The GAF is a 100-point tool rating overall psychological, social and

occupational functioning of people over 18 years of age and older. It

excludes physical and environmental impairment.

The GAF is included in the Diagnostic and Statistical Manual of

Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) in the
section on multi-axial assessments.

Superior functioning in a wide rage of activities, life's problems never seem to get
91-100 out of hand, is sought out by others because of his or her many qualities. No
symptoms.
Absent or minimal symptoms, good functioning in all areas, interested and
90-81 involved in a wide range or activities, socially effective, generally satisfied with
life, no more than everyday problems or concerns.
If symptoms are present they are transient and expectable reactions to
80-71 psychosocial stresses; no more than slight impairment in social, occupational, or
school functioning
Some mild symptoms OR some difficulty in social, occupational, or school
70-61 functioning, but generally functioning pretty well, has some meaningful
interpersonal relationships.
Moderate symptoms OR any moderate difficulty in social, occupational, or
60-51
school functioning.
Serious symptoms OR any serious impairment in social, occupational, or school
50-41
functioning.
Some impairment in reality testing or communication OR major impairment in
40-31 several areas, such as work or school, family relations, judgment, thinking, or
mood.
Behavior is considered influenced by delusions or hallucinations OR serious
30-21
impairment in communications or judgment OR inability to function in all areas.
Some danger or hurting self or others OR occasionally fails to maintain minimal
20-11
personal hygiene OR gross impairment in communication.
Persistent danger of severely hurting self or others OR persistent inability to
10-1 maintain minimum personal hygiene OR serious suicidal act with clear
expectation of death
100-point rating scale measuring psychological, social and
school functioning for children aged 6-17. It was adapted
from the Adult Global Assessment Scale and is a valid and
reliable tool for rating a child's general level of functioning
on a health-illness continuum.
Superior functioning in all areas (at home, at school and with peers),
involved in a range or activities and has many interests (e.g., has hobbies or
100-
participates in extracurricular activities or belongs to an organized group
91
such as Scouts, etc.). Likable, confident, "everyday" worries never get out of
hand. Doing well in school, no symptoms
Good functioning in all areas. Secure in family, school and with peers.
There may be transient difficulties and "everyday" worries that occasionally
90-81
get out of hand (e.g. mild anxiety associated with an important exam,
occasional "blow ups" with siblings, parents or peers).
No more than slight impairment in functioning at home, at school,
or with peers. Some disturbance of behavior or emotional distress may be
present in response to life stresses (e.g., parental separations, deaths, births
80-71
of a sib) but these are brief and interference with functioning is transient.
Such children are only minimally disturbing to others who are not
considered deviant by those who know them.
Some difficulty in a single area, but generally functioning pretty
well, (e.g., sporadic or isolated antisocial acts, such as occasionally playing
hooky or petty theft; consistent minor difficulties with school work, mood
changes of brief duration; fears and anxieties which do not lead to gross
70-61
avoidance behavior; self doubts). Has some meaningful interpersonal
relationships. Most people who do not know the child well would not
consider him/her deviant but those who do know him/her well might
express concern.
Variable functioning with sporadic difficulties or symptoms in
several but not all social areas. Disturbance would be apparent to those who
60-51
encounter the child in a dysfunctional setting or time but not those who see
the child in other settings.
Moderate degree of interference in functioning in most social
areas or severe impairment of functioning in one area, such as
might result from, for example, suicidal preoccupations and ruminations,
50-41 school refusal and other forms of anxiety, obsessive rituals, major
conversion symptoms, frequent anxiety attacks, frequent episodes of
aggressive or other antisocial behavior with some preservation of
meaningful social relationships.
 Major impairment in functioning in several areas and unable to
function in one of these areas, i.e., disturbed at home, at school, with
peers, or in the society at large, e.g., persistent aggression without clear
instigation; markedly withdrawn and isolated behavior due to either mood
40-31
or thought disturbance, suicidal attempts with clear lethal intent. Such
children are likely to require special schooling and/or hospitalization or
withdrawal from school (but this is not a sufficient criterion for inclusion in
this category).
Unable to function in almost all areas, e.g., stays at home, in ward or
in bed all day without taking part in social activities OR severe impairment
30-21
in reality testing OR serious impairment in communication (e.g., sometimes
incoherent or inappropriate).
Needs considerable supervision to prevent hurting other or self, e.g.,
frequently violent, repeated suicide attempts OR to maintain personal
20-11 hygiene OR gross impairment in all forms of communication, e.g., severe
abnormalities in verbal and gestural communication, marked social
aloofness, stupor, etc.
Needs constant supervision (24-hour care) due to severely aggressive or
10-1 self-destructive behavior or gross impairment in reality testing,
communication, cognition, affect, or personal hygiene.
Case #1

Sheri is a 47 year old African American female with Borderline Personality Disorder. She
has a history of substance abuse. She has a long history of crisis contacts, mostly around
her depression and relationship issues. She entered a Dialectical Behavioral Program
about a year ago. Since that time, she has had only one crisis contact and no self-abusive
behaviors. Sheri broke up with her boyfriend about six months ago and has been single
ever since. She has been in a women's support group for the past five months. She has
maintained a job for the past 18 months and is seen as an "excellent waitress." She says
that, aside from some minor conflicts with her sister, her life is going well in all areas.

Case #2
Ted is a 52-year-old Caucasian male with Schizoaffective Disorder. He had a severe
decompensation four years ago where he attempted to stab a County Designated Mental
Health Professional who was evaluating him for involuntary detention to a state hospital.
He was just released from the Legal Offender Unit of the state hospital six months ago.
Ted is in a supported housing placement since his release and is stable on his
medications. He is seeing his outpatient psychiatrist monthly for medication management
and has been attending a day treatment program for the past month. Ted's thinking is
relatively clear. He reports no significant relationships outside of the contact and support
he receives from his mother and brother. He also notes a low level of depression and a
general lack of interest in daily activities

Case #3
Rebecca is a 23 year-old Asian American female. She is currently diagnosed with Bipolar
Disorder. From 11-17 years old, she was psychiatric hospitalized on five occasions due to
suicide attempts. She is currently employed at the local mall, is returning to the
University next semester, and has been dating her current boyfriend for over six months.
Rebecca reports this is the most stable her life has been since she can remember. She also
acknowledges a low level of anxiety and depression as the structure and stability
continues

Case #4
Jake is a 20 year-old Caucasian male who had his first psychotic break last year. He is
diagnosed as Schizophrenic but has refused medications. His grandparents are currently
paying for his apartment. Jake smokes marijuana 4-7 times a week. He had enrolled in
the auto-body program at the local community college but is being dropped from
registration due to poor attendance. The majority of his thinking revolves around
delusions regarding government conspiracies. Jake has no friends and spends most of his
time camping up in the woods.

Case # 5
Rick is a 54 year-old, African-American, male with a diagnosis of Post-Traumatic Stress
Disorder with paranoid features. His onset of symptoms coincided with his service in
Vietnam. Rick was married when he was 27 years old and was divorced just over a year
later. He has dated sporadically, but has not had a relationship in 8 years. He lives in a
trailer on his parent's property. His parents are supportive and set clear boundaries. They
are also supporting his 92 year-old grandmother and are having a difficult time with
Rick's level of stress and anxiety. Rick is resistant to mental health services. He just lost
the factory job he had obtained six weeks ago. He has a meeting next week with the
Division of Vocational Rehabilitation.

Case #6
Kim is a 31 year old Caucasian female with Major Depression. She has a history of heavy
alcohol abuse and has been in inpatient chemical dependency treatment programs. Her
family of origin has a long history of mental illness and chemical dependency on both
sides. She is currently in a co-dependent relationship with an abusive boyfriend. Kim's
mother tries to support her, but is regularly involved in heavy alcohol use. Kim is on the
verge of losing another job and is expressing suicidal ideation, but has agreed to a "no
harm" contract.

Case #7
Marie is a 35 year-old Hispanic female living in a rural agricultural community. She has
been diagnosed with Post-Traumatic Stress Disorder and Psychosis. She has auditory and
olfactory hallucinations. Marie lived with her father after two failed marriages, both
involving domestic violence. Her father is an elderly migrant farm worker who cannot
care for her any longer. She was recently discharged from a 21-day community
hospitalization. Marie is tentatively stable in her Section 8 housing with a caregiver in her
home 6 hours daily to assist with chores and meals. She is sporadically attending the local
day treatment program.

Case # 8
Robert is a 71 year-old Caucasian male with a full-scale IQ of 83. He is obese,
incontinent, and suffers from esophageal reflux, which causes him to choke. He has Post-
Traumatic Stress Disorder from severe sexual and physical abuse by his alcoholic
stepfather. He is unable to maintain his own hygiene and needs assistance with his ADLs.
Robert has been getting increasingly agitated and verbally aggressive towards his new
male in-home caregiver.

Case # 9
Colin is a 31 year-old Caucasian male. He lived with his family until he was 26 years old.
There was a long history of domestic violence in his home growing up. Five months after
he moved out, his mother passed away. Colin has a history of substance abuse and
schizophrenia. He has been medication compliant for the last several years and is
currently in substance abuse treatment, though he is early in his recovery process. Colin
struggles with his hygiene issues and has been unable to hold a job. He spends some time
with his father but really wants to develop more peer relationships and a normal social
life
Case # 10

Frances is a 51 year-old Hispanic/Native American female with Schizophrenia - paranoid

type. From 1967, she was hospitalized 19 times over ten years. When she decompensates,
she becomes psychotic and very assaultive. She currently lives in a congregate care
facility. Historically, her placement has been in jeopardy with her frequent disruptions.
Her medications were adjusted again 2 months ago and she has been more aggressive and
recently assaulted her roommate with her dinner tray and had to be restrained.

Case # 11
Delia is a 64 year-old Caucasian woman with Paranoid Personality Disorder. She was
discharged eight months ago after two years in the state psychiatric hospital. She was
placed in a supported living home with four other women. In the past two months, Delia
has learned the bus system and goes shopping and on outings several times a week. Her
children are shocked by her improved functioning and her granddaughter is visiting her
every Sunday. In the next few weeks, Delia and her roommate will join the local senior
center

Case # 12
Abby is a 29 year-old Caucasian female. She is bulimic with a history of hospitalizations.
She is also diagnosed with Bipolar Disorder and Generalized Anxiety Disorder. Abby has
a 13 year-old daughter whom her parents adopted ten years ago. Her apartment is not
very well kept, she is isolating from her family and friends, and her job is in jeopardy due
to her frequent absences

Case # 13

Victor is a 48-year-old Caucasian male who had his leg amputated while serving in
Vietnam. He is diagnosed with Post-Traumatic Stress Disorder and Paranoia. Victor has
had suicidal ideation since his time in the service. His family lives in the Midwest and he
has not had any contact with them for over five years. He is currently homeless and was
released 3 days ago from a 8-day psychiatric hospitalization after a serious suicide
attempt. He has been using drugs and alcohol for the past three days and is threatening
suicide again.

Case # 14

Cameron is a 15y/o Caucasian male with Attention Deficit Hyperactivity Disorder,

Asperger's Disease, and is learning disabled. His father is in prison. He has a history of
legal involvement and has been in and out of juvenile facilities and psychiatric hospitals
for years. He has just been released from juvenile detention and his mother says that his
behavior is already out-of-control. He started a fire out in the garage requiring the fire
department to come to the home.
Case # 15

Robbie is a 13 y/o Caucasian male. His mother suffers from a major mental illness and
rejected him from birth. His grandmother has been struggling to raise him over the years.
Robbie has a history of stealing and destroying property. He was recently shoved a hose
in the neighbor's basement and turned it on while they were gone for the weekend. He has
been arrested and his grandmother is saying she can no longer manage his behaviors

Case # 16

Jake is an 8 y/o Caucasian male with ADHD and Bipolar disorder. He has a history of
self-harm behavior and aggression towards his mother. His mother called saying her son
is very emotional and threatening to kill himself. She says he is rolling on the floor,
pulling at his hair, crying, and repeating over and over that he just wants to die.

Case # 17

Kristen is a 7 year old Caucasian female. Her mother says her oppositional behavior had
been present since she was two years old. She was a child that refused to share and had
been very aggressive towards her younger sister with biting and hitting. Her mother says
that since she has been in school this year, all of those behaviors have ceased. Kristen's
teacher says she is very helpful in class and is always helping slower students out with
their work. While she is not always compliant at home, her mother says that she is not
acting out aggressively towards anyone in the home. Kristen has also become friends
with three kids in the neighborhood and plays with them daily