).

ATEC with online scoring and results: http://www.surveygizmo.com/s3/1329619/Autism-Treatment-Evaluation-Checklist-revised


Adams J. B., Johansen L. J., Powell L. D., Quig D., Rubin R. A. Gastrointestinal flora and gastrointestinal status in children with autism: Comparisons to typical children and correlation with autism severity. (2011). BMC Gastroenterology. 11, 22

Geier, D.A., Kern, J.K., & Geier, M.R. (2013).  A comparison of the Autism Treatment Evaluation Checklist (ATEC) and the Childhood Autism Rating Scale (CARS) for the quantitative evaluation of autism.  Journal of Mental Health Research in Intellectual Disabilities, Vol. 6, No. 4, pp 255-267.

Jarusiewicz B. Efficacy of neurofeedback for children in the autism spectrum: A pilot study. (2012). Journal of Neurotherapy. 6 pp 39–49.

Kern J. K., Geier D. A., Adams J. B., Geier M. R. A biomarker of mercury body-burden correlated with diagnostic domain-specific clinical symptoms of autism spectrum disorder. (2010). Biometals. 23, pp 1043–1051.

Lonsdale D., Shamberger R. J., Audhya T. Treatment of autism spectrum children with thiamine tetrahydrofurfuryl disulfide: A pilot study. (2002) Neuroendocrinology Letters. 23, pp 303–308.

Magiati I., Moss J., Yates R., Charman T., Howlin P. Is the Autism Treatment Evaluation Checklist a useful tool for monitoring progress in children with autism spectrum disorders? (2011). Journal of Intellectual & Disabilities Research. 55, pp 302–312.

Rimland B., Edelson M. Autism Treatment Evaluation Checklist. Autism Research Institute; 1999. 4812 Adams Avenue, San Diego, CA 92116. Retrieved from https://www.autismeval.com/ari-atec/report1.html.


Traumatic Events Screening Inventory (TESI)

Traumatic Events Screening Inventory (TESI-C; TESI-C-Brief Form; TESI-PRF-R; TESI-CRF-R)

  • Assesses a child’s experience of a variety of potential traumatic
    events including current and previous injuries, hospitalizations,
    domestic violence, community violence, disasters, accidents,
    physical abuse, and sexual abuse.
  • Additional questions assess DSM-IV PTSD Criterion A and other additional information about the specifics of the event(s).

Applicable population

  • Children – Ages vary according to version-TESI-C-age 6-18
  • Normative data – Yes
  • Publisher – The National Center for PTSD; Dartmouth Child Trauma Research Group


  • TESI-C is administered as an interview
  • TESI-PR-R parent report (demonstrated test–retest reliability
    kappas ranging from .50 to .79 (Berent et al., 2008)
  • The TESI-PRR provides a comprehensive analysis of child’s trauma exposure and
    is recommended as the best available option for assessing children’s trauma exposure under 10 (Stover & Berkowitz, 2005)

TESI-CR-F child report form

  • Adminstration time 10-30 min
  • Question format for 24 item version – Yes/No answers plus spaces
  • For example: Has someone ever told you they were going to hurt you really
    badly, or acted like they were going to hurt you really badly?
  • Followed by: When this happened, were you really hurt? Was someone else
    really hurt or even killed?


Ford et al (2002) Veteran affairs National Centre for PTSD.  The TESI-C/ TESI-C-Brief Form is downloadable at: The National Centre for PTSD http://www.ptsd.va.gov/professional/pages/assessments/tesi.asp


Berent, R., Crusto, C. A., Lotyczewski, B. S., Greenberg, S. R., Hightower, A. D., & Kaufman, J. S. (2008). Development and psychometric refinement of a measure assessing young children’s exposure to violence. Best Practices in Mental Health, 4(1), 19-30.

Ford, J. (2002). Traumatic Events Screening Inventory–Parent Report Revised (TESI). Unpublished manuscript. Storrs, CT: University of Connecticut.

Ford, J., Racusin, R., Rogers, K., Ellis, C., Schiffman, J., Ribbe, D., & Edwards, J. (2002). Traumatic Events Screening Inventory for Children (TESI-C) Version 8.4. National Center for PTSD and Dartmouth Child Psychiatry Research Group, Dartmouth VT.

Ghosh-Ippen, C., Ford, J., Racusin, R., Acker, M., Bosquet, K., Rogers, C., & Edwards, J. (2002). Trauma events screening inventory-parent report revised. San Francisco: The Child Trauma Research Project of the Early Trauma Network and The National Center for PTSD Dartmouth Child Trauma Research Group.

Stover, C. S., & Berkowitz, S. (2005). Assessing violence exposure and trauma symptoms in young children: A critical review of measures. Journal of Traumatic Stress, 18(6), 707-717.

Strand, V. C., Sarmiento, T. L., & Pasquale, L. E. (2005). Assessment and screening tools for trauma in children and adolescents: A review. Trauma, Violence, & Abuse, 6(1), 55-78.

Child and Adolescent Disruptive Behaviour Inventory (CADBI)

The Child and Adolescent Disruptive Behaviour Inventory (CADBI), Burns, et al., (2001a) is a 25-item parent and teacher questionnaire designed to assess a range of problem behaviours that often occur in childhood and adolescence. The CADBI has being used in research on disruptive behaviours in children. The CADBI was created by Julie Rusby from the University of Washington State. Dr. Leonard Burns, also from the University of Washington State, has collected CADBI data in various studies in the United States, as well as several other countries.

There is no age range specified for this measure, therefore clinical judgement would need to be used when deciding if this instrument is appropriate to use with your clients. However, the CADBI has been tested in multiple validation studies with children and adolescence aged 3 to 18. The CADBI can be used as a screening and diagnostic tool. The CADBI consists of three subscales that assess oppositional defiant behaviour, inattention and hyperactivity/impulsivity. Sample items from the oppositional defiant behaviour subscales include: “Annoys peers on purpose,” “Loses temper or gets angry with adults when doesn’t get own way” and “refuses to obey adult’s requests or rules.” The wording of the items is the same as the description of the symptoms in the DSM-IV with one exception, the term “often” was not included in the description (Burns, et al., 2001). Each item is rated on an 8-point Likert scale from one (“Never in the past month”) to eight (“10 or more times per day”). This measure can be administered in approximately ten minutes.

Several studies provide support for the reliability and validity of the CADBI as a measure of disruptive behavior (Burns, & Walsh, 2002). Teacher ratings on the oppositional defiant behaviour, inattention and hyperactivity/impulsivity dimensions predicted observer ratings of the same dimension in a classroom, demonstrating the predictive validity of the CADBI (correlation coefficient r = .64-.69).  The same researchers also found test-retest values for the subscales at 3-month interval; (correlation coefficient r = .86-.94) (Burns, & Walsh, 2002).  The scale has demonstrated high levels of internal consistency (Cronbach’s α = .91-.97), and structural validity (Burns, & Walsh, 2002).  According to Gomez et al., (2005), the scale was validated on 1475 Australian children Mean Age=8.28 using the DSM-IV AD/HD Rating Scale.

This measure assesses all of the specific diagnostic criteria for Oppositional Defiant Disorder, Conduct Disorder and Attention Deficit/ Hyperactivity Disorder. The close mapping of items against the diagnostic criteria in the DSM IV is an advantage of this measure over others, such as, the Child Behaviour Checklist.  Although, the scale does not provide enough information to make diagnoses (Burns, et al., 2001a).

Many instruments that measure disruptive behaviour in children and adolescents face the issue of being too long, while others are under copy write and too costly. This can be discouraging to parents (Burns, et al., 2001a). The creators of the CADBI sought to create a free and valid instrument that has a moderate number of items to help facilitate the cooperation of parents. The CADBI is freely available from many websites including the ‘Center on Early Adolescence’ http://measures.earlyadolescence.org/measures/view/40/


Burns, GL., Taylor, TK., & Rusby, J. C. (2001a) Child and Adolescent Disruptive Behavior Inventory 2.3: Parent Version. Pullman: Washington State University, Department of Psychology

Burns, G. L., & Walsh, J. A. (2002). The Influence of ADHD-Hyperactivity/Impulsivity Symptoms on the Development of Oppositional Defiant Disorder Symptoms in a 2-year Longitudinal Study. Journal of Abnormal Child Psychology, 30, 245-256.

Burns, G. L., Boe, B., Walsh, J. A., Sommers-Flanagan, R., & Teegarden, L. A. (2001). A Confirmatory Factory Analysis on the DSM-IV ADHD and ODD Symptoms: What is the Best Model for th Organization of These Symptoms? Journal of Abnormal Psychology, 29, 339-349.

Gomez, R., Burns, G., Walsh, L., & Hafetz, J. (2005). A Multitrait–Multisource Confirmatory Factor Analytic Approach to the Construct Validity of ADHD and ODD Rating Scales with Malaysian Children. Journal of Abnormal Child Psychology, 33(2), 241-254.

Centre for Epidemiological Studies Depression Scale for Children (CES-DC)


Formulated by Weissman, Orvaschel and Padian (1980) in the United States of America (USA), the Centre for Epidemiological Studies Depression Scale for Children (CES-DC) is one of the most widely used self-report inventories for the screening of depressive symptoms and the assessment of symptom improvement in children and adolescents aged 6- 17 years (Essau et al., 2013). The 20- item questionnaire was derived from the Centre for Epidemiological Studies Depression Scale for Adults (CES- D; Radloff, 1977), with the items later modified to encourage use with youths (Essau, 2013; Faulstich, Carey, Ruggiero, Enyart, & Gresham, 1986; Weissman et al., 1980). For instance, CES-D item “I felt like everything I did was an effort” was modified in the CES-DC to “ I felt like I was too tired to do things” (Essau, 2013). Possible scores range from 0- 60 and are calculated by summing scores from each question (Radloff, 1977; Weissman et al., 1980).

All items on the CES-DC are rated on a 4-point Likert scale in terms of its frequency of occurrence throughout the past week. A score of 0 indicates “not at all”; a score of 1 indicates “a little”; a score of 2 indicates “some”; and a score of 3 indicates “a lot” (Radloff, 1977; Weissman et al., 1980). To control for response bias, four items (questions 4, 8, 12 and 16) are worded positively and thus are scored in the reversed order when calculating total CES -DC scores; a score of 3 indicates “ not at all”; a score of 2 indicates “a little ”; a score of 1 indicates “some”; and a score of 0 indicates “a lot” (Radloff, 1977; Essau, 2013). Additionally, higher CES-DC scores correspond to greater levels of depressive symptoms (Radloff, 1977; Essau, 2013). Weissman et al. (1980) specify that a cut-off score of 15 is indicative of depressive symptomatology in children and adolescents. Taken together, youths who report scores of 15 or more may be experiencing significant levels of depressive symptoms and thus should be followed by further assessment (Weissman et al., 1980). Subsequently, based on the practitioner’s clinical judgement, further assessment is necessary for youths who exhibit symptoms of depression but do not screen positive (Weissman et al., 1980).

Researchers have implemented the CES-DC in both clinical and community settings, in addition to a number of differing cultures, including the USA (Faulstich et al., 1986; Fendrich, Weissman, & Warner, 1990; Weissman et al., 1980), Iran (Essau et al., 2013), Germany (Barkmann, Erhart, & Schulte-Markwort, 2008; Bettge et al., 2008), Spain (Aguilar & Berganza, 1990), Sweden (Olsson & von Knorring, 1997) and China (Li, Chung & Ho, 2010). As research has identified discrepancies in the severity of depressive symptoms amongst children and adolescents residing in different countries, it is plausible that culture may play an important role (Essau et al., 2013). For instance, Iranian females have proclivities to be viewed as being increasingly submissive provided their living conditions, approach in which they are socialised and the nation’s male-dominated societal constructs, hence potentially contributing to their higher reports of depressive symptoms (Essau et al., 2013). Following this perspective, studies that have implemented the CES -DC have indexed that girls tend to report significantly higher levels of depressive symptoms and impairments in daily functioning than boys, particularly somatic complaints (Bettge, et al., 2008; Essau et al., 2013; Fendrich, Weissman, & Warner, 1990; Olson & von Knorring, 1997). These gender discrepancies may be attributed to the psychological and social difficulties being more demanding for females, such as issues with body image and self-esteem (Essau et al., 2013). Moreover, Bettge and researchers (2008) identified significantly greater levels of depressive symptoms in




adolescents (12-17 years) than children (6-11 years). It is postulated that adolescents are potentially more sensitive to the description and perception of their depressive symptoms, even though such manifestations may not be intense enough to be classified as clinically significant (Bettge et al., 2008).

One of the major advantages of the CES-DC is that it is publically accessible with no cost affiliated with it (Essau et al., 2013). Subsequently, the psychometric properties of the CES-DC are renowned for their good reliability (Essau et al., 2013). The internal consistency of the CES-DC has been documented to range from good to excellent, with Cronbach’s alphas spanning from .71 to .91 (Barkmann et al., 2008; Essau et al., 2013; Li et al., 2010). Similarly, the CES-DC has evidenced strong test-retest reliability in adolescent samples (12 -18 years; Barkmann et al., 2008; Li et al., 2010), with coefficients ranging from .70 to .85. Conversely, given that it has been proposed that the CES-DC appears to measure state more than trait characteristics (Faulstich et al., 1986), test-retest reliability as the propensity to be negatively impacted. Germane to this, Faulstich et al. (1986) discovered that test- retest reliability for the CES-DC was very poor for children. This may be attributed to the wording or format of the tool, as it may surpass the comprehension level of young children (Faulstich et al., 1986). Collectively, when drawing conclusions from CES-DC data collected from clinical samples, results should be interpreted with caution.

A number of studies have also assessed the validity of the CES-DC. Researchers have examined the convergent validity of the CES- DC through the calculation of inter-correlational analyses with other inventories used for assessment of depressive symptoms in youths, such as the Children Depression Inventory (CDI; Doerfler, Felner, Rowlinson, Raley, & Evans, 1988) and the Beck Depression Inventory (BDI; Faulstich et al., 1986). Results have indexed significant correspondence between related concepts, suggesting that the CES-DC measures the same depressive constructs the CDI and BDI assess (Doerfler et al., 1988; Faulstich et al., 1986). Additionally, Achenbach (1979) reported that the CES-DC correlated significantly with Child Behaviour Checklist (CBCL), indicating that greater levels of depressive symptoms are related to greater levels of behavioural and emotional problems. Furthermore, Li et al. (2010) found a significant positive correlation between the Chinese version of the CES-DC and the State Anxiety Scale for Children (SACS; Li & Lopez, 2007), proposing that children experiencing heightened anxiety symptoms also report greater depressive symptoms. Germane to discriminant validity, studies have shown that the CES-DC is able to distinguish between children and adolescents presenting with or without psychiatric diagnoses (Fendrich et al., 1990; Weissman et al., 1980).

Radloff (1977) identified four factors when designing the CES-D, encompassing depressed affect, positive affect, somatic activity and interpersonal functioning. Confirmatory factor analyses demonstrate that these factors have also been replicated in various studies implementing the CES- DC amongst children and adolescent samples in different countries (Bettge et al., 2008; Essau et al., 2013; Fendrich et al., 1990; Li et al., 2010; Olson & von Knorring, 1997). However, as the CES-DC does not align with the Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic criteria, the CES-DC cannot be used as a diagnostic tool or for differential diagnoses encompassing depressive disorders (Faulstich et al., 1986). Similarly, the instrument is considered to be more sensitive to a subject’s emotional distress rather then their depressive symptoms (Faulstich, 1986). Collectively, further investigation is warranted if aggregated CES-DC scores are determined to be representative of depressive symptomatology (Faulstich et al., 1986; Fendrich, 1990).

Depressive problems continue to be a common occurrence amongst children and adolescents (Bettge et al., 2008). Given that these manifestations tend to go frequently undiagnosed, sufferers are delayed from accessing appropriate treatment (Essau et al., 2013). As such, early identification of clinically depressed children and adolescents is imperative so that suitable treatment can be administered, with much of this dependent on psychometrically rigorous screening instruments (Essau et al., 2013). Accumulating evidence suggests that that CES-DC is considered to be a reliable and valid tool for assessing and monitoring depressive symptoms in youths. However, its results should avoid being interpreted as a clinical diagnosis but instead signify the need for further evaluation. Provided its simplicity of scoring and administration, its implementation within psychiatric domains should be examined in further studies.


Achenbach, T. (1979). The child behavior profile: an empirically based system for assessing children’s behavioral problems and competencies. International Journal of Mental Health, 7, 24-42.

Barkmann, C., Erhart, M., & Schulte-Markwort, M. (2008). The German version of the Centre for Epidemiological Studies Depression Scale for Children: psychometric evaluation in a population-based survey of 7 to 17 years old children and adolescents – results of the BELLA study. European Child and Adolescent Psychiatry, 17, 116-124.

Bettge, S., Wille, N., Barkmann, C., Schulte-Markwort, M., Ravens-Sieberer, U., & BELLA Study Group (2008). Depressive symptoms of children and adolescents in a German representative sample: Results of the BELLA study. European Child & Adolescent Psychiatry, 17, 71-81.

Essau, C.A., Olaya, B., Gholamreza, P., Gilvarry, C., & Bray, D. (2013). Depressive symptoms among young children and adolescents in Iran: A confirmatory factor analytic study of the centre for epidemiological studies depression scale for children. Child Psychiatry and Human Development, 44, 123-136. doi:10.1007/s10578-012-0314-1

Doerfler, L.A., Felner, R.D., Rowlinson, R.T, Raley, P.A., & Evans, E. (1988). Depression in children and adolescents: a comparative analysis of the utility and construct validity of two assessment measures. Journal of Consulting and Clinical Psychology, 56, 769-772.

Faulstich, M.E., Carey, M.P., Ruggiero, L., Enyart, P., & Gresham, F. (1986). Assessment of depression in childhood and adolescence: An evaluation of the center for epidemiological studies depression scale for children (CES-DC). American Journal of Psychiatry, 143(8), 1024-1027.

Fendrich, M., Weissman, M.M., & Warner, V. (1990). Screening for depressive disorder in children and adolescents: Validating the Centre for Epidemiological Studies Depression Scale for Children. American Journal of Epidemiology, 131, 538-551.

Li, H.C.W., Chung, O.K.J., & Ho, K.Y. (2010). Centre for epidemiologic studies depression scale for children: Psychometric testing of the Chinese version. Journal of Advanced Nursing, 66, 2582-2591.

Li. H.C.W., & Lopez, V. (2007). Development and validation of a short form of the Chinese version of the State Anxiety Scale for Children. International Journal of Nursing Studies, 44, 566-573.

Olson, G., & von Knorring, A.L. (1997). Depression among Swedish adolescents measured by the self -rating scale Centre for Epidemiological Studies Depression Sale for Children (CES-DC). European Child and Adolescent Psychiatry, 6, 81-87.

Radloff, L.S. (1977). A CES-D scale: a self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385-401.

Weissman, M.M., Orvaschel, H., & Padian, N. (1980). Children’s symptom and social functioning self-report scales: Comparison of mothers’ and children’s reports. Journal of Nervous Mental Disorders, 168(12), 736-740.

Children’s Somatization Inventory (CSI-24)

The Children’s Somatization Inventory (CSI-24; Walker, Garber, & Greene., 1991) is a revised version from the original Children’s Somatization Inventory conceptualized by Walker and Colleagues in 1991. The original version of the CSI consisted of 35 items corresponding with symptoms consistent with the DSM-III-R criteria for Somatization Disorder. In 2009 the CSI was reviewed and a shorter version, consisting of 24 items, was created. The revised version was the result of eliminating 11 items that were rarely endorsed and had low item-total correlations.
There has been some controversy over the factorial structure of the instrument. Factorial Analysis of the CSI-24 found it not to be considered a strictly uni-dimentional instrument as although its items load onto one factor, with positive standardized factor loadings, the fit was found to be poor (Walker, Garber, & Greene., 1991). Further research has suggested that a 6-item one factor instrument demonstrates a better fit and adequate psychometric properties (Orgiles & Espada, 2013).
The inventory was conceptualized using a predominantly Caucasian clinical sample with a primary complaint of chronic abdominal pain, but this instrument has since been found a valid measure in community populations (Lavigne, Saps, & Bryant., 2012) and other cultures (Orgiles & Espada, 2013)
Psychometric properties
The CSI-24 has been found to correlate highly with the CSI-35 (– r=.99, p<.001; Walker et al., 2009) and hence has been considered a refined version of the original measure. The CSI-35 has been examined in numerous studies and has evidence of high concurrent and convergent validity (r>.4) with other measures of somatization, and good support from a number of studies for it’s construct validity.

  • Internal Consistency alpha .84-.92 (Cerutti et al., 2017; Lavigne, Saps, & Bryant., 2012)
  • Validity for the CSI-24 has been demonstrated in its correlation as expected with measures of anxiety, depression, functional impairment and quality of life (Lavigne, Saps, & Bryant., 2012)
  • Scores for older children and females tend to be higher with a low to medium effect size (d=0.52) (Walker et al., 2009).
  • Parent report has been shown to be lower in school samples and higher in clinical samples than the associated child report (Cerutti et al., 2017).


Cerutti R., Spensieri V., Valastro C., Presaghi F., & Guidetti V. (2017). A comprehensive approach to understand somatic symptoms and their Impact on emotional and psychosocial functioning in children. PLoS ONE, 12(2). doi.org/10.1371/journal.pone.0171867

Laird K., Sherman A., Smith C., & Walker L. (2015). Validation of the abdominal pain index using a revised scoring method. Journal Pediatric Psychology, 40(5). Doi:10.1093/jpepsy/jsu118

Lavigne, S.L., Saps, M., & Bryant, F.B. (2012). Reexamining the factor structure of somatization using the children’s somatization inventory (CSI-24) in a community sample. Journal of Pediatric Psychology, 37, 914-924. Doi:10.1093/jpepsy/jss060

Orgiles, M. & Espada, J. P. (2014). Spanish version of the children’s somatization inventory: factorial structure and psychometric properties in a community sample. International Journal of Behavioural Medicine, 21, 556-560. Doi:10.1007/s12529-013-9335-9

Walker, L. S., Beck, J. E., Garber, J., & Lambert, W. (2009). Children’s somatization inventory: Properties of the revised form (CSI-24). Journal of Pediatric Psychology, 34, 430-440.

Short Mood and Feelings Questionnaire – Child self-report (SMFQ-C)

The Short Mood and Feelings Questionnaire (SMFQ; Angold et al.,1995) is a 13-item self-report questionnaire designed to measure core depressive symptomology in children and adolescents aged 6- 17 years old. More specifically, it assesses the presence of affective and cognitive symptoms of depression that have been experienced in the past 2 weeks. Items are rated on a 3-point Likert scale (not true = 0; sometimes true = 1; not true = 2). Example items include ‘I felt miserable or unhappy’ and ‘I cried a lot’. Scores are calculated by summing the point values on each item response. Total SMFQ scores range from 0 – 26. There are no prescribed cut points for the SMFQ. Instead, it is advised that the user utilise their discretion and clinical judgement to assess scores on a case by case basis (Angold & Costello, 1987). However, it has been suggested that higher scores, such as those over 12, suggest greater severity in depressive symptoms and may indicate the presence of depression (Wood, Kroll, Moore & Harrington, 1995). The SMFQ has also been shown to a useful measurement of clinical remission (Wood, Kroll, Moore & Harrington, 1995).

The SMFQ is a unidimensional factor structure with 13 items loading from .36 to .78 (Angold et al. 1995; Kuo, Vander Stoep & Stewart, 2005). It emerged from the original 33- item MFQ developed by Angold, Costello, Pickles and Winder (1987), which was based off the DMS-III-R and ICD-10 diagnostic criteria for depressive disorders. The shortened 13- item version is characterised by the cognitive and affective items from the original MFQ item pool, however it also includes tiredness, restlessness and poor concentration (Angold & Costello, 1995). The high correlations between the MFQ and the shortened SMFQ indicates that little information was lost when more than half of the original items where removed. The SMFQ correlates moderately highly with the depression scales on the Child Depression Inventory (CDI) and the Diagnostic Interview Schedule for Children indicating good criterion validity. Furthermore, good discriminate validity is demonstrated though clear distinctions between psychiatric and paediatric, depressed and non-depressed, populations. Internal reliability is high (Cronbach’s alpha = 0.85), with 60% sensitivity and 85% specificity with a cut off score of 8 or more (Angold & Costello, 1995). In addition, one-year rank order stability coefficients ranged from .28 to .48 (Messer, 1995).

The SMFQ has shown to be a valid and reliable measurement of cognitive and affective depressive symptomology in children and adolescents aged between 6 and 17 years old. Whilst it is inexpensive and brief to administer, score and interpret, there are some notable limitations to its application. Firstly, it is inappropriate to use the SMFQ as a diagnostic tool for depression. It is unable to distinguish between children and adolescents with depression only, from those with anxiety only, comorbid anxiety, or comorbid conduct disorder (Kent, Vostanis, Feehan, 1997). As such, its uses should be strictly limited to screening the presence and severity of depression, as an indication of progress and remission during treatment, and in research. Secondly, its uses are restricted to children and adolescence between the ages of 6 and 17. Finally, the accuracy of self-reporting may be compromised by reading and comprehensive abilities, mood at time of administration and the child’s ability to accurately identify and report their feelings. Children’s understanding and attributions of the symptoms measured in the SMFQ may become more refined with age, leading us to rationalize that age may decrease error associated with self-reporting, thus clinicians may need to take greater care in administration and interpretation of the SMFQ in younger children (Messer, 1995).

The English version of the SMFQ has been translated into 3 languages including Arabic, Spanish and Norwegian. However, psychometric evaluations on these translated versions are somewhat limited. The SMFQ is freely available to the public and can be accessed through multiple online sources, such as the website for the Centre for Developmental Epidemiology at Duke University. At present, the MFQ suite is comprised of six different versions; adult self-report, child self-report and parent report of child. Each is available in 13 and 33 item versions. This is important to note as it has been suggested that while child-self reports discriminate depression status better than parent reports, using both makes for a more accurate evaluation than either does alone (Angold & Costello, 1995). However, it is essential to consider a combination of sources when assessing any clinically significant presentations of depression, such as multiple self and/or observer rating scales, interviews with parents, caregivers and teachers, and other sources to assist in building a sound clinical picture to inform differential diagnoses and inform appropriate interventions.


Angold, A., Costello, E.J., Messer, S.C., Pickles, A., Winder, F., & Silver, D. (1995). Development of a short questionnaire for use in epidemiological studies of depression in children and adolescence. International Journal of Methods in Psychiatric Research, 5, 237- 249.

Angold, A., Costello, E. J., Pickles, A., & Winder, F. (1987). The development of a questionnaire for use in epidemiological studies of depression in children and adolescents. London: Medical Research Council Child Psychiatry Unit.

Kent, L., Vostanis, P., & Feehan, C. (1997). Detection of major and minor depression in children and adolescents: Evaluation of the Mood and Feelings Questionnaire. Journal of Child Psychology and Psychiatry, 38(5), 565- 573.

Kuo, E.S., Vander Stoep, A., & Stewart, D.G. (2005). Using the Short Mood and Feelings Questionnaire to detect depression in detained adults. Assessment, 12(4), 374- 383.

Messer, S.C., Angold, A., Costello, J., Loeber, R., Van Kammen, W., & Stouthamer-Lober, M. (1995). Development of a short questionnaire for use in epidemiological studies of depression in children and adolescence: Factor composition and structure across development. International Journal of Methods in Psychiatric Research, 5, 251- 262.

Wood, A., Kroll, L., Moore, A., & Harrington, R. (1995). Properties of the Mood & Feelings Questionnaire in adolescent psychiatric outpatients: A research note. Journal of Child Psychology and Psychiatry, 36(2), 327-334.

Vanderbilt Assessment Scales (VAS)

The Vanderbilt Assessment Scales (parent/teacher) were created in 2002 by the American Academy of Pediatrics (AAP) and the National Initiative for Children’s Healthcare Quality (NICHQ) at the completion of a project aimed to create and implement a model of care for children with ADHD. The VAS is a brief scale completed by parents and teachers that assesses ADHD symptoms of inattention and hyperactivity along with conduct disorder, oppositional defiance disorder, anxiety, depression and academic performance (Fields & Hale, 2011).
Psychometric Properties
The scale has good internal reliability with Cronbach’s alpha coefficient of > .90 (parent) and >.89 (teacher) (Wolraich et al., 2002; Wolraich et al., 2013). Test-retest reliabilities were assessed as adequate (r >.80) (Bard et al., 2013). Interrater reliability, between the two scales is very low (r=.27 – .34) (Wolraich et al., 2002).
The four factor structure of the scale confirms it is a valid measure of inattention, hyperactivity, conduct disorder/oppositional defiance disorder, anxiety/depression. Convergent validity is evidenced by the moderate to high correlations with the Diagnostic Interview Schedule for Children-IV Parent Version (Bard et al., 2013; Collett et al., 2003).
The parent scale produced sensitivity measure (true positives) of 80% and specificity (true negatives) of 75% when predicting a diagnosis of ADHD. However when the parent and teacher scales were combined positive predictive value fell to 19% and the negative predictive value increased to 98% suggesting that the combined scale is very good for identifying children who do not have ADHD (Bard et al., 2013).
The VAS has been used with clinical and community samples of American, African American, Hispanic, Spanish and German children in rural, urban and suburban areas; with those at high and low risk of ADHD. Only small differences were found for gender, age, school grade or severity of ADHD symptoms (Wolraich et al., 2002).
The scale is: easy to complete and score, psychometrically sound, useful for collecting data from multiple sources and assessing academic and behaviour performance (Collett et al., 2003; Kratochvil et al., 2009). It can be used to establish baselines to measure treatment effectiveness (Kratochvil et al., 2009) and has utility to screen for comorbid disorders (Becker et al., 2012; Langberg et al., 2010). The teacher scale correlates highly with a diagnosis of ADHD (Austerman, 2015).
There is no evidence found for discriminant validity. Items are more relevant for school aged children than younger. Very low inter-rater reliability between scales and is to be used as a screening tool only.
Clinical utility:
The VAS provides a psychometrically sound method of data collection from both parents and teachers that can be used in the diagnostic process for children with ADHD.  It useful and acceptable to clinicians, readily available and provides assessment of performance and comorbid disorders (Bard et al., 2013).  It is so simple to use, a line can be drawn down the page to delineate meeting or not meeting diagnostic criteria (Molina, 2017).
Link to scale: https://www.nichq.org/resource/nichq-vanderbilt-assessment-scales

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: Author.
Austerman, J. (2015). ADHD and behavioral disorders: Assessment, management, and an update from DSM-5. Cleveland Clinic Journal of Medicine, 82, S2-S7.
Bard, D.E., Wolraich, M.L., Neas, B., Doffing, M., & Beck, L. (2013). The psychometric properties of the Vanderbilt attention-deficit hyperactivity disorder diagnostic parent rating scale in a community population. Journal of Developmental and Behavioral Pediatrics, 34, 72-82.
Becker, S.P., Langberg, J.M., Vaughn, A.J., & Epstein, J.N. (2012). Clinical utility of the Vanderbilt ADHD diagnostic parent rating scale comorbidity screening scales. Journal of Development and Behavioral Pediatrics, 33, 221-228.
Collett, B.R., Ohan, J.L., & Myers, K.M. (2003). Ten-year review of rating scales. V: Scales assessing attention-deficit/hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 42, 1015-1037.
Fields, S.A., & Hale, L.R. (2011). Psychoeducational groups for youth attention-deficit hyperactivity disorder: a family medicine pilot project. Mental Health in Family Medicine, 8, 157-165.
Kratochvil, C.J., Vaughan, B.S., Barker, A.M.., Corr, L., Wheeler, A., & Madaan, V. (2009). Review of pediatric attention deficit/hyperactivity disorder for the general psychiatrist. Psychiatric Clinics of North America, 32, 39-56.
Molina Healthcare (2017). Behavioral health provider toolkit. Retrieved from: http://www.molinahealthcare.com/providers/common/PDF/Behavioral-Health-Toolkit-for-Specialists.pdf
National Initiative for Children’s Healthcare Quality (2017). Attention Deficit Hyperactivity Disorder (ADHD) Learning Collaborative. Retrieved from: https://www.nichq.org/project/attention-deficit-hyperactivity-disorder-adhd-learning-collaborative
National Initiative for Children’s Healthcare Quality (2017). NICHQ Vanderbilt assessment scales. Retrieved from: https://www.nichq.org/project/attention-deficit-hyperactivity-disorder-adhd-learning-collaborative
Wolraich, M.L., Bard, D.E., Neas, B., Doffing, M., & Beck, L. (2013). The psychometric properties of the Vanderbilt attention-deficit hyperactivity disorder diagnostic teacher rating scale in a community population. Journal of Developmental and Behavioral Pediatrics, 34, 83-93.
Wolraich, M.L., Lambert, W., Doffing, M.A., Bickman, L.B., Simmons, T., & Worley, K. (2003). Psychometric properties of the Vanderbilt ADHD diagnostic parent rating scale in a referred population. Journal of Pediatric Psychology, 28. 559-568.