Global assessment of functioning represents an important aspect of assessment in clinical practice and research. It can help identify persons in need of psychiatric treatment, have predictive value and measure change over time, including treatment effects. This review examines publications concerning development, psychometric properties and usefulness of three scales for children: Axis-VI in ICD-10 Global Assessment of Psychosocial Disability (GAPD), Children's Global Assessment Scale (CGAS) and Axis-V in DSM-IV Global Assessment of Functioning Scale (GAF). It is based on literature searches in PubMed and PsycInfo (1977-2003), and screening of Scandinavian and English textbooks on child psychiatry. The three scales differ in theoretical guidelines, descriptions of codes/anchor points and psychometric aspects. CGAS has been evaluated in 69 papers and 33 have been published on GAF used for children. The one paper comparing GAPD and CGAS found both scales sufficiently reliable for clinical practice. Reliability of CGAS and GAF has been found to vary from fair to substantial, depending on raters, training and diagnostic groups. International consensus for the use of one scale for global assessment of functioning for children 4-18 years would improve reliability in clinical practice and ease comparisons of studies across countries. A training programme would assist in this.

Objectives:To summarise the types of case brought to the Clinical Ethics Committee of the National Hospital of Norway from 1996 to 2002 and to describe and discuss to what extent issues of information/communication have been involved in the ethical problems.Design:Systematic review of case reports.Findings:Of the 31 case discussions, (20 prospective, 11 retrospective), 19 cases concerned treatment of children. Twenty cases concerned ethical problems related to withholding/withdrawing of treatment. In 25 cases aspects of information/communication were involved in the ethical problem, either explicitly (n = 3) or implicitly (n = 22).Conclusion:Problems related to information/communication may underlie a classic ethical problem. Identification of these “hidden” problems may be important for the analysis, and hence, the solution to the ethical dilemma.

Mental health was evaluated early in the course of juvenile rheumatic disease; 106 parents of children (aged 1-17 yrs) were interviewed and 98 of the children were assessed when the child was hospitalized. Instruments included the Child Assessment Schedule (CAS), the Children's Global Assessment Scale (CGAS) and the Child Behavior Checklist (CBCL). Half the patients received a psychiatric diagnosis; psychosocial dysfunction of at least mild severity was found in 64% of the patients. In the polyarthritic group there was a negative correlation between CGAS and severity of disease. CBCL behaviour scores did not differentiate between patients and siblings when corrected for somatic components.

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A new computer-based quantification procedure was applied to data obtained from administering the Kvebaek Family Sculpture Technique (KFST) to 92 mothers of children with recent onset of rheumatic symptoms (median = 7 months). Four family configuration types (close, hierarchical, unspecified, and skewed) were defined on the basis of distance and structural parameters of the configuration. The types differed with regard to the childhood environment of the mother, chronic family difficulties, and the psychosocial functioning of the primary patient. Comparisons of the families of the mothers that did (n = 23) and did not (n = 69) wish a change of family configuration showed that the families of the mothers who wished change differed with regard to configuration types, distance variables, and psychosocial characteristics. The results are discussed in the context of structural family-systems theory. The computerized scoring procedure opens new possibilities for research about various family members' perspectives and assessment of changes in family configurations during therapy or over time.