How Can We Measure Functional Impairment in Young People with OCD and Related Disorders?

What you need to know

• A new brief scale called the Work and Social Adjustment Scale for Youth (WSAS-Y) measures how mental health conditions impact daily functioning in young people.
• The scale showed good reliability and validity when tested in youth with OCD and related disorders.
• Both child and parent versions of the scale were found to be sensitive to changes after treatment.

A new tool for assessing functional impairment in youth

When evaluating mental health conditions in young people, it’s important to assess not just symptoms but also how those symptoms impact daily life and functioning. However, existing measures of functional impairment in youth tend to be lengthy or don’t clearly separate symptoms from functional impacts.

Researchers have now adapted a brief functional impairment scale originally developed for adults, called the Work and Social Adjustment Scale (WSAS), for use with children and adolescents. This new youth version, the WSAS-Y, along with a parallel parent version (WSAS-P), shows promise as a quick and effective way to gauge how mental health conditions affect functioning across key life domains.

What the WSAS-Y measures

The WSAS-Y consists of just 5 items that ask young people to rate how much their mental health difficulties impair their ability to function in the following areas:

1. School and work (e.g. schoolwork, part-time jobs)
2. Daily activities (e.g. personal hygiene, chores)
3. Social activities (e.g. hanging out with friends)
4. Hobbies and leisure (e.g. sports, gaming)
5. Family relationships

For each item, youth rate impairment on a 0-8 scale from “not at all impaired” to “very severely impaired.” This generates a total score from 0-40, with higher scores indicating greater overall functional impairment.

The parent version (WSAS-P) asks parents to rate their child’s impairment across the same 5 areas.

Testing the scales in youth with OCD and related disorders

To evaluate how well the WSAS-Y and WSAS-P work, researchers tested the scales in over 500 young people aged 6-19 who were receiving treatment for obsessive-compulsive disorder (OCD) or related conditions like body dysmorphic disorder, tic disorders, and body-focused repetitive behaviors.

The youth and their parents completed the WSAS-Y/P along with other established measures of symptoms and functioning before and after receiving cognitive behavioral therapy treatment.

Key findings on reliability and validity

The study found several indicators that the WSAS-Y and WSAS-P are reliable and valid measures:

• Both scales showed excellent internal consistency, meaning the items hang together well as a cohesive measure.

• Factor analysis revealed the scales measure a single, unified construct of functional impairment.

• The scales correlated strongly with other measures of functional impairment and less strongly with symptom measures, indicating they specifically capture functional impacts rather than just symptoms.

• The child and parent versions were highly correlated with each other, but not perfectly, suggesting they capture overlapping but somewhat distinct perspectives on the child’s functioning.

• Test-retest reliability was adequate, showing the scales produce consistent results when repeated.

Sensitivity to change after treatment

Importantly, WSAS-Y/P scores decreased significantly after youth received cognitive behavioral therapy, demonstrating the scales are sensitive to changes in functioning over the course of treatment.

The scales were able to detect improvements not just in youth with OCD, but also those with related conditions. This suggests the WSAS-Y/P may be broadly applicable across different mental health conditions in young people.

Differences between diagnostic groups

Interestingly, youth with OCD showed higher levels of functional impairment on the WSAS-Y/P compared to those with related disorders as a group. This aligns with clinical observations that OCD tends to be more impairing than some related conditions.

However, there was variability within the related disorders group. Those with body dysmorphic disorder showed similar impairment levels to the OCD group, while those with tic disorders or body-focused repetitive behaviors tended to have milder functional impacts.

This demonstrates the scales can differentiate between conditions associated with different levels of impairment.

Practical implications

The WSAS-Y and WSAS-P offer several potential advantages for use in clinical and research settings:

• Brief and easy to administer, reducing burden on patients and clinicians
• Captures functional impacts separate from symptoms
• Provides perspectives from both youth and parents
• Sensitive to treatment-related changes
• May be applicable across a range of mental health conditions

The researchers suggest using both the youth and parent versions together to get a comprehensive picture of functioning across different contexts.

While further research is needed in other patient groups, these initial results suggest the WSAS-Y/P could be a valuable addition to assessment batteries for young people with mental health conditions. The scales may help clinicians and researchers more efficiently track functional outcomes alongside symptom changes.

Conclusions

• The WSAS-Y and WSAS-P are promising new tools for quickly assessing functional impairment in youth with mental health conditions.
• Initial testing shows the scales are reliable, valid, and sensitive to change in young people with OCD and related disorders.
• Using both youth and parent versions provides complementary perspectives on functioning.
• Further research should evaluate the scales in other mental health conditions and settings.