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Conceptual review of measuring functional impairment: findings from the Weiss Functional Impairment Rating Scale
  1. Margaret D. Weiss1,
  2. Nicole Michelle McBride1,
  3. Stephanie Craig2,3,
  4. Peter Jensen1,4
  1. 1 Division of Child and Adolescent Psychiatry, University of Arkansas Medical Sciences, Little Rock, Arkansas, USA
  2. 2 Department of Psychology, York University, Toronto, Ontario, Canada
  3. 3 LaMarsh Centre for Child and Youth Research, York University, Toronto, Ontario, Canada
  4. 4 The Reach Institute, New York City, New York, USA
  1. Correspondence to Dr Margaret D. Weiss, Division of Child and Adolescent Psychiatry, University of Arkansas Medical Sciences, 1210 Wolfe St, Little Rock, Arkansas, 72202, USA; margaret.weiss{at}


Objective This is a narrative review of validation and outcome studies using the Weiss Functional Impairment Rating Scale (WFIRS). The objective of the review is to establish a framework for understanding functional impairment and create a definition for functional response and remission.

Methods We conducted a literature search via MEDLINE, EBSCO and Google Scholar with no date restrictions and reviewed bibliographies of selected publications. Publications found in languages other than English were translated and clarification obtained from the author(s) if needed. Inclusion criteria were any manuscript that was either a WFIRS psychometric validation study or a clinical trial using the WFIRS as an outcome. There were no exclusion criteria.

Results The WFIRS has been validated in multiple cultures, and in clinical, research and control populations. The WFIRS has robust psychometric properties across ages, psychiatric status and informants. Outcome studies show variable improvement, with different response patterns between domains and among different interventions.

Conclusion Symptom improvement and remission needs to be complemented with evaluation of functional improvement and remission to obtain a full picture of clinical status over the course of treatment.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Contributors MDW provided rationale for the paper and contributed to all sections of the manuscript. NMM collected the data required to populate the data in tables 1 and 2 and provided detail about all the studies in the text. PJ and SC provided their expertise in editing the manuscript and provided numerous rounds of revision to the entire paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests MDW: consulting and honorariums from Purdue Pharma, Rhodes Pharmaceuticals, Shire and NLS Pharma. MDW has received travel reimbursement from Rhodes, Shire, NLS Pharma, The Israeli Society for ADHD and the World Federation of ADHD. The first author is also the developer of the measure discussed in this review. PJ: unrestricted educational grant from Shire, shareholder in CATCH Services, and book royalties from APPI, Guilford and Random House. SC and NMM have nothing to disclose.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement This manuscript contains no primary data.

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