# Child and Adolescent Symptom Inventory

The Child and Adolescent Symptom Inventory (CASI) is a behavioral rating checklist created by Kenneth Gadow and Joyce Sprafkin that evaluates a range of behaviors related to common emotional and behavioral disorders identified in the Diagnostic and Statistical Manual of Mental Disorders (DSM), including attention deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder, generalized anxiety disorder, social phobia, separation anxiety disorder, major depressive episode, mania, dysthymic disorder (pervasive depressive disorder in DSM-5), schizophrenia, autism spectrum, Asperger syndrome, anorexia, and bulimia. In addition, one or two key symptoms from each of the following disorders are also included: obsessive-compulsive disorder, specific phobia, panic attack, motor/vocal tics (uncontrolled sudden, repetitive movements or sounds), and substance use. CASI combines the Child Symptom Inventory (CSI) and the Adolescent Symptom Inventory (ASI), letting it apply to both children and adolescents, aged from 5 to 18. The CASI is a self-report questionnaire completed by the child's caretaker or teacher to detect signs of psychiatric disorders in multiple settings. Compared to other widely used checklists for youths, the CASI maps more closely to DSM diagnoses, with scoring systems that map to the diagnostic criteria as well as providing a severity score. Other measures are more likely to have used statistical methods, such as factor analysis, to group symptoms that often occur together; if they have DSM-oriented scales, they are often later additions that only include some of the diagnostic criteria.

## Overview

The number of items in the inventory vary by version, but all versions report four separate scores:
* Symptoms count scores which reflect symptoms that are evident and reflect a DSM diagnosis
* Symptom's severity scores that create T scores using normative data-severity scores range from 0 (never) to 3 (very often), and are viewed by a clinician as clinically significant if happening often (2) or very often (3)
* Impairment scores for each sub-category in order to determine the degree to which symptoms for each disorder interfere with functioning in both social and academic settings
* Clinical cutoff scores that compare the symptom count score and impairment score
There are both parent and teacher versions, completed by each, that are submitted to the professional working with the youth at his/her appointment. It is important to acquire information from both of these sources because there are different demands placed on youth in different environments and the different settings bring out different aspects of symptoms for different disorders. Furthermore, one care provider may be better at accurately evaluating symptoms in the youth over others. Lastly, knowing the different settings in which the symptoms manifest in the youth is essential in adapting the most successful treatment plan. The teacher version differs from the parent version in many ways. The main difference is the addition of items that address information regarding behavior in educational settings as well as academic performance to the teacher version. Furthermore, the teacher version excludes disorders that develop primarily in the home setting (i.e., separation anxiety, oppositional defiant disorder), as well as items in the parent checklist that the teacher would be unable to answer (i.e., regarding sleep, eating habits, activity at night). In order to compare the versions most accurately, the teacher version was not renumbered, but instead excludes the items that don't pertain to it. The wording of both version's was made user friendly by replacing psychiatric jargon of the DSM with more easily understood phrases by the care providers.

## Versions

* CASI-4R: This is the original version of the CASI, which combines the CSI-4 and ASI-4 to derive symptom counts that map to behavioral and emotional disorders in the DSM-IV for children and adolescents ages 5 to 18.
** Parent/Caregiver version:142 items, 8 pages
** Teacher version: 105 items, 7 pages
** Research version: 163 items
*** This version is used by longitudinal projects (lots of discussion of do we follow the new criteria because 10 years of data asking it the other way; in general longitudinal projects do no not want to switch halfway through; used by LAMS;
* CASI-5: This version was created in 2013 to include the changes made from the DSM-IV to the DSM-5 and therefore replaces the CASI-4R, however it does include all of the items from the CASI-4R. Changes/additions include the addition of new disorders, as well as changes in names of disorders, symptoms, and scoring for some disorders. The new disorders added to this version include disruptive mood dysregulation disorder, avoidance/restrictive food intake disorder, binge eating disorder, and social communication disorder.
*** Parent/Caregiver-context of the home: 173 items, 8 pages
*** Teacher version-context of school: 125 items, 7 pages

## Development and history

The Clinical Assessment of Symptoms for Individuals (CASI) originated as dual measures intended to aid clinicians in gathering information from caregivers about youths. Developed in the 1980s, these measures aimed to align with psychiatric diagnostic systems, providing a clearer connection to the diagnostic approach used in psychiatry and other professions. The creators sought to create a symptom checklist based on the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), enabling information collection for children in special education services. The goal was to categorize them based on learning and behavioral problems relevant to conventional psychiatric diagnoses, helping clinicians form diagnostic impressions. The checklist also incorporated symptom severity ratings, generating a severity score to guide treatment target selection.
Originally intended for research and data collection in schools, the measures showed potential for clinical use. This led to the development of the Stony Brook Child Symptom Inventory-3 (CSI-3) and CSI-3R in 1986–87, accommodating both teacher and parent checklists. The teacher checklist concentrated on behaviors more likely to occur in a school setting. In 1990, Dr. Gabrielle Carlson adapted the parent checklist from the CSI-3R for adolescent use, creating the first version of the Adolescent Symptom Inventory (ASI-3R).
With the publication of the DSM-IV in 1994, the CSI-4 emerged to accommodate changes. Available in both Spanish and English, the CSI-4 addressed the modifications in the DSM. Similarly, in 1995, the Adolescent Symptom Inventory (ASI) was updated to ASI-4 in response to DSM changes.

## Impact

The inventories provide a low cost way of gathering information efficiently and organizing it in a way that maps to diagnostic classifications.
The checklists also make it straightforward to collect and compare information from multiple informants. Teachers and parents oftentimes spend much more time with the youth than the clinician does. There are both parent and teacher checklists available. Clinicians can look at both the Symptom Count scores and the Symptom Severity scores and analyze them in order to determine whether or not it surpasses the Clinical Cutoff score.
The assessment can be used to measure symptoms over the course of treatment. The CASI-PM, also known as the assessment's progress monitor, is a facet of the inventory that is used to both monitor and analyze certain outstanding symptoms to see if there are disorders that are comorbid with other disorders that already exist within the patient. Thus, this part of the inventory can be used to track change in symptoms as the child or adolescent develops.

## Use in other populations

The most recent version of the inventory has thus far only been used in the United States. The YI-4, the ECI-4, the CSI-4 and the ASI-4 are all available in the Spanish language. According to the website, the creators of the inventory intend to make it even more accessible by translating it into more languages.

## Limitations

The assessment is commercially distributed; see details on the official website. Published versions are currently limited to English and Spanish language. The changes made to DSM-5 required some alterations in content and scoring of the CASI. Because it is so new, less research is available about the version that corresponds with the DSM-5.