Child Functioning Impairment Rating Scale

A culturally adaptable assessment tool that measures daily functioning levels of children living in low- and middle-income countries. Due to both a lack of mental health resources, and a dearth of appropriate psychometric tools specific to low and middle-income countries (LAMIC), the Child Functioning Impairment Rating Scale was developed as a tool that could be easily adapted for use across various LAMIC contexts. The pilot scale, designed and implemented in Indonesia, consists of 11-items that assess various social and ecological indicators of functional impairment in Indonesian children—individual activities (4 items), family activities (2 items), peer activities (2 items), school functioning (2 items), and one open item. Questions were developed following a series of mixed-methods data collection efforts that consisted of participant observations, two-week diary entries of daily activities by a sample of school children, and focus group discussions. The finalized questionnaire, scaled on a 4-point scale—None (1), A Little (2), Moderate (3), and Often Can’t do Activity (4)—was scored from 0 to 44, with higher scores indicative of higher levels of impairment. The pilot tool provides a foundational basis on which to develop similar, context-specific impairment rating scales.

Related Publications

Tol, W. A., Komproe, I. H., Susanty, D., Jordans, M. D., Macy, R. D., & De Jong, J. M. (2008). School-Based Mental Health Intervention for Children Affected by Political Violence in Indonesia: A Cluster Randomized Trial. JAMA, 300(6), 655-662.

Kohrt, B. A., Jordans, M. D., Tol ,W. A., Speckman, R. A., Maharjan, S. M., Worthman, C. M., & Komproe, I. H. (2008). Comparison of Mental Health Between Former Child Soldiers and Children Never Conscripted by Armed Groups in Nepal. JAMA, 300(6), 691-702.

What it measures




Children living in LMIC and/or have been affected by political violence


Tol, W. A, Komproe, I. H., Jordans, M. D., Susanty, D. & De Jong, J. M. (2001). Developing a function impairment measure for children affected by political violence: a mixed methods approach in Indonesia. International Journal of Quality in Health Care, 23(4), 375-383.