By:
SOPHIA F.
DZIEGIELEWSKI
In DSM-5, the multi-axial diagnostic system was eliminated as an option for diagnostic coding, and with this deletion was the expected recording of the individual level of functioning. The purpose of Axis V in the previous version of the DSM was to measure the behavioral functioning of an individual over the previous year.
To complete this task, the Generalized Assessment
of Functioning (GAF) scale was designed to enable the practitioner to differentially rank identified behaviors from 1 to 100, with higher
ratings indicating higher overall functioning and coping levels. By rating the highest level of
functioning a client had attained over the past year and then comparing it to his or her current
level of functioning, this measure provided helpful, repeated comparisons of changes in functioning. The GAF was first introduced in DSMIV.
ratings indicating higher overall functioning and coping levels. By rating the highest level of
functioning a client had attained over the past year and then comparing it to his or her current
level of functioning, this measure provided helpful, repeated comparisons of changes in functioning. The GAF was first introduced in DSMIV.
One major change between DSM-IV and DSM-IV-TR related to the
supplemental use of this scale, providing more detailed
instructions on how to apply the GAF. According to the DSM-5 task force, the major problem with the GAF that resulted
in its being dropped was the lack of clarity in
the numbered divisions and what each 10-digit
interval actually stood for, leading to questionable
psychometric properties (APA, 2013).
To replace the GAF, a global measure of
disability, the WHO Disability Assessment
Schedule (WHODAS, version 2.0), was adopted and
included in Section III. The WHODAS is based
on the International Classification of Functioning, Disability and Cognitive Health (ICF) and
can be used with adults and, in a separate version, with caregivers. The adult version is a 36-item self-administered measure for those age 18 and older that assesses disability across six domains.
on the International Classification of Functioning, Disability and Cognitive Health (ICF) and
can be used with adults and, in a separate version, with caregivers. The adult version is a 36-item self-administered measure for those age 18 and older that assesses disability across six domains.
The first domain involves understanding and communicating
and utilizes six questions
designed to measure the results of an individual’s cognitive domain. Answers to these six questions can be rated from no disability to so extreme that at its most severe point cognitive functioning can prohibit performance.
designed to measure the results of an individual’s cognitive domain. Answers to these six questions can be rated from no disability to so extreme that at its most severe point cognitive functioning can prohibit performance.
The second area involves five questions related
to how well the client can get around. This
subsection follows a similar scoring format, and
questions assess for problems with standing, moving, and walking inside and outside the home.
The third area is performance of self-care and
how capable the client is with basic skills required for grooming,
such as bathing and dressing, and the degree to
which self-feeding is possible.
The fourth area involves getting along with
people and how the person interacts with people
in his or her support system, as well as how he
or she makes new friends and interacts with
people he or she does not know. There is also
one question related to sexual activities.
The fifth
area relates to basic life activities, including household tasks,
school, and work, and gathers information
related to the appropriate life situation.
The sixth area has eight questions on how the
individual sees his or her role in society, along with any concerns or preoccupations with health.
What all six sections of the adult version of
the WHODAS share is that they assess behaviors over the past 30 days and can be
given as often as needed to examine changes in
individual perceptions and functioning.
The hope is that the WHODAS will assist with
measuring individual functioning and replace
the need for the GAF.Measuring the term clinically significant and how it relates to impairment in social and occupational functioning has always been difficult. The use of this measure is recommended, along with other possible assessment measures listed online (http://www.psychiatry.org/dsm5).
the need for the GAF.Measuring the term clinically significant and how it relates to impairment in social and occupational functioning has always been difficult. The use of this measure is recommended, along with other possible assessment measures listed online (http://www.psychiatry.org/dsm5).
When these measures are combined with getting information
from third parties such as family
members and others in the client’s support system, the most comprehensive diagnostic assessment will be obtained.
members and others in the client’s support system, the most comprehensive diagnostic assessment will be obtained.
References
SOPHIA F.
DZIEGIELEWSK, 2015, DSM-5TM
in Action, by John Wiley & Sons, Inc.
Read Also
Medication-Induced Movement Disorders and Other Adverse Effects of MedicationFactors Influencing Assessment
The Current Status of Health Measurement
Evaluating a Health Measurement: The User’s Perspective
Types of Health Measurements
Brief History of the DSM
The Person-in-Environment Classification System (PIE)
The official nomenclature used in mental health and other health-related facilities
The International Classification of Diseases (ICD)
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