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Protocol - Impairment - Adolescent

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Description:

The Columbia Impairment Scale (CIS) is a 13-item, self- or parent-reported instrument that measures four areas of functioning: interpersonal relations, broad psychopathological domains, functioning in job or schoolwork, and use of leisure time. Items are rated on a Likert scale ranging from 0 (no problem) to 4 (very big problem), indicating behavior at the present time.

Specific Instructions:

None

Protocol:

The Columbia Impairment Scale (CIS) Youth Version

INSTRUCTIONS FOR YOUTH

There are thirteen areas of behavior for you to rate from 0 (No problem) to 4 (Very bad problem) for you. Rate each item by circling the number that best describes your behavior at the present time. Since your behavior will change over time, only take into consideration how you feel your recent behavior (within the past week or two) has been. PLEASE RATE ALL THIRTEEN ITEMS. Circle the number 5 if you don’t know or the question does not apply to you. If you do not understand an item or items ask the staff person to clarify it for you. S/he will be glad to do so.

Please circle the number that you think best describes the child or youth’s situation:

0

1

2

3

4

5

No problem

Some problem

Very bad problem

Not applicable/Don’t know

 

In general, how much of a problem do you think you have with:

1)…getting into trouble?

2)…getting along with your mother/mother figure.

3)…getting along with your father/father figure.

4)…feeling unhappy or sad?

0     1    2    3    4    5

0     1    2    3    4    5

0     1    2    3    4    5

0     1    2    3    4    5

How much of a problem would you say you have:

5)…with your behavior at school? (or at your job)

6)…with having fun?.

7)…getting along with adults other than (your mother and/or your father)?

 

0     1    2    3    4    5

0     1    2    3    4    5

0     1    2    3    4    5

How much of a problem do you have:

8)…with feeling nervous or afraid?

9)…getting along with your sister(s) and/or brother(s)?

10)…getting along with other kids your age?

 

0     1    2    3    4    5

0     1    2    3    4    5

0     1    2    3    4    5

How much of a problem would you say you have:

11)…getting involved in activities like sports or hobbies?

12)…with your school work (doing your job)?

13)…with your behavior at home?

 

0     1    2    3    4    5

0     1    2    3    4    5

0     1    2    3    4    5

Scoring:

Responses are summed to give a total score. Scores can range from 0 to 52 with higher scores indicating more impairment.

Protocol Name from Source:

Availability:

Publicly available

Personnel and Training Required

None

Equipment Needs

None

Requirements
Requirement CategoryRequired
Major equipment No
Specialized training No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Self-administered questionnaire

Life Stage:

Adolescent

Participants:

Adolescents, ages 9 to 17

Selection Rationale

The Columbia Impairment Scale (CIS) is a brief, self-administered questionnaire with good psychometric properties that can be used to assess impairment across a broad range of diseases and conditions.

Language

English, Spanish

Standards
StandardNameIDSource
Common Data Elements (CDE) Adolescent Mental Health Impairment Questionnaire Assessment Score 4603777 CDE Browser
Derived Variables

None

Process and Review

This section will be completed when reviewed by an Expert Review Panel.

Source

Bird, H. R., Shaffer, D., Fisher, P., & Gould, M. S. (1993). The Columbia Impairment Scale (CIS): Pilot findings on a measure of global impairment for children and adolescents. International Journal of Methods in Psychiatric Research, 3, 167-176.

General References

Bird, H. R., Andrews, H., Schwab-Stone, M., Goodman, S. D., Dulcan, M., Richters, J., RubioStipec, M., Moore, R. E., Chiang, P. H., Hoven, C., Canino, G., Fisher, P., & Gould, M. S. (1996). Global measures of impairment for epidemiologic and clinical use with children and adolescents. International Journal of Methods in Psychiatric Research, 6(4), 295-307.

Ezpeleta, L., Granero, R., de la Osa, N., Domenech, J. M., & Bonilla, A. B. (2006). Assessment of Functional Impairment in Spanish Children. Applied Psychology: An International Review, 55(1), 130-143.

Singer, J. B., Eack, S. M., & Greeno, C. M. (2011). The Columbia Impairment Scale: Factor analysis using a community mental health sample. Research on Social Work Practice, 21(4), 458-468.

Ung, D., Wood, J. J., Ehrenreich-May, J., Arnold, E. B., Fuji, C., Renno, P., Murphy, T. K., Lewin, A. B., Mutch, P. J., & Storch, E. A. (2013). Clinical characteristics of high-functioning youth with autism spectrum disorder and anxiety. Neuropsychiatry (London), 3(2).

Protocol ID:

610101

Variables:
Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX610101_Impairment_Youth_Feeling_Nervous PX610101080000 How much of a problem do you have: more
ÔøΩwith feeling nervous or afraid? show less
N/A
PX610101_Impairment_Youth_Feeling_Sad PX610101040000 In general, how much of a problem do you more
think you have with: ÔøΩfeeling unhappy or sad? show less
N/A
PX610101_Impairment_Youth_Getting_Along_Adults PX610101070000 How much of a problem would you say you more
have: ÔøΩgetting along with adults other than (your mother and/or your father)? show less
N/A
PX610101_Impairment_Youth_Getting_Along_Father PX610101030000 In general, how much of a problem do you more
think you have with: ÔøΩgetting along with your father/father figure. show less
N/A
PX610101_Impairment_Youth_Getting_Along_Mother PX610101020000 In general, how much of a problem do you more
think you have with: ÔøΩgetting along with your mother/mother figure. show less
N/A
PX610101_Impairment_Youth_Getting_Along_Peers PX610101100000 How much of a problem do you have: more
ÔøΩgetting along with other kids your age? show less
N/A
PX610101_Impairment_Youth_Getting_Along_Siblings PX610101090000 How much of a problem do you have: more
ÔøΩgetting along with your sister(s) and/or brother(s)? show less
N/A
PX610101_Impairment_Youth_Getting_Into_Trouble PX610101010000 In general, how much of a problem do you more
think you have with: ÔøΩgetting into trouble? show less
N/A
PX610101_Impairment_Youth_Having_Fun PX610101060000 How much of a problem would you say you more
have: ÔøΩwith having fun? show less
N/A
PX610101_Impairment_Youth_Home_Behavior PX610101130000 How much of a problem would you say you more
have: ÔøΩwith your behavior at home? show less
N/A
PX610101_Impairment_Youth_School_Behavior PX610101050000 How much of a problem would you say you more
have: ÔøΩwith your behavior at school? (or at your job) show less
N/A
PX610101_Impairment_Youth_School_Work PX610101120000 How much of a problem would you say you more
have: ÔøΩwith your school work (doing your job)? show less
N/A
PX610101_Impairment_Youth_Sports_Hobbies PX610101110000 How much of a problem would you say you more
have: ÔøΩgetting involved in activities like sports or hobbies? show less
N/A
Mental Health Research
Measure Name:

Impairment

Release Date:

December 5, 2014

Definition

A self-administered questionnaire for assessing impairment and disability.

Purpose

This measure is used to assess impairment and difficulties in performing usual activities due to a variety of health conditions and diseases, including mental or emotional problems.

Keywords

Behavior, General Disability, Disability, Cognition, Mobility, Self-care, Getting along, Life activities, Participation, Function, Quality of life, Columbia Impairment Scale, CIS, Adolescent, Parents, Siblings, School, Home