Use items as probes to elicit the patients complete symptom repertoire. Internal consistency was very good for total score and subscales of both versions of the scale (Cronbach's =.70-.90). author = "Langley, {Audra K.} and Avital Falk and Tara Peris and Wiley, {Joshua F.} and Kendall, {Philip C.} and Golda Ginsburg and Boris Birmaher and John March and Albano, {Ann Marie} and John Piacentini". The https:// ensures that you are connecting to the WebThe Preschool Anxiety Scale (PAS) is a 28 item scale that is completed by a parent / guardian and which assesses anxiety in children between the ages of 2 and 6 years ______ ______ ______ OTHER 45. Lastly, the CALIS demonstrates strong test-retest reliability; pre- and post-waitlist administrations of the CALIS produced significant correlations. Symptom Checklist: The symptom checklist is the first of the two major sections of the PARS. The Multidimensional Anxiety Scale for Children (MASC; March, Parker, Sullivan, Stallings, & et al., 1997) is a 39-item self-report measure of anxiety symptoms A repository of free psychological assessment tools. We use cookies to improve your website experience. WebA reliability generalization of the Revised Children's Manifest Anxiety Scale (RCMAS) was conducted using the normative sample. The purpose of the current investigation was to examine the factor structure, reliability, and construct validity of both the Child and Parent version of the Child Anxiety Impact Scale (CAIS) using data obtained from the Child/Adolescent Anxiety Multimodal Study (Walkup et al., 2008 ). Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety . Obviously, there is considerable overlap in symptoms among these anxiety disorders. ______ ______ ______ 18. The total score ranges from 0 to 35. Internal consistency was very good for total score and subscales of both versions of the scale (Cronbach's =.70-.90). Reluctance or refusal to go to sleep alone. J Affect Disord. ______ ______ ______ 33. Of substantial clinical significance. 8600 Rockville Pike Moderate: Persistent physical symptoms of anxiety, especially during exposure 3 to the feared situation(s). The Child Anxiety Impact Scale : Examining Parent- and Child-Reported Impairment in Child Anxiety Disorders. The requirement of local anesthetic administration (in maxilla/mandible) for pulp therapies/extraction of primary teeth. a group of 20 things. The first answer would lead to the score of 5 on the UGDS gender dysphoria scale, indicating the highest possible level of gender dysphoria. No interference. Overall Avoidance of Anxiety-Provoking Situations NOTE: Rate all avoidance here; include school, home, activities, etc. Powered by Pure, Scopus & Elsevier Fingerprint Engine 2023 Elsevier B.V. We use cookies to help provide and enhance our service and tailor content. stream Journal of Anxiety Disorders,25(3), 450-5. doi: 10.1016/j.janxdis.2010.11.009, Yale Brown Obsessive Compulsive Scale (Y-BOCS), Short Post-Traumatic Stress Disorder Rating Interview (SPRINT). 0 Minimal: Very occasionally avoids the anxiety-provoking situation(s). Sports & Games a. Although the five first-order factors loaded strongly upon the higher-order anxiety factor, there was sufficient unique variance (between 40 and 60%) explained by three of the first order factors (social anxiety, obsessive compulsive disorder and fears of physical injury) to justify regarding them as dimensions worthy of independent consideration. 2004 Spring;14(1):105-14. doi: 10.1089/104454604773840544. ______ ______ ______ 23. Did you know that with a free Taylor & Francis Online account you can gain access to the following benefits? Severe: Marked physical symptoms of substantial clinical significance. Did you know that with a free Taylor & Francis Online account you can gain access to the following benefits? Register a free Taylor & Francis Online account today to boost your research and gain these benefits: The Child Anxiety Impact Scale: Examining Parent- and Child-Reported Impairment in Child Anxiety Disorders, Division of Child and Adolescent Psychiatry, University of California , Los Angeles, Psychology Department , University of California , Los Angeles, Department of Psychiatry and Biobehavioral Sciences , University of California , Los Angeles, Department of Psychology , Temple University, Department of Psychiatry , Johns Hopkins University, Department of Psychiatry , University of Pittsburgh Medical Center, Department of Psychiatry and Behavioral Sciences , Duke University Medical Center, Division of Child and Adolescent Psychiatry , Columbia University, /doi/full/10.1080/15374416.2013.817311?needAccess=true, Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. By continuing you agree to the use of cookies, Langley, Audra K. ; Falk, Avital ; Peris, Tara et al. Confirmatory factor analysis revealed that the a priori three-factor structure (school, social, and home/family) for the CAIS parent- and CAIS child-report was a reasonable fit, with a comparative fit index of.88 and root mean square error of approximation of.05. Sample Probes for Severe: Marked interference in relationships with family members and/or 4 performance at home. See more. Get Free Business Advice SCORE mentors know what its like to be a small business owner. ______ ______ ______ 42.Chest pain or discomfort. Journal of Clinical Child & Adolescent Psychology. Albano , A. M. , The structure of anxiety symptoms among preschoolers. Nightmares with a separation theme. The RCMAS consists of a Total Anxiety scale as Fear or reluctance to be alone. Moderate: Clear interference. Each item is rated on a four-point Likert-type response scale ranging from Never true about me (0) to Often true about me (3). The CAIS total scores demonstrated good construct validity, showing predicted significant correlations with the Child Behavior Checklist (CBCL) Internalizing Scale, the Multidimensional Anxiety Scale for Children (MASC) and Screen for Child Anxiety Related Emotional Disorders (SCARED) Total Scores, the Pediatric Anxiety Rating Scale, and the Children's Global Assessment Scale. Complaints of physical symptoms when separation occurs or is anticipated. ______ ______ ______ 4. Families participated in a structured diagnostic interview and then completed the CAIS along with other measures. 3 0 obj Internal consistency was very good for total score and subscales of both versions of the scale (Cronbach's =.70.90). Bethesda, MD 20894, Web Policies The SCAS consists of 44 items of which 6 are filler items. Piacentini , J. C. , No impact on relationships 1 with family members or performance (tasks, etc.) ______ ______ ______ 37. Difficulty concentrating or mind going blank. This site includes information about the Spence Children's Anxiety Scale (Child and Parent Versions) and the Preschool Anxiety Scale, plus other resources developed by the author and colleagues that you may find useful. The CALIS contributes to the development of a comprehensive understanding of a childs experience of anxiety by using multiple raters to evaluate its impact across multiple activities. The scales are copyrighted to the author and may not be reprinted in full in any publication nor resold for commercial purposes. Webscore: [noun] twenty. Registered in England & Wales No. Psychometric properties of the Child Anxiety Life Interference Scale (CALIS). title = "The Child Anxiety Impact Scale: Examining Parent- and Child-Reported Impairment in Child Anxiety Disorders". Confirmatory factor analysis revealed that the a priori three-factor structure (school, social, and home/family) for the CAIS parent- and CAIS child-report was a reasonable fit, with a comparative fit index of.88 and root mean square error of approximation of.05. Use the anchors for each item to assist the child and parent in establishing severity. To learn about our use of cookies and how you can manage your cookie settings, please see our Cookie Policy. Intermediate between 3 and 5. In addition, CAIS Social and School subscales were significantly related to similar subscales on the CBCL, SCARED, and MASC. Langley, Audra K. ; Falk, Avital ; Peris, Tara et al. AB - The purpose of the current investigation was to examine the factor structure, reliability, and construct validity of both the Child and Parent version of the Child Anxiety Impact Scale (CAIS) using data obtained from the Child/Adolescent Anxiety Multimodal Study (Walkup et al., 2008). Of substantial clinical significance. Participants were 488 children ages 7 to 17 (M age = 10.7, SD = 2.8 years) enrolled as part of the CAMS study across 6 sites and their primary parent or caregiver. Families participated in a structured diagnostic interview and then completed the CAIS along with other measures. Has fear of and/or avoids participating in group activities. Reluctant or refuses to change into gym clothes or bathing suit with others present. a T-score of 10 points above the mean T-score of 50 ) is approximately 1 standard deviation above the mean. Behaviour Research and Therapy, 36, 545566. Wright B, Tindall L, Scott AJ, Lee E, Biggs K, Cooper C, Bee P, Wang HI, Gega L, Hayward E, Solaiman K, Teare MD, Davis T, Lovell K, Wilson J, McMillan D, Barr A, Edwards H, Lomas J, Turtle C, Parrott S, Teige C, Chater T, Hargate R, Ali S, Parkinson S, Gilbody S, Marshall D. Health Technol Assess. There is rising concern about population mental health. Bookshelf Does not avoid the anxiety-provoking situation(s). Crying spells when in anxiety-provoking situations. xna_N!{#Aaq&A([%"t-qHmrtt,tT~::)ttGntwY:SAC6,d&1\Ifd? C'v`D8xh^,f9.w?1`_XB51 ;{n>gR8NDt,6A`A6YCC;fg#WYvh1N#)TE4Cy&xpj%Lv xqC]v UR - http://www.scopus.com/inward/record.url?scp=84904403641&partnerID=8YFLogxK, JO - Journal of Clinical Child and Adolescent Psychology, JF - Journal of Clinical Child and Adolescent Psychology. The results provide support that the CAIS is a reliable and valid measure for the assessment of the impact of anxiety on child and adolescent functioning. Registered in England & Wales No. Either performance of tasks at home or frequency 3 or quality of interaction with family members is affected: he/she might withdraw from interaction, or might be avoided/rejected by family members, or might have many conflicts with them. Some children do things to make sure they stay near their mother or father? Physical Signs/ Symptoms: Sometimes children notice feelings or changes in their bodies when they are anxious or worried? author = "Langley, {Audra K.} and Avital Falk and Tara Peris and Wiley, {Joshua F.} and Kendall, {Philip C.} and Golda Ginsburg and Boris Birmaher and John March and Albano, {Ann Marie} and John Piacentini". No impact on functioning outside of home, e.g., attending and performing group activities. 2022 Oct;26(42):1-174. doi: 10.3310/IBCT0609. Participants were 488 children ages 7 to 17 (M age = 10.7, SD = 2.8 years) enrolled as part of the CAMS study across 6 sites and their primary parent or caregiver. WebBackground: Perioperative experience can be one of the most distressful experiences in a child's life if not managed properly by healthcare professionals. https://doi.org/10.1016/s0005-7967(00)00098-x, https://doi.org/10.1037//0021-843x.106.2.280, https://doi.org/10.1016/S0005-7967(98)00034-5, Wender Utah Rating Scale 25 item version (WURS-25), Obsessional Compulsive Inventory Revised (OCI-R), International Trauma Questionnaire Child and Adolescent Version (ITQ-CA). Because the font sizes and layout tends to change when printed out from different computers a fixed scoring template is not provided. The present CALIS freely available from: http://www.mq.edu.au/, Lyneham, H., Sburlati, E., Abbott, M., Rapee, R., Hudson, J., Tolin, D., & Carlson, S. (2013). WebThe Childrens Revised Impact of Event Scale (CRIES) is a brief child-friendly measure designed to screen children at risk for Post-Traumatic Stress Disorder (PTSD), developed The CAIS-P is a 27-item parent self-report measure to assess the impact of a child's anxiety on three categories: school activities, social activities, and home/family Scoring: The total score for the PARS is total of the 7 severity items. All items, which relate to common activities (e.g. 2022 Sep 23. doi: 10.1007/s10578-022-01447-z. Intermediate between 3 and 5. Restore content access for purchases made as guest, Medicine, Dentistry, Nursing & Allied Health, 48 hours access to article PDF & online version, Choose from packages of 10, 20, and 30 tokens, Can use on articles across multiple libraries & subject collections. 2 Borderline clinical significance. Free downloads of this software can be found at. Check that all questions have been answered. Situational (e.g., airplane, elevator): Specify: __________________ ______ ______ ______ ACUTE PHYSICAL SIGNS & SYMPTOMS 32. Phillips KE, Buinewicz SAP, Kagan E, Frank HE, Dunning E, Benito KG, Kendall PC. 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. The New England Journal of Medicine , 359 , 2753 2766 . 2022 Oct 22;23(1):896. doi: 10.1186/s13063-022-06773-0. WebThe Academic Anxiety Scale is a recent measure of academic anxiety, developed and psychometrically validated in 2019. WebS.E. This is because the mean scores tend to be different between boys and girls and tend to change with age. It is not designed to be a diagnostic instrument for use in isolation although it provides important information to inform the assessment process. You or your institution has to pay for the scale: Impairment in Childhood Anxiety Disorders: Preliminary Exami The CAIS child and parent versions measure anxiety-related functional impairment in school, social, and family domains. Problems swallowing or eating. The CAIS total scores demonstrated good construct validity, showing predicted significant correlations with the Child Behavior Checklist (CBCL) Internalizing The PARS has two sections: the symptom checklist and the severity items. Web5 Steps for Mentoring. 2014;43(4):566-78. doi: 10.1080/15374416.2013.814541. Usually, for pre-teens, the interviewer starts with the parent(s) alone and subsequently interviews the child alone. ______ ______ ______ 8. Personality and mental health traits manifest early. Symptoms are noticeable by others and significantly interfere with his/her ability to function in the situation. Severe: Avoids anxiety-provoking situation most of the time 4 or more than one important situation is consistently avoided. However, due to limited evaluations of the scales 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. They cannot be modified, such as changing the wording of questions, the response format, nor by adding or removing questions. Intermediate between 3 and 5. A measure of anxiety symptoms among children. Temper tantrums when in anxiety-provoking situations. Impairment in childhood anxiety disorders: preliminary examination of the child anxiety impact scale-parent version. official website and that any information you provide is encrypted Internal consistency was very good for total score and subscales of both versions of the scale (Cronbach's =.70-.90). There is rising concern about population mental health. For clinical trials, severity is based on the sum of items #2,3,5,6, and 7. Webhow to score the child anxiety impact scale Have Any Questions? Let me give you some examples. For example, a percentile of 50 indicates the child has average levels of anxiety when compared to non-clinical preschool aged children. 1 0 obj ______ ______ ______ 12. ______ ______ ______ 22. Methods A cross-sectional study was ______ ______ ______ 47. Often unable to overcome these feelings. doi = "10.1080/15374416.2013.817311". 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. ______ ______ ______ 19. The CAIS child and parent versions measure anxiety-related functional impairment in school, social, and family domains. Families participated in a structured diagnostic interview and then completed the CAIS along with other measures. Participants were 488 children ages 7 to 17 (M age = 10.7, SD = 2.8 years) enrolled as part of the CAMS study across 6 sites and their primary parent or caregiver. In addition, CAIS Social and School subscales were significantly related to similar subscales on the CBCL, SCARED, and MASC. Confirmatory factor analysis revealed that the a priori three-factor structure (school, social, and home/family) for the CAIS parent- and CAIS child-report was a reasonable fit, with a comparative fit index of .88 and root mean square error of approximation of .05. 2007 Feb;46(2):252-60. doi: 10.1097/01.chi.0000246065.93200.a1. Trending News & Rumors for Football, Basketball, Baseball, Hockey, Soccer & More Chills or hot flashes. Unable to load your collection due to an error, Unable to load your delegates due to an error. Overall Number of Anxiety Symptoms (Circle code for past week only) Code Not applicable 8 Does not know 9 No symptoms 0 1 symptom 1 2-3 symptoms 2 4-6 symptoms 3 7-10 symptoms 4 More than 10 symptoms 5 Overall Frequency of Anxiety Symptoms Not applicable 8 Does not know 9 No symptoms 0 1 or 2 days a week 1 3 or 4 days a week 2 5 or 6 days a week 3 Daily 4 Several hours every day 5 Overall Severity of Anxiety Feelings Not applicable 8 Does not know. Feels sick to stomach, nausea or abdominal distress. Keeps distance from other people. Interference with Peer and Adult Relationships &/or Performance Outside of Home. Confirmatory factor analysis revealed that the a priori three-factor structure (school, social, and home/family) for the CAIS parent- and CAIS child-report was a reasonable fit, with a comparative fit index of .88 and root mean square error of approximation of .05. More details regarding the psychometric properties of the Academic Anxiety Register a free Taylor & Francis Online account today to boost your research and gain these benefits: The Child Anxiety Impact Scale: Examining Parent- and Child-Reported Impairment in Child Anxiety Disorders, Division of Child and Adolescent Psychiatry, University of California , Los Angeles, Psychology Department , University of California , Los Angeles, Department of Psychiatry and Biobehavioral Sciences , University of California , Los Angeles, Department of Psychology , Temple University, Department of Psychiatry , Johns Hopkins University, Department of Psychiatry , University of Pittsburgh Medical Center, Department of Psychiatry and Behavioral Sciences , Duke University Medical Center, Division of Child and Adolescent Psychiatry , Columbia University, /doi/full/10.1080/15374416.2013.817311?needAccess=true, Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. Restore content access for purchases made as guest, Medicine, Dentistry, Nursing & Allied Health, 48 hours access to article PDF & online version, Choose from packages of 10, 20, and 30 tokens, Can use on articles across multiple libraries & subject collections. Intermediate between 1 and 3. The purpose of this PEDIATRIC ANXIETY RATING SCALE (PARS) SYMPTOM CHECKLIST Instructions: Fill in the blanks with 1 (yes), 2 (no), or 9 (other, e.g., unable or unwilling to answer) SOCIAL INTERACTIONS or PERFORMANCE SITUATIONS Parent Child Rater 1. The results provide support that the CAIS is a reliable and valid measure for the assessment of the impact of anxiety on child and adolescent functioning. Sweating. (2013) advise that the CALIS be used in conjunction with symptom-specific scales, as it cannot independently support a diagnosis of anxiety. Mother-child disagreement in reports of child anxiety: Effects of child age and maternal anxiety. J Am Acad Child Adolesc Psychiatry. Families participated in a structured diagnostic interview and then completed the CAIS along with other measures. 5 Howick Place | London | SW1P 1WG. Then the interviewer asks if there have been any new symptoms during the past week. WebDefine score. In addition, CAIS Social and School subscales were significantly related to similar subscales on the CBCL, SCARED, and MASC. Let me give you some examples (refer to list). https://doi.org/10.1016/s0005-7967(00)00098-x, Spence, S. H. (1997). ->A2\)Az5X6`} 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). Hi Michele, I guess you have the article. Just in case, I include it. It is best that you ask the authors for the instrument. I have tried to find ______ ______ ______ 25. dog), etc? Participants were 488 children ages 7 to 17 (M age = 10.7, SD = 2.8 years) enrolled as part of the CAMS study across 6 sites and their primary parent or caregiver. This represents around the 84th percentile meaning that around 16% of children would be expected to show a score at this level and suggests elevated anxiety. Clipboard, Search History, and several other advanced features are temporarily unavailable. https://doi.org/10.1037//0021-843x.106.2.280, Spence, S. H. (1998). Reardon T, Ball S, Breen M, Brown P, Day E, Ford T, Gray A, Green I, Hill C, Jasper B, King T, Larkin M, Macdonald I, Morgan F, Pollard J, Sancho M, Sniehotta FF, Spence SH, Stallard P, Stainer J, Ukoumunne OC, Violato M, Williams C, Williamson V, Creswell C. Pilot Feasibility Stud. and the Total Anxiety Index identifies respondents whose anxiety scores warrant further clinical follow-up. Get resources for every stage of your business. Mild: Avoids anxiety-provoking situation(s) some of the time 2 but no important situation is consistently avoided. The time frame for the PARS rating is the past week. WebThe support of affected parents can positively impact the treatment of the child and should be integrated into the daily routine of the clinic. Currently, psychometric data for the CALIS is based exclusively on one evaluative study (Lyneham, et. The purpose of the current investigation was to examine the factor structure, reliability, and construct validity of both the Child and Parent version of the Child Anxiety Impact Scale (CAIS) using data obtained from the Child/Adolescent Anxiety Multimodal Study (Walkup et al., 2008). Behaviour research and therapy, 38(8), 835-855. de Ross, R. L., Gullone, E., & Chorpita, B. F. (2002). Would you like email updates of new search results? Fear of losing control or going crazy. +254 705790881 newretrowave bandcamp. 2 ` Borderline clinical significance. Easily fatigued. Participants were 488 children ages 7 to 17 (M age = 10.7, SD = 2.8 years) enrolled as part of the CAMS study across 6 sites and their primary parent or caregiver. Sufficient nutrition is fundamental to early development. The severity items are meant to elicit information about average symptom severity over the past week. Has fear of and/or avoids talking on the phone. Muscle tension or nonspecific tension. The RCMAS consists of a Total Anxiety scale as well as four subscales. Not clinically significant. Clings to parent, or follows parent around the house. Set goals for your small business with guidance from your SCORE mentor. The results provide support that the CAIS is a reliable and valid measure for the assessment of the impact of anxiety on child and adolescent functioning. WebThe GAD-7 is a self-assessment scale validated to screen for generalised anxiety disorder and to estimate the severity of symptoms present in the last two weeks by assigning an With some families, it may be preferable to interview the child and parent(s) together. For a follow-up rating, the interviewer can describe to the subject the symptoms that were endorsed at the prior rating. According to this study, the CALIS demonstrates moderate internal consistency, with Cronbachs Alphas ranging from .84 for children to .90 for mothers. Journal of Abnormal Psychology, 106, 280297. This is a trusted computer. WebA T-score of less than 60 (a percentile score less than 85%) can be said to be in the "normal" range. AB - The purpose of the current investigation was to examine the factor structure, reliability, and construct validity of both the Child and Parent version of the Child Anxiety Impact Scale (CAIS) using data obtained from the Child/Adolescent Anxiety Multimodal Study (Walkup et al., 2008). The goal of the checklist is to document the array of the patients symptoms that will be used to establish severity during the ratings of severity items. ______ ______ ______ 9. Symptoms are very obvious to others and often result in inability to function in the situation. For comprehensive information visit the Spence Childrens Anxiety Scale website at: www.scaswebsite.com Scores consist of a total raw score (range from 0 to 114) and six sub-scale scores, with higher scores indicating greater severity of anxiety symptoms. Intermediate between 1and 3. ______ ______ ______ 48. Confirmatory factor analysis revealed that the a priori three-factor structure (school, social, and home/family) for the CAIS parent- and CAIS child-report was a reasonable fit, with a comparative fit index of.88 and root mean square error of approximation of.05. The CAIS child and parent versions measure anxiety-related functional impairment in school, social, and family domains. ______ ______ ______ 11. Reliability and validity of parent and child versions of the multidimensional anxiety scale for children in community samples. Spence, S. H., Rapee, R., McDonald, C., & Ingram, M. (2001). 2022 Aug 10;8(1):176. doi: 10.1186/s40814-022-01140-x. Careers. ______ ______ ______ 36. The purpose of the current investigation was to examine the factor structure, reliability, and construct validity of both the Child and Parent version of the Child Anxiety Webhow to score the child anxiety impact scale Have Any Questions? ______ ______ ______ 43. Journal of Abnormal Psychology, 106, 280297. WebGet Live Cricket Score, Ball by Ball Commentary, Scorecard Updates, Match Facts & related News of all IPL 2020 Matches, International & Domestic Cricket Matches across the globe. Families participated in a structured diagnostic interview and then completed the CAIS along with other measures. Extreme: Totally or almost totally unable to maintain appropriate peer or 5 adult relationship and/or function outside of home. ' Accessibility WebBACKGROUND: Anxiety is highly prevalent in autistic adults and can cause a significant impact on functioning and quality of life. The CAIS child and parent versions measure anxiety-related functional impairment in school, social, and family domains. 4 0 obj Spence, S. H. (1997). WebThe purpose of the current investigation was to examine the factor structure, reliability, and construct validity of both the Child and Parent version of the Child Anxiety Impact Scale WebIMPORTANT NOTE: Psychometric analyses and mean scores are based on reports of children presenting for assessment of anxiety, of whom 92.3% were assessed as having U01 MH064003/MH/NIMH NIH HHS/United States, U01 MH064088/MH/NIMH NIH HHS/United States, U01 MH064089/MH/NIMH NIH HHS/United States. INSTRUCTIONS Overview: The Pediatric Anxiety Rating Scale (PARS) is to be used to rate the severity of anxiety in children and adolescents, ages 6 to 17 years. The results provide support that the CAIS is a reliable and valid measure for the assessment of the impact of anxiety on child and adolescent functioning.