The Global Assessment of Functioning Scale

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Where do you see yourself? Do you think the scale is a good representation of functioning skills?
I see myself at about 51-60, sometimes 61-70

I'm probably 41-50. Maybe 51-60.

It seems like a fair scale.

41 to 50

I'm usually at 41-50. I think I might currently be at 51-60 due to the lack of suicidal ideation, although I probably still qualify for that "unable to keep a job" which would keep me at 41-50.

I keep a job but have no friends. Depression and suicidal ideation have been present for 30+ years. There has been great variation in intensity, but not a day has passed in decades where at least the idea of self termination has crossed my mind. I'm actually doing much better having found my place on the spectrum. It has given me permission to let go of some things that I now know I cannot change.

It's probably worthwhile to say why I gave myself my rating. Severe depression and suicidal thoughts have been constants for me for many years. I'm doing better now, and only get depressed once in a while, and only get a suicidal thought once or twice a week. I can keep a job, but if I lose my current job, I don't know if I will be able to find a new one. I have a few casual friends. I have a couple of closer friends, but they live a long way from me. I can go through an entire year without socializing outside of work once.

The whole scale seems adequate enough but isn't specific enough to cover self care skills, which could range from keeping clean to paying bills.

http://en.wikipedia.org/wiki/Global_Ass ... unctioning

I'm 31-40 or 41-50, I would guess.

oops. I had every intention of providing a link. My mind must have wandered. Thanks for doing that.

interesting link. I knew my level of functioning was an issue but to see a list like this is pretty confronting and helpful actually. helps to see what other levels of functioning look like I suppose. I'm probably 41-50 or 31-40.

61-70 for me. Mild issues.

Somewhere between 11 and 24 I'd expect (unless some of my toileting issues would count in "minimal standards of personal hygiene" as 1-10, it's not really clear on that since the only example is smearing feces which I don't do -- I don't want to go into detail on what does happen but it's gross, suffice to say, even to me). Ironically that would mean I would have possibly moved up from 1-10 when a movement disorder ("autistic catatonia", parkinsonlike, etc.) became severe enough that my involuntary, severe head-banging was no longer possible. (I used to headbang until I went temporarily blind, knocked myself out, the room seemed to move under me when I walked, my motor skills became too crappy to do it further, and/or I had severe nausea or vomiting. Not fun. At all.)

I don't think it or any other linear scale is a good way to measure overall functioning in a person with a condition with so many different possible variables. Something similar could be good to measure, say, level of fatigue in a person with a physical condition thats main symptom was fatigue (this particular scale was designed for conditions considered "mental", whether they are or not, despite that the line between "mental" and "physical/neurological" is blurry at best, "autistic catatonia" (as well as catatonia in schizophrenia) would be considered mental when similar symptoms from Parkinson's or encephalitis lethargica would be considered purely physical). Because you could just measure amount of fatigue. But most conditions have a lot of different things they cause, and most of them have many qualitative differences that can't be accounted for by such a scale.

I do find it interesting that severe enough self-injury or feces smearing etc. (even if you have friends, family, a job, and ability to function otherwise "perfectly normal") will put you at or near the bottom of the scale, whereas having severe problems in several areas puts you higher. I think the reason is that this was designed to be about the urgency of a person getting care, rather than to actually describe how much trouble a person has doing things overall. So that's another reason that it may not be the best way to judge people's abilities. Simply being actively suicidal, severely self-injuring, etc. will make them disregard all of your other abilities.

Also I'd suggest reading this (I think it's a PDF):

http://www.newavenuesonline.com/provide ... aspx?id=45

That describes how people are "supposed to" use the scale. Still confusing to me. This part could be useful though if people are determined to try to rate themselves:

Also a description of how to score oneself within each 10-point range:



I also notice it's interesting that below 30 is supposed to mean the person is a candidate for "inpatient care", because that's exactly the standard I had to meet in the DD system to qualify for services. (That otherwise I would be in an institution. I'm eligible both for a nursing home and for an ICF/MR.) But they use totally different scales. (Vineland or the Adaptive Behavior Assessment System. I got the second one, was rated by a staff person who'd known me several years and got very close to the lowest score possible, when I had far more skills than now. That's a little depressing. I really hate things that rank you only according to your deficiencies.) I wonder if there's usually that much overlap or not. Honestly I think in the DD system there are people who could do a lot more than I can -- they have jobs (some with some without support), they have loads of friends, can do most daily living activities for themselves, etc. and just need a fairly light amount of guidance and help. They might score around maybe 60 or 70 even.

Oh and the last paragraph refers to this part:



...so maybe that does match the guess I just made in the DD system of people getting services up to a level of about 60 or 70 on this scale. (I hadn't read the part besides the 1-30 part when I said that.) I also notice that in my records at one point they estimated that my highest GAF score in my lifetime would probably be around 60. Fortunately the DD system here doesn't do regular GAF scores.

I don't like, however, this whole idea that a certain level below that you have to be in an institution of some kind. That's the whole point of services, is to keep us out of institutions, and many states, my state included, have laws saying that anyone has this right "regardless of severity of disability". Unfortunately my state has this for DD but not for psych, and the local psych services are crap compared to DD services even though they're two branches of the same agency. And I don't like the whole idea of rating people on linear scales, there's a long sordid history behind it that disturbs me.

As usual, you make some excellent points.

I think linear scales are useful when used in the correct context. Even this one allows framing a conversation around functional behavior. But as you point out, it is a measure along a very narrow range of definitions and using this one assessment in isolation is a recipe for disaster. Unfortunately, it is too easy for professionals to fall into overly simplistic methodologies for assessing individual functionality. Your comments on IQ are a classic example of this. Your IQ tests are meaningless in assessing your cognition. Yet you regularly relate to us experiences where such a useless assessment affects the decisions of providers involved in your care.

High 30s, low 40s, usually; lifetime it's ranged from the teens to the low 70s. My GAF is low mostly due to social issues and the fact that I'm not fully independent--it hasn't got anything to do with my actually being in serious trouble of any sort; just low skill levels in general. When I hit the teens and twenties some years ago, it was because of major depression, and that did involve suffering... and when I was a kid, my GAF was higher because nobody expected adult things of me yet, and it is not considered as problematic if a teenager cannot remind herself to take showers or go to bed, than if an adult cannot do the same.

Just goes to show that even with a relatively concrete scale like GAF, there's still a lot of cultural context, and you can't tell a person's subjective quality of life by looking at that one number.

I can't seem to download the pdf in question. I keep getting this: "getpdf.aspx"

Any suggestions?

Yesyesyes THAT.

It's really hard getting people to sometimes realize that in some ways I've never actually "gotten worse", I've just simply fallen behind as other people surpassed me. It's sort of like this weird illusion I've noticed on highways when a huge long truck passes you and you feel like you're going backwards even though you're not (and are even going forwards, just not as fast). Which I also consider the reason for my IQ droppage over time, I simply had certain things early but then either didn't develop at all in those areas, or developed very slowly compared to others, so they surpassed me.

That's not the only thing that happened with me, but it still weirds me out that people sometimes act like some way I am now is totally different than I was before, when it's not that I lost skills, I just never learned skills when other people were learning them.

One really really weird thing that happened in adolescence was... so ever since I was a kid I spent a lot of the time curled up in a ball ("fetal position" style). My parents just kind of laughed and called it "curling up small" when I did it. I did the exact same thing as a teenager and psych professionals totally flipped out on me about it. They called it "regressing to the fetal position" and just... wow... the amount of This Is Deadly Serious Business they attributed to it was bizarre. I even once put two photos of me side by side. One was of me sitting in that position (in this case, sitting rather than lying down, I do both) at maybe the age of seven or so, and another was of me (deliberately for a photo) sitting in the exact same position in adulthood. It's simply a comfortable position for me, it holds no more meaning than that. But the way people fussed about it when I was a teenager is amazing, and when people see me sitting that way now in pictures they've been a little freaked out by it even more so. Nothing changed. Just the expectations.

That's also sometimes what happens when children are considered to "regress" in early childhood. Sometimes parents think of it that way when all that happened was they failed to develop as expected. It's like people have this imaginary person in their heads, and when you don't turn into that person it's "regression". Not that true loss of skills doesn't exist (I experienced that both in early childhood and continually but more slowly since adolescence) but a lot of the time simply skills staying the same or even a tiny amount of progress on those skills is considered regression.

Also, people often fail to make the connection between my inability to clean my desk to save my life in school, even after given hours and hours of extra time to do it, and my inability to care for myself as an adult. But they're directly linked, they're two manifestations of something that has always been there. Same with my self-care skills, they have never been good and past a certain point they never got any better. (In a psych institution as a teen they tried to teach me to shower properly but all they taught me was go to in there and run water and mess with soap randomly until they told me to come out. While they stood there with clipboards and stopwatches.)

Anyway... yeah, I just completely agree with that point and wish more people would understand it. The way I see it, there's this line that charts the development of most people. It starts low and goes higher at a certain rate. And to most people, following that line does not mean change, it means staying the same. And since that line is seen as lack of movement, simple failure to learn as fast as that line, even if you don't get worse, is seen as movement backwards. It's a cognitive illusion of some kind. Also, nonautistic children regress too, but it's considered progress. For instance, they lose the ability to process in a certain way, sounds outside of their native language. I never regressed in that way, many autistic children don't, but nobody notices us failing to regress, because regression in nonautistic people is just about always seen as progress. Oops by "nonautistic" here I mean "nonautistic/nondisabled". There are other conditions that can pan out similarly to autism in this way.