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Protocol - Impairment - Adolescent

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Protocol Name from Source:

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

Availability:

Publicly available

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.

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.

Personnel and Training Required

None

Equipment Needs

None

Requirements

Requirement CategoryRequired
Average time of greater than 15 minutes in an unaffected individualNo
Major equipmentNo
Specialized requirements for biospecimen collectionNo
Specialized trainingNo

Mode of Administration

Self-administered

Life Stage:

Adolescent

Specific Instructions:

None

Research Domain Information

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.

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 Score4603777CDE Browser

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_Getting_Into_TroublePX610101010000In general, how much of a problem do you think you have with: ¿¿¿getting into trouble?4N/A
PX610101_Impairment_Youth_Getting_Along_MotherPX610101020000In general, how much of a problem do you think you have with: ¿¿¿getting along with your mother/mother figure.4N/A
PX610101_Impairment_Youth_Getting_Along_FatherPX610101030000In general, how much of a problem do you think you have with: ¿¿¿getting along with your father/father figure.4N/A
PX610101_Impairment_Youth_Feeling_SadPX610101040000In general, how much of a problem do you think you have with: ¿¿¿feeling unhappy or sad?4N/A
PX610101_Impairment_Youth_School_BehaviorPX610101050000How much of a problem would you say you have: ¿¿¿with your behavior at school? (or at your job)4N/A
PX610101_Impairment_Youth_Having_FunPX610101060000How much of a problem would you say you have: ¿¿¿with having fun?4N/A
PX610101_Impairment_Youth_Getting_Along_AdultsPX610101070000How much of a problem would you say you have: ¿¿¿getting along with adults other than (your mother and/or your father)?4N/A
PX610101_Impairment_Youth_Feeling_NervousPX610101080000How much of a problem do you have: ¿¿¿with feeling nervous or afraid?4N/A
PX610101_Impairment_Youth_Getting_Along_SiblingsPX610101090000How much of a problem do you have: ¿¿¿getting along with your sister(s) and/or brother(s)?4N/A
PX610101_Impairment_Youth_Getting_Along_PeersPX610101100000How much of a problem do you have: ¿¿¿getting along with other kids your age?4N/A
PX610101_Impairment_Youth_Sports_HobbiesPX610101110000How much of a problem would you say you have: ¿¿¿getting involved in activities like sports or hobbies?4N/A
PX610101_Impairment_Youth_School_WorkPX610101120000How much of a problem would you say you have: ¿¿¿with your school work (doing your job)?4N/A
PX610101_Impairment_Youth_Home_BehaviorPX610101130000How much of a problem would you say you have: ¿¿¿with your behavior at home?4N/A